Cancer CarePoint Blog

Teflon Chemical a Likely Carcinogen

Dr. Mercola cites an article about a chemical used in the manufacture of Teflon and other nonstick and stain-resistant products that should be considered a "likely" carcinogen, according to an independent scientific review panel advising the EPA.

Link: Panel: Teflon Chemical a Likely Carcinogen - Yahoo! News.

A chemical used in the manufacture of Teflon and other nonstick and stain-resistant products should be considered a "likely" carcinogen, according to an independent scientific review panel advising the Environmental Protection Agency.

The recommendation included in the panel's final draft report is consistent with its preliminary finding, which went beyond the EPA's own determination that there was only "suggestive evidence" from animal studies that perfluorooctanoic acid and its salts are potential human carcinogens.

Officials with Wilmington, Del.-based DuPont Co., the sole North American producer of PFOA, took issue with the panel's conclusions.

New pathway could present an intervention point for cancer treatment

The Baylor College of Medicine released a research finding that identifies a potential tumor suppressor.

Link: New pathway could present an intervention point for cancer treatment - Baylor College of Medicine.

A new cellular pathway leads to destruction of a protein that promotes growth of breast, prostate and similar cancers and could provide a new avenue through which to pursue treatment of such diseases, said a researcher at Baylor College of Medicine.

"It is another intervention point where one can now attack tumors. It's especially important for endocrine tumors such as those of the breast, prostate, ovary and pituitary gland," said Dr. Bert O'Malley, chair of the BCM department of molecular and cellular biology. O'Malley is senior author of a report on the research that appears in the current issue of the journal Cell and a faculty member in the College's Graduate School of Biomedical Sciences.

O'Malley and his colleagues concentrated their efforts on a powerful oncogene or cancer-promoting gene called the steroid receptor coactivator (SRC) 3 which is also a powerful promoter of tumor growth.

"In high concentrations, it drives the cells to relentless replications," O'Malley said.

However, studies in the laboratory showed that another molecule called REG-gamma takes SRC3 to the proteasome where it is destroyed.

"Because REG-gamma does this to SRC3, it is a tumor suppressor," said O'Malley.

In breast cancer, when levels of REG-gamma are low, SRC3 levels can be high, resulting in tumor growth, said O'Malley.

Should Mammography Has Disclaimers?

Sumer's Radiology Site points to an article by Leonard Berlin, MD, about the need for disclaimers for mammography. Excerpts below.

Source: A Manifesto for Truth-in-Mammography Advertising | November 2004 | ImagingEconomics.com

Should we care that the advertisements marketing mammography did not include any of these caveats or limitations? And if so, why? The one-word answer to the first question is "Yes." The one-word answer to the second question is "Malpractice."

The allegation of a delay in the diagnosis of breast cancer is the leading cause of medical malpractice litigation in the United States today, and has been for the past decade. ¹ Of all medical malpractice lawsuits filed in the United States that allege a delay in the diagnosis of breast cancer, radiologists are the most frequently sued specialists. Of all medical malpractice lawsuits lodged against radiologists, the most frequent cause is the allegation of a missed breast cancer on mammography. Why has "missed breast cancer" risen to first place in the medical malpractice standings? I suggest that it is because we have oversold mammography. We have marketed mammography without informing the American public all that we know about not only the benefits, but more important the limitations and potential harms of mammography.

In our well-intentioned and commendable effort to reduce the mortality and morbidity associated with breast cancer, we radiologists, along with the American Cancer Society and other medically related organizations, have through advertising and other marketing campaigns encouraged women to undergo screening mammography. True, the high level of mammographic utilization that we have achieved through these marketing efforts has resulted in overall improvement in the health and welfare of American women, but at the same time, this marketing has resulted in something that can be considered detrimental: an exponential growth in malpractice litigation alleging misinterpretation of mammograms.

The Impending Physician Shortage

Hospital Impact describes James Orlikoff's speech at the ACHE Chicago Chapter's annual meeting about the state of the healthcare system.

Link: hospital impact - Nursing Shortage? What about the impending physician shortage?.

What about the impending physician shortage? ...according to Orlikoff, the problem is five-fold:

- Our population is growing faster than the # of medical students (but this one is the least of our problems)

- 50% of current medical students are female, an all-time high. Orlikoff shared an astounding statistic: 10 years after graduation, 60% of female medical students will be working part-time or not working at all. 60%!

- Today's doctors are 3x less productive than the previous generation of doctors. This one is hard to believe until we start thinking about how important work/life balance is to us now.

- More and more medical school graduates don't practice medicine at all. Just look at the recent explosion of MD/MPH, MD/MBA, MD/JD, and MD/PhD degrees. Just look into any Wall Street firm covering biotech stocks and you'll find a boatload of MD healthcare analysts.

- Given that 22% of new MDs are born in other countries, more and more of them are returning back to their home countries. As medical tourism continues to expand, it is actually financially more favorable for some docs to set up a small shop back home.

Nursing Central — Information for Nurses

Michael at MedGadget reviews Nursing Central and concludes that it is a unique and powerful nursing tool. Excerpts below.

Source: Nursing Central - Nurses get mobile too! - Medgadget - www.medgadget.com

Nursing Central is built around the idea that the most frequently asked questions are about diseases, tests, and drugs. The core disease text is Diseases and Disorders: A Nursing Therapeutics Manual, Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications and Davis's Drug Guide provide test and drug information respectively. Taber's Cyclopedic Medical Dictionary is a nice addition. It is evident that Unbound Medicine felt it was important to have content written by and for nurses.

...tables of content for over 250 journals and literature alerts can be directed to your PDA when you synchronize. In addition, the same literature management toolset is included with Nursing Central and can be used on the Web to search MEDLINE, browse tables of contents, or review saved articles and search results in the "Archive". The default tables of contents alerts reflect nursing titles such as AJIC, AJN and RN.

MEDLINE searching from your Treo, BlackBerry or other internet enabled mobile device is via a simple and intuitive interface. It is nice to see that Unbound Medicine believes nurses consult the literature.

Medicine Central - Information for Physicians

Nicholas at MedGadget says Medicine Central is a comprehensive but flexible product. Excerpts below.

Link: Medicine Central - The All-in-One Solution to Medicine - Medgadget - www.medgadget.com.

For physicians on the go, Unbound Medicine has created a bundled resource called Medicine Central that combines premier reference content with powerful literature management tools. Unbound Medicine is unique in giving end users the freedom to access Medicine Central as a PDA download, or on the Web using a PC or a wireless device like Blackberry or Treo.

Medicine Central is built around the idea that the most frequently asked questions are about diseases, tests, and drugs. Reflecting the fact that physicians already have a favorite resource, Unbound Medicine allows customers to choose from among three popular references - 5-Minute Clinical Consult, Harrison's Manual of Medicine, or CURRENT CONSULT Medicine. A drug guide (Davis's Drug Guide) and a manual of diagnostic testing (PocketGuide to Diagnostic Tests) help users reach a diagnosis and establish a therapeutic regimen.

MEDLINE searching from your Treo, BlackBerry or other internet enabled mobile device is via a simple and intuitive interface. This is great for trainees or clinicians who like to consult the medical literature for the latest developments or to examine the evidence supporting a recommendation.

National Cancer Quality-of-Care Study Reports Mixed Findings

Bill Robinson describes the results of a NICCQ study on quality of care from the NCI web site.

Link: National Cancer Institute - HTML NCI Cancer Bulletin for January 24, 2006

Initial management of breast and colorectal cancer care in the United States is generally "consistent with evidence-based practice," but with substantial variations in quality across the nation and low adherence in many quality measures that suggest "opportunities for improvement."

Those are conclusions from the National Initiative for Cancer Care Quality (NICCQ) nationwide study lead by the American Society of Clinical Oncology (ASCO). The study was undertaken in response to a 1999 report by the Institute of Medicine that recommended establishing a quality monitoring system for cancer care. The NICCQ results were published online this month in advance of the February 1 issue of ASCO's Journal of Clinical Oncology.

NICCQ examined patterns of care for 1,287 breast cancer and 478 colorectal cancer patients in 5 U.S. cities (Atlanta, Cleveland, Houston, Kansas City, and Los Angeles). To evaluate patient care, the researchers developed "explicit quality measures" of care for breast (36 separate measures) and colorectal (25 measures) cancers spanning diagnosis, surgery, adjuvant therapy, managing treatment toxicity, and posttreatment surveillance. Patients were then surveyed and provided permission for researchers to review their medical records.

Based on that review and those measures, NICCQ found that breast cancer patients received 85 percent of recommended care and colorectal patients received 77 percent of recommended care. Compared with prior studies, NICCQ results "show strikingly higher adherence to processes of care believed to be essential for improving the outcomes of patients with breast and colorectal cancer," the researchers summarize.

NCI Deputy Director and Deputy Director for Cancer Care Delivery Systems Dr. Mark Clanton applauded the NICCQ study as the first comprehensive study of cancer quality-of-care issues. It provides new insights to help steer NCI's strategic initiatives to provide "leadership and research focus that analyzes the systems by which care is delivered and to make quality cancer care more accessible to all patients, especially the underserved and disadvantaged populations," Dr. Clanton noted.

New Players Emerge In Shifting Market For Prostate Tests

The PSA test may soon be obsolete as a test for prostate cancer, according to the article below.

Link: Investor's Business Daily: New Players Emerge In Shifting Market For Prostate Tests

For two decades, the PSA test has been the standard for diagnosing prostate cancer. But in 2004, the man widely credited for creating the test renounced it, sparking a medical furor.

Based on his own studies, Dr. Thomas Stamey of Stanford University said PSA testing detects enlarged prostates, not cancer.

"We need to recognize that PSA is no longer a marker for prostate cancer," he said.

PSA stands for protein specific antigen, a protein produced by the prostate. The PSA test measures the level of PSA in the blood. The more PSA, the greater the likelihood of prostate cancer. The problem: PSA tests push too many men into needless, painful and expensive biopsies.

Several biotechs seek a better indicator of prostate cancer. Canadian biotech DiagnoCure has developed a diagnostic method requiring only a urine sample. No blood test is required. Neither is a biopsy.

DiagnoCure's prostate cancer marker is a gene called PCA3. The company, which trades on the Toronto Stock Exchange, has partnered with San Diego-based Gen-Probe.

PCA3 is far better than a PSA, says Aaron Geist, analyst with investment bank Robert Baird & Co., which seeks Gen-Probe's business.

PCA3 has been 89% accurate in finding prostate cancer and 90% accurate in ruling it out, Geist says. Recent studies from various sources put the PSA at about 38% accuracy for finding prostate cancer and 38% for ruling it out.

This means PSA tests are raising false alarms. And those false alarms mean pain and suffering for men who endure biopsies to verify the PSA-based diagnosis, Geist says. Part of that pain is financial: A biopsy costs $2,000.

Also, there's no guarantee a biopsy will find cancer even in a cancerous prostate. The biopsy might take a sample from a noncancerous area of the prostate.

The procedure is so grim that up to 20% of men won't undergo it a second time, even if they have high PSA, Geist says.

Medication Errors Highest in Radiology

The Medical Connectivity Consulting blog describes a USP finding about medication errors in radiology.

Link: Medical Connectivity Consulting

Medication errors that harm patients are seven times more frequent in the course of radiological services than in other hospital settings, according to the analysis by the United States Pharmacopeia. (Press release)

From 2000 to 2004, 12 percent of the 2,032 medication errors reported in radiological services resulted in patient harm. This is more than seven times the percentage of harmful errors reported in the 2000–2004 general MEDMARX data set. Radiological services were also more likely to result in the need for additional care and consumption of resources.

Inpatient and outpatient radiological services include the radiology department, cardiac catheterization laboratory, and nuclear medicine. These services involve an increasing number of procedures and tests each year, despite the common misperception that radiology is limited to x-rays. In addition to diagnostic exams, radiological services include procedures such as draining abscesses, inserting gastric feeding tubes, inserting arterial stents, and performing angioplasties.

Patients in radiology may face higher risks because of the potentially dangerous drugs used in diagnostic tests and as a consequence of patients being transferred, with care being handed off from one department to another.

...of errors that occurred in radiology departments, 12 percent resulted in some kind of harm to patients, which is seven times higher than the percentage of hospital medication errors that caused harm overall.

Parents of Kids with Cancer Suffer Post-traumatic Stress

The American Cancer Society web site news describes research of the stress of parents whose children have been treated for cancer.

Link: ACS :: Parents of Kids with Cancer Suffer Post-traumatic Stress

Summary: A study of the parents of children undergoing treatment for cancer finds that in most of the families, at least one of the parents has symptoms of post-traumatic stress. Although the symptoms may fade with time, they can interfere with the care of the child and the parent's well-being, researchers from the Children's Hospital of Philadelphia report in the Journal of Clinical Oncology.

Why it's important: In the past, parents who were having trouble dealing with their child's illness were thought to be either "anxious" or "depressed." But the parents may really be having symptoms of post-traumatic stress, which can be far more damaging. Parents who experience these symptoms may have trouble complying with their child's caregiving needs. They may respond inappropriately to health care providers. The family may not function well when cancer treatment is over. Recognizing the post-traumatic symptoms and helping parents overcome them may avoid these problems.

The bottom line: The study authors say health care providers need to be aware of the effect cancer treatments and tests may have on the psychological health of the parents. Parents should be counseled on how to deal with the stress of their child's treatment and taught when to seek more extensive professional help.