Category Archives: Lab Tests & Diagnostics

App lets you determine your neighborhood’s radon risk

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Screen Shot 2014-01-21 at 11.28.29From the Washington State Department of Health

Olympia, January 21, 2014 – Washington residents now have a new online map to check and see if their neighborhood has a geological risk for the cancer-causing gas, radon, using a new state app. The new app is offered by the state Department of Health’s Washington Tracking Network.

Some areas of the state, such as Spokane and Clark counties, are well-known for having higher levels of radon, but the new online map shows that there are some areas around the Puget Sound such as Pierce and King counties that might come as a surprise.  Continue reading

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Patients going for free preventive care surprised by charges

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Exclamation PointBy Michelle Andrews
KHN

The new health-care law encourages people to get the preventive services they need by requiring that most health plans cover cancer screenings, contraceptives and vaccines, among other things, without charging patients anything out of pocket.

Some patients, however, are running up against coverage exceptions and extra costs when they try to get those services.  Continue reading

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Check your blood pressure, give your contact info away

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By April Dembosky, KQED

Health insurance companies are on the prowl for more customers. There are still three months to go for people to enroll in health plans under the Affordable Care Act, but insurers don’t want to rely solely on state or federal websites to find them.

solohealthSome are finding a path to new customers by partnering with companies that operate health-screening kiosks –- those machines in supermarkets and drug stores where people check their blood pressure or weight.

One of these kiosks sits in aisle 10 of a Safeway grocery store in a city near San Francisco. Sitting down at the machine is like slipping into the cockpit of a 1980s arcade game. Continue reading

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Nipple aspirator

Nipple aspirate test is no substitute for mammogram – FDA

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Consumer Update from the US Food and Drug Administration

ucm378297Many women admit that getting a mammogram is no fun, and may wish there was an easier, more comfortable way to screen for breast cancer in its earliest and most treatable stages.

Some companies today are promoting a test in which a breast pump is used to collect fluid from a woman’s nipple to screen for abnormal and potentially cancerous cells. This test—called a nipple aspirate—is being marketed as the latest and greatest tool in early breast cancer screening, one that is easier, more comfortable and less painful than the mammogram.

However, there is no clinical evidence to support these claims, says David L. Lerner, M.D., a medical officer at the Food and Drug Administration (FDA) and a specialist in breast imaging.

“FDA’s concern is that the nipple aspirate test is being touted as a stand-alone tool to screen for and diagnose breast cancer as an alternative to mammography,” Lerner explains. “Our fear is that women will forgo a mammogram and have this test instead.” This could result in serious health consequences if breast cancer goes undetected, he notes.

FDA is unaware of any valid scientific data to show that nipple aspirate tests, when used on their own, are an effective screening tool for any medical condition, including the detection of breast cancer or other breast disease, Lerner says. Researchers are still studying whether these tests may one day be used, in conjunction with other medical devices, to screen for disease.

In February 2013 FDA issued a warning letter to Atossa Genetics, Inc. that, among other things, informed the company that their test was misbranded in that its labeling was false or misleading. The agency asked the firm to take prompt action to correct the violations addressed in the warning letter. In October 2013, Atossa initiated a voluntary recall to remove the ForeCYTE Breast Health Test from the market.

Unsubstantiated Claims

In addition to stating that the test can help women 18 years and older determine their risk level for breast cancer, Atossa claimed that its test was “literally a Pap smear for breast cancer.” According to FDA medical officer Michael Cummings, M.D., who reviews obstetrical and gynecological devices for the agency, this claim is unsubstantiated.

“The cervical Pap smear has a known clinical benefit supported by extensive clinical studies over many years,” Cummings says. “Its scientific ability to screen for cervical cancer is unquestioned.” The nipple aspiration test has no such evidence supporting it, he attests.

In addition, Lerner explains that if a Pap smear shows abnormal cells of the cervix, there are follow-up procedures that can be done to try to identify the location of those cells, after which a biopsy of the area is possible. With a breast nipple aspirate, if there are abnormal cells, the test does not target where those cells are coming from, so a biopsy may not be possible. Moreover, while the risk of abnormal cervical cells progressing to cancer is known, the risk of abnormal breast cells progressing to cancer is not.

Lerner says the test may produce results that are falsely positive or falsely negative. “False positives are possible because cells can be damaged in the aspiration process and look abnormal,” he notes. “We are even more concerned about false negatives,” he adds. Companies acknowledge that over 90% of their fluid samples may contain either very scant cells or no cells at all. Yet the companies call such results “diagnostically useful” and even conclude that a patient is healthy based on a cell-free sample, he says. “The test may be missing cancers and giving women dangerous false assurance,” Lerner says.

Mammography Still the Best

The mammogram can be uncomfortable for the woman being screened because it compresses the breast to flatten out the breast tissue and increase the clarity of the X-ray image. Still, FDA is not alone in believing that mammography is the most effective method for screening for breast cancer. Other organizations agree, including the American Cancer Society, the American College of Radiology (the professional society of physicians who specialize in medical imaging) and the National Cancer Institute, a division of the National Institutes of Health.

The National Cancer Institute states that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 70. The National Comprehensive Cancer Network (NCCN) 2013 guidelines state that the clinical utility of nipple aspiration is still being evaluated and that it should not be used as a breast cancer screening technique.

FDA recommends that women who have received a nipple aspirate test as a form of breast cancer screening should also have a mammogram according to screening guidelines or as recommended by their doctor, and should talk to their health care professional about whether additional tests are needed.

“The bottom line is that women should not rely solely on these nipple aspirate tests for the screening or diagnosis of breast cancer, “Lerner says. “Mammography is still the gold standard.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Dec. 12, 2013

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Insurers question value of some genetic tests

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3d Chromosome with DNA visible insideBy Michelle Andrews

The day when a simple blood test or saliva sample can identify your risk for medical conditions ranging from cancer to Alzheimer’s disease seems tantalizingly close.

But while advances in genetic testing increasingly give people critical information that may help prevent disease, genetics experts say sometimes the hype around these tests has outstripped the science.

Insurers, meanwhile, generally only cover tests if there’s strong scientific evidence that it can provide a health benefit to patients.

“The utility of some tests is not as clear as we’d like to think,” says Sharon Terry, president and CEO of the Genetic Alliance, an advocacy organization aimed at promoting health through genetics. “These technologies are advancing at a really rapid rate, and they’ll make a big impact on health. But the data gathering you need to do to determine clinical utility is difficult.” 

Insurers don’t cover a $99 genetic test sold directly to consumers by 23andMe that provides information about more than 240 genetic health conditions and traits that the company says can help people understand their health risks and carrier status for inherited disease, among other things.

In November, the Food and Drug Administration ordered the company to stop marketing the test because the agency concluded it was a medical device and subject to FDA review and approval, which it hadn’t received. In early December, the company announced it would stop selling its health-related genetic reports while it undergoes federal review.

Insurers commonly cover many diagnostic genetic tests that are ordered by doctors, for example, tests to look for rare diseases like cystic fibrosis in infants or children.

Insurers will typically also cover preventive genetic tests if the patient meets criteria based on family history or other risk factors, and if there’s an effective test with proven clinical benefit that’s recommended by a standard-setting organization like the U.S. Preventive Services Task Force.

In such cases, insurers also typically cover genetic counseling to first collect someone’s family and personal history to determine whether that patient is a candidate for a particular genetic test, and then help patients understand their results, says Rebecca Nagy, president of the National Society of Genetic Counselors.

Coverage is generally routine, but in recent years some health plans have begun paying a declining percentage of the cost of testing, says Nagy. “Companies that were covering a test at 90 percent are now covering it at 80 percent,” she says. Testing can be pricey. A genetic test for the BRCA mutations, for example, may cost $3,000 or more.

Under the Affordable Care Act, most health plans must make genetic counseling and testing available without any out-of-pocket cost to women whose family history indicates they have a higher than average risk of having mutations in the BRCA1 or BRCA2 genes that predispose women to breast and ovarian cancers. The ACA prevention coverage requirements are based on recommendations by the U.S. Preventive Services Task Force, which doesn’t recommend other preventive genetic tests.

Women frequently request genetic testing for breast cancer mutations because they believe their risk is higher than it is, say experts.

This is particularly true since the actress Angelina Jolie disclosed that she had a double prophylactic mastectomy to guard against breast cancer after learning she has a mutation in the BRCA1 gene.

But if a woman’s only family history of the illness is one relative who developed breast cancer at age 65, for example, that, by itself, doesn’t mean she’s at higher risk, says Nagy. With counseling, “many times we can give them reassuring numbers.”

In September, health insurer Cigna began requiring genetic counseling for members who were interested in three “commonly ordered and commonly misunderstood” genetic tests, says David Finley, the company’s national medical officer.

The tests covered by the new requirement are those for the BRCA mutations for breast and ovarian cancers, colorectal cancer and Long QT syndrome, an inherited heart condition that can cause sudden, potentially fatal heart arrhythmias.

Doctors who order these tests don’t necessarily suggest patients receive genetic counseling, even though national organizations recommend it, says Finley.

“From our perspective, the only way to make sure that patients are getting the information and taking the time that they need about these tests is to require that they see a genetic counselor,” he says.

Like other insurers, Cigna typically doesn’t cover genetic tests that don’t provide clinical benefit to the patient. “You don’t test for testing’s sake,” says Susan Pisano, a spokesperson for America’s Health Insurance Plans, a trade group.

One of the tests insurers generally don’t cover identifies which of three versions of the APOE gene someone carries. The APOE gene is associated with late-onset Alzheimer’s disease, and someone with two so-called “e4” versions of the gene is at higher risk of developing the disease.

“[The APOE test] is ordered fairly frequently, but we don’t pay for it,” says Cigna’s Finley. “It’s not enough for a test to be accurate and scientifically reliable, it has to benefit the patient. And with the APOE test I don’t think they’ve met those standards.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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one in three

“Far too few” Americans being screened for colon cancer, CDC

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CRC screeningWhen the cancer is caught early, 90 percent of people with colorectal cancer will be alive five years later, but only 12 percent will survive 5 years if the cancer is already advanced when it’s found.

Yet, one in three Americans who should be screened for colorectal cancer have never been screened, according to a new report from the US Centers for Disease Control.

Here’s the report:

(For a PDF of the report click here.)

Vital Signs – CDC

Colorectal cancer (CRC) is the second leading cancer killer of men and women in the US, following lung cancer.

The US Preventive Services Task Force (USPSTF) recommends three CRC screening tests that are effective at saving lives: colonoscopy, stool tests (guaiac fecal occult blood test-FOBT or fecal immunochemical test-FIT), and sigmoidoscopy (now seldom done).

Testing saves lives, but only if people get tested. Studies show that people who are able to pick the test they prefer are more likely to actually get the test done. Increasing the use of all recommended colorectal cancer tests can save more lives and is cost-effective.

To increase testing, doctors, nurses, and health systems can:

  • Offer all recommended test options with advice about each.
  • Match patients with the test they are most likely to complete.
  • Work with public health professionals to:
    • Get more adults tested by hiring and training “patient navigators,” who are staff that help people learn about, get scheduled for, and get procedures done like colonoscopy.
    • Create ways to make it easier for people to get FOBT/FIT kits in places other than a doctor’s office, like giving them out at flu shot clinics or mailing them to people’s homes.

Problem

Not enough people are getting tested as needed.

About 23 million adults have never been tested.

  • The people less likely to get tested are Hispanics, those aged 50-64, men, American Indian or Alaska natives, those who don’t live in a city, and people with lower education and income.
  • People with lower education and income are less likely to get tested.
  • About 2 of every 3 adults who have never been tested for CRC actually have a regular doctor and health insurance that could pay for the test. Providers and patients do not always know about or consider all of the available tests.
  • The three main tests–colonoscopy, FOBT/FIT, and flexible sigmoidoscopy are all effective at finding cancer early.
  • Doctors often recommend colonoscopy more than other tests. Scientific studies have shown that many people would prefer FOBT/FIT if their health care provider gave them that option.

Currently, most health care providers and systems are not set up to help more people get tested.

  • Many people do not know they need to be tested and are not notified when it is time for them to be tested.
  • Most health care systems rely on doctors to remember to offer CRC tests to their patients. Nurses and other office staff should also talk with patients about getting tested and doctors can be reminded to offer CRC testing whenever patients are due, whether they come in for a routine check-up or when they are sick.
  • Health systems can make testing easier by:
    • Mailing out FOBT/FIT kits that can be completed by the person at home and mailed back, then making sure everyone with a test that is not normal promptly gets a colonoscopy.
    • Mailing out FOBT/FIT kits that can be completed by the person at home and mailed back, then making sure everyone with a test that is not normal promptly gets a colonoscopy.
    • Using a patient navigator to explain how to prepare for the test, how the test is done and to make sure people get to their appointments.

     

    CRC CDC colorectal screening

    Click on image for a larger version.

    SOURCE: Behavioral Risk Factor Surveillance System, 2012

    Choosing the right test

    Click on image for a larger version.

    SOURCE: Vital Signs 2013 and USPSTF

    What can be done:

    Federal government is:

    • Expanding insurance coverage of USPSTF recommended CRC tests at no cost to the patient through the Affordable Care Act.
    • Supporting the use of patient navigators who work directly with people to help them get the preventive tests they need.
    • Helping the Veterans Administration system’s doctors and nurses increase and track CRC testing of its patients in its hospitals and clinics.
    • Improving the delivery of preventive services by measuring CRC testing rates in health centers funded by the Health Resources and Services Administration (HRSA).
    • Using existing CDC screening programs to improve cancer screening rates for everyone, whether insured or not.
    • Identifying CRC screening as a Healthy People 2020 leading health indicator for clinical preventive services.

    State and local public health can:

    • Work with those doctors, health systems and public health professionals who have already greatly increased CRC testing rates.
    • Develop record systems to keep track of and notify those who need to be tested.
    • Promote recommended testing options with the public.
    • Use public health workers and patient navigators to increase testing rates in communities with low testing rates.
    • Work with state Medicaid programs, primary care associations, and Medicare quality improvement organizations to help people get tested and make sure they get additional tests or treatment if needed.

    Doctors, nurses, and health systems can:

    • Offer recommended test options, with advice about each.
    • Match patients with the test they are most likely to complete.
    • Use patient reminder systems to notify patients when it’s time to get a screening test done.
    • Make sure patients get their results quickly. If the test is not normal make sure they get the follow–up care they need.
    • Use patient navigators to help patients get checked.

    Everyone can:

    • Learn about testing options and get the test that is right for them.
    • Know their own family history and any personal risks they may have for CRC.
    • Encourage friends and family members to be tested for CRC.
    • Contact their local health department to learn how they can get tested for CRC.

Science Behind this Issue

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For-profit health screenings: Doing more harm than good?

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Life Line Screening medical assistant Kennea Blake prepares Stacy Riggs for an atrial fibrillation screening at Messiah United Methodist Church in Springfield, Va. (Photo by Jenny Gold)

By Jenny Gold
KHN Staff Writer

This KHN story was produced in collaboration with NPR

Messiah United Methodist Church in Springfield, Va., is unusually busy for a Thursday morning.

It’s not a typical time for worship, but parishioner Stacy Riggs and her husband have come for something a little different: a medical screening.

“I’m getting ready to turn 50 sooner than I’d like to say, and just thought it was a good time to get an overall screening,” said Riggs, of Fairfax, Va.

She doesn’t have any symptoms, but she stopped by the church, which is offering a day of testing by the company Life Line Screening as a service to parishioners.

For less than $200, Riggs is getting six different screenings for stroke, heart disease and osteoporosis.

Life Line says they’ve checked 8 million Americans this way at churches and community centers, and up to 10 percent of them are found to have some sort of abnormality.

But several of the tests performed by Life Line are on a list of procedures for healthy people to avoid.

The tests can potentially do more harm than good, according to the U.S. Preventive Services Task Force, an independent panel that recommends evidence-based treatments. Even though the screening tests may be noninvasive, follow-up exams and procedures often are not, and can increase a person’s odds of being injured or over treated.

One of those tests is the carotid artery screening, which screens for plaque buildup in a neck artery than can cause a stroke. The test is on the American Academy of Family Physicians’ list of procedures to avoid.

“What we’re talking about with the carotid artery screening is that the patient is more likely actually to have a stroke because of the screening and subsequent testing and possible surgery, then if they’d never been screened at all,” says Dr. Glen Stream, who chairs the academy’s board.

The problem, he says, is that many of the findings are false positives, or are better left alone. But once you find something, he says, it’s hard not to aggressively treat it, even when that’s not the right approach.

“There’s sort of a compelling momentum for patient and doctor both to say, well now that we know there’s a problem we need to investigate and understand it, and then there’s the dilemma about do we treat it,” Stream explains. “So many times watchful waiting is the right treatment option, but it just doesn’t always sit well.”

But Dr. Andy Manganaro, medical director of Life Line Screenings, says the company’s tests save many lives. Manganaro, who has been a vascular surgeon for 30 years, says he was often called to see a patient in the emergency room who had an already-ruptured abdominal aortic aneurism, for example, that could have been discovered earlier with one of Life Line Screening’s tests.

“Had they known they had the aneurism a week before, we could have fixed it with very little risk to them, and they would have been going home instead of to the morgue,” he says.

And while most of the research and advisory panels are nearly unanimous that several of the tests offered by Life Line and other companies like it are more likely to cause harm than good for people without symptoms, Manganaro counters that the research is out of date.

Even people who aren’t at major risk benefit, he says, because the tests push them to change their lifestyles before more damage is done.

“Yes, you can tell people in general, lose weight, stop smoking, exercise, lead a healthy lifestyle. But most often it goes in one ear and out the other,” Manganero says. “On the other hand though, if you show someone a picture of their carotid artery filled with plaque as compared to a normal carotid artery, they’re much more likely to throw out their Lucky Strikes on the way out the door.”

But it’s not just about quitting smoking or taking other steps to improve your health. It’s also about money.

Life Line Screening is a for-profit company, and it often partners with local hospitals and surgical centers, which help advertise the event. And if Life Line finds a problem, the patients can be referred to the hospital for follow-up care, meaning new business for the hospital. Cardiac care can be especially lucrative for hospitals.

Dr. John Santa, medical director at Consumer Reports Health, says the fact that for-profit companies are pushing these tests should raise consumer suspicions.

“When information comes in the form of an advertisement or promotion, regardless of the source, be skeptical. Realize that from a health point of view, if this was a really good and important thing to do you probably wouldn’t need to be advertising and promoting it,” Santa says.

And most importantly, he adds, talk to your family doctor before doing any kind of screening to make sure you’re getting the tests that are right for you.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Snohomish to offer free HIV tests for eligible gay & bisexual men, Oct. 1

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aids-ribbonIn support of National Gay Men’s HIV Awareness Day, the Snohomish Health District will host a free evening of information and testing from 4-7 p.m., Tuesday, Oct. 1 in Suite 108 at the Rucker Building, 3020 Rucker Ave., Everett, Wash.

The event is directed to gay and bisexual men who are at risk for HIV infection and other sexually transmitted diseases. No appointment needed. The event includes door prizes and light refreshments, and every man screened will receive a financial incentive.

Snohomish County currently ranks third in the state for new HIV cases, following King and Pierce counties. Recent data show that 58 percent of all new HIV cases in Washington State are among men who have sex with other men (MSM). Gay and bisexual men make up less than 10 percent of the population, but account for almost 60 percent of the burden of HIV disease.

The Health District also will offer free testing to qualified men for Hepatitis C and syphilis, and vaccine for Hepatitis A and B. Both the Hepatitis C and HIV tests are “rapid” antibody tests, requiring only a drop of blood pricked from a finger.

Test results will be available within 30 minutes. The tests are anonymous and confidential.

New prevention tool: Pre-exposure prophylaxis –PrEP

Information about a new HIV prevention tool will be shared by Michael Louella, outreach coordinator for the AIDS Clinical Trial Unit in Seattle.

Pre-exposure prophylaxis, or PrEP, is when HIV-negative individuals take a pill to prevent HIV infection.

The medicine currently is used to treat HIV, and has now been approved for this treatment by the Centers for Disease Control and Prevention, and the Food and Drug Administration.

Research studies show that PrEP can lower the risk of HIV transmission when used with other prevention measures, such as condoms.

For more information about HIV testing and risk, please call David Bayless, 425.339.5238.

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The $13 Test That Saved My Baby’s Life. Why Isn’t it Required For Every Newborn?

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by Michael Grabell
ProPublica

On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room.

We would not be going home, she told us. Our son had a narrowing of the aorta and would have to be transferred to the neonatal intensive care unit at NewYork-Presbyterian Hospital at Columbia, where he would need heart surgery.

It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects.

It was just by chance that we were in Connecticut to begin with. We live in New York, where such tests will not be required until next year. But our doctors were affiliated with a hospital just over the border, where the law took effect Jan. 1.

As we later learned, congenital heart problems are the most common type of birth defect in the United States. The Centers for Disease Control and Prevention estimate that about one in 555 newborns have a critical congenital heart defect that usually requires surgery in the first year of life.

Many cases are caught in prenatal ultrasounds or routine newborn exams. But as many as 1,500 babies leave American hospitals each year with undetected critical congenital heart defects, the C.D.C. has estimated.

Typically, these babies turn blue and struggle to breathe within the first few weeks of life. They are taken to hospitals, often in poor condition, making it harder to operate on them.

By then, they may have suffered significant damage to the heart or brain. Researchers estimate that dozens of babies die each year because of undiagnosed heart problems.

The new screening is recommended by the United States Department of Health and Human Services, the American Heart Association and the American Academy of Pediatrics. Yet more than a dozen states — including populous ones like Massachusetts, Pennsylvania, Florida, Georgia, Wisconsin and Washington — do not yet require it.

The patchy adoption of the heart screening, known as the pulse oximetry test, highlights larger questions about public health and why good ideas in medicine take so long to spread and when we should legislate clinical practice.

Newborns are already screened for hearing loss and dozens of disorders using blood drawn from the heel. The heart test is even less invasive: light sensors attached to the hand and foot measure oxygen levels in the baby’s blood. This can cost as little as 52 cents per child.

Our son’s heart defect was a coarctation of the aorta, a narrowing of the body’s largest artery. This made it difficult for blood to reach the lower part of his body, which meant that the left side of his heart had to pump harder.

A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:main pulmonary artery, 10:Aorta.

A: Coarctation (narrowing) of the aorta. 1: inferior caval vein, 2: right pulmonary veins, 3: right pulmonary artery, 4: superior caval vein, 5: left pulmonary artery, 6:left pulmonary veins, 7: right ventricle, 8: left ventricle, 9: main pulmonary artery, 10: aorta. – Source: Wikipedia

In the hospital, though, he appeared completely healthy and normal because of an extra vessel that newborns have to help blood flow in utero. But that vessel closes shortly after birth, sometimes revealing hidden heart problems only after parents bring their babies home.

Depending on the heart defect, the onset of symptoms can be sudden.

This is what happened to Samantha Lyn Stone, who was born in Suffern, N.Y., in 2002. A photograph taken the day before she died shows a wide-eyed baby girl lying next to a stuffed giraffe. The next morning, her mother, Patti, told me, she was wiping Samantha’s face when she heard a gurgle from the baby’s chest.

Before her eyes, Samantha was turning blue. Blood began to spill from her mouth. Ms. Stone dialed 911, and minutes later, a doctor who heard the call over a radio was there performing CPR. Samantha went to one hospital and was flown to another.

But the damage was irreparable. Samantha had gone 45 minutes without oxygen: She lapsed into a coma and died six days later.

It wasn’t until several years later that Ms. Stone learned about the pulse oximetry test. “This could have saved my daughter,” she told me. “There is no parent that should ever have to go through what I went through.”

Pulse oximetry is not a costly, exotic procedure. Most hospitals already have oximeters and use them to monitor infants who suffer complications. You can buy one at Walmart for $29.88.

A recent study in New Jersey, the first state to implement the screening, estimated that the test cost $13.50 in equipment costs and nursing time. If hospitals use reusable sensors similar to those found on blood-pressure cuffs, the test could cost roughly fifty cents.

As medical technology advances, few screenings will be so cheap or simple. Recent years have seen controversy over prostate cancer and mammography screenings. Medical ethicists have to weigh the costs of each program and the agony caused by a false positive against the lives saved.

But with pulse oximetry, the false positive rate is less than 0.2 percent — lower than is seen for screenings newborns already get. The follow-up test is usually a noninvasive echocardiogram, or an ultrasound of the heart. A federal advisory committee came down in favor — three years ago.

“There’s really no question, scientifically, this is a good idea,” said Darshak Sanghavi, a pediatric cardiologist and a fellow at the Brookings Institution. “The issue is, how do we change culture?”

Opposition has taken two forms. One is from doctors who believe policy makers shouldn’t interfere with how medical professionals do their jobs. The other is from smaller hospitals, which worry about access to echocardiograms and the costs of unnecessary transfers.

These concerns can be addressed fairly easily. Nurses in New Jersey and elsewhere have been able to work the test into their normal routines. A rural hospital should already have a protocol to transfer a newborn in serious condition. If Alaska can do it, less remote states can, too.

But this is not simply a rural health care problem. Cardiologists and neonatologists I’ve spoken with said they knew of hospitals in New York City, Boston and metropolitan Atlanta that weren’t screening newborns for heart defects.

“It’s completely the luck of the draw of where you deliver,” said Annamarie Saarinen, who has pushed for the screening since her daughter narrowly avoided leaving the hospital with an undetected heart defect.

Fortunately, our son’s condition was also caught and corrected. The only lasting effects are a three-inch scar on his side and checkups with a cardiologist. He will live a normal life. He will be able to play sports and climb things he’s not supposed to.

Shouldn’t every baby have that chance?

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Mosquitoes carrying West Nile virus found in five Washington counties

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Culex tarsalis mosquito about to begin feeding.

Photo: James Gathany/CDC

As people head outside to enjoy Labor Day Weekend, the Department of Health urges everyone to avoid West Nile virus by protecting themselves from mosquito bites.

Mosquitoes carrying West Nile virus have been found in Yakima, Spokane, Grant, Franklin, and Benton counties this year.

Although there have been no reports of human cases acquired in our state this year, it’s important to be aware that the virus is here and can cause very serious illnesses.

Most people bitten by a mosquito carrying the virus won’t get sick. Some people will develop mild symptoms including headache and fever that go away without treatment.

However, West Nile virus infection can be very serious and even fatal. Severe disease can include meningitis or encephalitis, and some neurological effects of the disease may be permanent. People over 50 and those with weak immune systems are at higher risk for serious illness.

It’s important to avoid mosquito bites to prevent infection. The best strategy is to wear pants and long sleeve shirts and use bug repellant when outdoors during times when mosquitoes are active.

It’s important to carefully follow the instructions on the repellent label — especially when using repellent on children. The strength of the repellant and the application method may be different.

Tracking and monitoring shows that most West Nile virus is found in south Central Washington. Liz Dykstra, public health entomologist for the Department of Health, says the combination of warm weather and standing water created by irrigation, along with trees and other vegetation, provides ideal habitat for mosquitoes and birds that carry the virus.

To learn more:

Updated West Nile virus information, prevention tips, and testing information are available online.

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Microscopic view of prostate cancer

New PSA screening guidelines urge weighing harms, benefits

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By Rita Rubin

This KHN story was produced in collaboration with 

Microscopic view of prostate cancer

Prostate Cancer

For nearly a quarter century, doctors have ordered annual PSA tests for men of a certain age to screen for prostate cancer, despite a lack of evidence that the benefits outweighed the risks — especially when tiny, slow-growing tumors were detected.

But the landscape appears to be changing. While questions about PSA screening remain, physicians increasingly recognize the need to discuss both the harms and benefits with patients.

The U.S. Preventive Services Task Force shook up the status quo last July when it advised against using the simple blood test, which measures levels of a protein called prostate specific antigen, with average-risk men of any age who had no prostate cancer symptoms.

That recommendation prompted a backlash from urologists, who argued that screening saves lives, but gave pause to primary care doctors.

In recent weeks, though, urology and internal medicine groups have published surprisingly similar directives.

“I would say it’s a shift toward a more targeted screening approach rather than a one-size-fits-all screening approach,” said Dr. H. Ballentine Carter, a Johns Hopkins urologist, of the American Urological Association guidelines released May 3 and developed by a committee he chaired. The international association has more than 19,000 members worldwide.

Carter’s committee noted that the greatest benefit appears to be for those 55 to 69 but urged that men in that age group discuss the pros and cons with their doctor before deciding whether to proceed.

For those who opt for screening, waiting at least two years between tests could minimize potential harms — namely false-positives and the detection of slow-growing tumors that wouldn’t have caused any symptoms — while preserving most benefits.

Similarly, the American College of Physicians, representing internists, released guidelines April 9 advising members to discuss the test’s “limited benefits and substantial harms” with patients 50 to 69 years old and let them decide.

Both groups agreed that doctors should not screen men younger or older than their guidelines’ age ranges or those expected to live less than 10 to 15 years because of other health conditions.

An elevated PSA level doesn’t necessarily signify prostate cancer, but it can trigger a cascade of tests and treatments that could be riskier than the disease itself, potentially causing impotence, incontinence or even death from prostate cancer surgery.

Even before the latest sets of guidelines were released, Dr. Michael Albert, a Hopkins internist, said he began to change his approach, spurred by the Preventive Services Task Force recommendations and a 2009 U.S. study that concluded PSA screening didn’t save lives.

“It used to be much easier for me to click on the PSA button and order it,” said Albert, medical director of the East Baltimore Medical Center, part of Johns Hopkins Community Physicians.

Dr. Gene Green, a board-certified family practice doctor and internist who is president of the Hopkins-affiliated Suburban Hospital in Bethesda, said he’s been screening a smaller percentage of patients and referring fewer of them with a PSA level of 4 — traditionally the point at which prostate cancer concerns are raised in older men — to urologists.

Carter, head of adult urology at Hopkins, said the AUA guidelines “had absolutely nothing to do with the task force,” and though the two groups’ guidelines were based on similar scientific evidence, they viewed the evidence differently.

“We interpreted the evidence from an individual’s perspective vs. a public health perspective,” he said. Prostate cancer might not represent a threat to the public health the way diabetes or heart disease does, but it’s a “major risk to an individual who’s in your office and who may be very concerned about the possibility,” Carter said.

Dr. Kenny Lin, a family physician, called the informed-consent approach a “cop-out.” Simply by raising the subject of screening, doctors push patients toward it, said Lin, who as a medical officer at the Agency for Healthcare Research and Quality wrote the evidence review on which the Preventive Services Task Force based its recommendation. So, said Lin, now on the faculty at the Georgetown University School of Medicine, “I don’t bring it up necessarily.”

Meanwhile, the American Association of Clinical Urologists, whose website said its membership includes 45 percent of U.S. urologists, warns in a statement that these recent sets of guidelines could leave the impression that early detection of prostate cancer is no longer needed.

The Preventive Services Task Force and the AUA committee agree that one life is saved for every 1,000 men screened.

“There’s really no doubt [it] saves lives,” said Dr. William Nelson, a medical oncologist and urologist who directs Hopkins’ Sidney Kimmel Comprehensive Cancer Center.

The death rate from the disease has been declining since it peaked 20 years ago, although it isn’t clear how much is due to PSA screening and how much to improved treatment.

Still, Nelson acknowledged, “a lot more men die with prostate cancer than will ever die of it. The greatest threat to their health and happiness is attempts to treat them.”

ProstateSince the 1990s, screening has led to a diagnosis of early-stage prostate cancer in more than a million U.S. men who probably never would have developed symptoms. More than nine out of 10 of them chose aggressive treatment.

Mark Humphrey, now 71, a retired General Electric executive, lived in western Massachusetts when a 2006 test showed his PSA had nearly doubled to 3.5. Although still in the normal range below 4, the rapid increase spurred his doctor to refer him to a urologist for a biopsy, which revealed abnormal cells.

But his cancer appeared unlikely to be aggressive. That information, coupled with memories of his late brother-in-law’s experience with incontinence and impotence after surgery, led Humphrey to take a pass on the aggressive approach.

So Humphrey, who now lives in Baltimore, enrolled in the world’s first prostate cancer “active surveillance program,” which Carter directs at Hopkins. Instead of treating Humphrey’s disease, Carter is keeping an eye on it, with PSA testing and a rectal exam every six months.

Approximately 1,000 men have opted for active surveillance since the program launched more than 16 years ago. By following the participants, Carter said, he and his colleagues hope to learn more about what distinguishes slow-growing from aggressive cancers. Their goal: to build a better screening test.

“And then we want to learn more about the personal preferences of patients,” Carter said. For example, are they comfortable living with cancer?

Albert remembers seeing one patient, an otherwise healthy man in his early 60s with a PSA-detected tumor. After six months in the program, the man chose surgery. “He couldn’t fathom the idea that you’d sit on a cancer that could metastasize.”

Carter, Nelson and Green are among a group of Hopkins urologists and primary care doctors working on an app to help doctors discuss the risks and benefits of PSA screening with patients.

The app, to be tested later this year, takes into account such factors as life expectancy and prior PSA levels. It will be integrated into patients’ electronic medical records.

Notes Green: “Very few times in our lives can we say ‘always’ or ‘never.’”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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