November 28th, 2022
Prairie Doc Perspective the Week of November 27th, 2022
"Lung Cancer Screening Saves Lives"
By Daniel G Petereit, MD, FABS, FASTRO
This year nearly 250,000 patients will be diagnosed with lung cancer and 130,000 will die from it. In SD, 660 people will be diagnosed and over 400 will die from the disease. Lung cancer accounts for the most cancer deaths in both the US and in SD.
Smoking is the most important risk factor for lung cancer and accounts for 80% of lung cancer deaths. Although smoking rates continue to decline in the US, in SD there are many rural and tribal communities where the smoking rates are still 20-40%. These patients continue to be at risk for developing and dying from lung cancer. The Lakota Sioux have the highest lung cancer death rates in the nation at 95%.
Lung cancer screening with low-dose computed tomography (LDCT) has been demonstrated to reduce lung cancer death rates by detecting earlier stages of cancer with relatively high cure rates – similar to other screen detectable cancers such as cervical, prostate, breast and colorectal. An LDCT is a five-minute, outpatient CT scan performed without IV contrast and has minimal radiation exposure. The current recommendations are for healthy adults ages 50-80 with a 20 pack year smoking history or who have quit within the last 15 years.
Unfortunately, many SD patients are at risk, and are unaware of the value of an LDCT. In SD, there are at least 30,000 patients who are eligible for this test.
If patients are diagnosed with early stage lung cancer, surgery is the standard treatment with high cure rates. If patients are not surgical candidates, they can be safely treated with 4 to 5 radiation doses, called stereotactic ablative radio-surgery, with essentially no side effects and also very high cure rates. This specialized form of radiation is offered at most cancer centers in SD.
To address the high lung cancer death rates among the Lakota Sioux, we implemented a lung cancer screening navigation program on the west river reservations in an attempt to lower these death rates as part of an ongoing program called Walking Forward that has been in existence since 2002. This is a community-based program based in Rapid City with staff who live and work in their communities of Pine Ridge and Rosebud. The overarching program goal is to lower cancer death rates for Lakota Sioux, through patient navigation, access to cancer screening and early detection and state of the art cancer treatments. To date we have referred over 420 patients for an LDCT with over 335 completed scans.
So, if you are a smoker: 1) try to quit; 2) if you are a candidate for lung cancer screening talk to your primary care provider about an LDCT, and 3) for the younger generation – don’t start smoking!
Bottom Line: lung cancer can be successfully treated if caught early – get screened if you are eligible.
November 18th, 2022
Prairie Doc® Perspectives for week of November 20th, 2022
“Gratitude for Grandparents”
by Joanie Holm, R.N., C.N.P.
A three-pound baby entered the world in recent days. This precious child was born after his Mom spent seven weeks in the hospital on bedrest. At home, Dad and two siblings were working, going to school, and worrying. Surrounding the family were two sets of grandparents who ensured that the pieces all fell into place. From meals and lawn care, to virtual school, from evening shifts and overnights to early mornings, these grandparents were there every step of the way. They will continue to offer support while the baby remains hospitalized and growing, and after he comes home, because that is what grandparents do, if they are able.
Grandparenting can be an awesome stage in life, benefitting the grandchildren, the parents, and of course the grandparents in significant ways. Grandparents are known to influence values and behaviors and provide valuable life experiences. A child who has a connection with grandparents may have increased self-esteem, with better emotional and social skills. A relationship with a grandparent can give a child strength and comfort into adulthood.
In an article titled “Why Grandparents are VIPs,” social researcher, educator and author, Susan V. Bosak writes, “The special kind of love you get from a grandparent is a love you can't get anywhere else. It is an important kind of love – in fact, a very important kind of love. Parents have to worry about who children will become in the future; their role is to be providers and disciplinarians. Grandparents can just enjoy children for who they are in the moment. The love of a grandparent is often freer, more unconditional, and far less psychologically complex than a parent's love. The love of a parent and the love of a grandparent are different, second in emotional importance only to the parent/child relationship.”
In a world of many dual-career families, the benefits of active grandparents can be lifesaving for parents. Often grandparents fill in the gap between school and the time parents get off work, driving kids to different events or helping them with homework.
Lastly, active grandparents report less depression and a higher degree of life satisfaction and a hopeful feeling for the future.
Margaret Mead, a well-known American cultural anthropologist, said the connection between generations was “essential for the mental health and stability of a nation.”
This Thanksgiving, may we celebrate the grandparent-grandchild relationship with gratitude.
November 14th, 2022
Prairie Doc® Perspective for the week of November 13th, 2022
“Looking out for all of you”
By Debra Johnston, MD
Recently, while visiting from out of state, my father had a “health hiccup.” As we navigated getting this problem investigated and addressed, he was very concerned that we keep his primary care doctor informed. As my dad has said repeatedly, “I give him more grief than any of my other doctors, but I also listen to him more than any of my other doctors. He’s the only one looking out for all of me!”
Like many Americans, particularly older Americans, my dad has a whole host of specialists he sees on a regular basis. One of my friends recently teased, what do primary care providers do, anyway? It seems that there is a specialist for pretty much any problem you can imagine!
If I see a cardiologist, an electrophysiologist, a urologist, an endocrinologist, a gastroenterologist, a rheumatologist, a nephrologist and maybe even an oncologist, why do I need one more doctor, who doesn’t seem to be handling anything?
Established readers of this column know that I, like Dr Holm before me, am a proponent of the annual wellness visit. It’s a chance to step back and look at the big picture, to review screenings, immunizations, and health promotion recommendations. Many factors can influence these recommendations, beyond age and gender. Did you know that older men who have smoked should be screened for aortic aneurysms, and that diabetes in pregnancy increases diabetes risk going forward?
The origin of a symptom is not always straightforward. For example, abdominal pain can originate not just from the digestive system, but from many other systems, and from causes that might surprise you, such as blood or metabolic diseases and poisonings. Some people, women especially, get their gallbladders removed, only to discover that the problem was, in fact, their heart. A primary care doctor can help sort things out in a more efficient way.
A primary care doctor looks at the big picture, In fact, all of us answering questions tonight are primary care doctors. We commonly say we are specialties of breadth, not depth. My father says the specialist studies one 1000 page book on their topic, while the generalist studies the 10 page summary for 100 different topics. We may ask for assistance from our specialist colleagues for more unusual, treatment resistant, or advanced diseases, but every day we help patients manage their health problems. We coordinate care between specialists, and watch for signs that the treatment for one problem is worsening another. In fact, I would argue that the more specialists you have, the more important it becomes to have someone “looking out for all of you.
Everyone deserves a primary care provider!
November 07th, 2022
Prairie Doc Perspective Week of November 6th, 2022
Prostate Cancer: Know Your Options
By Daniel G Petereit, MD, FABS, FASTRO
Over my 30 year career as a cancer physician I have witnessed firsthand the tremendous progress in treating cancer patients. There continues to be controversy in the screening and treatment of prostate cancer (PC) for which I am grateful to have the opportunity to share more information with you.
PC screening consists of obtaining a PSA and rectal exam, followed by a biopsy if indicated. In 2012, the United States Preventive Task Force (USPSTF) recommended against PC screening. Studies following their recommendations demonstrated a substantial decline in both PC screening and diagnosis of early stage PC, and a subsequent increase in the rates of more aggressive PC. In 2017 the USPSTF reversed their prior recommendation, listing PSA as a reasonable screening test in men ages 55- 69.
For men with early stage PC, active surveillance is recommended that includes obtaining a PSA every 6 months and a repeat prostate biopsy 1-2 years later. For patients who require treatment surgery and radiation are equivalent options. Many patients in the US and in SD only hear about these options from the urologist who performed the biopsy. There are advantages and disadvantages for both approaches.
Patients deserve to hear about both treatments before making a decision that impacts their life. One of the most effective radiation options for earlier stages of PC is prostate brachytherapy (BT) or “seed implants” for appropriate patients. This is a one hour outpatient procedure that yields some of the highest cure rates. Multiple studies have demonstrated quality of life and patient satisfaction favors BT and is the most cost-effective treatment.
A significant area of controversy is the management of aggressive PC as we are now seeing more of these patients due to the previous lack of screening. A misconception in the medical community is that these patients should all be surgically treated. While surgery is an appropriate option, many patients still require 6 weeks of radiation to eliminate cancer left behind with higher rates of incontinence and impotency. Another proven treatment option is daily external beam radiation followed by BT that produces some of the highest cure rates. The recurrence rates are lowest with this approach compared to surgery.
Unfortunately, many patients in the US do not have access to prostate BT, especially in rural areas. The only radiation option for them is 8 weeks of daily radiation which can be a dilemma with the travel required. Prostate BT was previously performed at cancer centers in SD, but is now only available in Rapid City.
Selective prostate screening and treatment reduces PC death rates. Proper patient selection is critical when deciding on treatment. Thoroughly informed patients who consent to treatment are less likely to regret their medical decisions.
Patients deserve to know their options.