Is Professional Medical Care Worthwhile?

Throughout my youth, we had a general policy of going in every year (at least) for a "check-up". Probably to see that development was proceeding normally and everything else was ok. Since graduation, I've been lax about this (I'm now 23 years old). I don't get sick very often, so I rarely see an MD. I have excellent insurance with my company, so I probably should take advantage of it more.

Who do you recommend seeing and how often? My insurance doesn't require me to go through a PCP, so I have the flexibility to choose any specialist within my network. Is there a specific type of MD who knows something about preventative medicine?

I've always wondered if a full-body MRI would be a good idea (to establish a baseline for future comparison). What do you think? I don't mind paying for it if it's worthwhile... Right now I'll probably just pick out the nearest "internal medicine" doctor, and go in for a check-up. It just seems like I should be doing more...

-edit-

I mean, if I can see any specialist, should I just run down the list and have them each do their standard check-up? ENT, Cardiologist, etc...?

I think for a 23 year old the whole body scan is over kill. I don't think most insurance plans will pay for that. Out of pocket I don't think it would be worth it for you and I think it can be a pricey thing. (I briefly considered doing it because I had some money left over in my medical spending account at the end of the year.)

Some have said that the problem with doing that scan is that you can get some false positives. You doctor or technician reading that scan may see something and have you going down some path for nothing. That is one problem with those scans, if you do see something then you can drive yourself crazy with worry over it and it may not be anything serious to worry about. Sometimes they can open up pandora's box and turn out to be a false alarm.

I don't believe that getting an MRI or a cat scan or those other screening tools is completely safe. Being exposed to strong magnetic waves is not without some effect on the body. I don't think we know exactly what the effect is though. So doing this at your age to make sure you are healthy may not be advisable by some doctors. But, there may be no reason to bring it up with your doctor if you really are serious about.

You might consider reviewing the medical history of your family and trying to pinpoint any possible problems from that. Any Alzheimer's? heart disease? diabetes? obesity? cancer? etc.

And any alcoholism in your family history? I ask about that last one separately because a family history of alcoholism I think can indicate possible risks for blood sugar problems. (Besides the fact that addiction may run in your family.) This is not just diabetes, but could mean food allergies too, which can mean nutritional problems because of malabsorption issues. Food allergies can be present in some people and they never know about it and never get it treated.

If there is some heart disease then definitely have your cholesterol checked. And try a regular check up and see what your doctor recommends.

I also happen to think that having your homocsyteine (HCY) levels checked can be an excellent indication of overall health and risk for cardio problems. That would be the one test I recommend, as a start. If that goes well then you should be fine for another year or so. But if your HCY levels are high there is a methionine load test that would help indicate how your body is methylating. I doubt you would have high HCY levels now.

I am not a big fan of mainstream medicine and the kind of care you get from the majority of practising doctors in health insurance networks. I don't think mainstream doctors really emphasize the prevention aspect enough. I don't know what type of doctor is best for emphasizing the prevention of disease but that would probably the best one for you.

If you don't have any concerns then it is hard to point you to some specialist. I don't think it could be practical to go to several different specialists and have then give you their own type of check up. Doctor appointments usually only last about 20 minutes but you can spend much longer sitting in the waiting room. Actually, some of the more holistic types can have you there for several hours taking blood, urine and some other things. Your insurance may foot the bill for your appointments but you probably have better things to do than wait around in some doctors office.

You should use all of the available technologies modern medicine can offer so you can live the longest and happiest life you can. There are certain evaluations that can detect diseases at an early enough point to stop them from manifesting.

Yes, a Colonoscopy does not sound like fun...but neither does getting colon cancer...

Edited by nootropikamil, 18 August 2006 - 11:04 PM.

You should use all of the available technologies modern medicine can offer so you can live the longest and happiest life you can.  There are certain evaluations that can detect diseases at an early enough point to stop them from manifesting.

on the nose

You should use all of the available technologies modern medicine can offer so you can live the longest and happiest life you can.  There are certain evaluations that can detect diseases at an early enough point to stop them from manifesting.

Yes, a Colonoscopy does not sound like fun...but neither does getting colon cancer...

mmm...secretly my favorite topic...colonoscopies... [sick]

I thought maybe some might appreciate this update:

News source

Doctors Who Take More Time With Colonoscopy Find More Tumours
14 Dec 2006

A new US study suggests that doctors who take more time (more than 6 minutes) to look for cancerous and pre-cancerous tumours in the bowel using colonoscopy tend to be better at detection than those who take less time.

The study is published in the New England Journal of Medicine.

The research team, led by Dr. Robert L. Barclay of Rockford Gastroenterology Associates, compared rates of detection of colorectal adenomas (polyps or abnormal growths in the bowel or digestive tract) against the time doctors spent searching for them. They looked at data from nearly 8,000 colonoscopies performed by 12 experienced gastroenterologists over a 15-month period in a community-based practice.

The researchers found large variations in the detection rates among the doctors, who overall detected tissue growths (neoplasia) in 23.5% of the patients. They also found that the time the doctors spent on searching for growths varied from 3.1 to 16.8 minutes for examinations where no polyps were removed.

The results indicated that those procedures that lasted an average of 6 minutes or less tended to detect fewer polyps, both cancerous and pre-cancerous, than those that took more time.

The researchers are cautious about generalising from these results since they come from a small study on 12 doctors in one practice. However, they suggest that doctors who perform colonscopies in order to find and remove polyps should perhaps spend a little more time on the procedure as this is likely to lead to more effective early detection of tumours.

Colonoscopy is a non-surgical examination performed under anasthetic where a fibre optic camera is inserted in the patient's anus and pushed up into the bowel. With this procedure doctors can see any abnormal growths and ulcers, remove small polyps and tissue samples and look at them under a microscope (biopsy) to check for signs of cancer.

Risks of serious complication from colonoscopies are extremely low (less than 0.5 per cent), which compared with the high rate of deaths from bowel cancer in the over 50s, makes this an effective screening test.

Click below for more information on bowel or colon cancer (US, National Cancer Institute).
http://www.cancer.go...olon-and-rectum

Written by: Catharine Paddock
Writer: Medical News Today
Article URL: http://www.medicalne...hp?newsid=59040

Save time! Get the latest medical news headlines for your specialist area, in a weekly newsletter e-mail. See http://www.medicalne...newsletters.php for details.

Send your press releases to pressrelease@medicalnewstoday.com


...Interestingly, Forbes' heading for the same news report is Colonoscopies Should Last at Least 6 Minutes

Back to my favorite topic...

Seatllepi.com: News Source



Fighting colorectal cancer, an equal-opportunity killer
Women as likely to get it as men

Monday, March 26, 2007

By SUSAN PHINNEY
P-I REPORTER

Call colorectal cancer a misunderstood killer.

While it kills fewer people in the United States than lung cancer, it's the second-place cancer killer of men, and third most frequent for women, according to the American Cancer Society.

Because ignoring this disease can be fatal, this has been designated Colorectal Cancer Awareness Month, a time to spread the message of early detection and raise money for research.

Surveys have found that women are more concerned about breast or ovarian cancer, and believe colon cancer affects mostly men. In reality, it affects men and women in almost equal numbers.

If it is discovered in its early stages, there's a 95 percent survival rate. That's the good news.

The bad? There are 145,000 new cases in the U.S. annually, and about 50,000 deaths. One in every 20 people will get the disease, but only about two in 10 will be tested for it, says Dr. William Grady, associate member of the Fred Hutchinson Cancer Research Center's Clinical Research Division, and gastroenterology section chief at the University of Washington.

Grady has been doing colon cancer research for 11 years, one member of what he calls "a small community" of scientists working on tests for the disease that will be faster, less invasive and less expensive than current screening measures.

The best test for colorectal cancer involves a colonoscopy, a word that inspires comics but rarely brings smiles to the faces of those being tested.

A colonoscopy is an invasive procedure involving pre-test colon cleansing, sedation and equipment entering your body via the rectum. It's a costly procedure that can run $1,500 to $2,000 (before insurance).

Television anchor Katie Couric had her colonoscopy televised in 2000 to raise awareness of the disease. Her husband, Jay Monahan, died from colorectal cancer when he was just 42.

While Couric's demonstration did increase the demand for testing by a small degree, death rates have not plunged, and as the population ages even more people are being diagnosed each year. Colorectal cancer is more prevalent in people 50 and up.

Grady's research is aimed at finding a test that would be acceptable to those unwilling to undergo a colonoscopy. The screening could involve blood, urine or stool testing. His research has been funded by the Damon Runyon Cancer Research Foundation, but money is always a problem.

"Funding is two-thirds to three-fourths less than it was five years ago," Grady said.

That's just one reason it's hard to predict when a new screening test for colorectal cancer will be available. "Hopefully, it will be five to 10 years," Grady said.

About 50 percent to 70 percent of risks for colorectal cancer are from environmental factors, 30 percent to 50 percent from hereditary factors. Diet and this cancer are closely linked. A diet heavy with red meat, but low in fiber, fruits and vegetables, can raise the risk, for example.

When colorectal cancer metastasizes it usually goes to lymph nodes or to liver or lungs. Once it spreads, patients have only a 5 percent chance of surviving five years.

HELP THE CAUSE
Jazz musician Steve Tyrell is bringing his band to Seattle on Thursday for a fundraiser to support colorectal cancer research at the University of Washington. Tyrell lost his wife, Stephanie, to this cancer in 2003. Since that time he has worked with Katie Couric as an ambassador and fundraiser for the National Colorectal Cancer Research Alliance.
The concert and silent auction at The Triple Door begin at 6 p.m.

For ticket information, go to maketheeveningmatter.com,

or call Robin Winstead at 206-852-4285.

--------------------------------------------------------------------------------

P-I reporter Susan Phinney can be reached at 206-448-8397 or susanphinney@seattlepi.com.

© 1998-2007 Seattle Post-Intelligencer

Here's another place Professional Medical Care might come in handy:

Reuters Health: News Source



CT screening may detect lung cancer early

Tue Mar 27, 2007 9:32PM BST
By David Douglas

NEW YORK (Reuters Health) - Annual computed tomographic (CT) screening for lung cancer resulted in the identification of a high proportion of patients who had early-stage disease, researchers report in the journal Radiology.

Principal investigator Dr. Claudia I. Henschke told Reuters Health that when CT screening is performed it is important to use an approach that is well-defined and well-tested to identify the patients who need further testing, what testing is needed and when it should be done.

However, this report by Henschke and her colleagues follows a study published in the March 7, 2007 issue of the Journal of the American Medical Association that found no meaningful reduction in deaths from lung cancer due to CT screening. A much larger study of 50,000 people, sponsored by the National Cancer Institute, is now underway that researchers say will be more definitive.

In the current study, Henschke, of New York Presbyterian Hospital-Weill Cornell Medical Center, and colleagues evaluated 6,295 subjects who were an average of 66 years old and had a history of smoking.

The results of the initial CT imaging led to recommendations for further workup in 906 (14.4 percent) subjects and for 361 (6.0 percent) of the 6014 annual repeat screenings.

In total, 101 patients had a diagnosis of lung cancer following the first CT test. Another three participants had a lung cancer diagnosis following symptoms, which developed before the repeat screening was performed. In all, 95 (91.3 percent) of these patients had no evidence that the cancer had spread (metastasized).

In the 20 patients for whom the diagnosis of lung cancer was made following the repeat screening, 17 (85 percent) had no evidence of metastasis.

Of a total of 134 recommended biopsies, 125 (93.3 percent) resulted in the diagnosis of lung cancer or another malignancy.

"These figures are very similar to those with mammography screening and quality assurance of mammography screening has proven highly successful in providing early diagnosis and early treatment for breast cancer," Henschke said.

"We have shown that we can diagnosis lung cancer early -- early treatment of early lung cancer is usually curative," she concluded.

SOURCE: Radiology, April 2007.


© Reuters 2006. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Reuters journalists are subject to the Reuters Editorial Handbook which requires fair presentation and disclosure of relevant interests.

Wonder's myspace has an image in her movie section that's pretty funny I think. That is, the equivalent to a male mammogram: "The Manogram."

Here is a link to an article called: "Autism's roots: mix of chance and genetics."

Hopefully, soon, Professional Medical Care will develop effective preventative measures and curative solutions to assist those individuals and families suffering from autism. Modern Medicine has been working to find solutions to autism, and even though some noble humanitarians have made substantial contributions to help autistic children and their families, there still is no cure for autism -- at least yet. It seems there's a lot more work to do.

Back to the topic "Is Professional Medical Care Worthwhile?":

Image Credit: Suzanne DeChillo/The New York Times
Dr. Elizabeth Morris of Memorial Sloan-Kettering Cancer Center in New York, a member of an expert panel that issued new guidelines.

March 28, 2007
Call to Increase M.R.I. Use for Breast Exam
By DENISE GRADY

Two reports being published today call for greatly expanded use of M.R.I. scans in women who have breast cancer or are at high risk for it.

The recommendations do not apply to most healthy women, who have only an average risk of developing the disease.

Even so, the new advice could add a million or more women a year to those who need breast magnetic resonance imaging — a demand that radiologists are not yet equipped to meet, researchers say. The scans require special equipment, software and trained radiologists to read the results, and may not be available outside big cities.

Breast M.R.I. costs $1,000 to $2,000, and sometimes more — 10 times the cost of mammography — so a million more scans a year would cost at least $1 billion. It is sometimes covered by insurance and Medicare, sometimes not.

One report is a set of new guidelines for using M.R.I. in women at high risk for breast cancer, and the other is a study in The New England Journal of Medicine showing that in women who have newly diagnosed cancer in one breast, M.R.I. can find tumors in the other breast that mammograms miss.

M.R.I. has drawbacks. It is so sensitive — much more so than mammography — that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false-positive findings may be acceptable. But the risk of needless biopsies and additional scans is not considered reasonable for women with just an average risk of breast cancer, and is the main reason M.R.I. is not recommended for them.

The new guidelines, from the American Cancer Society, are being published in the society’s journal CA: A Cancer Journal for Clinicians. They recommend scans and mammograms once a year starting at age 30 for high-risk women.

High risk is defined as a 20 percent to 25 percent or higher chance of developing breast cancer over the course of a lifetime. (The average lifetime risk for women in the United States is 12 percent to 13 percent.)

The high-risk group includes women who are prone to breast cancer because they have certain genetic mutations, BRCA1 or BRCA2, or those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested. These mutations are not common — they cause less than 10 percent of all breast cancers — but they greatly increase a woman’s risk, to 36 percent to 85 percent.

Women with even rarer mutations, in genes called TP53 or PTEN, are also advised to be screened, as are women who had radiation treatment to the chest between ages 10 and 30, for disorders like Hodgkin’s disease.

Others at high risk include women from families in which breast cancer is common, especially in their close relatives, even if no genetic mutation has been identified. Women and their doctors can estimate their odds by using one of several online risk calculators that factor in the medical history of both the woman and her family. A simple calculator is available at http://www.cancer.gov/bcrisktool/.

But different calculators can give quite different results, and women may need help from their doctors to interpret the results, said Dr. Elizabeth Morris, a member of the expert panel that drew up the guidelines and director of Breast M.R.I. at Memorial Sloan-Kettering Cancer Center in Manhattan.

“Just to figure out who should have it will be the hardest thing,” Dr. Morris said. “A lot of that onus is put on the referring physician. A lot of women are going to think they’re high risk, and they’re not.”

The cancer society said that for women with certain conditions, there was not enough information to recommend for or against M.R.I. screening. The uncertain group includes women with very dense breast tissue on mammograms, and women who had breast cancer in the past, or growths called carcinoma in situ or atypical hyperplasia.

Dr. Robert Smith, the cancer society’s director for screening, estimated that the new guidelines would add one million to two million women a year to the number who should have breast M.R.I.

Increased demand for such scans could easily outstrip the capacity, even though the number of centers offering them has increased markedly in the last five years, said Dr. Constance Lehman, another member of the panel that wrote the guidelines and a professor of radiology at the University of Washington. She said professional societies in radiology were scrambling to provide training and accreditation for the scans.

Insurers will probably cover the scans because the new guidelines are based on good evidence and promoted by a respected medical group, said Peter V. Lee, president of the Pacific Business Group on Health, a nonprofit coalition of large buyers of health care that cover about five million people. Huge amounts of money are now wasted on unnecessary M.R.I., Mr. Lee said, adding: “Here we have a case where there’s evidence. Hallelujah! Let’s use it.”

Not every imaging center is qualified to perform such scans, but some that are not up to par may offer it anyway, so patients must beware.

Special equipment is needed: a powerful, “high-field” magnet and a special breast coil to generate a magnetic field around the breast. The scan is done with the woman lying on her stomach on a special table with openings that let the breasts rest in wells surrounded by the coil.

“And you have to make sure they’re doing enough, not one a week, and make sure they have biopsy capability,” Dr. Morris said.

If the breast scan is done at a center that cannot perform biopsies, a woman with a suspicious finding may have to start all over again at another clinic.

The second new report describes a study showing that in women who had cancer in one breast, an M.R.I. scan of the other breast found tumors that mammograms had missed in 3 percent of the women. Researchers say M.R.I. can help women who already have one cancer by detecting a hidden tumor in the other breast, enabling them to have both cancers treated at once instead of having to go through treatment all over again when the second tumor is finally detected.

Research has shown that 10 percent of women who have cancer in one breast will eventually develop it in the other as well.

“This study supports the recommendation that women who are diagnosed with breast cancer consider the benefits of a breast M.R.,” said Dr. Lehman, the senior author of the study. “What we think is most important is that we understand the full extent of a woman’s breast cancer before her therapy is initiated.”

The scans are recommended in newly diagnosed cases, but not for most women who had breast cancer treated in the past.

Currently, women with newly diagnosed cancer in one breast are given mammograms of the other, but only a minority are offered M.R.I., Dr. Lehman said. This year, about 180,000 new cases of breast cancer are expected in the United States.

Some surgeons think every woman with a new diagnosis of breast cancer should have an M.R.I. of the other breast, and some think no one should, Dr. Morris said. She said the scans were most likely to be useful in younger women with breast cancer and dense tissue that hides tumors from mammograms. In older women with small, early tumors and clear mammograms, she said, such scanning is less important.

The study findings will make it harder for insurance companies to refuse to pay for such scans of the second breast in women with breast cancer, said Dr. Etta D. Pisano, another author of the study and a professor of radiology at the University of North Carolina.

The study, conducted at 25 medical centers, included 969 women with recently diagnosed cancer in one breast and a normal mammogram on the other. All were given M.R.I. scans, which discovered cancers in the supposedly healthy breast in 30 women, 3.1 percent of the group. Nearly all the cancers were at an early stage, and were treated at the same time as the ones originally discovered.

Without the scans, Dr. Lehman said, the tumors would not have been found until later, and then the women would have had to go through surgery, and perhaps radiation and chemotherapy as well, all over again. “We know cancers diagnosed later in these women don’t do as well as cancers diagnosed initially,” she said.

But to find 30 cancers, 121 women had biopsies, which were ordered because of abnormalities on M.R.I. That means 91 false-positive scans and biopsies of healthy tissue, and a false-positive rate of about 10 percent. Dr. Lehman said most cancer patients were willing to accept the risk of a false-positive and a biopsy in order to find out whether there was anything to worry about in the other breast.

The study was paid for by the National Cancer Institute.

Copyright 2007 The New York Times Company

Peace.

Edited by nootropikamil, 28 March 2007 - 09:37 PM.

Good article!

"M.R.I. has drawbacks. It is so sensitive — much more so than mammography — that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false-positive findings may be acceptable. But the risk of needless biopsies and additional scans is not considered reasonable for women with just an average risk of breast cancer, and is the main reason M.R.I. is not recommended for them."

Sounds like gatekeeper speak--The person rationing the resources. I'd rather know. It’s far better to ask for this test and routinely monitor any and all suspicious growths rather than be left in the dark. I can understand avoiding the biopsies if at all possible. MRI of course has the additional benefit of NO RADIATION as insignificant as it may be.

Radiologists have a bias towards "not missing anything". That manifests itself in their tendency to way over-interpret a film. I have twice been diagnosed with lethal conditions due to a radiologist's overactive imagination. The first time it was cleared up quickly, but the second time took several weeks during which I was expecting to die sometime soon. Because of this kind of issue, I would take the false-positive problem pretty seriously, because, well.. it's a serious problem.

I can understand that. False diagnosis is very serious business which is why many people will correctly be steered away from such a test. My perspective is this- Knowing the high sensitivity of the test going in, I'd be very aware and prepared for the increased possibility of false positives. Given the choice, and knowing the consequences, I'll take the high sensitivity test any day. Of course, as a practitioner, my opinion would be drastically different and I would support the articles stance.

I would not recommend random CT scans. One CT scan of the thorax subjects the body to equivalent radiation of 250 X-rays. My physiology professor said that after about 4 of those in a lifetime and you're not gonna be real happy. MRI on the other hand doesn't seem nearly as risky. It uses radio frequency (RF) waves rather than ionizing X-rays which are known to eventually be carcinogenic.

I would not recommend random CT scans. One CT scan of the thorax subjects the body to equivalent radiation of 250 X-rays. My physiology professor said that after about 4 of those in a lifetime and you're not gonna be real happy. MRI on the other hand doesn't seem nearly as risky. It uses radio frequency (RF) waves rather than ionizing X-rays which are known to eventually be carcinogenic.

So true lunarsolarpower.
I've done some investigation into the Helical CT body scans. Lets just say I wouldn't want too many. A simple heart scan can dose you with 400mRem (no dye.) The abdominal organ scans are far worse and aren't much good without contrasting dye anyway. The EBT CT emits far less radiation for someone wanting a simple heart calcium score scan. You've got to weigh the risks, the damage is cumulative. One dose is no big deal, but repeated testing dramatically increases ones risk for cancer.

Edited by thymeless, 29 March 2007 - 04:38 AM.

Found my linky from way back. This should provide a rough estimate of radiation exposure. Sobering, indeed.

http://www.newportbo...ationdosage.htm

http://radiology.rsn.../full/230/2/397

Good article!

"M.R.I. has drawbacks. It is so sensitive — much more so than mammography — that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false-positive findings may be acceptable. But the risk of needless biopsies and additional scans is not considered reasonable for women with just an average risk of breast cancer, and is the main reason M.R.I. is not recommended for them."

Sounds like gatekeeper speak--The person rationing the resources. I'd rather know. It’s far better to ask for this test and routinely monitor any and all suspicious growths rather than be left in the dark. I can understand avoiding the biopsies if at all possible. MRI of course has the additional benefit of NO RADIATION as insignificant as it may be.

It's good that you pointed that out thymeless -- this LA times article follows up on how CAD can often detect benign growths as potentially cancerous:

LAtimes: News Source



Study finds flaws with computer-aided mammograms
CAD system doesn't help radiologists detect more cancers and results in needless biopsies, a report says.

By Denise Gellene, Times Staff Writer
April 5, 2007

An increasingly popular technology that uses computers to scan mammograms actually produces worse results than human reviewers using their eyes and experience, according to a study released Wednesday.

Radiologists using computer-assisted detection software were more likely to interpret a benign growth as potentially cancerous, researchers said in the New England Journal of Medicine.

The false-positive readings led to additional scans and needless biopsies, adding $550 million to the annual cost of breast cancer screening in the U.S., researchers said.

In addition, the computer-aided detection system, known as CAD, did not help radiologists find more real cancers, the report says.

Dr. Ferris Hall, a radiologist at Beth Israel Deaconess Medical Center in Boston, who wrote an editorial accompanying the report, said some mistakes might have been the result of inexperience with CAD. It takes radiologists several years to learn the technology, he said.

Nonetheless, Hall said, the study is a setback for the technology, which is used in 30% of the more than 30 million mammograms performed in the U.S. annually. Many imaging centers promote their CAD services, which are potentially more profitable than standard mammography, he said. Medicare pays an additional $20 for each mammogram screened by CAD.

"This will have a major impact on radiology," Hall said. "They were calling people back for more scans and did more biopsies — that is hurting people. And what did they get for it? No significant increase in cancer detection."

The study shows other techniques are needed to detect breast cancer in its earliest stages, said Dr. John E. Niederhuber, director of the National Cancer Institute, which funded the study.

Breast cancer is the second most common cancer in women, next to skin cancer. The American Cancer Society estimates that 178,480 women will be diagnosed with the disease this year and that 40,460 will die of it.

Mammography, an X-ray image of the breast, has long been the primary tool for detecting breast cancer in its earliest stages, before tumors are large enough to detect in a clinical breast exam.

Last week, the American Cancer Society recommended annual magnetic resonance imaging for women at high risk for breast cancer.

Launched in 1998, CAD was designed to improve the accuracy of mammogram readings. A device converts X-ray film into a digital file that can be analyzed by computer and displayed on a monitor. The software marks suspicious areas on the screen image for the radiologist to review in addition to the areas detected by the radiologist's eyes.

Previous studies assessing the benefits of the technology have produced mixed results.

The latest study looked at mammography results for 220,000 women at 43 imaging centers in Colorado, New Hampshire and Washington state. Seven of the centers began using CAD during the study.

The researchers found that after using the software, the rate of women recalled for additional imaging tests went up 32%, along with a 20% increase in the number of breast biopsies. The women were later found not to have breast cancer.

Maryellen Lissak Giger, professor of radiology at the University of Chicago and an inventor of CAD technology, said the study had several flaws. It was too small to detect a slight improvement in cancer detection, she said. Moreover, the research, from 1998 to 2002, evaluated an early version of the CAD system, said Giger, who owns stock in Hologic Inc. of Bedford, Mass., which licenses its technology from the University of Chicago.

*

--------------------------------------------------------------------------------
denise.gellene@latimes.com

I guess it can depend on the skill of the specialist.

Returning once again to everyone's favorite topic:

Science Daily: News Source



Source: John Wiley & Sons, Inc.
Date: April 23, 2007

Virtual Colonoscopy Is Most Cost-effective Colon Cancer Screening Test, Study Says

Science Daily — A new study says targeting smaller (¡Ü5 mm) lesions does little to significantly reduce the incidence of colorectal cancer (CRC) and, in fact, results in extremely high financial costs and a large proportion of adverse events. Published in the June 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, a cost-benefit analysis study says the low malignancy rate among so-called diminutive polyps gives virtual colonoscopy with removal of lesions 6 mm or greater the best estimated value per life year gained and with fewer complications.

Effective screening through increased use of any of several available tests is the key to reducing deaths from colorectal cancer, the third leading cause of cancer death in both men and women. Despite the availability of effective screening tests, screening rates remain low and CRC-related deaths remain high.

Optical colonoscopy (OC) and flexible sigmoidscopy (FS) have been the primary screening tools for the last few decades but are associated with complications ¨C from abdominal pain to life-threatening bowel perforation and bleeding. Virtual colonoscopy, or CT colonography (CTC), has arisen as a potentially effective CRC screening tool. Using x-rays and imaging software to develop two- and three-dimensional images of the gastrointestinal tract, it has fewer adverse effects and is better tolerated by patients. Recent studies using new methods have demonstrated that the test is very sensitive for CRC and could be an effective screening option for patients.

Previous cost-benefit analysis studies comparing OC and CTC (with OC referral for all polyps of any size) have estimated that OC is more cost effective. However, these studies ignore current CTC guidelines that recommend only reporting polyps greater than 5 mm. Dr. Perry Pickhardt, a radiologist from the University of Wisconsin, collaborated with Dr. Cesare Hassan, a gastroenterologist from Rome, and colleagues to conduct a cost-benefit analysis comparing CTC with and without a 6-mm polyp size threshold, OC and FS.

In this model of 100,000 persons over 50 years old, CTC with OC follow-up of polyps greater than 5 mm was the most cost-effective screening test. According to cost per life-year gained calculations, CTC with a 6-mm threshold for follow-up cost only $4,361 while OC cost $9,180 per life-year gained. CTC with no polyp size threshold cost $7,138, and FS cost $7,407 per life-year gained.

The incremental costs of working-up lesions smaller than 6 mm at CTC resulted in a significant $118,440 per additional life-year gained and accounted for more than half of all OC procedures. Moreover, working up these small, almost always benign polyps with OC caused considerable complications. The study found almost half of all OC-related complications were attributable to work-up of diminutive lesions. Furthermore, targeting these lesions did not improve screening efficacy, reducing CRC incidence by only 1.3 percent.

The authors say the data support "CTC with nonreporting of diminutive lesions" to be "the most cost-effective and safest screening option available." "Providing additional effective yet distinct screening options like CTC could encourage more adults to undergo screening," conclude the authors, and consequently "increase overall compliance with screening" for CRC.

Article: "Cost-Effectiveness of Colorectal Cancer Screening With Computed Tomography Colonography: The Impact of Not Reporting Diminutive Lesions," Pickhardt PJ, Hassan C, Laghi A, Zullo A, Kim DH, Morini S, CANCER: (DOI: 10.1002/cncr. 22668); Print Issue Date: June 1, 2007.

Note: This story has been adapted from a news release issued by John Wiley & Sons, Inc..

Another place Professional Medical Care might come into handy...those ultrasounds...

News source: DogFlu.Ca




Vice President Dick Cheney has returned to work after finding out that the blood clot in his left leg is getting smaller

It is being reported that US Vice President Dick Cheney returned to work today after finding out that the blood clot in his leg is gradually improving.

"The vice president's doctors advised him to continue the current course of treatment. He has returned to the White House to resume his normal schedule," said Megan McGinn, a spokeswoman for Cheney.

To treat the blood clot, which was found in his left leg following his return from a trip to Asia, Cheney has been taking blood thinning medication.

"It's essentially like a snowball in that if one is not on a blood thinner, the snowball gets larger and larger," said Cameron Akbari, a vascular surgeon at the Washington Hospital Center who was not involved in Cheney's case. "But if one remains on the blood thinner, the snowball melts on its own. The same thing is happening to the clot."

According to McGinn, "the ultrasound was reassuring and showed that the clot is gradually resolving. His blood-thinning medication was found to be in the desired range."

This is not the first health scare that Cheney has had to endure. He has had 4 heart attacks, however none since taking over the role of Vice President back in 2001.

Here's a new and upcoming potential prostate cancer detection technology that will likely require "Professional Medical Care" to access...

News Source: Medical News Today



Onconome Announces Completion Of Breakthrough Research Study Highlighting New Blood Test For Prostate Cancer

26 Apr 2007 

Onconome, Inc., a privately held Seattle based biotechnology company, today announced the publication of a groundbreaking research study conducted at The Johns Hopkins School of Medicine. The study relates to a newly discovered blood protein, ProstaMark® EPCA-2 (Early Prostate Cancer Antigen) that could change the way men are screened for prostate cancer, a disease which kills more than 25,000 men each year. The simple to use blood test detected an unprecedented 94 percent of men with prostate cancer and correctly identified 97 percent of men who don't have the disease, according to the Hopkins study.

The study, conducted under the direction of Robert H. Getzenberg PhD, professor of urology and director of research at the James Buchanan Brady Urological Institute at the Johns Hopkins University School of Medicine, was underwritten by a grant from Onconome, and appeared today in the medical journal Urology.

"As a company committed to discovering and developing innovative biomarkers for the early and accurate detection of disease, we appreciate the vast implications of this technology," said Ray Cairncross, Onconome's CEO and Co-Founder. Onconome has exclusive, worldwide rights to the technology.

"The results from the Johns Hopkins University research study demonstrate that the ProstaMark® EPCA-2 test is highly specific and sensitive to prostate cancer and could greatly reduce the number of unnecessary prostate biopsies," continued Cairncross. As exclusive licensee, Onconome will focus on optimizing the blood test for routine clinical use.

A Significant Advancement in Testing

For the past 25 years, prostate-specific antigen (PSA) has been the standard in the effort to detect prostate cancer; however, it is not highly specific or sensitive. For example, 80 percent of patients with elevated PSA levels do not have prostate cancer and 15 percent of patients with normal PSA levels do have prostate cancer. Nevertheless, nearly 1.7 million prostate biopsies are performed each year based primarily on results from PSA testing and an estimated 25 million men have had at least one negative biopsy (i.e. no cancer found).

By contrast, the research study showed that the EPCA-2 test is negative in 97 percent of men who do not have prostate cancer and is positive in 94 percent of men with prostate cancer. "The study also shows that EPCA-2 levels are highest in patients with non-organ confined prostate cancer, which is important because cancer that has spread outside of the prostate is much more deadly," said Dr. Getzenberg.

New Advances in Testing

Onconome is focused on the discovery, development and commercialization of innovative biomarkers for the early detection of not only prostate cancer but also other types of cancer, such as colon, as well as other life-threatening human diseases.

"We are also working with Johns Hopkins University on an early detection test for colon cancer" said Cairncross. "Research results indicate that the performance characteristics of the colon cancer test are similar to those achieved in the development of the prostate cancer test."

Onconome will also utilize its novel, proteomic technologies to assist pharmaceutical companies in their efforts to develop cancer therapies and to select clinical trial candidates and will collaborate with in-vivo imaging and targeted therapeutics companies to improve treatment.

About Onconome, Inc.

Onconome, Inc. (Seattle, WA) was incorporated in 2000 as a biomedical company committed to the discovery and commercialization of products for the early detection of prostate, colon, and other types of cancer and life- threatening human diseases. Through its licensing arrangements with both Johns Hopkins University School of Medicine and the University of Pittsburgh, Onconome has obtained exclusive, worldwide rights to the use and development of numerous protein markers for the early diagnosis of cancer as well as for drug screening and in vivo imaging. Under a Contract Research Agreement, Onconome funds the discovery and development of these markers at Johns Hopkins University School of Medicine. For more information, visit the company's Web site at http://www.onconome.com.

Onconome, Inc.
http://www.onconome.com
Article URL: http://www.medicalne...hp?newsid=68985

--------------------------------------------------------------------------------

Save time! Get the latest medical news headlines for your specialist area, in a weekly newsletter e-mail. See http://www.medicalne...newsletters.php for details.

Send your press releases to pressrelease@medicalnewstoday.com 

Here's a new and upcoming potential prostate cancer detection technology that will likely require "Professional Medical Care" to access...

News Source: Medical News Today



Onconome Announces Completion Of Breakthrough Research Study Highlighting New Blood Test For Prostate Cancer

26 Apr 2007 

Onconome, Inc., a privately held Seattle based biotechnology company, today announced the publication of a groundbreaking research study conducted at The Johns Hopkins School of Medicine. The study relates to a newly discovered blood protein, ProstaMark® EPCA-2 (Early Prostate Cancer Antigen) that could change the way men are screened for prostate cancer, a disease which kills more than 25,000 men each year. The simple to use blood test detected an unprecedented 94 percent of men with prostate cancer and correctly identified 97 percent of men who don't have the disease, according to the Hopkins study.

The study, conducted under the direction of Robert H. Getzenberg PhD, professor of urology and director of research at the James Buchanan Brady Urological Institute at the Johns Hopkins University School of Medicine, was underwritten by a grant from Onconome, and appeared today in the medical journal Urology.

"As a company committed to discovering and developing innovative biomarkers for the early and accurate detection of disease, we appreciate the vast implications of this technology," said Ray Cairncross, Onconome's CEO and Co-Founder. Onconome has exclusive, worldwide rights to the technology.

"The results from the Johns Hopkins University research study demonstrate that the ProstaMark® EPCA-2 test is highly specific and sensitive to prostate cancer and could greatly reduce the number of unnecessary prostate biopsies," continued Cairncross. As exclusive licensee, Onconome will focus on optimizing the blood test for routine clinical use.

A Significant Advancement in Testing

For the past 25 years, prostate-specific antigen (PSA) has been the standard in the effort to detect prostate cancer; however, it is not highly specific or sensitive. For example, 80 percent of patients with elevated PSA levels do not have prostate cancer and 15 percent of patients with normal PSA levels do have prostate cancer. Nevertheless, nearly 1.7 million prostate biopsies are performed each year based primarily on results from PSA testing and an estimated 25 million men have had at least one negative biopsy (i.e. no cancer found).

By contrast, the research study showed that the EPCA-2 test is negative in 97 percent of men who do not have prostate cancer and is positive in 94 percent of men with prostate cancer. "The study also shows that EPCA-2 levels are highest in patients with non-organ confined prostate cancer, which is important because cancer that has spread outside of the prostate is much more deadly," said Dr. Getzenberg.

New Advances in Testing

Onconome is focused on the discovery, development and commercialization of innovative biomarkers for the early detection of not only prostate cancer but also other types of cancer, such as colon, as well as other life-threatening human diseases.

"We are also working with Johns Hopkins University on an early detection test for colon cancer" said Cairncross. "Research results indicate that the performance characteristics of the colon cancer test are similar to those achieved in the development of the prostate cancer test."

Onconome will also utilize its novel, proteomic technologies to assist pharmaceutical companies in their efforts to develop cancer therapies and to select clinical trial candidates and will collaborate with in-vivo imaging and targeted therapeutics companies to improve treatment.

About Onconome, Inc.

Onconome, Inc. (Seattle, WA) was incorporated in 2000 as a biomedical company committed to the discovery and commercialization of products for the early detection of prostate, colon, and other types of cancer and life- threatening human diseases. Through its licensing arrangements with both Johns Hopkins University School of Medicine and the University of Pittsburgh, Onconome has obtained exclusive, worldwide rights to the use and development of numerous protein markers for the early diagnosis of cancer as well as for drug screening and in vivo imaging. Under a Contract Research Agreement, Onconome funds the discovery and development of these markers at Johns Hopkins University School of Medicine. For more information, visit the company's Web site at http://www.onconome.com.

Onconome, Inc.
http://www.onconome.com
Article URL: http://www.medicalne...hp?newsid=68985

--------------------------------------------------------------------------------

Save time! Get the latest medical news headlines for your specialist area, in a weekly newsletter e-mail. See http://www.medicalne...newsletters.php for details.

Send your press releases to pressrelease@medicalnewstoday.com 

I must admit that the use of the word "Revolution" in the title: "A Prostate Cancer Revolution?" makes the story sound more exciting...however, this seems to be really good news!

Newsweek: News Source



A Prostate Cancer Revolution?

A new blood test for prostate cancer, currently being tested, could one day revolutionize the way the disease is diagnosed and treated.

WEB EXCLUSIVE

By Anne Underwood

Newsweek
Updated: 6:12 a.m. PT April 26, 2007

April 26, 2007 - Prostate cancer is the second leading cancer killer among men, after lung cancer. The American Cancer Society projects that in 2007 there will be 219,000 new cases and 27,000 deaths. Yet detecting the disease early has always been problematic. The only blood test available now—a test for prostate-specific antigen (PSA)—is not good at distinguishing malignancies from benign prostate enlargement (BPH). And it's useless for separating aggressive cancers from others that are so slow-growing they will likely never cause problems.

But a new blood test, described this week in the journal Urology, could change all that. In a study of 385 men, the new test was able to distinguish BPH from prostate cancer, and it pinpointed men who were healthy, even when their PSA levels were higher than normal. It also did the reverse—singling out men with cancer, even when their PSA levels were low. It may also distinguish cancer confined to the prostate from cancer that has spread beyond the gland. And it has the potential to dramatically reduce the number of biopsies performed every year. More trials are required, but if they're as promising as this initial study, the new test could reach the market in two to three years. NEWSWEEK's Anne Underwood spoke with the study's senior author, Dr. Robert Getzenberg, director of urology research at Johns Hopkins University School of Medicine. Excerpts:

NEWSWEEK: Why is the PSA test so problematic?

Robert Getzenberg: In the 25 years we've been using it, the PSA test has changed the face of prostate-cancer treatment. When I started in this field, half of patients had their cancer detected when it had already spread outside the prostate. Today we're finding cancer earlier, which is reducing mortality. But the test is problematic because PSA itself is not related to cancer. It's a protease [an enzyme that chops up proteins]. It's made by the prostate to keep the consistency of the ejaculate right, which is important. PSA may also protect against viral or bacterial invasions. But the prostate gland with cancer doesn't make any more PSA than the normal prostate. The levels are elevated because the PSA is not going into the ejaculate where it's supposed to go. Instead, it's going into the bloodstream, because cancer makes the prostate gland more leaky.

How is your test different?

It's a test for a structural protein found only in the nucleus of prostate-cancer cells, called early prostate cancer antigen-2, or EPCA-2. We don't know its exact function, but it's not expressed at all in normal cells. We think it gets into the blood through cell breakdown. Once it gets into the blood, it's very stable and hangs around a long time.

Does the level in the blood vary with the severity of the condition?

There are clear differences in levels between men who are healthy, those with BPH, those with cancer that's confined to the prostate and others whose cancer that has spread.

You studied men before and after prostate surgery. How did the levels change after surgery?

On average, six months later, the levels were at zero. Whatever caused the elevated EPCA-2 was removed.

How reliable is the test? Did you get any false positives?
About 3 percent of the time, when the test was positive, there was no prostate cancer there. In 6 percent of cases, there were false negatives [meaning the test came out negative but the patient did have cancer].

Still, that's much better than the situation today, where men with elevated PSA levels go for biopsies, which 80 percent of the time turn out negative.
An estimated 1.3 million to 1.6 million men undergo biopsies every year to identify the 230,000 or so patients with cancer. We're clearly overbiopsying.

And unless you stick the biopsy needle right into the tumor site—in other words, if you hit a part of the prostate without cancer—the biopsy will come out negative.

Doctors use ultrasound to guide the needle, but many lesions aren't visible by ultrasound. Often, they're very small. That's why doctors perform 12 core biopsies per patient—that means 12 needles. Some do 18 or more. You're looking for the equivalent of microscopic lesions inside a peach. Sometimes you hit it, sometimes you don't.

I never realized it before, but that means biopsying for breast cancer is easier. You start with a mammogram that shows the precise location of the suspicious lump.
Breast cancer lesions are typically bigger and easier to visualize on imaging. They are sometimes multifocal [found in multiple locations], but not as frequently. In prostate cancer, on average, you have five to six lesions. The prostate is also less accessible.

So if future trials go as well as this one, the EPCA-2 test could potentially revolutionize prostate care.
It will be the tool for identifying men with prostate cancer and separating them from others with BPH and prostatitis [inflammation or infection of the prostate]. It will identify the group that needs aggressive therapy from those who can use watchful waiting. Now, because we don't know which cancers are aggressive and which are indolent, we're overtreating some patients and undertreating others.

Do you see this test being used in conjunction with the PSA test?

Initially, yes. There's lots of work to do before we're ready to throw out the PSA. Eventually, if doctors find that the PSA test doesn't add much, they may decide they want to use EPCA-2 alone.

Do you foresee every man over 40 getting this test one day?

Yes, there's a window when cancers are curable. You want to catch them early. I would say men should start in their 40s, because that would establish the baseline, the normal level. How it changes over time is instrumental.

How exciting is this?

We've had the data for more than a year. We've been going over every aspect of it again and again, because it's almost too good for us to believe

URL: http://www.msnbc.msn.../site/newsweek/

Take care.

Those mammograms...

Health Day News: Source



New Study Stresses Mammogram's Importance in Breast Cancer Decline
Analysis shows effect of screening mammography

By Kathleen Doheny
HealthDay Reporter

SATURDAY, May 5 (HealthDay News) -- The decline in U.S. breast cancer cases is caused not only by fewer women using hormone replacement therapy but also by the use of mammography screening, new research suggests.

"Two distinct patterns are observed in breast cancer trends," wrote Dr. Ahmedin Jemal, strategic director for cancer surveillance for the American Cancer Society, in a report published in the May 3 online edition of the journal Breast Cancer Research.

After colleagues presented an abstract at a breast cancer symposium that attributed the 7 percent decline in U.S. breast cancer cases in the years 2002 to 2003 to the reduced use of hormone replacement therapy, Jemal's team decided to look at an older data base.

The researchers who linked the decline to reduced hormone use looked at a large data base from 2002 and 2003 called SEER (Surveillance, Epidemiology, and End Results). In 2002, a large federally funded trial -- part of the Women's Health Initiative -- was halted when evidence emerged of an increased risk of heart disease and breast cancer due to hormone therapy.

After that, women in large numbers went off their hormone replacement regimens.

But Jemal's team looked at older SEER data bases, from 1975 to 2003. The researchers looked at breast cancer incidence rates by tumor size, tumor stage, and whether the tumor was estrogen-receptor positive or negative among women who were age 40 or older in the years studied.

They found that the decline in breast cancer cases also dropped prior to the 2002-2003 SEER data, although the decrease was less dramatic -- about 5 percent between 1999 and 2000 there was a 5 percent drop, according to Jemal.

"The point is breast cancer started to decrease before 2002," Jemal said. And screening mammograms were the reason, he added.

The decline in breast cancer rates directly attributed to mammography, he said, has now leveled off.

"The message for women over 40 is still, they should get a mammogram every year so the tumor [if there is one] can be detected," Jemal said.

The new study is "a more nuanced analysis," said Roshan Bastani, professor and associate dean for research at the University of California, Los Angeles, and associate director for cancer prevention and control at the university's Jonsson Comprehensive Cancer Center. "It shows there were declines in breast cancer that started before the recent declines."

While from a public health perspective a plateau may have been reached when it comes to the benefits of screening mammography, Bastani added, it's still crucial for women over age 40 to keep their mammogram appointments. "About 75 percent of [U.S.] women are getting screened. That has not changed since 1999," she said.

More information

To learn more about breast cancer, visit the American Cancer Society.
http://www.cancer.or...I_2_3x.asp?dt=5

SOURCES: Ahmedin Jemal, D.V.M., Ph.D., strategic director for cancer surveillance, American Cancer Society, Atlanta; Roshan Bastani, Ph.D., professor and associate dean for research, and associate director for cancer prevention and control, Jonsson Comprehensive Cancer Center, University of California, Los Angeles; May 3, 2007, Breast Cancer Research, online

Copyright © 2007 ScoutNews, LLC. All rights reserved.
http://www.healthday.com/

Here's a group of doctors with a clue. I managed to stumble upon one, and was absolutely shocked when she gave me the Braverman test and knew everything I was talking about.

http://www.functionalmedicine.org/

Here's some introductory information regarding the primary source of evidence: the journal Neurology, a publication of The American Academy of Neurology - AAN -- from the U.S. Department of Health and Human Services:

American Academy of Neurology - AAN

Organization URL(s)

memberservices@aan.com
www.aan.com

Other Contact Information

1080 Montreal Avenue
St. Paul, MN 55116

800-879-1960 (Voice - Toll-free)
651-695-2717 (Voice)
651-695-2791 (FAX)

Description

The American Academy of Neurology (AAN) is a professional society composed of neurologists and professionals in related fields who share a common goal of continued growth and development of the neurological sciences.

Online Resources

Find a Neurologist
http://www.aan.com/membersearch/

Print Resources

The Academy publishes several brochures on neurology which are used by members for patient information. The Patient Information Guide for Neurology lists organizations which can supply information and materials on specific diseases. The publication, Neurologist, describes what a neurologist is and does. Serial publications: Neurology (journal), monthly; AANews (newsletter), monthly.

Here is some info from wikipedia on AAN:

The American Academy of Neurology (AAN) is a professional society for neurologists and neuroscientists. As a medical specialty society it was established in 1949 to advance the art and science of neurology, and thereby promote the best possible care for patients with neurological disorders.

Annual Meeting The annual meeting of the AAN is attended by more than 15,000 neurologists and neuroscientists from the US and abroad. The 2007 meeting will be in Boston featuring scientific presentations and educational courses. Plenary presentations on three days will highlight cutting edge clinical, translational and basic research. The annual "Future of Neuroscience" conference is titled "Therapies of Genetic Disorders" and will feature talks on enzyme replacement, gene therapy, siRNA, and stem cells ([1]).

Here is the study abstract:

NEUROLOGY 2007;68:751-756
© 2007 American Academy of Neurology

Serum cholesterol changes after midlife and late-life cognition
Twenty-one-year follow-up study

A. Solomon, MD, I. Kåreholt, PhD, T. Ngandu, BM, PhD, B. Winblad, MD, PhD, A. Nissinen, MD, PhD, J. Tuomilehto, MD, MpolSc, PhD, H. Soininen, MD, PhD and M. Kivipelto, MD, PhD
From the Department of Neuroscience and Neurology, University of Kuopio, Finland (A.S., T.N., H.S., M.K.); Department of Clinical Geriatrics (A.S., B.W., M.K.) and Aging Research Center (I.K., T.N., B.W., M.K.), Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland (I.K., A.N., J.T.); Department of Social Work, Stockholm University, Sweden (I.K.); Department of Public Health, University of Helsinki, Finland (J.T.); and South Ostrobothnia Central Hospital, Seinäjoki, Finland (J.T.).

Address correspondence and reprint requests to Dr. Miia Kivipelto, Aging Research Center, Karolinska Institutet, Gävlegatan 16, 11330 Stockholm, Sweden; e-mail: Miia.Kivipelto@ki.se

Background: Longitudinal studies have shown that high serum total cholesterol (TC) at midlife is a risk factor for dementia/Alzheimer disease. The significance of TC later in life is unclear. 

Objective:To investigate changes in serum TC from midlife to late life and their relationship with late-life cognition.

Methods: Participants of the Cardiovascular Risk Factors, Aging and Dementia study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals aged 65 to 79 were reexamined in 1998.

Results: Serum TC levels decreased in most individuals. High midlife TC represented a risk factor for more severe cognitive impairment later in life, and the values were significantly different between the control, mild cognitive impairment, and dementia groups. There were no significant differences in serum TC at reexamination. A moderate decrease in serum TC from midlife to late life (0.5 to 2 mmol/L) was significantly associated with the risk of a more impaired late-life cognitive status, even after adjusting for age, follow-up time, sex, years of formal education, midlife cholesterol, changes in body mass index, APOE 4 genotype, history of myocardial infarction/stroke/diabetes, and lipid-lowering treatment.

Conclusions: The relationship between serum total cholesterol (TC) and dementia seems to be bidirectional. High midlife serum TC is a risk factor for subsequent dementia/Alzheimer disease, but decreasing serum TC after midlife may reflect ongoing disease processes and may represent a risk marker for late-life cognitive impairment.
--------------------------------------------------------------------------------

The study is supported by Alzheimer Association, USA, Grant IIRG-04-1345, Marie-Curie EST Program, MEST-CT-2005-019217, EVO-grant 5772720 from Kuopio University Hospital, the Gamla Tjänarinnor Foundation and the Swedish Council for Working Like and Social Research (2004-1200).

Disclosure: The authors report no conflicts of interest.

Contributors: M.K. has been the principal investigator in diagnosing dementia. A.S. analyzed the data and drafted the paper. M.K., I.K., and T.N. assisted in analyses and writing. M.K., A.N., J.T., and H.S. contributed to the conception and design of the study; J.T. and A.N. were involved in the baseline surveys for the study. A.S., T.N., I.K., B.W., H.S., J.T., A.N., and M.K. took part in planning the study and interpreting the data and commented on the manuscript. M.K. is the guarantor.

Received July 4, 2006. Accepted in final form November 9, 2006.

Copyright © 2007 by AAN Enterprises, Inc.

I think this makes it clear that one should have one's serum Serum TC levels analyzed to ensure they aren't out of range -- this is a 21 year follow-up study that seems to clearly define a connection between serum total cholesterol (TC) and dementia.

Wonder's myspace has an image in her movie section that's pretty funny I think.  That is, the equivalent to a male mammogram: "The Manogram."

Here is a link to an article called: "Autism's roots: mix of chance and genetics."

Hopefully, soon, Professional Medical Care will develop effective preventative measures and curative solutions to assist those individuals and families suffering from autism.  Modern Medicine has been working to find solutions to autism, and even though some noble humanitarians have made substantial contributions to help autistic children and their families, there still is no cure for autism -- at least yet.  It seems there's a lot more work to do.

Back to the topic "Is Professional Medical Care Worthwhile?":

Image Credit: Suzanne DeChillo/The New York Times
Dr. Elizabeth Morris of Memorial Sloan-Kettering Cancer Center in New York, a member of an expert panel that issued new guidelines.

March 28, 2007
Call to Increase M.R.I. Use for Breast Exam
By DENISE GRADY

Two reports being published today call for greatly expanded use of M.R.I. scans in women who have breast cancer or are at high risk for it.

The recommendations do not apply to most healthy women, who have only an average risk of developing the disease.

Even so, the new advice could add a million or more women a year to those who need breast magnetic resonance imaging — a demand that radiologists are not yet equipped to meet, researchers say. The scans require special equipment, software and trained radiologists to read the results, and may not be available outside big cities.

Breast M.R.I. costs $1,000 to $2,000, and sometimes more — 10 times the cost of mammography — so a million more scans a year would cost at least $1 billion. It is sometimes covered by insurance and Medicare, sometimes not.

One report is a set of new guidelines for using M.R.I. in women at high risk for breast cancer, and the other is a study in The New England Journal of Medicine showing that in women who have newly diagnosed cancer in one breast, M.R.I. can find tumors in the other breast that mammograms miss.

M.R.I. has drawbacks. It is so sensitive — much more so than mammography — that it reveals all sorts of suspicious growths in the breast, leading to many repeat scans and biopsies for things that turn out to be benign. For women who are likely to have hidden tumors, the prospect of such false-positive findings may be acceptable. But the risk of needless biopsies and additional scans is not considered reasonable for women with just an average risk of breast cancer, and is the main reason M.R.I. is not recommended for them.

The new guidelines, from the American Cancer Society, are being published in the society’s journal CA: A Cancer Journal for Clinicians. They recommend scans and mammograms once a year starting at age 30 for high-risk women.

High risk is defined as a 20 percent to 25 percent or higher chance of developing breast cancer over the course of a lifetime. (The average lifetime risk for women in the United States is 12 percent to 13 percent.)

The high-risk group includes women who are prone to breast cancer because they have certain genetic mutations, BRCA1 or BRCA2, or those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested. These mutations are not common — they cause less than 10 percent of all breast cancers — but they greatly increase a woman’s risk, to 36 percent to 85 percent.

Women with even rarer mutations, in genes called TP53 or PTEN, are also advised to be screened, as are women who had radiation treatment to the chest between ages 10 and 30, for disorders like Hodgkin’s disease.

Others at high risk include women from families in which breast cancer is common, especially in their close relatives, even if no genetic mutation has been identified. Women and their doctors can estimate their odds by using one of several online risk calculators that factor in the medical history of both the woman and her family. A simple calculator is available at http://www.cancer.gov/bcrisktool/.

But different calculators can give quite different results, and women may need help from their doctors to interpret the results, said Dr. Elizabeth Morris, a member of the expert panel that drew up the guidelines and director of Breast M.R.I. at Memorial Sloan-Kettering Cancer Center in Manhattan.

“Just to figure out who should have it will be the hardest thing,” Dr. Morris said. “A lot of that onus is put on the referring physician. A lot of women are going to think they’re high risk, and they’re not.”

The cancer society said that for women with certain conditions, there was not enough information to recommend for or against M.R.I. screening. The uncertain group includes women with very dense breast tissue on mammograms, and women who had breast cancer in the past, or growths called carcinoma in situ or atypical hyperplasia.

Dr. Robert Smith, the cancer society’s director for screening, estimated that the new guidelines would add one million to two million women a year to the number who should have breast M.R.I.

Increased demand for such scans could easily outstrip the capacity, even though the number of centers offering them has increased markedly in the last five years, said Dr. Constance Lehman, another member of the panel that wrote the guidelines and a professor of radiology at the University of Washington. She said professional societies in radiology were scrambling to provide training and accreditation for the scans.

Insurers will probably cover the scans because the new guidelines are based on good evidence and promoted by a respected medical group, said Peter V. Lee, president of the Pacific Business Group on Health, a nonprofit coalition of large buyers of health care that cover about five million people. Huge amounts of money are now wasted on unnecessary M.R.I., Mr. Lee said, adding: “Here we have a case where there’s evidence. Hallelujah! Let’s use it.”

Not every imaging center is qualified to perform such scans, but some that are not up to par may offer it anyway, so patients must beware.

Special equipment is needed: a powerful, “high-field” magnet and a special breast coil to generate a magnetic field around the breast. The scan is done with the woman lying on her stomach on a special table with openings that let the breasts rest in wells surrounded by the coil.

“And you have to make sure they’re doing enough, not one a week, and make sure they have biopsy capability,” Dr. Morris said.

If the breast scan is done at a center that cannot perform biopsies, a woman with a suspicious finding may have to start all over again at another clinic.

The second new report describes a study showing that in women who had cancer in one breast, an M.R.I. scan of the other breast found tumors that mammograms had missed in 3 percent of the women. Researchers say M.R.I. can help women who already have one cancer by detecting a hidden tumor in the other breast, enabling them to have both cancers treated at once instead of having to go through treatment all over again when the second tumor is finally detected.

Research has shown that 10 percent of women who have cancer in one breast will eventually develop it in the other as well.

“This study supports the recommendation that women who are diagnosed with breast cancer consider the benefits of a breast M.R.,” said Dr. Lehman, the senior author of the study. “What we think is most important is that we understand the full extent of a woman’s breast cancer before her therapy is initiated.”

The scans are recommended in newly diagnosed cases, but not for most women who had breast cancer treated in the past.

Currently, women with newly diagnosed cancer in one breast are given mammograms of the other, but only a minority are offered M.R.I., Dr. Lehman said. This year, about 180,000 new cases of breast cancer are expected in the United States.

Some surgeons think every woman with a new diagnosis of breast cancer should have an M.R.I. of the other breast, and some think no one should, Dr. Morris said. She said the scans were most likely to be useful in younger women with breast cancer and dense tissue that hides tumors from mammograms. In older women with small, early tumors and clear mammograms, she said, such scanning is less important.

The study findings will make it harder for insurance companies to refuse to pay for such scans of the second breast in women with breast cancer, said Dr. Etta D. Pisano, another author of the study and a professor of radiology at the University of North Carolina.

The study, conducted at 25 medical centers, included 969 women with recently diagnosed cancer in one breast and a normal mammogram on the other. All were given M.R.I. scans, which discovered cancers in the supposedly healthy breast in 30 women, 3.1 percent of the group. Nearly all the cancers were at an early stage, and were treated at the same time as the ones originally discovered.

Without the scans, Dr. Lehman said, the tumors would not have been found until later, and then the women would have had to go through surgery, and perhaps radiation and chemotherapy as well, all over again. “We know cancers diagnosed later in these women don’t do as well as cancers diagnosed initially,” she said.

But to find 30 cancers, 121 women had biopsies, which were ordered because of abnormalities on M.R.I. That means 91 false-positive scans and biopsies of healthy tissue, and a false-positive rate of about 10 percent. Dr. Lehman said most cancer patients were willing to accept the risk of a false-positive and a biopsy in order to find out whether there was anything to worry about in the other breast.

The study was paid for by the National Cancer Institute.

Copyright 2007 The New York Times Company

Peace.

What might seem to be a related study was published today in The Lancet; one of the world's "premier" Medical Journals.

Here is some introductory information regarding this primary source of evidence; provided by Wikipedia; this information seems to be accurate as of August 10, 2007:

The Lancet is one of the oldest peer-reviewed medical journals in the world, published weekly by Elsevier, part of Reed Elsevier. It was founded in 1823 by Thomas Wakley, who named it after the surgical instrument called a lancet, as well as an arched window ("to let in light").

The present editor-in-chief is Richard Horton. The Lancet takes a stand on several important medical issues - recent examples include criticism of the World Health Organization, rejecting the efficacy of homeopathy as a therapeutic option and its disapproval of Reed Elsevier's links with the arms industry.

Impact
The Lancet has a significant readership throughout the world with a high impact factor. It publishes original research articles, review articles ("seminars" and "reviews"), editorials, book reviews, correspondences, amidst other regulars such as news features and case reports. The Lancet is considered to be one of the "core" general medical journals, the others being the New England Journal of Medicine, the Journal of the American Medical Association, and the British Medical Journal. The Lancet's impact factor is currently ranked #2 among general medical journals (click here for impact factor rankings).

Journals family
The Lancet has now given birth to a few sub-speciality journals, all bearing the parent title - The Lancet Neurology (neurology), The Lancet Oncology (oncology) and The Lancet Infectious Diseases (infectious diseases). All of them have established significant reputations as medical journals, though most started out publishing only review articles.

Volume renumbering
Prior to 1990, Lancet had volume numbering that reset every year. Issues in January to June were in volume i, with the rest in volume ii. In 1990, Lancet moved to a sequential volume numbering scheme, with two volumes per year. Volumes were retro-actively assigned to the years prior to 1990, with the first issue of 1990 being assigned volume 335, and the last issue of 1989 assigned volume 334. The table of contents listing on Science Direct uses this new numbering scheme.

Controversial articles
The Lancet was severely criticized after it published a paper in 1998, in which the authors linked the MMR vaccine with autism. In February 2004 The Lancet published a partial retraction of the paper (Lancet 2004;363:750). Dr Horton went on the record to say the paper had "fatal conflicts of interest" because one of the authors had a serious conflict of interest that he had not declared to The Lancet [1].

The Lancet published a controversial estimate of the Iraq war's Iraqi death toll--around one hundred thousand--in 2004. In 2006 a followup study by the same team suggested that the violent death rate in Iraq was not only consistent with the earlier estimate, but had increased considerably in the intervening period (Lancet surveys of mortality before and after the 2003 invasion of Iraq). The second survey estimated that there had been 654,965 excess Iraqi deaths as a consequence of the war. The 95% confidence interval was 392,979 to 942,636. 1849 households that contained 12,801 people were surveyed.[2]

In January 2006, it was revealed that data had been fabricated in an article by the cancer researcher Jon Sudbø and 13 co-authors published in The Lancet in October 2005 [3]. The fabricated article was entitled "Non-steroidal anti-inflammatory drugs and the risk of oral cancer: a nested case-control study". [4]. Within a week after this scandal surfaced in the news, the high-impact New England Journal of Medicine published an expression of editorial concern regarding another research paper published on a similar topic in the journal.

2007 Impact factors of top medical journals, The Lancet's impact factor ranked #3 in General Medicine:
http://www.epidemiol...or-leading.html

Anyways, so here's the potentially related abstract:

The Lancet 2007; 370:485-492

DOI:10.1016/S0140-6736(07)61232-X
Articles

MRI for diagnosis of pure ductal carcinoma in situ: a prospective observational study
Prof Christiane K Kuhl MD  a ,  Simone Schrading MD a,  Heribert B Bieling MS b,  Eva Wardelmann MD c,  Claudia C Leutner MD a,  Roy Koenig MD a,  Walther Kuhn MD d  and  Prof Hans H Schild MD a

Summary
Background
Diagnosing breast cancer in its intraductal stage might be helpful to prevent the development of invasive cancer. Our aim was to investigate the sensitivity with which ductal carcinoma in situ (DCIS) is diagnosed by mammography and by breast MRI.

Methods
During a 5-year period, 7319 women who were referred to an academic national breast centre received MRI in addition to mammography for diagnostic assessment and screening. Mammograms and breast MRI studies were assessed independently by different radiologists. We investigated the sensitivity of each method of detection and compared the biological profiles of mammography-diagnosed DCIS versus DCIS detected by MRI alone. We also compared the risk profiles of women with mammography-detected DCIS with those of MRI-detected DCIS.

Findings
193 women received a final surgical pathology diagnosis of pure DCIS. Of those, 167 had undergone both imaging tests preoperatively. 93 (56%) of these cases were diagnosed by mammography and 153 (92%) by MRI (p<0·0001). Of the 89 high-grade DCIS, 43 (48%) were missed by mammography, but diagnosed by MRI alone; all 43 cases missed by mammography were detected by MRI. By contrast, MRI detected 87 (98%) of these lesions; the two cases missed by MRI were detected by mammography. Age, menopausal status, personal or family history of breast cancer or of benign breast disease, and breast density of women with MRI-only diagnosed DCIS did not differ significantly from those of women with mammography-diagnosed DCIS.

Interpretation
MRI could help improve the ability to diagnose DCIS, especially DCIS with high nuclear grade.

Affiliations

a. Department of Radiology, University of Bonn, Bonn, Germany
b. Biomedical Sciences and Informatics, University of Bonn, Bonn, Germany
c. Department of Pathology, University of Bonn, Bonn, Germany
d. Department of Gynaecological Oncology, University of Bonn, Bonn, Germany

Correspondence to: Prof Christiane Kuhl, Oncological Imaging and Intervention, Department of Radiology, University of Bonn, Sigmund-Freud Str 25, 53105 Bonn, Germany

Health Day News issued a "mainstream" report on this matter, you can find "MRI Beats Mammograms at Spotting Early Breast Cancer" by clicking here

Take care.