Thursday, September 11, 2008

My health-o.k.

I realize I didn't post since all the tests I had. I think when I have to face my fears, I need to reach out more. The tests results all came back that I was still cancer-free. So I am relieved, of course. I did have a bone density scan and the results of that indicated I some bone-thinning in my neck. Other than taking calcium with vitamin D, nothing else is recommended at this time. I do wonder if some of this was an effect of the chemo, as it can be a side effect.

Follow-up Lacking

An article that was on cnn.com:

Study: Many colon cancer patients not followed up properly
Story Highlights
- 40 percent of study patients got all advised doctor visits, blood tests and screens
- Older patients, African-Americans, those with other health issues got less follow-up
- Colorectal cancer expected to be diagnosed in 149,000 Americans this year
NEW YORK (AP) -- Many colon cancer patients aren't getting the screenings recommended after surgery to make sure the disease hasn't returned, new research shows.Only about 40 percent of the 4,426 older patients in the study got all the doctor visits, blood tests and the colonoscopy advised in the three years after cancer surgery, according to the results released Monday by the journal Cancer.
While nearly all made the doctor visits and almost three-quarters got a colonoscopy, many didn't get the blood tests that can signal a return of colon cancer, according to the researchers at University Hospitals Case Medical Center in Cleveland, Ohio.
Whether doctors didn't offer the tests or patients failed to get them isn't known, said Dr. Gregory Cooper, who led the study. He said perhaps the follow-up care was being provided by doctors who aren't specialists and who aren't familiar with the guidelines.
"I would probably put most of the blame on the providers," said Cooper, a gastroenterologist at the hospital.
Colorectal cancer will be diagnosed in an estimated 149,000 Americans this year. Survival after five years varies from 90 percent for cancer that hasn't spread to 10 percent for advanced cases.
Cooper and his colleagues used a federal database of cancer cases and Medicare records for patients to see whether the guidelines were being followed. They focused on those 66 and older with less advanced cancer who had surgery that could cure them.
Patients were tracked for three years, beginning six months after surgery. When the study began in 2000, the minimum guidelines called for at least two doctor visits a year, twice yearly blood tests for two years and a colonoscopy within three years. Cooper said a colonoscopy is now recommended in the first year.
Overall, 60 percent of the patients didn't meet the guidelines. Of those who did, more than half actually got advanced medical scans such as CT scans and PET scans that are not recommended for routine screening. The scans could have been done because of signs or symptoms of a recurrence but the researchers said they suspect they were done for routine follow-up.
There was less screening among older age groups, African-Americans and those with other health problems.
"Quite honestly, I'm sorry to say, I'm not surprised about the findings," said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, which funded the study. Despite advanced medical technology, "our ability to deliver the recommended care to patients has left something to be desired."With the information resources available today, he said patients can take an active role in their follow-up care and make sure that they are getting the screenings they need.

Hereditary cancer?

http://misc.medscape.com/pi/editorial/dmeflash/2008/17063/nccn-cancerriskevaluation.pdf - This article provides the guideline for patient referrals for genetic counseling for cancer - breast and ovarian are on page 1; colorectal is on page 2. Specifically, for colorectal cancer:

RED FLAGS:
- Personal history of early-age-onset colorectal cancer (< 50 years of age)
- Personal or family history of multiple colorectal carcinomas
- Personal or family history of polyposis (> 10 adenomas) in the same individual
- Personal history or family history of more than 1 hereditary non-polyposis colorectal cancer
(HNPCC)-related cancer (eg, colon and uterine cancer) in the same individual
- Personal history of an HNPCC-related cancer and:
o One or more first-degree relative with HNPCC-related cancer prior to age 50
o Two or more first- or second-degree relatives with an HNPCC-related cancer
diagnosed at any age
- Personal or family history of a hereditary syndrome associated with cancer (eg, HNPCC,
FAP, MYH-associated polyposis, Peutz-Jeghers syndrome, juvenile polyposis) with or
without a known mutation
-HNPCC (also known as Lynch syndrome)-related cancers include: Colorectal; Endometrial; Ovarian; Duodenal/small bowel; Stomach; Sebaceous adenomas or sebaceous carcinomas; Ureteral/Renal pelvis; Hepatobiliary/pancreatic; and Brain tumors (particularly glioblastomas)
DEFINITIONS
􀂃 First-degree relative: parent, sibling, child
􀂃 Second-degree relative: aunt, uncle, niece, nephew, grandparents
􀂃 Third-degree relative: first cousin, great aunts, great uncles