Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you counsel women with a history of breast cancer who have dense breasts, with regards to mammography screening?
The question of how best to follow women after treatment for breast cancer is one that is of great concern to oncologists. Many factors play into the type and frequency of screening. However, little definitive data exists showing benefit of anything above annual screening with mammography. For our s...
What do you recommend for patients who experience anorexia due to loss of appetite?
"But to eat when you are sick, is to feed your sickness."- Hippocrates A lot of preclinical work (Valter longo, Warburg etc) show he was probably right and the fact that tumors will preferentially have access to gluocse and proteins (ie PET scan-Warburg effect)I would use steroids (dexamethasone or ...
Do you repeat the comprehensive BRCA analysis (like Myriad) in "at risk patients" with a positive family history, who tested negative for BRCA1 and BRCA2 deleterious mutations 10 years ago?
Yes.
In patients with Stage I seminoma who elect surveillance, how long do you recommend that tumor markers be followed?
I agree with @Dr. First Last that the data is vague. I would add the following: in series where patients are regularly re-staged with CT scans, serum tumor markers add essentially nothing. So if one follows the Princess Margaret Hospital schedule and gets scans every four months for the first 2 to 3...
Would you recommend lung cancer screening in someone who is not a surgical candidate?
This is our commentary on this topic: http://www.ncbi.nlm.nih.gov/pubmed/26226384
After chemotherapy for early and locally advanced breast cancer, how long do you advise women to wait before attempting to conceive?
This is an area with little data to guide recommendtions. Population databases have NOT found an increased risk of recurrence in patients who conceive after diagnosis and treatment - if anything those who conceive do better (this form of bias has been called the healthy mother effect). Timing of con...
Do you counsel patients on the risk of dementia following androgen deprivation therapy for prostate cancer?
No, I generally do not counsel men about this risk. The two studies from the same investigator use a data warehouse search algorithm that may not be accurate enough to fully characterize who gets Alzheimer's disease or may not be able to correct for confounding factors that may be different between ...
How do you counsel men with prostate cancer on the cardiovascular risks of androgen deprivation therapy?
This is a complex issue and depends on the specific setting (concurrent with XRT), the risk of the patient, and the specific CV risks of that patient. In the metastatic setting, there is almost never a contraindication to hormonal therapy given that prostate cancer is the likely cause of death in th...
How do you manage musculoskeletal pain in men receiving androgen deprivation therapy for non-metastatic prostate cancer?
This a very good question. Because bone pain can be a symptom of "benign" bone health issues without bone metastasis and because of the patient population demographics including risk factors, we obtain baseline bone health screening on most patients who must undergo Androgen Deprivation Therapy (ADT...
How do you counsel premenopausal women with BRCA1 or BRCA2 mutations on the need for bilateral oopherectomy?
I typically mirror the NCCN guidelines in this area. For those with BRCA 1 mutations, I recommend RRBSO between age 35-40 after completion of childbearing. Because those with BRCA2 mutations typically have onset of ovarian cancer later, it is reasonable to delay until age 40-45. Counseling needs to ...