A recent news story in the Journal of the American Medical Association (JAMA) reminds me that lots of things in our lives are changing these days, not the least of which is the shape of our bodies.
Oh, my. This aging thing isn’t so easy, and that is really the message behind Rita Rubin’s timely piece about shifting body mass and muscle as we age and its implications. Although focused on women, I can attest personally that men fall into the same trap as well. That 250 pounds when you are older simply is not the same 250 pounds when you were in college. Now 250 pounds looks more like 280—even though the scale still says 250. Go figure…
Although I may be trying to provide a little humor to the subject, the reality is it’s not humorous when it comes to our health. As we age, muscle turns to fat. In a process called “sarcopenia,” muscle begins an inexorable march to become fat, and for most of us it doesn’t make too much difference how much we try to forestall the shift. It is programmed into our bodies, and although exercise might help, Mother Nature simply doesn’t … Continue reading →
Sometimes It’s important to know the news behind the news: the comments and the cautions that don’t get into the article that the public gets to read. It’s the sort of thing that keeps me up at night: trying to convey the reality, while realizing what most people want to hear is the hope.
That’s the problem I have with a story posted on a major news network website yesterday, where I have a brief quotation that failed to capture the thoughts I tried to express at the time of the interview. The reporter had very limited time, and the information I wanted to provide was complicated. Instead of the caution I tried to convey to counter the potential “hype” about chewing gum to find cancer early, the report suggests that this is a test that will be available soon—while failing to inform how complicated it would be to achieve that goal.… Continue reading →
Are you a baby boomer? Have you been tested for hepatitis C virus (HCV)? Do you know why you should be tested for hepatitis C? Do you even know what hepatitis C is?
According to research published today by my colleagues from the American Cancer Society in the American Journal of Preventive Medicine, the odds are overwhelming that if you are in the boomer generation you have not been tested for the virus, and that has me wondering why that is the case. Could it be that we don’t know about hepatitis C? Could it be that our health professionals aren’t recommending testing? Could it be that the costs of treatment may be seen as a barrier to care?
Why is this important? Because if you do have hepatitis C you are at risk of dying from liver cancer and other diseases. The kicker: the deadly results of hepatitis C can be prevented with an effective, albeit expensive treatment. Deaths from liver cancer in the United States are increasing more rapidly than any other type of cancer, according to a recent report. And even when localized at diagnosis, liver cancer is most often fatal.
It doesn’t necessarily have … Continue reading →
It’s not often you are asked publicly to comment on a particular investment by an entrepreneur as well-known as Mark Cuban. And although I don’t usually offer such advice, this one piqued my interest—more so because of a larger story than the particular company itself.
Mr. Cuban wrote that he is “really excited about changing the economics and results of healthcare with this one.” I don’t doubt his sincerity, however may I suggest there are some much bigger problems that need to be addressed to meet that noble transformative and audacious goal?
The company in question is called LungDirect. They offer a program that gathers information on CT scans performed for the early detection of lung cancer, analyzes the data and facilitates reports required by the Centers for Medicare and Medicaid Services (CMS) for payment under the Medicare program (more about that below). In short, it’s a sophisticated approach to what we call a “medical registry.”
I can’t comment here nor do I know whether their tool is any better or any worse than other similar programs. What I do know is that although registry reporting can be complex, creating technology that assists in tracking patients, collating, … Continue reading →
After years of declining rates of colorectal cancer (CRC), a new study from the American Cancer Society raises the specter that not all is going as well as we would have hoped, especially among younger folks born since 1990. And that raises the question of what the future holds for this frequently preventable form of cancer, including a possible reexamination of when it is appropriate to start CRC screening for people at average risk of developing the disease.
The research, published today in the Journal of the National Cancer Institute looked at the rates of colon and rectal cancer diagnoses from 1974 through 2013 in several parts of the country. The researchers were particularly interested in changing patterns of CRC in people 20 years of age and older who were diagnosed with invasive CRC from 1974 through 2013.
There is a lot of complexity in the published results, so let’s focus on the main messages of the study:
- After decreasing since 1974, colon cancer incidence rates increased by 1% to 2% per year from the mid-1980s through 2013 in adults ages 20 to 39. In adults 40 to 54, rates increased by 0.5% to 1% per year from the
… Continue reading →
I am devoted to my fitness tracker, having used it for several years to remind me to be active, monitor my diet and improve my sleep. Now the New York Times tells me it doesn’t make a difference, at least when it comes to the weight loss part of the program. And I might agree, if only the evidence they relied on told the whole story. In my opinion, it did not.
Unfortunately, some of the science on which the Times’ reporter based his comments had a possible flaw that may influence the conclusion that fitness trackers not only don’t encourage weight loss, but improbably may lead to less weight loss when using the device.
That, my friends, would be a real bummer. However, if you had evaluated that research closely you may have been aware of the problem. From where I sit, I don’t think many folks have made that effort. And I remain unconvinced that the research supports the conclusion that fitness trackers–when used in typical real-life situations–don’t make a difference in keeping us engaged in our health including as an adjunct in weight loss programs.… Continue reading →
In 2011 with much fanfare the National Cancer Institute announced that lung cancer screening decreased deaths from lung cancer by 20%. In 2013, the American Cancer Society (among other organizations) published well-thought-out guidelines recommending high quality screening along with shared decision making so eligible patients could understand the risks and benefits of screening. In 2015 the Medicare program announced that lung cancer screening would be covered, along with the shared decision component.
With all of that evidence and support, one would think that lung cancer screening would see rapid uptake in the United States in an effort to reduce deaths from this all-too-frequent cause of cancer death.
If you thought that, you would be wrong. So the logical question is why? In the face of all this evidence, why are high risk current and smokers not being screened, and how do we make it right?
That question is the result of a spate of recent articles (links 1,2,3) in journals from the American Medical Association, along with a somewhat “direct” editorial that highlights the need to better understand how lung cancer screening works and the need to inform health professionals and their … Continue reading →
A report in this week’s Journal of the American Medical Association (JAMA) shows that too few women with recently diagnosed breast cancer and at high risk of a BRCA genetic mutation received appropriate genetic counseling and testing for the mutation—a missed opportunity not only to improve treatment for these patients, but also to prevent some breast, ovarian and other cancers in the first place.
This study makes the difficult point that when it comes to routine screening for genetic abnormalities in women (and men, for that matter) who may be at increased risk, we simply aren’t doing the job. The situation may well be worse than this report suggests, especially considering that in some areas of the country Medicare doesn’t even cover preventive testing for the BRCA mutation. And this is more than 20 years after the test was first discovered and placed into clinical practice.
I guess sometimes it takes a long time for the way we care for our patients to catch up with the science that we know works. But twenty years??? Uh, that seems like a long, long time.… Continue reading →
A full waiting room. To most of us, it’s a bad sign, as we anticipate the excruciatingly dull minutes ahead. But at a meeting I attended this past week, it was a sign of hope, of progress; of making a difference.
I was in Washington DC to attend the annual scientific session of the Melanoma Research Alliance (MRA) in Washington DC, an organization that is only eight years old. When this group first met, it was made up of a relative handful of melanoma researchers and clinicians who came together to figure out what they could do to discover and promote more research and better treatment options for patients with melanoma.
The people behind the effort were Michael Milken and Debra and Leon Black. For them the mission was personal: Mr. Milken was a prostate cancer survivor who wanted to devote his energies to accelerating discoveries in cancer care. The Blacks are also well known in financial circles, and Ms. Black was (and remains) a melanoma survivor.
At the time, the landscape for patients with advanced melanoma was bleak. There were a couple of available treatments, but they really didn’t have much of an impact on improving or extending … Continue reading →
The American Cancer Society has now released its newly updated Breast Cancer Screening guideline in the Journal of the American Medical Association
This guideline—which was last updated in 2003—reflects the American Cancer Society’s best thinking on breast cancer screening for women at average risk of breast cancer. They are not intended for women at high risk, such as those with genetic abnormalities (BRCA as an example), a personal history of breast cancer or a history of radiation therapy prior to age 30. That guideline is available on our website at www.cancer.org.
So let’s get right to the heart of the matter: what are the new recommendations?
- Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 (Strong recommendation*)
1a) Women aged 45 to 54 years should be screened annually (Qualified recommendation*)
1b) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. (*Qualified recommendation)
1c) Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (Qualified recommendation*)
2) Women should continue screening mammography as long as their overall health is good and they have a life … Continue reading →