Linda with one of her more spectacular quilts
Probably 2010
Dear Lord above, is there no limit to the caution –
pathological timidity might be a better term – of the medical profession? For centuries medical practioners have been obedient
to the stricture: First, do no harm. Now
they seem to worry almost as much about another: Whatever you do, don’t run up
the cost of medical care.
Dick Ingwall has
alerted me to a nice article in the NY Times on use of the ROCA method for
screening for ovarian cancer. To read the
article, click on http://www.nytimes.com/2015/12/18/health/early-detection-of-ovarian-cancer-may-become-possible.html?smprod=nytcore-ipad&smid=nytcore-ipad-share. To learn what I think of it, continue
reading.
I have written about ROCA several times in the past, the
earliest being in early 2013. ROCA seems
to be the fruit of scientific labor at the MD Anderson Cancer at the University
of Texas. It is a protocol for
estimating the risk of ovarian cancer – in fact, ROCA is short for Risk of
Ovarian Cancer Algorithm. To my
untutored mind it seems straight forward, logical, easy to apply – and ready
for prime time. But no: all the
scientific spokespersons quoted, discussing a big trial of the method in the
UJK, are “disappointed”, or “cautiously optimistic”. To generalize: More trials are needed. More money must be spent. More post-docs are requiredd. Well, nuts.
I admit that ROCA falls short of having ideal sensitivity
(telling you you’ve got it, if you do) and specificity (not telling you you’ve
got it if you don’t). This entails,
inevitably, more anxiety and expense associated with false positives, not to
mention heartbreak from false negatives. I stack this up against the 14,180
American women expected to die this year of OVCA. Can’t the medical profession put some version
of ROCA to work right now, if perhaps only for high risk women? Can’t the NCI get off its fat ass and at
least make some recommendations? As I said earlier, nuts.
And as you can tell, I am in an intolerant mood.
I have written five blogs about ROCA, which you might want
to read. I think I have found a way for
you to search all my blogs for a particular topic. Google Myrl’sBlog, then look for an inviting
line (on my machine, it is on the upper left) and type in a search term. You should get all the blogs I have written which
contain that term. I hope it works. Please let me know if it doesn’t.
Prenatal genetic testing has dealt with this issue for a long time. There is a blood test that can be done that picks up chromosome abnormalities, but sometimes there is a false positive, which causes a lot of heart ache. In my mind, false positives are worth it. You just need to educate the person as to how likely a false positive is - how likely that something is REALLY wrong from a positive test result. I guess you can let them decide if they want to risk it. I always think it's better than nothing. I've been having periodic CA125 tests for years, knowing that it is an imperfect test. It's better than nothing. Educate the patient ahead of time. I don't care if ROCA is perfect or not, the possibility of catching ovarian cancer at an early enough stage to cure it is worth the emotional toll of the false positive.
ReplyDeleteThanks, Kristen. This is the kind of "Comment" I really appreciate.
DeleteKristen, I'm glad you are being tested for CA125. I am not, which I may regret, but there is not a strong family history of breast or ovarian cancers.
DeleteThis story has generated something of a media blitz, with most of the articles concentrating on the potential of the method, not its problems. Here is an example:
ReplyDeletehttp://www.huffingtonpost.com/entry/should-women-start-to-screen-for-ovarian-cancer-yearly_56747a8be4b014efe0d590b9
I guess it was inevitable. ROCA, the Risk of Ovarian Cancer Algorithm, has become a hot topic – and hence ripe for commercialization. Here is a long article about the business structure of a group that wants to disseminate it. They will not do this for free, that’s for sure. Is this a good thing or a bad thing? My guess is that it could go either way.
ReplyDeletehttp://www.prnewswire.com/news-releases/abcodia-restructures-leadership-team-to-drive-commercialization-of-the-roca-test-564837471.html
More on OVCA screening:
ReplyDeletehttp://www.huffingtonpost.co.uk/entry/ovarian-cancer-symptoms-mistaken-for-ibs_uk_572a0a31e4b0e6da49a5a02c
More progress in early detection of OVCA
ReplyDeletehttp://www.startribune.com/boston-scientific-buys-nvision-medical-in-275m-deal/479920193/