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What’s New in Lung Cancer Screening?

For too long lung cancer has been detected too late to benefit from the most effective treatments.  Screening for lung cancer with Low Dose CT (LDCT) has been shown in large research trials to reverse this trend.  There is now cause for optimism that screening has the potential to change the negative statistics around lung cancer.

The current reality is that lung cancer related deaths in our country has surpassed those of prostate, breast, and colon cancers combined.  Although smokers are not the only people at risk for lung cancer they are at much higher risk than the average population.  In fact, if they have a smoking history of 1 pack per day for 30 years or more, are actively smoking or have quit in the last 15 years and are now 55 years old or older, they are considered in a higher risk group for developing lung cancer and would benefit from being screened to detect lung cancer early and at a treatable state.

The last decade has been pivotal in ....

What do parathyroid glands do?

Our parathyroid glands are four tiny glands that lie in our neck, just to the sides of our thyroid gland. When normal, they are the size of a grain of rice or a small flat bean.

These glands control calcium balance in our bodies. They do this by producing a hormone named parathyroid hormone (PTH). PTH acts on our bones, kidneys, and gut to keep the right amount of calcium in the right places.

When one or more of these glands become abnormal, they produce too much of this hormone (PTH). This can cause our bones to...

Breast Cancer Screening Recommendations Revisited

Are you confused about breast cancer screening recommendations? If you are, you are not alone.

Multiple organizations have come out with conflicting studies, data, and recommendations. Those advocating for reduced screening argue that screening does not improve the death rate from breast cancer; that women who have biopsies that are found to be benign suffer significant psychological harm; and that cancers are found that would never cause death.

Significant flaws have been found in these arguments by physicians who have committed their careers to understanding and treating breast cancer. There are multiple problems with the scientific methodology, assumptions, endpoints and analyses used in these critiques of mammogram screening recommendations. One problem is that medical science currently does not have the ability to distinguish between lethal cancers and those that will not cause death. Based on rigorous scientific data, we do know that the best way to improve survival from breast cancer is to detect it before it becomes clinically obvious and to treat it early.

None of the major oncology organizations support the guidelines calling for reduced screening. A letter to the New England Journal of Medicine ....

Lung Cancer Screening Saves Lives: So Why Aren't We Doing It?

The American Cancer Society recently came out with a recommendation about lung cancer screening for high-risk patients:

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Do you have chronic diarrhea?

Many people suffer from chronic diarrhea, not realizing that many times the cause can be found and corrected. Chronic diarrhea is defined as loose stools that last for at least 4 weeks. It usually means more than 3 or 4 loose bowel movements per day. Chronic diarrhea can have a substantial negative impact on quality of life and overall health. Many people with this problem have to stay near a toilet and are afraid to even leave the house because of fear that they will not be able to control their bowel action. It is particularly troubling if there is associated incontinence.

Chronic diarrhea can be caused by intestinal infections, endocrine disorders, inflammatory bowel disease, food sensitivity or allergy and a side effect of medications. These problems can often be diagnosed with a careful history and appropriate diagnostic testing.

There is one particular ..

Two key questions to answer in a suspected cancer workup

There are two questions to be answered if cancer is suspected:

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What test is best for breast screening?

I often get asked why can’t a woman just get a breast MRI rather than a mammogram. The imaging tests that we do for breast cancer screening and evaluation of abnormalities have different strengths and weaknesses.

Mammograms are very useful as a screening tool. They can be done quickly and read efficiently by the breast radiologist. They have minimal radiation exposure. They can be done by a mobile coach in locations that are more convenient to patients. They are excellent for identifying abnormal calcium deposits within the breast tissue and for seeing disrupted tissue and masses. They may be less effective in women who have dense breast tissue but the digital techniques have helped some with that. 

Ultrasound is a great tool for evaluating a mass or tissue asymmetry found on mammograms. It can distinguish between a benign appearing solid mass, a fluid filled cyst, a mass that is suspicious for cancer, or normal appearing breast tissue. There is no radiation exposure. It is less reliable as a screening tool because it can be dependent on the skill of the physician or technologist doing the procedure. It is possible to miss abnormalities or to mis-interpret normal findings as abnormal. There are studies underway evaluating using an automated version of ultrasound as a screening test but the results are not conclusive and this is not considered ready for standard practice.

Breast MRI is a highly sensitive test that is very dependent on...

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