Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What is the likelihood of a successful pregnancy following pelvic irradiation?
This is a very important question. The risks on future fertiltiy from radiation therapy to the abdomen/pelvis are twofold.1) Dose to the ovaries. The LD-50 to the ovaries may be as low as 2 Gy, thus the risk of ovarian dysfunction and premature menopause, is high. 2) Dose to the uterus leading to po...
After pelvic irradiation, how often do you recommend that female patients use a vaginal dilator and for how long?
The need for a vaginal dilator is dependent on the degree of stenosis, and related to the total dose, dose per fraction for HDR brachy patients, and patients underlying tendency to form scar tissue. In general we suggest evaluation by the physician every 3 months. If it appears that scar tissue con...
Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?
There are certainly circumstances where observation for limited stage, low grade follicular lymphoma is warranted. I would not rely on surgical resection alone for cure however. Occasionally surgery can be curative in Stage I extranodal MALT lymphoma.
How often do you order follow up mammograms after breast radiotherapy?
We do it once a year, as doing them more frequently than that has not been shown to improve outcomes and this is endorsed by national societies. There is a recent paper which showed higher yields with 6 month mammograms but this has not shown to improve outcomes and our approach at present is a year...
How do you counsel young women who want to become pregnant after breast radiotherapy?
It also depends on whether she is on tamoxifen or not and whether she has had chemotherapy. She has to be off tamoxifen if desires to have a pregnancy. We also counsel them that milk output is usually less in the treated breast and that it is not contraindiacted to breast feed.
What is your advice to patients who ask if dental X-rays correlate with oral/oropharyngeal cancer?
No good data to support positive correlation between dental X-ray and oral/oropharyngeal cancer Bharat
Is there an effective treatment for severe radiation fibrosis of the skin after radiotherapy to the breast or other areas?
I have used this regimen occasionally with moderate success. Worth a try. Topical Vitamin E as well can help.
At what PSA do you start calculating doubling time post-prostatectomy?
The problem you describe, I think, also applies to standard assays when values are at or near the limits of detectability. Is an increase from 0.1 to 0.2 in 3 months really indicative of a rapid rise? If you are seeing small changes at low PSA values, and you're not inclined to treat the patient, yo...
For patients eligible for and considering active surveillance for low-risk prostate cancer, do you routinely use tests for molecular risk stratification?
I have not incorporated genetic testing into my active surveillance strategy. As yet, it is not clear how to use this information to modify the approach to AS. At this point, multi parametric MRI is far more useful, and I recommend this test to all of my patients considering AS to try to rule out th...
How common is hypothyroidism in postradiation head and neck cancer patients?
The incidence of postradiation hypothyroidism is hard to determine, as the literature is quite varied. This variation is due to a combination of how hypothyroidism is measured, how much of the thyroid was treated, and when patients were assessed. Recent literature suggests the incidence can approxim...