Is it Cancer?

Today I called someone who may have cancer.  This is always a tough call, since at this stage, there are no clear answers yet.  We often know more about what things are NOT before we know what they are.

  • "There is something on the ultrasound that looks suspicious"
    • "What is it?"
  • "I'm not sure"
    • "Could it be … ?"
  • "Cancer?   Yes .. it could .. but it's not likely to be …"
    • "What should we do?"
  • "We'll need to do some additional testing … such as .. "

This is usually how it goes.  I always say the "C word" early in the conversation.  This gives us both permission to say it .. since it's always lurking in the background if we don't bring it out in the open.   Next, I need to reassure the patient that the likelihood of cancer is small.  This is often calming, but of course the worry persists.  Why do I say that the likelihood of cancer is small?  Because it usually is.  Much more often, abnormal findings are just abnormal findings. 

Of course we need to do our very best to follow through carefully, do appropriate and thorough physical evaluations, etc … and not ignore abnormal findings.  Yet the fear of the "really bad" outcome can be enormous and unnecessary, since a great deal of the time, the final result is reassuring.

Pap Smears

Craig's notes:  Family docs, pap smears, and cervical cancer risk opens up a compelling thought along the lines of my discussion the other day of prostate cancer screening:

"..The vast majority of the post-hysterectomy patients in my practice who were also seeing gynecologists or had previously seen gynecologists were still under the impression that they needed regular Pap smears."

He's right.  Like the PSA talk — this one takes a long time, and inherently involves a discussion of risk.  Women who are post-hysterectomy are not without some risk …but … the real risk is quite low:

"The probability of an abnormal Papanicolaou smear in this group of women was 1.1 percent, and the positive predictive value of the Papanicolaou test for detecting vaginal cancer was 0 percent "

 yet … like the free prostate screenings so commonly advertised in the local paper … this may be better business than it is medicine.  ugh.