Monday, May 27, 2013

Ovarian Cancer Screening

Here is a real case study from American Family Physician with the correct "answers" that may surprise women (and men).  It is a common case in my practice too as more and more women are health conscious and want to do everything possible to detect early cancer.

CASE STUDY

A 35 year old woman presents for a routine well-woman exam.  She is worried about ovarian cancer because one of her friends was recently diagnosed.  She has no family history of breast, ovarian or colon cancer.  What do you do?

Answer:  Based on U.S. Preventive Services Task Force recommendation on screening for ovarian cancer, you advise against screening tests because they do not have good sensitivity for cancer and there are too many false-positive results.  The screening tests like Ca125 and transvaginal ultrasound have not been shown to reduce the number of ovarian cancer deaths.

Keep in mind that these recommendations do not apply to the following women.  Studies show these woman would benefit from those screening tests:
  • A woman with a confirmed BRCA1 genetic mutation
  • A woman with multiple family members who have had colon cancer (Lynch Syndrome)
  • A woman whose mother, sister or grandmother had ovarian cancer and breast cancer also in the close family
  • An Ashkenazi Jewish woman with close family members with breast or ovarian cancer.
I know being advised NOT to undergo a screening test is hard to understand.  Most patients believe if there is a test that could remotely pick up an early cancer, they want to have it.  Unfortunately we just don't have good tests for ovarian cancer.  False positive tests usually lead to removal of an ovary and the harm outweighs the good.   Perhaps in the future we will have genetic biomarkers that will help detect cancer.  Right now we don't.


Monday, May 20, 2013

Blame Bunions on your Genes

Thanks to KM for sending a pic of her bunions (yes, genetic)
There is good news for women who love high heels and pointy toe shoes.  Contrary to what we've been told, they don't cause bunions.  A new study published in Arthritis Care & Research shows that bunions, hammer toes and other toe deformities can be blamed on your parents.  Yes, like so many disorders, it's all in the genes.

The medical name for bunion is hallux valgus and up to 60% of people get foot disorders and foot deformities in later life.  By using heritability software that performs genetic analysis of familial data, the researchers found out that these conditions are genetically passed down.

Before you throw away those Birkenstock sandals, however, remember there is always an interplay between genetics and environmental factors that affect our bodies.  One look at the feet of dancers shows that constant trauma or strange positioning of the foot structures can cause permanent change.

My advice to women who love heels is to walk barefoot in the sand as much as possible and give your feet a good rest.

Thursday, May 2, 2013

Few Americans Understand Basics of New Health Care Law


I wrote last week about the massive confusion about ObamaCare ( the Affordable Care Act) but it seems that it is much worse than I thought.  The Kaiser Family Foundation came out with a poll that shows 42% of Americans don't even know that ObamaCare is the law.  Seven percent of people think the Supreme Court struck it down and 12% think Congress repealed it. 

I understand that there is confusion about the way it will work and who will be affected.  But my advice to Americans is TURN OFF THE DAMN TV.  Really, we are blessed to live in an age where information about any subject is available with the click of a mouse and  people seem to know more about the Kardashians than they do about a health care law that is as important as Social Security or Medicare legislation.

I'm not surprised, however that most Americans said they don't have enough information to understand how ObamaCare will affect them.  The Administration should have hired the same marketing firm that did the superbowl ads or even the clever ads for Dollar Shave Club.  Sure, I get that health care is more complex than a Pepsi ad, but at least doctors and hospitals should have some understanding of it by now.  This is a huge marketing FAIL so far.

According to the Washington Post, the Administration is waiting until the optimal time to roll-out the details.  A public awareness campaign is slated for this summer, as open enrollment will begin in October.  That seems way too late to me.  Helping 30 million Americans understand that they will be buying insurance, making sure there are networks to care for these people, understanding the subsidies that most will get and understanding the various plan options is a huge undertaking and it will be here in 5 months.  I would say ObamaCare is in a pot of boiling water right now.

It is the private insurers (Cigna, Well-Point, Blue Cross, United Healthcare, etc)  that will have the exchange products to sell.  Has anyone ever truly understood their coverage provisions when dealing with these insurance companies?  Now imagine 3 tiers of new insurance products to chose from, with varying co-pays and pricing.  Now imagine covering Americans who don't use computers or have never really dealt with the insurance system.  Now imagine different options being offered in each State.

I would say there is a lot of work to be done by Health and Human Services.