More false positives with breast exam than mammogram
Source: Journal of the National Cancer Institute, Chiarelli, A., 2009; 101: 1236-43; Barton M., 2009; 101: 1223-25; www.breastcancer.org
Okay, some advice and some terms. First, women should be performing self breast exams (minds out of the gutter, or enlist a friend, whichever). The studies referenced compare physical exams by a doctor with current mammography. So what are “false positives?” Apart from a really poor usage of language, “false positives” in the medical world occur when a benign (non-cancerous) abnormality is felt to look like a malignant (cancerous) one. Like what you ask? Suspicious calcifications; architectural distortion, a cyst or a lump, to name a few.
Why is this important? I will slow down for those of you in the back rows. If an otherwise healthy patient has a “false positive” on a breast exam by a physician, certain protocols, which may include a needle biopsy or other invasive study are performed. Okay, so you require additional testing and a small incision in your breast, big deal, right? Right. Because “subtle findings” are not always detected on diagnostic studies, the breast self examination (BSE) and office physical exam remain useful tools in the diagnosis of breast cancer. Too many “false positives” and expensive insurance dollars used on follow up testing for “false positives” and protocols have a way of changing. Funny how that works.
So what are the numbers? The study of some 290,000 Canadian women (No their breasts aren’t colder children), found that physical breast exam and mammogram combined were 95% accurate in detecting breast cancers. Mammography alone was 89% accurate. Combined there was a 12% rate of “false positives” while Mammograms alone only had a 7.4% rate of “false positives.“ In other words, for every cancer detected by a doctor breast exam, there were 55 “false positives.” Mammography Centers appear to be in the forefront of pushing for the primary reliance on mammograms. Again, funny how that works. It’s an apportionment thing.
So there appears to be some statistical support for the false positives. However even a math idiot like me will note that that the difference in accuracy are also better with both clinical breast exam and mammography combined. And since it’s better to be accurate than good, or something like that, I think we should take this into consideration, but not invest too much consideration.
Posted by David Marc Schwadron, Esq.
From across the Pond: PSA Testing under Review
Source: BBC Health; British Medical Journal
A recent Swedish study (Yes, where the candy fish come from) comparing PSA (Prostate Specific Antigent) Test results of 540 men before they were eventually diagnosed with prostate cancer and 1,000 healthy men failed to determine the point where a PSA Test was a diagnostic predictor of prostate cancer.
What does that mean? Okay. Very low concentrations of PSA (less than 1 ng.ml) basically ruled out a future diagnosis of prostate cancer. The problem lies in setting the upper ranges. Currently those men with a PSA of 3 ng/ml who are aged 50-59 are candidates for urological follow up. Men 60 and over with a PSA of 5 ng/ml are also. But beyond that there is still not enough information. A viable concern is that over-diagnosis might lead to over-treatment with the attendant side effects of impotence and incontinence. (Aren’t you glad you don’t have a prostate ladies?)
Prostate cancer has risen to the 2nd most common cause of cancer related deaths in the UK. Rates are somewhat lower in the US with an average mortality age of 80. Prostate cancer is typically “survivable” if diagnosed and treated early. Oddly the UK approach of less PSA Testing seems to be the opposite of that in the States. Time will truly tell on this one.
Posted by David Marc Schwadron, Esquire
Progress on the Tobacco front -Well for non-smokers anyway
Source: US Food & Drug Administration
The FDA has officially banned the sale of cigarettes containing fruit, candy or clove flavors. The ban is associated with a national effort to reduce smoking in America via the Family Smoking Prevention and Tobacco Control Act.
It is clear from both the ban and the message from the FDA that they are particularly concerned with Tweens and Teens smoking. The FDA has made the not so far leap in logic that these are the likely audience for flavored cigarettes. According to FDA commissioner Dr. Margaret Hamburg, “Almost 90% of adult smokers start smoking as teenagers.”
Yes Europeans, laugh at the country ostensibly founded upon the principles of religious and personal freedom. At least we won’t be coughing when we have the last laugh. Granted we will probably be dead from diseases related to obesity and over-consumption but then the latest statistics seem to suggest that you are catching up to us there too. So smoke ‘em while you’ve got ‘em.
Posted by David Marc Schwadron, Esq.
Just in time for the Holloween Season -Ghostwriting Medicine
Source: New York Times
A stunning indictment of 6 of the “top” peer-reviewed medical journals –A significant number of medical articles published in 2008 were written by ghostwriters financed by drug manufacturers. Let’s review that one again, shall we?
10.9% of articles published in the New England Journal of Medicine, 7.9% of articles published in the Journal of the American Medical Association (JAMA) and 7.6% of the articles published in The Lancet were written, not by independent physicians, but by shills (I love using that word) for drug companies. Big deal, you say? It certainly is a big deal. This is not the Sun or the Post (with apologies to both). These are respected medical journals that physicians look to in determining standards of care and practice for their patients.
And if there are admissions to this shockingly high level of poor editorial standards, you can be assured that the numbers are far higher.
Spokespersons for the Medical Journals had the following to say in their defense, “We feel that [Viagra] there were no [Rogaine] improprieties in the editorial [Pfizer] review and publishing of [Glaxxo SmithKline] articles in our respective [Merk] journals. We expect [Abbott] and anticipate [Lilly] a full retraction of such allegations.” Okay, maybe not, but still.
Posted by David Marc Schwadron, Esq.
New Experimental Skin Cancer Drug Shows Promise
Source: BBC Health
Researchers from Memorial Sloan-Kettering Hospital, NYC, have found, “Unprecedented” results in the treatment of skin cancer (Melanoma). Melanoma is the deadliest cancer and often metastasizes (spreads) quickly.
A new drug, PLX4032 (A working name only) blocks the BRAF gene, which is widely felt to be responsible for determining the rate of spread of skin cancer. The study of 31 patients with advanced skin cancer resulted in “rapid and dramatic” tumor reduction. Within 2 weeks of the regimen.
A word of caution. Well a few, actually. One, the researchers themselves state that the new treatment is not a cure for skin cancer. Two, drugs in the research stage still take a long time to be approved and marketed in the US. Given that there are few effective treatments for melanoma currently, any promising research is welcome news.
Posted by David Marc Schwadron, Esquire
Do you have a medical malpractice case in PA or NJ?
You MAY have a medical malpractice case if:
_ You or a loved one were significantly injured from a surgical error or complication of surgery
_ You or a loved one were significantly injured from improper medical care or treatment
_ You or a loved one were diagnosed with breast, ovarian, prostate or other cancer after a year or more of having symptoms
_ You or a loved one experienced stroke, heart attack or pulmonary embolism after being discharged from a hospital ER
_ You or a loved one contracted a serious infection while in a hospital
_ You or a loved one have bed sores or broken bones from a fall during a nursing home stay
_ You or a loved one experienced significant injury while being treated at a Veterans’ Hospital
_ You or a loved one were prescribed the wrong medication or too much medication
_ Your baby experienced hypoxia, birth asphyxia or brain injury following delivery due to a delay in delivery
_ Your baby experienced shoulder dystocia or nerve injury to the shoulder, arm and hand following delivery
_ You or a loved one are having a hard time getting answers from your doctor or hospital
_You or a loved one are having problems getting your medical records from your doctor or hospital
_ The records from your doctor or hospital do not accurately reflect the care you received
If you have checked Yes to any of these questions and (IN PA and NJ) the medical treatment at issue occurred within the past 2 years, you MAY have a medical malpractice case. The Lewis Law Firm, PC will provide you with a free initial consultation to determine whether you have a medical malpractice case.
Complications, including significant injury or death, following medical treatment create confusion in addition to pain and loss. You may have “a gut feeling” that something went wrong. You may be too uncertain or even embarrassed about questioning medical care to consult with a lawyer.
The above is a quick check list of “red flags” which might indicate that your “gut feeling” is correct. Obviously one can never determine from a checklist whether you actually have a medical malpractice case. But these are certainly some good questions to start with.
Posted by David Marc Schwadron, Esquire
Safer surgery for babies -laparoscopy goes small
Source: BBC Health News
Laparascopic surgical instrumentation (“keyhole instrumentation if you’re British”) has gone smaller over the years and is finding new applications for the smallest of patients.
At only 7 months, “Charlie” received laparoscopic hernia surgery which took all of 40 minutes and shortened his recovery time to days instead of weeks. “Charlie’s” parents were advised to wait until after he was a year old to have conventional surgery before discovering this alternative.
Through 2 small incisions cutting instruments and a laparascope, an insertable medical device with a camera on the end, surgeons can repair hernias, debulk and remove tumors and perform a host of other procedures that were too risky for little ones or took to much time to perform conventionally.
The benefit? Happy and healthy infants who can go back to being, well infants, a lot sooner. Now who can’t get behind that?
Posted by David Marc Schwadron, Esquire
OMG No way! Fat middle aged smokers at risk?!
Source: BBC Health; British Medical Journal
A retrospective University of Oxford (that’s in England) study of some 19,000 male British civil servants between the ages of 40 and 69 has found that men with high blood pressure an high cholesterol who smoke may die 10 years earlier than their healthier cohorts.
Not entirely earth shattering news if you haven’t been living in a cave, but 10 years is a very significant difference. Not convinced? Let’s put it this way then, by the time the group was followed up on 38 years after the initial physicals and histories were taken, 13,501 (out of 19,000) had died.
Add diabetes and obesity and the 10 years you may lose increases to 15. And ladies, in case you are feeling a bit of relief, Professor Peter Weissberg, head of the British Health Foundation, adds, “There is no reason why the same should not apply to women.”
Downer for a Monday, I’m aware. But if it motivates only one of you then I feel better.
Posted by David Marc Schwadron, Esquire
Good news for French. Taking showers could make you Ill.
Source: BBC Health
Kidding! Sort of. A study from the University of Colorado at Boulder (yes, where they ski) suggests that dirty shower heads are an effective delivery system for harmful bacteria, M. avium (Mycobacterium avium). Levels in shower heads tested 100 times higher than in faucets.
Says Norman Pace, one of the researchers, “If you are getting a face full of water when you first turn your shower on…you are probably getting a particularly high load of [M. avium], which may not be too healthy.”
Okay, so it’s not really a problem for the majority of healthy people (or the non-showering types). However, if you have a weak or compromised immune system or are elderly or pregnant, you are susceptible to infection. Of 50 shower heads in 9 cities and 7 states including NYC and Denver, 30% had levels which were a health risk. Hot tubs carry a similar risk, according to researchers.
Only 30%? So why mention it? Because it is a potential source of illness. That plus it’s always fun to make fun of the French.
Posted by David Marc Schwadron, Esquire
2009-2010 Flu Season is here!
Source: US FDA Consumer Updates
The Flu (Influenza if you’re French) is a contagious URI (Upper Respiratory Infection) caused by different strains of influenza viruses. (Flu? They should eat more fresh fruit!) Each flu season, the US FDA, the CDC (Centers for Disease Control and Prevention) and the WHO (World Health Organization) work with vaccine manufacturers to focus upon the 3 flu strains projected to cause the most problems. For you budding virologists, this year it’s A/Brisbane/59/2007; A/Brisbane/10/2007; and, B/Brisbane/60/2008.
The current flu season vaccine (2009-2010) does not protect against the dreaded swine flu (H1N1). There is currently a swine flu vaccine pending approval and wide-spread dissemination. The approved vaccines are: Afluria (CSL, Ltd); Fluarix (GlaxoSmithKline); FluLaval (ID Biomedical); Fluvirin (Novartis); Fluzone (Sanofi Pasteur); and, FluMist (MedImmune).
Of the vaccines there are the traditional injection form and the nasal inhalant variety. Both are believed to be equally effective. Autumn (The Fall) is the best time for vaccination according to the CDC. Contrary to popular mythology, you can not get the flu from the flu vaccine. You can experience reaction to the medication, however.
Research from the CDC suggests that 5-20% of the US population gets the flu during active flu seasons causing hospitalizations for some 200,000 and the death of 36,000. Flu symptoms include: fever; headache; chills; body aches; extreme fatigue; and weakness.
Posted by David Marc Schwadron, Esq.