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By Elaine Schattner, MD, on February 28th, 2011
A worrisome report on breast cancer trends in the U.S. appeared on-line today, ahead of print in an AACR journal, Cancer Epidemiology, Biomarkers & Prevention.
The analysis, based on the NCI’s SEER data from 2000 — 2007, shows that the incidence of breast cancer in the U.S. is no longer declining. (A drop after 2002 in BC incidence is generally attributed to an abrupt reduction in HRT around that time.)
Since 2003 the overall BC rate has been steady overall, with a few exceptions:
The incidence of BC in non-Hispanic white women ages 60–69 rose by 4.8% in this period. “It remains to be seen if this trend will continue,” according to the study authors.
Among white women ages 40–49 rates of estrogen receptor (ER) positive (ER+) breast cancer significantly increased by an average of 2.7% per year during this period. In contrast, the rate of ER– breast tumors decreased, overall, although
See more Breast Cancer Rate in the U.S. is No Longer Declining
By Elaine Schattner, MD, on February 28th, 2011
 Since Watson won on Jeopardy, there’s been lots of talk of robots assuming doctors’ roles. Ten years into our future, machines with programmed empathy and nuanced diagnostic skills will solve diagnostic dilemmas, deduce optimal treatment and make us well.
Yesterday I found a new Xtranormal video, this one crafted by Dr. Charles of his excellent Examining Room blog, on Dr. Watson and the 7 Qualities of an Ideal Physician.
from the Examining Room of Dr. Charles
Dr. Charles cites a 2006 Mayo Clinic Proceedings review on what patients say are essential characteristics of a good physician: The ideal doctor is confident, empathetic, humane, personal, forthright, respectful, and thorough. In this clever, short movie crafted by Dr. Charles, the robot-doctor tries to demonstrate his capability in each of these dimensions in his interaction with a cartoon patient.
I hope the folks over at IBM, who are collaborating with real medical centers now about designing artificial doctors’
See more A Video About a Robot and a Patient
By Elaine Schattner, MD, on February 25th, 2011
Today a short article in the NY Times, New Kidney Transplant Policy Would Favor Younger Patients, draws my attention to a very basic problem in medical ethics: rationing.
According to the Washington Post coverage, the proposal comes from the United Network for Organ Sharing, a Richmond-based private non-profit group the federal government contracts for allocation of donated organs. From the Times piece:
Under the proposal, patients and kidneys would each be graded, and the healthiest and youngest 20 percent of patients and kidneys would be segregated into a separate pool so that the best kidneys would be given to patients with the longest life expectancies.
This all follows last week’s front-page business story on the monetary value of life.
I have to admit, I’m glad to see these stories in the media. Any reasoned discussion of policy and reform requires frank talk on health care resources which, even in the best of economic
See more Opening Up a Dialogue on the R-Word
By Elaine Schattner, MD, on February 24th, 2011
There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines.
The stated purpose of the research,* published in the journal Radiology, was to see how radiologists’ interpretive volume – essentially the number of mammograms read per year – affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed.
First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper:
…We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked full time (75%), had 20
See more Radiologists’ Experience Matters in Mammography Outcomes
By Elaine Schattner, MD, on February 23rd, 2011
 Lately I’ve been worrying about Kevin’s refusal to eat broccoli, and wondering what exactly is so good about those green bunches of roughage. In browsing the Web for more detailed information on the matter, I found a helpful vitamin chart.
This table comes from the HHS-sponsored National Women’s Health Information Center — a good spot to know of if you’re a woman looking on-line for reliable sources. It’s a bit simple for my taste. In the intro, we’re told there are 13 essential vitamins our bodies need. After some basics on Vitamin A — good for the eyes and skin, as you probably knew already — the chart picks up with a quick review of the essential B vitamins 1,2,3,5,6, 9 and 12 (my favorite), followed by a rundown on Vitamins C, D, E, H (that would be biotin) and K:
See more A Vitamin Chart From the National Women’s Health Information Center
By Elaine Schattner, MD, on February 22nd, 2011
 Last week I considered the relationship between the Prince Albert and his speech therapist in The King’s Speech. One aspect I wanted to explore further is why the future king initially insisted on calling the practitioner “doctor.”
In real life, now, patient-doctor relationships can be topsy-turvy. This change comes partly a function of a greater emphasis on patient autonomy, empowerment and, basically, the newfangled idea that the people work “together, with” their physicians to make informed decisions about their health. It’s also a function of modern culture; we’re less formal than we were a century ago.
Patients enter the office with their own set of information and ideas about what they need. The recent Too-Informed Patient video highlighted this issue, effectively.
Doctors are human, we are painfully aware in 2011. They make mistakes and they sometimes need to have dinner with their families. They may even let us down.
When I was a young physician, my patients almost universally called me …read more
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By Elaine Schattner, MD, on February 21st, 2011
On Friday the New York Times reported that surgeons are performing far too many open breast biopsies to evaluate abnormal mammogram results. A new American Journal of Surgery article analyzed data for 172,342 outpatient breast biopsies in the state of Florida. The main finding is that between 2003 and 2008, surgeons performed open biopsies in an operating room – as opposed to less invasive, safer biopsies with needles — in 30 percent of women with abnormal breast images.
I was truly surprised by this should-be outdated statistic, which further tips the mammography math equation in favor or screening.
See more New Numbers Should Factor Into the Mammography Equation
By Elaine Schattner, MD, on February 18th, 2011
 The FDA recently identified a link between breast implants and a rare form of lymphoma. From today’s report in the New York Times:
When talking to patients about a rare type of cancer linked to breast implants, plastic surgeons should call it “a condition” and avoid using the words cancer, tumor, disease or malignancy, the president of the American Society of Plastic Surgeons advised members during an online seminar on Feb. 3.
This is how doctors spoke to patients 50 and 100 years ago, and in some cultures still do, by not mentioning scary words – especially to women, and not calling a cancer what it is.
Cosmetic verbage?
Most cancers aren’t lethal* is one message for 2011: the “big C” turns out to be a spectrum of hundreds of diseases, each with distinct subtypes, and patients shouldn’t panic when they hear the word. Some are benign in behavior although technically malignant; others behave live chronic illnesses;
See more Stunning Comments on the Risk of Breast Implants, and Cancer
By Elaine Schattner, MD, on February 17th, 2011
 In today’s Times, Nicholas Wade reports on a potentially serious, besides costly, problem for biomedical researchers: Human DNA Contamination Seen in Genome Databases. He writes:
Nearly 20 percent of the nonhuman genomes held in computer databases are contaminated with human DNA, presumably from the researchers who prepared the samples, say scientists who chanced upon the finding while looking for a human virus…
The full report was published yesterday in PLoS One. The investigators, based at the University of Connecticut, screened for a common human sequence in 2,749 non-primate public databases — NCBI, Ensembl, JGI, and UCSC — and found 492 were contaminated with human DNA. Affected sequences included include bacterial, fish, plant and other genomes.
The implications are broad because if the findings in this report are true, scientists throughout the world have drawn inferences and conclusions and published papers based on incorrect DNA sequence information. As the PLoS authors write in
See more A New Source of Potential Error in Scientific Research
By Elaine Schattner, MD, on February 16th, 2011
I’m taking notes on the Cochrane Library. The site – a collection of databases and reviews — drew my attention yesterday when an embargo was breached for an article to be published there having to do with zinc’s putative power to squelch the common cold.
From the website, published John Wiley & Sons, Ltd.: the Library is put forth by the Cochrane Collaboration, an international group established in 1993. This on-line set includes the Cochrane Database of Systematic Reviews, which so far has published over 4000 papers. The stated aim is to help people make well-informed decisions about human health.
Professor Archibald Leman Cochrane, a health care researcher and pioneering epidemiologist, was born in Scotland in 1909. He attended Cambridge and studied medicine in London. His work was interrupted, extensively. According to the Cochrane site, he served in the International Brigade in the Spanish Civil War and was a captain in the
See more A Glimpse into the Cochrane Library
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