Treatment

The Task Force Shift on PSA: It Really IS A Big Deal

Sometimes it all depends on your point of view when it comes to areas of divergent opinion about the value of certain medical tests and procedures.

So it should be no surprise that the release earlier this week of the United States Preventive Services Task Force draft statement of their new updated recommendations on the use of the PSA test to screen men for prostate cancer has generated some controversy of its own.

However, this time around it’s not just the advocates or the detractors aiming their fire at the Task Force—it’s journalists and bloggers battling over how media reports and headlines portrayed the impact and ultimate meaning of that draft report (I emphasize “draft” with more on that later). The report basically took the PSA test out of Task Force purgatory by changing the prior recommendation from “don’t do it at all” to a more permissive “have a discussion and make a decision if it’s right for you.”… Continue reading →

Few Boomers Get Hepatitis C Test Even Though It Can Save Lives

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 →

Mark Cuban Asked And I Respond: Will This Company Transform The Economics and Results of Healthcare?

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 →

Millions Of Skin Cancers Occur Every Year, So Why Do Many Teens Still Use Tanning Beds?

4.9 million—yes, million— people are diagnosed with skin cancer every year in the United States. It costs an estimated $8.1 billion—with a “B— to treat those skin cancers, according to the Centers for Disease Control (CDC).

Do I have your attention? I hope so. The problem is we don’t have enough attention. There is no other way to explain why too many states still allow those under 18 to access tanning beds across this country.

Have we made progress? Yes, but not nearly enough according to a research paper and editorial published today in JAMA Dermatology.

The study, from the CDC, looked at surveys of high school students done every two years between 2009 and 2015. The researchers found that overall the frequency of tanning bed use in the previous year declined from 15.6% of all high school students in 2009 to 7.3% of all students in 2015.

That’s progress. However, when they took a closer look at different groups of students they found that among non-Hispanic white female students the numbers using a tanning bed the previous year dropped from 37.4% to 15.2%.

Sound good? Maybe—until you look at the percentages for those 17 and older: in … Continue reading →

We Can Find Lung Cancer Early And Save Lives, So Why Aren’t More Smokers And Former Smokers Getting Screened?

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 →

Mammograms At The Shopping Mall Raise Interesting Questions About How We Get Our Health Care

Is the future of cancer screening at your local shopping mall?

That’s the question sticking in my mind after reading a recent report about a local radiology practice opening a large mammography center in an upscale shopping mall in Long Island, New York.

Let’s face it: Medical care is changing. And with changes come new ideas. Some will work, some won’t. The thought of getting a mammogram while on a shopping trip may just be what the doctor ordered and the consumer needs, or it may not. I don’t know the answer, and only time will tell.

I grew up in a world—which is now fading away—where patients and doctors had relationships. You had your doctor, and your doctor knew the other doctors who would be best for your care, and that primary doctor followed you and cared for you for years. As you aged, someone knew you well—maybe even became a family friend or someone you interacted with in your community.

Today we have mega hospitals, mega practices, and failing long term primary care relationships in many parts of the country. Having those relationships was once thought to be a key to successful health strategies. Now we are handing … Continue reading →

We Order Anything From Anywhere In A Flash But Still Fill Out Paper Forms At The Doctor’s Office. Why?

In a world where in a moment I can order from thousands of items and have them delivered to my doorstep the same or next day at the press of a button without having to re-enter my name, address, and billing information each time, it would seem that filling out paper forms at the doctor’s office by hand to have someone else re-enter the information into a computer that doesn’t communicate with other computers in the same clinic system is craziness. And if someone doesn’t do it right, it can follow you everywhere forever–and you may never know.

After some recent personal medical visits, I can’t imagine what it is like for cancer patients and families dealing with serious illness trying to navigate the complex system we call healthcare. It’s time we get the technology working for the patients, not making their lives even more difficult.

In each of my encounters the setting was fairly typical for a large health system in a large metropolitan city. I needed to get care regarding two straightforward problems with two different clinics in the same system a couple of weeks apart. So far so good: the care was excellent, the support staff friendly … Continue reading →

Cold Caps May Prevent Hair Loss From Chemotherapy: What We Know–And What We Don’t

Some information just released is creating a lot of enthusiasm about the use of cold caps to prevent hair loss from chemotherapy in women with breast cancer. But a deeper look into the data shows that this welcome news is not nearly as clear-cut as it might seem. And I’m afraid doctors explaining the potential limitations of these devices to patients hearing enthusiastic reports are going to be left holding the bag if this new treatment doesn’t work as intended.

Let’s face it: losing one’s hair is traumatic, to say the least. For some folks, the risk of hair loss may affect their decisions about which chemotherapy treatment they should receive for their cancer, or whether they should receive it at all. No question: this is important to many women (and men) when faced not only with the trauma of treatment but with the very diagnosis of cancer itself.

Two articles and commentaries in this week’s issues of the Journal of the American Medical Association (JAMA) and its companion JAMA Oncology present new information about an old approach to preventing hair loss, along with some new thoughts and suggestions as to what this may mean longer term. And along … Continue reading →

Twenty Years Later, And We Still Don’t Routinely Offer BRCA Test To Women At High Risk For Breast Cancer

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 →

When It Comes To Breast Cancer, Doing More Tests Doesn’t Necessarily Mean Better Outcomes

When it comes to our health and our health care, we love the numbers. Sometimes, we even fall in love with the numbers, assuming that the numbers tell us the whole story when in fact that may not be the case. Cholesterol numbers, blood pressure numbers, body mass index, whatever. As patients and consumers, we are frequently defined by our numbers.

But what happens when those numbers and other medical tests such as CT scans really don’t tell the story we think they do? The recent evolution of prostate specific antigen (PSA) is a case in point: for decades we believed the numbers saved many lives. Turns out PSA did save some lives, but not as many as we thought and at the considerable financial and human expense of treating many men who probably did not benefit.

So in that vein an article and editorial in a recent issue of the Journal of Clinical Oncology makes the point that just because we have numbers does not really mean they offer us the scientific certainty about the course of cancer we may think they do.… Continue reading →