Early Detection

We do regularly try to detect some cancers early through mammograms, colonoscopies, and PSA tests. I think most of us (meaning the general public) are comfortable with these tests as we age. But what if there was a genetic test available which you could have done regularly, every few years or whatever time frame, to test you for several different cancers before they had a chance to spread.

A new test, CancerSEEK, has been tested on more than 1000 patients and seems very hopeful.

"The CancerSEEK test looks for mutations in 16 genes that regularly arise in cancer and eight proteins that are often released.

It was trialled on 1,005 patients with cancers in the ovary, liver, stomach, pancreas, oesophagus, colon, lung or breast that had not yet spread to other tissues.

Overall, the test found 70% of the cancers."

But do we want it? I'm not sure. Yes it would be nice to be able to get to cancer sooner but is it worth the stress and costs? By costs, I do not mean financial (because the earlier a cancer is detected the less it costs to treat) but emotional on the patients.

I know women, who have never had breast cancer, who get very stressed by their annual mammogram and hold their breath until they get the all clear (which is sometimes in the form of a letter sent weeks later). This can be a very bad time for them.

With my medical history, do I really want another pile of stress on me? I'm not sure. Yes cancer sucks but sometimes we just don't want to know what is lying in wait for us. I am very much up in the air on this.

I think this is in the category of 'just because we can, doesn't mean we should'. Medical professionals may think this is the holy grail of cancer detection, but I kind of find it like being micromanaged on my health.

Your Brain On Cancer

Once you enter cancerland, your brain takes detours all the time. Where do these detours go? BAD PLACES!

"Is that a zit? No, of course not. Its a tumor. Must be skin cancer."
"A headache? No, a brain tumor. Dead in 3 months."
"Is that a swollen lymph node? Quick, leukemia or lymphoma, which one?"

As you can easily see you brain with cancer goes down the wrong roads. Usually in the middle of the night. Or when your are stuck in traffic by yourself.

You start making little deals with yourself. "I'll wait a month and see if its still a problem. No, a month? No three weeks. Wait, two weeks. Maybe ten days. Do I have any blood work coming up? Maybe that will tell me something."

"Wait, am I a lunatic? Actually thinking like this will turn me into a lunatic!"

The big thing is to learn to control your brain so it doesn't take all the detours. That is the really hard part of living with cancer. Your brain develops a this ability to drive you crazy and lead you into bad places. You need to get it under control so you can keep your sanity and avoid things like depression and anxiety.

Its a lifelong problem. It will never go away.  Such is cancerland.

Cancer again....

Did you know that if you have cancer once you have a 3.5-36.9% chance of getting an unrelated second cancer (been there, done that). And that 70% of cancer people have a comorbid condition which requires better medical care for the rest of their life. So maybe you smoked and got one cancer, 15 years later you find you have lung cancer, eve though you quit smoking at your first diagnosis.

No I don't make this stuff up. Someone finally did a study on people who have cancer once and rates of developing a new cancer. They found out lots of interesting things:

• Many people who have cancer once do not take steps to reduce the risk of getting a new cancer.
• People who are successfully treated for early breast or lung cancer are likely to live a long time, thus increasing their risk of developing a new cancer 
• They are excluded from clinical trials which may prevent them from having access to the best potential treatment for thei new cancer

So where does this leave us? 

• Post cancer patients should continue to see specialists after a cancer.
• They should  receive  counseling on how to reduce their risk of additional cancers even more than people who have not had cancer previously. 
• Post cancer people should be included in clinical trials. 

Us cancer people need to stick together and reduce our risk of more cancer

Being Breast Cancer Savvy

Buried in another article based on a woman doctor's problems getting screened for breast cancer by the UK's NHS, are three rules on how to be 'Breast Cancer Savvy'

• You Don't Need to Examine Your Breasts
  All women, no matter what age, should get to know their breasts. But experts have stopped recommending self-examination routines. Studies have shown that most women who find breast tumours do so during the course of everyday life: while dressing, or just rolling over in bed. The key is to know what looks and feels normal to you.

I wholeheartedly agree with this. I am incapable of finding any lumps.

• Don't Ignore Symptoms
  The most common sign of breast cancer is a lump within the breast. But you might find one in the armpit or notice skin changes on the breast such as dimpling, and changes in the appearance of the nipple, or its shape or how it feels, or a discharge. Breast pain on one side that lasts after a period, a rash and any change in the size, shape or symmetry should be investigated.

Well 'doh!' If something not right, get it checked asap

• Make Sure You Go To That MammogramIf breast cancer is detected early, it is more treatable. Screening uses mammograms – a type of X-ray – to look inside the breast. All women between 47 and 70 are invited for screening every three years. NHS screening is opt-in after 70, so make sure you get in touch with your local unit to make an appointment: nhs.uk/breastscreening.

Um yes. Its a great tool for finding breast cancer before it gets really big and ug

I think I will be forced to blog about the rest of the article tomorrow maybe. 47 is way too late to start mammograms. My maternal aunt was diagnosed at 76 with breast cancer....  Grrr.

But in the meantime. Be savvy. Savvy is almost like being cool.

To Test or Not To Test

Once you are diagnosed with cancer, you have two key desires:

• Get the damn thing out of me! 
• Make Sure It Doesn't Come Back!

So you have surgery and they remove every thing they can. You might have to have more surgery to get those pesky clean margins. Then the give you nasty drugs for chemo and might zap you a few times as well with radiation as well. You might get some pills too. All sorts of fun and games thrown at you. 

The doctors swear to you that they have done everything possible to get the cancer out of  you.  So you go back to your oncologists and they tell you... see you in three months! You kind of freak out because you had been getting day to day care from your oncology team and they wanted to know about every fart and sniffle.

So you take a deep breath and wait three months. You go back to your oncologist and they tell you: 'your blood work looks fine, see you in another three months'. You take a really deep breath and ask shakily 'aren't there any more tests? How do you know there is no more cancer in me?' Your oncologist says 'there are no other tests that have been shown to be of any value in following your cancer.' 

This is a very real scenario. Although the patient may want more scans or tests to look for any teeny tiny cancer cooties, there may not be any else they can do to look for cancer for you. There is no evidence of your disease. They have no way of looking for anything now. 

They have to wait until you get some kind of symptom. This could be anything from a fever, swollen lymph nodes, or unusual pains. Then they can run more scans.

There are two reasons that doctors cannot provide more scans: 

1. Scans may not have the resolution to show anything smaller than say 7mm. So they have to wait until something is large enough for them to seem. Scans can include high doses of radiation or contrast agents. You really do not want to have many of them.
2. If you have bottomless pockets, you may be able to convince your doctor you will pay for them because your insurance may not cover scans unless you are symptomatic. 

An additional cost of scans is 'scanxiety'. This is the huge emotional toll on the patient at each scan. It is often better to stay off the emotional cancer roller coaster than to push your way back to the front of the line regularly.

I get it. I really do. I did recently get rid of a back doctor who didn't see a reason to rescan my back after 7 years of treatment even though I complained of different pains over the years. But I am very happy not to have any more cancer scans than the annual mammogram and annual neck check from my endocrinologist. I will speak up if I feel anything weird or think something is going on. (But my track record in noting bad things is awful - if I think there is something there isn't.)

I do not want to have any more scans. If there is a need to have more scans, that would freak me out just as much as a new cancer diagnosis. So test me less and I will be happy.I am happy to live in my cancer free la la land, than to be rediagnosed.

Would you get a dog?

I am a cat person but after reading this article about dogs who sniff out cancer, I briefly considered getting a dog. I am not a dog person. Its not that I don't like dogs, I do. I think for a pet they are a lot of work. You have to make sure you are home to walk them etc.

However, if my dog could sniff out any cancer in me before it could be found by a scan or test, I would be very happy with a dog. It would save me a lot of stress and anxiety.

Like all other cancer people, I have more concerns about another cancer than the average person. There is only so much kale and greens eating, green tea drinking, alcohol avoiding, and exercising that a person can do. We get examined, tested, lectured, and any other things our doctors tell us we should and shouldn't do often.

But we still have those 'what if' moments in the middle of the night. So if when one of those moments occurred and we had a cancer sniffing dog sleeping next to the bed who was not concerned about any cancer scents coming from us, we would be reassured that there was no need to concern and more easily go back to sleep.

So I will follow this research and consider getting a dog. I'll have to ask our cats about this as well.

Animal trainers not doctors

Okay, this is getting to be a bit too much. I'm sorry but cancer detection by animals? Well, birds too.

This all seems to be going on in the UK. First of all, pigeons are being trained to read breast cancer imaging to diagnose breast cancer. Yes you read that right. Pigeons. You know the 'rats with wings' (as I call them) that populate many cities.

"Pigeons, with training, did just as well as humans in a study testing their ability to distinguish cancerous from healthy breast tissue samples."

I am so happy to hear that we no longer need radiologists to read our mammograms for breast cancer diagnoses. Instead of 3 years of medical school and four years of a radiology residency, we can have pigeons trained for a few weeks who can spend their lives reading mammograms.

"After two weeks of training, the pigeons reached a level of 85% accuracy. Because they successfully identified cancerous tissue from images they had not seen before, the researchers ruled out rote-learning of the images as an explanation."

Talk about a birdbrain.

Next we have dogs who sniff out cancer. I have heard of this before. We have Lucy's story. She failed guide dog school so her owners thought they should try medical detection instead.

"For the next seven years, Lucy learned to sniff out bladder, kidney and prostate cancer, and was even used in a study. Over the years, she has been able to detect cancer correctly more than 95% of the time. That's better than some lab tests used to diagnose cancer.

Now, Lucy is part of one of the largest clinical trials of canine cancer detection. A British organization, Medical Detection Dogs, has eight dogs sniff out 3,000 urine samples from National Health Service patients to see whether they can discern who has cancer and who doesn't."

Is this a good use of our medical research dollars? I am not so sure. I know people claim their dogs have sniffed out their cancer or stay very close when they are sick but again I do not think a dog is good substitute for a doctor. This research may make us think we need more animal trainers instead of doctors.

You think I make this stuff up? You can read about it the pigeons and the dogs.

Early detection and saving lives

Laurie over at Not Just About Cancer blogged about the myth of early detection and linked to a very good article on the same subject in Psychology Today. Early detection is supposed to be a good thing meaning they caught your disease (whatever it maybe) before it got really nasty.

Amy Robach and others say 'my mammogram saved my life'. But is this really true? I am not saying that they are lying but the question is did their mammogram really save their life? I have friends who believe the same thing. They attribute their still being alive because of their 'life saving mammogram'.

Let's take a look at this. First of all, as the Psychology Today article points out, if we were detecting more cancers earlier wouldn't the numbers for late detection or deaths be decreasing? They aren't.

"But this dramatic increase in "early-stage" diagnoses has not been followed with a decline in advanced breast cancers, as would be expected if early detection was the key to stopping progression."

Next, breast cancer is not a linear disease. There are many types which are more or less treatable and some it doesn't matter when they are caught, they are still going to kill you. And others are never going to be fatal and will resolve themselves. We just aren't very good about telling them apart. 

"For all we do not know about breast cancer (i.e., what exactly causes it, how to prevent it, how to keep it from recurring, how to keep people from dying from it if it spreads), there are things we do know. Breast cancer is complex. It stems from multiple causes, some of which include radiation, carcinogenic chemicals, and cancer promoters such as endocrine disrupting compounds(link is external). There are at least ten subtypes of breast cancer that behave and respond to treatments differently. One-size-fits-all treatment does not work. Mammograms do not prevent breast cancer; nor do they guarantee that the cancer found on a mammogram (if it is found on a mammogram) is indolent, lethal, or somewhere in between. Acknowledging these complexities would not only help to shift the breast cancer paradigm, it would serve those who want to be well informed."

So if you feel your mammogram saved your life, you may or may not be right.

The imperfect mammogram

Sometimes I start to think, which can be a dangerous proposition and something that my husband believes I should not do too frequently. One thought that has wandered through my brain is that we make assumptions about mammograms and other medical tests and procedures. I also found an article that agrees with me.

To give a little history, I had a benign fibroadenoma at the age of 23, which was three years after my thyroid cancer, and have had mammograms since then. Fibroadenomas are benign and common in younger women but can put a woman at 1.5 or 2x the risk of breast cancer later on. (A little factoid I just learned and wish I had known decades ago.)

But after decades of mammograms, and breast cancer and a later fibroadenoma at the end of chemo, I can tell you I never felt they so wonderful or perfect. My first fibroadenoma was found by me and confirmed by a mammogram (my first). My breast cancer was found by a mammogram. My second fibroadenoma was found by an MRI and grew during chemo.

There has been a lot of disagreement, false information, arguments, stories about mammograms saving lives, and more in recent years. Komen says mammograms save lives (as her sister wanted - but that's another story). The AMA, ACS, and other groups have their own opinions.

But lets take a step back, as this writer describes, and think about the real mammogram numbers and results. Some cancers are missed on mammograms. Sometimes mammograms find benign conditions. These can lead to more testing or procedures or even over treatment.

First, no medical procedure, test, surgery or whatever is perfect. There is always a margin of error. Strep tests are good 99% of the time, flu shots don't prevent all cases of the flu, any surgery could have complications. Second, as patients we make assumptions that a medical whatever is going to save us. A doctor will come along and be able to save us from whatever. They do their best but research is always on going to learn more.

Screening for cancer can save lives but none of the tests I know of are perfect. A high number on a test can be a sign of cancer but it could be caused by something else. I am all for cancer screenings but we can't rely on them completely. We need to accept that medicine is not perfect but it is all we have.

Dense Breast Tissue and Laws

I feel conflicted about this one. There are new state laws enforcing that women with dense breast tissue must be notified by their medical providers. Okay, that's great but then what do they do?

Yes there have been women diagnosed with breast cancer which was not seen on mammograms but that is a small number. Advocates for this law want to help women be in more control of their healthcare. Advocates against it are concerned about overdiagnosis and additional costs - particularly in states where insurance companies are required to pay for ultrasounds after clean mammograms.

And doctors have said they don't have the tools to do much with the information.

"New ways of classifying dense breast tissue could put even more women in the category of receiving dense breast notifications, said Dr. Priscilla Slanetz, who recently wrote a New England Journal of Medicine article questioning the effectiveness of dense breast notification laws.

One reason she wrote the article, she said, was "in our state [Massachusetts] very few of our primary care providers have any knowledge about breast density and strengths and limitations of these different tests" for supplemental screening.

The same may hold true in California, where a small survey of primary care doctors found that only half of them had heard of the state's 2013 dense breast notification law and many felt they didn't have enough education to address what breast density meant for their patients.

On this point, both supporters and critics of the laws agree: doctors need better tools to help their patients identify their individual cancer risks."

Okay, so now we have people who want to have these laws but we do not have a way to deal with the information. How helpful.

Blood test for cancer?

[Did you take the survey yet on who reads blogs? There's still time. I'm sure you meant to go back and complete it later so here is a gentle reminder. You only have 9 more days. Go take the damn survey! http://fluidsurveys.com/s/blogimpact/]

So I am pleasantly surprised to learn about this new blood test that can detect cancer without a biopsy. They call it a liquid biopsy. Basically it means that they hope that cancer can be detected before its noticeable. This is not the same as the blood biopsy I blogged about the other day for breast cancer. This is something else that is new.

It has been tested on patients with lymphoma and one woman with lung cancer.

"The hope is that a blood draw — far less onerous than a traditional biopsy or a CT scan — will enable oncologists to quickly figure out whether a treatment is working and, if it is, to continue monitoring in case the cancer develops resistance. Failing treatments could be ended quickly, sparing patients side effects and allowing doctors to try alternatives."

This means that patients wont have to wait for months to see if their cancer treatment is working. They can be monitored through blood tests. And recurrences of lymphoma were detected three months before they were noticeable.

Of course more research is needed but things look good. Personally, while I am not a fan of too much blood work, I much prefer them to other tests or biopsies.

Breast Cancer Blood Test

A new blood test has been developed which tells which women will develop breast cancer in the next 2-5 years with an 80% accuracy rate. The point is that mammograms show when breast cancer has already occurred so this would be a way of telling before it happened.  And to quote:

"...the method could create a paradigm shift in early diagnosis of breast cancer as well as other diseases."

That's all great and stuff but I have some questions.

• If you are told you will develop breast cancer in the next two to five years, what do you do? Get a mammogram every month until it shows up? Or start chemo ahead of time? I'm not sure.
• What about the 20% inaccuracy? It won't work for one in five women so there is no benefit
• And all of us who were told we were too young or had no family history or risk factors? And then got breast cancer anyway?

So this is progress but I have concerns. I would like to see the blood test refined and have it be more accurate. That's easy for me to say. I guess I think this is a step in the right direction but will only help 80% of people. And I feel that all of us who were exceptions will still be exceptions.

A bit of overkill?

When is it a bit too much??? There is a new study out (of course another study - just what we needed) where the author calls for across the board BRCA testing. Yes really. Go read it here. And you can read what Dr Love thinks about this here.

My thoughts are now I know why people want to live off the grid without government interference. This really goes a bit too far.

I know breast cancer is a bad thing. The BRCA genes are responsible for somewhere around 25-30% of all hereditary breast and ovarian cancers and 5-10% of all breast cancers. So of the 250,000 or so breast cancer diagnoses each year in the US, this might lead to detecting 12,500-25,000 cases of breast cancer early.

I honestly don't see the benefit of testing millions of Americans to 25,000 cases annually. I know the cases add up and each person gets tested once so its not that clear but I do not see the cost/benefit ratio here. As Dr Love points out, who is going to pay for all this? The Affordable Care Act would probably want the insurance companies to pick up the tab - and you know the cost of that test is going to hit your premiums somewhere/somehow. And since men can carry the BRCA gene and get breast cancer, they would need to be tested as well.

And if you test positive for the gene you can take preventative measures such as tamoxifen and mastectomies but there is no guarantee you can prevent yourself from getting cancer. You can only reduce your risk.

I think the current system of looking at family history and then making educated decisions on a one-on-one basis with each person's doctor is better. Because if you look at the numbers the other way, 90-95% of the cases of breast cancer diagnosed each year are not due to the BRCA gene.

Before we go for across the board testing for anything, we need to look at the incidence of the disease being screened and the cost benefit ration. Breast cancer isn't contagious as so many think.

Predicting breast cancer recurrence five to fifteen years out

When I was diagnosed with breast cancer seven years ago, I heard about the Oncotype Dx test, for which I was not eligible (for some stupid reason I can't remember) that would help decide whether chemotherapy was necessary. It has now been available for ten years and has been shown that it can help predict late recurrence of breast cancer - which is defined as five to fifteen years out from the initial diagnosis.

I think this is real progress in reining in cancer. [I wasn't going to use the word battle or war or anything like that. I had to think and settled on reining in.] This ties in with extending the use of tamoxifen for ten years to obtain better results.

"As recognized by ASCO's guideline update, recent studies have shown that extending tamoxifen treatment for 10 years is associated  with better outcomes, however, we still need better tools to identify who those patients are," said Norman Wolmark, M.D., chairman of the National Surgical Adjuvant Breast and Bowel Project (NSABP). "This study confirms that Oncotype DX can help better define who is at greatest risk for late recurrences and the potential to benefit from extended tamoxifen, as well as those who are at lower risk and will likely have less absolute benefit from extended tamoxifen and, thus, could be spared prolonged exposure and risk of long-term side effects." 

Now of course, I am still do not have the criteria to belong to that group that was in the study but it is nice to know that there is progress in knowing about who is more likely to have recurrence. This in turns allow them to be better followed to catch any recurrence early.

A stupid idea in my opinion

So would you wear a breast cancer sensing bra? Or even add a smart device to your bra that would be an early warning for breast cancer? I think this is stupid.

The premise is that self exam and mammogram compliance is not 100% that this way your bra or a gizmo attached to it can detect breast cancer early. Hmmm.... Nope. No way.

Personally I wouldn't wear one if you paid me. I think it plays to the insecurities of all women who are scared they might develop breast cancer.

The developers of this gizmo have raised $560,000. It has the CE mark so they will start selling them in Singapore. This brainstorm  is because the Singapore government gave away 10,000 mammograms but only 30% were used so they feel the need is there. So are women in Singapore who didn't bother to get a free mammogram going to wear a gizmo on their bra? I am not so sure.

It still needs to get through FDA trials here and will take a few years but I won't be buying one. Sorry. I think this is an idea that had good intentions, but not going anywhere.

A Way to End the What Age for Mammograms Controversy?

Work with me here, what if everyone could agree on one option for the mammogram controversy? Wouldn't it make a lot more sense? I mean there has been so much ink about this single issue. On one hand is prevention and on the other is over diagnosis and false positives, with a lot of other data, crap, history, and arguments added on to each. So what is the real answer?

I believe JAMA has the right idea here. In the age of personalized medicine, why are we hung up on cross the board requirements? JAMA suggests that we "Stop One Size Fits All Mammography".

"A woman's decision to undergo mammography "should be individualized based on patients' risk profiles and preferences," concludes a systematic review of 50 years of breast cancer screening data, published in the April issue of JAMA.

How to best go about achieving that individualization is not entirely clear, but clinicians need to make an effort with the tools that are currently available, such as decision aids and risk models, 
suggest Lydia Pace, MD, MPH, and Nancy Keating, MD, MPH, both from Brigham and Women's Hospital in Boston, in their review."

Their argument is that a woman should be able to make a decision on mammography with their doctor based on their risk. The problem is that current science does not allow us to accurately estimate all women's risk of breast cancer. So the problem isn't with mammography but with the ability to predict breast cancer.

Before we jump ahead to that issue, let's stick with making mammography a personalized decision. I think this is a great idea. If someone has a high risk background, they should start mammograms earlier. If they do not have one, they should decide with their doctor when they should start them. Insurance companies should cover them regardless. There doesn't have to be a national rule on when they should be started.

Now switching to being able to predict breast cancer. We can't really. The BRCA genes allow us to predict women who are high risk but that does not cover all women who will get breast cancer, really less than 10% I believe. There can be other risk factors, family history, genetic background, and more.

Since we can't really tell who will or will not get breast cancer and may never be able to, we do need to use whatever screening methods we have. Until we have something better than mammography, it is our tool to use as best we can. But it should be the patient's choice and not the insurance company's.

A Teen Idol

Here is my teen idol. His name is Jack. He is fifteen (15). And he invited a simple test that will detect pancreatic cancer early on. It may also be used to detect other cancers such as ovarian and lung cancers. All these cancers have one thing in common - they are hard to detect early enough to be treatable.

I first read about him on Opposing Views. I thought it was too good to be true but he is the lead story on Smithsonian.com. We need more Jacks. We need more blood tests to detect more ailments. Especially ones that are 90% accurate like his test is.

They did it again

Once again, they changed their mind. This is the proverbial 'them' who create these vast conspiracies to oust political candidates, were the ones who really broke the window, or the the ones who change medical standards. Yes, more medical standards are changed in a vast plot to confuse the patients. Now we do not need annual pap smears, one every three to five years, depending on age and who you listen to.

In the 1930's they started suggesting annual pap smears as cervical cancer was the number one killer of women, more than breast cancer and lung cancer. Now only 4,000 women are died of cervical cancer and most had never been screened for cervical cancer or it was more than ten years prior.

I am confused. If women who aren't screened are the ones who are dying of cervical cancer and the women who are screened are not dying of it, why don't we need to be screened. Doesn't this put us all in the category of being unscreened or potentially dying of cervical cancer?

The suggestion is that if a woman has normal pap smears for three years can go to once every three years as it is a slow growing cancer. I'm all for less testing but don't we all need some testing? I don't know, I am confused. I'll have to think about this one for a bit.

Mammogram controversy - more on the if we can't kill them, let's confuse them theory

So when should women start having mammograms. One theory is that annual mammograms lead to more false alarms and unnecessary biopsies. Then the opposing side says mammograms in younger women are essential as younger women are more likely to have their cancers found in early stage through mammograms than by self exam.

Hmmm.... so what is a smart woman to do? On one hand if you have mammograms you might have scares and unnecessary stress. On the other hand, your cancer is much more likely to be caught early thus allowing you to live a longer life. Me? I would opt for the longer life idea. I have had annual mammogram since I had a fibroidadenoma (fancy word for benign tumor) at the age of 23 and my breast cancer was found in a mammogram at 45. I think I also would have been having mammograms anyway because of that other cancer.

So if you are confused you are not alone. I think it is a giant conspiracy anyway. So if you have a nasty medical diagnosis, your doctors give all kinds of advice and expect you to make a rational decision while in the fog of 'OMG-I-have-cancer-and-gonna-die'. Confused patients are much more malleable and cooperative.... 'Um, I'm not sure. Doctor what should I do?" And then they make the decision for you.  

To screen or not to screen

Well they finally figured out that they can't detect ovarian cancer in regular screenings. In fact the women who were screened had false positives and surgical complications as well as more deaths than the women who weren't screened. Oops. So I'll scratch that one off my list.

An annual mammogram, I can do that. A colonoscopy every ten years, I can do that. My husband who had that bad colonoscopy followed by surgery says he would rather have an annual colonoscopy than surgery again. I think prostate cancer screenings are up for debate these days. Annual skin checks I can cope with as well.

After one cancer diagnosis, never mind more than that, you get privileged to get every regular cancer screening there is. Because 'with your medical history, they need to be sure'.

Granted once you get on the cancer roller coaster, its too easy to over react to 'with your medical history we need to be sure' and start saying 'well I had cancer before, I need to make sure I don't have it again'.

But when talking with your doctor about a potential health issue that 'with your medical history they need to be sure', its a balancing act. I mean if they don't test and you have something, what if they catch it too late? Or do you need that extra trip on the cancer roller coaster as well as expense to get a negative test result?

But the point is that you should talk with your doctor. I like the times when my doctors tell me the normal protocol is this and there is no reason for anything more. I dislike the 'but with your medical history, we need to be sure' so here go some more tests and medical adventures.

The media plays a big part in the emotional roller coaster. If you listen to what the media tells you, you will be running from doctor to doctor, and eating red meat this week but not next week and upping your vitamin intake last week but switching to new supplements. Never mind that it seems that the media either reports on medical breakthroughs that are in the mouse-test stage or ones that aren't news because they have been around for a while.

There has never been a medical breakthrough that I learned about in the media that applied to me and was appropriate. My thought is to ask my doctor and skip the news reports.