Quotes of the Month

     The hectic Holiday activity precluded a December Webletter and I am sorry for that. I hope all of our readers had a very joyous Holiday Season and I wish you all a healthy, happy, and prosperous New Year.

     In this month's Webletter I am going to report on some new and innovative activity in the treatment and prevention of malignant disease. I trust you will find it interesting.

     Mammogram Crisis: At the recent meeting of American Roentgen Ray Society in Atlanta, Dr. Richard Tello, M.D., professor of radiology, epidemiology, and biostatistics at Boston University presented an analysis based on a statistical model which estimated that the cost of screening mammography litigation could exceed $250 million a year in 10 years. This could drive the cost per procedure from a conservative estimate of $70 to more than $200.

     Ed. It is unlikely that insurance companies will increase their remuneration just to cover costs of litigation. Also it is doubtful patients will pay the additional cost out of pocket. One solution, brought out at the Atlanta meeting, could be a federally sponsored litigation pool like the one existing for vaccine lawsuits. Another egregious consequence of frivolous malpractice litigation.

     Incidental Adrenal Masses: I know you question any "incidental mass" especially if it is yours. These are questionable tumors seen in the adrenal glands when CT x-rays are done trying to diagnose an unrelated problem. The concern is their significance. In the January 2003 issue of Baylor University Medical Center Proceedings, Dr. D.T. Arnold, et al presented an interesting paper addressing this problem. Nonfunctioning masses (no abnormal hormone or chemical findings) less than 3 centimeters in diameter should be followed with CT scans at 3 and 12 month intervals. If there is no change then nothing is indicated. If it grows during this time interval then an adrenalectomy is necessary. All over functioning tumors and those over 4 centimeters in diameter should be excised.

     Ed: This simplistic approach to this dilemma is not new but their clinical statistics support this approach as evidence based medicine (EBM).

     Pet Scan: In the same issue of Baylor University Medical Center Proceedings Drs. Moore and Griffith present an article touting the efficacy of Pet Scans in the diagnosis, treatment, and follow up of malignant tumors.

     Ed: It seems that this technology is becoming an absolute necessity for adequate and efficient management of patients with cancer or in patients suspected of having the same.

     Cancer Statistics: Hematology Oncology News and Issues (vol.1 no.11) gave some highlights from the recently released U.S. Cancer Statistics: 1999 Incidence.
Prostate cancer is still the leading cancer in men, followed by lung/bronchial and colon/rectal. Prostate cancer rates for African-American males are 1.5 times higher than those for white men.

Breast cancer is the most prevalent cancer in females, followed by lung/bronchial and colon/rectal and Breast cancer rates for white women are about 20%higher than those for African-American females.

Melanomas of the skin and cancer of the testis are among the top 15 cancers in white men.

Melanomas of the skin and cancer of the brain/nervous system are among the top 15 cancers in white women.

Multiple myeloma and cancer of the liver are among the top 15 cancers for African-American men.

Multiple myeloma and cancer of the stomach are among the top 15 cancers in African-American women.
     Ed: Multiple myeloma seems to be increasing in frequency. The full report is available at http://www.cdc.gov/cancer/npcr/uscs and http://www.seer.cancer.gov/statistics.

     Pancreatic Cancer: An abstract published in Oncology (Dec.2002, vol.16, no.12) gives some interesting facts regarding this dreaded malignancy. It is a leading cause of cancer related mortality. Treatment, unfortunately, has little efficacy and 5-year survival continues to be less than 5%. Advances in molecular genetics have paved the way for rational screening in high-risk individuals. Those at high risk include: persons in 6th to 8th decades of life, family history of pancreatic cancer, and those with a history of tobacco smoking. No standards for screening or prevention exist today, but strategies utilizing endoscopy, radiology, and molecular technology are under investigation.

     Ed: I have nothing good to say about this disease. If screening methods can diagnose small tumors before they become symptomatic, then perhaps the results of surgery will improve. The operation required is one of the most formidable in abdominal surgery.

"Evil comes at leisure like the disease; good comes in a hurry like the doctor."
     - G.K. Chesterton (1874-1936) British writer
     The Man Who Was Orthodox

"Not even remedies can master incurable diseases."
     - Seneca (c.4BC-65AD) Roman writer
     Epistulae ad Lucilium

"I know nothing of tomorrow, but I have seen yesterday and I love today."
     - Sr. Mary Irma Endres
Take care until next time,
Richard J.Turner, III, M.D., F.A.C.S.

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     West Nile/Cancers/Discontent with American Healthcare/Prescriptions
     History of Preventive Medicine
     Smoking Risks/Depression/The Western Diet
     Food Consumption/Cancer and Treatment Relationships
     Notes from the Spring Texas Surgical Society Meeting
     Alternative Medicine
     Breast Cancer Symposium
     Vitamin B, Passive Smoking, Statin Therapy, Common Cough
     Type 2 Diabetus Mellitus
     Antihistamines and Alcohol
     The Journal Club
     Let's Keep It Simple