Cancer Screening -- Should we?

It seems to make sense. Catch cancer early and it should be more curable.

And sometimes that is right. And as usual, there is more to the story.

Check out the New York Times article today by clicking on the link below.

Nothing is ever simple - is it?

http://www.nytimes.com/2009/07/17/health/17screening.html?pagewanted=1&em

Turning Heads in a beautiful way

I cannot stop writing about this book. Or stop looking at the photography.

If there is one book that can make people feel good this is it.

I've put up a sample of the photos in the book.

All taken by world class, famous, collectible, and damn good photographers.


I promise if you give this book to someone they will be so happy. You will be so happy.

Turning Heads will bring a smile to a face. It shows the power, grace, and beauty of women--no matter the circumstances. No matter the tribulation.

Or the smile may come from enjoying world class photography. Both in my case.

Below are the links to see and read the stories and photos. And to buy. And buy often.

The official Turning Heads Wesbite.

Click here to buy this book and give it to someone you love.

Valentine Day love yourself

Happy Valentines Day!

Let's show our love for ourselves.

As a special treat for yourself make this the day to promise to get the mammogram you've been putting off.

Hell, make it the day to promise to get the colonoscopy we've all been putting off.

Maybe a general checkup? How about a stress test. (Let's not forget the number one killer is heart disease)

Prove your love to yourself. Get checked this year. I am.

Do you need an MRI for breast cancer?

I stole some of this from Susan Love's blog. That's my disclaimer. But she has the best blog and by far the best info and is to be trusted.

MRI is often ordered before surgery for breast cancer. Good idea?
Maybe not according to a new study.

The MRI may not be the best idea after all.

Here is the conclusion (stolen right off of Dr. Love's blog)

So what is the conclusion: There is no evidence that having a preoperative MRI is useful in planning surgery, decreasing local recurrence by finding multifocal disease or preventing second cancers by finding lesions in the opposite breast. And it increases the amount of surgery, delays the definitive treatment, and doubled the rate of unnecessary mastectomies. We have very good data on breast conservation done without the benefit of preoperative MRI showing excellent results compared to mastectomy and should not be seduced by expensive pretty pictures that have been shown to make no difference in cancer outcomes.

Wow! Powerful stuff. More is not always better. In this case MRI may lead you right into an uneeded mastectomy.

Top 5 ideas to make treatment easier/better

This is my idea of what should be very helpful to most women with breast cancer.

1) Get a second opinion--now. For surgery, radiation, and chemo if need be. Never a bad idea.

2) Find a qualified breast surgeon-preferably a surgical oncologist. You would be surprised how the quality of surgery (scar, completeness) can be with the right surgeon.

3) Read Susan Love's Breast Book. A must --vital info.

4) For radiation ask about partial breast treatment, IMRT, and how much lung is being treated. More on this later.

5) Ask about long term side effects of radiation AND chemo. I've noticed most patients are not aware of the long terms side effects of chemotherapy. Not sure why.

DCIS and radiation

For the greater part of a decade there has been controversy regarding DCIS (ductal carcinoma in situ).

DCIS is different from invasive breast cancer in that abnormal, precancerous cells form within the milk duct of the breast but do not spread to other parts of the breast. If treated, it is usually curable. However, if left untreated, it substantially increases a woman's chance of developing invasive breast cancer.

Generally, if you have to have breast cancer this is a good one to get. It is 98-99% curable.

And it is curable with both mastectomy or lumpectomy/radiation. In some cases it is curable without the radiation --just the lumpectomy.

And there lies the controversy.

There are two schools of thought when it comes to DCIS. Kinda like Notorious BIG. There is west coast and east coast ways of treating.

In general, the standard recommendation after lumpectomy is to proceed with radiation to reduce the chance of local recurrence. This is East Coast and shown to be effective in a randomized trial and in a new analysis by Goodwin (Goodwin A, et al. Post-operative radiotherapy for ductal carcinoma in situ of the breast. Cochrane Database of Systematic Reviews 2009, Issue 1.)

Radiation works and with modern techniques is usually very well tolerated. Yes, there can be side effects. Again, most women do very well with the treatment.
We'll talk about side effects next time.

West Coast was born in Van Nuys CA and the father is Dr. Mel Silverstein. He is a surgical oncologist and founder of the Breast Center in Van Nuys and the Van Nuys Prognostic Index.

Mel and I worked together for five years in the late 90's. He is an excellent surgeon and prolific writer and has built a career on DCIS. His work is not randomized and is sometimes at odds with the East Coast philosophy.

Mel would like to eliminate (as much as possible) the use of radiation for DCIS. And he shown that certain subsets of patients do not need radiation if the lesion was small enough, slow growing enough, and widely excised. But again the work is retrospective and not always agreed upon around the country.

Bottom line?

If you have DCIS see a specialist in surgical oncology, a radiation oncologist, and get a second opinion. It never hurts.

Cuz West Coast and East Coast continue the fued till this day. And it can be confusing out there in the middle.

Sheryl Crow for Senate

Began today reading the news. Ouch. Bad idea. Can it really be that bad out there? Seems that way. Hope Obama can make as much of a difference as Sheryl Crow.

Sheryl Crow Sheryl Crow. Besides looking cool in print Sheryl is a hero to many women and most don't even know it.

So many woman who begin this journey thru surgery, chemo, radiation wonder how they will make it. It can be a long journey - a year or more- and may feel like three. But like most journeys it will end.

And here is where Sheryl (and Lance-but this ain't about Lance) shines on like a crazy diamond. Sheryl used the experience to focus on herself when need be, to get better, and then focused on everyone else. She became and remains the perfect role model for breast cancer patients.

Sheryl allowed herself to become the image of strength and hope and courage for woman. She went thru treatment without a public wimper and then went about her business. But now her business is helping in the fight. And she helps in so many different ways. Google her.

If you do google her you will find a ton of stuff about her helping and helping. City of Hope? She's with em. Changed her music after her experience. She basically let it shape her and she used it for the good - for herself and others.

I usually don't expound like this on this blog. Usually I offer advice. The only advice I can offer here is to think of Sheryl if you have breast cancer and I think it will help you get thru it and help you think of others at the same time.

Oh, and if I have to offer advice today it would be to go see "The Boy in the Striped Pajamas" and "Slumdog Millionaire".