Mak­ing sense of dis­ease risk

Pa­tients need a doctor to help them in­ter­pret new med­i­cal screen­ing tests

The Washington Times Daily - - OPINION - By Marc Siegel Marc Siegel, a physi­cian, is a pro­fes­sor of medicine and med­i­cal di­rec­tor of Doctor Ra­dio at NYU Lan­gone Med­i­cal Cen­ter. He is a Fox News med­i­cal correspondent.

Ineed a full arse­nal of med­i­cal screen­ing tools at my dis­posal to help my pa­tients. Some of the tools I have are new, and oth­ers have been around a long time. They help me as­sess the risk of get­ting a dis­ease, or in the case of a colonoscopy or a car­diac stress test, of al­ready hav­ing one.

This is why I op­posed the U.S. Pre­ven­tive Ser­vices Task Force (USPSTF) rec­om­men­da­tion (since 2012) that men not have the Prostate Spe­cific Anti­gen test. It is also why the new USPSTF rec­om­men­da­tion is­sued last week that men dis­cuss the risks and ben­e­fits of the PSA test and then de­cide whether or not to have it is still not good enough.

Ev­ery male over the age of 45 should have their PSA tested.

Prostate Spe­cific Anti­gen is a use­ful test that has come un­der un­jus­ti­fied at­tacks not be­cause of the test it­self but be­cause of the doc­tors who over­re­act to it. Close to 30,000 men still die of prostate can­cer ev­ery year and the PSA is still the best way I have to know there is some­thing wrong with the prostate. I check it in ev­ery male over 45 just as I check your choles­terol level. Re­search tells me that a high choles­terol puts pa­tients at risk of heart dis­ease and stroke. Whether I treat a high choles­terol with med­i­ca­tion or not has to do with many fac­tors, in­clud­ing fam­ily his­tory of heart dis­ease, weight, age, lifestyle, as well will­ing­ness to take the medicine.

Like choles­terol level, PSA does not tell me about a spe­cific dis­ease (in this case, can­cer) but whether the pa­tient has a med­i­cal prob­lem I need to ad­dress. I use PSA as a guide and I fol­low a trend much as I fol­low a choles­terol trend. I am also in­ter­ested in your fam­ily his­tory of prostate can­cer. I re­al­ize that PSA may be el­e­vated from an in­fec­tion or an en­larged prostate rather than can­cer and I fac­tor that in, too, be­fore I rush to or­der a biopsy. I com­bine the in­for­ma­tion the PSA gives me with the way a prostate feels when I ex­am­ine it. Is there a nod­ule? Do I need to do some­thing?

Over the past month alone I saw one 60-year-old pa­tient with a high PSA of 7, which hadn’t changed much in years and so I fol­lowed it. He had one biopsy, which was neg­a­tive. An­other 50-year-old pa­tient had a sud­den spike in his PSA from 2 to 5, but in turned out he had an in­fec­tion and his PSA re­turned to nor­mal af­ter re­ceiv­ing an an­tibi­otic. A third 67-year-old pa­tient with a ris­ing PSA turned out to have prostate can­cer and elected to have his prostate re­moved be­cause the can­cer ap­peared to be grow­ing rapidly and had reached the outer por­tion of his prostate.

The com­mon de­nom­i­na­tor in all three cases was a dis­cern­ing doctor to in­ter­pret re­sults and help guide the pa­tient.

Now we are en­ter­ing an ex­cit­ing, new era of per­son­al­ized medicine, when we will be able to as­sess the risk of a dis­ease be­fore the pa­tient ac­tu­ally get it. In fact, new ge­netic test­ing is al­ready be­com­ing widely avail­able. With 23andMe, the FDA has just ap­proved an over-the-counter ge­netic test, which pre­dicts with 99 per­cent cer­tainty whether you are at risk for 10 im­por­tant dis­eases, in­clud­ing Alzheimer’s, Parkinson’s, Celiac, clot­ting and iron over­load dis­ease. It sounds great, but what is miss­ing is the doctor to tell you what to do with these re­sults. The ac­cu­racy is suf­fi­cient but the rud­der­less process of ob­tain­ing it isn’t.

In­stead of wor­ry­ing what these re­sults mean — a nor­mal re­ac­tion if your test isn’t nor­mal — it would be much bet­ter if I ac­cu­mu­lated a pa­tient’s ge­netic risk data in the first place and then helped him in­ter­pret and re­spond to it.

The com­mon de­nom­i­na­tor in all three cases was a dis­cern­ing doctor to in­ter­pret re­sults and help guide the pa­tient.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.