Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
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...
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...