Entries for the ‘Cancer treatment’ Category

What is a patent and what did the US Supreme Court decide about human genes and patents?

Thursday, June 13th, 2013

117_1749June 13, 2014

The US Supreme Court ruled that human genes cannot be patented. A patent is the authority to make, use, or sell something. Myriad Genetics Inc. sought patents regarding genes for which some versions have been linked to breast and ovarian cancer–the BRCA gene mutations. The Court decided that identifying and isolating these genes is not worthy of a patent. On the other hand, Myriad also has created a synthetic form of DNA known as cDNA and that was determined to be worthy of a patent.

For patients, testing for BRCA gene mutations may become more accessible. Until now, Myriad has had the only genetic test for BRCA gene mutations. Perhaps others will now develop testing and contribute to cost reductions, since Myriad does not hold exclusive rights to make, use, or sell products associated with these genes.   

 

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Talking about Angelina Jolie’s dislcosure about BRCA mutation and surgery

Tuesday, June 4th, 2013

June 4, 2013

BreastExam01With Angelina Jolie’s disclosure about testing positive for the BRCA mutation that strongly predicts the likelihood of developing breast cancer, a lot of media stories have covered her genetic testing diagnosis and subsequent decision to have a mastectomy. A number of important ideas have been included in Angelina’s talk about her diagnosis and decision. She has emphasized that the genetic test is expensive–about $3,000. Perhaps there has been less emphasis on why and when health insurance is more or less likely to pay for the genetic testing, or some part of it at least. Payment is more likely in situations where a family member has tested positive for the mutation or has developed breast cancer at a young age.

The story has focused more on her decision perhaps than on the relative rarity of having the genetic mutation linked to breast and ovarian cancer. The decision to have the mastectomy relates to the 85% or more likelihood that she or anyone with the mutation would develop breast cancer. So this mutation of a gene that we all have is indeed very strongly indicative of a future breast cancer diagnosis. The decision to have breast tissue removed is Angelina’s way of reducing that risk to more like 5%.

Another fact that the stories have not emphasized is the reality that only about 5% of the women  diagnosed with breast cancer have a BRCA mutation. For the other 95%, environmental and behavioral factors contribute to the diagnosis. So it is critical that we focus attention on that reality.  

 

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When is reading a mammogram like looking for a polar bear in a snowstorm?

Thursday, August 9th, 2012

August 9, 2012

When you have dense breast tissue… at least, that is what some physicians say [go here, for more:  http://www.womentowomen.com/breasthealth/densebreasttissue-mammograms.aspx ].

It has been 15 years since my annual mammogram led to a callback from the doctor for more x-rays and then a needle biopsy and finally ‘the all clear’ — no sign of cancer pronouncement. But it happened again last week. I got my annual mammogram on my way out of town to go to Atlanta for a visit with my daughter and granddaughter and son-in-law. And the day after I had the screening, I got a message on my home machine to call for a return visit…

Things have changed in the last 15 years, of course. Now, digital mammography makes some things more likely to be seen on the x-ray compared to film. Go here for a comparison: http://www.umm.edu/breastcenter/digital_mammography.htm?gclid=CNbCiKu_27ECFUlnOgodsH4A_A  

At any rate, I returned to the imagery center for more x-rays. Here is how the communication went. First, it was nearly impossible to understand the message on my answering machine. My husband and I listened to it a half dozen times. We looked up the phone numbers of the imagery center, and none of them matched what we thought we were hearing. Nonetheless, I wrote what we thought they were saying and tried the number. It rang out to a message saying that it was long distance. Not likely then to be what I needed to call. Next, I tried calling the number using the first 3 numbers that all the numbers online for the imagery center used. And the last 4 numbers we thought the caller was saying that appeared nowhere in the online listing. Success. I got a nurse who checked and said, “When can you come in?” And I made an appointment for the day after I would return from my visit, which was a week after the first mammogram.

I went to the imagery center, this time with my husband coming in. The volunteer greeted me with, “Oh. I am so sorry.” Yikes. Not what you want to hear. She remembered me from the week before because we had a long chat about my height. At any rate, I would venture to say–“so sorry” is not quite the right expression in this situation. Perhaps “sorry you have to come in for more tests” if ‘sorry’ is to be used at all. The expression and her empathy were, however, unsettling.

Once I was in the room with the x-ray technician, I encountered the other end of the spectrum. The communication was reactive rather than proactive regarding what she wanted me to do. “Put your arm up and grab the handle? I did. “No. Turn this way. Face the machine.” Her tone was irritated. Wow. It is 9:30 in the morning. Why is she so grumpy? I am the one getting my boob smashed again.    

She sighed. Letting out a clear expression of annoyance, she said. “Stick your bum out.” Who talks like that? “No. Look at me– Like this–” she said as though talking to someone she regarded to be extremely stupid. Finally, she was satisfied.

Time for another image. She turns me a bit and I try to enact what I have learned. I stick my bum out. “No.” she says harshly. “Stand up straight.” My arm began to quiver. Unavoidably uncertain about what I was doing wrong. Several more images and abrupt commands later, we were done.

“Will the radiologist come in here to discuss these with me?” 

“No. Wait in the waiting room. I will get you when he is ready for you.”

I asked the volunteer if she would get my husband when I got called to the radiologist meeting. She told me to ask the technician to do it. So, when the technician came to get me, I asked her. And she did. No attitude. Wow!

And then there was the radiologist. I don’t think he could have been nicer or clearer. He put two pictures up on a screen and pointed to a small round dark spot about the size of a pellet for a BB gun. “This is what we’re looking at that’s different,” he said. “All this is your muscle and dense breast tissue.” It all looked like a lot of snow to me but I could see the BB…

“We’re going to do an ultrasound to see what we can learn about that spot.”

“What will the ultrasound tell you?”

He launched into a helpful answer that I will summarize as, ‘if the sound waves go through the mass, it’s a cyst. If they don’t it may be something we need to take a look at.’

The sound waves showed no mass. He spent plenty of time making sure that it did not appear in any direction. And then he announced, “I believe it’s a cyst. I will call this ‘normal’ and you won’t need to return for a year. Unless, of course, you see or notice changes that should be checked. Any questions.”

Hip Hip Hooray…. But I wish someone  would give me a satisfaction survey to fill out about the volunteer and x-ray technician. I have a few thoughts about how their communication could be improved.

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Health communication and Dr. Oz’s message about paraben

Tuesday, May 1st, 2012

May 1, 2012

I am in the midst of final exam week and grading. In the background, Dr. Oz started talking about ‘paraben’ and how it acts as an estrogen. I am always on the alert for these kind of messages. Hormones, research, cancer, blood clotting… these all came to mind. I got up from the computer and went to listen carefully. And then I went to my bathroom. My shampoo have five kinds of paraben in it. My two different types of body lotions had multiple forms of paraben as well. I got rid of them. Trash. Not a moment’s hesitation.

Why? Well, one of the facts Dr. Oz shared is that in one research study, 19 of 20 women diagnosed with breast cancer had significant levels of paraben in their breast tissue. I will hunt down the research and share it soon. For now, here is a summary of content from Dr. Oz with the link to the story at the end:

Flushed Away

We all know about industrial pollution and climate change, but there’s a new threat to the environment much closer to home – pharmaceutical  and personal care product pollution (PPCP). Experts are increasingly worried that marine life across America is showing us the harm its doing to our planet and ourselves.

 

What’s Happening to the Environment?

In river basins around the country, the United States Geological Survey has found fish with both female and male sex organs. Intersex frogs are also popping up all over. And experts have found evidence of chemicals called endocrine disruptors, such as atrazine (an herbicide) and Bisphenol-A (BPA) in the country’s water supplies.

 

What are Endocrine Disruptors? 

These chemicals alter the actions of hormones in our body, which can hurt us in 2 ways. First, they can block our hormones from acting as they normally would, and, secondly, they can act like hormones triggering effects that may include early onset puberty in adolescents.  

 

What’s Happening to Us?

Breast cancer rates are increasing, girls are entering puberty earlier, sperm counts and testosterone levels are falling drastically, and certain genital abnormalities are on the rise.

 

What Should We Watch Out For?

Though the evidence is not definitive, experts fear that products we are introducing into our environment could be to blame, and they are urging us to decrease the use of certain chemicals. Here’s what to look for:

 

Bisphenol-A (BPA)You may have heard about BPA, the chemical used to make hard plastics, line cans, and create carbonless receipts. It’s proven to raise the risk of breast cancer in rats and the FDA has raised an alarm about the potential harm BPA can cause; Connecticut even banned its use  in children’s products.

 

Ninety-three percent of us have BPA in our bodies. We live with it, and we excrete it when we go to the bathroom, sending the chemical into the environment.

[ pagebreak ]

Phthalates

These difficult-to-pronounce ingredients help fragrance linger on the body after you have applied a lotion or body cream to your skin. They’re also found in toys, floor coverings, detergent, soaps, nail polish, and shampoos. Unfortunately, they mimic the hormone estrogen and have been linked to reproductive problems in rodents, such as lower testosterone and fetal malformation. Often they are not listed on beauty products, so the best rule of thumb is to avoid any products with fragrance.

 

Parabens

Found in moisturizing shampoos and body lotions, parabens are the most widely used preservatives in the beauty product industry, and they also act similar to estrogen in our bodies. One study found parabens in the breast cancer tissue of 19 out of 20 women studied; experts worry there could be a connection.

 

Use these chemicals as a litmus test for a healthy product. If you see them listed on the label (often as methylparaben, butylparaben, or propylparaben), it shows that the manufacturer is not concerned about limiting exposure to potentially harmful chemicals.

 

Leftover Prescription Medicine

The medication we take ends up in our water supply in 1 of 2 ways. We secrete it in our urine (which we can’t control), but many of us also flush unused medication down the toilet, contributing to the rising amount of pharmaceutical pollution found in our water supply. In 2008, the Associated Press found that dozens of pharmaceuticals end up in our water supplies, and eventually, in our tap water. That’s because water treatment plants are designed to neutralize biological hazards, such as bacteria, but not pollutants such as antibiotics. Scientists are now discovering bacteria in the wild that are not only resistant to antibiotics, they can actually live off them.

 

What Can You Do?

  • Drink water from stainless steel bottles
  • Avoid plastics with the numbers 3, 6, and 7 on the bottom
  • Never heat plastic in the microwave (even if it says it is microwave safe)
  • Choose frozen and fresh produce over canned
  • Use BPA-free baby bottles
  • Avoid any products that contain fragrances; opt for those that get their scent from essential oils
  • Stay away from parabens
  • Choose products that are paraben- and phthalate-free
  • Dispose of leftover medication by throwing it in the trash with coffee grinds or cat litter (to keep harmful medications from being picked from the trash), return the unused portion to your pharmacy, or go online to find your local hazardous waste disposal facility.”

http://www.doctoroz.com/videos/flushed-away?page=2 

 

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When is disclosure of a medical test result an obligation?

Tuesday, April 17th, 2012

April 17, 2012

What does it mean to be a public figure like Warren Buffet? It seems that it includes a feeling of obligation to inform the public of medical test results. Which is what he did today. In a way that reflects hope and action. His message is a good example of talking about health.

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Telling it like it is…communicating about end-of-life

Wednesday, March 14th, 2012

March 13, 2012

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A stark reminder to check your prescriptions…closely

Thursday, March 8th, 2012

March 8, 2012

I heard the story about a pharmacy mix-up the other day that reminded me how important it is to inspect my medications closely before taking them. As the clip shows, a medication was given that looked the same in color and size, but very much was not the same. A cancer drug instead of fluoride tablets.

I found an error once. The pill was a different color than my prescription but the same size. So I looked closer and it wasn’t my medication. You can check your prescription by going to http://www.drugs.com/imprints.php and enter the number on your pill to be sure that it is what was prescribed according to the label.

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Talking about health, thyroid cancer, and x-rays

Friday, February 24th, 2012

February 24, 2012

…thanks to my sister, Tammy, for sending the message that it at the end of the post in an email to me. It led me to do some background research and learn more about thyroid cancer and exposure to x-rays.

In a nutshell, the use of a shield from x-rays during dental x-ray exams is recommended. Use of a shield when getting a mammogram is more contested.

Concerns about the number of cases of thyroid cancer has led to some debate. In the links I include here, some say that the increase in the number of cases can be explained by better screening efforts and technology. In other words, there were always as many cases, but now we diagnose them more often.

 There are efforts to explain this, including the possibility of exposure to x-rays during dental exams and mammograms. Others are looking for possible reasons that the number of cases may be on the rise. 

Regarding dental x-rays and thyroid cancer, here is an excerpt from a summary*: “Dental X-rays give a very low dose of radiation to the mouth. There is some scatter of radiation and the potential for some radiation absorption by the nearby thyroid and other organs. The American Dental Association notes that a leaded apron placed over the torso minimizes radiation exposure to the chest and abdomen and should be used when any dental X-ray is taken. The group also notes that a leaded thyroid collar can protect the thyroid from radiation and should be used whenever possible.”

*: Go to http://www.cnn.com/2011/

and enter after the slash: HEALTH/expert.q.a/03/30/thyroid.cancer.radiation.brawley/index.html

Dr. Oz has had conversations about this on his show [see here for a discussion across time: http://www.radiologytoday.net/archive/rt0611p18.shtml].

Some of the content in the link includes:

“Statistics cited in the ACR/SBI press release show that for annual screening mammography for women aged 40 through 80, the cancer risk from the amount of radiation scattered to the thyroid during a mammogram is “incredibly small,” measured at less than one in 17.1 million women screened. They stress that this “minute” risk of thyroid cancer be balanced with the fact that using a thyroid shield could impact the quality of the mammography image, interfere with the diagnosis, and ultimately result in the need for a second mammogram.

“As we told Dr. Oz, it was not just the fact that a thyroid guard was unnecessary and could compromise the mammogram, the concern is that misinformation over inconsequential issues will discourage women from participating in screening and its potential to save lives,” Kopans says.”

So it appears to be about ‘tradeoffs’ as is so often the case with health risk. In my book taking about health, the chapter titled ”How normal am I?’ encourages us to keep track of our own pesonal helth history and our family’s health history, together with environmental exposures so that we can form a better sense of the meaning of ‘normal’ for ourselves. Perhaps someone with a personal history or family history or higher risk for thyroid cancer would want to adopt this extra protection during a mammogram.

The note from my sister that began this exploration….

Thyroid cancer
On Wednesday, Dr. Oz had a show on the fastest growing cancer in women,
thyroid cancer. It was a very interesting program and he mentioned that
the increase could possibly be related to the use of dental x-rays and
mammograms. He demonstrated that on the apron the dentist puts on you for
your dental x-rays there is a little flap that can be lifted up and wrapped
around your neck. Many dentists don’t bother to use it. Also, there is
something called a “thyroid guard” for use during mammograms.

By coincidence, I had my yearly mammogram yesterday. I felt a little
silly, but I asked about the guard and sure enough, the technician had one
in a drawer. I asked why it wasn’t routinely used. Answer: “I don’t know.
You have to ask for it.” Well, if I hadn’t seen the show, how would I have
known to ask?

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Why?

Friday, February 10th, 2012

February 10, 2012

Why do we talk in “either” “or” terms when we know better?

It is not “either” we drill for Marcellus shale “or” we will remain energy dependent.  

It is not “either” we quit drilling for Marcellus shale “or” we will destroy the environment.

As long as we keep talking and thinking that way, here is the story…

 

 

 

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What interesting bit of information did I learn on the Rachael Ray show?

Thursday, September 8th, 2011

September 8, 2011

Imagine my surprise when I was listening to Rachael Ray’s cooking show and one of the guests was a female doctor who talked about a number of important health issues and took some questions from audience members. I was surprised that this guest was on a cooking show. But then I was surprised by some of the information she discussed.

Along the way, she told the audience that they should refrain from sexual intercourse for 24 hours before having a pap smear to screen for cervical cancer.  The reason for doing so is to increase the accuracy of the test results. I always receive written guidelines about preparing for my annual mammogram, including such things as not to wear deodorant or powder or lotion. But I have never received any guidelines about preparing for a pap smear. Not on an appointment reminder card. Not face-to-face with the person checking me in. Not from my doctor. Not in passing in conversation with other women.

I wonder how many dollars we would save if women knew to avoid sexual intercourse for 24 [the recommendation in the attached summary says 48] hours before an appointment for a pap smear and followed this advice. Apparently, sometimes the test result will show something that seems to be a problem but isn’t because a woman has had sexual intercourse.

I looked online and found some guidelines at http://womenshealth.about.com/cs/papsmears/ht/preparepapsmear.htm. I guess I will make it a goal to check whether there are things I should do to prepare for screening tests I have from now on. I suspect if you are like me, getting these things done on the prescribed timetable is hard enough. Too easy to procrastinate. I sure don’t want to have to them again just because I wasn’t prepared properly the first time.

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