There appeared to be an epidemic of melanoma skin cancer, but it seems to be a pseudoepidemic caused by overdiagnosis. Screening everyone with skin exams does more harm than good and can no longer be recommended. This lesion was suspicious enough to warrant a biopsy, but screening everyone for skin… read more "Melanoma: A Pseudoepidemic of Skin Cancer Prompts New Screening Recommendations"
Kidney Cancer and Incidentalomas
Kidney cancer diagnoses are increasing but there has been no increase in mortality or rate of metastases. Kidney cancer is most often diagnosed as an incidental finding on a CT scan that was done for unrelated reasons. Treatment may not always be needed. In the February 1, 2019 issue of American… read more "Kidney Cancer and Incidentalomas"
Osteopenia: When Does Decreased Bone Density Become a Disease Requiring Treatment?
Osteoporosis is routinely treated with bisphosphonates to prevent fractures. A new study suggests that osteopenia should be treated too. But questions remain. Bisphosphonate drugs have been shown to increase bone density and prevent fractures in postmenopausal women with osteoporosis (remember Sally Field in those ads for Boniva?) but what about… read more "Osteopenia: When Does Decreased Bone Density Become a Disease Requiring Treatment?"
Uncertainty in Medicine
Medicine is an uncertain business. It is an applied science, applying the results of basic science knowledge and clinical studies to patients who are individuals with differing heredity, environment, and history. It is commonly assumed that modern science-based doctors know what they are doing, but quite often they don’t know… read more "Uncertainty in Medicine"
Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid
A new stool DNA test was recently approved by the FDA for colon cancer screening. My first reaction was “Yay! I hope it’s good enough to replace all those unpleasant, expensive screening colonoscopies.” But of course, things are never that simple. I wanted to explain the new test for our… read more "Recent Developments and Recurring Dilemmas in Cancer Screening: Colon, Lung, Thyroid"
Prostate Cancer Dilemmas: To Test or Not to Test, To Cut or Not to Cut
The issue of PSA screening has been in the news lately. For instance, an article in USA Todayreported the latest recommendations of the US Preventive Services Task Force (USPSTF): doctors should no longer offer the PSA screening test to healthy men, because the associated risks are greater than the benefits. The story… read more "Prostate Cancer Dilemmas: To Test or Not to Test, To Cut or Not to Cut"
Re-thinking the Annual Physical
Please note: the following refers to routine physicals and screening tests in healthy, asymptomatic adults. It does not apply to people who have been diagnosed with diseases, who have any kind of symptoms or signs, or who are at particularly high risk of certain specific diseases. Throughout most of human… read more "Re-thinking the Annual Physical"
Dr. H. Gilbert Welch has written a new book Over-diagnosed: Making People Sick in the Pursuit of Health, with co-authors Lisa Schwartz and Steven Woloshin. It identifies a serious problem, debunks medical misconceptions and contains words of wisdom. We are healthier, but we are increasingly being told we are sick. We… read more "Overdiagnosis"
PSA – To Screen or Not to Screen
You’ve all heard the dramatic testimonials in the media: “I had a PSA test and they found my prostate cancer early enough to treat it. The test saved my life. You should get tested too.” The subject of screening tests is one that confuses the public. On the surface, it… read more "PSA – To Screen or Not to Screen"