National Radon Action Month

Care to Care, a Multi-Specialty Management company, is proud to observe January as National Radon Action Month. Radon is a naturally occurring radioactive gas that cannot be seen, smelled, or tasted. However, its effects may be deadly! Radon is the second leading cause of lung cancer in the United States and is the leading cause of lung cancer deaths among nonsmokers, claiming the lives of over 20,000 Americans each year. Radon is produced by the natural breakdown (radioactive decay) of uranium and is present in nearly all soils. The problem with radon occurs when the gas enters your home and becomes trapped. Elevated radon levels have been discovered in every state. The U.S. Environmental Protection Agency (US EPA) estimates that as many as 8 million homes throughout the country have elevated levels of radon.

 

Care to Care emphasizes the importance of testing radon levels in your home, schools, and office buildings to help prevent unnecessary exposure. Testing is easy and inexpensive. Short-term tests are useful to see if further testing is warranted and are available at home centers, hardware stores and online retailers. To conduct the test, simply place the radon tester in the lowest livable area of your house that is regularly used, since that will contain the highest radon level, and then mail the test to the lab for the results. Long-term tests measure levels for 90 days to one year and are available through state radon agencies and online retailers. Continuous radon tests are also available and may be used for both short-and long-term testing. The US EPA recommends doing a second test if an initial short-term test registers 4 picoCuries per liter (pCi/L) or higher. If a second test registers above 4 pCi/L, then consider taking steps to reduce radon levels in your home. There are several easy repairs to reduce radon levels, such as caulking foundation cracks and placing an airtight cover on your sump pump; however, usually, the installation of a radon mitigation system may be required to effectively reduce radon levels to an acceptable range. For more information, contact your state radon office at epa.gov/radon/whereyoulive.html.

 

 

Rachel S. Title, MD

Chief Medical Officer

Care to Care, LLC

Lung Cancer Awareness Month

Care to Care, a Multi-Specialty Management company, is proud to observe November as Lung Cancer Awareness Month. Although lung cancer is the second most common cancer in both men and women (second to prostate cancer in men and breast cancer in women), it remains by far the leading cause of cancer death among both groups. Each year, more people die from lung cancer than from breast, prostate, and colon cancers combined. The American Cancer Society estimates that in 2017, about 222,500 new cases of lung cancer will be diagnosed in the U.S. with about 155,870 deaths from lung cancer. Our goal, and the goal of this international health campaign is to increase understanding and awareness of the disease, encourage people to minimize their risk of developing lung cancer, and educate people on the appropriate lung cancer screening guidelines.

Care to Care emphasizes the importance of reducing one’s risk of developing lung cancer. The most effective way to do this is by not smoking. Smoking is by far the greatest risk factor for lung cancer, with an estimated 80% of lung cancer deaths resulting from smoking. The longer you smoke and the more packs per day you smoke, the greater your risk. Cigar smoking, pipe smoking, low-tar or “light” cigarettes, and menthol cigarettes are all as likely to cause lung cancer as regular cigarettes. Secondhand smoke is also a risk factor and is thought to cause more than 7,000 deaths from lung cancer each year. Other risk factors that should be minimized or eliminated include exposure to radon inside homes, exposure to asbestos (in mines, mills, textile plants, shipyards, and places where insulation is used), and exposure to other cancer causing agents in the workplace such as diesel exhaust, arsenic, cadmium, silica, vinyl chloride, nickel compounds, chromium compounds, coal products, mustard gas, and chloromethyl esthers.

 

The American Cancer Society (ACS) has issued guidelines for lung cancer screening with low-dose CT of the chest. This study is more effective than chest x-ray at detecting lung cancer, uses less radiation than a standard CT chest scan, and does not require the use of intravenous contrast dye. The ACS recommends an annual screening low-dose CT chest for people between the ages of 55 to 74 years old who have at least a 30 pack-year smoking history (pack-year equals the number of packs smoked per day multiplied by the number of years smoking), and are either still smoking or have quit smoking within the last 15 years. If you meet all of the above criteria, then talk to your doctor about your screening options. However, screening is not a good alternative to quitting smoking.  If you smoke, there are many programs and organizations available to provide counseling about quitting. For help quitting, call the American Cancer Society at 1-800-227-2345.

 

 

Rachel S. Title, MD

Chief Medical Officer

Care to Care, LLC

Patient Safety

Care to Care, a Multi-Specialty Management company, is proud to participate in Patient Safety Awareness Week on March 12-18th, 2017, marking a dedicated time and platform to increase awareness about patient safety among health professionals and the public. As a Radiologist and Chief Medical Officer of Care to Care, I hope to educate the public and health professionals on the importance of Radiation Safety.

 

Radiation is energy that travels through space as either waves or high speed particles. It is a daily part of our lives as it exists all around us. It is in our homes as part of our radios and microwave ovens, and we experience extremely low levels every moment from our natural environment. There are two types of radiation: non-ionizing radiation and ionizing radiation. Non-ionizing radiation does not have as much energy as ionizing radiation and is thus, generally less harmful. In contrast, ionizing radiation has enough energy to cause serious damage to tissues and cells, and the amount of damage depends on the amount and duration of ionizing radiation exposure. By damaging the genetic material (DNA) contained in the body’s cells, radiation can cause cancer. Fortunately, our bodies are extremely efficient at repairing cell damage.

 

Not all ionizing radiation is bad. Ionizing radiation is frequently used in the medical field for imaging, for example X-rays, Computed Tomography (CT), or treatment as in the case of cancer radiation. Whether it comes from the ground, the sky, or medical treatment, humans are constantly exposed to ionizing radiation from the world around them. According to the American Nuclear Society the average person is exposed to a dose of approximately 620 mrem per year. To put this in perspective, the international safety standard for healthcare workers is up to 5,000 mrem per year, a dose that is considered to be safe and not significantly increase the risk for radiation-related health effects. A single chest X-ray or dental X-ray, both of which are considered to be medically safe, exposes a patient to only 10mrem of radiation.

 

The potential harms of ionizing radiation include the development of malignant cancer, benign tumors, cataracts, and potentially harmful genetic changes. The risks of radiation exposure for children and adolescents are greater than for adults when given equal radiation doses. Children grow quickly, and their cells are more sensitive to radiation. Since effects of radiation take years to develop, children, who generally have a longer life expectancy than adults, have a larger window of opportunity for expressing radiation damage, most notably the development of cancer. As adults age, radiation exposure becomes less of a concern. The body tissues of older patients are less sensitive to the effects of radiation.

 

It is important to realize that medical imaging can be an essential medical tool, necessary for diagnosing and treating disease. If your healthcare provider thinks that you, a family member or friend may have a significant medical condition, a diagnostic examination should not be refused because of the fear of radiation exposure. The risk associated with these tests is very small compared to the benefits provided by the imaging test. Before you have an exam that uses radiation, ask your physician two questions: What do we expect to learn from this x-ray examination and will decisions about my healthcare be determined from my imaging exam? You and your healthcare provider must work together to decide what is necessary and best for you. Since no amount of radiation should be considered absolutely safe, only necessary CT examinations should be performed.

 

For any additional information regarding radiation safety for patients, please visit RadiologyInfo.org.

Rachel Title, MD

Chief Medical Officer

Care to Care LLC

Cervical Cancer Awareness

This January, Care to Care is proud to participate in National Cervical Health Awareness Month. Cervical cancer was once one of the most common causes of cancer death for women. However, the cervical cancer death rate has gone down by more than 50% over the last 40 years, mainly due to the increased use of the Pap test for screening and early detection. This amazing screening tool can find changes in the cervix before cancer ever develops, enabling doctors to treat pre-cancerous states. Unfortunately, not all women are getting screened. In 2012, 10% of US women ages 21-65 reported they had not been screened for cervical cancer in the last 5 years. According to the American Cancer Society (ACS), there will be an estimated 12,820 new cases of invasive cervical cancer diagnosed in 2017, with an estimated 4,210 deaths from the disease.

Another important fact that many may not know is that most cervical cancers are preventable! Nearly all cases of cervical cancers are caused by human papillomavirus (HPV) infection, with approximately 70% due to HPV types 16 and 18. In addition to causing cervical cancer, HPV is also a common cause of anal cancer, mouth/throat cancer, and cancers of the vulva, vagina, and penis. The HPV vaccine, which became available in 2006, offers the best protection against the virus. However, the vaccine is only effective if administered before exposure to the virus, which is why vaccination must be given before one becomes sexually active, in the preteen years.

To prevent more cervical cancer deaths, screening and vaccination efforts must increase! The ACS and the Centers for Disease Control and Prevention recommend routine HPV vaccination for females and males starting at age 11 or 12. The ACS recommends all women begin cervical cancer screening at age 21. Women between 21 and 29 should have a Pap test every 3 years. Women between ages 30-65 should have both a Pap test and an HPV test every 5 years. Women over age 65 who have had regular screenings with normal results do not require screening, but those who have been diagnosed with cervical pre-cancer should continue to be screened. Women who have had the HPV vaccine should still follow the screening guidelines for their age group.

With a vaccine to prevent the cancer causing HPV infection and with the sensitive Pap screening test to detect the disease in a pre-cancerous state, no woman should die of cervical cancer! It is our job as clinicians to help women understand what screening tests are best for them and help parents know the best time to immunize their children against HPV.

Rachel Title, MD

Chief Medical Officer

Care to Care LLC

Why is Compliance and Ethics important in Medicine?

National Compliance and Ethics Week offers a great opportunity to shine a spotlight on the importance of compliance and ethics at Care to Care and in the entire healthcare system at large. The culture of compliance is at the core of medicine.

This begins for doctors with the mandatory Hippocratic oath which is frequently recited at the beginning of medical school and again at its culmination, when the medical degree is received. The Hippocratic oath states the obligations and proper conduct of doctors, laying the groundwork for a career devoted to the care of others through strict adherence to medical ethics and compliance to government laws, hospital regulations, and specialty society guidelines. It is this strict obedience to an unyielding moral code that makes the physician worthy of the trust that the patient bestows on him, a trust that is essential in the physician-patient relationship.

Physicians are entrusted with the most personal information by their patients and are obligated to maintain complete privacy and security of this health care information. Our compliance with federal HIPAA laws is only one way that compliance plays an integral role in the physicians’ daily responsibilities.

Here at Care to Care, the medical directors and physician reviewers are dedicated to maintaining the highest degree of compliance and are committed to upholding the oath we took many years ago.

Rachel Title, MD
Chief Medical Officer