Monthly Archives: September 2005

Knowing Your Family History May Save Your Life

I have a confession to make: I don’t know my family medical history.


 


This may not sound like a very important matter, and I certainly won’t be taken to task by anybody for not having this information.  But in fact it is important for a variety of reasons. 


 


Perhaps a bit of background would help explain my interest in this topic.


 


There was much to learn when I was a medical student and in my post graduate training.  But it was also known that the “half life” of medical knowledge at that time was about 5 years. That meant one half of everything you knew would be different or out of date within the next 5 years.  I suspect that with today’s rapidly expanding medical discoveries, the half life is even shorter, not to mention the fact that no human being I know is able to get their arms around everything there is to know in medicine.


 


I concluded when I was a student that there was one skill set that would never change, and would serve me well throughout my medical career: knowing how to do a competent medical history and … Continue reading →

One more time: Smoking is harmful to your health!

How safe is safe for cigarettes?


The simple answer: there is no safe level of tobacco smoke.


How many people do you know who say, “I only smoke a couple of cigarettes a day” or “I only smoke on the weekends” as though that smoking won’t hurt them?


Two articles that appeared over the past week have once again put the spotlight on the question of how little one can smoke and still avoid the risks that accompany cigarette smoking.  The answer is that if you smoke even a couple of cigarettes, you are causing harm to yourself.  And, if you think cutting back on the number of cigarettes you smoke is a big deal, think again.


An article in the journal Tobacco Control reported that if you smoke 1-4 cigarettes a day, your risk of developing coronary artery disease increased for men about 2.75 times that of a non-smoking man, and for a woman almost 3 times the risk of a non-smoking woman.  For lung cancer the risk numbers were 2.79 times greater for men and about 5 times for women.  There was also a significantly increased risk of death from any cause at any age in “small time” smokers … Continue reading →

The Dilemma (Part 3): New Research Report

In my prior postings, I have mentioned an article that was published recently in the New England Journal of Medicine titled “Autoantibody Signatures in Prostate Cancer.” 


The report represents very sophisticated and elegant science of a new approach that may prove useful in screening men for this common cancer (in fact, the science is so sophisticated that the authors include a glossary in the article, which is very unusual in a research article of this type.  It essentially means that the doctors who read the article need an education in the research being reported in the article).


Basically, the researchers took some tissue from prostate cancer specimens and developed a test that could use blood (actually, serum) to see whether certain antibodies against prostate cancer were present in those blood samples.


What they found in testing blood from 60 patients with prostate cancer and 68 men without prostate cancer was that the blood test could detect the disease about 8 out of 10 times when it was present, and that its specificity was 88.2%, meaning in about 12 out of 100 men the test would say prostate cancer was present when in fact it was not.


These results are intriguing.  … Continue reading →

The Dilemma of Prostate Cancer Screening (Part 2)

When a message isn’t clear, sometimes that lack of clarity can offer people an excuse not to get screened for a potentially life threatening disease.


As I mentioned in my last posting, prostate cancer screening recommendations can at times be in conflict among organizations and experts in no small part because the blood test we recommend (called PSA, short for prostate specific antigen) is not a perfect test.  That is because it is sensitive to detecting prostate cancer, but not specific.   The result can be confusion among patients, doctors, other health care professionals, insurance companies and companies who provide health insurance to their employees.


What do the terms sensitivity and specificity mean?  Sensitivity in simple terms means that if a condition is present, the test is likely to pick it up.  That doesn’t mean every time, but at least frequently enough that there is only a small, but acceptable chance that the test will miss the condition it is testing for.  Specificity, on the other hand, means that if a test is positive how likely it is that the test is picking up only the condition it is testing for and not something else.


In the case of prostate cancer, … Continue reading →

The Dilemma of Prostate Cancer Screening (Part I)

One of the questions I am asked frequently is where I think the diagnosis and treatment of cancer will be in the next 5, 10 or 15 years?


As the saying goes, we live in exciting times.  Over the past 30 years we have learned much about how cancer cells become cancer cells, why they don’t behave like normal cells, how they function as cancer cells and what “targets” in cancer cells may be available for attack by new treatments.


We have also learned a lot about how cancer behaves in our bodies, and how our bodies respond to cancer cells which in fact are “foreign” to our bodies.  One of the questions that has been asked for many years is why our bodies don’t react effectively to cancer cells, much like we do to a virus or bacteria.


The reality is we probably do respond to cancer cells, and most of the time the cells don’t grow into a cancer that we can see.  And, as we have learned over the years, there are probably many cancers that occur in our bodies that will not cause us difficulty.  As our imaging techniques such as CT scans, MRI machines and … Continue reading →

To Travel So Far, and Walk So Little

It became obvious to me this weekend why we are having trouble with overweight and obesity in this country.  Not that the observation is new, or dramatic.


It’s pretty simple: we just don’t use our feet enough.


A couple of months ago I found myself in a not unusual situation.   I had been traveling extensively, sitting in long meetings, and generally not being particularly careful with my diet.  The results were becoming obvious to me:  my weight was headed north, my aches and pains were returning, and I just generally didn’t feel good.


Some of my colleagues and I were having a discussion when we started talking about the commitment it takes to stay healthy, especially when a demanding schedule gets in the way.  (These schedules are not limited to doctors or business travelers; a busy mom taking care of kids or juggling job and home responsibilities has similar difficulties.)  My co-workers impressed on me how important it was to stay active every day, even as part of routine daily activities.  Their answer?  10,000 steps—every day, no matter what.


Given the fact that one of those colleagues is our local expert in nutrition and physical activity, I thought they must … Continue reading →

Colorectal Cancer: What We Know and What We Do

Why can’t we do more about colorectal cancer?


I gave a talk to a group of doctors today on the prevention and early detection of colorectal cancer.  The main theme was that we could prevent about 30,000 deaths a year from this disease, if we only applied what we already know.  Imagine for a moment: 30,000 people a year could avoid death from a disease that is the second leading cause of cancer deaths in the United States, and the third most common cancer that occurs in men and women.  That represents over 50% of the people who are projected to die this year from colorectal cancer.  And, it doesn’t require any new knowledge beyond what we already know, and have known for a number of years.


So the question is a simple one: why aren’t we doing better?  Why can’t we help save the lives of 30,000 mothers, fathers, grandfathers, grandmothers, sons, daughters, aunts, uncles, friends, and colleagues among others?


There will always (ok, perhaps we can hope it will not always be “always”) be situations where we wouldn’t have found the disease because people are too young and wouldn’t fit into our normal screening recommendations (begin to get … Continue reading →

The Paradox of Living Longer

We haven’t been hearing much good news on the health front recently.  Obesity has become topic #1, and the data shows that, nationwide, the rates of obesity are increasing alarmingly.  Almost daily, there are stories about the impact of our lifestyles on our health and our lives, especially as our children spend more and more time in front of the television or the computer instead of outside engaging in some form of physical activity.


Lost in the discussion is the fact that we have been making some progress over time. 


An article that was just published in the Journal of the American Medical Association, written by my colleagues from the Epidemiology and Surveillance Department here at the American Cancer Society, highlights some of the positive news.


The authors found that there have been dramatic improvements in the rates of death over the past 32 years in the United States.  For example, there has been a 1/3 decline in the death rate for all causes.  For some diseases, the decreases were more dramatic than others: heart disease declined 52%, stroke 63% and accidents 41%.  For cancer, the rate of death actually increased from 1970 to 1990, and then decreased through … Continue reading →

Vitamin C: Have we learned from the past?

An interesting article about vitamin C appeared this week in the highly regarded journal Proceedings of the National Academy of Sciences.
The researchers who wrote the report are from the National Institutes
of Health, the Food and Drug Administration and the University of Iowa,
and consequently their findings have to be taken seriously.

What they
found, through a series of laboratory experiments, was that high doses
of vitamin C given intravenously selectively killed cancer cells and
not normal cells. They suggested that this was due to the production of
hydrogen peroxide in the fluids surrounding the tumor cells.

Normally,
laboratory experiments such as this are just that: laboratory
experiments that are a long way from application to people. There are
many reports of cancer related experiments that are successful in
laboratory dishes, or in laboratory animals. And it is easy to fall
into the misconception that these experiments should translate easily
and/or immediately to people. But that is usually not the case, and it
is only a very small number of such experiments or laboratory findings
that ultimately find their way to the bedside or the clinic to benefit
patients with cancer or other diseases.

The vitamin C situation… Continue reading →

Why is prevention and early detection so hard?

For
many years, I have been of the opinion that there is much more we can
do to prevent some of the more common forms of cancer as well as
improve the general state of our health.  And, as adults we could do a better job of screening for those cancers where we know early detection produces positive benefits.

 

We
know that almost 1 out of 3 cancer deaths could be avoided if we
followed a healthy diet, maintained an ideal body weight, and exercised
regularly.  All cancers caused by cigarette smoking
and heavy use of alcohol could be prevented completely, according to
the American Cancer Society’s Cancer Facts and Figures 2005. A recent report from the Institute of Medicine
estimated that 100,000 cases of cancer and 60,000 cancer deaths could
be avoided each year if we applied what we already know about the
causes, prevention and early detection of cancer.

 

What
has struck me after many years as a practicing physician is how
difficult it can be at times to get people to take medical advice
seriously, especially when it involves subjects like modifying your
diet, or getting more exercise.  It is just
Continue reading →