Routine use of CT to screen for lung cancer risky
Routine use of this unique tool on symptomless individuals is
potentially hazardous. Need for caution: Population based screening for
lung cancer is not recommended and may, ultimately put the patient at
risk for further complications.
 The American College of Chest Physicians (ACCP) oppose the use of low
dose computed tomography (CT) for general screening of lung cancer (EurekAlert,
September 10). One hundred multi-disciplinary panel members developed
and published the new evidence-based guidelines in a supplement to the
September issue of CHEST, ACCP's peer reviewed journal.
Mortality unaffected
Dr. W. Michael Alberts, Chief Medical Officer, H. Lee Moffitt Cancer
Center and Research Institute, Tampa, Florida, cautioned that even in
high risk populations, currently available research data do not show
that lung cancer screening alters mortality outcomes.
"Population [based] screening for lung cancer is not recommended and
may, ultimately, put the patient at risk for further complications,"
said Dr. Gene L. Colice, Director, Pulmonary, Critical Care and
Respiratory Services, Washington Hospital Center, Washington DC and vice
chairman of the ACCP lung cancer guidelines.
He clarified that during screening, physicians may commonly find
nodules; however, to determine whether they are cancerous or not
requires fairly invasive and extensive additional testing.
The patient may have to face needless risk, both physically and
psychologically. "Diagnosis and Management of Lung Cancer: ACCP
Evidence-Based Clinical Practice Guidelines (2nd Edition)" contains 260
of the most comprehensive recommendations related to lung cancer
prevention, screening, diagnosis, staging, and medical and surgical
treatments. Some of these apply to computed tomography screening.
"There is little evidence to show that lung cancer screening impacts
mortality in patients, including those who are considered at high risk
for the disease" an ACCP press release asserted.
CT screening of symptom-free individuals is controversial. Peter B.
Bach and his co-workers analysed lung cancers in 3,246 asymptomatic
current or former smokers screened for lung cancer from two academic
centres in the U.S. and one in Italy and found that screening for lung
cancer with low dose CT may increase the rate of lung cancer diagnosis
and treatment, but may not meaningfully reduce the risk of advanced lung
cancer or deaths from lung cancer (JAMA, March, 7).
They argued that until more conclusive data are available,
asymptomatic individuals should not be screened outside clinical
research studies that have a reasonable likelihood of further clarifying
the potential benefits and risks.
Conclusions opposed
These results contradict the conclusions of the International Early
Action Lung Cancer Programme, which claimed that CT screening of high
risk individuals could prevent 80 per cent of lung cancer deaths (New
England Journal of Medicine, 2006).
After reviewing these two papers, Drs William C. Black and John A.
Baron concluded thus: "Although expensive and time consuming, rigorous
trials for cancer screening are far more cost-effective than what might
be the alternative" widespread adoption of costly screening
interventions that cause more harm than good (JAMA, March, 7, 2007).
The unambiguous ACCP guidelines must settle the issue. The ACCP
Thoracic Oncology NetWork, the Health and Science Policy Committee, the
Board of Regents, and external reviewers from the journal CHEST reviewed
and approved these guidelines.
The American Association for Bronchology, American Association for
Thoracic Surgery, American College of Surgeons Oncology Group, American
Society for Therapeutic Radiology and Oncology, Asian Pacific Society of
Respirology, Oncology Nurses Society, Society of Thoracic Surgeons, and
the World Association of Bronchology also endorsed them.
Over 2,200 CT scan units are used in India. These are beneficial
tools only in clinically indicated diagnostic tests.
Each CT scan exposes patients to radiation doses equal to a few
hundreds of chest x-ray examinations. Routine use of this unique tool on
symptomless individuals is potentially hazardous.
Panel of specialists
Professional associations in India must develop robust guidelines. In
the absence of such efforts, the Health Ministry must urgently set up a
panel of specialists with representatives from Indian Council of Medical
Research, the Atomic Energy Regulatory Board and professional
associations to review the ACCP recommendations and other similar
guidelines.
The panel may be asked to examine the applicability of these
guidelines in the Indian context and make appropriate recommendations.
K.S. Parthasarathy, Former Secretary, AERB, -
The Hindu.
Keep On Smilin'
How to keep your teeth picture-perfect:
Now, thanks to the many alternatives of cosmetic dentistry-from
whitening to braces-we can all have something to smile about
 Imagine never smiling. Or talking with your hand over your mouth.
Many people don't know what it's like to grin from ear to ear-all
because they are ashamed of their teeth. Now, thanks to the many
alternatives of cosmetic dentistry-from whitening to braces-we can all
have something to smile about.
Tooth whitening
Anyone can buy over-the-counter whitening products that improve the
flat surface of the tooth, but for more thorough results there are home
whitening kits and laser bleaching.
With whitening kits, patients wear custom-made trays filled with a
carbamide peroxide gel every night for 10 to 14 days. Dentists handle
tooth sensitivity by adjusting the concentration of the gel solution.
Results can be touched up when needed, usually every six to eight
months, or before special events.
"When you bleach teeth, old dental work may look dark," says Dr.
James McKenzie of the Whistler Dental Office, B.C. Bleaching won't harm
veneers or crowns but it won't bleach bonding either. When scheduling
cosmetic dentistry work, bleach first so you can match the work to the
new colour.
Laser bleaching is an in-office procedure where different
concentration of laser light helps activate the brushed-on bleaching
solution. The light is applied in a cycle lasting from one to two hours,
and "teeth can lighten up to ten shades," says McKenzie. Touch-ups are
done with your own custom at-home bleaching trays. This instant result
costs about three times as much as gel bleaching.
Tooth and gum contouring
"I had a patient who always thought she had short, stubby teeth,"
says McKenzie. "In reality, her gums had overgrown." Gum contouring
revealed long, beautiful teeth.
Although tooth contouring is used to file minor chips and to shape,
most contouring takes place with the soft tissues, says McKenzie. Done
under local anaesthetic, gum contouring may be performed with
electrosurgery, blades or soft-tissue laser.
Prior to putting on veneers or crowns, some dentists prefer to
balance the symmetry of the mouth or solve a "gummy smile" through gum
contouring. Done in-office under local anaesthetic, healing takes about
two to four weeks. More extensive cases may be referred to a
periodontist (gum specialist).
Bonding and White Fillings
Bonding is the term for applying a soft composite material directly
to your teeth and hardening it with light.
This can be used for white fillings or on front teeth, where dentists
usually use a combination of colours to achieve the natural creamy
colour along the gum line, lighter colour mid-tooth and translucence on
the edge. "It's great for small chips and gaps," says Dr. Deborah
Cooper-Lall, clinical director of Dental One in Calgary.
"It's also an opportunity to not invest a lot and still have a nice
smile." Bonding is best for children or teens, emergency applications,
or someone with gum disease who can't invest long-term in the mouth.
It costs less than veneers and crowns but it also doesn't last as
long (five to ten years) and will stain. "A lot depends on the personal
hygiene and habits of the patient," says Cooper-Lall. Smokers, coffee
and tea drinkers may want to cut down.
Usually performed under local anaesthetic, the procedure can take
anywhere from an hour for a chipped tooth to fours hours for more teeth.
Crowns and Veneers Unlike bonding, porcelain veneers and crowns are
created in a lab from moulds of your teeth.
They won't stain, and last 10 to 15 years. Patients should be adults
in good health and free from gum disease. These procedures works best
for gaps, mildly crooked teeth and replacing old dentistry (discolouration,
bonding, worn crowns and veneers).
Crowns cover the entire tooth while veneers cover the front only.
Keep in mind old crowns can only be replaced by new crowns.
Porcelain-only crowns are revolutionizing dentistry, says Cooper-Lall,
replacing the popular porcelain-fused-to-metal crowns that may leave a
dark line, which becomes visible as gums recede. As well, your
practitioner may opt for a crown instead of a veneer to stabilize the
bite.
Overall, the procedure consists of a series of steps, starting with
an initial consultation to analyze the smile and determine treatment.
Too often the practitioner treats too few teeth "because we only see the
front when we smile," says Cooper-Lall. "But when you talk, you can see
where the good dentistry stops and the bad begins."
Once the overall plan is established you'll need local anaesthetic
while the teeth are reshaped, impressions taken and you are fitted with
temporaries. At the next appointment, also under anaesthetic, you'll try
on the teeth and critique the shape and colour. Finally, a couple days
later you are fitted with your polished veneers. Altogether, the
treatment can be 10 to 15 hours and is spread over several weeks.
Implants
In the past it was necessary to cut down the teeth adjacent to a
missing tooth to use them as handles for a bridge that replaced the
missing tooth. With implants, the adjacent teeth are not altered.
In the first of a two-step process, a titanium rod replaces the root
of the tooth. It's as invasive as a tooth extraction, says McKenzie, and
is done under a local anaesthetic, taking about one hour per tooth.
After the implant is placed, the gum is stitched over it and left for
three to six months as the titanium integrates with the bone. At that
point, the gum is lifted and the implant is topped with a crown.
Orthodontics
"There are two different types of orthodontics," says Dr. Kevin Davis
of Davis Orthodontics in Richmond Hill, Ont. "Comprehensive orthodontics
straightens all the teeth and corrects the bite whereas limited
orthodontics 'sets the table' so the cosmetic dentist can finish the
job."
If the shape and size of your natural teeth is satisfactory and you
want to avoid any artificial materials in your mouth, then comprehensive
orthodontics is the answer. It might involve clear braces or removable
invisible trays, and take anywhere from six to 24 months.
Pre-cosmetic orthodontics is necessary if the general dentist cannot
do his/her job because of the current position of the teeth. Examples
include a very large space between the front teeth that would look
unsightly if corrected with oversized veneers, or a bite problem that
would break your new veneers if the orthodontics were not completed
first.
Limited orthodontics usually requires less time than comprehensive
orthodontics. Teeth never lose their ability to be moved, so adults are
excellent candidates for orthodontics.
"Unlike days gone by, one-third of my orthodontic patients are
adults," notes Davis, "because today's tooth-moving tools are much more
invisible than the metal braces of the past."
- locateadoc.com
|
