What do you think is the best way to choose an experienced and quality surgeon? Some researchers think it's by reputation. That's how I got mine. A friend told me who he'd use if his wife or mother developed breast cancer and then more and more people began recommending the same surgeon. It seemed logical I'd use him too. And I'm glad I did.

A study published in the January 20 Journal of Clinical Oncology reveals that women who actively choose their surgeons by reputation are more likely to be treated by experienced surgeons in hospitals with comprehensive cancer programs. Reputation even beat out accepting referrals from other doctors or health plans.

Recently, a relative of mine lost his wife to a hospital-acquired infection after a successful cancer surgery. She had been expected to make a full recovery from the cancer.

Such infections are on the rise. A recent media report states that a drug-resistant form of staphylococcus, methicillin-resistant staphylococcus (MRSA), may be infecting as many as 5 percent of hospital and nursing home patients. This rate is about ten times the rate previously estimated.

What can you do to protect yourself or a loved one during a hospital stay? Some tips include asking staff and visitors to wash their hands often and asking the doctor to wash any stethoscopes used. Before a surgery, be sure to ask your surgeon about the hospital's infection rate, about showering or bathing daily with chlorhexidine soap three to five days before the surgery and about the necessity of an antibiotic treatment an hour before the surgery.

My relative who suffered this tragic, unnecessary loss of his wife has started a non-profit organization to educate the public, ODEE PD Health Safety Initiative. From the ODEE educational materials, perhaps the most important piece of advice on how to protect ourselves, changing our attitude:

Protecting ourselves begins with changing our mindset. Maybe we are not accustomed to speaking up! Much as we are impressed by the care our doctors and hospitals can give us, we must not be timid about letting them know our concerns for safety in the hospital.

Today, more than ever, we need to speak up and speak out. We cannot accept the fact that deadly hospital infections exist and threaten our safety. We can be polite, but also must be very firm and persistent. We cannot be shy or feel funny about speaking up.

For more tips on how to protect you or a loved one against hospital-acquired infection, see HospitalInfections.org, Protecting Yourself.

What can I do at Careplace?

At Careplace you can connect with others who's lives are like yours. Discuss treatments in online forums, create personal webpages, show support with virtual hugs, send private messages, create your own photo albums, groups and online journals.

• Join or start a group - Groups are places that people can organize to discuss common interests. If you take a certain medication and want to discuss your progress or side effects, you can share with other group members who take this medication. You can also create groups about fishing or baseball, anything goes!
• Join a discussion - Forums are where people come together to support one another, ask questions and share news or experiences.
• Send a private message - Sending private messages is a great way to get to know others better, share a friendly greeting or ask them for more information about something with which they have some experience.
• Send someone a hug - Sending hugs are an easy way to show someone you care and remind them they are not alone.

Careplace is a knowledge portal that isn't bogged down with medical jargon and words you don't understand. The pages have lists of personal experiences people have had with medications,treatments, doctors and hospitals.

International pharmaceutical company AstraZeneca is donating $10 million to the American Cancer Society (ACS). The donation is one of the largest gifts ever received by the ACS and will help provide support for patients in United States hospitals.

Support will come in the form of specially-trained ACS employees who will work in 60 different hospitals and cancer centers and will offer social, emotional, financial, and transportation assistance in medically underserved Atlanta areas.

London-based AstraZeneca, maker of breast cancer drug tamoxifen and other breast and prostate cancer drugs, made $26 billion in sales last year, the same year the company gave $7 million to a Boston Cancer Society for the development of a Hope Lodge.

Secondhand smoke rears its ugly head once again -- this time in the form of study results revealing high levels of secondhand smoke in the workplace can double the risk of lung cancer for non-smokers.

Researchers at the University of Illinois at Chicago looked at results from 22 studies conducted in the United States, Canada, Europe, India, Japan, and China. What they found -- and published in the American Journal of Public Health -- is a lung cancer risk 50 percent higher than normal for non-smokers exposed to smoke on the job for more than 30 years. They also found risk increases with level of exposure.

"We believe that our study provides the strongest evidence to date that smoking in the workplace does present a substantial risk to workers -- and particularly to workers who are working in highly exposed areas such as bar workers or restaurant workers," lead researcher Leslie Stayner said.

Previous evidence for increased lung cancer risk caused by secondhand smoke comes from studies of non-smokers married to smokers.

Secondhand smoke -- also known as passive smoke and environmental tobacco smoke -- is smoke from a cigarette, pipe, or cigar as well as smoke exhaled from the lungs of smokers and inhaled by non-smokers. It can cause cancer, respiratory problems, and asthma in non-smokers and is leading to increased efforts by communities to ban or limit smoking in the workplace.

This week in France, bans begin in offices, stores, schools, and hospitals. Come January 2008, cafes and restaurants must also comply with bans. For now, smoking in these areas is permitted in hermetically sealed rooms without any services.

It has just recently been discovered that CT scans for children have been inappropriately used in two Ontario hospitals. As a result, some children have received excessive doses of radiation, putting them at greater risk of developing cancer later in life.

Staff at the two hospitals -- Peterborough Regional Health Centre is one -- reported that in close to 50 percent of selected cases, the appropriate equipment settings were not used.

Herein lies the problem -- developing organs are more susceptible to damage, and giving a small child an adult dose of radiation in a CT scan delivers the same amount of radiation as 4,000 traditional X-rays. Research shows that increased exposure to radiation over time can cause radiation-induced cancer.

CT scans are valuable diagnostic tools because they create 3-D images of organs, offering a better view of head injuries, chest trauma, cancer, and fractures. So they should not be disregarded -- but clearly, hospitals need to improve the management of all scanning procedures.

In Ontario, a diagnostic image safety committee has already been formed. The goal of this committee is to develop standards and do a better job of tracking radiation levels.

Experts are encouraging Ontario parents to refrain from worry unless their children have received many CT scans. And all parents are encouraged to speak up before their children receive CT scans. "Is my child receiving a pediatric protocol?" is all it takes.

The CyberKnife -- a powerful new weapon in the war on cancer -- involves no cutting, like the name implies. This robotic system instead uses hundreds of focused radiation beams to destroy a tumor. A robotic arm moves around the patient and an image-guided system tracks the targeted tumor. CyberKnife delivers small blasts of radiation from up to 200 angles and keeps the tumor in its sights at all times. CyberKnife treatments are completed in one to five days which is just one of the benefits of this therapy compared to traditional radiation therapy.

With traditional radiation, patients often endure treatment for five to eight weeks. And healthy tissue can be destroyed every time the patient shifts or breathes. The CyberKnife attacks the cancerous tumor only -- even while the patient breathes. CyberKnife therapy, available in only 50 hospitals in the United States, requires no mold to position patients, can treat anywhere in the body, and can help patients who no longer respond to traditional treatments.

CyberKnife is covered by insurance and approved by Medicare.

US News & World Report ranked 5,189 hospitals -- only 176 made it on this year's list of America's Best Hospitals 2006.

Of those 176, only 14 hospitals are on the Honor Roll. Johns Hopkins Hospital made the number one spot, the Mayo Clinic came in at number two and The Cleveland Clinic claims the third position. Wonder where your hospital ranks? Check Best Hospitals 2006.

Hospitals were also ranked by specialty. 52 hospitals specializing in cancer were ranked. Here are the top ten:

• Memorial Sloan - Kettering Cancer Center, New York
• University of Texas M. D. Anderson Cancer Center, Houston
• Johns Hopkins Hospital, Baltimore
• Mayo Clinic, Rochester, Minn.
• Dana - Farber Cancer Institute, Boston
• University of Washington Medical Center, Seattle
• Duke University Medical Center, Durham, N.C.
• University of Chicago Hospitals
• UCLA Medical Center, Los Angeles
• University of California, San Francisco Medical Center

Statistics in North Carolina show that breast cancer is the most common cancer diagnosed in women statewide and the second leading case of cancer related deaths statewide. Lung cancer is first. The new Breast Cancer Resource Directory of North Carolina is now available and can be found at the N.C. Center for Genomics and Public Health located in the UNC-Chapel Hill School of Public Health. The directory is free. You can also call (800) 514-4860 or email bcresources@med.unc.edu if you are a NC resident and receive a free copy.

The directory covers many topics for women diagnosed or in a high risk category for breast cancer like diagnosis and treatment, insurance and finances, a listing of support groups, and a listing of cancer treatments at hospitals in North Carolina. The NC Triangle Affiliate of the Susan G. Komen Breast Cancer Foundation is a longtime sponsor of the project along with the Breast Cancer Coalition of North Carolina, the N.C. Center for Genomics and Public Health and UNC Lineberger Comprehensive Cancer Center.

Despite tensions between the United States and the Middle East, Laura Bush announced Monday a plan to raise breast cancer awareness in the Middle East -- first with partnerships with the United Arab Emirates and Saudi Arabia and later with Morocco and Jordan. Joining forces also with the Susan G. Komen Breast Cancer Foundation, the MD Anderson Cancer Center in Houston, and Johns Hopkins Medical Center, the First Lady outlined a plan that will allow governments, hospitals, researchers, and survivors to work globally to defeat breast cancer. Campaigns specific to each country will target research, training, and community-outreach programs. The reason for this partnership -- to raise awareness in countries where women are too embarrassed or too uninformed to seek treatment -- stems from compassion and human decency and a desire to form diplomatic friendships too. Laura Bush, whose own mother is a breast cancer survivor, shared that the tragedy of losing a loved one to breast cancer -- and the joy of watching a loved one survive this same disease -- is felt universally. Breast cancer affects all women in all countries. Borders make no difference in this matter. And helping save lives is the right thing to do.

From the Homer Simpson D'oh Research Institute comes the results of a study ... No, wait. I'll start again. Baby boomers are aging. The largest percentage of cancer diagnosis occurs in the older population. When it comes to cancer, it is a true and unavoidable fact that the older one gets, the greater the risk for developing cancer.

One day, with continued advancements in prevention and research, that fact might change. But for now, that is where we are in the reality of cancer risks. The baby boomers, a generation born between 1946 and 1960, are reaching, in mass, people of a certain age. Old age. Don't say that to them. Baby boomers decided, upon reaching 40, that 40 was the new 30, and 50 was the new 40. But you can't fool mother nature, and like it or not, we are all getting older. The first baby boomers turn 60 this year.

Which brings me to the point of the isn't it obvious study from the Homer Simpson D'oh Research Institute.

With the healthcare system in crisis now -- with public and private providers scrambling to figure out how to pay for all the cancer treatments needed for all the patients who have been diagnosed with cancer now -- what is the future of healthcare going to look like, say in ten more years, as significant numbers of baby boomers continue to age and more get sick from age-related life-threatening diseases -- specifically cancer?

When it comes to baby boomers, it is difficult to predict. Since coming of age in the 1960s, they have influenced the cultural landscape as no other generation. They are, as a whole, innovatively affluent, and have in subtle ways, already begun to change the healthcare system. An example is the marketing hospitals do to attract baby boomers as patients with amenities unimagined in previous decades. Some hospitals now serve wine with the hospital meal.

Baby boomers are the premiere paradigm shifters. If there is no change in the current system, we are in terrible trouble in the next ten years. It will be interesting to watch how the baby boomers decide to define and shape the approach to health issues that old age brings. 

Disclaimer: The Homer Simpson D'oh Research Institute is an imaginary facility that does not conduct research because it doesn't exist in real life.

I have been invited to a celebration. A celebration of cancer survivorship. I received my invitation the other day for a picnic of sorts sponsored by my local American Cancer Society office, and I have since learned that in communities all over the map, similar celebrations will happen. June 4 is National Cancer Survivors Day and that is surely cause for a party. 

National Cancer Survivors Day is recognized annually, on the first Sunday in June. This year marks the 19th year of this special occasion that will feature in more than 700 communities an array of carnivals, parades, art exhibits, races, dances, workshops and more. The idea for this day began 21 years ago when a lung cancer survivor and his wife sponsored a rally in Kansas City, Missouri and the idea caught on. Now the non-profit National Cancer Survivors Day Foundation supports hundreds of hospitals, support groups, and other organizations that host events on this day. 

It's nice to know that the hospital and clinics and organizations that are stops on my breast cancer journey may be recipients of the festivities that take place in my city on June 4. And it's nice to know that I have a celebration to attend in honor of all those, like me, who have been victorious in the war against cancer.

Few would disagree that the health care system in this country is breaking down. If you are one of the 45 million without health insurance you already know how difficult it is to get health care, and if you have medical insurance you continue to watch as your insurance premiums and deductibles go up year after year. Medicine has become more about money and less about patient care. We are told we spend more because we have the best health care system in the world.

But as Maggie Mahar points out in her new book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, "We spend twice as much as Japan on health care -- yet few would argue that our health care system is twice as good." Mahar, a seasoned financial journalist, takes an in depth look at what she calls America's complicated and increasingly dysfunctional health care system, and what she finds is disturbing. Frankly, from a patient's perspective, it's reprehensible.

Doctors aren't allowed to function as doctors in putting a patient's needs first -- no -- medicine is business and corporations decide on a patient's treatment. To put it bluntly, medicine is a market-driven $2 trillion industry rife with competition. To cite just one example of what is taking place, and to illustrate how medicine truly sees itself  -- Milwaukee hospitals spent more in one year on advertising than fast food business did. Reviewers are calling Mahar's book a thoroughly researched and carefully reasoned study. I call it gutsy because she takes no prisoners and she isn't keeping any secrets. Until the day comes when doctors are allowed to practice medicine once again, with the priority on the patient and not corporate profit, the wheels on this buggy are going to keep falling off one by one until the axle completely splits in two. A must read for anyone who wants to understand how the system works and what motivates the players. The patients aren't even in the game. And that is what is truly appalling.