Posts Tagged ‘cancer screening’

Cancer: HIV/AIDS Patients At Increased Risk

Monday, June 27th, 2011

It is estimated that there are more than a million people in the U.S. infected with HIV.  In 2009 alone, there were roughly 50 thousand new HIV cases. There are approximately 16-18 thousand AIDS-related deaths in the U.S. each year. Although medical advancements have enabled many HIV/AIDS patients to live a relatively normal life, the truth is that the HIV/AIDS epidemic has been and continues to be a public health disaster of astronomic proportions.

As if life with HIV/AIDS is not difficult enough, researchers have also found that HIV/AIDS patients are also more prone to developing various malignancies when compared with the non-infected population. In fact, cancer is one of the leading causes of mortality in the HIV/AIDS  population. It is estimated that 30%-40% of HIV patients will develop some type of cancer during their life time.

The types of cancer that affect HIV patients can be generally divided into two groups: AIDS defining cancers and opportunistic cancers. An HIV positive patient who develops a cancer defined by the Center for Disease Control and Prevention as AIDS defining is considered to have AIDS.  These AIDS defining cancers include: Kaposi’s sarcoma, non-Hodgkin’s lymphoma, and invasive cervical cancer. Other cancers are generally categorized as opportunistic.

Researchers have found that HIV/AIDS patients have a 2-to-3 fold increase in the overall risk of developing opportunistic cancers. Not only are HIV/AIDS patients more likely to develop cancer but the cancer prognosis is worse when compared with that of non-infected patients. HIV/AIDS patients also present with more advanced cancers at the time of diagnosis and, on average, they develop cancers at a younger age.

So, why is the risk for developing cancer higher in the HIV/AIDS population? It remains unclear whether the actual virus has a direct impact on the development of malignancies. It is believed, however, that the increased incidence of cancer is due to the fact that HIV/AIDS patients have a compromised immune system, which can lead to an impaired ability to produce antibodies or inflammatory responses.

Needless to say, if you are an HIV/AIDS patient or you know someone who is, please be aware of the increased risk for developing cancer. Be proactive and pursue proper and timely cancer screening. If you are experiencing unusual symptoms, don’t automatically attribute them to having HIV/AIDS (e.g., unusual fatigue). Unfortunately, they might just be symptoms of cancer.

 

Related posts:

H.I.V. treatment advances, but what are the implications of terminating research early?

 

 

Most Doctors Don’t follow Colon Cancer Screening Guidelines

Monday, October 18th, 2010

Each year in the United States, colorectal cancer causes over 50,000 deaths.  Despite the obvious seriousness of colorectal cancer, a new study published in the Journal of General Internal Medicine reports that 81 percent of doctors are not following all recommended colon cancer screening guidelines.  While approximately 40% of doctors follow guidelines for some tests, a shocking 40% don’t follow recommended guidelines for any colon cancer screening tests.

First off, what are screening tests?  A screening test is a test for a certain disease that is given to patients who do not have symptoms of the disease.  This is different from a test that a doctor orders in response to a specific symptom, e.g., a finding of blood in the stool that results in a colonoscopy to discover the cause of the bleeding.  The purpose of a screening test is to catch a disease early, before it gets to the point where it starts to cause symptoms.  The earlier colon cancer gets detected, the better chance the patient has for a successful outcome.  Knowing this, it is difficult to understand why doctors are not following recommended guidelines.

One factor that the study’s authors noted was the age of the doctor.  Younger, board-certified doctors were the most likely to properly follow the guidelines.  Older doctors, on the other hand, were less likely to do so.  It appears that older doctors may be following guidelines that were in effect at the time of their training rather than keeping up to date with current guidelines.  This is not to suggest that the non-compliant doctors are all failing to recommend any screening tests.  The study indicates that some doctors are actually over-using the tests.  This, however, can result in additional risk (e.g., risk of injury from a colonoscopy) as well as unnecessary tests and higher medical costs.

From the patient’s perspective, it is wise to know yourself what the recommended guidelines are so that you can have a meaningful discussion with your doctor about what tests you should be getting and when.  As reported in the linked article:

Here are the American Cancer Society’s current guidelines on checking for colorectal cancer and polyps (often precursors to cancer). Starting at age 50, men and women should follow one of these testing schedules:

To detect both polyps and cancer (preferred) :

To primarily detect a cancer:

Some people may require a different screening schedule due to personal or family history; the cancer society recommends that you talk with your doctor to determine which schedule is best for you.

A Sticky Wicket No Doubt – study suggests unnecessary screening of advanced cancer patients being done.

Wednesday, October 13th, 2010

An article published today in JAMA reports a case-control study regarding the efficacy of continued surveillance through screening of patients with advanced cancer. The conclusion of the researchers: “A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.”

The study, according to a synopsis provided in an email alert we received from Physician’s First Watch, “used the Surveillance, Epidemiology and End Results (SEER) cancer registry to identify roughly 88,000 patients aged 65 or older diagnosed with advanced lung, colorectal, breast, gastroesophageal, or pancreatic cancer (median survival after diagnosis, 4–16 months). The researchers then examined whether patients were screened for other cancers.”

What the synopsis didn’t mention was that these were “fee-for-service Medicare enrollees.” For those of you having to deal with Medicare issues (which we do all the time in light of the super lien issues affecting our clients who receive Medicare and Medicaid benefits), one wonders just how big a role this “payor” issue played in the reason for the study and its conclusion.

It is common knowledge that Medicare’s solvency remains a major issue in our politically charged financial landscape. On August 5, 2010, U.S. Department of HHS Secretary, Kathleen Sebelius, joined Treasury Secretary Tim Geithner, Hilda Solis, Secretary of Labor, and the Social Security Administrator, Michael Astrue (the latter being also Trustees of the Social Security and Medicare Trust) in releasing the 2010 Annual Social Security and Medicare Trustees Report. In essence, they announced that the solvency of the Trust Fund would be extended by 12 years until 2029.” A “Fact Sheet” has been published by the Centers for Medicare and Medicaid Services (CMS) for those interested in reviewing the substance of the report. While the actual statistical findings are readily available in the JAMA abstract, here is a more concise version of the study’s findings:

  • Overall, cancer patients were screened between one third and one half as often as cancer-free controls.
  • Roughly 9% of women with cancer underwent mammography, and 6% had Pap tests.
  • Some 15% of men with cancer underwent prostate-specific antigen testing.
  • About 2% of cancer patients had lower GI endoscopy.
  • Putting aside the issue of financial expediency, how do you feel about avoidance of screening for “other cancer” in such patients? Is it worth the cost? Not worth the cost? Should we restrict such testing to avoid its apparent financial impact on our Medicare system?