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OZ AND ROIZEN

Docs describe how to prevent being misdiagnosed

Progress also being made toward early detection of pancreatic cancer

Monday, May 20, 2013 - 12:01 am

Q: My husband went to the emergency room for shortness of breath, and they sent him home, saying it was a result of his weight. Four hours later, we had to call an ambulance. He almost died — of an asthma attack! How can this happen? — Mary M., Nashville, Tenn.

A: Let us assure you that everyone in the health-care field is working to prevent such mistakes. But misdiagnosis a persistent problem: A new report says 39 percent of U.S. malpractice payments are for non-diagnosis or an incorrect or delayed one. And of all medical mistakes, diagnostic errors appear to be the most common, most costly and most dangerous.

On the health-care providers' part, missed diagnoses can come from fragmented medical records, overworked doctors, errors in pathology interpretations and lack of individualization of medical procedures and tests.

Patients contribute to the problem, too: You may fail to clearly communicate symptoms or not mention your family disease history. And, Mary, obesity further compounds the problem. Asthma symptoms often appear like breathlessness associated with excess weight.

One study showed that one-third of obese folks who had asthma were misdiagnosed. Obesity also means MRIs and CT scans can be inconclusive. This problem has doubled in the past 15 years.

But misdiagnosis happens to people of all ages, weights, backgrounds and afflictions. So here's what you can do:

1. After any diagnosis ask: What else could it be? And why did you rule that out?

2. Show up with a short list of questions, then speak up; don't let the doc rush you.

3. Always call for lab tests results; don't wait for the doc to get back to you.

4. Share your medical info/diagnosis/ test results/medications with all your doctors, and get them talking to one another.

5. Get a second opinion. No good doctor will ever object to you doing that.

Q: I had a friend who recently died of pancreatic cancer, about three months after diagnosis. Since then, I've heard most cases are caught too late to do anything. Isn't there a way to detect this sooner? — K. Beals, West Lafayette

A: We are sorry for your loss. Today, 80 percent of those diagnosed with pancreatic cancer already have it in their lymph nodes or beyond. Even for those who have localized disease, fewer than 25 percent live for five years.

But researchers have made some important breakthroughs. And none is more exciting than the discovery in 2012 of a then-15-year-old high-school student named Jack Andraka. He came up with a test strip (like those used to monitor blood sugar) that's infused with a substance that reacts to a biomarker called mesothelin that's present in your blood or urine when the disease first starts.

Dip the strip, which costs 3 cents to make, and results show in 5 minutes. It will very accurately register positive or negative for pancreatic cancer.

It seems to make early detection/screening possible; and it works for early, hard-to-diagnose, ovarian and lung cancer, too! Jack has won prizes for this, and it's been widely reported in the media, but we've yet to see it in clinical trials or picked up by a pharmacuetical company.

Hopefully, that breakthrough can piggyback on a newly developed clinical test to screen for genetic mutations in patients with a family history of pancreatic cancer, and on a potential gene-based test to determine pancreatic cyst type. All this may translate to more effective and individualized treatments.

One new possible treatment is the use of a bacteria to infect pancreatic cancer cells and zap them with radiation. Animal studies found it killed metastasized cancer without harming adjacent healthy cells.

Dr. Mike's Cleveland Clinic is searching for genetic markers of pancreatic cancer, and Dr. Oz's New York-Presbyterian is studying a vaccine that may prevent recurrence in people who have had pancreatic tumor surgery. We hope that soon, pancreatic cancer will be understood as well as and treated as effectively as breast cancer.

Dr. Mehmet Oz is host of "The Dr. Oz Show," and Dr. Mike Roizen is chief medical officer at the Cleveland Clinic Wellness Institute. Submit your health questions at www.doctoroz.com.