ΟΜΟΙΟΠΑΘΗΤΙΚΗ ΦΡΟΝΤΙΔΑ ΥΓΕΙΑΣ
Δρ Τάσος Βαρθολομαίος,ΜD,PhD,MFHom
Ομοιοπαθητικός - Ιατρός Ιστοπαθολόγος
Μέλος και του Βρετανικού Ιατρικού Συλλόγου-Tακτικο Μέλος Βρετανικής Εταιρείας Ομοιοπαθητικής Ιατρικής (Faculty of Homeopathy, M.Bρετανία, MFHom)περισσότερα
Ακμή- Προλακτινωμα Υπόφυσης
Νεαρή δασκάλα,με πολύ άσχημη μορφή ακμής στο πρόσωπό της,το οποίο ήταν παραμορφωμένο από διαπυήσεις και ουλες σε όλη του σχεδόν την έκταση,ενώ παράλληλα παρουσίαζε διαταραχές περιόδου και γαλακτόρροια.Ο εργαστηριακός έλεγχος είχε δέιξει σημαντικά αυξημένη προλακτίνη στο αίμα και ένα κυστικό όζο,πιθανόν αδένωμα και μάλιστα προλακτίνωμα στην υπόφυση,διαμετρου λίγων χιλιοστών.Η νέα αυτή παρουσίαζε τυπική ιδιοσυγκρασιακή εικόνα Tuberculinum,με προεξάρχοντα τα συγκινησιακά στοιχεία και μάλιστα προς την κατεύθυνση του ρομαντισμού,του πάθους καιτης υστερίας.Μετά από ομοιοπαθητική αγωγή λιγων σχετικά μηνών η ακμή υποχώρησε αισθητά,ενώ αποκαταστάθηκε η προλακτίνη ορού στα ανώτερα φυσιολογικά όρια και εξαφανίσθηκε ο όζος,το απεικονιστικά διεγνωσμενο σαν προλακτίνωμα μόρφωμα,της υπόφυσης.περισσότερα
ΤΙ ΕΠΙΔΙΩΚΕΙ ΚΑΙ ΤΙ ΜΠΟΡΕΙ ΝΑ ΠΕΤΥΧΕΙ Η ΚΛΙΝΙΚΑ ΠΡΟΣΑΝΑΤΟΛΙΣΜΕΝΗ ΟΜΟΙΟΠΑΘΗΤΙΚΗ ΣΤΟΥΣ ΠΑΣΧΟΝΤΕΣ ΑΠΟ ΚΑΡΚΙΝΟ
Δρ Τασος Βαρθολομαίος , Κλινικός Ομοιοπαθητικός- Ιατρός Ιστοπαθολόγος
Η ΚΛΙΝΙΚΗ ΕΦΑΡΜΟΓΗ ΤΗΣ ΟΜΟΙΟΠΑΘΗΤΙΚΗΣ ΣΤΟΝ ΚΑΡΚΙΝΟ ΑΠΑΙΤΕΙ ΥΨΗΛΗ ΓΝΩΣΗ ΤΗΣ ΙΣΤΟΠΑΘΟΛΟΓΙΑΣ ΤΟΥ ΚΑΡΚΙΝΟΥ ΚΑΙ ΤΗΣ ΕΠΙΣΤΗΜΟΝΙΚΑ ΤΕΚΜΗΡΙΩΜΕΝΗΣ ΟΜΟΙΟΠΑΘΗΤΙΚΗΣ
Οι φαρμακολογικές δυνατότητες της Ομοιοπαθητικής προσφέρονται κατεξοχήν για την υποστήριξη του οργανισμού των καρκινοπαθών . Στη διαδικασία αυτή η Ομοιοπαθητική μπορεί να χρησιμοποιείται και παράλληλα με τη Συμβατική Ιατρική (χημειοθεραπεία, ακτινοθεραπεία,κτλ).
Ο ρόλος της Ομοιοπαθητικής Φαρμακολογίας στον Καρκίνο είναι η ενίσχυση των μηχανισμών άμυνας του οργανισμού σύμφωνα με τα σύγχρονα δεδομένα της ανοσολογίας και η υποβοήθηση των ομοιοστατικών μηχανισμών σύμφωνα με τα σύγχρονα δεδομένα της παθολογικής φυσιολογίας.
CONTROVERSIES ON MAMMOGRAPHY
The following informations and guidelines are given by the National Cancer Institute,USA:
What is a mammogram?
A mammogram is an x-ray picture of the breast.
Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-ray pictures, or images, of each breast. The x-ray images make it possible to detect tumors that cannot be felt. Screening mammograms can also find microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer.
Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found. This type of mammogram is called a diagnostic mammogram. Besides a lump, signs of breast cancer can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape; however, these signs may also be signs of benign conditions. A diagnostic mammogram can also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, such as the presence of breast implants.
How are screening and diagnostic mammograms different?
Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis.
What are the benefits of screening mammograms?
Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread. Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50 (1). However, studies to date have not shown a benefit from regular screening mammography in women under age 40 or from baseline screening mammograms (mammograms used for comparison) taken before age 40.
What are some of the potential limitations of screening mammograms?
False-positive results. False-positive results occur when radiologists decide mammograms are abnormal but no cancer is actually present. All abnormal mammograms should be followed up with additional testing (diagnostic mammograms, ultrasound, and/or biopsy) to determine whether cancer is present.
False-positive results are more common for younger women, women who have had previous breast biopsies, women with a family history of breast cancer, and women who are taking estrogen (for example, menopausal hormone therapy).
False-positive mammogram results can lead to anxiety and other forms of psychological distress in affected women. The additional testing required to rule out cancer can also be costly and time consuming and can cause physical discomfort.
Overdiagnosis and overtreatment. Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated. However, they can also find cancers and cases of DCIS that will never cause symptoms or threaten a woman’s life, leading to "overdiagnosis" of breast cancer. Treatment of these latter cancers and cases of DCIS is not needed and leads to "overtreatment." Overtreatment exposes women unnecessarily to the adverse effects associated with cancer therapy.
Because doctors often cannot distinguish cancers and cases of DCIS that need to be treated from those that do not, they are all treated.
False-negative results. False-negative results occur when mammograms appear normal even though breast cancer is present. Overall, screening mammograms miss about 20 percent of breast cancers that are present at the time of screening.
The main cause of false-negative results is high breast density. Breasts contain both dense tissue (i.e., glandular tissue and connective tissue, together known as fibroglandular tissue) and fatty tissue. Fatty tissue appears dark on a mammogram, whereas fibroglandular tissue appears as white areas. Because fibroglandular tissue and tumors have similar density, tumors can be harder to detect in women with denser breasts.
False-negative results occur more often among younger women than among older women because younger women are more likely to have dense breasts. As a woman ages, her breasts usually become more fatty, and false-negative results become less likely. False-negative results can lead to delays in treatment and a false sense of security for affected women.
Some of the cancers missed by screening mammograms can be detected by clinical breast exams (physical exams of the breast done by a health care provider).
Finding cancer early does not always reduce a woman’s chance of dying from breast cancer. Even though mammograms can detect malignant tumors that cannot be felt, treating a small tumor does not always mean that the woman will not die from the cancer. A fast-growing or aggressive cancer may have already spread to other parts of the body before it is detected. Women with such tumors live a longer period of time knowing that they likely have a fatal disease.
In addition, screening mammograms may not help prolong the life of a woman who is suffering from other, more life-threatening health conditions.
Radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low, but repeated x-rays have the potential to cause cancer. The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure. Nevertheless, women should talk with their health care providers about the need for each x-ray. In addition, they should always let their health care provider and the x-ray technician know if there is any possibility that they are pregnant, because radiation can harm a growing fetus.
Where can I find current recommendations for screening mammography?
Many organizations and professional societies, including the United States Preventive Services Task Force (which is convened by the Agency for Healthcare Research and Quality, a federal agency), have developed guidelines for mammography screening. All recommend that women should talk with their doctor about the benefits and harms of mammography, when to start screening, and how often to be screened.
Although NCI does not issue guidelines for cancer screening, it conducts and facilitates basic and translational research that informs standard clinical practice and medical decision making that other organizations may use to develop their guidelines.
What is the best method of detecting breast cancer as early as possible?
Getting a high-quality screening mammogram and having a clinical breast exam on a regular basis are the most effective ways to detect breast cancer early.
Checking one’s own breasts for lumps or other unusual changes is called a breast self-exam, or BSE. This type of exam cannot replace regular screening mammograms or clinical breast exams. In clinical trials, BSE alone was not found to help reduce the number of deaths from breast cancer.
Although regular BSE is not specifically recommended for breast cancer screening, many women choose to examine their own breasts. Women who do so should remember that breast changes can occur because of pregnancy, aging, or menopause; during menstrual cycles; or when taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for breasts to be swollen and tender right before or during a menstrual period. If a woman notices any unusual changes in her breasts, she should contact her health care provider.
What is the Breast Imaging Reporting and Database System (BI-RADS®)?
The American College of Radiology (ACR) has established a uniform way for radiologists to describe mammogram findings. The system, called BI-RADS, includes seven standardized categories, or levels. Each BI-RADS category has a follow-up plan associated with it to help radiologists and other physicians appropriately manage a patient’s care.
Breast Imaging Reporting and Database System (BI-RADS)
Category Assessment Follow-up
0 Need additional imaging evaluation Additional imaging needed before a category can be assigned
1 Negative Continue regular screening mammograms (for women over age 40)
2 Benign (noncancerous) finding Continue regular screening mammograms (for women over age 40)
3 Probably benign Receive a 6-month follow-up mammogram
4 Suspicious abnormality May require biopsy
5 Highly suggestive of malignancy (cancer) Requires biopsy
6 Known biopsy-proven malignancy (cancer) Biopsy confirms presence of cancer before treatment begins
How much does a mammogram cost?
For most women with private insurance, the cost of screening mammograms is covered without copayments or deductibles, but women should contact their mammography facility or health insurance company for confirmation of the cost and coverage.
Medicare pays for annual screening mammograms for all female Medicare beneficiaries who are age 40 or older. Medicare will also pay for one baseline mammogram for female beneficiaries between the ages of 35 and 39. There is no deductible requirement for this benefit. Information about coverage is available on the Medicare website or through the Medicare Hotline at 1–800–MEDICARE (1–800–633–4227). For the hearing impaired, the telephone number is 1–877–486–2048.
How can uninsured or low-income women obtain a free or low-cost screening mammogram?
Some state and local health programs and employers provide mammograms free or at low cost. For example, the Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program. This program provides screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States and in several U.S. territories. Contact information for local programs is available on the CDC website or by calling 1–800–CDC–INFO (1–800–232–4636).
Information about free or low-cost mammography screening programs is also available from NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237) and from local hospitals, health departments, women’s centers, or other community groups.
Where can women get high-quality mammograms?
Women can get high-quality mammograms in breast clinics, hospital radiology departments, mobile vans, private radiology offices, and doctors’ offices.
The Mammography Quality Standards Act (MQSA) is a Federal law that requires mammography facilities across the nation to meet uniform quality standards. Under the law, all mammography facilities must: 1) be accredited by an FDA-approved accreditation body; 2) be certified by the FDA, or an agency of a state that has been approved by the FDA, as meeting the standards; 3) undergo an annual MQSA inspection; and 4) prominently display the certificate issued by the agency. More information about MQSA is available from the FDA.
Women can ask their doctors or staff at a local mammography facility about FDA certification before making an appointment. Women should look for the MQSA certificate at the mammography facility and check its expiration date. MQSA regulations also require that mammography facilities give patients an easy-to-read report of their mammogram results.
Information about local FDA-certified mammography facilities is available through NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). Also, a searchable list of these facilities can be found on the FDA website.
What should women with breast implants do about screening mammograms?
Women with breast implants should continue to have mammograms. (A woman who had an implant following a mastectomy should ask her doctor whether a mammogram of the reconstructed breast is necessary.) It is important to let the mammography facility know about breast implants when scheduling a mammogram. The technician and radiologist must be experienced in performing mammography on women who have breast implants. Implants can hide some breast tissue, making it more difficult for the radiologist to detect an abnormality on the mammogram. If the technician performing the procedure is aware that a woman has breast implants, steps can be taken to make sure that as much breast tissue as possible can be seen on the mammogram. A special technique called implant displacement views may be used.
What is digital mammography? How is it different from conventional (film) mammography?
Digital and conventional mammography both use x-rays to produce an image of the breast; however, in conventional mammography, the image is stored directly on film, whereas, in digital mammography, an electronic image of the breast is stored as a computer file. This digital information can be enhanced, magnified, or manipulated for further evaluation more easily than information stored on film.
Because digital mammography allows a radiologist to adjust, store, and retrieve digital images electronically, digital mammography may offer the following advantages over conventional mammography:
Health care providers can share image files electronically, making long-distance consultations between radiologists and breast surgeons easier.
Subtle differences between normal and abnormal tissues may be more easily noted.
Fewer follow-up procedures may be needed.
Fewer repeat images may be needed, reducing the exposure to radiation.
To date, there is no evidence that digital mammography helps to reduce a woman’s risk of dying from breast cancer compared with film mammography. Results from a large NCI-sponsored clinical trial that compared digital mammography with film mammography found no difference between digital and film mammograms in detecting breast cancer in the general population of women in the trial; however, digital mammography appeared to be more accurate than conventional film mammography in younger women with dense breasts (2). A subsequent analysis of women aged 40 through 79 who were undergoing screening in U.S. community-based imaging facilities also found that digital and film mammography had similar accuracy in most women. Digital screening had higher sensitivity in women with dense breasts .
Some health care providers recommend that women who have a very high risk of breast cancer, such as those with a known mutation in either the BRCA1 or BRCA2 gene or extremely dense breasts, have digital mammograms instead of conventional mammograms; however, no studies have shown that digital mammograms are superior to conventional mammograms in reducing the risk of death for these women.
Digital mammography can be done only in facilities that are certified to practice conventional mammography and have received FDA approval to offer digital mammography. The procedure for having a mammogram with a digital system is the same as with conventional mammography.
What is 3D mammography?
Three-dimensional (3D) mammography, also known as breast tomosynthesis, is a type of digital mammography in which x-ray machines are used to take pictures of thin slices of the breast from different angles and computer software is used to reconstruct an image. This process is similar to how a computed tomography (CT) scanner produces images of structures inside of the body. 3D mammography uses very low dose x-rays, but, because it is generally performed at the same time as standard two-dimensional (2D) digital mammography, the radiation dose is slightly higher than that of standard mammography. The accuracy of 3D mammography has not been compared with that of 2D mammography in randomized studies. Therefore, researchers do not know whether 3D mammography is better or worse than standard mammography at avoiding false-positive results and identifying early cancers(Source: National Cancer Institute)
An article titled “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board” and published at the New England Journal of Medicine,offers certain very essential observations:
“In January 2013, the Swiss Medical Board, an independent health technology assessment initiative under the auspices of the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences, was mandated to prepare a review of mammography screening. The two of us, a medical ethicist and a clinical epidemiologist, were members of the expert panel that appraised the evidence and its implications. The other members were a clinical pharmacologist, an oncologic surgeon, a nurse scientist, a lawyer, and a health economist. As we embarked on the project, we were aware of the controversies that have surrounded mammography screening for the past 10 to 15 years. When we reviewed the available evidence and contemplated its implications in detail, however, we became increasingly concerned.
First, we noticed that the ongoing debate was based on a series of reanalyses of the same, predominantly outdated trials. The first trial started more than 50 years ago in New York City and the last trial in 1991 in the United Kingdom. None of these trials were initiated in the era of modern breast-cancer treatment, which has dramatically improved the prognosis of women with breast cancer. Could the modest benefit of mammography screening in terms of breast-cancer mortality that was shown in trials initiated between 1963 and 1991 still be detected in a trial conducted today?
Second, we were struck by how nonobvious it was that the benefits of mammography screening outweighed the harms. The relative risk reduction of approximately 20% in breast-cancer mortality associated with mammography that is currently described by most expert panels came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies, and overdiagnosis of breast cancers — cancers that would never have become clinically apparent. The recently published extended follow-up of the Canadian National Breast Screening Study is likely to provide reliable estimates of the extent of overdiagnosis. After 25 years of follow-up, it found that 106 of 484 screen-detected cancers (21.9%) were overdiagnosed. This means that 106 of the 44,925 healthy women in the screening group were diagnosed with and treated for breast cancer unnecessarily, which resulted in needless surgical interventions, radiotherapy, chemotherapy, or some combination of these therapies. In addition, a Cochrane review of 10 trials involving more than 600,000 women showed there was no evidence suggesting an effect of mammography screening on overall mortality.1 In the best case, the small reduction in breast-cancer deaths was attenuated by deaths from other causes. In the worst case, the reduction was canceled out by deaths caused by coexisting conditions or by the harms of screening and associated overtreatment. Did the available evidence, taken together, indicate that mammography screening indeed benefits women?
Third, we were disconcerted by the pronounced discrepancy between women's perceptions of the benefits of mammography screening and the benefits to be expected in reality. The figureU.S. Women's Perceptions of the Effects of Mammography Screening on Breast-Cancer Mortality as Compared with the Actual Effects. shows the numbers of 50-year-old women in the United States expected to be alive, to die from breast cancer, or to die from other causes if they are invited to undergo regular mammography every 2 years over a 10-year period, as compared with women who do not undergo mammography. The numbers in Panel A are derived from a survey about U.S. women's perceptions,4 in which 717 of 1003 women (71.5%) said they believed that mammography reduced the risk of breast-cancer deaths by at least half, and 723 women (72.1%) thought that at least 80 deaths would be prevented per 1000 women who were invited for screening. The numbers in Panel B reflect the most likely scenarios according to available trials1-3: a relative risk reduction of 20% and prevention of 1 breast-cancer death. The data for Switzerland, reported in the same study, show similarly overly optimistic expectations. How can women make an informed decision if they overestimate the benefit of mammography so grossly?
The Swiss Medical Board's report was made public on February 2, 2014 (www.medical-board.ch). It acknowledged that systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected. At the same time, it emphasized the harm — in particular, false positive test results and the risk of overdiagnosis. For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age, 490 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent.5 The board therefore recommended that no new systematic mammography screening programs be introduced and that a time limit be placed on existing programs. In addition, it stipulated that the quality of all forms of mammography screening should be evaluated and that clear and balanced information should be provided to women regarding the benefits and harms of screening.
The report caused an uproar and was emphatically rejected by a number of Swiss cancer experts and organizations, some of which called the conclusions “unethical.” One of the main arguments used against it was that it contradicted the global consensus of leading experts in the field — a criticism that made us appreciate our unprejudiced perspective resulting from our lack of exposure to past consensus-building efforts by specialists in breast-cancer screening. Another argument was that the report unsettled women, but we wonder how to avoid unsettling women, given the available evidence.
The Swiss Medical Board is nongovernmental, and its recommendations are not legally binding. Therefore, it is unclear whether the report will have any effect on the policies in our country. Although Switzerland is a small country, there are notable differences among regions, with the French- and Italian-speaking cantons being much more in favor of screening programs than the German-speaking cantons — a finding suggesting that cultural factors need to be taken into account. Eleven of the 26 Swiss cantons have systematic mammography screening programs for women 50 years of age or older; two of these programs were introduced only last year. One German-speaking canton, Uri, is reconsidering its decision to start a mammography screening program in light of the board's recommendations. Participation in existing programs ranges from 30 to 60% — variation that can be partially explained by the coexistence of opportunistic screening offered by physicians in private practice. At least three quarters of all Swiss women 50 years of age or older have had a mammogram at least once in their life. Health insurers are required to cover mammography as part of systematic screening programs or within the framework of diagnostic workups of potential breast disease.
It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice."Επιστροφή