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Fact or Fiction: Educating skin cancer survivors on risks of tanning bed use could reduce recurrence of melanoma.
Well… it depends on the individual. For more than 20% of skin cancer survivors, the desire to maintain a killer tan overrides the known dangers of tanning bed use and overexposure to sunlight without sunscreen. According to an article published on MDLinx, “Some melanoma survivors still use tanning beds, skip sunscreen,”it’s important to understand that melanoma, although the least common type of skin cancer, is the most dangerous, claiming over 9,000 American lives annually. While the majority of melanoma survivors educate themselves and take precautionary measures to protect themselves from recurrence, reportedly over 20% do not.
Major risk factors for melanoma include:
- Overexposure to ultraviolet (UV) light, commonly due to sunlight and tanning beds/lamps on unprotected skin
- Fair skin and Freckles
- Immune suppression
At the most recent annual meeting of the American Association for Cancer Research, a study found that 27% of melanoma survivors still do not use sunscreen, 15% rarely stayed in the shade when outdoors and 2% still use tanning beds.
Many medical professionals find it disturbing that after surviving skin cancer, patients continue their pre-cancer perilous behavior by not implementing the recommended skin protection practices and ignoring the risk of recurrence. Tthere is clearly a need for more effective intervention and education on the part of healthcare providers to reduce the use of tanning beds/lamps and exposure to the sunlight, especially when educating patients who have already survived a bout with skin cancer. The question remains: Can better outcomes be achieved in time to save lives?
Find more articles about skin cancer at mdlinx.com/oncology:
As the shift from traditional fee-for-service to value-based reimbursement gains momentum, many practices are adding patient navigators and care coordinators to their teams. In fact, one out of every five respondents to 2013 Staff Salary Survey said they employ a care coordinator whose sole job is to coordinate patient care and/or offer referrals to other healthcare providers.
What is a care coordinator? The role of care coordinator is difficult to define because it often differs practice to practice. Still, care coordinators tend to share some common responsibilities, such as helping patients navigate the healthcare continuum, increasing patient outreach and monitoring (especially of high-risk patients and/or those with chronic conditions), and helping manage transitions of care.
Who is a care coordinator? Because the role of a care coordinator is so patient-centered, many practices employ care coordinators who are also registered nurses. Sometimes practices will ask their current nurses to take on care coordination responsibilities; others will hire nurses whose sole purpose is to serve as care coordinator.
Why care coordinator are gaining traction: Care coordinators tend to be found most often in primary-care practices that are transitioning to medical homes, or that are already medical homes.
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*To read the full article from Physicians Practice, click here, and choose Go To Abstract.
Studies suggest shaving, clipping, and waxing the genital region increases your chances of contracting an STI
If someone were to ask you what the latest fashion phenomenon was, what would pop into your head? Maybe the latest body-hugging pants for women or the newest European cut men’s jacket would come to mind.
Dr. Francois Desruelles, of the Department of Dermatology at Archet Hospital in France and noted case study lead author, has a much more brazen idea of the latest “fashion” trend influencing the masses. “Genital hair removal has become a fashion phenomenon in the last decade," he explains. While Desruelles’ definition of fashion can be called into question, the premise of his statement stands firm, backed by behavioral data collected in recent years.
But like most things we do for the sake of aesthetics, the hairless-body craze does not come without a downside. French researchers caution that pubic hair removal to any extent, including shaving, clipping, and waxing, may boost one’s risk for a pox infection, and possibly more pathogenic sexually transmitted infections. The irritation to the skin brought on by the removal of the protective pubic hair could explain the recent increase in cases of molluscum contagiosum, a minor sexually transmitted virus.
"At the same time, the number of cases of molluscum contagiosum has risen," Desruelles added in reference to the rise in both trends and the possible correlation. But he errs on the side of caution, explicitly explaining that the correlation still needs to be confirmed by controlled studies. Even with the disclaimer accompanying his theory, Desruelles remains confident that the growing popularity of genital grooming, which occurs in both men and women, raises the risk for this type of infection.
Genital hair removal may also increase the risk of developing genital warts due to infection with papillomavirus, he adds.
The group of researchers led by Desruelles describes their theory in greater depth in a letter published in the journal, Sexually Transmitted Infections on 19 March 2013. Although the correlation theory is just a theory, to investigate a possible link between the condition and hair removal, the authors studied 30 infected French patients who sought the services of a private skin care clinic in Nice, France in 2011 and 2012.
Although the findings revealed that one-third of patients suffered from various other skin disorders, including warts and cysts, the research group ultimately theorized that the pox virus may have spread through “self-infection;” specifically, damaging or scratching irritated skin likely irritated during the process of hair removal.
So where does this leave those who prefer a shaven genital region? In need of an au naturale makeover? Not necessarily, Desruelles explains your options.
"Laser hair removal doesn't seem to be involved in this association," Desruelles said, "because there are no microscopic cuts or bleeding during the removal of hair. For the same reason, waxing could be less 'at risk' than shaving."
Cervical cancer screening: What’s new and what’s coming?
Cleveland Clinic Journal of Medicine, 03/19/2013
JIN X.W. et al.- In their 2012 guidelines for cervical cancer screening, several organizations call for less-frequent but more-effective screening that incorporates testing for human papillomavirus (HPV). This article will review the newest screening guidelines and the evidence supporting these recommendations for primary care providers. They also review the potential role of novel biomarkers, newer HPV tests, and possible future strategies for cervical cancer screening. Advances in our understanding of the pathogenesis of cervical cancer, new tests for human papillomavirus (HPV), and the development of HPV vaccines in the last decade are transforming the way we screen for cervical cancer. As a result, screening guidelines are evolving rapidly, requiring clinicians to keep up-to-date with the evidence and rationales supporting the latest guidelines to properly convey best practices to patients.
- The new guidelines still recommend starting screening with cytologic (Papanicolaou) testing at age 21, but now recommend repeating the test less often, ie, every 3 years rather than every 2 years for women age 21 to 29.
- Women age 30 and older who are screened by combined cytologic and HPV testing should be rescreened every 5 years if both tests are negative (instead of every 3 years, as previously recommended). Alternatively, they can be screened by cytology alone every 3 years.
- We can stop screening women at age 65 if they have had adequate screening until then and no history of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in the past 20 years. Once screening is discontinued, it should not resume, even if the patient has a new sexual partner.
- Screening should not change after HPV vaccination.
- When women have negative cytology but positive HPV results, tests for the HPV 16 and 18 genotypes can help to identify those at higher risk of developing CIN2+.
- These guidelines apply to the general population only. They do not apply to women at high risk who may require more intensive screening, such as those who have a history of cervical cancer, are immunocompromised (eg, positive for human immunodeficiency virus [HIV]), or were exposed in utero to diethylstilbestrol.
Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening
Cancer Epidemiology, Biomarkers & Prevention, 03/25/2013 Clinical Article
Read more: http://www.mdlinx.com/oncology/news-article.cfm/4527459/
Houssami N et al. – Our models identify risk factors for interval second BC in PHBC women.
- Screening mammograms from women with history of early-stage BC at Breast Cancer Surveillance Consortium-affiliated facilities(1996-2008) were examined. Associations between woman-level, screen-level, and first-cancer variables and the probability of a second BC were modeled using multinomial logistic regression for three outcomes (screen-detected invasive BC, interval invasive BC, or DCIS) relative to no second BC.
What should your patients know about anaphylaxis?
Anaphylaxis is the rapid onset of a severe and potentially lethal allergic reaction. Unpredictable in nature, the key identifiers for this condition are variable. While most people who experience an anaphylactic reaction have a pre-existing and known allergy to a trigger substance, a smaller fraction of those afflicted are not even aware that they have an allergy. Although the lifetime prevalence is estimated at 0.05-2%, the rate of occurrence is on the rise and even the first episode of anaphylaxis can result in fatality.
Symptom onset commonly occurs within 2 minutes to 1 hour of exposure to a specific trigger.
It is uncommon, but it is possible that symptoms do not develop for several hours.
80- 90% of anaphylactic reactions include hives (urticarial) and swelling of the skin (angioedema).
Approximately 70% of reactions cause respiratory symptoms, which are more common in individuals with chronic respiratory diseases.
Severe anaphylaxis causes sudden collapse without other symptoms; this form occurs most commonly after a person is given a medication intravenously or is stung by an insect.
EYES: Tearing, redness, itching and swelling
SKIN: Flushing, hives (urticaria), or swelling (angioedema)
HEART: Weakness, dizziness, fainting, rapid or irregular heartbeat, and low blood pressure
NERVOUS SYSTEM: Confusion and anxiety
DIGESTIVE SYSTEM: Vomiting, abdominal cramps, nausea and diarrhea
NOSE & MOUTH: Runny nose, sneezing, nasal congestion, swelling of the tongue and metallic taste
LUNG & THROAT: Difficulty breathing, excessive coughing, chest tightness, wheezing or other sounds of labored breathing, increased mucus production, throat swelling or itching, hoarseness, change in voice and choking sensation
Who is at risk?
Some people are more likely than others to experience anaphylaxis, for example, those who have one or more of the following:
Previously experienced a sudden severe allergic reaction involving the whole body
Those diagnosed with asthma
Those with other types of diagnoses
People with chronic lung disease, especially older adults with chronic obstructive pulmonary disease (COPD) or emphysema, are at increased risk of complications during an anaphylactic reaction. People with coronary artery disease and other heart diseases are also at greater risk of developing complications.
How to prevent/treat?
If patient has had an anaphylactic reaction or has suspected triggers:
See an allergist for evaluation and for specific training and diagnosis.
Seek out testing to determine the trigger; an allergist should perform skin testing at least 3-4 weeks after an anaphylactic reaction b because if done too soon after the event, such tests may give false negative results.
Avoid triggers! When a trigger has been identified, the individual should be urged to stay away from the substance.
Always wear medical identification and carry epinephrine!
During an anaphylactic episode:
Call for emergency help immediately. Episodes are often times life-threatening-- it should be treated as a medical emergency.
Treat the person with epinephrine, those with a history of anaphylaxis should always carry an injector.
Place the person on their back or in a semi–reclining position with the lower extremities raised
During the episode, if needed, give high flow supplemental oxygen, establish intravenous access to provide high volume fluids, and perform cardiopulmonary resuscitation.
Go to the hospital, after injecting epinephrine; it is important to be evaluated in a hospital emergency department. There is no reliableway to predict whether or not a late-phase reaction will occur, but up to 20% of people with anaphylaxis have a late-phase reaction and might require additional treatment.
All HCPs are encouraged to talk with their patients who have a history of these types of reactions to develop an Anaphylaxis Action Plan. Many people find having a treatment plan to respond to future reactions reassuring.