Conditions

Poll: Should men still be screened for prostate cancer?

Screening for prostate cancer has become controversial.

The US Preventive Services Task Force concludes that the evidence is insufficient to fully endorse prostate cancer screening in younger men and they recommend against screening for prostate cancer in men over the age of 75.

And a recent study from the National Institutes of Health found that, after 7 to 10 years of follow-up, screening men with a prostate specific …

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Should we start screening women for ovarian cancer?

The answer is no.

Besides the fact that the USPSTF already recommends against ovarian cancer screening, MedPage Today reports a study concluding that screening led to a high rate of unnecessary surgery.

During four years of screening with a transvaginal ultrasound and the CA 125 biomarker , “the surgery-to-cancer ratio was 19.5:1,” meaning that almost 20 surgeries would be needed for every case of ovarian cancer …

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Are we wasting money on Alzheimer’s care?

According to the Alzheimer’s Association, now is the time to address the burgeoning Alzheimer’s crisis, especially with baby boomers in the midst of Medicare age.

Alzheimer’s dementia boosts the cost of caring for the elderly almost three-fold, from about $10,000 to $33,000 per year, and as Amy Tuteur blogs, “the report of the Alzheimer’s Association assumes that the enormous cost of Alzheimer’s care is a morally necessary burden, but …

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Should children be screened with an EKG prior to starting stimulants for ADHD?

According to some cardiologists, the answer is yes.

However, MedPage Today reports that, in a recent study presented at the American College of Cardiology meetings, the positive predictive value of such a strategy was low, and that, “To screen enough children to identify one with complex congenital heart disease or potentially life-threatening arrhythmia, the cost was $42,904.”

Pediatricians have challenged this finding, calling mass screening for children, …

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How much do we really need mammograms?

With the recent controversy surrounding prostate cancer screening, it’s now time to look at mammograms and breast cancer screening.

Like the PSA test, there is little data saying that mammograms decrease the mortality rate from breast cancer. And indeed, some of the harms of breast cancer screening are being publicized in the UK.

The number needed to treat, a statistic that is gaining increasing relevance in …

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How screening for prostate cancer can be a gamble, and why either screening or not has consequences

Should mortality be the only outcome that matters?

Dartmouth’s Gil Welch has a nice op-ed in the LA Times, discussing whether the very small benefit in lives saved from prostate cancer screening (via Schwitzer) is worth the substantial cost of side effects from overtreatment.

When talking about the recent European study finding a very small benefit to screening, Dr. Welch observes that, “Being 50 times more likely …

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Will patients accept the limitations of prostate cancer screening?

Recent studies in the NEJM have fueled the uncertainty surrounding prostate cancer screening.

The USPSTF recommends against screening men older than age 75 for prostate cancer, and gives an “I” recommendation for younger men.

Despite the controversy, there are plenty of anecdotes of men whose lives were saved by the PSA blood test. Will the lack of evidence sway men away from getting the test?

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False positive cancer screening tests doesn’t resonate in Congress

Criticizing cancer screening advocates can be a difficult thing to do.

Gary Schwtizer writes about the case of Rep. Debbie Wasserman Schultz (D-Fla.), who is introducing a new bill advocating breast cancer screening to begin earlier than the current suggested age of 40.

Ms. Wasserman Schultz was diagnosed with breast cancer at age 42, and wants “to educate the public, particularly young women and their doctors, about …

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A free colonoscopy contest, but what’s the catch?

CBS is promoting a free colonoscopy sweepstakes, which, I guess, is enough of a prize to pique a person’s interest during the recession.

But, as Dr. Wes points out, there are serious issues with the contest. First, take a look at the extensive fine print, with not-so-subtly warns that any information given will be shared with advertisers third-parties.

He also wonders about the posh Center for …

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Does a breast MRI have any benefit for patients with breast cancer?

Ah, a perfect question for comparative effectiveness research.

Surgeon Jeffrey Parks takes a look at a study looking at breast MRIs during the pre-operative workup of patients with breast cancer.

Essentially, surgical outcomes were not improved, and worse, “leads to a higher rate of unnecessary mastectomy, and is extremely expensive (about $1600 a pop, out of pocket).”

Although there are specific cases where a breast MRI …

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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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