August 21, 2015
On August 20, 2015, the New York Times published an article with the provocative title, “Doubt is Raised Over Value of Surgery for Breast Lesion at Earliest Stage.” In it they reference a study by Narod reported in JAMA Oncology that looked at breast cancer death after a DCIS diagnosis.
But, the questions addressed by the article were different than the questions generated by the research.
December 28, 2014
Participants at the San Antonio Breast Cancer Conference were recently updated on the status of OncotypeDx for DCIS.
Providers at the Swedish Cancer Institute have been using this technology since it became available about 4 years ago. The test is done on the tissue after surgery to see if it might be safe to not add radiation therapy to lumpectomy / partial mastectomy for carefully selected DCIS patients.
There is now data on ...
April 20, 2013
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 ...
February 08, 2013
With the vague hint of spring in the air, many families are gearing up for the onslaught of practices and games that come with spring sports. As the kids strap on their pads and cleats again, keep in mind that a healthy athlete needs more than just good physical conditioning; fueling their bodies with proper nutrition is just as important to keep them competitive!
Nutrition is vital for the health of people of all ages and activity levels but young athletes have higher fluid and energy needs. Nutrition can also help
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January 21, 2013
Han·gry [ h·ng gree ]
- feeling very annoyed because you are hungry
- a combination of hungry and angry
We’ve all experienced it: the short temper that comes from being hungry, better known as being “hangry.” Sometimes in the hustle and bustle of life, eating can become a secondary priority. Unfortunately our brains and bodies aren’t meant to function without food and so we get hangry. Low blood sugar and a grumbling tummy can turn us into less than pleasant parents, partners and coworkers. So in spite of all the messages out there saying eat less, hear this message instead: Eat sensibly when you’re hungry. Here’s why (and how)...
January 14, 2013
The holidays are a beautiful time but as the New Year begins, the aftermath may be less than pleasant. With all the parties, traveling, eating, drinking and general merriment from the past few months, many of us may be dealing with a post-holiday headache. But what if your pain is more than just a passing ache? For those with chronic pain, especially in the back and neck, the added stress of the holidays can make it worse. Our minds and bodies play off each other so when one is stressed, the other one usually is, too. For instance, have you have noticed how a little rest and relaxation can cut both the physical and men...
January 09, 2013
There are two truths most of us have to live with on a daily basis:
- We have to eat to survive
- Life is busy
These two truths together often mean that we grab for processed foods (chips, cookies, crackers) when we feel hungry. Other times, it’s just easier to order take-out or fast-food in between meetings, classes or appointments. Of course, these foods often have less nutritional value and more calories. With the New Year underway and many of us aiming to shed pounds or improve our nutrition, why not make a resolution to pack your lunch at least 3 to 5 times per week?
Packing your own lunch has many benefits including...
January 04, 2013
Jingle bells may no longer be ringing in your ears, but the constant barrage of New Year’s resolution pressure probably is! Yet for all the commercials that promise the next great way to shed pounds or get more physically active in the New Year, children are left out of the resolution discussion. But that doesn’t necessarily mean that they shouldn’t be involved in setting healthy goals. Why not turn your New Year’s goals into a family affair?
For children, the goal shouldn’t be “pounds lost” but “healthy habits made.” Set an example for your children by not trying every fad diet but instead making a more concerted resolution to live a healthy lifestyle. Here are some fun ideas to involve your kids in your healthful resolutions...
December 14, 2012
A recent article in the Seattle Times references the 2012 Dartmouth Atlas Report: Improving Patient Decision-Making in Health Care. Unfortunately their take home line, "A new report that found wide geographical variation in the use of elective surgical procedures in Pacific states reflects the preferences of physicians – not what patients want or need, the authors say,” oversimplifies a complicated situation.
On my reading of the report, it stresses the values that an individual woman brings to the decision:
October 08, 2012
Since October is Breast Cancer Awareness Month, I’ve been paying more attention to online blogs about breast cancer and realize there is a lot of information and misinformation out there. How can you know what’s correct, what’s marketing, and what is just plain wrong? Here are some tips:
- Be an aware and questioning reader: Ask yourself some of the following questions. What is the source of the information? Does the author have anything to gain financially from the information? Are there studies that provide data supporting the recommendations? Who funded the studies and were there any potential conflicts of interest?
Investigate more than one source: Healthcare has become very politicized and complicated but you can find reliable sources. But realize even with trusted sources the information provided may be conflicting. Some reliable sources include:
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August 15, 2012
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 he...
July 16, 2012
Frequently women will ask me: Where should I get my mammograms? There are several things to think about.
First, you want to go to a Center that is accredited by the American College of Radiology. This means that they have high quality images and well-trained radiologists. It is preferable to have a digital mammogram but if that technology is not available, then film mammograms are better than not having one done. While it is not clear that digital mammograms improve survival, they do allow the radiologist to examine the images more clearly and to use computer assisted diagnostic tools.
The radiologists’ experience is also important. Dedicated breast centers usually have radiologists who are specialized in breast imaging. These sub-specialized radiologists are very experienced in using mammograms, ultrasound, and breast MRI to diagnose breast disorders and are less likely to miss abnormalities.
Convenience is also a consideration. You want to make it ea...
June 04, 2012
We at the Swedish Cancer Institute are excited about the new True Family Women’s Cancer Center, located in downtown Seattle, which opens on June 5. Recognizing that women may have unique needs when faced with a cancer diagnosis, the True Center brings together multiple specialists who treat women with all types of cancer and provide care that is compassionate, caring, and highly coordinated. It is funded entirely by philanthropy.
The True Center is located on floors 5 and 6 of the Arnold Pavilion at 1221 Madison. Floor 5 will house medical oncology teams, our psychiatrist, social workers, genetic counselors, naturopathic physicians, nutritionists, The Rivkin Ovarian Cancer Center Clinic offices, a patient education satellite, our American Cancer Society Patient Navigator, and a financial counselor. The 6th floor will be the home to our multidisciplinary clinic, which will house our breast surgery teams, cancer rehabilitation physician, physical ther...
May 14, 2012
You may be hearing more talk about standardization in medicine these days. What does it mean and why is it important to everyone? People who are not in the medical field may worry that standardization will result in their care being less personalized and more “cookie-cutter.” Nothing could be further from the truth.
For several years, medical providers, healthcare administrators, healthcare quality experts and others have been talking about improving medical care and health outcomes through increased use of data and standardization. The term “evidence based medicine” is used to indicate that medical recommendations and decisions are based, to the extent possible, on data – rather than just doing things because they have always been done that way.
Data can be obtained through clinical trials (where patients are randomized to various treatments and then the outcomes are compared), observation (where the outcomes of various ...
May 04, 2012
A little perspective as we head into the weekend:
Life does not get easier as we get older; we take on more responsibility at work and at home. In this economy, it often feels that we are living on the edge and all it would take is one thing to tip the scales and throw our life off-balance. Taking time to slow life down can sometimes help. Here are some things that may help:
May 03, 2012
Each year, thought leaders from around the world join their colleagues from Swedish Neuroscience Institute (SNI) as they present the latest advances in the management of cerebrovascular disease and stroke. This two-day course is held May 17-18 at the Swedish Cherry Hill campus in Seattle, WA, and includes faculty from Swedish Neuroscience Institute, Providence as well as guest speakers from around the country.
In addition, each year we honor the memory of Dr. Merrill P. Spencer, M.D. through an annual lecture. Dr. Spencer enjoyed a long and distinguished career as a physician, professor, researcher and innovator. He ea...
April 11, 2012
In 2009, the United States Preventive Services Task Force (USPSTF) created significant controversy and confusion for both providers and patients when they revised their breast screening guidelines. (The USPSTF is promoted as an unbiased group that reviews relevant studies and makes guideline recommendations. Specialists may be asked to review the guidelines but no breast specialists (surgeons or radiologists) were on the actual review panel.)
The guideline development process aims to weigh the potential benefit of services against the potential harm, and make recommendations accordingly. For breast screening, the harms considered were “psychological harms,” imaging tests and biopsies in women who were ultimately found not to have cancer, inconvenience, and the possibility of treating a cancer that might not have been life threatening. Radiation exposure was considered to be a minor concern. Regarding benefits – the only benefit considered was reduc...