http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande
Hi Fellow Hanger's Out:
I didn't want to threadjack in MayKs thread about her journey, a success by anyone's measure, but I did want to post this article, which I find to be an outstanding characterization of cancer, diagnoses, and treatment planning.
Some posters on that thread posed questions or observations and I wanted to respond but not in that thread.
In short, not all cancers behave the same way.
When I worked at the august healthcare institution I just retired from, I saw women in their 80s come in for a physical exam who had large tumors in their breasts and had them for many decades. They were otherwise in outstanding health and would go on to die of other problems like a stroke or heart attack. This type of breast cancer is indolent cancer, slow growing, no metastases, and not the cause of mortality. Clearly, these were women who weren't having mammograms. They did not die of breast cancer.
I saw patients with cancers that early detection mattered a great deal in terms of quality of life AND mortality: Colon cancer and melanoma are prime examples. Absolutely, get screened and get on it if you come up positive on screening/diagnosis.
Sadly, there are cancers where early detection makes no difference in terms of mortality.
For sure, what I also learned in healthcare was this: Make sure your *data* is good before you even consider diagnosis and treatment planning. Data=lab tests, imaging, pathology, and clinical exam. This is what will determine your outcome. Mistakes are made. Some results are open to interpretation and you want the most experienced interpreter reading your imaging/slide/bloc. You want an oncologist who specializes in your problem. Go to a Center of Excellence for your particular issue. Example: Ovarian cancer, gold standard is now IP chemo, meaning intraperitoneal chemotherapy. Adds a lot of time on to lifespan and without destroying the health of the patient. Only 16 centers in the US are doing IP chemo for patients with ovarian cancer. WTH.
Keep a binder in which you keep a copy of your blood tests and physician visits and this is most important: GET YOUR IMAGING RESULTS AND THAT MEANS BOTH THE RADIOLOGIST'S REPORT *AND* THE ACTUAL IMAGES EITHER AS AN ATTACHMENT OR A DISC. For pathology (biopsies), have your slides sent along with the pathology report for second opinion.
Institutions are going to lose your test results and images and slides or the staff isn't going to rush them for you. If you already have them in your possession, your next provider can get working for you right away.
Hi Fellow Hanger's Out:
I didn't want to threadjack in MayKs thread about her journey, a success by anyone's measure, but I did want to post this article, which I find to be an outstanding characterization of cancer, diagnoses, and treatment planning.
Some posters on that thread posed questions or observations and I wanted to respond but not in that thread.
In short, not all cancers behave the same way.
When I worked at the august healthcare institution I just retired from, I saw women in their 80s come in for a physical exam who had large tumors in their breasts and had them for many decades. They were otherwise in outstanding health and would go on to die of other problems like a stroke or heart attack. This type of breast cancer is indolent cancer, slow growing, no metastases, and not the cause of mortality. Clearly, these were women who weren't having mammograms. They did not die of breast cancer.
I saw patients with cancers that early detection mattered a great deal in terms of quality of life AND mortality: Colon cancer and melanoma are prime examples. Absolutely, get screened and get on it if you come up positive on screening/diagnosis.
Sadly, there are cancers where early detection makes no difference in terms of mortality.
For sure, what I also learned in healthcare was this: Make sure your *data* is good before you even consider diagnosis and treatment planning. Data=lab tests, imaging, pathology, and clinical exam. This is what will determine your outcome. Mistakes are made. Some results are open to interpretation and you want the most experienced interpreter reading your imaging/slide/bloc. You want an oncologist who specializes in your problem. Go to a Center of Excellence for your particular issue. Example: Ovarian cancer, gold standard is now IP chemo, meaning intraperitoneal chemotherapy. Adds a lot of time on to lifespan and without destroying the health of the patient. Only 16 centers in the US are doing IP chemo for patients with ovarian cancer. WTH.
Keep a binder in which you keep a copy of your blood tests and physician visits and this is most important: GET YOUR IMAGING RESULTS AND THAT MEANS BOTH THE RADIOLOGIST'S REPORT *AND* THE ACTUAL IMAGES EITHER AS AN ATTACHMENT OR A DISC. For pathology (biopsies), have your slides sent along with the pathology report for second opinion.
Institutions are going to lose your test results and images and slides or the staff isn't going to rush them for you. If you already have them in your possession, your next provider can get working for you right away.