A cancer diagnosis is scary. Some doctors say it’s time to rename low-grade prostate cancer to eliminate the alarming C-word.
Cancer cells develop in nearly all prostates as men age, and most prostate cancers are harmless. About 34,000 Americans die from prostate cancer annually, but treating the disease can lead to sexual dysfunction and incontinence.
Changing the name could lead more low-risk patients to skip unnecessary surgery and radiation.
“This is the least aggressive, wimpiest form of prostate cancer that is literally incapable of causing symptoms or spreading to other parts of the body,” said University of Chicago Medicine’s Dr Scott Eggener, who is reviving a debate about how to explain the threat to worried patients.
The words “You have cancer” have a profound effect on patients, Eggener wrote Monday in the Journal of Clinical Oncology.
He and his co-authors say fear of the disease can cause some patients to overreact and opt for unneeded surgery or radiation.
“If you reduce anxiety, you’ll reduce overtreatment,” said Dr David Penson of Vanderbilt University. “The word ‘cancer’ puts an idea in their head: ‘I have to have this treated.'”
Diagnosis sometimes starts with a PSA blood test, which looks for high levels of a protein that may mean cancer but can also be caused by less serious prostate problems or even vigorous exercise.
When a patient has a suspicious test result, a doctor might recommend a biopsy, which involves taking samples of tissue from the prostate gland. Next, a pathologist looks under a microscope and scores the samples for how abnormal the cells look.
Often, doctors offer patients with the lowest score — Gleason 6 — a way to avoid surgery and radiation: active surveillance, which involves close monitoring but no immediate treatment.
In the US, about 60 per cent of low-risk patients choose active surveillance. But they might still worry.
“I would be over the moon if people came up with a new name for Gleason 6 disease,” Penson said. “It will allow a lot of men to sleep better at night.”
But Dr Joel Nelson of the University of Pittsburgh School of Medicine said dropping the word “cancer” would “misinform patients by telling them there’s nothing wrong. There’s nothing wrong today, but that doesn’t mean we don’t have to keep track of what we’ve discovered.”
Name changes have happened previously in low-risk cancers of the bladder, cervix and thyroid. In breast cancer, there’s an ongoing debate about dropping “carcinoma” from DCIS or ductal carcinoma in situ.
In prostate cancer, the 1960s-era Gleason ranking system has evolved, which is how 6 became the lowest score. Patients may assume it’s a medium score on a scale of 1 to 10. In fact, it’s the lowest on a scale of 6 to 10.
What to call it instead of cancer? Proposals include IDLE for indolent lesion of epithelial origin or INERRT for indolent neoplasm rarely requiring treatment.
“I don’t really give a hoot what it’s called as long as it’s not called cancer,” Eggener said.
Steve Rienks, a 72-year-old civil engineer in Naperville, Illinois, was diagnosed with Gleason 6 prostate cancer in 2014. He chose active surveillance, and follow-up biopsies in 2017 and 2021 found no evidence of cancer.
Calling it something else would help patients make informed choices, Rienks said, but that’s not enough: Patients need to ask questions until they feel confident.
“It’s about understanding risk,” Rienks said. “I would encourage my fellow males to educate themselves and get additional medical opinions.”
By CARLA K JOHNSON
AP Medical Writer
MARS Wildlife Centre closes due to avian influenza – Squamish Chief
The MARS Wildlife Centre north of Courtenay is closing to the public temporarily after avian influenza was found this week in a small poultry flock in the Comox Valley.
As of Monday, the visitor centre and gift shop will not be accessible to visitors.
“Our commitment to the safety and well-being of our resident ambassador birds (eagles, owls and crows) and wildlife patients is our first priority, and we hope that this additional precautionary measure will help reduce the risk of on-site transmission of the virus,” Gyl Andersen, centre manager of wildlife rehabilitation, said in a statement.
The Mountainaire Avian Rescue Society worries that needed donations to operate the centre will drop during the time the centre it is closed, at a time of year when expenses rise.
Andersen is asking supporters to donate to its animal care fund.
It is “baby season” and the influx of injured and orphaned baby birds, raccoon kits, and other small mammals has begun, Andersen said.
The largest expenses at this time of year are food and nursery supplies. Also needed are personal protective equipment and cleaning supplies to combat viruses.
The Canadian Food Inspection agency confirmed Wednesday that Vancouver Island’s first case of the H5N1 virus was found in the small flock.
This is the first reported case on the Island, which may have been caused by infected migrating wild birds.
Increased bio-security measures have been put into place to protect birds at the centre, where its wildlife hospital remains open, Andersen said.
Sanitizing footbaths, a separate patient admission building, quarantine zones for different species, and covering the ambassador enclosures are among safety measures implemented.
Anyone bringing an injured animal to the Merville centre must remain in their vehicle and call the hospital at 250-337-2021, extension zero to speak to rehabilitation staff, who will come and collect the animal.
The centre said dead birds can not be brought to the centre. Call the centre for advice. The bird hotline can be called at 1-866-431-2473.
Rise of acute hepatitis among kids: Find out what is causing it, symptoms to note and all about the role of vaccines – Times of India
Besides the adenovirus 41, scientists continue to investigate COVID-19 as a potential underlying cause of the rise in recent cases of acute hepatitis in children.
An Indian study conducted by a team of researchers from the Bundelkhand Medical College (BMC), Sagar, Madhya Pradesh and the Post Graduate Institute of Medical Research, Chandigarh found that of 475 children, who tested positive for COVID-19 from April-July in 2021, 37 were diagnosed with COVID Acquired Hepatitis (CAH).
“We observed a peculiar rise in hepatitis cases. Usually, the beginning of monsoon marks a rise in hepatitis cases. Last year (2021) we started to see this in April, or summer, in covid positive children who were part of follow-up. Most of them in fact had recovered from their covid,” said Sumit Rawat, Associate Professor, Microbiology, BMC, and one of the authors of the study.
“Hepatitis A and E are specific to certain villages or regions, B is present through the year and D is usually from a parent or from a blood transfusion. Last year, following the Delta wave we saw these cases from all over the state, defying the usual histories,” he added.
Another recent case study suggested a possible link between liver disease and COVID-19.
The study published in the Journal of Pediatric Gastroenterology and Nutrition observed a previously healthy three-year-old girl who developed acute liver failure a few weeks after recovering from a mild COVID infection.
Dr. Anna Peters, a pediatric gastroenterologist at the Cincinnati Children’s Hospital Medical Center and the lead author of the study said, “”The patient had liver biopsy findings and blood testing consistent with a type of autoimmune hepatitis which may have been triggered by COVID infection.”
“I think it’s important for physicians to be aware that this is a rare condition that may happen during or after COVID infection. It’s important to check liver tests in patients who aren’t improving as expected,” she added.
About 11 per cent of admitted COVID patients return to hospital or die within 30 days: study – CTV News
A new study offers a closer look at possible factors that may lead to some hospitalized COVID-19 patients being readmitted within a month of discharge.
At roughly nine per cent, researchers say the readmission rate is similar to that seen for other ailments, but socio-economic factors and sex seem to play a bigger role in predicting which patients are most likely to suffer a downturn when sent home.
Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults hospitalized for COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18 per cent — 8,496 patients — died in hospital between January 2020 and October 2021, which was higher than the norm for other respiratory tract infections.
Among those sent home, about nine per cent returned to hospital within 30 days of leaving, while two per cent died.
The combined rate of readmission or death was similar in each province, at 9.9 per cent or 783 patients in Alberta, and 10.6 per cent or 2,390 patients in Ontario.
For those wondering if the patients were discharged too soon, the report found most spent less than a month in hospital and patients who stayed longer were actually readmitted at a slightly higher rate.
“We initially wondered, ‘Were people being sent home too early?’ … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” co-author Dr. Finlay McAlister, a professor of general internal medicine at the University of Alberta, said from Edmonton.
“So it looked like clinicians were identifying the right patients to send home.”
The report found readmitted patients tended to be male, older, and have multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with home care or to a long-term care facility.
McAlister also found socio-economic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits, but “that wasn’t as good a predictor for post-COVID patients.”
“Including things like socio-economic status, male sex and where they were actually being discharged to were also big influences. It comes back to the whole message that we’re seeing over and over with COVID: that socio-economic deprivation seems to be even more important for COVID than for other medical conditions.”
McAlister said knowing this could help transition co-ordinators and family doctors decide which patients need extra help when they leave the hospital.
On its own, LACE had only a modest ability to predict readmission or death but adding variables including the patient’s neighbourhood and sex improved accuracy by 12 per cent, adds supporting co-author Dr. Amol Verma, an internal medicine physician at St. Michael’s Hospital in Toronto.
The study did not tease out how much socio-economic status itself was a factor, but did look at postal codes associated with so-called “deprivation” indicators like lower education and income among residents.
Readmission was about the same regardless of neighbourhood, but patients from postal codes that scored high on the deprivation index were more likely to be admitted for COVID-19 to begin with, notes Verma.
Verma adds that relying on postal codes does have limitations in assessing socio-economic status since urban postal codes can have wide variation in their demographic. He also notes the study did not include patients without a postal code.
McAlister said about half of the patients returned because of breathing difficulties, which is the most common diagnosis for readmissions of any type.
He suspected many of those problems would have been difficult to prevent, suggesting “it may just be progression of the underlying disease.”
It’s clear, however, that many people who appear to survive COVID are not able to fully put the illness behind them, he added.
“Looking at readmissions is just the tip of the iceberg. There’s some data from the (World Health Organization) that maybe half to two-thirds of individuals who have had COVID severe enough to be hospitalized end up with lung problems or heart problems afterwards, if you do detailed enough testing,” he said.
“If you give patients quality of life scores and symptom questionnaires, they’re reporting much more levels of disability than we’re picking up in analyses of hospitalizations or emergency room visits.”
The research period pre-dates the Omicron surge that appeared in late 2021 but McAlister said there’s no reason to suspect much difference among today’s patients.
He said that while Omicron outcomes have been shown to be less severe than the Delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.
“If you’re unvaccinated and you catch Omicron it’s still not a walk in the park,” he said.
This report by The Canadian Press was first published May 16, 2022.
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