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Posts Tagged ‘USPSTF’

From the Physician’s Desk … Weekly Blog!

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

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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

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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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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…

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