Top Physician Topics of 2010
3. New Guidelines for Prostate Cancer Screening
The advent of better tests -- such as prostate-specific antigen (PSA) screening -- can in some cases save lives with early treatment. But these tests can also pose new dilemmas, as the American Cancer Society (ACS) emphasized on March 3 when it updated its prostate cancer screening guidelines. The test picks up benign disease as well as cancer, and it can't distinguish between aggressive and mild forms of the disease, the ACS pointed out. In some cases, it has led to expensive and invasive treatments in patients who might never have experienced symptoms. So the ACS is calling on physicians to spend more time counseling patients about their options (despite the difficulty of billing for such counseling). The PSA controversy intensified when the scientist who discovered PSA in 1970, Richard Ablin, PhD, of the University of Arizona College of Medicine in Tucson, Arizona, said categorically that the test should not be used to screen all men older than 50. That's a direct contradiction of the ACS guidelines. Controversy about the value of PSA testing continued when results of studies on both the effectiveness of the test and on chemoprevention were reported.
4. Revised Diabetes Guidelines
Screening technology popped up in the news again in December 2009 when the American Diabetes Association published new clinical practice recommendations. Although published late last year, it has been among the top read topics on Medscape in 2010. The guidelines promote the use of the hemoglobin A1c test as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes. A1c measures average blood glucose levels for roughly the past three months. Previously it was used only to evaluate diabetic control with time, but because it doesn't require fasting, A1c testing will encourage more people to get tested, leading to treatments and lifestyle changes that could prevent the worst effects of the disease, the American Diabetes Association said.
5. Calcium Without Vitamin D Boosts Heart Attack Risk
Prevention guidelines also made headlines when a large study found that calcium supplements taken without vitamin D may increase the risk for heart attack as much as 30%. Researchers reported the finding online July 29 in BMJ, based on their analysis of 15 trials with up to 11,921 participants. Most guidelines for osteoporosis recommend the supplements, despite relatively small benefits in bone health, but the senior author of the study says that in most cases, "discontinuation of calcium would seem appropriate." The study raised many questions, such as why calcium could have this effect during a relatively short period of time. Pending further research, some experts advised eating foods high in calcium rather than taking supplements.