Davis Square Family Practice Newsletter
In This Issue
Flu Vaccine is In!!
Changes in Prostate and Breast Cancer Screening
Run to Cure Carcinoid
New Clinicians at Davis Square Family Practice 
You May Have Also Heard...
Drugs for Osteoporosis May Have Risks 
Deborah Bershel, M.D.
 Marcia Tanur, M.D.
 Marie Botte, N.P.
Robert Love, N.P.
Anne Roche
Practice Manager
Qianna Price
Lead Medical Assistant
Kristen O'Callaghan
Medical Assistant
Meghan Rappa
Medical Assistant
 Marina Tiola
Medical Assistant
 Monica Pereira
Dorothy Anderson
Issue: # 13      Sept. 2010     

We hope that you enjoy our newsletter. It's designed to be informative on both medical and office issues. Any suggestions you have to make the newsletter more meaningful for you are most appreciated. 
Deborah Bershel, MD
Flu Vaccines Are In
 Recommended for Everyone
We have the flu vaccine in for all patients who are over 6 months of age. Please call to make arrangements to be immunized prior to this season's outbreak. Click on the link below to get the CDC's information on the flu vaccine.
While the vaccine is recommended for
everyone over 6 months of age there are certain groups that are at greater risk for complication: children under 5 years of age; people with chronic illness such as those with asthma, heart disease and diabetes; people over 50 years of age; and pregnant women.
Those with severe allergic reactions to eggs should avoid the vaccine. And people with latex allergies should get the vaccine form a mulidose vial rather than the prefilled syringes.
Cancer Screening - Prostate, Colon, Breast, Lung

Cancer  Screening - A Big Dilemma

Cancer is scary. Nobody wants to get it let alone die from it. For women the most common potentially deadly cancers are breast, lung and colon and for men it is lung, colon and prostate.

There are screening tests for all of these diseases, but that does not mean that each screening test is of equal utility. It would seem obvious to most people that screening men for breast cancer with mammograms would be ridiculous. Yet for many diseases, we screen people without much scrutiny of the test's real value. Without getting too technical, a screening test ideally should be sensitive and have few false positives.  A false positive is when the test says you have the cancer but you actually do not have it. Also, if we detect the cancer with the test, are we able to either cure it or add meaningful life for the patient. Another important thing to consider is, how much better is the cure from the cancer itself Every treatment has potential side effects, complications and even death associated with it. In addition, some screening tests may have small but potentially real side effects themselves.  For example, there is a small radiation dose from a mammogram.

Here is a link to the estimated 2010 incidence (new cases in that year) and deaths from the major cancers for men and women.
So basically we are talking about four cancers that cause most cancer-related deaths in adults: lung, breast, colon and prostate.
Lung Cancer
90% of lung cancer is smoking-related. The next highest risk factor of lung cancer is radon exposure. Screening with x-rays has proven nearly useless and CT scans have many false positives and expose people to high doses of radiation if you perform them on a regular basis. It is just best to avoid risk factors. For example, stop smoking and check basements for radon.
My feelings about the PSA blood test have modified over the past year. Screening for prostate cancer with a PSA yields many false positives and this is not a good situation. What makes screening even more complicated is that it is difficult to determine who has an aggressive cancer which is more likely to kill them, and prostate biopsies are no walk in the park. Couple that with the fact that the treatment for prostate cancer is not without potentially significant complications. Radiation of the prostate can cause problematic internal colon scarring, and surgery can cause impotence and urinary incontinence. Many long-term studies comparing 'no treatment ' to 'treatment' have shown no significant difference in 10-year survival rates. Perhaps some improvement is death from prostate cancer after 15 years in the treatment group. If you have a family history of prostate cancer, especially early prostate cancer, then perhaps screening is indicated. When you come in for your physical exam around 50 years of age, we should talk about the risks versus the benefits of a PSA blood test.
There are many varying opinions among the different medical societies as to the proper screening for breast cancer. There are about 200,000 cases of breast cancer diagnosed
annually and about 30,000 deaths.  The Preventive Service Task Force came out with with some controversial recommendations last year, and I'll summarize them now. They no longer recommend mammograms every 1-2 years for all women between the ages of 40-50.  Rather, they suggest discussing individual risk/benefit with your physician.  They now recommend mammography every other year between 50-74. They say that the evidence isn't there to recommend for or against mammography for women 75 and older. They recommend against teaching the breast self exam.  The feeling is that between the ages of 40-50 the risk of breast cancer is 1 in every 1000 women which is much less than the occurrance in older women and that a lot of unnecessary biopsies are performed in premenopausal women as a result.  Breast cancer prior to menopause tends to be a somewhat different entity than postmenopausal cancer. On the other hand, we are treating, and sometimes curing, woman with many years of potential life ahead of them in the premenopausal group.  As with prostate cancer screening, a discussion with your clinician is the best course of action when you turn 40 as certain groups of patients are higher risk.
Colon Cancer
Colon cancer is the archetype disease for screening. The colonoscopy will catch a polyp (a tiny clump of cells) when it is small. When caught early and removed, you are 'cured', but when ignored and allowed to spread, it is very difficult to treat. The risks of the colonoscopy (i.e. bowel perforation) are rare. I don't believe that merely checking the stool for occult (microscopic) blood is very sensitive although some authorities say it can suffice.  A stool test for cancer cells is available, but it is not as sensitive as the colonoscopy (which should be done every 10 years unless cancerous polyps have been found previously). Colonoscopies generally begin at 50 years of age unless there is a family history of colon cancer and screening may be recommended earlier.
Cancer Screening
Avoid whole body CT scanning for cancer. Chances are much greater that you will get a false positive test then catch a curable cancer early. Radiation from CT scans is not inconsequential so only subject yourself to it when it is medically indicated.
Also, if you hear a movie star or football coach on TV tell you about cancer screening, please run the information by us - we happen to be the medical professionals.
Support Our Half Marathon Run on Sunday October 17
Deborah Gerson and I am running the Lowell 1/2 Marathon on Sunday October 17th. Carol Dansky, who many of you know, devoted over 15 years to her patients here at Davis Square Family Practice. You may not know that she has battled with carcinoid for almost 20 years, and we are dedicating this run in her honor. We are hoping to raise funds to help cure carcinoid. If your want to contribute please go to the First Giving web page Cure Carcinoid.  100% of your donation will go to Caring for Carcinoid.
I've enjoyed seeing so many of our patients on the Minuteman Trail over the past 6 weeks as I train. I did 12 miles in the heat this past Saturday. Any support you can give to Deb Gerson and I would surely make the 13.1 miles a little easier for us.
New Clinicians at Davis Square Family Practice
 New Kid In Town
There are two new clinicians at Davis Square Family Practice - Bob Love, NP and
Marcia Tanur , MD
For those of you who have already had the opportunity to meet Bob Love, you know he practices comprehensive care. In addition to his training as a nurse practitioner, he has extensive experience in mental health counseling.
Dr. Marcia Tanur is a family physician who will be joining our practice in November.  She has been practicing medicine in the Boston area for over 15 years as well as many years of experience in acupuncture.  Dr. Tanur will open up a valuable new avenue to healing for our patients. Please feel free to call and schedule an appointment with her. Since she will only be working with us part-time, I expect her openings to fill up rapidly
Two Treatments for Osteoporosis  May Be Hitting Rough Seas
Calcium Supplements and Heart Disease
Also Bisphosphonates(Fosamax)
and Esophageal Cancer  
It was in the news recently that calcium supplements may increase the risk for heart attack. The studies that were looked at did not include people who took vitamin D along with the calcium. For the time being I'd ignore this study unless you have a significant risk for heart attack to begin with. Also, if your risk is low for osteoporosis, consider not taking calcium supplements.
The second study looked at bisphosphonates (Fosamax, Actonel, Boniva) and esophageal cancer. These drugs are now one of the main treatments to prevent the progression of osteoporosis. Researchers found the risk for esophageal cancer was doubled in those that had taken these drugs for over 3 years. Esophageal cancer is fortunately rare.
There has developed in our society a sort of emotional frenzy about treating osteoporosis with drugs. Regular exercise, such as walking and quitting smoking are two simple and safe ways to help prevent the disease. A hip fracture can be devastating, but we must always be mindful that almost all medicines have a potential downside.
Until Next Time, 
Please visit our website
www.dsfamilypractice.com to request prescription refills and referral authorizations or just read back issues of our newletters as well as many interesting articles in our medical library.
If you know someone who would like to receive our newsletters, they can join by visiting our website and accessing the Newletter link at the top of the page. 
In Health,
Deborah Bershel, M.D.