Feeds:
Posts
Comments

Archive for the ‘Breast Cancer’ Category

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

—————————–

October is Breast Cancer Awareness Month and it is that time of year again, when American Cancer Society seeks our support. The Making Strides Against Breast Cancer Walk is being held in many cities throughout the United States. Have you joined a team and offer your financial support?

breast pinkThis could be a template for all other cancers. Imagine for a moment, if there is a walk for a specific cancer every 2 weeks…that would be awesome right?! Prostate Cancer, Colon Cancer, Gastric Cancer, Lung Cancer, Thyroid Cancer, Brain Cancer, etc.,… Imagine the societal impact and the health benefit for the participants too? A walk every 2 weeks…Why not? Just imagine…

Learn more about upcoming American Cancer Society Breast Cancer walk in your city, by clicking HERE and also see the videos below. Who knows, maybe you will see me at one of these walks…be sure to say hello! 🙂

ACS 2015

ACS Video

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

—————————–

OCTOBER is Breast Cancer Awareness Month

The More You Know…

Screening beginning at the age of 40 reduces breast cancer deaths by 18%.

Despite the above known fact, the United States Preventive Services Task Force (USPSTF) recommendations prioritize sparing women the potential negative aspects of having a mammogram, and in their opinion, their task is to try and maximize the number of lives saved, per mammogram. Shouldn’t they be more interested in how many lives are saved…period? Many advocacy groups are against the USPSTF recommendation draft listed below and I’m joining their ranks.

Hypothetically, if we are able to save one life, but it would take 500 mammograms, but that one life saved is yours at age 45, surviving to age 50 to start screening would likely not be an option for you. Would you be for, or against the starting age of 50 for screening? That is the issue with population based decision making processes – it takes the “person” out of it and aim for the greater good (but the greater good for who?)

 The other issue? If the information to NOT screen women until age 50 becomes widely accepted, then many women between the ages of 40-49 would honestly not even be aware of the USPSTF fine print recommendation to “individualize” screening. They just would not receive a mammogram. So what does that mean? Per the statistics above, 18% of women between the ages of 40-49 who missed the early opportunity of mammography diagnosis, would die from breast cancer. That is unacceptable…yes?

A similar decision is being made for age 75 and older – insufficient evidence to recommend screening. Majority of our “Baby-Boomers” are actually quite active and doing well…so more to follow on that topic.

However, despite my bias FOR screening mammogram to begin at age 40, it is always good practice to hear the other side of the story. Please see USPSTF explanation video below and link to USPSTF is HERE

What are your thoughts?

USPSTF Breast Ca Draft

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

———————————

Every new year, brings new resolutions and 2015 is no different! Many listed “weight loss” and improving nutritional diet overall, as one of their top 3 priorities…including yours truly. There are many good reasons to try and attain these goals (of lower BMI/weight loss and healthier eating habits), but sometimes published data helps!

Read previous blog on the Obesity Epidemic in America and review definition for obesity/increase BMI by clicking HERE

“Body-mass index (BMI) and risk of 22 specific cancers: A population-based cohort study of 5.24 million UK adults”  – big title and a huge claim! (no pun intended). This was published in The Lancet medical journal AUG 2014. They noted that:

  • obesity antiPeople who were obese had a higher risk of Leukemia as well as cervical, colon, gall bladder, kidney, liver, ovarian, uterine and postmenopausal breast cancers than leaner people
  • People who were obese had a higher risk of esophageal cancer (after they took smoking into account)
  • People who were obese had a lower risk of premenopausal breast cancer and total prostate cancer (though there is controversy, because other studies have shown that advanced stage prostate cancers are linked to excess weight. This study did not review advance stage prostate cancer. Additionally, you may not be at risk for these 2, but increased risk for the other types of cancers remain elevated)
  • Underweight people had a higher risk of lung, mouth and throat cancer than leaner people, but the link was due to smoking, since it was absent in those who had never smoke.

obesity-epidemicTheir conclusion/Interpretation states: “BMI is associated with cancer risk, with substantial population-level effects. The heterogeneity (mixture of results) in the effects suggests that different mechanisms are associated with different cancer sites and different patient subgroups.”   The Lancet Vol 384, No.9945 Aug 2014

Bottom line: Everyone is different, but if you lose or avoid gaining excess weight (exercise, increase vegetable & fruit intake, etc.,), quit smoking, your weight control/improvement may be helpful overall, as it pertains to decreasing your cancer risk. Hhhmmm. Sounds familiar?

Watch video below for insight into the state of Obesity in America!

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

———————————-

As October comes to an end and breast cancer awareness publicity winds down…many continue to live with, and fight this disease. Often, I am asked, “when can I say I am a survivor? When can I say I am disease free?” I use to think this was a difficult question. But, with maturity and experience comes wisdom. The answer is not a generic one…

Survivor JeannineWalston500

“I did not think I’d still be alive after diagnosed with a brain tumor in the spring of 1998 at age 24, 15 years ago.” Says Jeannine Walston in her blog.

During a recent cancer walk, the buzz was all about being a cancer  “over-comer” and not a “survivor” … Hhhmm.  I say, whichever phrase empowers you most…use it! The Merriam Webster dictionary defines both as:

Survive: To remain alive or in existence; live on. To continue to function or prosper; to continue to function or prosper despite … (Merriam-Webster)

Overcome: to defeat something. To successfully deal with or gain control of (something difficult). To affect (someone) very strongly or severely

Strong terms!

About 7 years ago while wrestling with the different faces and phases of cancer…I chose to express myself on paper (not sure I would call it a poem though). It never gets easier to handle…as physician, we need an escape too. I choose to download to Jesus daily…and leave it at the alter. Yes…I pray for my patients in private…

 

The identity of cancer1

 

To ALL the Survivors and Over-comers – Blessings, Peace and Love!

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

———————————-

malebreastRecently, I have noted a commercial about Men Against Breast Cancer (MABC), that advocate providing “caretakers” information to males who are taking care of their female love ones, who are diagnosed with breast cancer. How Marvelous! We cannot have enough advocacy relating to Cancer…period.  Breast Cancer is leading the way in publicity, support, advocacy and outreach that should be emulated by less commonly diagnosed cancers.

male breastWhat about men WITH breast cancer? Breast Cancer has been painted so pink (feminine) …that when a male is diagnosed with Breast Cancer, to some, it can be emasculating. Some have presented with advance stage breast cancer, simply because of refusal to believe that the growth on the chest was “breast cancer”…they would not have any part of that diagnosis.

So what to do? It is my belief, that ANY advocacy, publicity, support or outreach, about breast cancer should make it their responsibility to make it known that MEN ARE ALSO DIAGNOSED WITH BREAST CANCER! This would go a long way in removing the stigma.

Male-breast-cancer-man

After Mastectomy – removal of cancer from breast tissue

Yes…Men do have breast. There is “under-developed” breast/fatty tissue just below the nipple area in ALL males (see diagram above). The breast growth was stunted by hormones (lack of certain hormones) during puberty. Have you noticed any men with a “little extra tissue” below the nipple area? This is called “Gynecomastia” which simply means enlargement of a man’s breast, usually due to hormone imbalance, or hormone therapy.  Gynecomastia is just an overgrowth and is a benign condition (it is not malignant/cancerous) and can be seen temporarily during puberty or in overweight men.

Breast cancer in men is a rare disease. However, in 2014, about 2, 360 men are expected to be diagnosed with breast cancer (<1% of total breast cancer diagnosis). Many thanks and deepest gratitude to all who support breast cancer efforts! Let us take one more step and be more inclusive of ALL breast cancer diagnosis and survivors for BOTH sexes – Men and Women!

Thank you for all you do! Until next week …

Please share with the men in your life!

 

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org  and click on “Cancer Information”

———————————-

TRIPLE NEGATIVE BREAST CANCER

Females are VERY vocal. If you were ever in doubt about the strength in numbers and just how vocal females can be regarding a cause of mutual interest … take a look at Breast Cancer.  Everyone knows pink = breast cancer.

However, despite the awesome global attention and exposure and the many research underway, there still exist a problem; patients are still not certain of the “labels” that physicians use in describing certain aspect of Breast cancer and are often times terrified by the information found on the internet – especially as it relates to triple negative breast cancer. The questions I am often asked are;

  1. What are receptors?
  2. What does “triple negative” breast cancer mean?
  3. Is “Triple Negative” breast cancer a good or bad thing?
Receptors - Complicated?

Receptors – Complicated?

What are receptors?  There are currently 3 receptors of interest in Breast Cancer: Estrogen Receptors (ER), Progesterone Receptor (PR) and Herceptin receptors (Her-2-neu)

Receptors are often times describe as, “little antennae’s” on the surface of cells that controls behavior, such as rate of growth, of the cell.  Clear as mud? Apologies, that is still “Doctor talk” that would not make sense to my non-medical Mom…so probably not for you either.

Uuhhhmmm….thinking, thinking…Lord Help me here…Hhhmmm. Got it! A bit overly simplified…but,

Think of Breast Cancer Growth being similar to a plant. There are 3 things required to make a plant grow;

  1. Soil
  2. Water
  3. Sun

Think of each of these components as a receptor, and things that make a cancer grow,

  1. Soil   (Estrogen receptor or ER)
  2. Water (Progesterone receptor or PR)
  3. Sun (Her2neu receptor)

When all 3 are present, the Plant grows (cancer grows).  We also have the ability to “block” each of these components in hopes of preventing the Cancer from growing.

  • If the soil is removed, the plant will be destroyed. (ER+, PR-, Her2Neu-)
  • If water is taken away from the plant, it will be destroyed. (ER-, PR+, Her2neu-)
  • If  Sun exposure is removed, the plant will be destroyed. (ER-, PR-, Her2neu+)

When there are positive receptors, we have available medications that will block the growth of cancer cells in addition to the regular treatment of surgery, radiation therapy and chemotherapy. Oncologist like this, because there are more options of Medications to use, and the more different types of drugs we have, it is believed that the chance of controlling the cancer, will theoretically improve. You may be familiar with some of these drugs Tamoxifen, Arimidex,  Herceptin, etc.,

Triple Neg How ChemoIn Triple Negative Breast Cancer (ER-, PR-, Her2neu-) … The example would be a plant that is not sustained by any identifiable component…yet it is growing; a plant in a dark room, without soil or water available…grows. What is causing it to grow? Other factors that are not hormone receptor related (Well research are ongoing in this area).  However, we are still able to offer the same Surgery, Chemotherapy and Radiation Therapy as for hormone positive tumors…we just lack that “extra arsenal” of hormone/Antibody blockade that we have for positive receptor tumors.  For this reason, triple negative breast cancer is sometimes considered more aggressive. BUT, others sees it as a Breast Cancer without the hormone treatment options…3 out of 4 still remains (surgery, chemotherapy, radiation therapy). Glass half empty or half full?

Now that you understand the basics, more will be explored next time! Questions? Let me know!

Click below to watch.

Robin Roberts speaks on Triple Negative Breast Cancer

——————————————–

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…

Read Full Post »

From the Physician’s Desk … Weekly Blog!

==============================

Please see previous weeks’ blog on the definition of “Metastases”…

Brain Metastases is the most common type of intracranial tumor with an incident of over 170,000/yr in the United States. The primary cancers most likely to metastasize to the brain are lung, breast and melanoma.

  • Solitary = one brain metastasis, only site of disease
  • Single = one brain metastasis, + other sites of disease also present
  • Multiple = more than one brain metastasis/lesion

In evaluating for brain metastasis, an MRI with and without contrast is used. If it is a solitary lesion, a biopsy to evaluate tissue, is usually recommended.

Brain mets RT

Response sometimes depends on “type” of Primary Cancer

Doctors are often asked, “how long do I have to live?” That is coined “Prognosis” in medical terminology…So a patient, after reading this blog may ask, “Doc, what is the/my prognosis?” While I am not a big believer in giving time line for survival, studies have been done to look at survival time after diagnosis of brain metastases, based on prognostic factors of – Karnofsky Performance Scale (KPS = how well are you able to carry on normal daily activities), is the primary cancer controlled, age <65>, is the metastases to brain only or other areas as well. This is then divided into classes of I-III. See video below for more information on RPA = Recursive Partitioning Analysis

TREATMENT:

  1. Steroids (Decadron/Dexamethasone) – improve headache and neurological function, but has no impact on survival. There is no role for steroids if the patient has no symptoms.
  2. Surgery – surgical removal of the lesion from brain. See below as combined as often combined with radiation therapy
  3. Radiation therapy – is recommended as whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). In SRS, no actual surgery is performed. However, the beam of radiation is very focused and intense, that it is liken to “surgery”, though no scalpel or cutting – just a sharp, focused, “laser like beam” of radiation.

So who gets WBRT vs SRS? It all depends on the patients overall health status (KPS), number of brain lesions (less is better for SRS, but if have disease elsewhere, physician may opt for WBRT).

Example: Patient with history of stage 1 lung cancer treated with surgery 5 years ago, present to the ER after tripping over a rug at a party, and hitting his head on a table. Persistent headache in the morning prompted a visit to the ER. An MRI showed a solitary brain lesion with necrosis (likely mets vs blood based on central location). PET-CT of the body shows no active disease elsewhere.

This patient who otherwise has good KPS (function), no seizures, no disease elsewhere may be recommended for:

  1. Surgical resection + WBRT
  2. WBRT + SRS
  3. SRS alone (with SRS or WBRT for salvage later on, should additional brain lesion appear)
  4. WBRT alone

If there are multiple lesions (and or large size), then surgical resection would likely not be recommended and choices between WBRT and SRS remains on the table. An indepth discusiion with the Radiation Oncologists and Surgeon +/- Medical Oncologist (Oncology Team) is always recommended before such an important decision is made.

Complications: Neurocognitive deficits after WBRT in long term survivors (changes in memory, etc.,). There is an ~5% rate of symptomatic brain necrosis after SRS, generally treated with steroids, sometimes requires surgery for intractable symptoms. Of course, there are complications associated with long term use of steroids, surgery and chemotherapy as well.

As you can see, the treatment for Brain Metastases, is based on several factors and must be personalized. Please see videos below for more information.

————

These are lectures presented mostly for Healthcare professional … if do not understand, please feel free to ask! No problem!

Radiation for Brain Metastases

Overall treatment approaches

——————————

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…

Read Full Post »

Older Posts »