Archive for the ‘ACS’ Category
Posted on January 28, 2010 07:30:43 PM
My friends at the American College of Surgeons’ Operation Giving Back have come up with a really smart strategy to collect as much information as possible about surgical cases in Haiti. Thanks to a new data collecting tool, every surgeon who volunteers in Haiti can contribute to this case log. The potential result will be one of the most comprehensive registers of surgical care in a disaster situation. Depending on what we find, I think that this data could make a big difference in preparing surgical responses for future missions.
This is an example of crowd-sourcing at its best.
Here is a summary statement from ACS: (more…)
Posted on November 19, 2009 09:53:31 AM
I was having an interesting Twitter chat with online friends (Liz Cohen @, Dr. Chuk Onyeije @; Dr. David Gorski @gorskon; Dr. Marya Zilberberg @murzee; Sherry Reynolds @cascadia; and @speakhealth) about the mammogram debate. They asked me “where I drew the line” on paying for expensive screening tests that may save lives but require unnecessary surgery for countless others. My opinion takes into account human nature and political savvy rather than pure science and statistics on this one.
To me, the bottom line is that the mammogram is a sloppy screening test. It’s expensive, there are lots of false positives and unnecessary surgeries, yet it saves occasional lives (which is dramatic and meaningful). We have to appreciate that women have come to accept the risks/benefits of this test, and have been told for a long time that they should begin screening at age 40.
It’s not emotionally or politically possible to reverse course on this recommendation until a better choice is available. You can trade the mammogram for a better test, but you can’t trade it for doing nothing. The amount of drama associated with the perception of having something potentially life-saving taken away is just not worth the cost savings. It may be a reasonable value judgment based on the data, but it’s not politically feasible so we should mentally take it off the table.
Instead we must focus on the search for a better test - something that’s more accurate and less expensive. We will be stuck paying for lots of unnecessary mammograms/biopsies for now, no way around it. But let’s think of it as a temporary predicament - not an eternal waste of resources.
In the end, women should have a nuanced conversation with their doctor about whether or not they are at risk for breast cancer, and make an informed personal decision about when to begin mammography screening. Guidelines are not mandates - though the USPSTF’s well intentioned report would probably have been better left unwritten.
Now let’s fund some serious research into a better screening test!
Posted on November 18, 2009 05:00:51 AM
Dr. Avrum Bluming is a medical oncologist and clinical professor of medicine at the University of Southern California. He is also a dear friend, scientist, and careful analyzer of data. I asked him to help me understand the current mammogram guidelines debate, and what women (now faced with conflicting recommendations) should do about breast cancer screening. Please listen to his fascinating discussion captured here:
What I learned is that the guidelines must be tailored to each woman’s unique situation. The variables that must be considered are incredibly complex, as breast cancer risk factors include everything from when and if one has given birth, to a history of smoking, drinking, overweight, breast cancer in the family and even the age of your parents when you were born. Beyond risk factors, new research suggests that some breast cancers spontaneously resolve without treatment, but our technology is not advanced enough to distinguish those from others that will go on to become life-threatening tumors - so we treat all cancers the same.
Dr. Bluming did reassure me that the radiation exposure of mammograms is very low - about the equivalent of what one would get from about the equivalent of the cosmic radiation experienced during a round trip airflight across the U.S., and that having surgery (for a false positive biopsy) is quite rare.
When I suggested that the USPSTF guidelines more closely resemble European breast cancer screening strategies, so that maybe the US has been over-testing all along, Dr. Bluming simply responded that cancer death rates in the US are much lower than in Europe, probably because of more aggressive early detection.
He concludes: “I support healthcare reform, because the current situation is untenable. However with universal healthcare systems, cost cutting becomes the focus and screening tests are limited by necessity.”