Most people know that colorectal screening is on the “to do” list when they reach 50 years of age, barring any high risk concern for where screening would begin earlier. Screening saves lives and prevents many colon cancers. With the increase in public awareness and availability of colonoscopy screening, the rates of colon and rectal cancers have been declining and survival rates increasing for people between the ages of 50 and 74. This is great news for our mature population, but a recent study indicates a concerning trend of increased risk of colorectal cancer in young people, ranging from ages 20 to 34 and 35-49 year olds.
Swedish Cancer Institute and Seattle Radiology have been screening for lung cancer by low dose CT scan since 2000 as Principal Investigators in the International Early Lung Cancer Action Program, an international screening registry. This program, in addition to the large National Lung Screening Trial by the National Cancer Institute and several other international lung screening research trials, has been instrumental in delivering the need for lung cancer screening to the forefront and addressing this dreadful cancer in a complete face off. This research has clearly demonstrated an ability to significantly improve survival and save lives by early detection of lung cancer through routine low dose CT scan imaging.
Nearly a year ago the United States Preventive Services Task Force made a formal Grade B recommendation for lung cancer screening, by low dose CT scan, in high-risk people. People ..
For most parents, the newborn period is a time of profound joy, incredible challenges, and LOTS of questions. As pediatricians, some of the questions we are frequently asked are related to a simple blood test done on all infants in Washington State. Commonly referred to as the “newborn screen” or “NBS”, “PKU”, or “newborn metabolic testing”, this test checks for several congenital disorders that are rare but can be life-threatening.
Often parents want to know:
What does the test involve? The newborn screen is done by pricking the heel of the infant at around 24 hours of age, then collecting a few drops of blood onto a piece of test paper. This is dried and then sent to the state lab, where the testing is performed. Because some of the conditions may take several days to show up, the test is repeated at 7-14 days old (usually by your primary care doctor; it can also be done in the hospital if the baby is still there for any reason).
Does it hurt? The needle prick is performed by trained nurses and is done quickly. It may feel similar to pricking your finger to test blood sugar. And you can significantly decrease the discomfort of the quick poke by breastfeeding your baby during or immediately after the test!
Why do we need this? The diseases we check for are typically rare, but if undiagnosed and untreated can cause a variety of complications, including blindness, poor growth, brain damage, and even death. The reason that testing every baby is essential is that babies with these conditions can look and act perfectly healthy even while the disease is damaging their bodies, until they get so sick they need to be hospitalized or have permanent damage. Starting treatment as early as possible can prevent many of the complications.
What are you testing for? The ...
A palpable neck lump in any patient should raise some concern. In the case of a pediatric patient, the concern may be less, since reactive and infectious nodes in the neck can be fairly common in children. When a child has a bad episode of pharyngitis, tonsillitis (sore throat), or even a bad cold, the lymph nodes of the neck may react and become enlarged. In that type of scenario, your doctor should prescribe appropriate antibiotics to resolve the enlarged lymph nodes and follow up to make sure that the nodes have regressed.
Very few pediatric neck masses will end up being concerning. Besides infectious neck lymph nodes as stated above, some of the other more common causes of pediatric neck mass are congenital cysts. However, none of the pediatric neck masses should be ignored. A neck lump that persists for more than a few days should be looked at by a pediatrician.
In the adult population, a neck mass or lump can be much more concerning. Essentially when an adult patient presents to us with a neck mass, we have to fine the root cause and basically rule out a tumor. Of course, infectious lymph nodes do happen in the adult patients as well, but it is less common. Congenital cysts are also much less common in the adult patient.
The more common causes of a neck mass in the adult patient are ....
We screen for breast cancer with mammography, colon cancer with colonoscopy, and prostate cancer with blood tests and exams – why not lung cancer?
If you’re a smoker or a former smoker, or even if you’ve had significant second-hand smoke exposure, you’ve probably worried about your chances of getting lung cancer, and whether there is anything you can do about it. Perhaps you even asked your doctor about getting an x-ray; he or she may have told you that there is no proof that it helps. That’s because a national study done years ago showed no benefit from getting chest X-rays, and therefore it’s not recommended.
However, since 2000, Swedish has participated in an international study – the International Early Lung Cancer Action Project (I-ELCAP) - to see whether CT scans or CAT scans – very highly detailed X-rays – might be able to find lung cancer earlier and improve cure rates. The study was begun by a group of investigators from Cornell University in New York. They knew that CT scans were very sensitive and would probably show a lot of abnormalities, and that most of them wouldn’t be cancer, so they worked out a system to determine which abnormalities were likely to be cancer. Their system worked, and they showed that when lung cancer was discovered through their screening system the cure rate was over 80%. That’s remarkable, because the normal cure rate for lung cancer is only 15%.
Because of their success, the National Cancer Institute (NCI) began a randomized study with over 50,000 participants. Half of them got annual CT scans and the other half got only chest X-rays. The results were just completed and were very exciting. The group that got CT scans had 20% fewer deaths from lung cancer than the other group!
The results are still being analyzed and there are concerns about safety from too many interventions, radiation exposure, and cost. It will take time to work through these issues, and there is still no general endorsement of lung cancer screening. However, several national organizations now cautiously support screening in high risk groups that meet the criteria for the national study.
Who should get screened, and how?