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: Tags: Patient Cancer Source Type: blogs

Health Affairs’ April Issue: The Cost And Quality Of Cancer Care
This study is part of Health Affairs’ DataWatch series. Under the new pay-for-performance models, how do low performers fare? Jessica Greene of George Washington University’s School of Nursing and coauthors studied the impact of a primary care provider compensation model—that of Fairview Health Service, a Pioneer accountable care organization in Minnesota—in which 40 percent of providers’ compensation was based on their clinic-level quality outcomes. The researchers examined providers’ performance data before the model and two years after implementation, The best predictor of improvement was the primary care pr...
Source: Health Affairs Blog - April 6, 2015 Category: Health Management Authors: Chris Fleming Tags: Access All Categories Chronic Care Comparative Effectiveness Consumers Europe Health Care Costs Health Care Delivery Pharma Policy Quality Research Source Type: blogs

Ignorance, Knowledge, and Bliss; Not Always Obvious
I’ve just finished sitting through a wonderfully aptly named lecture: Probability and Sadistics, in which, among other things, we learned (again) that the utility of various clinical tests depends at least as much and generally more on the patient and condition involved than on the specific test itself. From stress tests to mammograms to PSAs, the relationships of true and false positive and negatives, positive and negative predictive values all hinge on the prevalence of disease; or how likely is it that a given condition is present before you even do the test. Lots of times when you crunch those numbers, the best a...
Source: Musings of a Dinosaur - March 22, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs

Stop with the curbside consultations. They don’t help anyone.
Recently a friend of my husband’s in San Diego had a mammogram that showed some suspicious microcalcifications in her right breast.  She underwent a stereotactic biopsy which revealed ductal carcinoma in situ, the earliest form of breast cancer also known as stage 0 breast cancer.  This type of cancer is non-invasive and does not metastasize, however, if untreated it can progress or recur as a more serious type of breast cancer, so at the very least excision of the abnormal area is indicated, and in some cases radiation and/or mastectomy are necessary.  My husband asked if I would speak to her regarding her breast can...
Source: Kevin, M.D. - Medical Weblog - January 29, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

I Have DCIS, Should I Have a Bilateral Mastectomy?
By ROBERT McNutt, MD Benefit: There is none. No women with DCIS have been included in a randomized controlled trial. Harm: Cosmetic outcomes are unclear; Second operations to fix the cosmetic outcome may be needed, but reasonable estimates for harm and complications do not exist as bilateral mastectomy has not been systematically studied in DCIS. […] (Source: The Health Care Blog)
Source: The Health Care Blog - December 18, 2014 Category: Consumer Health News Tags: THCB Bilateral Mastectomy Ductal Carcinoma in Situ Source Type: blogs

Top stories in health and medicine, December 17, 2014
From MedPage Today: Gene Test Has Promise for Nailing DCIS Recurrence Risk. A multigene panel predicted recurrence risk in ductal carcinoma in situ (DCIS), according to a population-based study. Docs, Guns, and Smokes. One day in clinic, 2 years ago, a patient handed Adam Goldstein, MD, MPH, a request for a concealed weapon permit, soliciting his signature. Memory Complaints Linked to Risk. Feeling like your memory is going could signal a modestly higher risk of stroke, particularly for well-educated people. Standards Help Diabetes Devices Talk to Each Other. The first set of interoperability standards for diabetes devic...
Source: Kevin, M.D. - Medical Weblog - December 17, 2014 Category: Journals (General) Authors: Tags: News Cancer Diabetes Endocrinology Neurology Source Type: blogs

Treating precancers reduces breast cancer deaths
Breast cancer deaths rose through the '70s and '80s, but declined in the '90s. For nearly the past 20 years, American women have had about a 2% annual drop in the breast cancer death rate.Here is the mortality graph provided by the National Cancer Institutes SEER (Surveillance, Epidemiology and End Results) program.Though nobody wants to take the blame for the rise in breast cancer deaths in the '70s and '80s, lots of people want credit for the fall of breast cancer deaths that began in the '90s. Was it due to a reduction to the exposure of carcinogens, or to better treatment, or to earlier diagnosis? The fall in breast...
Source: Specified Life - July 13, 2014 Category: Pathologists Tags: cancer prevention cancer treatment early treatment precancer precancer treatment preneoplasia preneoplastic Source Type: blogs

Understanding Women’s Choice for Mastectomy
Mastectomy – From Wikipedia It’s a bit of a conundrum – Despite advances in breast cancer treatment, and ongoing proof that survival is just as good after breast conserving surgery as it is with mastectomy, more and more women are opting for mastectomy for earlier and earlier stage cancers, especially DCIS. In a well written, insightful post, Dr Deanna Attai, president-elect of the American Society of Breast Surgeons, outlines both the arguments against mastectomy and why women might make a reasonable choice to have a mastectomy anyway. What we see in our offices is a rational fear: Many women underst...
Source: The Blog That Ate Manhattan - June 4, 2014 Category: Primary Care Authors: Margaret Polaneczky, MD Tags: Uncategorized Source Type: blogs

Invasive Micropapillary Carcinoma of the Breast
DefinitionBreast carcinoma with a prominent (pseudo) micropapillary patternDiagnostic CriteriaNumerous small pseudo-papillary clusters of cellsNo fibrovascular coresFrequent central lumen formation in clustersPeripherally located nuclei frequently bulge out with knobby appearance, "the hedgehog" tumorClusters surrounded by clear spacesOne or only a few clusters per spaceScant mucin rarely detectable in spacesSpaces surrounded by loose fibrocollagenous stromaFrequent high nuclear grade reported in some seriesFrequently has abundant eosinophilic cytoplasmFrequent lymphatic involvementOccasional psammoma bodiesAssociated DCIS...
Source: Oncopathology - March 1, 2014 Category: Cancer & Oncology Source Type: blogs

Invasive Micropapillary Carcinoma of the Breast
DefinitionBreast carcinoma with a prominent (pseudo) micropapillary patternDiagnostic CriteriaNumerous small pseudo-papillary clusters of cellsNo fibrovascular coresFrequent central lumen formation in clustersPeripherally located nuclei frequently bulge out with knobby appearance, "the hedgehog" tumorClusters surrounded by clear spacesOne or only a few clusters per spaceScant mucin rarely detectable in spacesSpaces surrounded by loose fibrocollagenous stromaFrequent high nuclear grade reported in some seriesFrequently has abundant eosinophilic cytoplasmFrequent lymphatic involvementOccasional psammoma bodiesAssociated DCIS...
Source: Oncopathology - March 1, 2014 Category: Pathologists Source Type: blogs

Invasive Micropapillary Carcinoma of the Breast
DefinitionBreast carcinoma with a prominent (pseudo) micropapillary patternDiagnostic CriteriaNumerous small pseudo-papillary clusters of cellsNo fibrovascular coresFrequent central lumen formation in clustersPeripherally located nuclei frequently bulge out with knobby appearance, "the hedgehog" tumorClusters surrounded by clear spacesOne or only a few clusters per spaceScant mucin rarely detectable in spacesSpaces surrounded by loose fibrocollagenous stromaFrequent high nuclear grade reported in some seriesFrequently has abundant eosinophilic cytoplasmFrequent lymphatic involvementOccasional psammoma bodiesAssociated DCIS...
Source: Oncopathology - March 1, 2014 Category: Cancer & Oncology Source Type: blogs

New Study Raises More Questions About the Value of Mammograms
This chart, published in British Medical Journal, shows that the breast cancer mortality of patients who underwent mammogram screening vs. those who did not is practically equal.A new, long-term study in BMJ provides perhaps the most compelling argument to date that screening mammograms may not be effective in reducing the death rate from cancer and may in fact cause harm from overtreatment in some women. The study is based on results from the Canadian National Breast Screening Study. For this research, 89,835 women ages 40 to 59 were randomly assigned to receive either annual mammograms for five years, or no mammograms ...
Source: Our Bodies Our Blog - February 14, 2014 Category: Health Medicine and Bioethics Commentators Authors: Rachel Tags: Breast Cancer Research & Studies Source Type: blogs

Top stories in health and medicine, September 6, 2013
From MedPage Today: MRI No Help for Breast Cancer Recurrence After DCIS. Perioperative MRI did not reduce the risk of breast cancer recurrence after treatment of ductal carcinoma in situ (DCIS). Warnings on Packs Deter Kids From Smoking. The addition of graphic warnings on cigarette packs were more likely to discourage teens from smoking than when warnings were text-only, but did little to dissuade teens who were already regular smokers. Antidepressants Have No Effect on Bone Loss. The use of selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants among women in midlife didn’t lead to a greater...
Source: Kevin, M.D. - Medical Weblog - September 6, 2013 Category: Family Physicians Tags: News Cancer Endocrinology Pediatrics Source Type: blogs

What's in a name?
If the name is "cancer," plenty. When people are told they have cancer, they ordinarily are terrified. And they and their doctors feel compelled to do something about it. Doing something about cancer normally means surgery, chemotherapy, radiation -- all extremely expensive, unpleasant, and in fact damaging to your health.It turns out, however, that since we've undertaken massive programs to screen the general population for what is generally called cancer, we've been detecting a lot of phenomena which, if untreated, would never hurt anyone. But the doctor tells the person "You have cancer," and  off we go.The Nationa...
Source: Stayin' Alive - July 31, 2013 Category: Health Medicine and Bioethics Commentators Source Type: blogs

Lets redefine cancer
The question has arisen as to how to redefine cancer. A scientific panel states we are using a 19th century definition in the 21st century. The issue is should some precancerous conditions be redefined with out the use of the words cancer or carcinoma."In one example, they say that some premalignant conditions, such as one that affects the breast called ductal carcinoma in situ — which many doctors agree is not cancer — should be renamed to exclude the word carcinoma. That way, patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the sur...
Source: Caroline's Breast Cancer Blog - July 30, 2013 Category: Cancer Tags: cancer diagnosis Source Type: blogs