American Cancer Society | COPD and Other Stuff

Greetings… Following is a copy of an email plea from the National Lymphedema Network to the Journal Of American College of Surgeons.

I’ve produced it here almost verbatim because I have leg lymphedema and it is one of the most painful difficult to live with diseases I have. Last year it flared again and oozed, taking about 10 months to heal, including a month in Harrison, a month at Martha and Mary Rehab Center, and months of my husband daily cleaning and re-wrapping my lower legs and feet.

Breast cancer survivors need to be educated to the risks of getting lymphedema. I can promise – as a patient with lower leg lymphedema – nobody should get this disease if it can be avoided.

Patients, please talk to your doctor about lymphedema. If she/he will not discuss it, find a doctor who will.

“National Lymphedema Network

In response to an article published in the March issue of the Journal Of American College of Surgeons (http://www.journalacs.org/article/S1072-7515(12)01312-9/abstract) the NLN Medical Advisory Committee is responding to a Press Release released on February 25, 2013 (http://www.facs.org/news/jacs/lymphedema0313.html) in the Journal of American College of Surgeons, “Breast Cancer Patients Fear for Developing Lymphedema Far Exceeds the Risk ”

Respectfully:

Saskia R.J. Thiadens RN

Executive Director

“March 1, 2013

On 2/25/2013 the Journal of American College of Surgeons released a statement entitled, “Breast Cancer Patients’ Fear of Developing Lymphedema Far Exceeds the Risk.” The press release was in response to findings from a single-site study published in the March issue of the Journal of the American College of Surgeons noting that some breast cancer survivors take extraordinary measures to try to prevent lymphedema that may not be necessary. The rate of development of lymphedema in the limbs of the study patients (N=120, followed to 12 months) was similar to reported incidence in the medical literature. Three percent of patients having a sentinel lymph node biopsy developed lymphedema and 19% of patients having an axillary lymph node dissection developed lymphedema. The study indicated that patients with sentinel lymph node biopsy worried and took precautions as much as those who had axillary node dissections.

The National Lymphedema Network agrees with the statement in the press release that “future research should be aimed at better predicting which women will develop lymphedema, thus allowing for targeted prevention and intervention strategies and individualized plans for risk-reducing behaviors for each woman during and after her breast cancer treatment.” However, since this type of risk stratification and broad education does not currently exist, it is important for patients to be given accurate information by their doctors and oncology care providers on reasonable approaches to reducing the risk of developing lymphedema.

The American Cancer Society estimates that in 2013 there will be about 232, 340 new cases of breast cancer in the US and there are approximately 2.9 million breast cancer survivors in the US. If 20% of those who have axillary dissections, and, conservatively, 3% with sentinel lymph node biopsies, are at risk of developing lymphedema, this is still a very large number of women who have reason to be concerned about their risk of developing lymphedema.

Lymphedema is a progressive, debilitating condition that is not merely swelling, but an immune system dysfunction. When recognized late in its course, or inadequately treated, lymphedema leads to chronic infection and progressive disability. Women who are at risk for lymphedema have reason to be concerned and these concerns should not be minimized.

The National Lymphedema Network advocates a reasonable approach to risk reduction guidelines, given that a large population of women is still at significant risk of developing lymphedema. In the NLN Position Paper on Risk Reduction, revised in 2012 and available at www.lymphnet.org , a risk stratification approach is detailed so patients can take appropriate precautions according to their medical situation. Every breast cancer survivor deserves accurate information about her or his risk of developing lymphedema and reasonable precautions based on the available scientific evidence.

The American College of Surgeons, and all providers of care to breast cancer patients, are encouraged to provide every breast cancer patient with accurate information about lymphedema, so patients can make informed choices. Given the imperfect state of the science on risk reduction for lymphedema, there are many reasonable, healthy suggestions for patients at risk of lymphedema to reduce their risk, such as weight management and exercise. The Position Papers on the NLN website on Exercise, Risk Reduction and Screening for Breast Cancer Related Lymphedema were written by a panel of medical experts in the field of lymphology and lymphedema treatment.

The National Lymphedema Network urges the American College of Surgeons to endorse the NLN Position papers, provide them to their members, and acknowledge that a large number of breast cancer survivors are at risk of or currently have lymphedema. These patients need education and information that will allow them to take precautions that are reasonable and not excessive. Education is the key and then what each one does with that information is a personal choice and a part of personalized health care.”

…NLN Medical Advisory Committee * Hotline: 1.800.541.3259

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Best wishes and thanks for reading … Sharon O’Hara <familien1@comcast.net>

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Lung cancer is almost entirely caused by smoking…just as in COPD and COPD kills more people per year than lung cancer and breast cancer combined.

A vast difference though is that COPD is a long slow smother without treatment other than inhaled steroids, several other inhalers, lung reduction and lung transplant while physical exercise beyond the shortness of breath and inhalers, is the single most important thing a COPDer can do to help them live a quality life

Lung cancer is usually faster from diagnosis to death since most lung cancer is not diagnosed until a late stage.

Why?
Because there is no proven screening process that can find it earlier while early detection is possible for COPDers with the simple Spirometry test …the only problem is finding a doctor willing to give the quick, inexpensive test….and the only opportunity to give the patient, if a smoker, a chance to change behavior knowing what lies ahead.

Keep in mind too, only about 20 % smokers develop COPD while about 80% COPDers were smokers. (Speaking of patient changing behaviors if the consequences and benefits are known…my next post here will challenge me to do what I preach and throw out a challenge)

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According to Jennifer Croswell, MD, of the National Institutes of Health…” Low-dose computed tomography — now under study in two large randomized trials — has delivered significantly more false positives than chest X-rays…”
The false positives can lead to “… more invasive diagnostic procedures among patients screened with the low-dose CT, Dr. Croswell said at the annual meeting of the American Society of Clinical Oncology and “”False-positive results may create increased psychological stress in patients and an increased burden on the healthcare system…”
…
“According to the American Cancer Society, the five-year survival rate for localized lung cancer is 49.5%, but that falls to 20.6% for disease that has spread outside the lung and 2.8% if there are distant metastases.

The authors of the current study “break a little bit of new ground” in that they are looking at a study with a comparison group, according to Peter B. Bach, M.D., of Memorial Sloan-Kettering Cancer Center in New York.

But it has been known for some time that CT screening uncovers a “very, very high” frequency of lung abnormalities — up to 50% in one study and usually in the same range found by Dr. Croswell and colleagues.
Such findings can be nerve-wracking for patients, he said, and can require invasive procedures to pin down the cause of the “abnormal thing in the lung.”

But “only very rarely is that thing a lung cancer,” he said. “

Complicating the issue, Dr. Bach said, is that for physicians, the results of a CT scan that showed a minor abnormality are rarely a Yes or No issue. Instead, he said, they may increase suspicion and lead a doctor to follow a patient more or less closely.
…
The work of Dr. Croswell and colleagues, he said, adds to the available information, but “nothing really changes here. There is no organization in the world that recommends screening for lung cancer with CT” or any other technique.
“The status of the science is that (screening is) unproven, no one has ever shown it’s beneficial, numerous studies have shown it causes harm, and no one should be doing screening until we have randomized trials that are completed and show a benefit that outweighs all the harms,” he said.

On the other hand, “there is no question that CT screening will detect many lung cancers,” said Martin Edelman, M.D., of the University of Maryland Greenebaum Cancer Center in Baltimore.

The question is whether the approach will reduce the risk of death and illness, while minimizing harm to patients, said Dr. Edelman, who is on the independent committee verifying the endpoints of the National Lung Screening Trial.
So far, there is still a “complete absence of evidence that this approach decreases mortality or morbidity due to lung cancer,” he said.

Advocates for screening “have long claimed that there is little or no risk of harm, Dr. Edelman said, but Dr. Croswell and colleagues “demonstrate that there is a small, but real potential for harm from screening.”
What’s more, he said, “the potential for false positivity is highest in those at greatest risk for lung cancer.” “

medpagetoday.com/MeetingCoverage/ASCO/14432?utm_source=WC&utm_medium=email&utm_campaign=Meeting_Roundup_ASCO

More later… Sharon O’Hara

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