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Posts Tagged ‘chance’

For today’s consideration I offer up some statistics and information about two cancers common in both men and women, bladder and colorectal, along with some pointers about risk and detection.

For starters, how about a little definition of what exactly we’re talking about. First, the bladder. If you remember anything of biology or health and fitness classes, you might recall that the bladder stores urine until certain signals tell you it’s “full,” and then it contracts to help push the urine down the urethra and out of the body. Secondly, the colorectal area. Since they are connected physically and work in tandem as part of the digestive system, the colon and rectum are often grouped under the collective “colorectal” description. Essentially, the colon is the large intestine, and the rectum is the last six inches or so before the anus.

Okay, with the anatomy lesson over, lets get to the bits that actually matter. Bladder cancer is one of the more common cancers found in men and women but is rarely publicized. According to the American Cancer Society (ACS), in 2009 some 52,810 new cases of bladder cancer were expected in men. Using Census Bureau population estimates, that means any given man had a 0.00035% chance of being diagnosed with a new bladder cancer. Those are whopping odds, I know; and, ladies, you’re numbers are even lower. For 2009, any given woman had a roughly 0.00012% chance of being diagnosed with a new bladder cancer. The 18,170 estimated new cases of bladder cancer in women in 2009 means that men are several times more likely to develop bladder cancer than women are. In fact, the ACS reports that “bladder cancer incidence is nearly four times higher in men than in women and more than two times higher in white men than in African American men.” Sorry Team Blue.

But don’t let the numbers get you down. For men, the cumulative chances of developing bladder cancer remain less than 1% until age 70 and beyond. Lifetime odds are less than 4%. And the odds of dying from it? One-fifth the chance of developing it. Women, as the earlier numbers indicated, have even less to worry about: bladder cancer odds never breach 1% by age group and is only 1.2% over the course of a lifetime. So not exactly a raging pandemic by any means. Which is especially good because bladder cancer has no good method of early detection. The most effective assessment of bladder cancer involves running an endoscope up the urethra and taking a look around. For obvious reasons, this is a procedure to be avoided unless you happen to fall among a high-risk group and or show troubling signs (especially painful urination or bloody urine). For the vast majority of us, this will never be a problem, so don’t concern yourself over it too much.

Colorectal numbers are higher. The ACS expected 75,590 new cases in men and 71,380 new cases in women in 2009, making it “the third most common cancer in both men and women.” Those numbers are also fairly even between the sexes, unlike bladder cancer. However, like bladder cancer and prostate cancer and breast cancer and most other cancers as well, the highest odds come later in life. “91% of [colorectal cancer] cases are diagnosed in individuals aged 50 and older,” reads the ACS statistics release. But it also related that in both men and women, the odds of developing colorectal cancer are less than 1% until age 60. Again, little reason to worry.

But if the 5 – 5.5% chance of developing colorectal cancer over your lifetime have you on edge, there are several methods of early detection. Most of us are familiar with the colonoscopy procedures as described (and sometimes filmed) on TV, where an endoscope is run through the large intestine in search of suspicious lesions or polyps. But if that’s too invasive for your tastes, you might consider a sigmoidoscopy, where physicians examine the rectum and lower third of the colon for abnormalities through a thin device called a flexible sigmoidoscope. It takes about 15 minutes, is less invasive, and can still take biopsies of anything suspicious. It’s recommended every five years and, like conventional colonoscopy, can occasionally (but not commonly) cause bleeding or tears in the intestinal walls, both requiring surgery to repair.

If those don’t fit your fancy, perhaps a double-contrast barium enema (DCBE) would do the trick. Recommended every five to 10 years, it involves a very thorough barium sulfate enema that physicians use to examine the lower digestive tract via x-ray. It exposes the patient to less radiation than a typical CT scan (also called CAT scan) and is somewhat less invasive than colonoscopies or sigmoidoscopies. However, if you don’t mind an enema or the slightly higher radiation of CT or MRI scans, you might opt for the virtual colonoscopy. After an enema, a small tube pumps air into colon (for better differentiation) while CT or MRI scans provide images of the intestinal tract. It’s still less invasive than traditional colonoscopies but does not allow for biopsies or as thorough an internal view. However, it does allow for imaging of surrounding tissues and produces more accurate images than DCBEs.

But if you’re not fond of any foreign materials up the backside, you might just opt for the simplicity and complete non-invasiveness of fecal blood tests. There are two types but both are quite accurate and inexpensive. One type, called FOBT (fecal occult blood test), tests feces for the heme blood component (“heme” as in hemoglobin, part of our red blood cells). The other, called FIT (fecal immunochemical test), is more sensitive and tests for the globin blood component. Pre-cancerous polyps in the colon or rectum often bleed into the fecal matter passing through the digestive tract, which can be detected by these tests. They are simple enough to do at home and are sometimes handed out free of charge at proctology centers, clinics, and other medical service providers. Doctors recommend triple-testing to reduce false positives as the body expels small amounts of blood in feces under normal circumstances. But the tests return positive results for bleeding anywhere between the mouth and anus, so don’t automatically assume colorectal cancer even if there is blood. These fecal blood tests are considered a line of primary identification, as are the similar fecal DNA tests, but for conclusive diagnoses you’re still expected to see a doctor and perhaps choose a colorectal treatment of a more invasive kind.

I think the most important thing to remember is how unlikely these cancers are. And being diagnosed with cancer is a long way from dying of it. So keep an eye on yourself, and get your regular medical check-ups if you like, but don’t waste time and energy worrying about something so unlikely. No matter what you hear on the news.

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I last wrote about breast cancer in my informal “medical series” here on the blog so, to be fair, I’ll now address prostate cancer. Unlike the enthusiastic pink-banner-waving breast warriors-of-awareness, prostate cancer’s agents of information fly below the radar with little hoopla, few public endorsements, and no ribbon brigades. But statistically, prostate cancer is just as prevalent as breast cancer and results in about 30,000 deaths annually.

But how about a bit of good news to start? Most guys are familiar with the “probing finger” method of prostate examination, but how many have heard of the PSA blood test that can also be used? Ideally, the American Cancer Society suggests they be used in conjunction to help identify prostate issues, and generally only after age 50. But, fellas, there’s our loophole; you have the right to request the blood test and forego the finger.

Now, back the issue at hand (no pun intended). Prostate cancer, like many other cancers, increases in probability with age. Roughly two-thirds of cases are diagnosed in men 65 and older. And whereas a 40 year old man has only a 0.01% chance of being diagnosed with prostate cancer, a man aged 75 has a 12.5% chance. Which, incidentally, is twice the odds of a woman the same age being diagnosed with breast cancer. In fact, from age 55 on, men are at a higher probability of prostate cancer than women of the same age are of breast cancer. And over the course of a lifetime, men are over 30% more likely to develop prostate cancer than women are breast cancer. I don’t recall seeing any blue ribbons for that in the New Yorker.

And although men make up less than half of the country’s population, they are more likely to develop cancer of any major class but one. Digestive cancer? More prevalent in men. Respiratory cancer? Men. Bone, skin, brain? Men. Lymphoma, myeloma, leukemia? Still men. The only major class not led by men is cancers of the endocrine system, involving hormones. (And I dare say most men could offer an explanation for why women are number one in that.)

So I think we should begin a blue-ribbon brigade, to save the men. They are a minority in the populace, suffer a shorter average life span than women, and are at higher risk for debilitating disease. If that doesn’t deserve a ribbon, I don’t know what does. But I don’t think we can rely on super-aid-celebrities like Bono to go waving any flags for the cause (mostly because I think he needs to grow a pair first), so men, take a stand for yourselves. Wave your own banners and be your own warriors-of-awareness. And women, if you support the pink ribbon then you need to support the blue one, too. We have to fight for equal rights, equal awareness, and equal funding together, breasts and prostates alike.

Go blue!!

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I don’t keep up with many recording artists. The pool of popular people changes too rapidly for me to notice even half of them, and most of the half I do notice have little to offer. But there are, of course, exceptions.

Unless you’ve been living under a rock for the last decade or so, you’ve heard of Pink and listened to her songs on the radio. From her 2000 debut song “There You Go” to her latest and biggest hit yet, “So What,” Pink has belted out noteworthy songs across five albums. In 2001, with Missundaztood, arguably her most well-known album, and a slice of the global hit “Lady Marmalade” in her pocket, she seemed to find her voice and hit her stride. Between 2002 and 2007 two more albums came out and she was married in 2006 to motocross racer Carey Hart. (They separated in 2008 and are “trying to work it out”). And then last fall came her latest album, Funhouse, producing her biggest hit to date (also the first of her albums I actually bought).

[Please note: the unedited album contains some explicit lyrics; the edited version does not but is still not suitable for children or “tweens.”]

Pink has gathered quite a following with her pull-no-punches attitude and songs to match. Perhaps more interesting are the chinks in her armor where she displays surprising vulnerability without drifting into the maudlin. Funhouse is a great mix of the two, a step up I believe, while retaining all the bite that appealed in her previous albums.

“So… So what! I’m still a rock star. I got my rock moves, And I don’t need you. And guess what? I’m having more fun… And you’re a tool…”

her wonderfully rough voice announces in track #1, “So What.” If you haven’t seen the music video, you’re missing a good thing.

As for the album tracks that follow “So What,” well they certainly don’t disappoint.

“I don’t wanna be the girl that has to fill the silence. The quiet scares me ’cause it screams the truth.” [Sober]

“I’m drinking wine and thinking bliss Is on the other side of this… I’ve had my chances and I’ve taken them all, Just to end up right back here on the floor…” [Crystal Ball]

“If the darkest hour comes before the light, Where is the light? Where is the light?” [Ave Mary A]

“Have you ever wished for an endless night? …Have you ever held your breath and asked yourself will it ever get better than tonight?” [Glitter In the Air]

It’s a good mix of fun and serious and is, I think, by far her best album. There you go.

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Very few people haven’t heard of S. E. Hinton, a young adult genre author who makes the required reading list in most if not all English classrooms. She is famous for having penned the new-classic short novel The Outsiders as well as Tex, Rumble Fish, and That Was Then This Is Now. All were written from the perspective of young adults and were/are very popular among that crowd.

Now that the history lesson is covered, I’ll get down to business. Hinton didn’t publish anything for many years after Taming the Star Runner and rumors circulated that she had essentially retired after her short but glorious run. (Dropping off the page for 16 years can do that.) Then in 2005 came the dark and wholly unexpected Hawke’s Harbor, the newest spine on my bookshelf.

I’ll make no bones about it, I loved S. E. Hinton and, as a child and young adult, read everything of her hand I could find. I scanned the pages of The Outsiders more times than I can remember and even voluntarily wrote an essay on the book in middle school. But then came Hawke’s Harbor, and I was unsure. I passed it by on Amazon and in the local bookstore, wary of her new work, suspicious that it would be yet another dreadful “comeback novel” and could never live up to my old favorites. But like nearly every book published, a few copies of it eventually wound up in the bookstore’s bargain bin. And I, desperate for new reading material (as usual), could not resist the temptation of a bargain.

My worries firmly in place, I began to read … and found out that I could not have been more wrong. Hawke’s Harbor is a gorgeous, touching story. It quickly found its way into my cubby of favorites on the bookshelf and slid its hooks deftly into my heart. But it is totally unlike her earlier works. Had I not known, her name would never have entered my mind on a list of possible authors. Perhaps the greatest shock was the inclusion of a vampire in the plot, which could not be more removed from what she wrote about in the 1970’s and 1980’s. This bit of supernatural did not sit well with many of her former fans but, in all honesty, it was so well wrought I didn’t mind. That’s not to say I wasn’t surprised, and still a bit disappointed; and I seriously questioned whether or not I’d made a mistake picking this dark story from the bargain bin. Apparently this also threw a lot of other readers who were expecting another Tex or Rumble Fish. Because serious readers – we minority of dedicated, avid consumers of words, we Constant Readers – treasure our books like great friends, and treasure the authors of those books like loved ones. So when someone drops off the publishing map for a decade and a half and re-emerges with a totally different and unexpected voice, it can be very personal.

Think of it as if a loved one were in a bad accident and fell into a coma. And at first the doctors were very optimistic for a full recovery … but as the months and then years wore on, a darker prognosis appeared. And you resigned yourself to losing this loved one. You wanted the coma to break and for that person to open their eyes and be every bit the person they were before … but you understood the chances of that were infintesimal. Then one fine day that loved one stirred and opened their eyes. And the doctors cried, “Come quick!” And you rushed to their bedside with a great wild hope galloping through your veins … only to find that this loved one didn’t remember you. Or themselves. And watching them recover is like watching a stranger, and that it is somehow worse than losing them to a coma, or even to death. Because there they are, right there, you can reach out and touch them … but it isn’t the person you knew.

That probably sounds ridiculous. And of course not everyone is so effected, but many are. And it is so personal to them that it feels like a betrayal, willful or not. Authors who publish fairly regularly and whose voices change slowly over time have a much greater advantage. S. E. Hinton did most certainly not have that advantage and the reviews of this book prove it. So, just for the record, let me state that this is nothing like her earlier work … except that it is still a striking, moving story. Despite my misgivings, I loved it. It is hard to explain but the vampire thread did not discredit the story or the characters, who practically breathe and move on the page (and this from a reader who has avoided every other vampire story I have ever come across because I simply detest them). I loved it.

In closing, I offer a word of advice: If you pick this book up expecting it to be anything like her other books, you will be disappointed. Because Hinton has a new voice. It is still unerringly beautiful and wrenching but in a very different way. She has changed, as have we all.

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