Still think screening for breast cancer doesn’t matter?  In this country there is a lot of debate about that very topic.  Opponents of screening suggest that it results in over-treatment for “lumps” that may be benign cysts or nothing at all.  What is over-treatment?  Sometimes simple referral for ultrasound [...]]]> Source:  BBC Health; Journal of Medical Screening

Still think screening for breast cancer doesn’t matter?  In this country there is a lot of debate about that very topic.  Opponents of screening suggest that it results in over-treatment for “lumps” that may be benign cysts or nothing at all.  What is over-treatment?  Sometimes simple referral for ultrasound or MRI and sometimes referral to a breast surgeon for aspiration (withdrawing cells through a needle), biopsy (cutting out a portion of the lump) or excision (removal of the lump).

Well the latest study, out of England, focused upon 80,000 women aged 50 and over.  (Women in England between 50 and 70 receiving screening every 3 years under the National Health System).  The results?  Over a period of 20 years,  5.7 (yeah, I don’t know what a .7 person is either) breast cancer deaths were prevented for every 1,000 women screened.  2.3 of those 1,000 women were told they had a lump of unclear significance.  Okay, that’s raw numbers, what does it mean?  Well, for every 28 cases diagnosed, 2.5 women had their lives saved and 1 woman was over-diagnosed.

According to the authors of the study, “The benefits in terms of numbers of deaths prevented are around double the harm in terms of over-diagnosis.”  Projecting forward leads them to believe that, “A significant reduction in breast cancer deaths in association with mammographic screening.”

Because of research such as this the NHS plans to extend mammography to women 47 to 73 by 2012.  Meanwhile, here in the United States and with the possible implementation of a National Health Care Service we appear to be going in the opposite direction.  Here we debate the costs of screening women under 50.  Whether or not it’s prudent.  Economically effective.  And whether or not too much screening, rather than resulting in more diagnosis and lives saved, results in over-treatment (read more money).

And back across the pond, a spokesperson for Cancer Research UK, Sara Hiom, was quoted saying, “What we need to remember is that detecting cancers earlier generally means improved survival.  And we know through trials and through research that breast cancer screening can save lives.”

Deputy Directer of the NHS cancer screening programmes (thats Brit for programs) adds, “There is a risk of over-diagnosis and possible subsequent over-treatment associated with any screening programme” and that, “The latest independent study shows that the risk of over-diagnosis is very much lower than some other recent estimates have claimed and that the benefits [of mammography screening] far outweigh the risks.”  Well put.

~Posted by D.M. Schwadron, Esquire

A Duke University study published in the American Journal of Roentgenology (that’s x-rays) found that plain x-rays miss a surprising amount of fractures compared with MRI.  How many?  Out of 92 patients undergoing x-ray and then checked with MRI, 35 fractures were missed.  That’s more than 1/3 of fractures [...]]]> Source:  American Journal of Roentgenology; BBC Health

A Duke University study published in the American Journal of Roentgenology (that’s x-rays) found that plain x-rays miss a surprising amount of fractures compared with MRI.  How many?  Out of 92 patients undergoing x-ray and then checked with MRI, 35 fractures were missed.  That’s more than 1/3 of fractures for the slow at math.  Oh and 11 patients had a fracture suggested by x-ray that wasn’t on the MRI (a false positive).

The problem? Well outside of the obvious, is that a negative finding read on an x-ray will not result in any additional study.  In a Hospital Emergency Room Setting, the goal is to rule out traumatic fractures and move on to other diagnoses.  Which means that patients are getting sent home with fractures that could potentially result in greater injury (ie. risk of fall, accident, extension of fracture, etc).

The suggestion of the authors was to use MRI in addition to x-rays, where doctors have doubts -particularly in the frail or elderly patient population.  (Like you, I was looking to see if the study was funded by the MRI Manufacturers Association, but I could neither confirm nor deny that.) Hip and pelvic fractures are common among this group.  (Who else thinks putting the call back upon the doctor is an inherently good idea?)  Maybe I’m missing something (no pun intended) but if ER doctors are using x-ray to rule out fracture, why would they go any further once they get a negative result.  Further, won’t the hospital administration and the Insurance Companies question the diagnostic rationale of obtaining an additional study when the first study was negative?

Okay, here is the point where I go off on an associated tangent, but a tangent, nonetheless.  The point of this study was to use MRI as a back up where there were questions about an x-ray finding.  Maybe the better practice would be to simply use MRI as the first study and do away with conventional and, apparently out-dated, x-ray technology?

What do I mean by “outdated?”  A quick history lesson.  It was 11/08/1895 when Wilhelm Conrad Röntgen accidentally discovered an image cast from his cathode ray generator.  A week after his discovery, Rontgen took an X-ray photograph of his wife’s hand which clearly revealed her wedding ring and her bones. The photograph electrified the general public and aroused great scientific interest in the new form of radiation. Röntgen named the new form of radiation X-radiation (X standing for “Unknown”).  Wilhelm’s wife, who served as chief tester would later die of radiation over-exposure.  In 1913, William Coolidge invented the X-ray tube which then revolutionized the generation of X-rays and is the model upon which all X-ray tubes for medical applications are based.  I’d consider that outdated.  Hey, what do I know, I’m a lawyer, not a doctor.

~Posted by D.M. Schwadron, Esquire

You will recall that in October of 2009, we reported on the FDA’s investigation of Cedars-Sinai Hospital in LA and documented overdosing of radiation during CT scans.  http://www.medicalmalpracticelawyerblogphiladelphia.com/?p=394

And you may further recall that I said this was likely an emerging trend.  Well, you will be shocked to know that 50 [...]]]> Source: US FDA; Wall Street Journal

You will recall that in October of 2009, we reported on the FDA’s investigation of Cedars-Sinai Hospital in LA and documented overdosing of radiation during CT scans.  http://www.medicalmalpracticelawyerblogphiladelphia.com/?p=394

And you may further recall that I said this was likely an emerging trend.  Well, you will be shocked to know that 50 additional patients have been identified as those receiving overdoses of radiation with CT. Further, the investigation has spread to facilities other than Cedars-Sinai. One such site has been identified as Glendale Adventist Medical Center where overdoses were reported with CT scans to diagnose stroke.

The Cedars scanners were manufactured by corporate giant, GE, however there are other manufacturers involved in the latest. For their part, GE stands by their products.

In published remarks, Cedars-Sinai stated that the appropriate people of the State of California, “accepted the hospitals plan to correct the problem.”  In the words of Christian Bale on set….”Oh, gooood for you!”

~Posted by David Marc Schwadron, Esquire

It seems like just last week (okay so it was 3 weeks ago) that I was blogging on the newly announced recommendations relative to mammography.  http://www.medicalmalpracticelawyerblogphiladelphia.com/?p=439

I also suggested that there were larger forces at work behind such things as US Preventative Services Task Force recommendations which surface during governmental [...]]]> Source: Associated Press; The Wall Street Journal

It seems like just last week (okay so it was 3 weeks ago) that I was blogging on the newly announced recommendations relative to mammography.  http://www.medicalmalpracticelawyerblogphiladelphia.com/?p=439

I also suggested that there were larger forces at work behind such things as US Preventative Services Task Force recommendations which surface during governmental debates on health care and which represent a swing in a particular direction.

So you don’t think I’ve put on my tinfoil hat and gone all “Olver Stone” on you, the “Task Force” responsible for the recommendations has now been summoned to testify before the US Congress. Oooh. What did they say? What did they say?

Well, the Task Force acknowledged that ACOG (the American College of Obstetricians & Gynecologists) expressed concern that the panel’s recommendations might be misunderstood by clinicians, patients, policy makers and insurers (funny, no mention of trial lawyers) and said, “Our message was misunderstood.”

So that’s their story. They were “misunderstood.”  They were NOT trying to create some sort of political expediency whereby women under 50 were denied routine mammography as a cost saving measure for the government and for insurers.

Oh and from my prior blog post, the one where I wrote, “That aside, anticipate the pro-mammography lobby to push for a formal adoption/return to the 40 and over recommendation for various reasons both medical and economic.”  Radiologists affiliated with Harvard and UC Irvine have spoken out that adopting the newer guidelines would result in increased deaths and negate the gains made over the past 20 years.

Still think medicine isn’t a business?

~Posted by David Marc Schwadron, Esquire

Research published in the Journal of Urology appears to demonstrate that adjuvant radiotherapy (radiation treatment) within 18 weeks of surgery significantly reduced the risk of recurrence and metastasis of prostate cancer. Additional associations were reduced need for hormonal therapy and increased survival. This compared with the typical “watch and [...]]]> Source:  Journal of Urology; Medscape Medical News

Research published in the Journal of Urology appears to demonstrate that adjuvant radiotherapy (radiation treatment) within 18 weeks of surgery significantly reduced the risk of recurrence and metastasis of prostate cancer. Additional associations were reduced need for hormonal therapy and increased survival. This compared with the typical “watch and wait” approach, so-called “salvage therapy.”

How significantly?  Of the 425 men studied, 214 received adjuvant radiation.  (It is important to note that the patients were staged T1-2 with at least one critera of T3).  Only 93 of the 214 in the radiation group became metastatic as opposed to 114 of the 211 who didn’t.

88 of the 214 in the radiation group did not survive their disease however 110 of the 211 who didn’t receive radiation did not survive prostate cancer.  A median survival rate of 1.7 years.  This is fairly medically significant.

This a “practice-changing” study, according to Dr. J. Brantley Thrasher of the University of Kansas School of Medicine and spokesperson for the American Urological Association.  Let’s see how quickly it becomes implemented into practice.

~Posted by David Marc Schwadron, Esquire

An exercise study of those aged 45 to 55 of medically average weight found that damage to cartilage and ligaments was caused by those who perform high impact exercises.  Shocking, I know. Knees [...]]]> Source: Radiological Society of North America (RSNA) (Now available on Twitter, btw); with a nod to BBC Health for finding it too.

An exercise study of those aged 45 to 55 of medically average weight found that damage to cartilage and ligaments was caused by those who perform high impact exercises.  Shocking, I know. Knees were the most likely to suffer with running and jumping linked to more injuries than swimming or cycling. (Wonder where Aikido falls in?)

The “study” was in fact a questionnaire with MRI scan follow up for osteoarthritis (a degenerative joint disease involving small bits of bone known as osteophytes).  Naturally the researchers advocate low impact and non-weight bearing exercise which is fine for what it is. Fortunately, I have a few more years yet to worry about such things so I’ll be in the dojo doing high impact and weight bearing exercise.

Personally, I was actually more amazed that anyone would subscribe to a Twitter from the RSNA than this groundbreaking research study.  But that’s just me.

~Posted by David Marc Schwadron, Esquire

The US Preventative Services Task Force has released the latest (11/2009) recommendations for Breast Cancer Screening.  Were I a woman or performing breast self-examination (BSE) on, well myself, I’d be confused.

The Task Force has un-recommended (hey if “un-friend” is now a word, this can’t be [...]]]> Source: US Department of Health and Human Services November 2009 Release

The US Preventative Services Task Force has released the latest (11/2009) recommendations for Breast Cancer Screening.  Were I a woman or performing breast self-examination (BSE) on, well myself, I’d be confused.

The Task Force has un-recommended (hey if “un-friend” is now a word, this can’t be far behind) screening mammography for women under 50. In fact, they specifically recommend against routine screening mammography in women ages 40-49.

This represents a return to the previous recommendation for biennial screening mammograms for women ages 50-74.  The Task Force saw no benefit to routine screening for women under 50 or 75 and over.

The Task Force additionally recommends against teaching patients to perform breast self- examination, a position which runs contrary to that taken by this pro BSE blogger. See http://www.medicalmalpracticelawyerblogphiladelphia.com/?p=376 It is the anecdotal and lay experience of the author that many women under age 50 discover masses or lumps on breast self-examination and that this discovery directly leads to their diagnosis.

That aside, anticipate the pro-mammography lobby to push for a formal adoption/return to the 40 and over recommendation for various reasons both medical and economic.

~Posted by David Marc Schwadron, Esquire

The FDA just announced a potential patient safety issue with perfusion CT imaging of the head.  The issue? overexposure to dangerous levels of radiation.  Where is this test most prominent?  For imaging to diagnose stroke and to determine treatment for stroke.

Over an 18 [...]]]> Source: US Food & Drug Safety Administration (FDA) and The Wall Street Journal

The FDA just announced a potential patient safety issue with perfusion CT imaging of the head.  The issue? overexposure to dangerous levels of radiation.  Where is this test most prominent?  For imaging to diagnose stroke and to determine treatment for stroke.

Over an 18 month period, 206 patients at an unidentified hospital received radiation doses 8x the level expected. The maximum recommended dosage for the head is 0.5 Gy.  Patients in the investigation received 3-4 Gy.  So what’s a little hair loss and erythema (redness of the skin), right?

Well the Wall Street Journal was kind enough to “out” the facility under investigation as Cedars-Sinai Medical Center in LA.  According to a spokesperson for Cedars-Sinai, there was a “misunderstanding about an embedded default setting.” No sh*t, Sherlock.

The reason any of this matters to you? One, it proves that even we trial lawyers are correct about medical errors every once in a while. Two, the FDA has suggested that the incident, “May reflect more widespread problems with CT quality assurance programs and may not be isolated to this particular facility or this imaging procedure.” Government speak for, “OMG! WTF?!”

According to their official statement, the FDA is, “Working with the parties involved to gather more data about the situation and to understand its potential public health impact.”

Oh good. I feel safer already.

Posted by David Marc Schwadron, Esquire

No, this will not help your golf game. But it may save your life. Remember Night Time Radiology? Yeah, it’s like that. High quality videoconferencing systems have been accepted as, “[A]n effective avenue to eliminate disparities in access to acute stroke and TIA (transient [...]]]> Source: American Heart Association (AHA) and American Stroke Association (ASA) 05/2009

No, this will not help your golf game. But it may save your life. Remember Night Time Radiology? Yeah, it’s like that. High quality videoconferencing systems have been accepted as, “[A]n effective avenue to eliminate disparities in access to acute stroke and TIA (transient ischemic attack or “mini stroke”) care, erasing the inequities introduced by geography, income or social circumstance.” Great PR Quote, huh?

In simpler terms, not everyone has equal access to good quality medical care, particularly those who are poor or regionally isolated (think living on a mountain). Enter the video phone. “Telestroke” invloves a specialist (neurologist or neuroradiologist) and a bi-directional video and audio conferencing system to interact with a doctor at bedside for “real time” consultation and treatment recommendations. One call to a specialist who can access CT and MRI results could result in an immediate, or rapid, diagnosis of a stroke.

And when one is having a stroke, time until treatment is initiated is extremely important. Oh and the author of that great PR quote, Dr. J. Donald Easton, along with other similarly obtuse quotes, and author of the article recommending use of this technology is also a “consultant/advisor” for the companies which produce the technology.

While consider the source applies, this actually is a valuable medical technology.

posted by David Marc Schwadron, Esq.

Researchers have found that a little known ultrasound feature may be beneficial in the detection of malignant breast masses. Elastography, literally testing the stretch of breast tissue, diagnosed all malignant masses in the study vs. 88.5% diagnosed by routine ultrasound. Elastography is generally available on ultrasound machines [...]]]> Source: American Roentgen Ray (x-ray) Society 2009 Annual Meeting

Researchers have found that a little known ultrasound feature may be beneficial in the detection of malignant breast masses. Elastography, literally testing the stretch of breast tissue, diagnosed all malignant masses in the study vs. 88.5% diagnosed by routine ultrasound. Elastography is generally available on ultrasound machines as an added feature.

It’s use was largely experimental 3 years ago in other countries and unfortunately, remains only a research tool in the United States. The continued development of the technology gives hope to both radiologists and patients that they may soon have another tool available for the early detection of malignant breast masses.

posted by David Marc Schwadron, Esq.