Tag Archives: cancer screening

Adjusted risk pool has some rethinking cervical cancer rates

Brenda Goodman

About Brenda Goodman

Brenda Goodman (@GoodmanBrenda), an Atlanta-based freelancer, is AHCJ’s topic leader on medical studies, curating related material at healthjournalism.org. She welcomes questions and suggestions on medical study resources and tip sheets at brenda@healthjournalism.org.

What if experts wanted to figure out the rate of tonsil cancer, but forgot to exclude all the people who’d had their tonsils removed?

Those people are no longer at risk for tonsil cancer, and since there are more than half a million tonsillectomies performed each year in the U.S., counting them in the risk pool would dramatically dilute the true rate of the disease.

That’s what seems to have happened with cervical cancer, according to a thought-provoking new study published in the journal Cancer.

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Navratilova, GMA uncritically push screening

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.

“The reason I wanted to speak about this is to encourage these woman to have mammograms,” (Navratilova) said. “I just want to encourage women to have that yearly check-up.”

Navratilova said she doesn’t agree with recent recommendations that women between the ages of 40 and 49 should not necessarily get regular breast cancer screenings.

“The cancer knows that you’re not 50 yet?” she said. “I can’t speak for the doctors, but in my personal case I’m so glad that I did it.”

In her blog “A Healthy Piece of My Mind,” writer and PR rep Eve Harris pointed out the fallacies lurking in the tennis star’s screening recommendations, beyond the obvious age-related concerns.

First, Harris said, Navratilova exhorts women to scrape together the money to pay for screenings, yet doesn’t mention the many programs available to help uninsured and underinsured women pay for mammograms.

Second, Navratilova claims that she was lucky, and would have been in serious trouble had she not detected the cancer when she did. In fact, Harris writes, there is not enough information about the natural progression of such cancers to make that declaration.

GMA correspondent Robin Roberts, who also has battled breast cancer, failed to point out any of that and, in fact, offered a very simplified interpretation of what the new breast cancer screening recommendations say.

(Hat tip to @lauranewmanny)

Rounding up some of the latest health coverage

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

With good topics for the blog flooding in and a short holiday week to get them all posted, I’m taking a shortcut to point you toward some interesting stories:

ProPublica: What Health Care Reform Means for the underinsured

Rapidly rising premiums have forced them to increase their deductible every year, and now they have a policy with a $5,000 deductible per illness per year.

Steve Lopez in the Los Angeles Times: A doctor is flummoxed by the costs when he becomes the patient

As a physician, he’s well aware that emergency room treatment is very expensive. But knowing the true cost of the limited supplies and labor required to treat such a minor wound, he found the experience more than a little disturbing.

Trevor Butterworth in Forbes.com: Why mall Santas do need the H1N1 vaccine, featuring AHCJ board member Maryn McKenna’s take on how well the media has covered H1N1.

McKenna gives the media a “gentleman’s C” for its coverage of swine flu, but believes it has been getting better in the past few months.

AHCJ member Elaine Schattner, M.D., in the Huffington Post: Mammography: A Not-So-Fatalistic View

I’m a medical oncologist and breast cancer survivor who holds a highly informed and intensely personal perspective on the subject. In my view, the press is getting and giving the wrong message on mammography. There are significant flaws in recent analyses that have escaped most headlines.

Times crafts strong reminder of screening’s dangers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Sarah-Kate Templeton, in The Times of London, tells the story of one victim of medical screening and overtreatment, wrapping that story in the larger debate about unnecessary medical screening and finally caps it all off with the news of a “Making Sense of Screening” guide, produced for the charity Sense About Science by a group of British scientists and doctors.

Templeton’s story provides a forceful reminder of the dangers of some early screening and aggressive treatment, all in the words of a 56-year-old math teacher who was diagnosed with a dormant form of breast cancer, and whose doctors recommended radical treatment.

The National Health Service has had to rewrite its advice to include warnings about potential harm caused by the screening process “after research showed that thousands of women have been misled into having unnecessary surgery.”

(Hat tip to Gary Schwitzer)

Scans at LA hospital spewed 8x normal radiation

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On Oct. 8, the FDA issued an alert recommending hospitals review CT scan radiation levels after dangerous doses were detected at an unnamed hospital. The Los Angeles Times‘ Alan Zarembo took over from there, finding that serious radiation overdoses at Los Angeles’ Cedars-Sinai hospital had prompted the warning.

Zarembo followed up with a series of stories on the radiation and its aftermath:

CT
Heading into the CT scanner, photo by grewlike via Flickr.

Cedars-Sinai investigated for significant radiation overdoses of 206 patients

Zarembo leads with a summary of what exactly went down at Cedars-Sinai:

More than 200 patients at Cedars-Sinai Medical Center were inappropriately exposed to high doses of radiation from CT brain scans used to diagnose strokes, hospital officials told The Times on Friday.

About 40% of the patients lost patches of hair as a result of the overdoses, a hospital spokesman said.

Even so, the overdoses went undetected for 18 months as patients received eight times the dose normally delivered in the procedure, raising questions about why it took Cedars-Sinai so long to notice that something was wrong.

Class action filed for Cedars radiation patients

Zarembo checks with experts who say the class-action suit filed on behalf of victims has little chance of success because it’s difficult to prove damages, especially since they may not develop for years.

Cedars-Sinai head expresses regret for radiation overdoses

A quick-hit story in which the hospital details exactly what they’ve done to ensure it doesn’t happen again.

4 patients say Cedars-Sinai did not tell them they had received a radiation overdose

Zarembo tracked down patients who said that, while they were contacted by the hospital concerning hair loss, they weren’t informed of radiation overdose or potential cancer risk.

Hospital error leads to radiation overdoses

Zarembo writes that the problem has been traced to a CT scanner reset in early 2008.

Cedars-Sinai radiation overdoses went unseen at several points

In one of the most remarkable moments, Zarembo writes that, before every single scan, technicians were shown a screen indicating, among many other things, the unusually high radiation level. The error was in plain sight the entire time.

Beginning in February 2008, each time a patient at Cedars-Sinai Medical Center received a CT brain perfusion scan– a state-of-the-art procedure used to diagnose strokes – the dose displayed would have been eight times higher than normal. No standard medical imaging procedure would use so much radiation, which one expert said is on par with the levels used to blast tumors.

Somebody should have noticed. But nobody did – everybody trusted the machines.

Related

The New York Times‘ Walt Bogdanich added a broader perspective on the story, adding an additional case and subtly weaving it into the debate about the dangers of medical screening.

Cancer society’s messages on screening conflict

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI
MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.