Stay Healthy, Men!

November 28, 2010 by  
Filed under Video: Health Tips for Men

I just found this health related video on YouTube … and thought you might enjoy it!

youtube.com/watch?v=e9xs6A9quB8%3Ff%3Dvideos%26app%3Dyoutube_gdata

In honor of Men’s Health Month, the MHS offers health tips for men and suggests many preventive disease screenings.

What do you think?

Has your baby been screened for hearing impairment?

October 25, 2010 by  
Filed under HEARING

Hearing impairment is something that is not easily discernible in adults, much more in babies and little children. Studies have shown that even the slightest hearing impairment can translate to behavioural and learning difficulties in children. Those who suffer from more serious hearing problems can face a lifetime of speech and language deficits, poor academic performance and social and psychological problems. This is because even though the child can hear, he or she is missing some details of what is going on the environment, but cannot understand what is going on. It is thus important that children be screened early in life for hearing problems.

Hearing impairments may be congenital or acquired. Thus, screening for hearing loss should start early, in fact, right after the delivery of the baby. This means that a baby is screened before it leaves the hospital or the maternity clinic.

The two most commonly used hearing screening procedures for babies are (source: American Speech-Language Hearing Association (ASLHA):

The initial result of the screening is “pass” or “fail”. Those who pass are considered free from hearing impairment till the next screening. Those who fail require an intensive evaluation by an expert such as an audiologist or an ear specialist. They will be closely monitored for progression of the impairment plus other auditory-related effects.

In the clinical report of the American Academy of Pediatrics (AAP) entitle “Hearing Assessment in Infants and Children: Recommendations Beyond Neonatal Screening”:

“… researchers have developed an algorithm to assist pediatricians determine the course of treatment when a hearing screening indicates hearing loss in children from infants to 18 years of age. Confirmed abnormal hearing test results require ongoing evaluation and intervention by a team of specialists including an audiologist, otolaryngologist, speech-language pathologists and teachers. At least one-third of children with hearing loss will also have a coexisting condition, so they should continue to be monitored for developmental and behavioral disorders and referred for additional evaluation when necessary.”

Lp(a) – another fat that is bad for our heart

July 1, 2010 by  
Filed under HEART AND STROKE

Another bad fat has been identified to be bad for our heart. And we should get tested for it, according to experts.

The European Atherosclerosis Society (EAS) has recent issued new guidelines regarding cardiovascular screening. The group issued a consensus statement recommending testing for elevated levels of Lp(a), which stands for lipoprotein(a). The recommendations are meant for patients with high to moderate risk of cardiovascular disease. This is in addition to the current practice of screening for total, LDL- and HDL cholesterol and triglycerides. The upper limit for Lp(a) is 50 mg/dL.

So what is this bad new fat Lp(a)?

“Lp(a) is a plasma lipoprotein consisting of a cholesterol-rich LDL particle with one molecule of apolipoprotein B-100 and a molecule of apolipoprotein A. About 20% of people are thought to have plasma Lp(a) levels over 50 mg/dL; there are no gender differences in Lp(a) concentrations, but racial differences have been observed, with whites and Asians having lower levels while black and Hispanics generally have somewhat higher levels.”

Although scientists have been aware of the dangers of Lp(a) and it being a risk factor for cardiovascular disease, it is only now that it is included in clinical screening guidelines. The EAS based their recommendations on evidence from recent clinical studies.

According to consensus panel cochair Dr John Chapman:

“We consider the level of evidence to be sufficient to warrant the identification of Lp(a) as a causal, independent cardiovascular risk. So that raises the ante on Lp(a) very considerably from its position over the past five or 10 years. [There have been] a series of publications, both epidemiological and genetic, over the past two years that have really clarified the evidence base around Lp(a) and its role as a risk factor.”

How can Lp(a) levels be controlled?

Unlike in the case of cholesterol and other lipids in the blood, Lp(a) is not greatly influenced by lifestyle factors, making it almost a non-modifiable risk factor. Aside from the recommendation to screen, the EAS also recommends the use of niacin or nicotinic acid at a daily dose of 1 to 3 g to control and lower Lp(a) levels under 50 mg/dL.

The new EAS recommendations were presented at the EAS 2010 Congress in Hamburg, Germany last month.

Obesity screening at age 6

January 26, 2010 by  
Filed under OBESITY

There is cancer screening. There is screening for diabetes. Now health experts urge for obesity screening in children starting at age 6 years. This is according to recommendations from an expert panel of the US Preventive Services Task Force (USPSTF) and published in the journal Pediatrics.

According to the panel led by chair Dr. Ned Calonge from the Colorado Department of Public Health and Environment in Denver.

“Since the 1970s, childhood and adolescent obesity has increased three- to sixfold. Approximately 12% to 18% of 2- to 19-year-old children and adolescents are obese (defined as having an age- and gender-specific BMI [body mass index] at >95th percentile)….Previously, the USPSTF found adequate evidence that BMI was an acceptable measure for identifying children and adolescents with excess weight.”

So what does this obesity screening in children entails? The USPSTF panel gives the following recommendations to primary health clinicians:

Routine measurements of weight and height during the so-called regular health maintenance visits in children aged 6 to 18 years old. With data on height and weight, body mass index (BMI) can be calculated. BMI is an indicator of excess weight or obesity.

Moderate-to-high interventions for those who need them. The USPSTF panel reviewed the current state of evidence and concluded that comprehensive, moderate- to high-intensity (but not low intensity) interventions can improve BMI in children with excess weight. Moderate- to high-intensity intervention programs as those which involve more than 25 hours of contact with the child and/or family during a 6-month period and include 3 components:

The task force does not recommend the use of pharmacologic agents to manage obesity. Currently, there are anti-obesity drugs in the market that are used in combination with behavioral interventions but these drugs come with side effects that include increased heart rate and blood pressure and gastrointestinal problems.

The American Academy of Pediatrics (AAP) agrees with the latest USPSTF recommendations although the it would prefer to start screening even earlier – at age 2 years. According to AAP spokesperson Dr. Sandra Hassink:

“Recognition that screening is the first step to individual evaluation and counseling for obesity prevention and treatment should be standard in practice now. Working with families to screen for high-risk nutrition and activity behaviors that contribute to obesity in early childhood must be part of that task. With that said, the current USPSTF report is significant because it provides evidence that obesity treatment can be effective and extend beyond the immediate intervention and that pediatricians in the context of a medical home model that supports multidisciplinary care, with the appropriate supports of training and reimbursement, can provide effective obesity prevention and treatment for the families and children in their care.”

Photo credit: stock.xchng

The mammogram debate: the two sides

November 25, 2009 by  
Filed under CANCER, Featured

Mammogram guidelines questioned

breastMammogram, the gold standard for breast cancer, is currently questioned just like what happened to prostate-specific antigen (PSA) s for prostate cancer. This was brought about by inconclusive research evidence that screening starting at 40 and beyond increases survival rates.

Last week, a heated debate started when the US Preventive Services Task Force (USPSTF) issued new federal guidelines on mammography which recommends that the starting age for mammograms to be raised to 50.

The previous US guidelines, with full backing from the American Cancer Society recommend that women should have the mammograms every 2 years starting at age 40. The recommendations applied to women with no family history of breast cancer and are therefore not considered to be high-risk. Those who have high risk profiles still need to continue regular screening tests.

The pros

The reasons for these new recommendations are quite similar in some ways to the reasons why many medical professionals (including the American Cancer Society) do not support routine prostate cancer screening with the PSA tests. Some of these reasons are:

  • Too many false positives that result in unnecessary but invasive biopsy
  • Overdiagnosis and overtreatment of a disease that is not necessarily fatal and may go away by itself.
  • Too many false alarms that lead into mental pressure, unnecessary fears and worries. Why worry 10 years earlier?
  • Mammograms present health risks, such as exposure to radiation
  • Upgrade to international standards.
  • Unnecessary healthcare costs

Indeed some of these points sound familiar in connection with the PSA test in 2008 and it was the same task force USPSTF that recommended the PSA 2008 guidelines. However, those guidelines were widely accepted, even embraced by the health community.

Regarding international standards, guidelines vary from country to country. Many developed countries, including the UK, Canada, set the age limit at age 50. I had my first mammogram 4 years ago in Germany. During my last gynecological check up here in Switzerland, I asked my doctor whether it’s time for the next one. But you are not yet 50, she told me.

Health care cost is another sore issue. Countries with universal health care system tend to cut down on screening methods that do not show conclusive benefits in order to allocate limited resources for what is necessary without compromising health care quality. Americans may dismiss this as “rationing” but it does have the upside of giving access to affordable health care to everybody.

The fact remains that there is no significant differences in breast cancer mortality between countries who start screening at 40 and those who start 10 years later.

The contras

Many health experts however, do not agree with the new guidelines

  • For one thing, women without family history of breast cancer can have the disease before the age 40. For these women, forewarned is forearmed. They’d rather take unnecessary anxiety than miss the chance of an early diagnosis and therefore early treatment.
  • Although the recommendations are not binding, there is danger that insurance companies might not cover mammogram expenses before the age of 50.

Some high profile health experts explicitly expressed their disagreement with the new guidelines.

American Cancer Society (ACS)

According to Dr. Otis W. Brawley Chief Medical Officer of ACS

The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.

Health and Human Services Secretary Kathleen Sebelius

Secretary Kathleen Sebelius in an interview advises women to “keep doing what they have been doing” with regards to breast cancer screening.

“The task force has presented some new evidence for consideration but our policies remain unchanged.Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action. ..My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you.”

Former head of the National Institute for Health Dr. Bernadine Healy

Ex-NIH director Dr. Bernadine Healy’s take is to ignore the new guidelines, which he believes, could save money but not lives.

Other resources:

Mammogram advice accurate but not ‘right’

Five Reasons to Welcome the New Mammogram Guidelines

Summer is coming: how to prevent and check for melanoma

May 6, 2009 by  
Filed under CANCER

sunflower_fieldResource Post for May

In preparation for the summer season, there are health observances in May that are focusing on awareness about skin cancer.

May is Melanoma/Skin Cancer Detection and Prevention Month and May 4 was Melanoma Monday and sponsored by the American Academy of Dermatology (AAD).

Identifying melanoma

It is estimated that 1 million cases of skin cancer is diagnosed in the US each year. About one in five Americans will develop skin cancer in their lifetime. Of all types of skin cancers, melanoma is the most deadly, commonly affecting young adults aged 25 to 29 years of age.

Melanoma is characterized by pigment-producing cells that grow and reproduce uncontrollably. It may suddenly on the skin or may develop on an existing mole. According to researchers at St. Louis University, the identifying signs of melanoma are:

Who is at risk of developing melanoma?

Current guidelin1045672_cheeky_monkey_2es recommend regular screening for skin cancer, especially those at high risk for the disease. The risk factors include

  • People older 40 years of age
  • People with a fair complexion
  • People who sunburn easily
  • People who have many moles
  • People with a personal or family history of skin cancer
  • People who spend long periods of time exposed to the sun
  • People exposed to UV radiation at recreation or the work place, e.g. use of tanning salons, sunbathing, etc.

However, just because you are of the dark-haired, dark-skinned type, and you never sunburn easily doesn’t mean you don’t have to worry about UV radiation. According to a study presented at the annual meeting of the American Association of Cancer Research (AACR), certain variants of the MC1R gene increase the melanoma risk of people who are normally of low risk profile by almost two-fold. The study was presented by researchers from the Pennsylvania University.

How do we prevent skin cancer?

Here are simple tips on skin cancer prevention.

Use sunblock. It is advisable to use sun protection, even in children. Regular use of sunblock during the first 18 years of one’s life can reduce the lifetime risk by 78%. Use sunscreens whicsuncreamh blocks UV A as well as UV B radiation. For it to be effective, a sunscreen must have a minimum sun protection factor (SPF) of 15.

Stay out of the midday sun. UV radiation is strongest at midday. Enjoy th early morning or late afternoon sun instead.

Have regular skin cancer screenings. Free skin cancer screenings are being offered by health and advocacy groups. The American Academy of Dermatology (AAD) offers free screening all over the US. You can request a notification from the AAD when there is a scheduled screening within a 50-mile radius from where you live. You can also send an eCard to family and friends to help spread awareness on skin cancer and inform about free screenings.

Do a self-check for skin cancer. By using the abovementioned signs for melanoma, you can check yourself and your family for suspicious pigmentation. The AAD also gives us instructions on how to perform a skin self-exam.

Avoid suntanning beds. Even artificial UV rays from suntanning lamps and beds can cause skin cancer.

The latest research news on skin cancer

Researchers from St. Louis Unisunbedversity report on the effectiveness of a topical cream in treating certain melanoma. The researchers used the cream imiquimod in treating lentigo maligna (LM) which the most common type of melanoma of the head and neck. LM is “a type of “melanoma-in- situ”, the earliest stage of melanoma [which] precedes the more invasive form, lentigo maligna melanoma (LMM).” Imiquimod was used in conjunction with surgery. Skin surgery removed the invasive area while the topical cream was applied in the surrounding area. The cream supposedly can supposedly limit the area of surgery as well as minimize disfigurement and the risk of recurrence.

According to lead researcher Dr. Scott Fosko, chairman of the department of dermatology at Saint Louis University School of Medicine

“As we’re seeing melanoma in younger and younger people, in their 30s and 40s, there is a longer window for the cancer to return and a greater desire to avoid disfiguring surgery…This subtype of melanoma is becoming more and more common, and can be one of the more challenging melanomas to manage”.

In lab tests, researchers at the M. D. Anderson Cancer Center demonstrated that that the yellow spice curcumin which is also found turmeric and curry powder seems to be able to block the pathway to melanoma development.

Denial can be deadly – participate in the National Alcohol Screening Day

April 9, 2009 by  
Filed under ADDICTION

alcoholApril 9th is the 9th Annual National Alcohol Screening Day (NASD). Have you even thought of taking a self-assessment for alcohol problems? Or are you in denial? You’d be surprised to know that the following may have some alcohol problems:

  • Straight A college students
  • Pregnant women
  • Successful professionals
  • Well-off retirees

And you could be one of these!

According to Dr. Ting-Kai Li, director of the National Institute on Alcohol Abuse and Alcoholism

“As many as one-third of Americans may engage in drinking practices that place them at heightened risk for the medical disorders alcohol dependence (alcoholism) and alcohol abuse.”

One fo the sponsors of NASD is the not-for-profit organization Screening for Mental Health (SMH).  SMH is offering a confidential and free screening for alcohol problems to help people find out whether a professional consultation is necessary. The screening can be done online and is designed for individuals aged 17 years old and older. It is anonymous and the privacy of the respondent is protected.

Many people think they have everything under control. “Other people have alcohol problems but not me“, is something that is heard often. However, denial can be deadly.

According to Charles G. Curie, administrator at the Substance Abuse and Mental Health Services Administration

“A truthful self-assessment about alcohol use may not be easy but denial can be devastating or even deadly. Too many Americans realize too late that alcohol misuse can lead to incredible losses: lost family and friends, lost jobs and opportunities, and lost lives. Especially during this stressful time, we urge all American adults to understand the effects of alcohol on health and learn their own risk levels. Doing so can change lives.”

Here are three scenarios that SMH describes to indicate whether you need to take the alcohol screening self-assessment or not:

Drink so much you forget what happened?

Tried to cut back but couldn’t?

Friends and family concerned about your drinking?

Alcohol screening.org is also offering another online self-assessment called “How much is too much?

Many organizations have planned screening events to today to encourage people to be honest to themselves and go for screening. Colleges and universities across America are especially concerned by the rising incidence of binge drinking among college students and are therefore offering free screening and counseling today.

Also: check out addiction books in this site.

Think about your colon (even if you don’t want to talk about it)

April 8, 2009 by  
Filed under CANCER

The colon is an organ that people would rather not talk about. It is associated with waste and dirt, thus a subject matter that is almost taboo. Yet, cancer of the colon is a real problem that people should think, if not talk about.


Problems with the colon actually occur very often throughout a person’s life. However, these problems can add up with time, so that the incidence of colon cancer can be quiet high among the elderly. That is why current guidelines recommend for regular colon cancer screening starting at age 50. But how does it all start?

According to researchers at the University of Michigan

Regular wear and tear on the colon can cause little out-pockets called diverticula in one in three adults over the age of 65. They are sometimes more common when there is persistent constipation, which causes people to strain to pass stool that is too hard. The high pressure from straining causes the weak spots in the colon to bulge out and become diverticula.

Diverticuli are normally harmless. They usually form in areas where the blood vessels go through the intestinal muscle walls, making these areas weak. Diverticuli can get plugged up with waste and become infected by bacteria, resulting in a condition called diverticulitis. The older people get, the more diverticuli are formed in the colon, and the chances of plugging up, inflammation and infection go up.

It is said that 30% of adults aged at least 65 years old have diverticuli in their colon. By age 85, the incidence increases to 65%. Complications of diverticulitis can lead to colon cancer.

Colon cancer, however, is highly preventable. According to Dr. Kim Turgeon, a gastroenterologist in Internal Medicine at the University of Michigan Health System, it is important to keep the colon healthy and this can be done by

  • Keeping the bowels moving with a high fiber diet
  • Exercising regularly
  • Drinking lots of fluids throughout the day

Previous recommendations about not eating nuts and seeds to avoid little particles plugging diverticuli are no longer valid, as recent research studies have shown. These food can in fact be beneficial as they are rich in fiber.

It is also important that adults above the age of 50 should be routine screened, for example, through colonoscopy. Even if you are healthy, and had no history of colon or bowel problems, screening is still recommended.

It can be embarrassing to talk about your colon to friends. So why not talk to your doctor about it?

April is National Cancer Control Awareness Month

April 6, 2009 by  
Filed under CANCER

linked_handsApril is the month to step up on cancer control awareness. So how can we help?

Several cancer research institutes in the US are actively campaigning during this month. And they give us some tips on how we can help.

Cancer Institute of New Jersey (CINJ)

As one of the nation’s 40 National Cancer Institute-designated Comprehensive Cancer Centres and the only one in New Jersey, The Cancer Institute of New Jersey (CINJ) delivers advanced comprehensive care to adults and children, and conducts cutting-edge cancer research. Their researchers and physicians transform discoveries into clinical practice and provide education and outreach regarding cancer prevention, detection and treatment.

CINJ is a Centre of Excellence of UMNDJ-Robert Wood Johnson Medical School. This April, the institute is highlighting its clinical trial programs and the importance of patients having access to quality information about these cancer studies right at their fingertips. It is with this objective in mind that the CINJ-operated, web-based New Jersey Cancer Trial Connect (NJCTC) website was set up. With NJCTC, patients can conduct research and match diseases and drugs with cancer clinical trials

Michigan Cancer Consortium (MCC)

Do you know that there are over 100 types of cancer? That 1 out of every 4 deaths in the US is caused by cancer? These are just a few facts and figures from the Michigan Cancer Consortium (MCC) in observance of the National Cancer Control Awareness Month. MCC “is a dedicated group of public, private, and voluntary organizations committed to reducing the human and economic impact of cancer in Michigan. MCC members are collaborating to address cancer control priorities in Michigan.” To highlight cancer control awareness and help spread the word, here are a few ideas from MCC:

  • You can get involved as an individual or as an organization.
  • Have a prerecorded phone message about cancer screening. You can use this on your private phone or in your business phone. The message, can for example run in lieu of music while the client is put oh hold.
  • Get involved in disseminating the MCC Cancer Early Detection Recommendations.
  • Include MCC Early Detection Guidelines in your newsletters, journals, or blogs.
  • Share or distribute cancer resource materials to family, friends and colleagues.

All guidelines, resources and recommendations are available from the MCC website.

 

Photo credit: stock.xchng

Experts: routine depression screening for teenagers

March 31, 2009 by  
Filed under DEPRESSION

teen-depressedIt is a problem that many parents face: clinical depression among teenagers.

As many as two million American teenagers suffer from depression and most go undiagnosed, thus untreated according to the United States Preventive Services Task Force. The task force has recently came up with guidelines recommending primary health care practitioners to routinely screen teenage patients for clinical depression. The new recommendations have been published in the April issue of the journal Pediatrics.

The guidelines apply to adolescents aged 12 to 18 years old. However, the task force found there is insufficient evidence to show the benefits of screening younger children for clinical depression

Depression in young people can lead to

  • poor health outcomes
  • difficulties in school
  • disruptions of family and social relationships
  • lowerquality of life
  • self-destructive behavior/suicide
  • depression in adulhood

It is therefore necessary that clinical depression be diagnosed as early as possible.

“Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed,” said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. “It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression.”

However, screening for clinical depression should only be done “when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care.” Treatment of clinical depression among teenagers can be through by psychotherapy or by pharmacological means using selective serotonin reuptake inhibitors (SSRIs), or combined therapy (SSRIs plus psychotherapy). However, the prescription of anitdepressants SSRIs should be done with care as this class of drugs is associated with an increased risk of suicidality.

The new guidelines go further than the previous guideline issued by the Academy of Pediatrics which recommended pediatricians to ask their young patients questions about depression.

The new recommendarions cited using “two questionnaires that focus on depression tip-offs, like mood, anxiety, appetite and substance abuse.” The screening should be done by the family doctor or pediatrician who is known to the family and the patient.

Almost 6% of Amrican teenagers aged 13 to 18 are clinically depressed. A lot of cases do not show over symptoms and are therefore easily overlooked by parents and teachers. Suicide due to clinical depression is the 3rd leading cause of death in US adolescents in the age range 15 to 24 years old.

Photo credit: stock.xchng

Screening for prostate cancer: the pros and the cons

March 23, 2009 by  
Filed under CANCER

Resource post for March

yes_no_3In almost all diseases, screening and early detection is the key to management and cure. What used to be fatal diagnoses of late stage breast and cervical cancer have now become uncommon as more and more cases are detected early by regular screening.

In men, prostate cancer is the third leading cause of cancer mortality. The Institute for Cancer Research (ICR) in the UK gives us the following statistics:

As many as 80% of men develop prostate cancer during their lifetime, but in most cases it does not cause any ill health. Around 6% of men experience symptoms of the disease, while 3% of men die of prostate cancer.

Screening for prostate cancer is done in two ways, namely:

PSA test. Prostate-specific antigen (PSA) is protein biomarker produced by prostate cells. PSA is normally present in blood in low amounts. Cancerous (malignablood-testnt) prostate cells are expected to produce more PSA than noncancerous cells, leading to elevated PSA levels in the blood. PSA testing consists mainly of testing for levels of the antigen in a blood sample. If PSA levels are found to be high, other tests, including a prostate biopsy may be deemed necessary. Currently, the American Urologic Association, the American Cancer Society, and the National Comprehensive Cancer Network recommend that all men 50 years and older should have annual PSA tests. Men with high risk profiles (e.g. of African American heritage, family history of prostate cancer) are advised to get tested starting at the age of 40.

Digital rectal examination. This examination is performed by a doctor by inserting a lubricated finger through the rectum. Through the walls of the rectum, the doctor can feel for structural abnormalities (bumps, growths, enlargement) in the prostate.

The usefulness of the PSA test in screening for prostate cancer has always been a subject of controversy. Some studies have produced inconclusive results regarding its benefits as well as its side effects. Potential risks include, unnecessary invasive testing (biopsy), and unnecessary treatment with serious side effects, and unnecessary expense. However, 95% of male urologists and 78% of male primary care clinicians admit to having had a PSA test themselves. PSA gives the potential benefits of catching cancer at its early stages, with better prognosis.

In the March issue of the New England Journal of Medicine, results of two studies on PSA screening were presented: one study conducted in the US, and one study conducted in Europe. Unfortunately, instead of resolving the controversy once and for all, the two studies actually produced contradicting results.

The American study:

Mortality Results from a Randomized Prostate-Cancer Screening Trial
This study is part of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. The study looked at 76,693 men from 1993 to 2001. doubt2About 50% of the participants had PSA screening every year for 6 years and digital rectal examination for 4 years. The other half did not undergo screening for prostate cancer. The PLCO results showed that after 7 to 10 years the incidence of prostate cancer was 116 per 10,000 person-years in the screening group and 95 in the control group. The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group. Statistically speaking, there was no difference in cancer incidence and mortality between the screened group and the unscreened group.

The European study:

Screening and Prostate-Cancer Mortality in a Randomized European Study
The European Randomized Study of Screening for Prostate Cancer (ERSPC) started in the 1990s and followed up 182,000 men aged between 50 and 74 years old for about 12 years. The study had also two groups. In one group, PSA screening way conducted on average, once a year. The other group did not undergo PSA screening. The study was conducted in 8 European countries, namely Belgium, Finland, France, Italy, Netherlands, Spain, Sweden and Switzerland The results of the study showed that

PSA-based screening reduced the rate of death from prostate cancer by 20% but was associated with a high risk of overdiagnosis

Both studies will now look into the cost effectiveness and overall quality of life of the PSA testing. Although PSA testing itself is non-invasive, the subsequent confirmatory tests such as biopsy can be invasive and present with risks.

About PSA testing

Many expertbalance2s observe that PSA testing is not specific enough and has a 30% rate of false positives – e.g. cancers are non-aggressive and are indolent or slow-growing. It is sometimes difficult to decide which really cancer needs treatment which one doesn’t. While many would opt to be on the safe side and go for early treatment, the treatment comes with side effects such as impotence and incontinence.

A more conservative form of prostate cancer monitoring is called “Active Surveillance which aims to individualise the management of early prostate cancer by selecting only those men with significant cancers for curative treatment… Patients on active surveillance are closely monitored using PSA blood tests and repeat prostate biopsies. The choice between continued observation and curative treatment is based on evidence of disease progression during this monitoring.

It seems that prostate cancer screening by PSA testing have its pros and cons. In the end, it is always a question whether the benefits outweigh the costs.

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March is Colorectal Cancer Awareness Month

March 16, 2009 by  
Filed under CANCER

March is the month to step up on awareness of colorectal cancer, the third leading cause of cancer mortality in the US, according to the American Gastroenterological Association (AGA). Approximately 149,000 new cases of colorectal cancer have been predicted for 2008. Abointestineut 50,000 Americans die this disease every year

The good news is that colorectal cancer is preventable and treatable when detected at an early stage. And early detection is possible through screening.

The bad news is that, “even in the best economic environment, only half of the people who need colorectal cancer screening receive the life-saving test.” The low screening rate maybe due to a lot of causes. Screening is mainly done by colonoscopy, which involves gently inserting an intrument called colonoscope into the rectum and large intestine. The instrument enables the doctor examine the walls of the lower gastrointestinal tract. Unfortunately, many people find this screening method embarrassing and invasive. With the economic recession, it is expected that even more people will forego screening for colorectal cancer due to loss of health insurance and financial difficulties. In addition, there seem to be cultural and ethnic barriers that are also related to health insurance coverage. According to AGA, African Americans and Hispanics are less likely to be screened and are therefore more likely to die from colorectal cancer than other ethnic groups.

A study by the Lewin Group made public early this year predicts that there will be a shortage of actively practicing gastroenterologists in the US in the next ten years. This shortage will further lead to low screening rates.

Hopefully, legislation will help solve the issue. Texas Rep. Kay Granger reintroduced the Colorectal Cancer Early Detection, Prevention and Treatment Act in the US Congress in February, a bill whose aim is

to amend the Public Health Service Act to establish a national screening program at the Centers for Disease Control and Prevention and to amend title XIX of the Social Security Act to provide States the option to provide medical assistance for men and women screened and found to have colorectal cancer or colorectal polyps.”

The bill can hopefully establish a life-saving program similar to the Breast and Cervical Cancer Screening Program. Screening for colorectal cancer is recommended for people between 50 and 64 years old but also those younger than 50 but have high risks profiles. The bill will also facilitate screening, follow-up, and treatment of those who do not have insurance coverage.

Risk factors for colorectal cancer (source: American Cancer Society) are:

  • Age older than 50 years old
  • Previous history of polyps and inflammatory bowel disease
  • Family history of colorectal cancer
  • Other hereditary diseases (Peutz-Jeghers syndrome, familial adenomatous polyposis, and Lynch syndrome).
  • Racial and ethnic background
  • Lifestyle-related factors including smoking, diet, lack of exercise, obesity, heavy alcohol consumption, and type 2 diabetes.

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Expert recommendations:heart patients should be screened for depression

February 15, 2009 by  
Filed under DEPRESSION

Background

Time and time again, studies have shown that many patients become depressed after suffering from major cardiac events. This occurs even after successful surgery and interventions. The reasons for this depression are many and may differ depending on the age of the patients (see previous post).

With this knowledge in mind, the American Heart Association (AHA) issued a new science advisory endorsed by the American Psychiatric Association which recommends that primary health care physicians should routinely screen their cardiac patients for signs of clinical depression. This would include referring suspected cases to mental health specialists for assessment, monitoring, and therapy.

Depression in heart patients

According to Dr Viola Vaccarino

Despite a long-standing popular belief that stress and emotions affect the cardiovascular system, it was not until the mid-1980s that the first studies linking depression to higher mortality after a myocardial infarction (MI) began to appear in the medical literature. Since then, scientific interest in the link between depression and heart disease has grown steadily over time, with an increasing number of research studies addressing depression as a prognostic factor in cardiac patients. There is now a sufficient consensus that depression is a risk factor for coronary heart disease (CHD), as well as an important prognostic factor in cardiac patients. It is also recognized that depression is a growing global problem. By 2030, depression is projected to be the second leading cause of disability worldwide (after HIV/AIDS) and the number one cause of disability in high-income countries.

Screening methods

The recommended assessment for depression in cardiac patients is fast and easy. The patients only have to initially answer 2 questions. Longers questionnaires may be needed when further assessment is deemed necessary.

Experts believe that the recommended questionnaires

are validated tools and an efficient, evidence-based way of finding possible cases and referring them on for further assessment and treatment.”

However, a big problem would be how the patients would accept the recommendations for screening and the diagnosis of depression. People with heart disease would not necessarily be happy (and they are already unhappy) when they hear they have another clinical problem to face.

Treatments

The AHA advisory recommends pharmacological treatment of depression. As first line of treatment, the selective serotonin reuptake inhibitors (SSRIs) sertraline and citalopram are recommended. Furthermore, AHA cautions that some antidepressant drugs may have some cardiotoxic effects that can worsen existing cardiovascular conditions.

For those who cannot tolerate antidepressant medications or prefer nonpharmacological treatments, cognitive behavior therapy is recommended. A combination of both psychotherapy and medications may also work for some patients. The important thing is to find the right therapeutic approach for patients.

Is skin cancer on the rise?

January 22, 2009 by  
Filed under CANCER

The incidence of skin cancer is increasing. And this increase is not only due to better screening and diagnostic techniques. The threat is real and not just an artefact of better technology, according to researchers at the Stanford University Medical Center in California.

This rise of skin cancer incidence has been reported both in the US and Europe. In the US, the increase is on average, 3.1% each year, from 1992 to 2004.

The Stanford researchers argue that improved screening methods will detect more skin tumors which are thinner and most likely to be benign, the kind that were easily missed before the new methods were introduced. However,

“after assessing 70,596 previously documented cases of cancer diagnosed between 1992 and 2004 in the United States, they found that there were significantly more cases of tumours of all thicknesses”.

Another indication of skin cancer increase is the fact that the rise is evident in all socioeconomic groups, not only among those who belong to higher income groups in the US and therefore have better access to health care and insurance coverage.

The findings of the two studies indicate that skin cancer is indeed on the rise.

Skin cancer incidence reports are quite controversial, because the disease is closely associated to exposure to the sun. In recent years, there is a rapid increase in vitamin D deficiency the world over because people tend to avoid sun exposure for fear of skin cancer. However, vitamin D deficiency has been linked to a variety to chronic conditions, including cardiovascular problems, osteoporosis, neurodegenerative disorders, as well as pregnancy complications.

According to lead researcher Eleni Linos

Over the past 100 years, people are really changing the amount of time they spend in the sun, the clothes they wear, and whether their hobbies and work are indoor or outdoor.” This has been confounded by the thinning of the ozone layer which led to “increased exposure to ultraviolet light or a longer-term increase in the genetic susceptibility to cancer.”

According to the Medline Medical Encyclopedia,

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

  • skin cancer commonly occurs in people who
  • have light-colored skin, hair and eyes
  • are older than 50 years old
  • family history of skin cancer
  • spend a lot of time outdoors in the sun.

Photo credit: stock. xchng

First baby preselected as “breast cancer gene-free” born in the UK

January 13, 2009 by  
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Resource post for January

It is not surprising that it happened in the UK first. After all, this is the country where the first in vitro fertilization baby was born 30 years ago. It is the country where last year, development of human-animal embryo hybrids for research was legalized as well as the conception of savior siblings.

Thus, it is no surprise that the first supposedly “breast cancer-free” baby way born in the UK a couple of days ago and took over the headlines and raised some ethical questions.

Prenatal and preimplantation diagnostics

Prenatal diagnostics is not new. Fetuses are screened for chromosomal aberrations such as Down Syndrome early in the gestation period by amniocentesis and chorionic villus sampling (CVS). Preimplantation genetic diagnosis (PGD) or preimplantation genetic screening (PGS) goes even further and tests for genetic aberrations that cause life-threatening disorders such cystic fibrosis, sickle-cell anemia, and Huntington’s disease before implantation of the embryo. Testing for the breast cancer susceptibility genes was approved by the UK’s Human Fertilisation and Embryology Authority in 2006.

The breast cancer susceptibility genes

The so-called breast cancer-free baby was conceived through in vitro fertilization. Several eggs from the mother were fertilized with the father’s sperm in the lab. The resulting embryos were then screened for mutations in the genes BRCA1 and BRCA2 which make them susceptible to breast cancer. Two of the embryos were declared free from these mutations and were implanted in the mother’s uterus. A healthy baby girl was born on a few days ago.

The parents deemed the genetic preselection of the embryos necessary because all of the father’s close female relatives had breast cancer, making him a most likely carrier of the breast cancer genes. Women with either faulty BRCA1 or BRCA2 are seven times more likely to develop breast cancer during her lifetime compared to those who do not have them. By making sure that their baby is free from these genes, the parents hoped to break the genetic chain that passes on the faulty genes to the next generation.

Dubbing the baby, however, as “breast cancer-free” as many newspapers have done is kind of premature, a misnomer in fact. The BRCA1 and BRCA2 mutations accounts only for about 5 to10% of cases of breast cancers. There is still a lot to know about the remaining 90 to 95% of cases, which may be caused by environmental factors as well as other yet unidentified genes. Thus, the baby is currently “breast cancer gene-free” or more accurately “BRCA1 and BRCA2-mutation-free.”

The ethical questions

However, regardless of how she is called, the baby will learn one day that the circumstances of her conception and birth triggered ethical debates the world over.

Some criticized the doctors and parents for “playing God” by using PGD.

Some claim this is the start of the “Gattaca era” recalling the 1997 science fiction movie of that title about a world populated by “genetically designed” individuals.

There are others, however, who sympathize with the parents, and feel they would do the same if they had the chance of “freeing” their offsprings from potentially deadly diseases. In the end, this type of prenatal selection is more justified than sexual preselection in favor of male embryos, which is commonly (though not openly) practiced.

Another ethical concern, an issue that is not unique to PGD alone but is true to the whole field of IVF and assisted reproduction techniques is the fate of the rejected embryos. The number of left over embryos from IVF procedures that are currently stored in deep freeze is quite high – 500,000 embryos in the US alone. And the question of their fate is something that that parents, doctors, and lawmakers cannot agree upon. A survey by Duke University researchers presented IVF parents the following options:

  • indefinite freezing
  • donation for research
  • reproductive donation
  • thawing and discarding

The most popular options were the first 2 whereas the last 2 were not acceptable. However, indefinite freezing is not a real solution and donation for research is not legal in many countries.

In the US, several states are considering legislation would recognize an embryo as a person. Thus, “abandoned” embryos may become wards of the stat and can even be put up for adoption.

The future of PGD

Doctors handling the case emphasize that PGD is not the answer to every genetic disorder problem nor is it a cure for cancer. PGD is also not suitable for all cases and all couples. Besides, the use of PGD in the UK is still highly regulated and is evaluated on a case to case basis. However, the case has definitely set a precedent that many would try to follow suit. Louise Brown, the first IVF baby was born a little over 30 years ago in the UK. Since then, millions of babies have been conceived through IVF. We would therefore expect that PGD in connection with breast cancer and other cancers with identified susceptibility genes will soon be a standard procedure in fertility clinics. Whether the ethical issues can be resolve soon is another matter.

So tell us, what is your take on PGD?

Photo credit: stock. xchng

Prostate cancer screening and marital status

December 30, 2008 by  
Filed under CANCER

As in most diseases, early detection of prostate cancer can greatly improve the chances of treatment and survival. According to the Mayo Clinic, about 40% of prostate cancer cases are not detected until they have spread beyond the prostate gland. A lot of cases are asymptomatic in its early stages so that screening by a medical professional is sometimes the only way to diagnose the disease. However, some men are wont to avoid the issue. That is why it is important to understand psychosocial factors that influence men from having or not having prostate cancer screening.

Screening for prostate cancer can be done in many ways but the two most commonly recommended diagnostic tests are:

  • The prostate-specific antigen (PSA) test, which looks at the levels of the biomarker PSA in the blood. High PSA levels can indicate inflammation or enlargement or cancer of the prostate
  • The digital rectal examination (DRE) is done by a medical professional by manual examination of the rectum. About 70% of prostate tumors develop on the outer part of the gland, which can then be felt by a finger inserted in the rectum.

Dr. Lauren Wallner of University of Michigan, Ann Arbor and her colleagues investigated the factors that influenced men to get tested for this deadly disease. Medical data of 2447 men from the Olmsted County Study on Urinary Symptoms and Health Status were collected and used for this specific study. These men were randomly selected in 1990 and information on family history of prostate cancer, prostate cancer concerns, marital status and medical and laboratory records was analyzed.

The patients who were included in the study have an age median of 51.9 years, 85% of which were married or living with someone. Approximately 9% of them have history of prostate cancer in the family while about 10% have shown concern or worry about the disease.

Statistical analysis showed that men with prostate cancer history in the family do have prostate cancer screening more frequently that those without history. Men who also showed more concern or worry more about the disease are more likely to have frequent screening that those who don’t. Married men or those with live-in partners are also found to have frequent prostate cancer screening compared to their single, unattached counterparts.

“Among men with a family history of prostate cancer, those who were married or living with someone were more likely to get screened compared with men who were not, suggesting a role for marital status in influencing screening behaviour,” the researchers concludes.

Could it be that emotional attachments make men more conscious of their health?

Olympics Special: Athletes screening using ECG

August 11, 2008 by  
Filed under HEART AND STROKE

The Summer Olympic Games in Beijing have just started. What better way to start this week than talk about athletes’ heart rates?

There are certain tests that professional athletes have to go through before they can complete. I am not only referring to those tests that detect the use of performance enhancing drugs. Athletes also have to go through tests to determine their health status. A major determining test in the preparticipation screening of athletes is the electrocardiogram or ECG which reads the heart’s electrical activity and look at the heart rate patterns. ECG measurements are usually done while at rest. Athletes who have abnormalities in their ECG are disqualified – for their own safety. Many cardiac events happen during sports competition.

Most professional sports and health bodies, including the International Olympic Committee and the European Society of Cardiology endorse the use of ECG in the preparticipation screening of athletes. However, the American Heart Association (AHA) finds that ECG screening has certain limitations including low sensitivity and high rate of false positive results. In addition, recent studies (see this previous post) have shown there are racial differences in ECG patterns of athletes that might complicate interpretation of the results.

Instead, AHA recommends a 12-step screening program that can help detect potential health problems. The screening program requires completion of a questionnaire covering the following:

Personal history

Family history

Physical examination

A recent study by Italian researchers indicate that exercise ECG, e.g. ECG measurements done during active exercise should be used because they tend to be more sensitive in detecting cardiac abnormalities than ECG measurement at rest. Looking at over 30,000 athletes, they observed discrepancies between the results of resting ECG and exercise or stress ECG. 1,812 or 6% of the participants showed resting ECG abnormalities, some of which turned out to be “innocent” changes. Only 1,459 (4.9%) of the participants showed abnormalities for exercise ECG. However, exercise ECG detected cardiac anomalies in 1,227 participants not detected by resting ECG. Furthermore, they only observed that these anomalies are more common in athletes older than 30 years old.

In the next days, this blog will feature more health news around the theme of competitive sports and athletics.

Photo credit: morguefile

 

New Prostate Cancer Screening Recommendations

August 6, 2008 by  
Filed under CANCER

Yesterday the U.S. Preventative Services Task Force (USPSTF) released its recommendations regarding prostate cancer screening.

Summary of Recommendations:

  • USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.
  • The USPSTF recommends against screening for prostate cancer in men age 75 years or older.

    What is the USPSTF?

    “The U.S. Preventive Services Task Force (USPSTF) , first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.”

    More on Prostate Cancer:

    Prostate cancer is the most common cancer in men after lung cancer, affecting one in six men in the U.S.

    Prostate cancer rarely affects men under the age of 40. Diagnosis is usually over made after 50 and in fact two-thirds of all cases are diagnosed in men over 65.

    60 to 61% of the time it is diagnosed in an African American male.

    A male is twice as likely to be diagnosed with prostate cancer if he has/had a father or brother with the disease. There is also an inherited gene for prostate cancer, affecting 5 to 10 % of all diagnosed cases. While research into genetic testing is promising, it is not yet available.

    Current American Cancer Society Guidelines recommendations for screening:

    Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy.

    Screening will begin with:

    • Digital Rectal Exam-part of a regular yearly physical to exam the gland for changes.
    • PSA-Prostate Specific Antigen blood test-higher than normal levels may indicate a problem.

    And may proceed to the following if your DRE and PSA indicate the need.

    • Ultrasound-A small probe inserted into the rectum will take pictures of the gland using sound waves.
    • Biopsy-Tissue samples examined by a pathologist to determine the staging of a cancer diagnosis.

    Prevention:

    The Mayo Clinic recommends a diet low in fat and rich in lycopene and regular exercise.

    Treatment:

    Treatment may include surgery, radiation, chemotherapy and hormone therapy.

    The Prostate Calculator offers disease forecasts based on real patients and artificial intelligence

    More articles on the screening recommendations of the U.S. Preventative Services Task Force (USPSTF):

    The Wall Street Journal: Prostate Cancer Screening: Making Decisions Without Evidence

    Forbes . Com: Do You Need a Prostate Cancer Screening?

    The Big FIVE-O

    March 24, 2008 by  
    Filed under CANCER

    Time to start screening for colon/colorectal cancer. NOW!

    colon.jpg

    The Facts:

    March is National Colon/Colorectal Awareness Month.

    The lifetime risk for being diagnosed with colorectal cancer is 1 in 19.

    90% of all colon cancer diagnoses are in people age 50 or older.

    It is the third leading cancer diagnosis in men and the fourth in women.

    The disease strikes about 150, 000 people and causes approximately 50,000 deaths per year.

    African-American’s are the highest racial or ethnic group at risk in the U.S.

    The disease usually starts with a polyp.

    The 5 year survival rate for those diagnosed early is 90%

    Only 39% of those diagnosed are diagnosed early.

    Read more

    Who is Prostate Cancer?

    March 18, 2008 by  
    Filed under CANCER

    He can be any man.

    Prostate cancer is the most common cancer in men after lung cancer, affecting one in six men in the U.S.

    He is rarely under the age of 40, usually over 50 and in fact two-thirds of all cases are diagnosed in men over 65.

    60 to 61% of the time he is an African American male.

    He is twice as likely to be diagnosed with prostate cancer if he has/had a father or brother with the disease. There is also an inherited gene for prostate cancer, affecting 5 to 10 % of all diagnosed cases. While research into genetic testing is promising, it is not yet available.

    For more information on who is prostate cancer see the Prostate Cancer Foundation site.

    The Prostate Cancer Research Foundation of Canada offers a risk assessment quiz on their website.

    Read more

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    NOTE: The contents in this blog are for informational purposes only, and should not be construed as medical advice, diagnosis, treatment or a substitute for professional care. Always seek the advice of your physician or other qualified health professional before making changes to any existing treatment or program. Some of the information presented in this blog may already be out of date.