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From the Physician’s Desk … Weekly Blog! 

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I have been asked, “Is the “new” breast mammogram another better than regular mammogram?”  Well, let me tell you a little about what it is…and then you can become your own advocate and make the decision best for you.

Breast tomosynthesis (also known as 3-D mammography) was approved by the US Food and Drug Administration (FDA) for routine clinical use in addition to standard/conventional mammography (Tomosynthesis should not be used alone). Tomosynthesis is a modification of digital mammography that uses a moving x-ray source that can reconstruct thin slices of images and allow the Radiologist to detect and distinguish abnormalities better.

In the screening setting, tomosynthesis may help to decrease recall rates by being able to show true lesions better. This was proven in several studies.

In the diagnostic setting, tomosynthesis improves lesion characterization that may result in fewer false positive biopsies and increase the rate of cancer detection.

breast density

When used in screening mode, the patient is exposed to approximately twice the usual radiation dose, which is sometimes is greater if the patient has dense or thick breasts. However, newer tomosynthesis creates a synthetic 2-D image from the 3-D images, and thereby lowers the radiation dose to slightly above that of a conventional mammogram.  See video below for further explanation on how tomosynthesis works.

Is this a trade off? My opinion…no. Improved detection and lower recall rates with slight increase in radiation dose vs “normal” radiation exposure from conventional mammogram with higher recall rates…and all the anxiety and psychological effects to boot? However, the decision is yours.

Watch videos below to learn the basics of breast self exam and tomosynthesis (Digital 3-D mammography)

 

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog! 

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SMOKING … why is it so important to stop? Well, it is proven to cause harm … proven to cause cancer (carcinogen).  The promotion of smoking cessation is essential, as cigarette smoking is thought to be causal in 85 to 90 percent of ALL lung cancer.

smoking poison

lung_cancer_treatment

Lung Cancer deathsPrevention, rather than screening, is the most effective strategy for reducing the burden of lung cancer in the long term. Most lung cancer is attributed to smoking, including lung cancer in nonsmokers in whom a significant proportion of cancer is attributed to environmental smoke exposure.

  • Lung cancer is the leading cause of cancer-related death among men and women, and the third leading cause of cancer in the United States
  • Worldwide, lung cancer and lung cancer-related deaths have been increasing in epidemic proportions, largely reflecting increased rates of smoking. studies suggest that for any level of smoking, women are at higher risk of developing cancer than men.
  • In the year 2013, the American Cancer Society predicts that there will be approximately 224,230 new cases of lung cancer diagnosed, and approximately 159,260 lung cancer-associated deaths in the US

Recommendations for screening by expert groups — A 2012 systematic review of available evidence was commissioned by the American Cancer Society (ACS), American College of Chest Physicians (ACCP), American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) to serve as a basis for screening guidelines for these societies.  Screening guidelines supporting low-dose CT scans for identified high-risk groups, based upon this review, were issued by the NCCN and by theACCP/ASCO.

So, how should you approach this with your Doctor if interested in screening? Click link below for a guide developed just for patients!

NLSTstudyGuidePatientsPhysicians

A 2013 systematic review for the US Preventive Services Task Force (USPSTF) serves as the basis for revised guidelines for the USPSTF. Many expert screening groups have incorporated results from the NLST in their recommendations. The recommended age cut-off for screening varies between groups, with modeling studies suggesting that extending screening beyond the 74 years of the NLST cohort will provide further benefit

 

Senator Santiago Diagnosed with advance lung cancer. Press arrow below to watch!

AMERICAN COLLEGE OF CHEST PHYSICIANS LUNG CANCER GUIDELINES

 

SUMMARY AND RECOMMENDATIONS

  • Prevention (promoting smoking cessation) is likely to have far greater impact on lung cancer mortality than is screening. Nonetheless, lung cancer screening has the potential to significantly reduce the burden of lung cancer.
  • Early trials of chest x-ray screening found no mortality benefit for x-ray alone or x-ray plus sputum (spit) cytology
  • Low-dose CT (LDCT) refers to a noncontrast study obtained with a multidetector CT scanner during a single maximal inspiratory breath-hold with a scanning time under 25 seconds. Radiation dose exposure is less than a third of a standard-dose diagnostic chest CT examination.
  • A large randomized trial (NLST) of annual low-dose CT screening in patients with a 30 pack-year history of smoking, including those who quit smoking in the preceding 15 years, demonstrated a decrease in lung cancer and all-cause mortality
  • All patients who smoke should be strongly counselled to quit smoking as the most-effective intervention to reduce the risk of lung cancer.
  • Patients who currently smoke or have a history of smoking should be advised of the risks and benefits of screening for lung:
  • For patients in good health who are thought to have a risk for lung cancer and for whom the cost of screening is not an issue, we suggest annual screening with low-dose helical CT
  • High-risk criteria for participation in the NLST were age 55 to 74 years, a history of smoking at least 30 pack-years and, if a former smoker, had quit within the previous 15 years. Also suggest screening for high-risk patients in good health to age 80
  • Plain chest x-ray screening has been shown to be ineffective for lung cancer screening. We recommend not screening for lung cancer with chest x-ray

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

 

 

 

 

From the Physician’s Desk … Weekly Blog! 

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Colorectal cancer screening in older adults who have never been screened  (New Information: JUL 2014)

Discontinuing screening — The decision to stop screening should depend upon whether an individual patient’s life expectancy justifies the risk and inconvenience of screening. Age alone is only one determinant of the impact of screening; in one modeling study, screening individuals aged 67 to 69 with three or more comorbidities (chronic illnesses – diabetes, heart disease, etc.,)  would save fewer lives than screening individuals aged 75 to 79 with no comorbidity (81 versus 459 lives saved per 100,000).

Many of the “Baby Boomers” are living longer and healthier lives, so continued screening may be justified.

At 93yo Dr. Eugster hopes to turn the heads of "Sexy 70yo on the beach!"

At 93yo Dr. Eugster hopes to turn the heads of “Sexy 70yo on the beach!”

Most guidelines recommend that screening for colorectal cancer stop when the patient’s life expectancy is less than 10 years. Which is a difficult concept for many patients to face…who will raise their hands to say they are likely to live less than 10 years? Who truly knows?  The US Prevention Study Task Force (USPSTF) guidelines recommend that patients over age 85 not be screened, and recommend against screening in adults 76 to 85 years, unless there are individual considerations that favor screening.

Older adults with no prior screening — One-time screening in older adults who have never been screened (23 percent of US elderly individuals) appears to be cost-effective up to age 86 years, based on results of a modeling study. In this simulation study, colonoscopy was cost-effective to age 83 years, sigmoidoscopy to 84 years, and fecal immunochemistry testing to 86 years for patients without comorbidity and at average risk for CRC. Colonoscopy was the most effective, and most expensive, strategy for one-time screening.

Signs and symptoms of colorectal cancer

Colorectal cancer may cause one or more of the symptoms below.  However, most of these symptoms are more often caused by conditions other than colorectal cancer, such as infection, hemorrhoids, irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD). Still, if you have any of these problems, it’s important to see your doctor so the cause can be found and treated, if needed.

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • A feeling that you need to have a bowel movement that is not relieved by doing so
  • Rectal bleeding, dark stools, or blood in the stool (often, though, the stool will look normal)
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss
  • And any other signs of concerns…

SCREENING PEOPLE AT INCREASED RISK — The evidence for how high-risk patients should be screened is weaker than for average-risk patients. Thus, guidelines are based mainly upon arguments relating to knowledge of the biology of colorectal cancer (CRC):

If the patient is at risk for earlier onset CRC (eg, first-degree relative (mother, sister, brother etc.,) with onset of CRC before age 50), screening should begin earlier.

If the patient is at risk for more rapid progression of disease, screening should be performed more frequently.

If the patient is at risk for more proximal lesions (eg, hereditary nonpolyposis colorectal cancer [HNPCC]), screening should be performed with colonoscopy.

If the patient is at risk for a greatly increased incidence of disease (eg, HNPCC or familial adenomatous polyposis [FAP]), they should be screened with colonoscopy, the most sensitive test for complete examination of the colon.

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Happy Independence Day!

Today, we celebrate the Independence of our Great Nation…but often we forget to celebrate our “own” independence. The Freedom to make wise choices … and to be free from bondages, of all forms (fear, depression, anxiety, illness, phobias…and the list goes on and on). Please take a moment to slowly absorb and enjoy this poem. I wish you Independence from all your bondages … as those too, can lead to DIS-EASES … diseases.

Be as independent as DESIDERATA  recommends…

desiderata_by

 

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

From the Physician’s Desk … Weekly Blog! 

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Greetings! Now that you are aware of the meaning of “Adjuvant” *smile* let us review a recent article from the New England Journal of Medicine (NEJM) on 1 JUN 2014 and some other recent changes for Breast Cancer treatments (not to worry! I will also cover other types of Cancers as information becomes available;).

In the diagnosis of breast cancer, the receptor status is very important (please review blog here on receptor status).  If, the Estrogen Receptor (ER) and/or the Progesterone Receptor (PR) are positive, then a medication in pill form (Endocrine/Hormone Therapy) is usually given for 5-10 years. Depriving ER-positive breast cancers of estrogen can slow their growth. Tamoxifen is an anti-estrogen that has long been a mainstay of hormonal (or endocrine) therapy for breast cancer.

The type of medication given in the adjuvant setting (after surgery and/or Radiation Therapy) to women who are still having monthly menstrual cycle (Pre-menopausal) is different from the medication given to those who are no longer have menstrual cycles (Post-menopausal – or as my elders refer to it as, having “gone through the change of life!” ).  A previous study showed that an AI decrease recurrence risk more than Tamoxifen in post-menopausal women and so AIs are commonly used in the post-menopausal setting.

breastIn general terms, the study question was – Can we decrease the recurrence risk for pre-menopausal women as we did for post-menopausal women with the use of an AI? If we made patients who are still having menstrual cycle become “post-menopausal” would their outcome also improve with an AI ? The study concluded that;

“…for premenopausal women with hormone-receptor-positive breast cancer, adjuvant treatment with ovarian suppression plus and aromatase inhibitor (AI) Exemestane … [as compared with ovarian suppression plus tamoxifen] … provides a new treatment option that reduces the risk of recurrence. Premenopausal women who receive ovarian suppression may now benefit from an AI, a class of drugs that until now has been recommended only for post-menopausal women.”        June 1, 2014 at the 2014 American Society of Clinical Oncology Annual Meeting and published online on the same day by the New England Journal of Medicine.

Read more about this study by clicking HERE

In essence, if you are diagnosed with estrogen receptor positive (ER+) Breast Cancer at a young age, that is, while still experiencing monthly menstrual cycle, a NEW option of AI plus ovarian suppression can reduce your risk of breast cancer coming back…the “suggestion” is that AI in this setting may be better than Tamoxifen.  Toxicity may be an issue for some patients, so should be taken into consideration. This is definitely worthy discussion with your Medical Oncologist to decide which option is best for you (or individual patient)!

So for pre-menopausal women in the adjuvant setting:

Tamoxifen OR

Ovarian Suppression plus Tamoxifen    OR

Ovarian Suppression plus Exemestane (AI) OR

 

MORE INFORMATION BELOW ON OTHER CHANGES IN BREAST CANCER TREATMENTS!

 

breast pink

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog! 

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As physicians, we are sometimes entrenched in our medical verbiage, and often forget to slow down and explain clearly the medical concepts used while speaking with our patients. I ponder on this process quite often, and tend to use the patient’s area of occupation or hobby to relay an understanding of difficult topics – especially the science of radiation or cancer. So, as I sat and prepare to browse through a few articles, I came across titles such as:

whipple1

Surgery for Pancreatic Cancer

  • Management of borderline resectable pancreatic Cancer
  • Neoadjuvant vs Adjuvant therapy for resectable pancreatic cancer
  • The role of intraoperative radiation therapy in patients with pancreatic cancer, etc.,

…I shook my head in appreciation of the difficult task physicians have to explain these options to a patient recently diagnosed with Pancreatic Cancer. The patients are often times in sheer shock from the news/diagnosis are rendered unable to listen and/or process such technical, yet very important information. It is a daunting task, both for the physician to explain and for the patient to grasp.   Hhhmmm.

A Few Basic Cancer Terminologies

  1. Borderline resectable – there is a high probability that the cancer can be fully removed via surgery without leaving any parts of it behind (resected to a “negative” margin) but treatment with chemotherapy or radiation is usually required first, to shrink the tumor. (conversely, a “positive margin” means that there is a high probability that cancer cells are left behind). Borderline resectable is common term in Pancreatic Cancer, Sarcoma, and other cancer types.
  2. Adjuvant – refers to the treatment that is given after an “initial/first” tumor directed treatment. Such that “Adjuvant Chemotherapy” is given after surgery in some cancers, and “Adjuvant Radiation Therapy” can be given after surgery or after chemotherapy. Adjuvant = after
  3. NeoAdjuvant – in this case, “neo” means doing something out of the normal order and doing it “before/first” the usual treatment. Example: in breast cancer, usually the process is surgery, followed by chemotherapy and then radiation therapy. However, in some cases, if the tumor is large or close to the chest wall, chemotherapy can be done “before” surgery, in an effort to shrink the tumor. In this instance, it would be said that the patient is receiving “Neoadjuvant” chemotherapy.
  4. Intraoperative Radiation therapy – see and watch news news clip

IORT-procedure-4UP

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog! 

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MAYHEM can occur to anyone (As the All-State commercials so aptly describes). However, you can decrease your likelihood of an ER visit with a few precautions/Safety tips!

JUNE is National Safety Month

Injuries are a leading cause of disability for people of all ages – and they are the leading cause of death for Americans ages 1 to 44. The good news is everyone can get involved to help prevent injuries.

burnDuring National Safety Month, Legacy Health Educator is working with community members to help reduce the risk of injuries. This June, we encourage you to learn more about important safety issues like prescription drug abuse, distracted driving, and slips, trips, and falls.

  • Prescription drug abuse: Prescription painkiller overdoses are a growing problem in the United States, especially among women. About 18 women die every day from a prescription painkiller overdose – more than 4 times as many as back in 1999.
  • Slips, trips, and falls: One in 3 older adults falls each year. Many falls lead to broken bones and other health problems.
  • Distracted driving: Doing other activities while driving – like texting or eating – increases your chance of crashing. Almost 1 in 5 crashes (18%) that injured someone involved distracted driving.
  • Watch out for motorcyclists … PLEASE!

You can make a difference. Find out ways to help reduce the risk of these safety issues.

See video below – may sound simple, but many of these activities lead to Emergency Room visits regularly!

Safety Starts With YOU!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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