Mammography Screening SlideShare Presentation

Why was screening implemented? What is overdiagnosis?

  • Why was screening implemented?
  • What is overdiagnosis?
  • The evidence for overdiagnosis
  • Available data
  • Facts from recent studies
  • Risks of screening
  • The illusion of early detection
  • Harms due to overdiagnosis
  • Benefit-risk balance
  • So, what to do?
Sources:

L’infertilité masculine: témoignage d’un Fils Distilbène

Les tabous de l’infertilité masculine – REPLAY #touteunehistoire

Les hommes face à l’infertilité, avec  Christophe Coupez, fils distilbène.
Emission Toute une histoire, France 2, vidéo publiée le 5 octobre 2015.

En savoir plus
  • Si dans environ 33% des cas, l’infertilité a une cause purement féminine, dans 21% des cas, elle implique seulement l’homme. Mais cette stérilité masculine est encore un sujet tabou dans notre société. Pour beaucoup, elle représente une honte et est synonyme d’émasculation. Pourtant, ce problème n’est pas nécessairement accompagné de troubles sexuels et n’a pas de rapport direct avec la virilité. Nos invités ont décidé d’en parler en plateau afin de briser ce tabou. Christophe notamment a décidé de lever le voile sur son infertilité en écrivant un livre : Père malgré tout.
  • Vidéo La fertilité de l’homme remise en question.
  • Christophe Fils distilbène, peremalgretout.blogspot, samedi 22 mars 2014.
Le Distilbène DES, en savoir plus

Diethylstilbestrol DES-induced clear cell adenocarcinoma of the vagina metastasizing to the brain

Necessity of close extended follow-up in the DES-exposed

metastasizing-to-the-brain
This 2007 case report highlights the necessity of close extended follow-up in patients with a history of vaginal CCA and demonstrates the potential for spread of primary vaginal CCA to the brain.

2007 Study Abstract

BACKGROUND:
Primary vaginal clear cell adenocarcinoma (CCA) is a rare gynecological malignancy occurring predominantly in young females with a history of diethylstilbestrol exposure in utero. Vaginal CCA commonly metastasizes to the lungs and the supraclavicular lymph nodes; however we present a rare case of diethylstilbestrol-induced vaginal CCA with cerebral metastases.

CASE DESCRIPTION:
A 43-year-old woman with prenatal diethylstilbestrol exposure and history of vaginal CCA treatment 8 years prior to current presentation noted new onset headache and dizziness. MRI showed an enhancing mass in the right frontal lobe. Histopathology was consistent with CCA.

CONCLUSIONS:
This case report highlights the necessity of close extended follow-up in patients with a history of vaginal CCA and demonstrates the potential for spread of primary vaginal CCA to the brain.

Sources and more information
  • Diethylstilbestrol (DES)-induced clear cell adenocarcinoma of the vagina metastasizing to the brain, Gynecologic oncology, NCBI pubmed 17292458, 105(1):273-6. Epub 2007 Feb 8.
More DES DiEthylStilbestrol Resources

Medical experts call for improvements in estrogen testing methods

Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues

Measuring-Estrogen-Exposure image
Accurate data on patients’ estrogen levels are needed to ensure appropriate and effective patient care, reduce the need for retesting, and enable clinicians to implement the latest research in patient care, Research studies, however, found high inaccuracies among different estrogen tests, especially when the test is measuring low estrogen levels in postmenopausal women, men and children.

Endocrine Society – Hormone Science to Health – release: Panel Recommends Improvements in Estrogen Testing Accuracy

Washington, DC – Unreliable estrogen measurements have had a negative impact on the treatment of and research into many hormone-related cancers and chronic conditions. To improve patient care, a panel of medical experts has called for accurate, standardized estrogen testing methods in a statement – Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues – published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).

The panel’s recommendations are the first to address how improved testing methods can affect clinical care, and were developed based on discussions at an estrogen measurement workshop hosted by the Endocrine Society, AACC and the Partnership for Accurate Testing of Hormones (PATH).

Estrogen is primarily produced in the ovaries and is also produced in small amounts by the adrenal glands, which is why men as well as women have estrogen in their bodies. It is critical for fertility in women, and also plays a role in many health conditions, from precocious puberty to cancers of the breast, ovary, prostate and liver. Accurate blood tests for estrogen are necessary to diagnose patients with these conditions and ensure they receive appropriate, effective treatment. Many medical studies also rely on estrogen tests, such as research assessing the connection between estrogen levels and the risk of breast or prostate cancer.

Accurate data on patients’ estrogen levels are needed to ensure appropriate and effective patient care, reduce the need for retesting, and enable clinicians to implement the latest research in patient care,” said one of the authors and co-chair of the PATH Steering Committee, Hubert Vesper, PhD. “Research studies, however, found high inaccuracies among different estrogen tests, especially when the test is measuring low estrogen levels in postmenopausal women, men and children.”

The expert panel called for improving the accuracy of measurements through standardization, and recommended clinicians, researchers and public health officials support standardization programs like CDC’s and other efforts to ensure estrogen measurement is accurate and consistent.

The panel also advised clinicians and researchers to consider the purpose of the test when selecting an estrogen measurement method. Clinicians and researchers currently use several methods to measure estrogen, including mass spectrometry and immunoassays. The experts agreed both methods are valid, but that one may be more effective than the other depending on the situation. For instance, mass spectrometry—the more expensive, but also more sensitive testing method—may be appropriate in people who tend to have low estrogen levels, including postmenopausal women and children beginning puberty.

Additionally, the experts recommended that medical journals require authors to fully explain the estrogen measurement testing methods used in studies. Ensuring researchers explain the processes they used will help the field move toward standardized methods.

In addition to Vesper, other authors of the study include: L.M. Demers of Pennsylvania State University School of Medicine in Hershey, PA; S.E. Hankinson of the University of Massachusetts in Amherst, MA; S. Haymond of the Ann and Robert H. Lurie Children’s Hospital of Chicago, IL; T. Key of the University of Oxford in Oxford, U.K.; W. Rosner of Columbia University in New York, NY; R.J. Santen  of the University of Virginia Health Sciences System in Charlottesville, VA; F.Z. Stanczyk of the University of Southern California Keck School of Medicine in Los Angeles, CA; and R.G. Ziegler of the National Cancer Institute in Bethesda, MD.

The manuscript, “Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues,” is published in the June print issue of JCEM.

The American Health Care Paradox

A challenge to American doctors…

A challenge to American doctors…

Why Spending More is Getting Us Less

For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We’ve left out of our tally the most impactful expenditures countries make to improve the health of their populations—investments in social services.

In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.

Offering a unique and clarifying perspective on the problems the Affordable Care Act won’t solve, this book also points a new way forward.

More information

1985 Swiss case of vaginal adenocarcinoma after uterine exposure to diethylstilbestrol

Schweizerische medizinische Wochenschrift, NCBI pubmed 3841230 2;115(44):1555-61, Nov 1985.

CCAC
Following reports on a few cases in other countries, this 1985 report was the first in a Swiss female, aged 23, with stage III DES-induced adenocarcinoma of the vagina.

1985 Study Abstract

From 1946 to 1971, diethylstilbestrol, a nonsteroid synthetic estrogen, came in for widespread use in the USA, and in other countries only occasional use, for the treatment of high-risk pregnancies.

In 1971 a retrospective epidemiologic study showed a close association of this therapy with occurrence of vaginal and cervical adenocarcinoma in young women (mean age 19 years). Up to 1981 63% of 429 clear cell carcinomas of the vagina and cervix were related to DES exposure in utero in the USA.

Following reports on a few cases in other countries, the present report is the first in a Swiss female, aged 23, with stage III DES-induced adenocarcinoma of the vagina.

The risk of DES-related adenocarcinoma is estimated at about 1%, but benign teratogenic lesions are present in over 50% of patients. Vaginal adenosis is the most frequent finding, but other malformations of vagina (septa), cervix, uterus and fallopian tube may be found. Malformations of the genital tract have also been described in DES-exposed male offspring.

Sources and more information
  • A case of vaginal adenocarcinoma after uterine exposure to diethylstilbestrol, Schweizerische medizinische Wochenschrift, NCBI pubmed 3841230  2;115(44):1555-61, Nov 1985.
More DES DiEthylStilbestrol Resources

Votre enfant est-il pollué de perturbateurs endocriniens?

Etude exclusive que “l’Obs” a commandée cet été au laboratoire luxembourgeois Human Biomonitoring Research Unit (HBRU)

Votre-enfant-est-il-pollué
“L’Obs” a fait analyser – au laboratoire luxembourgeois Human Biomonitoring Research Unit (HBRU) – 63 mèches de cheveux d’un panel d’enfants de moins de 12 ans. Résultat : les perturbateurs endocriniens, des substances chimiques qui dérèglent les hormones, s’y bousculent !

Arnaud, dites-moi, vous avez un chat chez vous, non ?

” Etonnement du journaliste. Euh, oui en effet, mais… “

Et parmi vos trois fils, celui qui joue le plus avec le chat est celui-ci, non ?

” Mais comment diable Brice Appenzeller, directeur de la Human Biomonitoring Research Unit (HBRU), un laboratoire de recherche public situé au Luxembourg, qui n’a jamais mis un pied chez l’auteur de ces lignes, sait-il tout ça ? Le chercheur désigne en souriant le tableau qui s’affiche sur son écran d’ordinateur. “

Regardez la colonne ‘fipronil’. Observez les concentrations élevées que l’on trouve chez votre fils.

” Argh ! Le fipronil est un antipuces prescrit par les vétérinaires pour les chats. Accessoirement, c’est un perturbateur endocrinien qui s’attaque à la thyroïde, dont les conséquences sur le développement des enfants sont plus qu’inquiétantes. “

Monthly Breast Self-Exam Poster

Hang this poster in the bathroom or laminate it and hang it in the shower!

Breast-Self-Exam poster
Hang this poster in the bathroom or laminate it and hang it in the shower!

According to the Johns Hopkins Medical Center: “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important”.

Association between breastfeeding and reduced risk of aggressive breast cancer

Breastfeeding and breast cancer risk by receptor status—a systematic review and meta-analysis

breastfeeding image
A large international study shows that breastfeeding is associated with a lower risk of developing an aggressive form of breast cancer called hormone-receptor negative. This new combined evidence shows the risk was reduced by up to 20% in women who breastfed. Breastfeeding by Maja.

2015 Study Abstract

Background
Breastfeeding is inversely associated with overall risk of breast cancer. This association may differ in breast cancer subtypes defined by receptor status, as they may reflect different mechanisms of carcinogenesis. We conducted a systematic review and meta-analysis of case–control and prospective cohort studies to investigate the association between breastfeeding and breast cancer by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status.

Design
We searched the PubMed and Scopus databases and bibliographies of pertinent articles to identify relevant articles and used random-effects models to calculate summary odds ratios (ORs) and 95% confidence intervals (CIs).

Results
This meta-analysis represents 27 distinct studies (8 cohort and 19 case–control), with a total of 36 881 breast cancer cases. Among parous women, the risk estimates for the association between ever (versus never) breastfeeding and the breast cancers negative for both ER and PR were similar in three cohort and three case–control studies when results were adjusted for several factors, including the number of full-term pregnancies (combined OR 0.90; 95% CI 0.82–0.99), with little heterogeneity and no indication of publication bias. In a subset of three adjusted studies that included ER, PR, and HER2 status, ever breastfeeding showed a stronger inverse association with triple-negative breast cancer (OR 0.78; 95% CI 0.66–0.91) among parous women. Overall, cohort studies showed no significant association between breastfeeding and ER+/PR+ or ER+ and/or PR+ breast cancers, although one and two studies (out of four and seven studies, respectively) showed an inverse association.

Conclusions
This meta-analysis showed a protective effect of ever breastfeeding against hormone receptor-negative breast cancers, which are more common in younger women and generally have a poorer prognosis than other subtypes of breast cancer. The association between breastfeeding and receptor-positive breast cancers needs more investigation.

Sources and more information
  • Breastfeeding and breast cancer risk by receptor status—a systematic review and meta-analysis, Oxford Journals, Medicine & Health, Annals of Oncology, Advance Access, 10.1093/annonc/mdv379, October 26, 2015.
  • Study shows association between breastfeeding and reduced risk of aggressive breast cancer, American Cancer Society, 27-OCT-2015.

Let’s make electronic health records (EHRs) better

EHR State of Mind | #LetDoctorsBeDoctors | ZDoggMD.com

We need to talk about the elephant in the exam room. Electronic health records (EHRs) are failing to improve the connection between patients and providers – and distracting providers from their real work. With more than two-thirds of doctors saying they wouldn’t recommend their EHR and the American Medical Association calling for a “major overhaul of EMR systems” it’s time to demand change.

More information