Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How soon after pelvic RT can a routine colonoscopy be completed?
I have had them get it done once acute side effects subside in 8 -12 weeks. I do inform them about avoiding rectal biopsy and informing endoscopist about it.
How would you manage a patient with low risk prostate cancer on active surveillance who develops high risk features but absolutely refuses a repeat biopsy?
In the setting of a suspicious mpMRI lesion, we start by acknowledging the patient's likely negative experience with their transrectal biopsy. We ask if they are referring to the one where they were rolled on their side, had a probe inserted in their rectum, and heard a bunch of loud CLICKs. We empa...
When do you refer patients for acupuncture for AI associated joint pain?
We recently presented the results of S1200, a phase III trial comparing 12 weeks of true acupuncture to sham (fake) acupuncture to a wait list control group (no intervention), and found that acupuncture improved pain more than the other 2 groups and the effects persisted over 24 weeks. Duloxitine, c...
How do you counsel a woman regarding her previous hormonal contraception and the risks with her newly diagnosed invasive breast cancer?
I believe the risk of breast cancer from the use of hormonal contraception is very small, in the absence of other contributing risk factors such as family history.A recent 2017 NEJM article (Morch et al) assessed the associations in a large cohort of 1.8 million women in Denmark followed for > 10 ye...
What is your approach to genetic testing for high risk patients?
At our center, clinical assessment initiated at diagnosis and anybody who meets the NCCN criteria is referred to genetic counsellor
Do you routinely screen for pituitary dysfunction after radiation therapy for nasopharyngeal cancer?
I don’t, only if symptoms
How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?
It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages co...
If a man has been on a 5-alpha reductase inhibitor for urinary symptoms prior to prostate radiation therapy, is there value in continuing it after radiation therapy?
5-alpha reductase inhibitors, e.g. dutasteride, are indicated for the treatment of symptoms related to BPH and an enlarged prostate and have some efficacy for this indication, especially when combined with alpha blockers. 5-alpha reductase reduces a double bond in testosterone to create a more poten...
How do you counsel a patient with a history of breast cancer regarding use of breast MRI for screening?
In our Breast Survivorship Clinic at MD Anderson we do not regularly recommend a surveillance breast MRI to screen for local recurrence or for new breast cancer in all of our breast cancer survivors, since there is lack of data to support this practice. Not to mention the elevated cost and the possi...
How do you manage dry mouth after head and neck RT?
I think it is important to very clearly explain to the patient that xerostomia is common and even should be expected, even in the era of highly conformal treatment plans. If a patient is highly motivated to preserve saliva, pilocarpine can be used concurrently with radiation where it has been shown ...