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Wiseman
03-08-2011, 11:31
I'm reading a paper that talks about a portable NMR machine that is very accurate at detecting specific cancer biomarkers which eliminates the need for biopsies and a large room for the procedure. I don't know if SF medic curriculum covers cancer diagnosis but if it does, this is something could be of interest due to the low cost and well not having to lug around a large MRI machine.

Here is a general article ( http://www.switched.com/2011/02/28/cancer-scanner-costs-200-diagnoses-via-iphone/)

Here is the scientific article ( http://stm.sciencemag.org/content/3/71/71ra16.abstract )

You have to pay for the scientific article if you don't have access but if you email the Dr, their project coordiantor will give you a PDF copy to read.

PedOncoDoc
03-08-2011, 12:06
I work in both oncology and do research in biomarkers. This test looks promising and interesting, but I don't think it has much application in cancer diagnostics outside of a hospital that can support surgical biopsies and/or radiologic-guided (think x-ray or ultrasound pictures showing you where your needle is going) biopsies.

The article is arguing that NMR can be superior to IHC in diagnosing an unknown cancer that is within a limited differential diagnosis based upon location of the presumed primary tumor and pattern of spread of disease. I would argue they should be complimentary and not mutually exclusive of each other. Making the diagnosis is one thing - knowing if there may be benefits of treatment "A" over treatment "B" is an entirely different matter which requires analysis of DNA mutations within a tumor, areas within the tumor that look different from the others as well as looking for specific cellular markers.

Perhaps someone with more wilderness/field medicine training and experience than myself could elaborate on the potential benefit of biomarker analysis in the field ? I just don't see the need for such fine-tuned diagnostics in an area of medicine where the need is to stabilize and maintain/mobilize to the nearest medical station environment.

Wiseman
03-08-2011, 12:14
My rationale would be for this to be done on an indigenous population as a routine medical procedure ( if the medic suspects that there a tumor involved) in nations were complex equipment is not readily available.

I mean, having done IHC and cryosectioning, it is time consuming and this is just expedient. Now, there are definitely more markers one can use aside the usual suspect such as p53, EGFR, HER2... and etc

PedOncoDoc
03-08-2011, 13:39
My rationale would be for this to be done on an indigenous population as a routine medical procedure ( if the medic suspects that there a tumor involved) in nations were complex equipment is not readily available.

I mean, having done IHC and cryosectioning, it is time consuming and this is just expedient. Now, there are definitely more markers one can use aside the usual suspect such as p53, EGFR, HER2... and etc

What do you propose to do with the indiginous person who gets diagnosed with cancer by this test? The therapies ain't cheap and typically are not stable for periods of time. We currently have a national shortage of BCNU which is used in almost all lymphoma treatment protocols to the extent that we are nto able to administer it to our patients here in the states.

We have enough trouble paying for treatment and providing it to our own - taking this to the third world does not make sense to me. Unless you want to impress the locals with your ability to predict death and want to be labeled as a "prophet/seer".

Wiseman
03-08-2011, 13:58
I don't have a solution regarding therapies following diagnosis but it is a portable device can make the case for indigenous people to be transported for treatment as part of a winning hearts and minds instead of spending money on MRI while in the States. I think cost wise it makes sense. Becoming a prophet is not my intention but it's hard for most individuals to turn against you once they see that you are trying to help. Now before anyone thinks that I we should start spending money on these devices, I am not, merely I am just pointing something out and people who are more qualified can make a decision on whether this is useful.

PedOncoDoc
03-08-2011, 16:42
The money and efforts would be better spent on vaccines, antibiotics, antiparasitics and sustainable potable water systems IMHO.

Telling them, "You've got cancer," without the ability to provide treatment does them no service and may cause harm to relationships that are trying to be established and fostered.

YMMV...

The Reaper
03-08-2011, 19:24
The money and efforts would be better spent on vaccines, antibiotics, antiparasitics and sustainable potable water systems IMHO.

Telling them, "You've got cancer," without the ability to provide treatment does them no service and may cause harm to relationships that are trying to be established and fostered.

YMMV...

Exactly.

Wiseman, you fail to understand the difficulties of practicing medicine on indigenous people. We don't run many oncology clinics overseas, nor would the prognosis/outcome be generally favorable. The resources are better directed to simple things as POD noted.

TR

xsf18cdf
04-12-2011, 09:16
I've been doing medicine for about 25 years now. I always ask myself "what am I going to do with the results- positive or negative" before I order a test. If it will not alter or contribute to the treatment, I don't order it. It becomes more of a curiosity satisfier than a value, medically.

G