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What tests do we really need?

Wouldn't it be great if we could receive full-body scans every year to check for early signs of cancer and other disease? Even if possible and affordable -- right now, scans cost about $900 -- it still wouldn't be such a great idea.

Full-body scans often result in false alarms. People with harmless abnormalities may end up facing more tests, more risks, and more worry in order to rule out illness. The scan itself can present health hazards too. It exposes patients to more radiation than a chest X-ray and could slightly increase the risk of cancer, especially for those scanned every year.

How do we know, then, if something has gone awry in our bodies? Well, we can do our self-exams -- breast exams, testicular exams, skin exams -- and we can report for annual check-ups. We can respond to symptoms we experience -- if headaches are bothersome and persistent, your doctor may prescribe a head scan -- and we can pursue tests and screening that we really need for cancer prevention and early detection. Here are just a few:

Continue reading What tests do we really need?

Tumor markers predict cancer growth -- sometimes

Cancer cells sometimes secrete specialized proteins into the bloodstream that serve as indicators of tumor growth. These tumor markers are often distinctly associated with a particular type of cancer. Like prostate cancer.

The most well-known tumor marker today is the PSA -- the prostate-specific antigen. PSA is a highly specific protein that is secreted only by cells of the prostate gland. It is one of the most widely used -- and the only widely accepted -- screening test for cancer.

There's also the tumor marker CA-125, used in the diagnosis of ovarian cancer and in the monitoring of response to treatment for the same disease. There's CEA for colon cancer, CA-19-9 for pancreatic cancer, AFP for liver and testicular cancer, beta-HCG for testicular cancer, and CA 15-3 for breast cancer. And research is under way on newer, more useful tumor markers. This is a good thing -- because some tumor markers are not specific enough or sensitive enough to accurately predict tumor growth.

This is why my oncologist does not recommend I enter the world of tumor markers, despite my status as a breast cancer survivor. He suggests I rely simply on how I feel for monitoring my chances for cancer recurrence. If I experience any worrisome symptoms, he will be the first to wage an all-out assessment of my health. But without symptoms, tumor markers are not likely to help me at all.

A peek at my breast cancer tumor markers would likely be hazy, inconclusive, and not all that helpful. Examination of tumor markers can lead to false positives. It can lead to expensive and often unnecessary follow-up testing. It can lead to worry and panic and even alarm if the numbers are not in the hoped-for range.

Although an abnormal tumor marker level may suggest cancer, this alone is typically not enough to diagnose the disease. Measurements of tumor markers are usually combined with other tests, such as a biopsy, to confirm cancer. So what would I do with an abnormal number and nothing suspicious to biopsy? I would worry. I would panic. Perhaps unnecessarily.

My doctor suggests I refrain from a wild cancer chase. And I am happy with his suggestion. Between my own awareness, follow-up oncology appointments, mammograms, annual OB/GYN check-ups, and more, I am confident any health issues that come my way will be detected early -- and can be resolved in good time. I have no need for confusing tumor marker details. Unless they are conclusively recommended, I will survive without them. More important, I will survive without worry.

Lumpectomy technique saves patients from repeat surgery

On Sunday, for the very first time, I read a magazine article about the hospital where I received treatment for breast cancer. I had never before seen mention of my hospital, my doctors, my city in anything other than local and regional newspapers and on area television stations. I figured news about Shands Hospital at The University of Florida was out there -- in more areas than my own -- because it's a well-known facility. People travel from all over to receive treatment here. So I know it's a good place. But to see in the October 2006 issue of Good Housekeeping an actual blurb about a new kind of lumpectomy -- pioneered right here in Gainesville, Florida -- is exciting.

I am the happy recipient of this new kind of lumpectomy -- which really is not new at all. It was developed 20 years ago by the surgeon who performed my own lumpectomy, and it allows women who undergo lumpectomy the chance to avoid return trips to the operating room.

The method is called frozen section analysis, and it was first used by Dr. Edward Copland III, first director of the UF Shands Cancer Center, who was tired of waiting for pathology reports and tired of operating on patients two and three times to ensure clear tumor margins.

It all happens like this -- a surgeon removes the breast cancer tumor, takes tissue samples, freezes them in an embedding compound, and sends them to a pathologist for immediate analysis. In a typical case, this frozen section process adds just 15 minutes to the operating time. If pathology reveals more tissue must be removed, the surgeon returns to the patient, still under anesthesia, and continues surgery. The patient does not need to return for more surgery.

Surgeons at most institutions rely on a method called permanent section analysis to determine whether or not cancerous cells remain along the margins of a tumor. The technique is labor-intensive, takes days to complete, and requires patients to return for additional surgery if margins are not clear. Surgeons using the frozen section method still consult permanent sections to confirm margins are clear -- but they are mostly certain of their findings during frozen section.

Studies show frozen section analysis to be safe and effective -- and it adds just $851 to the cost of surgery, a savings considering the cost of returning for surgery as a result of permanent analysis.

There are many advantages -- but the procedure is tricky and on occasion can fail to detect some cancerous margins, indicating frozen section should continue to be used in conjunction with permanent section. Opponents of the practice say false positives could result in unnecessary mastectomy. But Copeland says this has never happened at UF -- and he would never remove a woman's breasts until permanent section confirmed it was necessary.

Despite the promise of this method, only a handful of institutions make practice of this surgery-sparing technique. Shands at UF is the only hospital in North Florida where breast surgeons perform frozen section analysis on a regular basis.

The procedure -- which is not risky, is not harmful, and clearly saves patients from returning for surgery -- is the exact procedure I received almost two years ago. Dr. Copeland removed my tumor, froze tissue samples, sent them to pathology, and 15 minutes later knew my tumor had clear margins and had not spread to my lymph nodes. He visited my family in the hospital waiting room just after surgery and told them the good news -- clear margins, no spread, a 1.1 cm. tumor, stage I. And while other tumor criteria, such as ER/PR status and HER2 status, did not come my way immediately, I at least knew the basics when I woke from surgery. No waiting. No worrying. No complaints.

Warm blanket solves the cancer scan brown fat false positive dilemma

Whoever stumbled across this discovery is a genius! First let me say there is nothing that will knock the breath right out of you than being told a test for cancer has come back positive. False-positive results are determined when the second follow-up test reveals the first test is an error in diagnosis. I am certain the first reaction is relief -- and then a sort of aggravation that you had to be put through the harrowing emotions of a cancer diagnosis in the first place.

False-positives can happen for a number of reasons, but one of them involves body heat generated by brown adipose tissue, or brown fat, which can mimic cancer during a PET/CT scan. The current solution is the use of valium and beta blockers during the scan, and studies have shown it reduces reading error by 30 percent. However -- and here is where the whoever thought to do this is a genius comes into play -- the simple use of a warm blanket is more than twice as effective as the administration of drugs in preventing the uptake of tracer by brown fat in the body. According to the researchers, everyone has brown fat, but it is more common in slender women.

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