The human cost of breast cancer screening
This article originally appeared in Forbes.
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Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 18, 2015 Category: Journals (General) Authors: Peter Ubel, MD Tags: Conditions Cancer Source Type: blogs
An avoidable catastrophe?
This is an observational study only, and it doesn't completely answer the question, but this analysis in JAMA Oncology certainly poses one. Understanding this is a bit complicated, and remember, I'm not a real doctor, I'm a doctor of philosophy, but let me tell you what it means to me.Narod et al used a registry called the Surveillance, Epidemiology and End Results (SEER) database to see what happened over 10 and 20 years to women who were diagnosed with so-called Ductal Carcinoma in Situ (DCIS). These are clusters of abnormal cells inside the milk duct. Until the widespread use of screening mammography, they were essentia...
Source: Stayin' Alive - August 21, 2015 Category: American Health Source Type: blogs
You can never be prepared for a diagnosis of breast cancer
November of last year found me living as best I could with several health issues, the most debilitating of which stems from never having recovered from a serious viral infection in 2001. I’ve been diagnosed with chronic fatigue syndrome, a little understood and much-misunderstood illness. It keeps me virtually housebound. For the most part, I’ve made peace with feeling sick all the time. In fact, recently I’d been thinking that I could be OK with the prospect of spending the rest of my life with flu-like symptoms as my constant companions.
Then, totally unexpectedly, I was diagnosed with breast cancer. It was discov...
Source: Kevin, M.D. - Medical Weblog - July 6, 2015 Category: Journals (General) Authors: Toni Bernhard, JD Tags: Patient Cancer Source Type: blogs
What is Breast Reconstruction? What are your Options?
Breast reconstruction makes women whole again after breast cancer. It restores something that nature provided but cancer has taken away. It is covered by insurance in the majority of cases thanks to a 1998 Federal Mandate.Unfortunately, many breast cancer patients who are facing or who have had mastectomy or lumpectomy are not offered all their reconstructive options.Women have several breast reconstruction options. These include breast implants and "natural" techniques like flaps and fat grafting which use the patient's own tissue. The nipple and areola can also be recreated.The animated presentation below provides an exc...
Source: Breast Cancer Reconstruction Blog - May 12, 2015 Category: Cancer & Oncology Tags: breast reconstruction breast reconstruction options Source Type: blogs
What is Breast Reconstruction? What are your Options?
Breast reconstruction makes women whole again after breast cancer. It restores something that nature provided but cancer has taken away. It is covered by insurance in the majority of cases thanks to a 1998 Federal Mandate.Unfortunately, many breast cancer patients who are facing or who have had mastectomy or lumpectomy are not offered all their reconstructive options.Women have several breast reconstruction options. These include breast implants and "natural" techniques like flaps and fat grafting which use the patient's own tissue. The nipple and areola can also be recreated.The animated presentation below provides an exc...
Source: Breast Cancer Reconstruction Blog - May 12, 2015 Category: Cancer & Oncology Tags: breast reconstruction breast reconstruction options Source Type: blogs
MKSAP: 54-year-old woman asking advice about bone health
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman comes to the office for advice regarding maintaining bone health. She has no history of fracture. The patient recently had a lumpectomy and radiation therapy to treat breast cancer, is currently taking tamoxifen, and will begin taking an aromatase inhibitor in 2 months. She underwent menopause at age 52 years and has persistent hot flushes. Her risk factors for osteoporosis include a slim body habitus and a mother who had a hip fracture at age 67 years.
Physical examination findings, includin...
Source: Kevin, M.D. - Medical Weblog - March 21, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Endocrinology Source Type: blogs
The nuances of breast cancer surgery don’t fit in a headline
Recently, NPR published the results of a study confirming that removal of both breasts (a double mastectomy) fails to improve the chance of survival compared to breast conserving treatments for breast cancer. The headline of the story was “Double Mastectomies Don’t Yield Expected Results, Study Finds.”
This finding is not actually news to informed physicians. Since the 1980s, there has been widespread recognition that both mastectomies and lumpectomies offer an equal survival benefit for properly selected patients. This finding has been confirmed and reconfirmed by randomized clinical studies conducted in the U.S...
Source: Kevin, M.D. - Medical Weblog - November 3, 2014 Category: Journals (General) Authors: Pat Whitworth, MD Tags: Conditions Cancer Mainstream media Surgery Source Type: blogs
I am just a medical student
She’s 58, but appears maybe three days older than 42. Her eyes are sunken, tearful, worried, anxious. She tells me about her two grandchildren, and how she just visited them in Michigan. She came to the hospital, straight from the airport. She’s worried.
She’s worried because her shortness of breath hasn’t gone away for over a month now. She has had breast cancer, and opted for a more conservative approach: a lumpectomy with axillary node biopsy without radiation. She’s admitted, and gets a chest x-ray and a CT scan, which show a pleural effusion with what looks like nodules in both lungs. “Like...
Source: Kevin, M.D. - Medical Weblog - August 12, 2014 Category: Journals (General) Authors: Edwin Acevedo, Jr. Tags: Education Medical school Source Type: blogs
Why It’s So Tempting To Over-screen: A Personal Perspective
Health screening is part of good preventive care, though over-screening can lead to increased costs, and potential patient harm. Healthcare professional societies have recently developed excellent public service announcements describing the dangers of over-testing, and new research suggests that though additional medical interventions are associated with increased patient satisfaction, they also lead (ironically) to higher mortality rates.
And so, in a system attempting to shift to a “less is more” model of healthcare, why is resistance so strong? When the USPSTF recommended against the need for annual, screeni...
Source: Better Health - July 14, 2014 Category: American Health Authors: Dr. Val Jones Tags: Opinion True Stories Benefits Cancer Colonoscopy Guidelines Harms Mammogram Over-testing Over-treatment Screening Tests USPSTF Source Type: blogs
I used to be jealous
Back in 2007 when I had radiation for my breast cancer. I had to undergo the traditional radiation treatment which meant 37 visits spread over 7 weeks - five days a week that lasted FOREVER. I knew people online who were getting the short version and getting radiation for five days - brachytherapy - with two visits a day. I was jealous because I was (and still am) sick of going to the (damn) hospital.I had asked at the time and was told by my radiation oncologist that they did not offer the shorter option nor did most hospitals in Boston at that time. A few years later I attended a conference where I learned they were star...
Source: Caroline's Breast Cancer Blog - March 8, 2014 Category: Cancer Tags: breast cancer treatment radiation side effects Source Type: blogs
Get rid of the cancer first before considering breast reconstruction
When it comes to surgery for cancer, having a “positive margin” is a bad thing. It means that when the surgeon said he “got it all,” even though he meant it with all of his heart, likely he didn’t. For a woman undergoing a lumpectomy for breast cancer, that positive margin means a re-excision of the lumpectomy site or alternatively, a mastectomy. For a woman who has just had a mastectomy, it means that she will likely be seeing me.
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Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 3, 2014 Category: Family Physicians Tags: Conditions Cancer Surgery Source Type: blogs
A very unsettling conversation
Yesterday, as part of my day to myself, I dragged my sorry a$$ to the gym. As part of my getting ready ritual, I pulled on my lymphedema sleeve. An older woman entered the previously empty locker room and asked me if it was a lymphedema sleeve. Often I just say it is a compression sleeve so as not to enter the 'what is lymphedema' conversation and get into my medical history with a virtual stranger.She looked somewhat on edge. I told her it was a lymphedema sleeve. She said she had been diagnosed with breast cancer 28 years ago when she had a lumpectomy and radiation. Then she had a recurrence 7 years ago (I am pretty sure...
Source: Caroline's Breast Cancer Blog - February 8, 2014 Category: Cancer Tags: breast cancer cancer bonds lymphedema recurrence Source Type: blogs
Prevention: Take Control of your Breast Health
It was the summer before college and I was hanging out in my Aunt’s living room with my grandmother, uncles, and cousins. It was a fairly typical summer afternoon in Detroit: we were eating lunch, watching bad day time T.V., and generally joking around while avoiding the muggy July heat. My aunt, 40 at the time, had just returned from her second lumpectomy. At first she was her usual self, warm and in good spirits. We joked, gossiped about family members, and enjoyed each other’s company. But then without warning, her eyes filled with tears as she began to cry. Her tears were filled with fear, relief, and gra...
Source: Disruptive Women in Health Care - October 16, 2013 Category: Health Medicine and Bioethics Commentators Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs
The Gold Standard for Breast Cancer Screening
Mammograms are still the gold standard for breast cancer screening. Although I go to great lengths to get my friends to go for a yearly mammogram, I am always surprised at how many women try to avoid it or make excuses not to have one. To be clear, by screening I mean testing to reveal cancer when none is suspected. The goal is to detect breast cancer before it becomes invasive.
Finding a breast tumor while it is still in-situ, or in the duct results in a much better outcome and possibly avoids extensive surgery and treatment. Both my mother and my mother-in-law were fortunate to be diagnosed with breast cancer while ...
Source: Life with Breast Cancer - October 14, 2013 Category: Cancer Authors: Kathy-Ellen Kups, RN Tags: Breast Cancer Breast Cancer Screening Mammograms Thermography Source Type: blogs
Making your own medical decisions
The newest trend in medical care is to involve the patient in the decision making process. Sometimes it can be easy to just go with the flow. The doctor says you have this so we need to do that. Simple?But what if the doctor says 'what do you want me to do for treatment?' Eek! Now you can't sit there passively you have to become a participant. This can take research. It can take time online. It can take deep thought. And it can impact your life significantly.Using the example of a woman with breast cancer where the choices with relatively equal outcomes are lumpectomy and radiation or mastectomy. Shouldn't the patient get ...
Source: Caroline's Breast Cancer Blog - October 14, 2013 Category: Cancer Tags: medical decisions being a patient Source Type: blogs
