Archive for the ‘cancer screening’ Category

Screening For Prostate Cancer-New Guidelines and One Doctor’s Advice

May 10, 2013

Prostate cancer is the most commonly diagnosed non–skin cancer among U.S. men. It can be life-threatening, and many men have cancer without knowing it. For those reasons, doctors sometimes look for prostate cancer in healthy men (screen for cancer) by measuring blood levels of prostate-specific antigen (PSA), a protein secreted by the prostate gland. High PSA levels can be caused by cancer and may lead a doctor to take a sample of prostate tissue to see whether cancer is present (biopsy). Most prostate cancer grows very slowly, however, and many men with prostate cancer die of other causes. Neither PSA testing nor prostate biopsy tells doctors with certainty which cases of prostate cancer are threatening and which require treatment. As a result, many men with slow-growing cancer have biopsies and treatment after PSA testing that they would not have needed if doctors had never tested them.

The value of the PSA test has recently come into question, however, with several studies suggesting it causes men more harm than good — spotting too many slow-growing tumors that, especially in older patients, may never lead to serious illness or death. In 2012, the U.S. Preventive Services Task Force, an influential government-appointed panel, advised against any routine use of the PSA test for prostate cancer in all men.

Since most urologists consider the Task Force’s guidelines and global ban on PSA testing far too stringent For that reason, a group of experts at the recent 2013 American Urologic Association’s annual meeting in San Diego recently recommended against annual testing and prostate biopsies at certain PSA levels, usually a level greater than 4.0ng\ml. It is possible that using the PSA test differently (for example, by testing less often) would still be useful but reduce the harms of unnecessary treatment such as urinary incontinence and erectile dysfunction that come from more frequent testing.

What are the new AUA recommendations? There are several ways of using the PSA test to help men make the diagnosis of prostate cancer while reducing the harms of testing. The first way is to stop screening after age 70 years because men older than 70 years tend to have higher PSA levels without having prostate cancer, or if they have cancer, it is usually the slow-growing variety and does not result in a cause of older men’s mortality. Another way to use the new guidelines included measuring PSA levels less frequently such as every two years in men whose levels are normal especially when the initial PSA levels are less than 1.0ng\ml. Finally, the doctor caring for older men might recommend that they have higher levels of PSA before recommending a biopsy and possible unnecessary treatment.

It is hoped that the new recommendations by the American Urologic Association will result in more personalized health management where discussions will take place between doctor and patient and where the risk of having prostate cancer and the age of the man are balanced against the value of screening.
The new AUA guidelines are more nuanced. The group does recommend against the PSA test for men under age 40 or for those aged 40 to 54 at average risk for prostate cancer.

The AUA says, however, that men aged 55 to 69 should talk to their doctors about the risks and benefits of PSA screening and make a decision based on their personal values and preferences.

Routine PSA screening is not recommended for men over age 70 or any man with less than a 10- to 15-year life expectancy.

The best evidence of benefit from PSA screening was among men aged 55 to 69 screened every two to four years. In this group, PSA testing was found to prevent one death a decade for every 1,000 men screened. The guidelines also said PSA screening could benefit men in other age groups who are at higher risk of prostate cancer due to factors such as race, i.e., African American men and men with family history of prostate cancer. These men should discuss their risk with a doctor and assess the benefits and potential harms of PSA testing.

Bottom Line: What do I recommend that you tell patients? I agree with the guidelines that men over age 70 probably do not need to be tested. Also men younger than age 50 do not need to be tested. The exception is African American men and men with a family history of prostate cancer. I would not test a man with multiple chronic conditions, which would decrease his life expectancy to less than 10 years. I would also suggest that men with very low PSA levels, i.e., less than 1.0ng\ml, be tested every two years.

Finally, the discussions between a patient and his doctor on the PSA test are extremely important. I suggest you ask the man if he gets a PSA test, would he submit to a prostate biopsy and if he has prostate cancer would he accept treatment for the condition? If the answer is no, then I would document this in the chart and not obtain the test.

Screening For Colorectal Cancer

September 9, 2012

If you don’t have time to read this blog on colorectal cancer, do take the time to look at this informative and humorous video from Israel about screening colonoscopy. Click Here To View Video

Colorectal cancer is a disease in which cells in the colon or rectum become abnormal and divide without control, forming a mass called a tumor. Colorectal cancer is the third most common type of non-skin cancer in men (after prostate cancer and lung cancer) and in women (after breast cancer and lung cancer). It is the second leading cause of cancer death in the United States after lung cancer. Although the rate of new colorectal cancer cases and deaths is decreasing in this country, an estimated 141,210 new cases of colorectal cancer and 49,380 deaths from this disease are expected to occur in 2012.

Risk of Developing Colorectal Cancer
Colorectal cancer is more likely to occur as people get older. Although this disease can occur at any age, most people who develop colorectal cancer are over age 50.

Polyps are abnormal growths that protrude from the inner wall of the colon or rectum. They are relatively common in people over age 50. Most polyps are benign(noncancerous), but experts believe that the majority of colorectal cancers develop in polyps known as adenomas. Detecting and removing these growths may help prevent colorectal cancer.

A person who has already had colorectal cancer is at an increased risk of developing colorectal cancer a second time. Also, research studies have shown that some women with a history of ovarian, uterine, or breast cancer have a higher than average chance of developing colorectal cancer.

Close relatives (parents, siblings, or children) of a person who has had colorectal cancer are somewhat more likely to develop this type of cancer themselves, especially if the family member developed the cancer at a young age. If many family members have had colorectal cancer, the chances increase even more.

Ulcerative colitis is a condition that causes inflammation and sores (ulcers) in the lining of the colon. Crohn colitis (also called Crohn disease) causes chronic inflammation of the gastrointestinal tract, most often of the small intestine (the part of the digestive tract that is located between the stomach and the large intestine). People who have ulcerative colitis or

Crohn’s colitis may be more likely to develop colorectal cancer than people who do not have these conditions.
Some evidence suggests that the development of colorectal cancer may be associated with high dietary consumption of red and processed meats and low consumption of whole grains, fruits, and vegetables. Some evidence suggests that a sedentary lifestyle may be associated with an increased risk of developing colorectal cancer. In contrast, people who exercise regularly may have a decreased risk of developing colorectal cancer. Increasing evidence from epidemiologic studies suggests that cigarette smoking, particularly long-term smoking, increases the risk of colorectal cancer.

Why screening is important? Screening is checking for health problems before they cause symptoms. Colorectal cancer screening can detect cancer; polyps; nonpolypoid lesions, which are flat or slightly depressed areas of abnormal cell growth; and other conditions.

Screening Methods Your doctor may suggest one or more of the following tests for colorectal cancer screening: Fecal occult blood test (FOBT) checks for hidden blood in fecal material (stool). The guaiac FOBT, uses the chemical guaiac to detect blood in samples of stool.

Colonoscopy—examines the colon using a lighted instrument called a colonoscope. During colonoscopy, precancerous and cancerous growths throughout the colon can be found and either removed or biopsied. This procedure is usually done in the doctor’s office or in an ambulatory treatment center. Most patients are sedated during the procedure.

Bottom Line: People should talk with their health care provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks (potential harms) of each test, and how often to schedule appointments.

Cancer Prevention For Women-Listen To Your Body

February 23, 2012

Your body may be the best detective for discovering cancer This blog will provide tenant signs and symptoms that may help you discover cancer in the early stages when treatment is most likely to be successful.

Breast changes
If you feel a lump in your breast, you shouldn’t ignore it even if your mammogram is normal. If your nipple develops scaling and flaking, that could indicate a disease of the nipple, which is associated with underlying cancer in nearly 95% of cases. Also any milky or bloody discharge should also be checked out.

Irregular menstrual bleeding
Any postmenopausal bleeding is a warning sign. Spotting outside of your normal menstrual cycle or heavier periods should be investigated.

Rectal bleeding
Colon cancer is the third most common cancer in women. One of the hallmarks is rectal bleeding. Your doctor will likely order a colonscopy.

Vaginal discharge
A foul or smelly vaginal discharge could be a sign of cervical cancer. And examination is necessary to determine if the discharge is due to an infection or something more serious.

Bloating
Ovarian cancer is the #1 killer of all reproductive organ cancers. The 4 most frequent signs of ovarian cancer are bloating, feeling that you’re getting full earlier than you typically would when eating, changing bowel or bladder habits such as urinating more frequently, and low back or pelvic pain. You can expect a pelvic exam, transvaginal sonogram, and perhaps a CA-125 blood test to check for cancerous cells.

Unexplained weight gain or loss
Weight gain can occur with accumulation of fluid in the abdomen from ovarian cancer. Unexplained weight loss of 10 pounds or more may be the first sign of cancer. Weight loss in women can also be due to an overactive thyroid gland.

Persistence cough
Any cough that lasts 2 or 3 weeks and is not due to an allergy or upper respiratory infection or a cough that has blood in the sputum needs to be checked. Also, smoking is the number one cancer killer in women.

Change in lymph nodes
If you feel lymph nodes in your neck or under your arm, you should be seen by your doctor. Swollen, firm lymph nodes are often the result of an infection. However, lymphoma or lung, breast, head or neck cancer that has spread can also show up as an enlarged lymph node.

Fatigue
Extreme tiredness that does not get better with rest should warrant an appointment with your doctor. Leukemia, colon, or stomach cancer-which can cause blood loss-can result in fatigue.

Skin Changes
Any sores irritated skin the vaginal area, or a non-healing vulvar lesion can be a sign of vulvar cancer.
Bottom Line: If you notice something different about your body, get it checked out. Most likely it’s not cancer, but if it is, cancer is treatable and often curable.

Screen Tests Are Not Just For Male Movies Stars

February 9, 2012

Getting the right screening test at the right time is one of the most important things a man can do for his health. Screenings find diseases early, before you have symptoms, when they’re easier to treat. Early colon cancer can be nipped in the bud. Finding diabetes early may help prevent complications such as vision loss and impotence. The tests you need are based on your age and your risk factors.

Prostate Cancer
Prostate cancer is the most common cancer found in American men after skin cancer. It tends to be a slow-growing cancer, but there are also aggressive, fast-growing types of prostate cancer. Screening tests can find the disease early, sometimes before symptoms develop, when treatments are most effective.
Screenings for healthy men may include both a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. The American Cancer Society advises men to talk with a doctor about the risks and limitations of PSA screening as well as its possible benefits. Discussions should begin at:
• 50 for average-risk men
• 45 for men at high risk. This includes African-Americans.
• 40 for men with a strong family history of prostate cancer
The American Urological Association recommends a first-time PSA test at age 40, with follow-ups per doctor’s orders.

Testicular Cancer
This uncommon cancer develops in a man’s testicles, the reproductive glands that produce sperm. Most cases occur between ages 20 and 54. The American Cancer Society recommends that all men have a testicular exam when they see a doctor for a routine physical. Men at higher risk (a family history or an undescended testicle) should talk with a doctor about additional screening. I suggest that most men learn how to do a self-examination. You can gently feeling for hard lumps, smooth bumps, or changes in size or shape of the testes. If you find an abnormality, contact your doctor. For more information on testis self-examination, please go to my website: http://www.neilbaum.com/testes-self-examination-tse.html

Colorectal Cancer
Colorectal cancer is the second most common cause of death from cancer. Men have a slightly higher risk of developing it than women. The majority of colon cancers slowly develop from colon polyps: growths on the inner surface of the colon. After cancer develops it can invade or spread to other parts of the body. The way to prevent colon cancer is to find and remove colon polyps before they turn cancerous.
Screening begins at age 50 in average-risk adults. A colonoscopy is a common test for detecting polyps and colorectal cancer. A doctor views the entire colon using a flexible tube and a camera. Polyps can be removed at the time of the test. A similar alternative is a flexible sigmoidoscopy that examines only the lower part of the colon. Some patients opt for a virtual colonoscopy — a CT scan — or double contrast barium enema — a special X-ray — although if polyps are detected, an actual colonoscopy is needed to remove them.

Skin Cancer
The most dangerous form of skin cancer is melanoma (shown here). It begins in specialized cells called melanocytes that produce skin color. Older men are twice as likely to develop melanoma as women of the same age. Men are also 2-3 times more likely to get non-melanoma basal cell and squamous cell skin cancers than women are. Your risk increases as lifetime exposure to sun and/or tanning beds accumulates; sunburns accelerate risk.
The American Cancer Society and the American Academy of Dermatology recommend regular skin self-exams to check for any changes in marks on your skin including shape, color, and size. A skin exam by a dermatologist or other health professional should be part of a routine cancer checkup. Treatments for skin cancer are more effective and less disfiguring when it’s found early.

High Blood Pressure (Hypertension)
Your risk for high blood pressure increases with age. It’s also related to your weight and lifestyle. High blood pressure can lead to severe complications without any prior symptoms, including an aneurysm — dangerous ballooning of an artery. But it can be treated. When it is, you may reduce your risk for heart disease, stroke, and kidney failure. The bottom line: Know your blood pressure. If it’s high, work with your doctor to manage it.
Blood pressure readings give two numbers. The first (systolic) is the pressure in your arteries when the heart beats. The second (diastolic) is the pressure between beats. Normal blood pressure is less than 120/80. High blood pressure is 140/90 or higher, and in between those two is prehypertension — a major milestone on the road to high blood pressure. How often blood pressure should be checked depends on how high it is and what other risk factors you have.

Cholesterol Levels
A high level of LDL cholesterol in the blood causes sticky plaque to build up in the walls of your arteries (seen here in orange). This increases your risk of heart disease. Atherosclerosis — hardening and narrowing of the arteries — can progress without symptoms for many years. Over time it can lead to heart attack and stroke. Lifestyle changes and medications can reduce this “bad” cholesterol and lower your risk of cardiovascular disease.
The fasting blood lipid panel is a blood test that tells you your levels of total cholesterol, LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (blood fat). The results tell you and your doctor a lot about what you need to do to reduce your risk of heart disease, stroke, and diabetes. Men 20 years and older should have a new panel done at least every five years. Starting at 35, men need regular cholesterol testing.

Type 2 Diabetes
One-third of Americans with diabetes don’t know they have it. Uncontrolled diabetes can lead to heart disease and stroke, kidney disease, blindness from damage to the blood vessels of the retina (shown here), nerve damage, and impotence. This doesn’t have to happen. Especially when found early, diabetes can be controlled and complications can be avoided with diet, exercise, weight loss, and medications.
A fasting plasma glucose test is most often used to screen for diabetes. More and more doctors are turning to the A1C test, which tells how well your body has controlled blood sugar over time. Healthy adults should have the test every three years starting at age 45. If you have a higher risk, including high cholesterol or blood pressure, you may start testing earlier and more frequently.

Human Immunodeficiency Virus (HIV)
HIV is the virus that causes AIDS. It’s in the blood and other body secretions of infected individuals, even when there are no symptoms. It spreads from one person to another when these secretions come in contact with the vagina, anal area, mouth, eyes, or a break in the skin. There is still no cure or vaccine. Modern treatments can keep HIV infection from becoming AIDS, but these medications can have serious side effects.
HIV-infected individuals can remain symptom-free for many years. The only way to know they are infected is with a series of blood tests. The first test is called ELISA or EIA. It looks for antibodies to HIV in the blood. It’s possible not to be infected and still show positive on the test. So a second test called a Western blot assay is done for confirmation. If you were recently infected, you could still have a negative test result. Repeat testing is recommended. If you think you may have been exposed to HIV, ask your doctor about the tests.
Most newly infected individuals test positive by two months after infection. But up to 5% are still negative after six months. Safe sex — abstinence or always using latex barriers such as a condom or a dental dam — is necessary to avoid getting HIV and other sexually transmitted infections. If you have HIV and are pregnant, talk with your doctor about what needs to be done to reduce the risk of HIV infection in your unborn child. Drug users should not share needles.

Glaucoma
This group of eye diseases gradually damages the optic nerve and may lead to blindness — and significant, irreversible vision loss can occur before people with glaucoma notice any symptoms. Screening tests look for abnormally high pressure within the eye, to catch and treat the condition before damage to the optic nerve.
Glaucoma Screening
Eye tests for glaucoma are based on age and personal risk:
• Under 40: Every 2-4 years
• 40-54: Every 1-3 years
• 55-64: Every 1-2 years
• 65 up: Every 6-12 months
Talk with a doctor about earlier, more frequent glaucoma screening, if you fall in a high-risk group: African-Americans, those with a family history of glaucoma, previous eye injury, or use of steroid medications.

Bottom Line: There’s a saying New Orleans that if ain’t broke, don’t fix it. Well that doesn’t apply to maintaining your car and it certainly doesn’t apply to your health and well-being. Men need to have screening tests in order to detect disease states early when they are treatable and curable.

Prostate cancer test promising- A Simple urinalysis might lead to more-precise diagnoses

February 6, 2012

Prostate cancer test promising
Urinalysis might lead to more-precise diagnoses.

Researchers said Thursday they are closer to developing a urine test that can better detect which prostate cancers are aggressive and potentially life-threatening.
Such a test would be welcome. More than half of prostate cancers are slow growing and unlikely to kill, and experts say watchful waiting is the best option for many patients — especially if doctors were better able predict their course.
Currently, biopsies — in which several small tissue samples are taken from different parts of the prostate — are used to try to identify large, aggressive tumors.
The hope is that an accurate urine test might in some cases replace the need for biopsy, while easing fears in men who opt to delay or forgo treatment.
The study included 401 men, about 70 from San Antonio, who were picked because doctors thought their cancers were low-risk and good candidates for watchful waiting. Of those, the urine test found about 10 percent had more aggressive disease, making them candidates for surgery — results that were confirmed by biopsy.
Prostate biopsies are invasive and don’t always pick up all of the cancer. Post-digital-rectal exam urine collection is much less invasive. If a urine-based diagnostic test could be developed that could predict aggressive disease or disease progression as well as or better than a biopsy, that would be ideal.
The urine tests, PCA3 and T2-ERG, together provide a kind of genetic profile of the cancer. Added to the current PSA test, a digital rectal exam and factors such as age, race and family history, they could help doctors make more accurate predictions if the results are confirmed in the larger study.

Bottom Line: Ultimately, doctors would like to be able to have these tests and be able to confirm the man has a low-risk cancer which means less treatment, less complications, less side effects, and longer survival. Instead of seeing the patient every six months and doing a biopsy every two years, your doctor might tell men with low risk cancers: “You have a low-risk cancer, see you in five years.”

Read more: http://www.mysanantonio.com/news/local_news/article/Prostate-cancer-test-promising-2969055.php#ixzz1lbdmooJc

PSA Screening-Advice From A Doctor On the Front Line and In The Trenches

October 30, 2011

What are the symptoms of early prostate cancer? Answer: there are NO early symptoms of prostate cancer. At this time, the ONLY way to diagnose prostate cancer is the PSA test or prostate specific antigen blood test.
The PSA test, which measures the amount of PSA protein released into blood, is by far the best tool I have for detecting this dreaded disease. A high PSA reading is a clear red flag. Because this type of cancer is almost always asymptomatic at first, the PSA — to a much greater extent than the annual digital rectal exam — is my best way to find it.
With over 200,000 new cases of prostate cancer every year in the USA, and more than 30,000 deaths (this number is decreasing because of the PSA), prostate cancer is the second leading cause of cancer death among American men.
Two large long-term European studies showed a 30 percent-50 percent reduction in death from prostate cancer as a result of PSA screening. Even though not all studies showed the same dramatic results, to cast aside this test — seemingly on a whim — is bad public policy that appears to treat life with little regard. And mortality rates don’t tell the whole story: without the PSA, prostate cancer would often be detected at an advanced stage, leading to more suffering for the patient.
PSA screening is the way most prostate cancers are diagnosed today. Without the test, many men will learn of their prostate cancer well after there is a chance to cure the cancer.
This month, the U.S. Preventive Services Task Force said there’s no evidence that routine PSA (prostate-specific antigen) testing saves lives. For the vast majority of men, the panel said, it may cause more harm than good. And last Monday, a study by Dartmouth College cast fresh doubt on the value of mammograms in fighting breast cancer. I, as well as most of my colleagues, am outraged at the publicity given to a recent report that suggests that men should not be screen for prostate cancer.
Of course we will diagnose some indolent cancers and miss lethal ones, and perhaps some doctors and frightened patients will rush forward rather than proceeding with caution. But finding exactly how and when to react to a rising PSA is part of the art of medicine.
If we cast aside the PSA, fewer men will become impotent or suffer the discomfort of additional testing. But more men will die.

Bottom Line: So what is my recommendation and the bottom line? There certainly is a role for cancer screening including prostate cancer and breast cancer. This is a decision that each man needs to make with the advice of his\her doctor.