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    Then, at home that evening having a bit of fun with Chris’s parents Sharlene flipped opened one of the baby name books, and declared their search over: Their son would be named Ace.

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    The Smokescreen of Screening

    In medical school I was taught that a screening test should have 3 characteristics. It should have a high sensitivity and specificity. It should be inexpensive,
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    It gets considerably more complicated in the real world. The standard that has been most often applied has been cost per year of life saved. That theoretically takes all of the desired characteristics into account.

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    Colonoscopy is the best screening test for colon cancer if done by qualified individuals. It is strongly supported by clinical research. It is supported by the drop in mortality since it became the standard. It is more cost effective than mammography in breast cancer. Still, the long term trial to prove it absolutely saves lives is lacking.

    The United States Preventive Services Task Force (USPSTF) looked at colorectal cancer screening last year. They did so right after a joint statement had been issued by a number of other organizations. Differences were present but the one that got the most attention was CT Colonography (Virtual Colonoscopy) not being endorsed.

    That came as no surprise based on the medical literature. Some studies have shown the test can be highly sensitive and specific but others have not. It is also not cost effective unless patients with polyps less than 1 cm in size are not sent for colonoscopy.

    One thing that gastroenterology has learned over the years as a field is that out screening and surveillance intervals are too short. Over the past 25 years the intervals to follow up on pre cancerous polyps (adenomas) have gone from yearly to up to 5 year intervals.

    There is even a push now to treat a patient with a single diminutive adenoma the same as a patient with no polyps.

    It can go the other way. Hyperplastic polyps were thought to not be a risk factor for cancer 15 years ago. Now, depending on size and location some of them (not all) have been found to be more dangerous than adenomas.

    Increasing screening intervals can be difficult. It is hard to do a test every year and then start telling patients it will now be every 3 or 5 years. The data may support it but people will naturally feel as if they are putting themselves at risk.

    Anchorage gastroenterologists all follow the screening guidelines. Unfortunately, there have been patients in my office from elsewhere who were told to have colonoscopies done well before the guidelines recommend. That is a tough discussion because most patients do not know who to trust and can remain skeptical even when they read the guidelines themselves.

    Guidelines are just guidelines. Modifications can occur at times. There are findings that the guidelines do not take into account. Hence, there will be times when someone is told a shorter interval because of legitimate reasons.

    The USPSTF just recently published new recommendations for breast cancer screening.

    Breast cancer is a politically charged diagnosis. It has many advocates and it explains why diseases that kill far more people, including colorectal cancer, get less attention.

    As soon as the recommendations were published it seemed like everybody was an expert on breast cancer. It become a battle cry for what we could expect under a new health care system.

    The health care bills have major problems but this change in recommendations has nothing to do with reform. If you read through the rationale, it is easy to understand. All of the concepts mentioned above about how to measure screening tests were used.

    The media has been full of examples of women who are alive today because they received a mammogram before age 50. There are plenty of people alive today because they had a colonoscopy done before age 50. Most of them had risk factors that led to the test being done and the USPSTF states cases can be individualized.

    Why not screen everybody for everything starting at age 20? After all, that might save millions of lives worldwide. It is also cost prohibitive and has other downsides.

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    Change that appears to be taking something away is difficult to implement. It only gets worse with the legal and political climate in this country.

    There is no way to stop all disease. The idea is to create a system where you identify the people at the highest risk and treat them appropriately. Sometimes people will not be caught in the net because the net is designed to catch most and not all cases.

    Guidelines need to be based on data and the right decisions need to be made. It is what is right even if it is not what is always popular.

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    Glaciers Of Kilimanjaro

    I recently acquired some old photos depicting Kilimanjaro from the 1920 through to the 1960 Although the massif that is Kilimanjaro is easily recognisable in shape and size the dramatic decline in the glaciers is so apparent that the mountain is almost unrecognisable to what is was 80 years ago.

    The glaciers have existed for around 12,000 years, but it is estimated that they have decreased in size by approximately 82% since 1912. If they continue declining at such a rapid rate then they could completely disappear from the African landscape by 2020.

    Most people like to blame global warming for the decline in the glaciers, but some scientists beg to differ and believe the reason behind their loss could be far more complex. One hypothesis is the deforestation that is being carried out in the region to free up land for farming and honey production is greatly reducing the surrounding forest,
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    Great white sharks ended up in Mediterranean after taking ‘wrong turn’

    Great white sharks may have ended up in the Mediterranean after taking a wrong turn 450,
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    Research has discovered four of the deadly predators found off the coasts of Turkey, Tunisia and Sicily had DNA which showed they belonged to a family from Australia.

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    Later generations of the great shark may then have stayed in the area as they like to return to their birth place.

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