Oncology (cancer) – Page 9

News on Aspirin After Breast Cancer

February 18, 2010September 13, 2021 Elaine Schattner M.D.

There’s promising news on the breast cancer front.

A study published on-line this week in The Journal of Clinical Oncology (JCO) suggests that regular, low-dose aspirin use reduces the risk of recurrence and death from breast cancer among women who’ve had stage I, II or III (non-metastatic) disease.

This is a phenomenal report in three respects:

1. The dramatic results: among women who’ve had breast cancer, regular aspirin use was associated with a reduced risk of recurrence and of death from cancer by more than half;

2. The relevance; these findings might affect millions of women living after breast cancer, today;

3. The cost: aspirin is widely available without patent restriction. Aspirin costs around $5 for 100 tablets, several months’ supply.

Posted in Breast Cancer, cancer survival, cancer treatment, Medical News, Oncology (cancer), Women's HealthTagged aspirin, Breast Cancer, cancer medicine, cancer treatment, medical news, Women's Health2 Comments

Health Care Costs, Communication and Informed Choices

February 12, 2010August 30, 2011 Elaine Schattner M.D.

For those of you who’ve been asleep for the past year: the health care costs conundrum remains unsolved. Our annual medical bills run in the neighborhood of $2.4 trillion and that number’s heading up. Reform, even in its watered-down, reddened form, has stalled.

Despite so much unending review of medical expenses – attributed variously to an unfit, aging population, expensive new cancer drugs, innovative procedures, insurance companies and big Pharma – there’s been surprisingly little consideration for patients’ preferences. What’s missing is a solid discussion of the type and extent of treatments people would want if they were sufficiently informed of their medical options and circumstances.

Maybe, if doctors would ask their adult patients how much care they really want, the price of health care would go down. That’s because many patients would choose less, at least in the way of technology, than their doctors prescribe. And more care.

What I’m talking about is the opposite of rationing. It’s about choosing.

Posted in cancer treatment, Communication, Empowered Patient, health care costs, Informed Consent, Medical Ethics, Patient AutonomyTagged cancer medicine, chemotherapy, communicating in medicine, decisions, doctor-patient relationship, empowered patient, end-of-life, life as a patient, palliative care1 Comment

Henrietta’s Cells Speak

February 5, 2010September 13, 2021 Elaine Schattner M.D.

“One of the ways that I gained the trust of the family is that I gave them information.” (R. Skloot, a journalist, speaking about her interactions with Henrietta Lacks’ family, Columbia University, 2/2/10)

Posted in Books, Communication, Essential Lessons, Ideas, Informed Consent, Life as a Patient, Medical Education, Medical Ethics, Oncology (cancer), Patient Autonomy, Patient-Doctor Relationship, Privacy, Reviews, Science, Women's HealthTagged books, cancer research, cervical cancer, communicating in medicine, HeLa cells, Henrietta Lacks, Johns Hopkins, life as a patient, medical education, medical ethics, medical research, patient-doctor relationship, Women's Health1 Comment

A Visit With My Oncologist

January 28, 2010February 28, 2010 Elaine Schattner M.D.

After a while my oncologist stepped out into the waiting area and guided me to the hall by her office. “The cells are low,” she said. “We’ll have to wait another week, that’s all.”

I knew she was right. But a week seemed like a lifetime to me then….

Posted in Breast Cancer, cancer survival, cancer treatment, Life as a Patient, Women's HealthTagged blood cells, Breast Cancer, cancer screening, cancer treatment, chemotherapy, health, life as a patient, mammography, Women's Health2 Comments

How to Avoid Death in the ICU

January 25, 2010September 13, 2021 Elaine Schattner M.D.

It was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.

Posted in cancer treatment, Communication, Empowered Patient, Essential Lessons, health care costs, Life as a Doctor, Medical Ethics, Palliative Care, Patient Autonomy, Patient-Doctor RelationshipTagged being in the hospital, communicating in medicine, community awareness, DNR order, DNR orders, doctor-patient relationship, doctors' lives, empowered patient, end-of-life, health, hospice care, intensive care, life as a patient, palliative care, patient-doctor relationship, Women's Health4 Comments

Looking Ahead: 7 Cancer Topics for the Future

January 4, 2010October 30, 2013 Elaine Schattner M.D.

Here’s my short list, culled from newsworthy developments that might improve health, reduce costs of care and better patients’ lives between now and 2020, starting this year: 1. “Real” Alternative Medicine. By this I don’t mean infinitely-diluted homeopathic solutions sold in fancy bottles at high prices, but real remedies extracted from nature and sometimes ancient […]

Posted in Future of Medicine, Health IT, Oncology (cancer), Science, Selected TopicsTagged alternative medicine, cancer immunology, cancer treatment, chemotherapy, e-health, Future of Medicine, health, health care costs, internet medicine, IT, palliative care, pharma, technologyLeave a Comment

Looking Ahead on Breast Cancer Screening

December 31, 2009December 31, 2013 Elaine Schattner M.D.

The risks and costs of breast cancer screening are exaggerated and misrepresented in the recent news…. My conclusion is that rather than ditching a life-saving procedure that’s imperfect, we should make sure that all doctors and radiology facilities are up to snuff.

We need to distinguish between errors in the measurement (cancer or not) and errors in decisions that we – patients and doctors – make after upon detecting a premalignant or early-stage malignancy in a woman’s breast.

Posted in Breast Cancer, cancer screening, Diagnosis, health care costs, Oncology (cancer)Tagged Breast Cancer, DCIS, decisions, false positives, health care costs, LCIS, mammography, screening controversy, Women's HealthLeave a Comment

A Bit More on False Positives, Dec 2009, Part 1

December 29, 2009October 25, 2011 Elaine Schattner M.D.

Why bother, you might ask – wouldn’t it be easier to drop the subject?

“Make it go away,” sang Sheryl Crow on her radiation sessions.

I’ll answer as might a physician and board-certified oncologist who happens to be a BC survivor in her 40s: we need establish how often false positives lead, in current practice, to additional procedures and inappropriate treatment…These numbers matter. They’re essential to the claim that the risks of breast cancer screening outweigh the benefits.

Posted in Breast Cancer, cancer screening, health care costs, Medical News, Statistics, Women's HealthTagged Breast Cancer, cancer screening, false positives, health care costs, mammography, mammography math, medical news, screening controversy, statisticsLeave a Comment

Legitimate Concerns and Unfortunate Timing on Radiation from C.T. Scanning

December 15, 2009November 23, 2010 Elaine Schattner M.D.

The risks of radiation from CT scanning will almost certainly add to the current confusion and concerns about the risks of breast cancer screening.

Mammography differs from CT scanning in several important ways:

1. Mammograms involve much less radiation exposure than CT scans.
2. Mammography is well-regulated by the Food and Drug Administration (FDA) and other agencies. The Mammography Quality Standards Act (MQSA) requires…
3. Women who undergo screening mammograms can control when and where they get this procedure. Screening mammograms are elective by nature..

Posted in Breast Cancer, cancer screening, Diagnosis, Medical News, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer screening, decisions, health, mammography, media on medicine, medical news, radiation risk, Women's HealthLeave a Comment

How Well Do You Really Want to Know the “Red Devil?”

December 11, 2009September 13, 2021 Elaine Schattner M.D.

I know what it’s like to get the “red devil” in the veins.

You can learn about Adriamycin, a name brand chemotherapy, on WebMD. Or, if you prefer, you can check on doxorubicin, the generic term, using MedlinePlus, a comprehensive and relatively reliable public venture put forth by the National Library of Medicine and National Institutes of Health. If you’re into organic chemistry, you might want to review the structure of 14-hydroxydaunomycin, an antibiotic and cancer therapy first described 40 years ago…

Posted in Breast Cancer, cancer treatment, Essential Lessons, Life as a Doctor, Life as a Patient, Medical Education, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer medicine, cancer treatment, chemotherapy, communicating in medicine, decisions, health, life as a patient, medical education, Women's Health2 Comments

On Juno and Screening Test Stats

December 3, 2009November 23, 2010 Elaine Schattner M.D.

“Well, well” says the convenience store clerk. “Back for another test?”

“I think the first one was defective. The plus sign looks more like a division symbol, so I remain unconvinced,” states Juno the pregnant teenager.

“Third test today, mama-bear,” notes the clerk.

…”There it is. The little pink plus sign is so unholy,” Juno responds.

She’s pregnant, clearly, and she knows she is.

(see clip from Juno the movie*)

Think of how a statistician might consider Juno’s predicament…

Posted in cancer screening, Diagnosis, Medical Education, Movies, StatisticsTagged cancer screening, decisions, empowered patient, false positives, health, interpreting medical data, Juno's pregnancy test, medical education, medical tests, movie, sensitivity and specificity, statistics, Women's HealthLeave a Comment

Another Take on Mammography

November 23, 2009October 12, 2011 Elaine Schattner M.D.

Three key issues have escaped the headlines: 1. The expert panel carried out a careful analysis using data that are, necessarily, old; 2. The recommendations don’t apply to digital mammography; 3. Mammograms are not all the same.

We need to set the bar higher for mammography…

Posted in Breast Cancer, cancer screening, Diagnosis, Medical News, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer screening, health, health care costs, mammography, medical news, screening controversy, Women's HealthLeave a Comment

Getting the Math on Mammograms

November 20, 2009July 20, 2011 Elaine Schattner M.D.

But consider – if the expert panel’s numbers are off just a bit, by as little as one or two more lives saved per 1904 women screened, the insurers could make a profit!

By my calculation, if one additional woman at a cost of, say, $1 million, is saved among the screening group, the provider might break even. And if three women in the group are saved by the procedure, the decision gets easier…

Now, imagine the technology has advanced, ever so slightly, that another four or five women are saved among the screening lot.

How could anyone, even with a profit motive, elect not to screen those 2000 women?

Posted in Breast Cancer, cancer screening, cancer treatment, Diagnosis, health care costs, Medical Ethics, Medical News, Policy, Women's HealthTagged Breast Cancer, breast cancer screening, cancer screening, health care costs, mammography, mammography math, screening controversy1 Comment

Hello Readers!

November 18, 2009March 3, 2010 Elaine Schattner, MD

Well, I went ahead and started this blog without a proper introduction. Why was I in such a hurry?

Because I think the media’s getting – and giving – the wrong message on breast cancer screening. When it comes to long, boring medical publications like those published this week in the Annals of Internal Medicine, perhaps it’s not the devil that’s in the details so much as are the facts.

To Screen is Human

November 17, 2009February 12, 2016 Elaine Schattner M.D.

Smack in the midst of October-is-breast-cancer-awareness-month, the Journal of the American Medical Association published a provocative article with a low-key title: “Rethinking Screening for Breast Cancer and Prostate Cancer.” The authors examined trends in screening, diagnosis and deaths from cancer over two decades, applied theoretical models to the data and found a seemingly disappointing result.

It turns out that standard cancer screening is imperfect.

The subject matters, especially to me. I’m a medical oncologist and a breast cancer survivor, spared seven years ago from a small, infiltrating ductal carcinoma by one radiologist, an expert physician who noted an abnormality on my first screening mammogram…

Posted in Breast Cancer, cancer screening, Diagnosis, Medical News, Oncology (cancer), Women's HealthTagged Breast Cancer, cancer medicine, cancer screening, decisions, health, health care costs, mammography, media on medicine, screening controversy, Women's HealthLeave a Comment

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