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There are multiple methods for estimating the extent of DCIS (see Figure):DCIS in 1 block: The area involved by DCIS can be measured from a single slide, if DCIS is present in only 1 block. If separate foci are present, the largest distance between foci should be reported. This method will underestimate the extent of DCIS when multiple blocks are involved and should not be used in such cases. Serial sequential sampling: The entire specimen is blocked out in such a way that the location of each block can be determined. The extent of the DCIS can be calculated by using a diagram of the specimen, the thickness of the sli...
Source: Oncopathology - March 28, 2018 Category: Cancer & Oncology Source Type: blogs
What If The Pathologist Is Wrong?
And they won ' t review all the tests. This is a two part misadventure.First I was horrified by thisfirst story where two women were found to have been misdiagnosed by a pathologist at a hospital in Ireland. Their original breast cancer diagnoses were incorrect. One woman was diagnosed with DCIS in 2010 and had a mastectomy. Based on the original pathology she was not required to have any additional treatment. In 2012, to the surprise of her and her doctor, her cancer came back." Her original 2010 biopsy had shown invasive cancer but this had been missed.The hospital said this was a mistake that any pathologist could have ...
Source: Caroline's Breast Cancer Blog - February 22, 2018 Category: Cancer & Oncology Tags: breast cancer treatment cancer diagnosis medical errors pathology report Source Type: blogs
Precision Medicine and the Reinvention of Human Disease (Book Index)
In January, 2018, Academic Press published my bookPrecision Medicine and the Reinvention of Human Disease. This book has an excellent " look inside " at itsGoogle book site, which includes the Table of Contents. In addition, I thought it might be helpful to see the topics listed in the Book ' s index. Note that page numbers followed by f indicate figures, t indicate tables, and ge indicate glossary terms.AAbandonware, 270, 310geAb initio, 34, 48ge, 108geABL (abelson leukemia) gene, 28, 58ge, 95 –97Absidia corymbifera, 218Acanthameoba, 213Acanthosis nigricans, 144geAchondroplasia, 74, 143ge, 354geAcne, 54ge, 198, 220geAcq...
Source: Specified Life - January 23, 2018 Category: Information Technology Tags: index jules berman jules j berman precision medicine Source Type: blogs
What We Know and What We Think
ROBERT McNUTT, MD
What matters is what we know, not what we think
In the late 1980’s I cared for a pregnant woman with breast cancer. Breast cancer is the most common cancer in pregnancy, but uncommon in number, occurring in about 1 in 3000 pregnancies. It is a compounded emotional treating experience for sure, and at that time uncertainty in how to treat was the norm. The woman had a mastectomy but did not take chemotherapy based on concern for her baby.
Three months after her delivery, now getting chemotherapy for her aggressive breast cancer, the woman asked me to consider treating her newborn child with “mild” ch...
Source: The Health Care Blog - December 22, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
What Know and What We Think
ROBERT McNUTT, MD
What matters is what we know, not what we think
In the late 1980’s I cared for a pregnant woman with breast cancer. Breast cancer is the most common cancer in pregnancy, but uncommon in number, occurring in about 1 in 3000 pregnancies. It is a compounded emotional treating experience for sure, and at that time uncertainty in how to treat was the norm. The woman had a mastectomy but did not take chemotherapy based on concern for her baby.
Three months after her delivery, now getting chemotherapy for her aggressive breast cancer, the woman asked me to consider treating her newborn child with “mild” ch...
Source: The Health Care Blog - December 22, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Why a case report being circulated by advocates doesn't show that the ketogenic diet combats cancer
In conclusion, this combined metabolic approach appears effective in treating advanced TNBC, given this patient’s complete response with a good quality of life.Now, there is one thing that is interesting here. The doses of chemotherapy used were considerably lower thanwhat is usually used, with doses decreased by at least half or more. Does this mean anything? Who knows? cPR rates for TNBC have been reported to range from 20-35%. It could mean the regimen made the chemotherapy more effective, or it could mean that this woman just happened to have a particularly chemosensitive tumor. Even if we take this case report at fa...
Source: Respectful Insolence - October 4, 2017 Category: Surgery Authors: oracknows Source Type: blogs
Why a case report being circulated by advocates doesn't show that the ketogenic diet combats cancer
In conclusion, this combined metabolic approach appears effective in treating advanced TNBC, given this patient’s complete response with a good quality of life.Now, there is one thing that is interesting here. The doses of chemotherapy used were considerably lower thanwhat is usually used, with doses decreased by at least half or more. Does this mean anything? Who knows? cPR rates for TNBC have been reported to range from 20-35%. It could mean the regimen made the chemotherapy more effective, or it could mean that this woman just happened to have a particularly chemosensitive tumor. Even if we take this case report at fa...
Source: Respectful Insolence - October 4, 2017 Category: Surgery Authors: oracknows Source Type: blogs
Why You Should Get a Second Opinion on Your Mammogram
Never say no to a second opinion, especially if you ’re concerned about breast cancer. According to a new study, radiologist subspecialists can detect breast cancer in screenings that were initially deemed negative.Lead investigator, MD and her colleaguesexamined2,400 cases that took place between January 2010 and June 2014. They discovered that 11.3 percent, or 271 patients had a malignancy. Out of the 189 patients (7.9 percent) who underwent a subsequent biopsy, 24 of them were diagnosed with cancer. In the final biopsy, radiology subspecialists found 15 cases of breast cancer, 10 invasive carcinomas, and five ductal c...
Source: radRounds - June 3, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs
Why One Should Always Solicit a Second Opinion for a Serious Disease
This article makes the important point that some patients may be financially constrained by their health insurance when seeking a second opinion. This is because some insurers will balk at having diagnostic studies repeated. I suspect, however, that there will only infrequently be a need to repeat radiology studies like CT scans and MRIs. But and as noted above, it's probably worth the cost to pay out-of-pocket for a surgical pathology review as part of a second opinion because the interpretation of a tissue biopsy can sometimes be subjective.Citin...
Source: Lab Soft News - May 1, 2017 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Clinical Lab Testing Healthcare Delivery Lab Industry Trends Lab Processes and Procedures Medical Education Medical Ethics Quality of Care Surgical Pathology Source Type: blogs
Risk Vs. Worry
You get cancer, get treated, and they say ' here, go on with your life ' . (That last part is so helpful! NOT.) Somewhere in the middle of all that treatment crap, they give you all the numbers about statistics - which,as the patient, we interpret wrong. If they say you have a 99% chance of living five years, all us patients put ourselves into the 1% who are not going to make it. (And we ignore the fact that the entire 99% could be hit by a bus at any time.)Over at 'The Big C and Me' , I read today ' s post by Renn about' Five Years and Counting ' and she included the American Cancer Society ' s statistic about survival ra...
Source: Caroline's Breast Cancer Blog - January 1, 2017 Category: Cancer & Oncology Tags: breast cancer cancer recurrence cancer risk statistics stress worry Source Type: blogs
Cleveland Clinic TV Advertisement: Get a Second Opinion in Cardiology
I recently viewed a TV commercial for the Cleveland Clinic on MSNBC. One of the major themes of it was: Get a second opinion if you have a diagnosis of a cardiology condition. There is nothing surprising about a tertiary care center like Cleveland Clinic promoting second opinions. I have been a strong advocate for this in selected cases and have blogged about the idea many times (see:Seeking A Second Opinion as a Partial Solution to the DCIS Controversy;Fourteen Ways to Avoid Getting Screwed by the U.S. Healthcare System;Some Tips for Selecting a"...
Source: Lab Soft News - August 30, 2016 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Health Insurance Healthcare Business Healthcare Delivery Medical Consumerism Medical Ethics Quality of Care Source Type: blogs
Wisdom…
…the quality of having experience, knowledge, and good judgment.
I read today a collection of words that exude wisdom. I share it with you because the purpose of this blog is to do create value through education.
Peggy Girshman was an award-winning health journalist. When ill with a life-limiting illness, she wrote her own eulogy. NPR published it today after her death.
Must-read is an overused phrase, but it modifies perfectly her words. Here are a few excerpts, with my thoughts.
Work-Life Balance: Though Girshman wished she could have worked longer, “to convince someone I was right,” she also wished she...
Source: Dr John M - May 9, 2016 Category: Cardiology Authors: Dr John Source Type: blogs
It’s Time to Talk about Cancer Surgery Volume
By JENNIFER MALIN, MD
Twenty years ago as a newly trained oncologist, I faced the same challenge that many cancer patients and their families do as they try to figure out where to turn when my mother was diagnosed with ductal carcinoma in situ– or pre breast cancer. Her surgeon, who had come highly recommended by her family doctor,told her she needed to have a lymph node dissection, which can result in lifelong disability due to lymphedema or swelling of the arm. As an oncologist, I knew it was not recommended for ductal carcinoma in situ, but she resisted my suggestion to get a second opinion. Despite the fact that...
Source: The Health Care Blog - February 10, 2016 Category: Consumer Health News Authors: Simon Nath Tags: THCB Jennifer Malin Source Type: blogs
Do cardiologists prescribe too many drugs?
One of the most common reasons people require medical care is their medical care.
This is a distinctly modern problem. In times past, doctors treated disease. Patients saw their doctor when they were sick. They had a problem; doctors offered help.
The doctor of today often improves health by removing healthcare. It’s one of my favorite tricks—stopping nonsense.
Excess healthcare happens for many reasons. Three big ones are the conflating of risk factors with disease, overdiagnosis and the one-disease-one-treatment mindset.
A high cholesterol level is not a disease but it is treated with a pill. When women acquire the d...
Source: Dr John M - September 20, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
The human cost of breast cancer screening
This article originally appeared in Forbes.
Image credit: Shutterstock.com
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
