Technorati Tags: Cancer, colon cancer, Diabetes, health care, Healthcare, pharmacist, pharmacy

Learn about the symptoms, treatment, and prognosis for melanoma in situ, the earliest stage of melanoma.

.By Diana Rodriguez

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With regular and thorough examinations of your skin, you can increase your changes of catching any abnormalities very early — which is good news in terms of treatment and prognosis if that abnormality turns out to be a malignant melanoma. In fact, experts now recommend that men and women of all ages check their skin frequently to increase their odds of spotting potential malignant mole at the earliest possible point: stage 0, or melanoma in situ.

What Is Melanoma In Situ?
Melanoma in situ comes from the Latin phrase “in situ,” which means “in place.” Melanoma in situ is cancer in the very early stages, when it affects only the top layer of the skin. At this point, the cancer has not spread deeper into the body. Cancer diagnosed at this early stage also means that it is less likely to recur or spread to other parts of the body than melanomas that are diagnosed at a later stage.

The very first symptoms of melanoma are any abnormalities in one or more moles on the skin. Abnormalities include moles with anyAsymmetry, uneven Borders, different Colors, large Diameter, orEvolution (any change). That’s why learning the ABCDEs of melanoma and checking yourself regularly are so important. If you see anything different about any of your moles, it could be a sign of melanoma in situ. The best course is to report any changes that you see to your doctor and schedule an exam to rule out melanoma, or to catch and treat it early.

How Is Melanoma In Situ Treated?
The treatment for melanoma in situ is usually fairly simple. In a doctor’s office, an outpatient procedure can be performed in which the melanoma is cut out of the skin, a process that medical personnel call resecting or excising.

“The treatment option for early stage melanoma is a wide excision procedure,” says Bruce A. Brod, MD, a clinical associate professor of dermatology at the University of Pennsylvania School of Medicine. “The key prognostic feature in melanoma is the thickness [in millimeters] of the melanoma, which is based on the initial biopsy of the lesion.”

How much skin needs to be cut out depends, then, on the biopsy results. “The consensus for treatment of melanoma in situ is to remove a half-centimeter diameter around the lesion or the initial biopsy site,” Dr. Brod says. “The consensus for treating melanomas less than 2 millimeters in thickness is to remove a 1-centimeter diameter, if possible, around the lesion.”

If the melanoma is larger in size, more skin may need to be removed, and a biopsy performed. “In melanomas greater than 2 millimeters [in thickness], the consensus is to excise a 2-centimeter diameter area around the lesion,” he says. “Since melanoma can spread to the lymph nodes in close proximity to the initial melanoma, a biopsy of lymph nodes is sometimes performed for melanoma close to or greater than 1 millimeter in thickness at the time of the wide excision procedure.”

Following Up on Melanoma in Situ
The good news? People who are diagnosed with melanoma in situ and receive early treatment have a great survival rate — 100 percent at 5 and 10 years. And everyone with melanoma in situ, including those diagnosed at an early stage, should check in with their doctors frequently to be certain that the cancer has not returned. Patients should have a complete physical and skin exam every six months for a year or two after their initial diagnosis, and typically once each year for several years after that.

“When melanoma is found early, it is easily cured with simple outpatient surgery,” says Catherine Poole, president and co-founder of the Melanoma International Foundation. “When found in later stages, it may become life-threatening, and there are few effective therapies to treat metastasized melanoma.”

Some good advice for healthy, cancer-free skin: Protect your skin at all times. “The most effective sun protection is to wear protective clothing, a broad-rimmed hat, seek shade, avoid being in the sun during the prime-time solar hours of 10 to 4, and use sunscreen as an adjunct to these behaviors,” says Poole.

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Note *

A couple of weeks ago an ugly mole was removed from my stomach. After the biopsy results came back Doctor Rowe said that it was confirmed to be ‘Melanoma In Situ.’
Got it early enough that it shouldn’t be serious. I Praise God and thank the Veterans Administration!

Going back for one more minor surgery as a precautionary move. — Bob Diamond

Technorati Tags: Cancer, Melanoma, Melanoma In Situ, Skin Cancer

NIH-funded research shows genetics can predict success of smoking cessation and need for medications

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Genetics can help determine whether a person is likely to quit smoking on his or her own or need medication to improve the chances of success, according to research published in today’s American Journal of Psychiatry. Researchers say the study moves health care providers a step closer to one day providing more individualized treatment plans to help patients quit smoking.

The study was supported by multiple components of the National Institutes of Health, including the National Institute on Drug Abuse (NIDA), the National Human Genome Research Institute, the National Cancer Institute, and the Clinical and Translational Science Awards program, administered by the National Center for Advancing Translational Sciences.

“This study builds on our knowledge of genetic vulnerability to nicotine dependence, and will help us tailor smoking cessation strategies accordingly,” said NIDA Director Nora D. Volkow, M.D. “It also highlights the potential value of genetic screening in helping to identify individuals early on and reduce their risk for tobacco addiction and its related negative health consequences.”

Researchers focused on specific variations in a cluster of nicotinic receptor genes, CHRNA5-CHRNA3-CHRNB4, which prior studies have shown contribute to nicotine dependence and heavy smoking. Using data obtained from a previous study supported by the National Heart Lung and Blood Institute, researchers showed that individuals carrying the high-risk form of this gene cluster reported a 2-year delay in the median quit age compared to those with the low-risk genes.  This delay was attributable to a pattern of heavier smoking among those with the high risk gene cluster. The researchers then conducted a clinical trial, which confirmed that persons with the high-risk genes were more likely to fail in their quit attempts compared to those with the low-risk genes when treated with placebo. However, medications approved for nicotine cessation (such as nicotine replacement therapies or bupropion) increased the likelihood of abstinence in the high risk groups. Those with the highest risk had a three-fold increase in their odds of being abstinent at the end of active treatment compared to placebo, indicating that these medications may be particularly beneficial for this population.

“We found that the effects of smoking cessation medications depend on a person’s genes,” said first author Li-Shiun Chen, M.D., of the Washington University School of Medicine, St. Louis. “If smokers have the risk genes, they don’t quit easily on their own and will benefit greatly from the medications. If smokers don’t have the risk genes, they are likely to quit successfully without the help of medications such as nicotine replacement or bupropion.”

According to the Centers for Disease Control and Prevention, tobacco use is the single most preventable cause of disease, disability, and death in the United States. Smoking or exposure to secondhand smoke results in more than 440,000 preventable deaths each year — about 1 in 5 U.S. deaths overall. Another 8.6 million live with a serious illness caused by smoking. Despite these well-documented health costs, over 46 million U.S. adults continue to smoke cigarettes.

The study can be found at: http://ajp.psychiatryonline.org/article.aspx?articleID=1169679. For information on tobacco addiction, go to: www.drugabuse.gov/drugs-abuse/tobacco-addiction-nicotine. For more information on tools and resources to help quit smoking, go to: www.smokefree.gov/.

Technorati Tags: Genetics, Nicotine, Quit Smoking

ATLANTA — With “baby boomers” believed to account for 75% of the hepatitis C infected population in the U.S. — the CDC is recommending that everyone ages 47 to 67 be tested for infection.

The CDC estimates that some two million Americans born from 1945 to 1965 are infected with HCV — that’s about 3% of the boomer generation. But because many years usually elapse before noticeable symptoms develop, most don’t know they are infected.

The CDC said one-time HCV testing of all “baby boomers” “could identify more than 800,000 additional people with hepatitis C, prevent the costly consequences of liver cancer and other chronic liver diseases, and save more than 120,000 lives.”

“CDC believes this approach will address the largely preventable consequences of this disease, especially in light of newly available therapies that can cure up to 75% of infections,” the agency said in a statement issued Friday.

Most boomers do not have the risk factors that, until now, the CDC had used as the basis for testing recommendations. Those risk factors include use of illegal injected drugs, receiving blood products or organ transplants before HCV testing became routine, known exposures to HCV, presence of hepatitis symptoms, and all patients with HIV.

Vietnam era veterans — all baby boomers — are a well-know risk group due to blood exposure in military field hospitals as well as drug use.

Infection with HCV often leads to liver cancer. However, the recent introduction of HCV protease inhibitors, including telaprevir (Incivek) and boceprevir (Victrelis), has made the disease more manageable, possibly even curable.

The recommendation will be open for public comment from May 22 to June 8, after which the CDC will release a final version.

The CDC also set Saturday, May 19, as “National Hepatitis Testing Day,” and announced that it would make a total of $6.5 million in grants to make testing available to specific populations including Asian-American Pacific Islander communities (which have high rates of hepatitis B infection) and injection drug users, as well as members of the “boomer” generation.

John Gever

Senior Editor

John Gever, Senior Editor, has covered biomedicine and medical technology for 30 years. He holds a B.S. from the University of Michigan and an M.S. from Boston University.

Technorati Tags: Baby Boomers, Boomers, Hepatitis C

By John Fauber, Reporter, Milwaukee Journal Sentinel

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Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids — an agenda that critics say was not supported by rigorous science — the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.

But the UW Pain group is just one link in a network of national organizations and researchers with financial connections to the makers of narcotic painkillers.

Beginning 15 years ago, that network helped create a body of “information” that today is found in prescribing guidelines, patient literature, position statements, books and doctor education courses, all which favored drugs known as opioid analgesics.

Without rigorous scientific evidence to prove that their benefits out weigh potential harm, drugs like OxyContin and Vicodin increasingly have been used to treat a wide array of chronic pain syndromes including low back pain and fibromyalgia.

Current practices reflect a gradual shift from the use of these drugs to treat short-term acute pain such as post-surgical pain, as well as severe pain associated with metastatic cancer or end-of-life pain — uses that were based on solid evidence that such use was safe and effective.

But the benefit seen for those conditions was extended to treatment of chronic pain syndromes, an extrapolation that had no evidence to back it up.

Caught in the middle are millions of Americans with real pain that can last for years and thousands of doctors who want to help them.

It’s a situation that was ripe for the influence of the pharmaceutical industry, said Mark Sullivan, MD, a professor of psychiatry and behavioral sciences at the University of Washington.

By 2010, those firms were selling four times as many prescription painkillers to pharmacies, doctors’ offices and hospitals as in 1999.

Led by OxyContin, sales of prescriptions of opioid drugs totaled $8.4 billion in 2011, up from $5.8 billion in 2006, according to data supplied by IMS Health, a drug market research firm.

“We’ve never really exposed so many people to so much drug for so long,” Sullivan said. “We don’t really know what the long-term results are.”

Click here to read the entire article > Chronic Pain Fuels Boom in Opioids

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What kind of pills are these?

Worried about those capsules you found in your teenager’s room? Not sure about some of those leftover pills still in the bathroom cabinet? There’s a good chance that our Pill Identification Wizard (Pill Finder) can help you match size, shape, colour… then lead you to find the detailed description in our drugs database.

NOTE: As a general rule, we should all periodically check our medicine cabinets for any expired, re-bottled, or unidentified pills. The safest bet is to keep all medications in their original bottles or packets, with pertinent labeling and instructions attached, to avoid confusion and mistakes.

Most pills can usually be identified by color, size, shape and a combination of letters and numbers.

Click here for a Pill Identification Wizard

Technorati Tags: Medicine, Pill Identification

The Basics

Food poisoning (foodborne illness) is when you get sick from eating or drinking something that has harmful germs (like bacteria, viruses, or parasites) in it. Two common causes of food poisoning are E. coli and Salmonella.

Good habits like these can help protect your family from food poisoning:

• Buy food from stores that look and smell clean.
• Don’t buy food past “sell by,” “use by,” or other expiration dates.
• Wash your hands often with warm water and soap – especially before and after touching food.
• Make sure food is cooked to a safe temperature.
• Keep raw meat and seafood away from cooked and ready-to-eat food.
• Keep cold foods cold. Keep hot foods hot.

Technorati Tags: food handling, food poison, food poisoning

By Kristina Fiore, Staff Writer, MedPage Today Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco. .

CHICAGO — Women ages 40 to 49 with no family history of breast cancer have similar rates of invasive disease as those with familial risk, radiologists reported here, firing yet another salvo at government mammography guidelines. Among a group of more than 1,000 breast cancer patients, 64% of those with no family history of breast cancer had invasive disease, as did 63.2% of those with family history, a non-significant difference, according to Stamatia Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., and colleagues. “We were intrigued and surprised by the data,” Destounis said during a press briefing at the Radiological Society of North America meeting, noting that general wisdom suggests women with a family history are at greater risk of developing the disease than other women. “Since there’s no difference in the rate of invasive breast cancer for women in their 40s whether they have a history of breast cancer or not, the recommendation should be that women in their 40s have screening mammography yearly,” Destounis said. In 2009, the U.S. Preventive Services Task Force recommended against routine screening for women ages 40 to 49, leaving patients and clinicians to make individual decisions based on their risk. Mammograms should start at age 50, the committee said, and be performed every two years. Yet the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists, and other groups have called for continued screening in this age group, which Destounis said has led to confusion among patients and their doctors. Still, the debate has shown few signs of letting up, as studies have continued to flood in — some showing that screening women 40 to 49 offers a robust mortality benefit while others have found only a trivial benefit. Destounis and colleagues reviewed data on all breast cancer patients seen at their clinic between 2000 and 2010, with a total of 1,071 patients ages 40 to 49 treated for 1,116 cancers. A total of 373 of those had been diagnosed via screening at their clinic; 61% of those patients had no family history of the disease, while 39% did. There were no significant differences in terms of the percentage of patients in either group who had a personal history of the disease. The investigators also found that similar percentages of patients with and without familial risk had disease that metastasized to the lymph nodes (29.4% of those without versus 31.3% of those with). “We agree with the ACS, which recommends screening for every woman in her 40s,” Destounis said. Gary Whitman, MD, of MD Anderson Cancer Center in Houston, who was not involved in the study, told MedPage Today there are “very few mammographers who feel differently about the need to screen all women at 40 years of age.” Edith Perez, MD, of the Mayo Clinic in Jacksonville, Fla., who also was not involved in the study, noted that it may show that family history isn’t necessarily useful for deciding whether a younger woman may be at greater risk of breast cancer, though this hypothesis would need further testing.

Technorati Tags: Breast Cancer, Cancer, Healthcare

nist.gov image

by Rosemary Gibson

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The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.

Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine at the Stanford University School of Medicine highlighted seven often unnecessary things done in primary care, such as EKGs in patients without symptoms, that were identified by the Good Stewardship groupconvened by the National Physicians Alliance.

Later, Dr. Steve Weinberger, Executive Vice President and CEO of the American College of Physicians identified sensible principles to guide the integration of a “less is more” theme in public policy, such as:

• Avoid interventions that don’t help and may harm
• Give incentives to physicians and patients to avoid low value care
• Use payment approaches that are politically feasible, medically appropriate and minimally burdensome
• Recognize that there will always be exceptions.

The discussion addressed the tip of the iceberg. The next step is to move to the big-ticket items where the literature is quite clear that patients are harmed by back surgeries for which there is no evidence of efficacy, cardiac bypass surgeries that are unwarranted, and duplicative and unnecessary diagnostic imaging that exposes patients to cancer-causing radiation, among many other tests and procedures performed that may cause more harm than good.

We can’t put all of the health care reform burden on patients, even with shared decision-making. Physician leadership is essential. That’s why this meeting will hopefully be the first of many conversations on K Street and on Capitol Hill.

In the end, this is all about good care of the patient. That’s the primary motivation. It’s also true that as a society, we don’t have money to waste. As I wrote in The Treatment Trap, the best way to preserve Medicare is to pay for things that improve health and well-being, and to stop paying for things that don’t. If we don’t get it right, and get it right soon, even the good things will be cut. Let’s act on the wisdom we have that knows the difference.

Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation.  She is author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. This article originally appeared on The Medical Professionalism Blog.

Technorati Tags: Healthcare, Medical Tests, Medicare

By Ryan Jaslow

(Credit: Joe Raedle/Getty Images)

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(CBS/AP) The Listeria outbreak from cantaloupes is now the deadliest foodborne illness outbreak in the U.S. in more than 25 years.

Pictures: 10 dangerous but common food safety mistakes

The CDC announced Wednesday that 23 people have died from listeriosis, while another 116 have been sickened. Not since 1985, when Listeria from Mexican-style soft cheeses killed 52 people, has a foodborne illness outbreak been this deadly in America. The current death toll also surpassed a 1998 Listeria outbreak linked to processed meats that killed 21 people.

Officials say the tainted cantaloupes from Jensen Farms in Holly, Colo., should be off store shelves by now, as they were recalled mid-September and their shelf life is about two weeks. But the number of deaths may continue to grow. Symptoms of listeriosis can take up to two months to appear.

The CDC on Wednesday confirmed two more deaths in Louisiana. Other deaths have been reported in Colorado, Indiana, Kansas, Maryland, Missouri, Nebraska, New Mexico, New York, Oklahoma, Texas and Wyoming.

Listeria illnesses have been reported in Alabama, Arkansas, California, Colorado, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maryland, Missouri, Montana, Nebraska, New Mexico, New York, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Virginia, West Virginia, Wisconsin and Wyoming.

FDA investigators said that Colorado health officials found Listeria in cantaloupes taken from grocery stores and from a victim’s home that were grown at Jensen Farms. Matching disease strains were found on equipment and cantaloupe samples at Jensen Farms’ packing facility in Granada, Colo. FDA officials have said they were looking at the farm’s water supply and possible animal intrusions among other things to figure out the source of the problem. Listeria grows in moist and muddy conditions, and the bacteria are often are carried by animals.

Jensen shipped the cantaloupes to about half the states, but added that it wasn’t sure where the cantaloupes went because they have been sold and resold. Some companies may be unaware that they bought or distributed the tainted fruit.

Listeria is more deadly than other well-known pathogens such as salmonella and E. coli. While most healthy adults can consume Listeria with no ill effects, it can kill the elderly, those with compromised immune systems, and unborn children of pregnant women. The CDC said the median age of those sickened is 78, and most people who are ill are over 60. The CDC said it is also aware of one miscarriage linked to the outbreak.

Colorado has the most illnesses with 34, while Texas has reported 17.

Technorati Tags: Listeria