Tag Archives: American Cancer Society

Straight, No Chaser: Recommendations for Early Detection of Prostate Cancer

prostate-to-do-2

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the latest (2016) recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?


prostate screening risks benefits

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 3 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

prostate exam

There are two tests commonly used to screen for prostate cancer.

  • A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
  • The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

prostate cancer screening guidelines

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

  • If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
  • If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2018 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Prostate Cancer Screening

prostate-to-do-2

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?


prostate screening risks benefits

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

prostate exam

There are two tests commonly used to screen for prostate cancer.

  • A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
  • The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

prostate cancer screening guidelines

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

  • If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
  • If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress
 

Straight, No Chaser: Ovarian Cancer

 ovarian-cancer

You are likely aware that the ovaries produce a women’s eggs as well as being the main source of the female’s sex hormones. Ovarian cancer is not the most common gynecological cancer. In fact, it only causes approximately 3% of cancers in women. However, it’s an important one to know because it causes more deaths than any other cancer of the female reproductive system. It is impossible to do justice to ovarian cancer in one blog, so this Straight, No Chaser will feature frequently asked questions on the topic.
How serious is ovarian cancer?

Ovarian Cancer_1in71women

Very. According to the American Cancer Society (ACS), in 2014 the following is expected:

  • Approximately 21,980 new cases of ovarian cancer
  • Approximately 14,270 deaths from ovarian cancer

The lifetime risk of dying from invasive ovarian cancer is about 1 in 100.
Who is relatively more likely to obtain ovarian cancer?

  • Ovarian cancer is more common in whites than African-Americans.
  • Approximately half of those diagnosed are 63 years or older.

What increases the risk of developing ovarian cancer?

ovarian-cancer-risk factors

Factors linked to an increase in ovarian cancer risk include the following:

  • Increasing age, particularly after menopause
  • Obesity
  • Breast cancer (those with or have had breast cancer also have a higher risk of ovarian cancer)
  • Family history of ovarian cancer
  • Family history of breast or colorectal cancer

Do any actions reduce the risk of developing ovarian cancer?
This needs to be discussed with your physician, as your individual circumstance has a lot to do with actions you can take to lower your risk. That said, general factors linked to a lower risk of ovarian cancer include the following:

  • Consuming a low-fat diet
  • Having been pregnant
  • Having had a hysterectomy (i.e. uterine removal) without removing the ovaries
  • Having had a tubal ligation (i.e. having had your “tubes tied”)
  • Having engaged in breastfeeding
  • Use of birth control pills
  • Use of the contraceptive injection depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®)

ovarian cancer anatomy

Can ovarian cancer be found early? Are there screening tests?
Only about 1 in 5 ovarian cancers are found at an early stage. Those that do find it early have an improved chance of successful treatment. About 9 out of 10 women treated for early ovarian cancer will live longer than 5 years after the cancer is found. The best way to find ovarian cancer is to have regular women’s health exams and to see the doctor if you have symptoms.
So far, no screening tests have been shown to lower the risk of dying from ovarian cancer, therefore no tests are recommended.
What are the signs and symptoms of ovarian cancer?

ovarian cancer BEAT

Two of the issues in detecting ovarian cancer are symptoms often aren’t present early in the cancer process, and even when symptoms occur, they are easily confused with symptoms more often caused by other things. It’s reasonable to suggest to you that routine evaluation for problems in your gynecological system, particularly those that make you feel different than normal and/or are persistent should prompt an evaluation by a physician.
The most common symptoms are:

  • Abdominal or pelvic pain
  • Abdominal swelling or bloating
  • Difficulty eating and/or a quick sensation of feeling full while eating
  • Frequent and/or urgent urination

Other symptoms can include:

  • Abdominal swelling that is accompanied by weight loss
  • Back pain
  • Constipation
  • Fatigue
  • Menstrual changes
  • Painful sexual intercourse
  • Upset stomach

If you have any of these problems, talk to your doctor so that the cause can be found.
Diagnosis, treatment, staging and recovery considerations are discussed at www.sterlingmedicaladvice.com.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Prostate Cancer Screening

prostate-to-do-2

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?


prostate screening risks benefits

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

prostate exam

There are two tests commonly used to screen for prostate cancer.

  • A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
  • The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

prostate cancer screening guidelines

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

  • If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
  • If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Ovarian Cancer

 ovarian-cancer

You are likely aware that the ovaries produce a women’s eggs as well as being the main source of the female’s sex hormones. Ovarian cancer is not the most common gynecological cancer. In fact, it only causes approximately 3% of cancers in women. However, it’s an important one to know because it causes more deaths than any other cancer of the female reproductive system. It is impossible to do justice to ovarian cancer in one blog, so this Straight, No Chaser will feature frequently asked questions on the topic.
How serious is ovarian cancer?

Ovarian Cancer_1in71women

Very. According to the American Cancer Society (ACS), in 2014 the following is expected:

  • Approximately 21,980 new cases of ovarian cancer
  • Approximately 14,270 deaths from ovarian cancer

The lifetime risk of dying from invasive ovarian cancer is about 1 in 100.
Who is relatively more likely to obtain ovarian cancer?

  • Ovarian cancer is more common in whites than African-Americans.
  • Approximately half of those diagnosed are 63 years or older.

What increases the risk of developing ovarian cancer?

ovarian-cancer-risk factors

Factors linked to an increase in ovarian cancer risk include the following:

  • Increasing age, particularly after menopause
  • Obesity
  • Breast cancer (those with or have had breast cancer also have a higher risk of ovarian cancer)
  • Family history of ovarian cancer
  • Family history of breast or colorectal cancer

Do any actions reduce the risk of developing ovarian cancer?
This needs to be discussed with your physician, as your individual circumstance has a lot to do with actions you can take to lower your risk. That said, general factors linked to a lower risk of ovarian cancer include the following:

  • Consuming a low-fat diet
  • Having been pregnant
  • Having had a hysterectomy (i.e. uterine removal) without removing the ovaries
  • Having had a tubal ligation (i.e. having had your “tubes tied”)
  • Having engaged in breastfeeding
  • Use of birth control pills
  • Use of the contraceptive injection depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®)

ovarian cancer anatomy

Can ovarian cancer be found early? Are there screening tests?
Only about 1 in 5 ovarian cancers are found at an early stage. Those that do find it early have an improved chance of successful treatment. About 9 out of 10 women treated for early ovarian cancer will live longer than 5 years after the cancer is found. The best way to find ovarian cancer is to have regular women’s health exams and to see the doctor if you have symptoms.
So far, no screening tests have been shown to lower the risk of dying from ovarian cancer, therefore no tests are recommended.
What are the signs and symptoms of ovarian cancer?

ovarian cancer BEAT

Two of the issues in detecting ovarian cancer are symptoms often aren’t present early in the cancer process, and even when symptoms occur, they are easily confused with symptoms more often caused by other things. It’s reasonable to suggest to you that routine evaluation for problems in your gynecological system, particularly those that make you feel different than normal and/or are persistent should prompt an evaluation by a physician.
The most common symptoms are:

  • Abdominal or pelvic pain
  • Abdominal swelling or bloating
  • Difficulty eating and/or a quick sensation of feeling full while eating
  • Frequent and/or urgent urination

Other symptoms can include:

  • Abdominal swelling that is accompanied by weight loss
  • Back pain
  • Constipation
  • Fatigue
  • Menstrual changes
  • Painful sexual intercourse
  • Upset stomach

If you have any of these problems, talk to your doctor so that the cause can be found.
Diagnosis, treatment, staging and recovery considerations are discussed at www.sterlingmedicaladvice.com.
Feel free to ask any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Prostate Cancer Screening

prostate-to-do-2

Every so often, controversies regarding medical treatment recommendations get in the news and seemingly only serve to confuse the public. Every blog, article or research paper is a single entity that may or may not adjust the body and weight of evidence on a given topic. Even most well-done research articles do not completely change the standard of care for medical practice. Prostate cancer screening is a great example. At the end of it all, controversies aren’t as important as the consensus recommendations that emerge from medical and public health professionals tasked with reviewing such information.
In this Straight, No Chaser, we will review the 2015 recommendations from the American Cancer Society (ACS) for early detection of prostate cancer. Remember, when you hear dissenting views, consider the source and balance that against the formal recommendations of ACS.
In an earlier Straight, No Chaser, several questions regarding prostate cancer were addressed. However, there is one additional question that is important to review.
Does Everyone With Prostate Cancer Get Treated?


prostate screening risks benefits

This is the source of controversies regarding screening of prostate cancer. Most men diagnosed with prostate cancer do not die from the disease. I mentioned previously that 30,000 men with prostate cancer die of the disease every year. However, over 2.5 million men in the U.S. are currently living with a diagnosis of prostate cancer. Based on these statistics, the question then becomes…

Why Do All Men Need to Be Screened For Prostate Cancer?
A certain stream of logic asks why screening is necessary if most of those who are diagnosed don’t die. Many treatments (e.g. surgery, medications, radiation) have additional risks that could be avoided if interventions were avoided. Similarly, some have taken to asking if any screening program is necessary. The view here is information is empowering. It’s always better to have information regarding the state of your health. Working with your medical team and family, the correct decisions about next steps can be made. This option is only available if you know what’s happening with your health.
How Does Screening Occur?

prostate exam

There are two tests commonly used to screen for prostate cancer.

  • A digital rectal exam (DRE) is when a doctor inserts a gloved, lubricated finger into the rectum and estimates the size of the prostate and assesses it for lumps or other abnormalities.
  • The prostate specific antigen (PSA) test measures the level of PSA in the blood. PSA is a substance made by the prostate, and PSA blood levels can be higher in men who have prostate cancer. Unfortunately the PSA level isn’t specific for prostate cancer, as it can be elevated in other conditions that affect the prostate such as age, race, certain medications or medical procedures, prostate enlargement or infection.

So What Are The Current Recommendations for screening?

prostate cancer screening guidelines

The American Cancer Society (ACS) recommends that men get to decide if they want to be screened, based on a recommendation from their physician and having received information about the risks, benefits and uncertainties surrounding screening. In other words, we don’t even talk about screening anymore; now it’s “Who should have a conversation with their physician about getting screened?”

  • If you’re age 50 and have an average risk of prostate cancer and are expected to live at least 10 more years. Because prostate cancer grows slowly, if your life expectancy is less than 10 years, you wouldn’t benefit from screening or treatment for prostate cancer.
  • If you’re age 45 for men and are at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • If you’re age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Among these groups, when the decision is made to screen, those men will be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Assuming no prostate cancer is found as a result of screening, the need for future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences. Please at least have the conversation with your physician.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, AmazonBarnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright, Sterling Initiatives, LLC. 2013-2015

Straight, No Chaser: Ovarian Cancer

 ovarian-cancer

You are likely aware that the ovaries produce a women’s eggs as well as being the main source of the female’s sex hormones. Ovarian cancer is not the most common gynecological cancer. In fact, it only causes approximately 3% of cancers in women. However, it’s an important one to know because it causes more deaths than any other cancer of the female reproductive system. It is impossible to do justice to ovarian cancer in one blog, so this Straight, No Chaser will feature frequently asked questions on the topic.
How serious is ovarian cancer?

Ovarian Cancer_1in71women

Very. According to the American Cancer Society (ACS), in 2014 the following is expected:

  • Approximately 21,980 new cases of ovarian cancer
  • Approximately 14,270 deaths from ovarian cancer

The lifetime risk of dying from invasive ovarian cancer is about 1 in 100.
Who is relatively more likely to obtain ovarian cancer?

  • Ovarian cancer is more common in whites than African-Americans.
  • Approximately half of those diagnosed are 63 years or older.

What increases the risk of developing ovarian cancer?

ovarian-cancer-risk factors

Factors linked to an increase in ovarian cancer risk include the following:

  • Increasing age, particularly after menopause
  • Obesity
  • Breast cancer (those with or have had breast cancer also have a higher risk of ovarian cancer)
  • Family history of ovarian cancer
  • Family history of breast or colorectal cancer

Do any actions reduce the risk of developing ovarian cancer?
This needs to be discussed with your physician, as your individual circumstance has a lot to do with actions you can take to lower your risk. That said, general factors linked to a lower risk of ovarian cancer include the following:

  • Consuming a low-fat diet
  • Having been pregnant
  • Having had a hysterectomy (i.e. uterine removal) without removing the ovaries
  • Having had a tubal ligation (i.e. having had your “tubes tied”)
  • Having engaged in breastfeeding
  • Use of birth control pills
  • Use of the contraceptive injection depot medroxyprogesterone acetate (DMPA or Depo-Provera CI®)

ovarian cancer anatomy

Can ovarian cancer be found early? Are there screening tests?
Only about 1 in 5 ovarian cancers are found at an early stage. Those that do find it early have an improved chance of successful treatment. About 9 out of 10 women treated for early ovarian cancer will live longer than 5 years after the cancer is found. The best way to find ovarian cancer is to have regular women’s health exams and to see the doctor if you have symptoms.
So far, no screening tests have been shown to lower the risk of dying from ovarian cancer, therefore no tests are recommended.
What are the signs and symptoms of ovarian cancer?

ovarian cancer BEAT

Two of the issues in detecting ovarian cancer are symptoms often aren’t present early in the cancer process, and even when symptoms occur, they are easily confused with symptoms more often caused by other things. It’s reasonable to suggest to you that routine evaluation for problems in your gynecological system, particularly those that make you feel different than normal and/or are persistent should prompt an evaluation by a physician.
The most common symptoms are:

  • Abdominal or pelvic pain
  • Abdominal swelling or bloating
  • Difficulty eating and/or a quick sensation of feeling full while eating
  • Frequent and/or urgent urination

Other symptoms can include:

  • Abdominal swelling that is accompanied by weight loss
  • Back pain
  • Constipation
  • Fatigue
  • Menstrual changes
  • Painful sexual intercourse
  • Upset stomach

If you have any of these problems, talk to your doctor so that the cause can be found.
Diagnosis, treatment, staging and recovery considerations are discussed at www.sterlingmedicaladvice.com.
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Straight No Chaser: Warning Signs of Cancer – Take CAUTION

fight-cancer

Cancer. The Big C. The medical ‘death sentence’. No diagnosis scares as much as cancer, which is why it is so important that you be as empowered as possible. Be reminded that if you fall into certain risk categories, please get screened. Because many cancers are asymptotic during early stages, screening and early detection gives one the best possible chance for a good outcome.
In the event that symptoms are present, it’s helpful for you to know what typical symptoms are. Courtesy of the American Cancer Society, here is a mnemonic that teaches signs and symptoms to alert you to the possibility of cancer. Think ‘CAUTION’.

  • Change in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge
  • Thickening or lump in the breast, testicles, or elsewhere
  • Indigestion or difficulty swallowing
  • Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore
  • Nagging cough or hoarseness

Additional symptoms that may be suggestive include unexplained weight loss, persistent headaches, nausea, vomiting, fatigue or pain, repeated infections and fever. Given that these non-specific symptoms could be due to many other things, as a cancer consideration, typical recommendations are to get these types of symptoms evaluated if they’ve been present for more than two weeks.
Just remember, cancer is something you want to detect, not ignore. If you wait until it’s too late, then, well it’ll be too late.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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From the Health Library of SterlingMedicalAdvice.com: "What’s a PSA test, and why is it important?"

GU

Prostate-specific antigen (PSA) is a protein that is secreted from the prostate gland. It is important marker of disease. The higher the PSA level, the more likely it is that prostate cancer is present (this is not the same as saying that if your PSA level is high, you have or will have prostate cancer). It is useful and important as a screening tool and a monitor for prostate cancer recurrence after treatment or response to treatment.
According to the American Cancer Society, the following groups of men should consider having a PSA test.

  • Those at age 50 if they are at average risk of prostate cancer
  • Those at age 45 if they are at high risk
  • Those at age 40 if they are at very high risk (those with first-degree relatives who had prostate cancer at an early age)

Please discuss the value of prostate cancer screening with your physician. There is a fair amount of controversy about the test, which is why having the test done is a ‘consideration’ instead of a must. The specifics of this can be discussed with your physician or personal healthcare consultant at SterlingMedicalAdvice.com.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer

stage-2-breast-cancer

So, after all we’ve discussed this week, this is what it comes down to: the one in eight lifetime risk has landed at your doorstep. What happens next is very important. The ability to recognize and obtain early treatment for breast cancer (or not) will determine the length and quality of the rest of your life. Remember, most women survive breast cancer; there are approximately 3 million breast cancer survivors in the U.S. That said, also remember that there are about 40,000 annual deaths from breast cancer. The combination of breast self-exams and widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Unfortunately, many others go undetected because of the limitations or failure to engage those two modalities.
I really want you to become familiar with your bodies (in this instance, your breasts). The most common symptom of breast cancer is a new lump, but you should be in tune with any new change or irregularity, including pain, swelling, redness, irritation, nipple inversion or other irregularity. Remember, breast tissue extends into the armpit (axilla), and you may find swollen and tender lymph nodes in the axilla or near the collarbone (clavicle). My bottom line: you be responsible for diligently assessing any abnormalities, and your healthcare team will determine the cause and if it’s cancer.
One more pitch for early detection: if breast cancer is detected prior to spread to the lymph nodes, the 5-year survival rate (with appropriate treatment) is as high as 98%. If it’s reached the lymph nodes, that drops to approximately 84%, and if it has spread to other body parts (e.g. the lungs, liver and bone – this is called metastatic cancer or carcinoma), the average 5-year survival rate drops to 23%.
This represents a drop in mortality rates by about 25% since 1990. Unfortunately, survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself. That said, recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences and 50% of new cancers in the opposite breast occur after 5 years.
Many of you have asked about tumor ‘predictors’. I’ll end this post with a look at three considerations, although there are many others:
1. Breast cancer cells may contain binding sites for hormones (estrogen and progesterone). When that’s the case, these cells are called hormone receptor-positive; if not, they’re called hormone receptor negative. When cancer cells are hormone receptor positive, they are responsive to certain medications (such as tamoxifen and others). This improves prognosis. These types of cells also happen to grow more slowly, which also helps. On the other hand, hormone receptor-negative cells only respond to chemotherapy.
2. Tumor markers are proteins released from cancer cells that are able to be identified during the disease. They are notable for demonstrating (or predicting) how aggressive one’s cancer may be. The one I will mention (yes, there are others) is the HER2 marker, which is especially quick-growing and aggressive. The American Cancer Society recommends all newly diagnosed women be tested for this. Fortunately, only 20% women with invasive breast cancer are positive for HER2.
3. Curiously, tumor location within the breast has proven to be an important predictor. Tumors in the middle of the breast are most serious than those toward the outside.
I wish all of you breast cancer survivors or those with family members affected all the best with this. I hope these posts have again pointed out the importance of lowering your risk profile and early detection and treatment. This is another illustration of the shortcomings of our typical approach to health care; relying on medical care is not the same as comprehensive healthcare. The time to engage the fight against breast cancer is not in the midst of advanced disease.
I welcome your comments or questions.
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Straight, No Chaser: How to Perform the Breast Self-Exam

self-breast-exam

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.
A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.
It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

  • Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
  • Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

 

  • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
  • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

  • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
  • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.
  • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
  • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.
I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public, including the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. I have used these and other sources over the course of the week to integrate my practices and have distilled their information in many cases. I highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

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Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors

breastcancerincidence

Even as a physician, I am left to think about the horror of being a woman with a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, it must be emphasized early and often: risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.
Breast cancer is the second most common cancer contracted by American women (after skin cancer), and it is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly, and approximately 40,000 women will die from complications of breast cancer annually (that’s over 100 deaths every day).
In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized.  This is largely thought to be due to declining rates of post-menopausal hormone use in response to results from major research projects. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.
Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor, and there are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with; if you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.
There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams and seeking early care for suspicious findings.  Now, there are other risk factors you can minimize. Oral contraceptive use, postmenopausal hormonal therapy, choosing not to breast feed, alcohol use and obesity are all risk factors for breast cancer that are under your control.
The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.
I welcome your questions and comments.
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