Rebecca Bechhold, MD

How long ago did we learn that smoking caused lung cancer? The USPSTF is poised to recommend annual screening CT scans for the detection of lung cancer in high risk individuals. Are there enough CT scanners to handle the volume? The LLC’s are forming now to put a dedicated lung screening CT machine next to every convenience store. Get your carton and CT in one stop!

Fat. It isn’t said in polite company, and doctors never use it with patients because it is considered rude and inflammatory. But fat is now a disease. OK-obesity is a disease. The American Medical Association has proclaimed it as such, and now we are free to discuss it unhindered by rules of etiquette.

If you or your loved one had cancer, how would you go about picking their treating oncologist? What would you want to know about their experience in that disease? And if a patient asks you how many cases you have treated with their diagnosis, will you look at them and be totally honest?

Have you ever read someone’s note in the EMR and noticed it says “normal” in every section under physical exam, when in fact, the patient has had a mastectomy, a markedly enlarged liver, 3+ edema, or (horrors!) an amputation that goes undocumented?

Buy toxic chemicals and support breast cancer research! Not lying-just saw an ad on TV for weed killer and it had a pink ribbon logo on its packaging indicating, “A portion of every sale goes to support breast cancer research and awareness.” We have plenty of weed killer and a perfect lawn at our house, so I am no critic of the product. But have you noticed the pink ribbon logo on virtually every conceivable item or service?

How many times have you been killed for being the messenger with the bad news? You can often tell who is going to be angry when the CT scan shows recurrent disease. It is one of many things that are so stressful about being an oncologist. Let’s be honest; over the course of our career, we give a lot of bad news.

When you start seeing a patient for the first time who has been treated elsewhere and the previous oncologist has not followed standard protocol, how do you present this new way of doing things without alienating the patient or sounding critical of the previous doctor?

It used to be so easy. Patients with ER-positive breast cancer got 5 years of tamoxifen. You could anticipate most of the side effects. No one showed up with an armload of internet downloads ready to debate the utility of hormone therapy, the risks, and metabolism or drug interactions. No more.

Without naming drugs, because there are several that fall into this category, has anyone else noticed that many of the new cancer drugs show an infinitesimal improvement in progression-free survival or overall survival?