Physicians writing on KevinMD about cancer: the screening argument that has run since 2009, how a diagnosis is delivered, what treatment costs patients, life after treatment, and what the work does to oncologists. Four maintained records draw on this archive: Cancer: what physicians say, in their own words, End of life: what physicians say, in their own words, Prior authorization: what physicians say, in their own words, and Opioids: what physicians and pain patients say, in their own words.

Analyzing the reporting of lung cancer CT screening

Conditions and Diseases
July 1, 2011

It’s been another challenging week for journalists covering various screening stories.

First the new analysis of Swedish mammography studies: Some familiar flaws surfaced in some stories.

Then came the followup analysis of the National Lung Screening Trial – first reported last fall.

This week various headlines announced:

  • More evidence CT scans better at detecting lung cancer
  • Study bolsters evidence that screening reduces lung cancer deaths
  • Nat’l Study Shows Long-Term Smokers Should Get Lung …

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Analyzing the reporting of lung cancer CT screening

MKSAP: 61-year-old man with progressive weakness

Conditions and Diseases
June 18, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 61-year-old man is evaluated in the office for a 6-month history of progressive weakness of the lower extremities. He says he has difficulty rising from a seated position and walking up stairs and also has episodes of dry eyes, dry mouth, and erectile dysfunction. The …

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MKSAP: 61-year-old man with progressive weakness

MKSAP: 50-year-old woman with advanced multiple myeloma

Conditions and Diseases
June 11, 2011

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 50-year-old woman with advanced multiple myeloma diagnosed 6 months ago undergoes a follow-up visit. Treatment includes daily oral thalidomide and pulse dexamethasone. The patient now feels well.

Laboratory studies indicate a serum monoclonal protein concentration of 3.0 g/dL (30 g/L). Hemoglobin concentration, serum calcium level, and …

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MKSAP: 50-year-old woman with advanced multiple myeloma

Why private practice surgeons perform more open breast biopsies

Physician
June 9, 2011

A Florida study assessed the rate of needle versus surgical breast biopsies over a period of five years.

What we’re talking about here are non-palpable abnormalities that are identified on screening mammography. A mammogram report will come back that assesses the relative risk of an abnormal collection of calcifications harboring an invasive or pre-invasive cancer (staged on a scale from I-V). With such data, one is obligated, …

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Why private practice surgeons perform more open breast biopsies

Why families and advocacy groups accept the torture of dying patients

Physician
June 9, 2011

by Aroop Mangalik, MD

A man has lung cancer that has spread to the brain. The cancer in the brain has been growing despite full dose radiation. His lungs have failed and he has been on a respirator for 10 days with progressive worsening of lung function.

Despite multiple discussions between the doctors and the Intensive Care Unit’s team …

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Why families and advocacy groups accept the torture of dying patients

A doctor’s letter to a patient with newly diagnosed cancer

Physician
June 9, 2011

Dear “Robin,”

Nothing in my career in medicine has prepared me for being a friend to someone with such a terrible disease.  As a doctor I dispense advice on a daily basis, but those interactions remain strangely impersonal.  With you, cancer has invaded our inner circle, and we all share your shock and despair.

No one can know exactly what it feels like …

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A doctor’s letter to a patient with newly diagnosed cancer

5 important cancer prevention updates

Conditions and Diseases
June 7, 2011

Most people agree — the best way to beat cancer is to prevent it. What can we do as a nation to help people live healthier lives today so they can avoid cancer tomorrow?

Major research findings and policy changes are steps in the right direction. Here are some important cancer prevention milestones we’ve reached in the past year.

1. Lung cancer screening is now a reality for selected patients

Smoking causes …

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5 important cancer prevention updates

Do doctors have more influence than the media in cancer screening?

KevinMD
June 6, 2011

Not all cancer screening saves lives.

I alluded to this recently in a New York Times’ Room for Debate piece, discussing why Medicare shouldn’t pay for prostate cancer screening in men over the age of 75.

And, when it comes to ovarian cancer screening, a recent study showed that annual CA-125 antigen testing and transvaginal ultrasound did not save lives.  In …

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Do doctors have more influence than the media in cancer screening?

How Susan G. Komen for the Cure affects other cancer non-profits

Patient
June 6, 2011

by Gayle A. Sulik, PhD

In response to increased publicity surrounding Susan G. Komen for the Cure’s questionable trademark and marketing activities, the organization published an official statement on its website, titled: “Susan G. Komen for the Cure® Sees Trademark Protection as Responsible Stewardship of Donor Funds.”

According to the statement, Susan G. Komen for the Cure® has never sued other charities or put other non-profits out of business, and the …

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How Susan G. Komen for the Cure affects other cancer non-profits

Examining the evidence behind a community health screening

Physician
June 3, 2011

The following deceptive advertisement appeared in my church’s bulletin yesterday:

Life Line Screening, the nation’s leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the …

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Examining the evidence behind a community health screening

Unrealistic optimism in early phase new drug studies

Medications
June 3, 2011

In a thoughtful posting in the New York Times, Dr. Pauline Chen, a well respected observer of the doctor-patient relationship, points out an ethical dilemma that faces cancer researchers working in drug development conducting early phase (I) new drug studies. Ethicists have identified that patients in these studies often have unrealistic optimism about their personal outcomes despite …

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Unrealistic optimism in early phase new drug studies

Guiding patients through fragmented health care

Patient
May 31, 2011

“The most important thing I learned was that different doctors know different things: I need to ask my internist different questions than I do my oncologist.”

This was not some sweet ingénue recounting the early lessons she learned from a recent encounter with health care.  Nope.  It was a 62-year-old woman whose husband has been struggling with multiple myeloma for …

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Guiding patients through fragmented health care

Benefits of chance meetings with other cancer patients

Patient
May 28, 2011

My wife had just finished meeting with her medical oncologist for her bi-annual check-up at MD Anderson’s Thoracic Clinic.

We were sitting in an area called “the Park” rehashing what her doctor had said when a mother and her daughter sat down at our table.   There were lots of empty seats in area but for some reason they decided to sit with us.  Call it serendipity. …

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Benefits of chance meetings with other cancer patients

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Cancer screening on autopilot in patients with advanced cancer

Physician
May 25, 2011

by Alex Smith, MD

I used to get Sports Illustrated, and my favorite column was titled, “This week’s sign that the apocalypse Is upon us.”  Well, JAMA recently published the medical equivalent.

Sima and colleagues at Memorial Sloan Kettering used a population based dataset of patients with cancer to compare rates of cancer screening (mammography, PAP smears, PSA …

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Cancer screening on autopilot in patients with advanced cancer

Breast implants and the risk of cancer

Conditions and Diseases
May 23, 2011

The FDA has issued a statement alerting physicians and patients to a possible link between breast implants and a rare type of cancer.   Although anaplastic large cell lymphoma (ALCL) is extremely rare, the FDA believes that women with breast implants may have a very small but increased risk of developing the condition.

ALCL in the presence of breast implants has been noted in sporadic case reports over the past 25 years.  To date, …

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Breast implants and the risk of cancer

Cancer will always be a part of a patient’s identity

Patient
May 20, 2011

So, you’ve cut off your breast(s) and poisoned and radiated your body.  You’ve hit all your medical milestones – surgery, chemo, herceptin. You’ve recovered and the  hair on your legs has grown back to plague you, and you have gotten back to a normal life.  Work, jobs, family. Shaving.

Yet you are changed.  You didn’t expect this, but each time you get dressed or undressed, you can’t help but notice your mastectomy …

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Cancer will always be a part of a patient’s identity

5 rules for living well with a chronic illness

Patient
May 14, 2011

Dr. Elvira Aletta is a clinical psychologist with a unique perspective on what it’s like to live with a chronic illness. In her early twenties, she was diagnosed with nephrotic syndrome, a rare kidney disease that usually affects young boys. Then in her thirties, she came down with a chronic autoimmune condition called scleroderma.

She’d never heard of that, either. She describes her …

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5 rules for living well with a chronic illness

Sunscreen advice from a dermatologist to prevent skin cancer

Conditions and Diseases
May 12, 2011

by Susan Y. Chon, MD

You know you need sunscreen. But with so many lotions, sprays and gels to choose from, how do you know which sunblock will actually prevent sunburns — and skin cancer?

When it comes to shielding your skin from the sun, the type of sunscreen you choose is as important as how you use it.

I hear many people blame their sunscreen when …

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Sunscreen advice from a dermatologist to prevent skin cancer

Using genomics in cancer, and for early diagnosis in infectious disease

Conditions and Diseases
May 11, 2011

In the previous post I discussed the field of pharmacogenomics.

Today I will focus on:

  • Nutragenomics
  • Disease classification
  • Disease prognostication
  • Early and rapid diagnosis
  • Prediction of diseases to develop later in life

Nutragenomics or the science of how our genes affect what we eat is a developing field.

Here is one example. Cholesterol is an important part of our physiology although too much in the wrong places is harmful. Cholesterol is carried in the body by …

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Using genomics in cancer, and for early diagnosis in infectious disease

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