Coming Up – Screening For Lung Cancer

What is screening? 

What is cancer screening?

Simply put, screening is a test that is looking for early stages of a disease in people WITHOUT any symptoms.

In order for screening to “make sense” on the larger scale it has to look for a disease that can be cured or treated if found early.

When is screening recommended?

There are a lot of factors that need to be considered in regards to whether or not to screen for something and also whom to screen.

Not all screening is appropriate for everybody.

There is potential harm involved such as extensive follow up testing in false positive cases.

Additionally, there may be anxiety from the positive test results.

Sometimes, we might find a cancer that would normally have been progressing so slowly that the person would have died from other causes before even reaching end-stages of this cancer.

Screening is a big topic and I will talk more about it as we go along.

Today I want to mention something that is coming up!

And since we spoke about smoking yesterday it is right up the alley:

Screening for lung cancer!

Screening for lung cancer in smokers! 

Up until now there has been no screening method that has been proven to be successful when looking for early stages of lung cancer.

The US Preventive Services Task Force (USPSTF) has just released a draft recommendation (it is not finalized yet) for lung cancer screening in smokers.

You may check out the draft of this recommendation on their website by clicking here. The draft will be accessible until August 26, 2013 only.

Here some of their main points:

• Lung cancer is leading cause of cancer death in the USA
• 90% of people diagnosed with lung cancer will die from it as it is found too late
• the biggest risk factor for lung cancer is SMOKING
• 85% of lung cancer are caused by smoking
• the most important means to reduce your risk of developing lung cancer is to stop smoking and to avoid any exposure to tobacco

Screening for lung cancer in smokers: 

Low-dose CT scan for screening of lung cancer

How?

CT-scan (“CAT scan”) with lower dose of radiation

(low-dose CT, also LDCT) of the lung

Who is a candidate?

A person who is

• Between 55-79 years of age
• WITH a history of heavy smoking



Don't gamble with your health!

• AND is still a smoker or has stopped smoking within 15 years 

How often?

Once a year

What is defined as “heavy smoking”?

30 “pack years” and above is considered heavy

What is a “pack year”?

Smoking 1 pack of cigarettes per day (PPD) for 1 year = 1 “pack year”

So, 30 pack years are equivalent to the following:

• 1 pack per day for 30 years
• 2 packs per day for 15 years
• 3 packs per day for 10 years

What are some of the harms of screening?

• Radiation exposure
• False positive test results that may lead to
• More testing
• Anxiety
• worry

As I mentioned this is currently still a draft but probably coming up as an official USPSTF recommendation soon.

If you fulfill the criteria for screening, discuss it with your doctor whether or not you are a candidate and whether or not you want to go forward with this.

Stop smoking TODAY!

If you still smoke: STOP (check yesterday’s post)!

Nothing good comes from smoking! 

Do I HAVE to go for the screening, if I don't want to?

Nobody can force you to do anything. You can make your decision. Just think through all the options and discuss them with your doctor and people you trust.

If you have many medical problems and already feel burdened by all the medical treatment that you are undergoing you may want to think about what the consequence of a positive test result would be for you. 

Would you want treatment?

Would you consider further testing, surgery, or chemotherapy?

If not, you may not want to do the screening test to begin with.

Sometimes it is better not to know.

Have a wonderful rest of your day.

Be well,

Dr. B

PS: This is based on a systematic review published in the Annals if Internal Medicine on July 30, 2013. Click here for link to article.

Smoking - Is Bad For You. Period.

Smoking is your enemy!

By now we have all heard it:
Smoking is really bad for you!

You are basically inhaling hundreds of toxic substances. 

I want to emphasize this today: 

Smoking does so much damage to your health and well-being that it is NEVER too late to quit.

What smoking does: 

• puts you at higher risk for many cancers (e.g. lung, throat, kidney, pancreas - to name a few)
• increases your risk for a heart attack or a stroke (check out yesterday's post on stroke risk)
• damages your lungs and may likely lead to COPD / emphysema or asthma
• puts you at higher risk for pneumonia and other infections
• may give you erectile dysfunction



Smoking is ugly! Not cool!

• stains your teeth and gives bad breath

Be aware that second hand smoking is harmful as well!

And consider also that ALL tobacco products are hazardous, no matter what form they come in.

Essentially, smoking is the number one cause for premature, preventable death in the United States!

Stop smoking TODAY!

The best and most important thing you can do for your health today, no matter how old you are, is to STOP smoking!!! 

It is never too late to stop smoking!

The good news are that the overall percentage of smokers among older Americans has decreased over the last decades.

There are plenty of immediate and longterm benefits of quitting smoking, no matter your age. But of course, the earlier the better!!

Nicotine is an addictive substance and it may not be easy to do this alone. Ask your physician for guidance, help and possibly medications. Also, check this cancer website for more info.

Check out this book by Allen Carr: Easy Way to Stop Smoking. I know people who swear by this book (although I personally have not read it).

Value your body and health!

Value your body and your health! Take responsibility!

Make the best of it!

Be well,

Dr. B

Will I Get A Stroke? Stroke Risk Awareness

A stroke can be a very devastating event; it can even lead to death. What most people are afraid of is not necessarily dying but rather surviving with severe disability. Whereas some people may recover fully after a stroke others might suffer from the effects for the rest of their lives. They might become bed-bound, unable to swallow, unable to speak and with severe damage to their cognition (vascular dementia).

Strokes are "brain attacks"

What is a stroke? 

Simply put a stroke is a “brain attack”. There is either lack of blood flow to areas of the brain (called ischemic stroke) or a sudden brain bleed (hemorrhagic stroke).

What are some of the symptoms of a stroke?

As per the National Stroke Association (NSA) these are the symptoms of stroke:

• Sudden numbness or weakness of face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

Other important but less common symptoms include:

• Sudden nausea, and vomiting - different from a viral illness because of how fast it begins (minutes or hours vs. several days)
• Brief loss of consciousness or a period of decreased consciousness (fainting, confusion, convulsions or coma)

If you have any of these symptoms or see them in someone else, call 911!

Treatment can be more effective if given quickly. 

Every minute counts!

What is a TIA or a mini-stroke?

TIA stands for transient ischemic attack and it basically means that stroke-like symptoms appear and then spontaneously resolve without causing an actual infarction of the brain (Easton et al in Stroke 2009).

Up until recently the definition included the time window of 24 hours: if your neurological findings resolved within 24 hours this was considered a TIA.

We now recognize that even 2 hours of neurological symptoms may lead to actual damages in your brain.

Additionally, a TIA is a serious warning sign that a larger stroke may occur within the next 24-72 hours!

You may need brain imaging when stroke is suspected.

Can I do anything to prevent having a stroke? 

Yes, you most definitively can!

The majority of strokes are potentially preventable!

How do I prevent a stroke?

Know your risk factors and adjust your lifestyle!

Some Risk factors for stroke that you have no control over:

• Your age (the older you are the higher your risk)
• Your gender (more women have strokes than men per year, partly because women live longer)
• Your race (African Americans have highest risk)
• Family or own history of stroke / TIA

STOP smoking!

Risk factors for stroke that you can control or treat: 

• Smoking
• Drinking too much alcohol
• Obesity
• High Blood Pressure
• Diabetes
• High Cholesterol
• Atrial Fibrillation
• Atherosclerosis

Click here to access the Stroke Risk Scorecard of the National Stroke Association. 

If you think you may have any of these risk factors, speak to your physician about it and then work with your physician to reduce your stroke risk.

• STOP smoking, if you smoke (it is recommendable for many reasons!)
• Start exercising (even if it only 30 min of brisk walking 3 times a week)
• Open a conversation about your wishes at severe illness or end of life (check blog post on documentation at end-of-life on Health Care Proxy for more info).

Make the best of the life you have!

Make the best out of the life you have! 

Be well,

Dr. B

PS: For more info check out NSA website. 

Wear sunscreen – encore

Based on several questions that came up after the "wear sunscreen" article I wanted to write a few small additional note:

• The amount of SPF in makeup is not sufficient to cover you properly

• Even in the winter you should wear sunscreen on your face, neck, and hands

• There are special formulations for the face, these "milks" absorb much faster and feel nicer on the skin (I like Neutrogena: click here)

• Use high SPF on face, hand, neck (at least 55 SPF) all year round

• Even on a cloudy day you are not protected from UV radiation without sunscreen

• Sprays can be difficult to handle:

1. You inhale much of it while spraying
2. They are greasy and make your skin feel sweaty
3. When you spray them indoors they leave a film on your carpet, hardwood floors or tiles
4. The film on the tiles or hardwood floor can get dangerously slippery and you may fall on it (this almost happened to me)
5. You never know whether you applied the right amount of spray

When to use spray?

• It might be easier to use spray on small children rather than the lotion
• Outdoors or at the beach the spray falls into the sand rather than on your furniture
• If you don't have anybody to help you lotion your back you might be able to spray it yourself (might be tricky for some of you)

Otherwise, look for a lotion

• There are lighter formulations in lotions out there and I would really continue looking until you find what you like
• I would definitively use the highest SPF you can get for the days spent outside
• we usually don't apply the amount recommended (so we already lose SPF from that)
• after 45 min of sweating or in the water you cut your SPF in half

Example:   

• you start with 50 SPF lotion
• you put on too little: now you are at ~ 30 SPF
• after 45 min of sweating you are down to about 15 SPF
• You continue to lose half of that every 45 min without re-applying...
• So: Reapply, reapply, reapply

In the end of the day: Be a role model for others.

And don't get frustrated. I can't even get my own husband to use sunscreen regularly; but I won't give up!

Be well,

Dr. B

Wear Sunscreen

I am sure you have heard this over and over and yet I think it is so important that it cannot be said enough times:

Wear Sunscreen !!  

I attended a presentation by a dermatologist yesterday and got inspired to write to you today (I also went to CVS immediately after and restocked on highest SPF in the house!!)

Each time you get a sunburn you significantly increase your risk of getting melanoma. Melanomas are malignant cancer of the skin that can kill. These cancers don’t just stay confined to the skin but they can travel all over your body and seed in other organs like your brain or your lungs.

When you tan without burning you put yourself at acquiring other forms of skin cancers such as basal cell cancer – which is the most common cancer in humans.

It is true that the lighter you are the more susceptible you may be for burns and certain skin cancers, however, having dark skin does not protect you and you should still use sun screen.

What to do? 

• Use sunscreen every day even when you are not going to the beach (light or dark colored skin)
• Use sunscreen even when you wear clothing (a light white T-Shirt provides only about 15 SPF and next to none when wet)
• Use the highest SPF (sun protection factor) as it loses its protective factor when you sweat or get wet (after about an hour of sweating it may have lost half its SPF already)
• Reapply SPF frequently and use a “shot glass” amount on the whole body (a family of 4 at the beach should use one whole bottle of sun screen –scary, isn’t it? These bottles often last 2 summers!)
• Stay in the shade but beware: at the beach the sun will still reflect UVB radiation onto your skin and will still increase your skin cancer risk! So, even in the shadow: sun screen! 
• Wear a hat with a brim to protect your scalp

By the way, for the vain ones amongst us: one of the main factors contributing to the aging of our skin is UV radiation! So, the less exposure the younger you may look.

What about vitamin D?

You may have heard that it is necessary to be exposed to sunlight in order for the production of vitamin D to occur in your skin. This is true, however, 15 min per day are already enough for most of us. You don’t need to fry for hours!

There is a lot of information out there on the internet, check out this woman’s personal experience: click here.
Here some tips on sun screen brands by a dermatologist: click here.

And when in doubt: ask your doctor or see your dermatologist.

It probably is a good idea to see a dermatologist at some point and get the recommendation on how frequently you should return for follow ups.

Stay cool out there and remember:

Wear sun screen!

Dr. B