Lung cancer screening

Posted on November 21, 2014 by drlesliegreenberg
flickr.com/ photos/lanier67/ 237055775

flickr.com/ photos/lanier67/ 237055775

Wow! Lung cancer accounts for 27% of all cancer deaths in the United States. 7% of Americans will be diagnosed and 6% will die from it.   Among heavy smokers, 33% of them will die from lung cancer.   In the 1960s and 70s, annual screening with chest x –ray was recommended in smokers. At the time this seemed to improve survival, but more recent studies have shown that this does not reduce lung cancer deaths.

More recently we have thought that low-dose CT scan of the lungs showed promise for the early detection of lung cancer. After rigorous randomized controlled trial, an annual low-dose CT screening is recommended to those with risk. persons 55 to 80 years of age with at least a 30-pack-year history (for example, one pack-per-day for 30 years) who are otherwise healthy smokers or who have quit smoking within the previous 15 years.

The results of this low-dose CT of the lung has showed that those in the lowest lung cancer risk were unlikely to have any benefit. Studies showed more than 96% of all positive results in the lowest lung cancer risk group were false positives (the test showed cancer when indeed there was none). Another drawback is that we are unsure of the cumulative effect of annual screenings with radiation exposure.

Perhaps the most important issue with low-dose Ct lung screening is that the technology is available, but that this is a costly test in response to what is a behavioral and lifestyle problem. Researchers note that smoking is responsible for 85% of lung cancers. Our job as physicians to offer smoking cessation programs is far more effective in preventing lung cancer deaths than low-dose CT lung screening. The CT screening cannot prevent most lung cancer deaths compared to smoking cessation.

So, smoking cessation programs are the key. Low-dose CT lung screening is also an option.

Posted in Cancer, General Medicine- Adults, lung conditions, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Lung cancer screening

Prostate cancer screening. To screen or not to screen?

Posted on November 17, 2014 by drlesliegreenberg
flickr.com/ photos/ tokaris/ 207335658

flickr.com/ photos/ tokaris/ 207335658

The US Preventive Services Task Force recommend against routine prostate-specific antigen (PSA) testing.

The PSA test was introduced in the late 1980s. This lab test showed us that the incidence of prostate cancer increased dramatically compared to when we could not easily diagnose it. Even though we were able to diagnose men with prostate cancer, the death from prostate cancer decreased only a little bit. A European randomized controlled trial shows that 1,055 men would have to be screened for nine years to prevent one death from prostate cancer. The PSA blood test has started a “conundrum of overdiagnosis” which is a difficult situation. We cannot tell at the time of diagnosis who is overdiagnosed (and will live with prostate cancer uneventfully) and who has clinically significant disease (and may die from prostate cancer).

25 years after the introduction of PSA testing, two lessons have been revealed. A screening test for cancer should not be introduced until trials have shown that the test leads to significantly reduced mortality. Secondly, (without evidence showing net benefit or harm) PSA testing is likely to remain controversial until it is replaced by a better test. We do not have a significantly better screening test for prostate cancer at this time.

Posted in Cancer, General Medicine- Adults, Male issues, prostate cancer, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Prostate cancer screening. To screen or not to screen?

Nuts and bolts on colon cancer screening

Posted on November 14, 2014 by drlesliegreenberg
normal colonic mucosa

normal colonic mucosa

The U.S. Preventive Services Task Force tells us who and when and how to test for which disease.   Their research takes into account patient population characteristics and the evidence.

Who should be screened for colon cancer? All adults 50 to 75 years of age.

How often should colon cancer screening be done?

  • Colonoscopy (a scope is placed up the rectum to the cecum which is 100% of the way around the large bowel) every 10 years.
  • Or fecal occult blood testing every year (putting stool onto a special card and sending this to the lab to look for microscopic blood in the stool).
  • Or flexible sigmoidoscopy (a scope is placed up the rectum to 60 cm which is the 1/3 of the way around the large bowel) every 5 years plus fecal occult blood testing every 3 years.

The Centers for disease Control and Prevention estimates that in 2012 only 27% of eligible adults had never been screened.

As a caveat, the screening guidelines above are for patients without family history of colon cancer and without any symptoms.  Those with symptoms of abdominal pain, blood in stool, change in stools do not fall into the “screening” category. So, you may need a colonoscopy sooner than age 50 or more frequently than every 10 years.

Hope this helps.

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Nuts and bolts on colon cancer screening

Cancer screening key issues. Why, who, which test do we use?

Posted on November 10, 2014 by drlesliegreenberg
flickr.com/photos/ saturnino/ 1813270775

flickr.com/photos/ saturnino/ 1813270775

I recently read a great article demonstrating biases in the evaluation of screening tests. This is timely as last week I had a 75 year old female visibly upset that she no longer needed regular pap smears. She sighed and said “I guess no one cares if I die of cervical cancer.”

Cancers have different growth rates—which determines their potential to be detected by screening.   Also there are different characteristics of the disease. How fast does the cancer grow? Might the early-stage abnormalities regress on its own (without treatment)? Is there effective and acceptable treatment available? Are patients asymptomatic for a time during which detection and treatment will significantly reduce morbidity and mortality?  Do we have an effective screening test during the time that we could “catch” the problem in time to save their life?

What are the characteristics of the screening test?  Is the test sensitive enough to detect the disease during the asymptomatic period? Is the test specific enough to minimize false positives (a false positive test shows you have the disease, but indeed, you do not)?

What are the characteristics of the screened population? At what age is which screening test appropriate? (Should we test 10 year-olds for colon cancer?) Are patients willing to comply with subsequent tests and therapy if needed?

 

What does all this mean? Researchers are pooling studies to give us more insight into which tests should be performed in which patients. This is so that there is less chance of false positives (which leads to patient worry and further work ups) and more chance to find those most at risk. I think medical school ingrained in me a perpetual weighing of risks and benefits.

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Cancer screening key issues. Why, who, which test do we use?

Mindless weight loss

Posted on October 31, 2014 by drlesliegreenberg
flickr.com/ photos/ reallyboring/ 2860775800

flickr.com/ photos/ reallyboring/ 2860775800

This would be great, right?  Well, if you use the following rules, then you will mindlessly eat less and may lose weight.

keep kitchen counters clear.  The only exception is you can keep a bowl of fruit in sight.  There should be no visible snack food, no nuts, no bread, not even breakfast cereal in sight.  When there is food in sight, we tend to nibble.  And, the nibbling adds up.

To trick yourself into drinking less wine, use taller white wineglasses.  The shape of the glass and the red-color of red wine help us drink less.  If it is easier to see we pour “9 percent less red wine.”

Sit in well-lit areas of restaurants (near windows or doors) as we tend to eat less when we can see our food better.  Also, ask for a doggie bag and take 1/2 your meal to go.  It’s best to ask for this before you are even served.

Keep fruit on the top shelf of the refrigerator.  When good-for-us food is at eye-level we are more likely to  opt for this instead of more caloric options.

Make environmental changes so that you are not tempted.  You’ll just eat less.

Brian Wansink Ph.D. has penned a new book “Slim by Design: Mindless Eating Solutions for Everyday Life.” He is an entertaining writer and impeccable researcher.  Enjoy!

Posted in General Medicine- Adults, obesity | Tagged , , , , , , , , , , , , | Comments Off on Mindless weight loss

Recognizing and treating teen depression

Posted on October 27, 2014 by drlesliegreenberg
.flickr.com/photos / blushingmulberry/ 4001277317/

.flickr.com/photos / blushingmulberry/ 4001277317/

October is national Mental Health Awareness month.    No one is immune from mental illness.  Adolescents are especially vulnerable to mental illness and are a major at-risk population for developing severe depression.  The Centers for Disease Control and Prevention show that nearly one in six high school students have considered suicide and one in 12 have attempted suicide. 

The National Institutes of Mental Health note that suicide is the third leading cause of death among adolescents.

Teenage depression can be scary for parents who may observe changes in their child.  Behaviors to watch for are

  • irritability,
  • loss of interest in activities,
  • personality change,
  • sadness or hopelessness,
  • changes in sleeping and eating habits,
  • thoughts of suicide,
  • difficulty concentrating or focusing.

If teenager is suicidal or in immediate danger, the teen should be brought to the emergency room or crisis center.  Call 911, if needed. 

Treatment for adolescent depression can involve antidepressant medication, psychotherapy or a combination of both medicine and counseling. 

If you see a change in your teen, talk to them about depression.  It is a difficult topic to approach, but it can be life saving.

Posted in Pediatrics, safety, Uncategorized | Tagged , , , , , , , , , , | Comments Off on Recognizing and treating teen depression

Which complementary medicine modalities are worth doing?

Posted on October 24, 2014 by drlesliegreenberg
flickr.com /photos/tingy /484468

flickr.com /photos/tingy /484468

Consider taking fish oil to decrease high triglycerides.   The American Heart Association recommends 2 to 4 grams per day of fish oil with DHA to help decrease triglycerides.   The most common side effects of fish oil is bloating and belching and should not be given after an acute bleeding event.

 

Oral glucosamine sulfate may reduce osteoarthritis pain and improve joint function. Glucosamine is an amino sugar that is considered a building block of cartilage proteoglycans. It occurs naturally in the body, but the glucosamine in supplements is from seashells. Glucosamine stimulates components of the knee to help delay joint degeneration. Glucosamine 500 mg three times a day was found to be significantly helpful in studies.

 

Antibiotic-associated diarrhea is a common problem. Probiotics can prevent antibiotic-associated diarrhea. The studies showing this benefit gave between 5 billion to 40 billion colony forming units per day. The most commonly used probiotics are from Lactobacillus and Saccharomyces genera. These are considered relatively safe, but are not recommended for immunocompromised people or those with an indwelling medical device.

 

Acupuncture should be considered as an additional modality to help patients with chronic low back pain. Also, yoga has helped with both short-term and long-term decrease in back pain.   For more information see http://bit.ly/yoga-as-therapy

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , , , | Comments Off on Which complementary medicine modalities are worth doing?

Warts. Do I need to treat them?

Posted on October 17, 2014 by drlesliegreenberg

No. 

There was a study of 1100 children. 1 of 3 of them had at least one wart.  One year later (without any treatment) 1/2 of all the warts were gone.  This was especially true in younger and nonwhite children.

So, if you can wait it out… all your children’s warts may resolve spontaneously and without treatment. 

flickr.com /photos/ sea-turtle/6061032366

flickr.com /photos/ sea-turtle/6061032366

Posted in infections, Pediatrics | Tagged , , , , , , , , , | Comments Off on Warts. Do I need to treat them?

Do you need to fast before cholesterol lab?

Posted on October 13, 2014 by drlesliegreenberg

No…  but, occasionally yes. 

A study of over 209,000 cholesterol labs found that if we are only looking at total cholesterol and LDL (bad) cholesterol, that patients do NOT need to fast. 

The triglycerides (another part of the cholesterol/lipid panel) will be elevated by less than 20% if taken nonfasting compared to fasting.

So, this means, that unless I am concerned about high triglycerides, the patient can have lab drawn conveniently during an office appointment regardless of timing of last meal.

Posted in Cholesterol, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Do you need to fast before cholesterol lab?

Notice: hydrocodone will be more difficult to refill!

Posted on October 6, 2014 by drlesliegreenberg

You may not take the popular pain medicine hydrocodone (also known as Vicodin, Lortab, and Norco).   But, if you do… refills are going to be more difficult starting today.  The Drug Enforcement Administration is changing hydrocodone to a stricter drug class. 

Why?  The DEA cites 7 million Americans who abuse prescription drugs and 100,000 deaths from overdoses in the past 10 years. 

What are the changes?  Hydrocodone pain medicine will only be given by pharmacies in 30-day supplies.  No refills will be allowed on a prescription.  Each prescription must be handwritten by a doctor (no faxing or phoning in a prescription).  Only physicians can write for hydrocodone (no midlevel providers like physician assistants or nurse practitioners).

The intent of this new rule is for the physician to make a conscious review of the case monthly and consider if this medication should be refilled.  I think this is a good rule.  Let’s see how it plays out…

Posted in General Medicine- Adults, medication issues | Comments Off on Notice: hydrocodone will be more difficult to refill!