Conditions

Are doctors doing too much cancer screening?

Screening for certain cancers, such as breast, colon, or cervical cancer, have been shown to save lives.

However, the same can’t be said for a multitude of others, including lung, pancreatic, or ovarian cancer.

Major media outlets, like NBC’s Today Show, have in the past, irresponsibly trumpeted recommendations that have no basis in evidence.

To their credit, journalism professor Gary Schwitzer says they are …

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Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives

Prostate cancer screening is about to get a whole lot cloudier.

Published this morning in the NEJM, the results of the study by the National Cancer Institute showed that, for men who were screened with both a PSA and digital rectal exam, there was no difference when compared to men who received “usual care.”

The results confirm the suspicions that many physicians already had, namely, that screening …

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Is prostate cancer being overdiagnosed?

Recent data has suggested that we may be finding too many cases of prostate cancer.

This is important, since there are no studies suggesting that screening for early prostate cancer saves lives. In many cases, “most prostate tumors grow so slowly that had they not been screened, those men would have died of something else without the anxiety.”

In fact, the USPSTF recently recommended that men over …

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How much radiation am I getting with my X-ray, CT scan, or nuclear medicine test?

Here’s a handy resource for patients to calculate their radiation exposure to a variety of imaging tests.

Radiation exposure, and the subsequent risk of cancer, is a small, but very real, risk of X-rays, CT scans, and other radiology procedures. But, how much is too much, and what is the cumulative effect?

That’s a question I encounter daily, and …

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Remember to remove medication patches prior to your MRI

I wrote a few months ago that MRI suites can be the most germ-infested room in the hospital.

Now, comes another precaution patients have to consider prior to undergoing an MRI.

MedPage Today reports on a recent FDA announcement, warning patients to remove medication patches, like the fentanyl or nicotine transdermal systems, prior to having an MRI.

“Some patches contain small amounts of aluminum or other …

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Dying from cervical cancer, and the questions surrounding Jade Goody

Jade Goody is 27-year old British reality TV star who is dying from cervical cancer.

As part of an ongoing reality show, her last days will be filmed and broadcast.

In this day and age of the Pap smear, cervical cancer should be all but eradicated. And Ms. Goody did have Pap smears. Several, in fact. However, as gynecologist Margaret Polaneczky observes, she ignored letters …

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Waiting for the biopsy result is as stressful as being told you have cancer

Doctors should realize the stress that patients undergo while waiting for test results.

Surgeon Jeffrey Parks discusses a recent study examining the issue, showing that a woman’s “stress hormone levels were just as high during the waiting period as levels determined in women who were told the biopsy was positive for cancer.”

A needle breast biopsy should not take longer than two days for a result, although …

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Poll: Testosterone replacement therapy in men with prostate cancer

Men of any age can present with the symptoms of low testosterone – including erectile dysfunction, fatigue, difficulty concentrating, decreased muscle mass and bone density. Is it safe to treat these symptoms with testosterone replacement therapy?

There are several ways to treat men with low testosterone: the most common are gels, patches, and injections. These treatments are effective for relieving symptoms, and are generally safe.

There …

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How many proton beam therapy centers does Central Ohio need?

Despite the fact that proton beam therapy for the treatment of prostate cancer is expensive, and its efficacy questionable, that didn’t stop local journalists from writing a puff piece touting its impending arrival in central Ohio.

Journalism professor Gary Schwitzer, however, takes them to task. He questions an advertisement in a local newspaper, and wonders why cost isn’t mentioned, nor any discussion of the benefits versus risks.

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The quality of CT and MRI scans vary, and how old machines can affect the treatment course

Medical imaging is one of the largest drivers of health care spending.

In a recent NY Times piece, Gina Kolata points to the fact 20 to 50 percent of scans ordered are not necessary. Indeed, as health reformers like to point out vis-a-vis the Dartmouth Atlas study, more care isn’t necessarily better.

In fact, it can lead to worse outcomes, as these scans can point to …

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Why do I need a rectal exam, and what can doctors find with the gloved finger?

Have you ever wondered why doctors have to perform a digital rectal exam?

Well, look no further, as primary care doctor Rob Lamberts gives us the answers discerning readers demand.

Simply by looking at the rectum, which by the way, indeed “takes some getting used to,” can lead to significant diagnostic findings. Furthermore, does tight sphincter tone matter? And should you be worried about the large hands …

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Does using Plavix with a proton pump inhibitor raise the risk of death in heart attack patients?

A recent, albeit retrospective, study suggests a correlation.

MedPage Today reports on a recent JAMA study that looked at patients who had an acute coronary syndrome. It found that those who took both a proton pump inhibitor (PPI), like omeprazole, Nexium or Protonix, with Plavix had a 25 percent increased risk of death or rehospitalization.

If true, that’s a pretty significant finding, especially since PPIs are …

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Having a stroke, and taking clot-busting drugs at home

How bad did this doctor want to avoid the emergency room?

Freakonomics’ blogger Steven Levitt recounts a story told by his physician-grandfather.

The 80-something year old started having symptoms consistent with a stroke. Instead of calling 911, or finding a way to an emergency room, he “called in a prescription to the drugstore around the corner for some clot-busting drugs and sent my grandmother to the …

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Are whites more likely to be screened for colon cancer?

According to a recent study looking at the Medicare population, the answer appears to be yes.

MedPage Today
reports a study showing that elderly white patients had colon cancer screening rates ranging from 39 to 47 percent, compared to 29 to 38 percent in blacks and 23 to 33 percent in Hispanics.

First off, all those rates are dismally low. There should be no reason that …

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Medicare will not cover virtual colonoscopies, gastroenterologists breathe a sigh of relief

CT, or “virtual”, colonoscopy is an emerging imaging test designed to screen for colon cancer.

However, the data supporting its efficacy is not conclusive, and despite several studies performed by radiologists, its accuracy does not yet match that of a traditional, endoscopic colonoscopy.

Recently, the USPSTF reviewed the evidence, and could not recommend virtual colonoscopy as an acceptable method to screen for colon cancer.

Justifiably, MedPage …

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Why implant more than one embryo per in vitro fertilization cycle?

The answer is cost.

Because the costly treatment isn’t often covered by insurance, doctors are sometimes pressured by patients to implant more than one embryo per cycle.

Since a single cycle can cost as much as $12,000, and those who aren’t successful often keep on trying, the cost of having a baby can reach into the hundreds of thousands of dollars.

As this reproductive endocrinologist recounts, …

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Should you be screened for oral cancer, and are companies profiting from the uncertainty?

Most dentists do a thorough visual mouth evaluation to screen for oral cancer.

Whether there is data to support this practice is in question, with few studies suggesting a mortality benefit. The recommendations themselves are extrapolated from studies looking at other cancers.

Like other diseases where there is a gray area surrounding the efficacy of screening, like ovarian, lung, or pancreatic cancer, companies are rushing in …

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Does masturbation really cause prostate cancer?

A small study garnered significant media attention last week, with headlines blaring an association between masturbation and prostate cancer.

Before anyone gets really worried, obstetrician-gynecologist Amy Tuteur takes a closer look at the data, and is not impressed.

The retrospective, case-control study actually didn’t reveal any significant initial findings, so the authors kept manipulating the variables until they saw a possible association.

Dr. Tuteur believes that …

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Why are black patients more likely to refuse lung cancer surgery?

Of those diagnosed with early stage lung cancer, 69 percent of black patients opted for surgery, compared to 83 percent of white patients.

MedPage Today reports the findings from a cohort study in the Archives of Surgery. All the patients had Medicare, making insurance a non-factor.

Possible reasons include different racial-based beliefs, including that blacks “were more likely to believe that surgery accelerated tumor …

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When ear piercings lead to keloid formation

A rare occurrence where a routine ear piercing goes horribly wrong.

Keloids are fibrous growths that uncommonly occur in cases of wound healing. They present predominantly in blacks, and any type of skin piercing can affect those predisposed to the disease.

The lesions can be severely disfiguring and painful, and often recur after treatment. The first-line therapy is injection of steroids into the keloid, with a 70 …

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