Category Archives: Cancer Screening

Politics, Patients, and Prostate Cancer

YOU OWE IT TO YOURSELF TO TALK TO YOUR DOCTOR ABOUT PROSTATE CANCER SCREENING

Whatever your politics, it’s true that ObamaCare came between you and your doctor in more ways than one.  Nothing says that more than the USPSTF decision to reverse its recommendation about PSA screening for prostate cancer.  USPSTF is a mouthful that stands for United States Preventative Services Task Force. 

USPSTF reversed its recommendation for PSA screening for prostate cancer for men 70 years and younger.  The USPSTF now says there is “at least a moderate certainty that the net benefit is small.”  Jamie Bearse, the CEO of ZERO, a patient advocacy group said “While the improved recommendation is a step in the right direction, there is much work to do.  We must undo a decade-long message that discouraged men from getting tested, and encouraged men to talk to the doctor about their risks and the test.”  In 2012, the USPSTF advised against all PSA testing in men of any age. 

But for men 70 years and older, I urge you to discuss PSA testing with your doctor.  Some risks are not so obvious.  For example, a history of breast cancer and ovarian cancer in your family may indicate a greater risk for prostate cancer in men.  Other factors are well-known.  African-American men have a greater risk of prostate cancer than white man.  And recent work from the Johns Hopkins University School of Medicine showed that 2/3’s of all prostate cancers are just due to chance or bad luck.  So it is not so simple as it seems.

 If you have any questions about PSA testing or treatment of your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-Dayton 1.  I guarantee that I will see you in consultation within 1-3 days of your phone call.

2017 New Year’s Resolution: Get a PSA Test

KNOW YOUR RISKS. Graphic credit econugenics.com

Turn on the radio or TV this month and prepared to be flooded with commercials for new diet plans and new exercise equipment, costing 100’s of dollars. 

But I’m asking that you spend $48 more wisely and get a PSA test for prostate cancer.  PSA screening for prostate cancer may just save your life, especially if you are a senior American man. 

PSA Screenings Work

When I first came to Dayton in 1994, routine PSA screening by your primary care physician had great results, like a 50% decline in prostate cancer deaths and a 70% decline in detecting stage IV prostate cancer diagnosis.  Diagnosis with prostate cancer metastasis or stage IV disease is treatable, but not curable. 

But in 2012, the US Preventive Services Task Force (USPSTF) recommended against prostate cancer screening in any American man, regardless of age. 

The Government Took Over

So what happened over the past 4 years?  For American men 75 years or older, 6.6% of men had metastasis or stage IV disease in 2004 compared to 12% in 2013.  There was a near doubling of men with stage IV disease only a few years after screening was halted for prostate cancer.  The rate of diagnosing senior American men with localized disease-intermediate or high-grade prostate cancer-also rose from 58% in 2004 to 72% in 2013.  Similar results were also seen in American men younger than 75 years. 

The study of over 1 million American men was reported in the January 2017 issue of JAMA Oncology. 

Take Back Control

What does this mean for you, your spouse, or significant other?  I’d ask your doctor pointblank about adding PSA testing to your routine yearly blood work panel.  PSA testing may not be covered by your insurance company, but the test cost only $48 at independent laboratories not affiliated with hospitals. 

The PSA blood test may just save your life.  Diagnosing prostate cancer at an early age, rather than an intermediate or advanced age, gives you more options and fewer side effects. 

Take control of your own prostate health.  Call me, Dr. Edward Hughes, at 855-DAYTON1 about the diagnosis and treatment options for prostate cancer.  I guarantee that I will see you 1-3 days after your call.  No other cancer center in Dayton makes that promise.

Give Yourself a Lifesaving Gift – Get Screened

Low-dose lung CT scans can save lives – as many as 30,000 Americans each and every year.

But lung cancer screening can give smokers a false sense of security.  An unexpected consequence of lung cancer screening with low-dose CT scans show that many smokers continued to smoke.  It was as if a negative screening lung CT scan gave them a new lease on their smoking lives. 

With a Negative CT Scan, Can I Still Smoke?  

The short answer is NO WAY!  The 2016 analysis of the National Lung Screening Trial (NLST) concluded that those men and women who stopped smoking for 7 years had a 30% decrease in lung cancer deaths.  That’s huge. 

Dr. Nicole Tanner of the Medical University of South Carolina was the senior author on the study that was published in the March 1, 2016 issue of the American Journal of Respiratory and Critical Care. 

With a Negative CT Scan Do I Need Another Lung Scan? 

The short answer is YES!  And more often than what you think.  Waiting 2-1/2 years between low-dose lung CT scans resulted in detecting lung cancers at a more advanced stage when it’s less curable.

The Dutch-Belgian Lung Cancer Survey Trial showed that 17.3% of lung cancers were stage III or stage IV when smokers were screened 2-1/2 years later compared to 6.8% for smokers screened more frequently. 

The Dutch-Belgian results were published in the June 30, 2016 issue of the journal Thorax. 

What are My Recommendations?  

CT Scans are painless and non-invasive.

For smokers, I recommend getting screened right away for the first time and then every 12-18 months thereafter.  In this Holiday Season, the gift of a $99 low-dose CT scan at First Dayton Cancer Care just may be lifesaving for you and for your loved ones. 

If you have any questions about lung cancer screening or your lung cancer treatment, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1

September is Prostate Cancer Awareness Month

September is Prostate Cancer Awareness Month. Are you wearing your Blue Ribbon? Where are the walks, the rallies, the NFL players? Men do not like to talk about it. But it is very important that every man is aware of the importance to be screened.

Cancer.org tells us, “About 1 man in 39 will die of prostate cancer. Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.9 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.” However if prostate cancer goes untreated it can cause some series health problems such as urinary incontinence, erectile dysfunction and worst case scenario-metastasize to other organs that can lead to death.

Watch as Dr. Hughes discusses the importance of Prostate Cancer Screenings on Living Dayton.

3 New Studies On Prostate Cancer You Need to Know About

1.  Stop PSA Screening  –   Not so Fast!

In 2012, the US Preventative Services Task Force (USPSTF) came out against routine PSA screening  for prostate cancer in men, regardless of age.  But the major study used for this recommendation was likely flawed.

More importantly, since 2012, the number of men diagnosed with advanced stage prostate cancer is increasing (Cancer Epidemiology Biomarkers Prev.  2016; 25:259-263).

Dr. Richard Hoffman, an expert in shared decision-making about prostate screening, told Medscape Medical News that “abandoning PSA screening is proving harmful.”

 From my own vantage point in our clinic, PSA testing for men ages 55-70 makes a lot of sense.  Urologists and radiation oncologists are now well aware of overtreatment of patients with early-stage prostate cancer.  Active surveillance can be offered for a number of our patients.  But missing advanced stage prostate cancer or aggressive prostate cancers can be deadly.  Most of the patients that I see in my clinic are not aware of the fact the prostate cancer is the second biggest killer of men in the US, second only to lung cancer.

2.  Artery-Sparing Radiation May Help with Erectile Dysfunction 

Dr. Patrick McLaughlin of the University of Michigan Medical School reported on the benefits of using MRIs in radiation planning for patients with early stage prostate cancer.  His study was published recently in the British journal, Lancet Oncology.  While sparing the critical arteries and nerves going into the prostate gland, Dr. McLaughlin and colleagues reported that 92% of men were still able to be sexually active even 5 years after radiation. 

In my opinion, Cyber Knife offers the best sparing of the arteries and nerves leading into the prostate of any of the radiation technologies.  And at First Dayton Cancer Care, our patients have the choice of Cyber Knife or IMRT or IMRT combined with temporary, robotic seed implants.

3.  Atkins Diet Can Help Some Side Effects of Hormonal Therapy for Prostate Cancer 

Dr. Stephen Freedland of Cedars-Sinai Medical Center in Los Angeles reported on the low carbohydrate diet and hormonal therapy at the recent American Urologic Association (AUA) annual meeting.

While on hormonal therapy for prostate cancer, the Atkins diet or low carbohydrate diet resulted in better blood sugar control and weight loss than in those men who ate a regular diet.

So there is some hope in managing the side effects of hormonal therapy or androgen deprivation therapy (ADT) for patients with prostate cancer.  Unfortunately, there was no difference in PSA levels. 

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

10 Steps to Beat Lung Cancer

CT Scans are painless and non-invasive.

CT Scans are painless and non-invasive.

Screening for lung cancer can save lives – 26,000 to 36,000 Americans every year – by use of low dose CT scans. Dr. Florian Fintleman from Massachusetts General Hospital in Boston reported on the 10-step model at the 2016  American Roentgen Ray Society (ARRS) meeting in Los Angeles.

Dr. Fintelman’s program can be summarized as follows:

  1. Patient Eligibility:
    • Current smokers age 55-77 years old
    • Former smokers age 55-77 with a 30-pack-a year history
    • Former smoker who quit within 5 years
  2. Physicians and Patient Education:
    • Educating primary care physicians on the US Preventative Services Task Force (USPSTF) guidelines and results. Stressing that nearly 30,000 lives can be saved every year. Only 15% of lung cancer patients are found with stage I or stage II disease, with survival rates of 80-85%. With lung cancer screening, that percentage can nearly be doubled, saving many more lives when the lung cancer is caught early.
    • Medicare (CMS) requires a visit between the referring physician and patient, with the visit focusing on “counseling and shared decision making”, i.e. part of a routine visit.
  3. Ordering screening lung CT scans:
    • CMS guidelines call for a physician or qualified non-physician provider such as a nurse practitioner, physician assistant or nurse specialist to order the low dose CT scan.
    • Patients who would simply like a CT scan screening may self refer as long as they meet the screening criteria.
    • First Dayton Cancer Care has special LDCT Lung Screening order forms with the established criteria. We will even acquire the prior authorization if needed. Call us today.
  4. Image Acquisition:
    • The American College of Radiology (ACR) and CMS established parameter for low dose, non-contrast CT scan optimal for lung screening.
    • First Dayton Cancer Care is an approved imaging facility through the Intersocietal Accreditation Commission with the longest accreditation term that they grant so you can be rest assured that the best possible low-dose, non-contrast CT lung screenings will be given here.
  5. Image Review:
    • At First Dayton Cancer Care our scans are read by board certified diagnostic radiologists from ProScan Imaging, a nationally recognized group of radiologists based in Cincinnati.
  6. Communication with Physicians:
    • Clear and concise reporting to referring physicians is provided within 24-48 hours of scan.
    • Images are available for viewing by physicians who so desire.
    • Images are compared to any previous screening scans if made known by the patient or ordering physician.
    • Referring physicians will get a telephone call from the Medical Director, Dr. Edward Hughes, to follow up on any positive CT Scans. Referring physicians can call Dr. Hughes for his medical opinion regarding further follow up, like biopsies and/or PET/CT scans.
  7. Communications with the Patient:
    • First Dayton Cancer Care will educate the patients with a negative screening to continue to follow up with their General Practitioner and the importance of routine care and need for future screenings.
    • Clinical research showed that an unexpected result from screening was the patients with a negative CT scan felt they have a new lease on life and continue to smoke. So we stress that a smoking cessation and or an appointment with their General Practitioner to discuss this habit is imperative.
  8. Quality Improvement
    • CMS has begun a program to collect data on lung screenings. They are just beginning to role out this registry but the hope is that these results will help fine-tune the guidelines and provide some benchmarks for further understanding the importance of these screenings.
  9. Cost/Insurance Coverage
    • Since December 2013, many private insurers will cover the cost of this routine screening for those meeting the criteria.
    • CMS covers lung cancer screening by its own criteria since February 2015 for those enrolled in the registry. Medicare is rolling this registry program out and hopefully soon all screening centers will be enrolled.
    • For other eligible patients, a low dose CT scan is only $99, the cost of a couple of cartons of cigarettes.
  10. Research Frontiers
    • As always, many questions remain unanswered, like the optimal interval between CT scans and how long should one have low-dose screenings.
    • Stereotactic radiosurgery, like that delivered by the Cyber Knife, has the same results as open surgery, but without the risk of thoracotomy. And the risk of surgery is not only confined to surgical complications, but there is a defined risk of death from thoracotomy, especially in elderly patients with multiple medical problems.

If you have any questions, please feel free to write or to call me, Dr. Edward Hughes at 855-DAYTON1.

I PASSED THE TEST- CAN I KEEP SMOKING?

Our friendly staff will help to make your low dose lung screening easy and painless.

Our friendly staff will help to make your low dose lung screening easy and painless.

 

Lung cancer screenings can give smokers a false sense of security. An unexpected consequenceof lung cancer screening showed that many smokers continue to smoke.  It was as if a negative low-dose CT scan gave them a new lease on their smoking lives. But a recent study showed that they are not off the hook.

Screening Low Dose CT scans for Lung Cancer Save Lives

The National Lung Screening Trial (NLST) was a breakthrough discovery.  Low-dose CT scans were done on 53,454 men and woman smokers every year for 3 years. The NLST showed a 20% decrease in lung cancer deaths. That’s 20,000-30,000 Americans saved from lung cancer death every year.  And it’s covered by most insurance companies.

So with a Negative CT Scan Can I Still Smoke?

In short, the answer is NO! The men and women in the NLST continue to be monitored. A recent “second look” analysis showed that those who stopped smoking for 7 years had an even greater decrease in lung cancer deaths – over 30%.  That’s huge!

Dr. Nichole Tanner of the Medical University of South Carolina authored the study that was published last month in the American Journal of Respiratory and Critical Care, March 1 2016.  Dr. Tanner commented to OncologyPractice.com that “this study is the first to quantify the benefit of smoking cessation coupled with lung cancer screening in a cohort that is asymptomatic.  The findings highlight the importance of integrating smoking cessation efforts and lung cancer screening programs.”

So What Does This Mean for Smokers?

The benefits of screening smokers with low dose CT scans are colossal.  Coupled with stopping smoking, the number of Americans saved every year would fill Great American Ball Park. And there are no excuses for not having a screening because CT scans are painless, done in minutes with minimal radiation exposure, and low cost.

Stop smoking programs get a lot a lip service but it’s hard to do.  But there’s good news. There are a lot of options for quitting smoking, like prescription Chantix, hypnosis, acupuncture, and even cell phone apps like on Livestrong.com.  So there’s no time like the present to put down the cigarettes and call for an appointment to be scheduled for your low dose CT scan.

Should You Be Scanned?

Screening is recommended for:

Smokers age: 55-75                                                                                                                             Smoked: 1 pack per day for 30 year                                                                                                               2 packs per day for 15 year habits                                                                                            Current smokers or smokers who quit within the past 15 years

If you think you need a lung cancer screening, please feel free to call me, Dr. Ed Hughes, at 855-Dayton1.

Lightning Can Strike Twice: Why Follow-up Visits Are Important

A new study of over 32,000 patients showed that survivors of certain cancers, namely head and Cancer-Screeningneck cancer, bladder cancer, and lung cancer are at an increased risk of another, yet different cancer.  And the second cancer can be lethal – and it’s called non-small cell lung cancer.

Dr. Geena Wu presented her research from the City of Hope National Medical Center at the recent 2016 annual meeting of the Society of Thoracic Surgeons Dr. Wu and colleagues looked at the SEER national database of 32,058 patients with a prior cancer who then went on to be diagnosed with a lung cancer 6 months or later following completion of their initial treatment.

Dr. Wu found that patients with a history of certain, specific cancers had higher rates than expected of getting non-small cell lung cancer years after their first cancer was cured.  Survivors of head and neck cancer, lung cancer, and bladder cancer were especially at risk.  Even survivors of lung cancer were at risk for coming down with a completely different second, unrelated lung cancer.  And it follows that smoking is not only the likely culprit of not only the first cancer, but the second one as well. Smoking can cause multiple cancers.

As a cancer specialist, I see patients for follow-up visits each and every day.  I hear the same story.  “I’m finally done with surgery.  I’ve been through months of chemotherapy and weeks of radiation.  And now I have to come for follow-up visits, not just for months but for years? So why won’t you specialists just give me a break?”  The answer, without question is that follow-up visits are important. You need to continue to be screened for other cancers.

Unfortunately there is no limit on the number of cancers a person can get. Especially when you are talking about cancers that can be driven by lifestyle choses such as tobacco use. Cancer screenings like mammograms, colonoscopies, skin checks, and low dose lung cancer CT scans all still need to be performed on a regular basis for cancer survivors. These routine follow ups are more important for survivors than for those who have never had cancer.

I hear our survivors tell me on a day-to-day basis, “But can’t my family doctor just do the follow-up visits?”  I think that follow-up visits by primary care physicians are ideal, but a recent poll of primary care physicians showed the two thirds preferred follow-up visits for cancer be done by cancer specialists, not the family doctor.  I think that primary care physicians are already put upon to look after your general health in a 15 minute visit.  I think the cancer specialists are uniquely trained to spot early signs of recurrent cancer as well as spotting the symptoms of a new, unrelated cancer.  Once again, early detection is key to survival.  Follow-up visits with your cancer specialist is time well spent.

If you have any questions, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

Prostate Cancer- The Government Did Make it a Federal Case

Is "Watchful Waiting" the best approach for Your Prostate Cancer?

Is  “Watchful Waiting” the best approach for Your Prostate Cancer? There is now a genetics test that can help answer your question.

1. PSA Screening Declines Following Government Mandate 

In late 2011, the US Preventative Service Task Force (USPSTF) recommended against routine PSA screening to detect prostate cancer in men without symptoms.  A new study from the Brigham and Women’s Hospital at Harvard, authored by Dr. Michael Zavaaski and colleagues, analyzed 27 million primary care visits by men ages 50-74 years old.  The major finding was a 57% drop in PSA screening by primary care physicians compared to only 4% in PSA testing by urologists.  Their study was published in the February 8, 2016 issue of JAMA Internal Medicine.  Dr. Zavaaski’s study compared PSA testing from 2010-2012, before and after the USPSTF guidelines were issued.  So it appears that primary care physicians really took the Federal government’s recommendation to heart.

Although I believe these results are dramatic, Medicare or CMS is now considering actually imposing a penalty on doctors who order PSA tests that do not meet the Federal government’s standards.  Certainly this is an unprecedented action and represents a very slippery slope for doctors as well as patients.  My fear is that the bed rock of medical practice-the concern and loyalty of a doctor to his or her own patients-will be trampled upon by the Federal government.  Doctors will now be judged and paid not by attention and concern for the individual patient sitting in front of them, but rather by how doctors treat “populations of patients.”  This is a profound shift in the doctor-patient relationship.  And it is already in Dayton, Ohio.  I just smiled when I received a request from one of the region’s hospitals to attend a new seminar entitled “Treating Populations of Patients in the Future.” To me patients are people, not ‘populations’.

2. Breakthrough Genetic Testing May Help You Choose the Best Prostate Cancer Treatment for You 

For those men who already have been diagnosed with prostate cancer, hope is on the way.  A number of genetic tests on the prostate cancer itself can help you and your cancer specialists judge whether you need treatment or not.  Once such test is the Oncotype DX prostate test.  The Oncotype score can be added to cancer stage, PSA level and Gleason score to help estimate how likely your prostate cancer is to spread to bone-a fatal complication.  I think the Oncotype adds key information that can help you decide whether a watch and wait approach is good for you.

Dr. Evans and colleagues looked at the genetic profiles over 1000 prostate cancers in men with high risk features.  Their study showed a number of genes responsible for DNA damage and repair may be used to help select those patients who need more than standard surgery or radiation-options like adding chemotherapy or hormonal therapy or both.  Their study was published in the Journal of the AMA Oncology January 7, 2016 issue.

And don’t forget-not all men have early-stage prostate cancer.  Now that routine PSA screening has declined, many patients are referred to urologists and radiation oncologists with high risk prostate cancer.  Men at high risk are those with a Gleason score 7 prostate cancer and a PSA of greater than 10 ng/ML or a Gleason 8-10 prostate cancer regardless of PSA level.

So What’s a Man to Do? 

From my experience as a cancer specialist as well as the patient, no man looks forward to the annual digital rectal exam.  Or even a needle stick in the arm for routine blood work.  But I would not be so quick to throw out either test so fast, despite what the Federal government says.  I still may be a “true believer” but I still hold that my job, my obligation if you will, is to the patient sitting in front of me, and not to the Federal government.  If my brother or father had prostate cancer, I would certainly be tested with PSA and undergo a yearly digital rectal examination. As a cancer specialist, it is remarkable to me that Medicare wants to halt PSA testing while, in the next breath, President Obama is launching a new “Moon Shot” in the war against cancer.  With all the talk about precision medicine, I hope that personalized medicine-putting the patient first and foremost-is not forgotten altogether.

If you have been denied a PSA and think you need one; or you have an elevated PSA and are not sure if watchful waiting is best for you, give me a call to set up a visit at 855-DAYTON1

 

“A New Test for Early Stage Prostate Cancer – If Medicare Approves Oncotype DX Prostate Cancer, It Must Be Good.”

prostate02A man has to make many decisions in his life.  Over 1 million American men each year undergo prostate biopsy and 240,000 men face the decision about the right treatment for their own prostate cancer.  But for many men, no treatment at all may be a good option.  It’s called “active surveillance”-a fancy term for what used to be called “watch and wait.”  The “active” part is men now taking responsibility, in a major way, for their own prostate health.

Whether or not to treat prostate cancer is a hard decision.  There are lots of options-so many, I think, that men can get overwhelmed by the choices.  But the more we learn about the biology of prostate cancer, the more we recognize, as cancer specialists, that not all men with prostate cancer need to be treated with surgery or radiation.

The New Oncotype DX Prostate Cancer Test Helps Men with Early Stage Prostate Cancer

Each and every week, I face newly diagnosed men with prostate cancer who have a lot of questions.  How fast is my prostate cancer growing?  How aggressive is my cancer?  How can you be sure that the biopsies reflect all the cancer in my prostate?  Is my prostate cancer localized or spreading?  What are my options?  What are the side effects?  Is radiation or surgery the only answer?  Can I watch and wait?

As prostate cancer patients and prostate cancer specialists, it is only human to want a single test to have all the answers.  It’s just not that simple.  But the results of the Oncotype DX prostate cancer test go a long way in helping us to answer whether men with low risk prostate cancer need immediate treatment or not.  The results of a major study were presented at the 2015 American Urologic Association meeting held in New Orleans this spring.

This first large-scale study of 4,000 prostate cancer patients was analyzed with the Oncotype DX prostate cancer test showed positive results.  Of those men with so-called “low risk” prostate cancer, 36.9% had results indicating “very low risk,” while 11.3% had worse disease with higher risk prostate cancer. So about one third of those men with low risk disease by standard criteria were felt appropriate for a watch and wait approach.

So What’s a Man with Early-Stage Prostate Cancer to Do?

Clearly, the Oncotype DX Prostate Cancer test is not the one and only test we all hoped for; but I think it‘s another important tool for prostate cancer specialists to be aware of.

My recommendations for watch and wait approach are the following:

  • PSA less than 10 ng/mL
  • PSA doubling time of greater than 12 months
  • Gleason score 6 or lower and no perineural invasion
  • No more than 2 positive biopsies
  • No prostate nodule on digital rectal exam
  • No family history of prostate cancer
  • No extracapsular extension on MR scan
  • A low Oncotype DX prostate cancer score

If you have any questions about your prostate cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.  I guarantee that I will see you within 1-3 days of your call.