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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...

Dodging A Bullet (Spike's Ordeal)

This post is reposted with permission from Spike O’Neill – see his original post here.

Some of you may have heard of my recent health scare. For those of you who heard and sent along your well wishes, I thank you. For anyone who hasn't, please allow me to share a scary story of ignorance and arrogance that almost cost me big time.

About a month ago, I was carrying my 8 year old daughter on my shoulders. We were leaving a family outing and she was griping about being tired. I didn't have to carry her very far, but when I put her down I noticed a weird ache in my jaw and in both arms, as well as a dull thick ache and a kind of puffiness in my hands. It went away pretty quickly and I blew it off as a pinched nerve or something. But when I felt the same thing a week later after lifting a few boxes in my garage I was a bit more concerned.

I tried again to dismiss the incident, but I have to give it up for my family, who INSISTED that I go see my family doctor just to be sure. I saw my Doc, who had just given me a complete physical a couple months ago, He checked me over, gave me an EKG and suggested a stress test just to be sure. I figured what the hell? Better to be safe than sorry right?

I had no idea how good that advice really was.

I took my stress test 4 days later at Swedish Hospital's Cherry Hill facility. A stress test is just you on a treadmill, wired to a bunch of stuff that measures heart function, pulse and blood pressure. Well, the normal EKG they gave me before the test started went completely sideways a few minutes later when they fired up the speed and incline of the treadmill. That's when they brought in Dr. Peter Demopulos, cardiologist.

Dr. Demopulos said that...

Prostate Cancer Screening

This week a large European consortium updated the data on a huge study on prostate cancer screening. The study included over 160,000 men in eight European countries followed for an average of 11 years. The men were randomly assigned to prostate cancer screening with the PSA blood test or no screening. The primary endpoint of the study was death from prostate cancer. The current report in the New England Journal of Medicine gave an additional two years of follow-up data over the prior reports.

As expected with longer follow-up, the benefits from screening have become more clear. The study now shows a 29% decrease in the number of men dying from prostate cancer in the screened group. This confirms the expected benefit for early detection.

This publication comes at a time of great controversy regarding prostate cancer screening here in the United States...

Mercer Island Half Marathon and Colon Cancer Prevention

On Sunday, March 25, 2012, the Mercer Island Rotary Club will be hosting the 40th Annual Mercer Island Half Marathon. Children and adults of all ages participate and we anticipate more of the same this year. In addition to the half marathon race around the Island, there will also be a 10K Run, a 5K Run and Walk and a Kids’ Dash. So anyone can participate!

Swedish and the Swedish Cancer Institute are sponsors of this signature event. We are so excited to be part of this event again. One of the main purposes of the day is to raise awareness of colon cancer prevention.

In addition to the various runs and walks, you can still visit, have fun and maybe learn something new. You can also visit the “COLOSSAL COLON”! For the first time you get to walk through the colon and see what the inside looks like! Just don’t get lost in there. Don’t worry, it doesn’t smell!

This year will be particularly special as the 40th anniversary run. In honor of the anniversary, the Mercer Island Rotary Club has collected the “40 Faces of Colon Cancer”. This is a terrific idea. It’s a way to make colon cancer personal and real. Patients of all ages, races and backgrounds have agreed to share their personal stories and cancer experiences. Each story is unique as are the individuals with cancer. What they have in common is a passion to raise awareness of colon cancer and the need to get screened.

Colon cancer is unique among cancers in that nearly all can be prevented with appropriate screening.

Upcoming livestream on colonoscopy, colon cancer, and colon health

If you're 50 (or nearing it), you should be thinking about getting your colonoscopy. Not a pleasant thought, but it's important for everyone to get screened at 50. If you don't know much about colonoscopies, why they are important, or have questions that you're too embarassed to ask, tune in to the livestream next Wednesday between 9 a.m. and noon (Pacific Time) at www.swedish.org/colonlive.

Drs. Raman Menon and Nicholas Procaccini are hosting a livestream to discuss the benefits of colonoscopy, and why it is important that everyone at age 50 get screened. Patients at risk and those with family members who have had colon cancer may need earlier screening. March is colon cancer awareness month – and Swedish is committed to identifying new ways of communicating to better inform and to provide a new level of education to the community.

You'll be able to watch them chat live, narrate recorded colonoscopy procedures, and answer your questions live (and you can submit them anonymously - so no need to feel embarassed).

What is colon cancer?

Colon, or colorectal, cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). Other types of cancer that can affect the colon include lymphoma, carcinoid tumors, melanoma, and sarcomas. These are often rare but can often be detected by a colonoscopy.

What is a colonoscopy?

A colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a CCD camera or a fiber optic camera on a flexible tube passed through the anus. By having a colonoscopy, doctors are able to see potential ulcerations or polyps within the colon. During the procedure, if these are found, doctors have the opportunity to biopsy or remove suspected lesions.

Why a livestream of a colonoscopy?

The American Cancer Society says that colorectal cancer is one of the leading causes of cancer-related deaths in the U.S. However, if caught early it often leads to a complete cure. Education and awareness is our goal. Because of awareness, the death rate for colon cancer has dropped in the last 15 years ...

March is Colon Cancer Prevention Month: What you should know about colon cancer

Colon cancer remains one of the most prevalent cancers in the US, affecting 1 in 18 Americans during an average lifetime. This year, more than 143,000 new cases and 51,000 deaths are expected (only lung cancer kills more women and men than colon cancer). Men and women are affected equally. Age is a major risk factor with dramatic increases in colon cancer after age 50. A family history of colon cancer is another major risk factor that accounts for approximately one third of all cases. A family history in a first degree relative (parent or sibling) portrays a lifetime risk of colon cancer of 10-33%.

Colon cancer for the most part is a preventable disease. Incidence and death rates have been declining for the past 20 years because of increased use of screening tests and better treatments. However, only about 6 in 10 adults are up to date on getting screened for colon cancer. Most colon cancers arise from a preexisting noncancerous growth referred to as an adenomatous polyp. The hallmark of colon cancer screening is to identify those individuals who form precancerous polyps, and to have them removed non-surgically through colonoscopy.

Colonoscopy is the gold standard for colon cancer screening because of its accuracy in identifying small cancers and polyps and, the ability to remove them in one outpatient procedure. Colonoscopy has been found to significantly reduce colon cancer deaths by greater than 50%. This number compares favorably with mammography for breast cancer in women.

Colonoscopy may be the most unloved cancer screening test ....

Are You Up to Date on Your Pap Smear?

Recent changes to Pap guidelines may have you wondering when exactly you need to have a pap smear and in turn, how often you really need an annual exam with your gynecologist. Here I’m going to review the new pap guidelines so you can determine if you are up to date! Of course, every patient should check with their physician about what they recommend regarding the timing of cervical cancer screening because some specific populations may have different recommendations. These are just the general guidelines.

Pap smears are a screening test for cervical cancer. They have helped decrease the incidence of cervical cancer by more than 50% in the last 30 years. Over the last decade we’ve also begun testing for HPV (or Human Papillomavirus) which is by far the most common cause of abnormal pap smears and cervical cancer. It is an incredibly common sexually transmitted virus that can be spread by genital to genital contact but also oral to genital and manual to genital contact. It has been estimated that 75 to 80 percent of sexually active adults will acquire a genital tract HPV infection before the age of 50. Luckily, most HPV-infected women, especially younger women, will mount an effective immune response to the virus and will never develop dysplasia or cancer.

HPV is not like herpes —YOU CAN GET RID OF IT! The amount of time it takes to get rid of the virus varies but most experts think it takes an average of 8-24 months. Women with persistent HPV infections are more likely to get dysplasia and if it goes undetected or untreated, over time it can develop into cancer. HPV infections of the cervix do not cause symptoms and can only be detected by pap screening. Unfortunately we don’t have a cure for HPV, but vaccinations are available and FDA approved for girls and now boys ages 9-26. More on HPV is sure to show up in future blog posts, so stay tuned!

The American College of Obstetrics and Gynecology (ACOG) recommends starting pap screening ....

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