The dangers of overdiagnosing
By Dr. Anthony Policastro
A recent article in the British Medical Journal addressed an issue called overdiagnosis. The article pointed out that we use a lot more diagnostic tests that we did in the past. These tests sometimes reveal things that we would never have known about in the past. The result is that we then treat something that we would not have treated in the past. Patients then get complications of treatment that they would never have gotten. When I was a medical student, I did a pathology rotation. We had to attend autopsies. There were frequently autopsies done on individuals who had died of heart attacks or strokes. In some of these individuals, we found cancers that were at an early stage. They might ultimately have been fatal. However, they were not the thing that killed the patient. Some of the things that we overdiagnose are related to changes in the level of measurement. For example, there are many women who have evidence of diabetes during pregnancy (gestational diabetes). Over the years, the level of blood sugar that qualifies a woman as a gestational diabetic has been lowered. For that reason, we have more women with gestational diabetes. Over the years we have lowered the level of what we consider a normal blood pressure. When I graduated medical school, we would accept anything below 140/90 as normal. That number now stands at 120/80. The level of cholesterol that we consider significant has been lowered over the years as well. In most cases, the numbers were changed with good reason. We did scientific studies that showed that a higher percentage of individuals with the higher number had problems. However, that was only a higher percentage. It was not everybody with the higher number. Thus, when we treat everybody with the higher numbers, we end up treating some people who probably don't need treatment. The result is that we see some complications of treatment that we would not have seen in the past. Another area of significance is in the diagnosis of cancer. Over the years, the diagnosis of cancers of various types has increased. Thyroid cancer, prostate cancer, melanoma, kidney cancer and breast cancer is diagnosed more frequently. However, the death rates from all these cancers have shown little change. This suggests several things. The first is that some of these individuals would be like the one I saw in medical school. They indeed had cancer but would die of something else before the cancer killed them. In many cases cancers grow more slowly than we would think. That is why we recommend colonoscopies every 10 years for low risk individuals. The feeling is that the frequency is still high enough to pick up slow growing colon cancers. The second thing it suggests is that some of these things are small enough that the body might be able to overcome them. We have all heard stories about individuals who have had their cancers miraculously disappear. We need to remember that we frequently form cancer cells. Our body's immune system will usually remove them. The cells that get by the immune system are the problem ones. We really don't know how big a cancer the body can remove. Perhaps some of the ones that we now find would be gone if we looked for them later. Another problem area relates to finding something abnormal on a test. It then requires further testing to see what it is. Then after those tests, it is determined that it is not anything significant anyway. In the meantime, the patient has undergone another series of tests which carry their own complications. Overdiagnosis is enough of a problem that it is being approached by the scientific community in an organized fashion. There is a website entitled, www.preventingoverdiagnosis.net. There is going to be a 2013 scientific meeting just to discuss overdiagnosis which is a relatively new problem. However, as our testing techniques get more sophisticated and criteria for diagnosis change, it is likely to become a more common problem.
Volunteers needed for cycling event Want to join the fun of Delaware's largest and premier cycling event, but not as a cyclist? Bike MS: Bike to the Bay presented by NRG Energy Indian River Generating Station is just over a month away and the Delaware Chapter of the National Multiple Sclerosis Society needs volunteers to help organize and run the event. Bike to the Bay attracts more than 1,800 participants of all levels, to ride a 17-, 45-, 75-, 100-, 150-, or 175-mile route from Dover to The Towers at Seashore State Park in Dewey - all to raise money and awareness of the devastating effects of multiple sclerosis. The Delaware Chapter needs over 200 people to help hand out rider numbers and t-shirts, to load and unload the equipment truck, man rest stops, direct traffic, and provide logistical and clerical support every step of the way. To volunteer for Bike to the Bay, contact Ainsley Hertrich, at 302-655-5610, ext. 129. Or email your interest to email@example.com.
Bayhealth recruits veterans Discipline. A strong work ethic. A team attitude. Those are just a few of the attributes which make military veterans outstanding employees when they return to civilian life. And those are just a few of the reasons why Bayhealth is renewing its efforts to recruit veterans. The August 13th event, sponsored by Delaware's congressional delegation, gave vets the opportunity to meet and mingle with Bayhealth and other employers representing banking, law enforcement, and a wide range of other industries. "The veterans job fair not only helped make a connection between employer and prospective employee, but it also helped raise public awareness of why veterans are so valuable to our workforce," said Hayward, who noted that the vets attending the recent event represented a diverse range of professions including mechanics, engineers, security, clerks, radiology technicians and nurses.
Golf group donates proceeds The Seaford Ladies Nine Hole Golf Association recently held a "Pretty In Pink" cancer fundraiser which included a dinner, fashion show, Live/Silent/Chinese auctions, and golf tournament.
Proceeds totaled $17,000 and were donated to Nanticoke Cancer Care Services to assist patients with transportation costs. Patients often find it difficult to travel to and from appointments. Some live alone, do not have family in the surrounding area, or are not able to operate a vehicle and cannot afford public transportation. Proceeds from "Pretty In Pink" will help offset these costs for these patients. Nanticoke Cancer Care Services recently affiliated with the Tunnell Cancer Center to provide comprehensive medical and radiation oncology services in Western Sussex County. In addition, the affiliation will expand support services to patients and provide access to clinical trials in Seaford. With this affiliation the number of cancer patients treated at Nanticoke is expected to grow which also means an increase in the financial need of patients.
Prostate screenings offered September is Prostate Cancer Awareness Month. The Cancer Care staff at Nanticoke Memorial Hospital will once again provide prostate screenings (D.R.E. & blood test) on Friday, Sept. 7 from 8 a.m. to 5 p.m. at the Cancer Care Center (located at 701 Middleford Rd., Seaford). There is a $10 screening fee and pre-registration and fasting are not required. Nanticoke Memorial Hospital encourages men over the age of 50 to take advantage of this service. Also men age 40 and at high risk of developing prostate cancer are encouraged to participate. African-American men and men who have a family history of the disease have a higher risk for developing prostate cancer. For more information, call Melinda Huffman, nurse navigator, at 629-6611, ext. 3765.
NHS announces new directors Nanticoke Health Services is pleased to announce three recent promotions. Lori Lee, RN, BSN, has been promoted to the position of senior director of nursing. In this position, Lee will help to manage the daily operations of the nursing departments. She has over 15 years of patient care experience at Nanticoke Health Services. Robert Seeley RN, BSN has accepted the position of director of Clinical Decision Unit (CDU) and Patient Flow. Seeley will be responsible for moving patients effectively and efficiently through the admission and discharge process, as well as direct an observation unit with a focus centered around cardiac diagnostics and intervention. He has over 15 years of patient care experience. Rachel Gardner, RN has been promoted to director of the Medical Surgical Unit and the Progressive Care Unit. Gardner will be working with leadership and staff to help maximize patient services/outcomes and to improve service in the Medical Surgical Unit and the Progressive Care Unit. She has over 30 years of patient care experience.
Ferrer earns national certification Alina Ferrer, Spanish language medical interpreter at Beebe Medical Center, has been credentialed as a Certified Healthcare Interpreter (CHIª) in Spanish by the Certification Commission for Healthcare Interpreters (CCHI). Ferrer has been the Spanish language medical interpreter at Beebe Medical Center since 2003, and was the first to hold such a position at a hospital in the state of Delaware. Ferrer also coordinates the language service for the deaf at Beebe Medical Center, and developed the Spanish-language Patient Safety Satisfaction Survey. Before becoming a Spanish Language Medical Interpreter, she worked with patients in a Hospice organization and at Beebe's Tunnell Cancer Center. Ferrer holds a master's in social work. In 2011, she was elected as a director to the national board of the National Council for Interpreters in Healthcare (NCIHC). She is a member of Beebe Medical Center's Patient Relation's Department. For more information about the services that Ferrer offers, or that are available through the department, call 645-3300, ext. 5367.
NMH offers CPR classes Nanticoke Memorial Hospital will offer community CPR classes to anyone interested in learning CPR at the Nanticoke Training Center located on Water Street in Seaford. Participants will learn how to perform the basic skills of CPR on adults, children, and infants and how to help an adult, child, or infant who is choking and use of the AED. This classroom-based, video, and instructor-led CPR course offers families, friends, and community members the opportunity to learn CPR and need a course completion card. Classes are open to participants ages 12 and up. This program is specifically designed for those who prefer to learn in a group environment with feedback from an instructor. The target audience is those who have a duty to respond to a cardiac emergency. Cost is $40. Payment and registration is required by no later than five business days prior to the class. Late registrations may be accepted if seating is available. To register and to obtain a listing of class dates/times, contact the Nanticoke Memorial Hospital's Training Center office at 629-6611, ext. 8919. Pre-registration is required.
HIV/AIDS Support Group A new support group for HIV/AIDS will meet every other Wednesday, at 7 p.m., in the Branford Lounge at Epworth United Methodist Church at 19285 Holland Glade Rd., Rehoboth Beach. The group is sponsored by Epworth UMC, CAMP Rehoboth, the AIDs Delaware and Delaware HIV Consortium. For more information, contact David at firstname.lastname@example.org.
Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. To learn more, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.