On Wednesday, June 29th, a special meeting of the Evergreen Pathfinders was held at the Fire Pit – special because it was open to the public instead of just the men who belong to the discussion group.
Under the title of “Cancer and Misdiagnoses,” six panelists brought insight to an all-too-frequent problem – the misdiagnosis of cancer in patients. Ken Carlson, president of the Pathfinders, said it was Linda Kirkpatrick’s column about being told she had a mass on her pancreas – something that proved not true when she went into the hospital to be biopsied – that spurred the panel discussion.
The following panelists participated:
- Linda Kirkpatrick, editor and owner of JustAroundHere.com since 1010, recipient of the Evergreen Chamber award in 2012 for a business considered “uniquely Evergreen,” and recipient of a lifetime leadership award in 2015 for 30+ years of leadership accomplishment in Evergreen.
- Dr. John Witwer, a graduate of Amherst College and Cornell Medical School who practiced medicine for 30 years including 23 years at Lutheran Medical Center. He was chairman of the Radiology Department and President of the Medical Staff at Lutheran. He served as our State Representative of House District 25 from 1998 through 2005. He currently teaches in the Physician Assistant program at Red Rocks Community College."
- Dr. Ralph Hall, who holds a BA from the University of Denver and an M. D. from the University of Kansas. He was Director of Medical Education and Research at St Luke’s hospital I Kansas City, Missouri and Professor of Medicine at the University of Missouri in Kansas City. He served as Director of Medical Affairs at Lutheran Hospital, in Wheat Ridge, Colorado and later as Director of Medical Affairs at Memorial hospital in Long Beach California and Associate Dean for Graduate Medical education at the University of California at Irving.
- Dr. Eunice Larson, who received her B.S. from Washington State University and her M.D. from Washington University in St. Louis. She was Director of Pathology at the Children’s Hospital in Honolulu and later on the faculty of the University of California, Irvine School of Medicine. She was the pediatric pathologist at Miller Children’s Hospital in Long Beach, CA. She was a member of the Pathology Residency Training faculty at LBMMC and at UCI School of Medicine.
- Dr. Dan Cooper, who earned his B. A. in science and his M.D. from the University of Southern California and served his residency in anesthesiology at Denver General Hospital and UCLA. While in the military, he served at Tripler Hospital in Hawaii. He practiced anesthesiology at Rose Hospital and Saint Anthony Hospital in the Denver area. He’s personally dealt with colon cancer.
- Tammy Reed, a representative of the American Cancer Society.
"Among the many points of discussion, Dr Witwer talked about the difficulty in seeing tumors in dense breast tissue, especially in younger women. False positives, i.e. concerning findings in a normal breast may be as high as 1 in 10 screening mammograms and will require further testing to determine that the vast majority of those breasts are indeed normal. Also, because of dense breast tissue, tumors may be present, but hidden (false negative). As many as 10% of tumors may be missed initially on mammograms, that is why breast self examinations and regular checkups are so important.
Newer mammography techniques such as 3D Tomosynthesis and MRI exams are more expensive than digital 2D screening mammograms but are significantly improving accuracy of diagnosis with fewer false negative and false positive exams.
With regard to mammograms, having older mammograms for comparison is very helpful. All insurance companies must cover breast screening one time per year, although sometimes with a deductible.
He said male breast cancer tends to be very aggressive.
Generally, he stressed the need to talk to patients in terms of probabilities and giving the patient options. He emphasized that if the patient is concerned, he/she should get a second opinion.
Dr. Hall, an Endocrinologist specializing in the pancreas, diabetes and nutrition, said when he began practicing, cancer of the pancreas was fairly rare, but has increased dramatically in recent years as the incidence of obesity has increased. He pointed out thought that he frequency of cancer of the stomach has decreased because of the treatment of H Pylori , a bacteria in the stomach. “An increase in body weight is associated with an increase in many types of cancer,” he said.
He talked about the sensitivity of tests for cancer and the specificity, (false positives) of the tests. He emphasized that diet may play a part in developing various types of cancer.
Dr. Larson spoke on the importance of having good tissue samples to be tested and how that can vary by doctor. She felt a specimen with necrosis (the death of body tissue) could mask cells needed for diagnosis. She stressed the importance of second opinions, something to which all other doctors on the panel agreed. “There’s nothing wrong with asking a physician to refer you for a second opinion,” she said. Dr. Larson said the quality of life for children with cancer is better than it used to be, with increased longevity and more effective treatment.
She suggested taking someone with you when treatment for a malignancy is being discussed. “Write down what you hear.” Generally, “after a person heard ‘cancer,’ they shut down and don’t hear the rest,” she said.
Dr. Cooper told his personal experience with colon cancer, having developed ulcerative colitis at age 21 and then, after several years, developing a rare kind of cancer of the colon that spread through the lining of the colon.
Collectively, the doctors addressed the issue of evaluating doctors. “It’s very difficult,” Dr. Cooper said. “The hospital could be sued if the hospital is wrong.” He said hospitals are prevented from sharing information about anesthesia professionals when other hospitals are inquiring.
Dr. Larson said professionals are evaluated in each subset or specialty.
Despite the cost to take away privileges an inept doctor at a hospital – often in the neighborhood of $100,000 – Dr. Witwer and Dr. Hall had jobs evaluating doctors at Lutheran Hospital and were pleased to say they’d “sent 16 doctors packing” to maintain the high quality of care at that facility.
While finding out how good a doctor is has been quite difficult, in recent years the Colorado Medical Society has begun publishing online the number of lawsuits involving each doctor, information that follows state to state. The Department of Regulatory Agencies (DORA) is responsible for compiling this information.
Tammy Reed, a representative of the American Cancer Society, herself a cancer survivor, gave a slide presentation about cancer screenings. She said 134,000 people will be diagnosed with colorectal cancer in 2016, and 49,000 will die from it. It is the second leading cause of cancer but that 50 percent of the cases can be averted. “There is a 90 percent survival rate if caught early.” She pointed out that the mortality rate is higher in rural areas because of the lack of resources available for being screened.
The history of cancer in one’s family is important in predicting one’s likelihood of developing cancer, she pointed out. Some doctors say “no more colonoscopies after age 70,” but Medicare will still pay for them up to age 75.
She said obese women are at a 20 percent higher risk of being diagnosed with breast cancer.
Someone in the audience raised the point that Kaiser is no longer regularly providing PSA testing but will provide the test if requested to do so.
Terminology about finding cancer was discussed, as one patient had heard four different terms being used: lesions, spots, masses and tumors. Spots are generally referenced with regard to the lungs. A lesion is “something unexpected.” Masses and tumors are more self-explanatory.
Pathfinders is a sponsor of Mountain Area Relay for Life, a fundraiser scheduled for August 12, 2016, which remembers those who have lost their lives to cancer and honors survivors and those still battling the disease. For more information, click here.