What about this new blood test for cancer?

An FDA advisory panel recently recommended approval of the Galleri blood test that uses DNA technology to look for evidence of over 50 cancers in people without symptoms. The idea, like all “screening” tests, is to find cancers before they cause symptoms and when they are easier to treat.

While it has not yet received FDA approval, I expect this to follow.

How good is this test and should you get tested?

Blood tests have been used before to look for asymptomatic cancer. The grand daddy is the PSA (prostate specific antigen) test that has been used for almost 40 years to look for early prostate cancer. (Its value is still controversial after all this time.)

Other cancer markers have proven to only detect advanced cancer and are used to monitor patients with known cancers, but are not recommended for screening. Examples would be the CEA test, elevated in colon, pancreas, breast, ovarian and other cancers and CA125, elevated in ovarian and other cancers.

Two DNA tests are now approved to look for asymptomatic colon cancer: Shield and SimpleScreen. These very similar tests have the common problem of being very good at detecting advanced cancer but not very good at detecting precancerous polyps or small stage 1 cancers. They are recommended for screening only in people who refuse colonoscopy.

What about Galleri?

Large trials have shown that about 1% of people over 50 with no symptoms to suggest cancer will have a positive test. About half of those with a positive test do have cancer. The test is also able to identify the origin of the cancer in most cases.

The problem? The test is much better at detecting advanced cancers than stage 1 cancers. The trial failed its goal of reducing the numbers of stage 3 and 4 cancers in those tested compared to those not tested.

Should you ask for the test? You can get it now with a doctor’s prescription but must pay for it yourself, at a cost of $800-$950. Once it has FDA approval, many insurance companies will pay for the test but are not required to do so.

Until a better test is available that reliably picks up very early cancers, I do not plan to have one of these tests done. You may feel differently. It is a personal decision.

Whether you do or do not, it is crucial that you get regular mammograms and colonoscopies, which have been shown to detect cancers early, when the results are best. Galleri is not a substitute for these proven screening tests.


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I am feeling dizzy. Should I take Antivert?

Many of us get dizzy occasionally. “Dizzy” means different things to different people. It may be weakness or lightheadedness at times. Most often, it is vertigo: a sense that the room is spinning or that you are spinning.

Historically, doctors have prescribed meclizine (brand name Antivert), a sedating antihistamine, to treat vertigo. While it is FDA-approved for this purpose, it is not always a good choice.

The commonest cause of vertigo is a shift of tiny stones in the middle ear (“otoliths”) into the wrong position. This causes BPV: benign positional vertigo. It typically comes on with a change of position. You feel as if you just got off a merry-go-round when all you did is get out of bed or lie down. [Note – the vertigo can come with any change in position – lying down or turning to one side may trigger it as well as getting up.]

Weakness or wooziness without the sense of spinning when getting up is NOT BPV, but more likely a drop in blood pressure resulting in less blood getting to the brain.

The treatment of BPV is a maneuver that moves the head to get the otoliths back into the right place. It can be done by a physician, nurse or physical therapist who know how, and usually cures the problem. Pills, with their side effects, have no place in treating this condition.

Meniere’s disease is a recurrent vertigo, usually accompanied by hearing loss and/or ringing in the ears that comes for no reason. Here meclizine may be helpful, but should only be used for the acute attacks, not on a prolonged basis.

Acute labyrinthitis comes on suddenly and can be severely disabling, making walking almost impossible. It is due to inflammation of the nerve to the inner ear. It can be accompanied by hearing loss, and if it is, is an emergency, requiring steroids to prevent permanent deafness. Sometimes the vertigo is so severe that the hearing loss is overlooked.

Meclizine can be used for a few days to help the troubling dizziness of labrynthitis, with the understanding that it is treating symptoms that are going to pass on their own. It is not curing the condition.

Why not use meclizine more freely?

A recent study looked at people who had been diagnosed with vertigo who were or were not prescribed meclizine. Those prescribed meclizine had almost three times as many falls resulting in emergency department visits as those who were not.

Add that to the concern that sedating antihistamines contribute to confusion, and it is clear. Meclizine may help with troubling vertigo, but it should be used in as low a dose and for as short a time as possible.

Finally – a warning. The new onset of vertigo that lasts for more than half an hour can be a stroke, and demands immediate evaluation.

What shots should I get this fall?

Ah, fall. Children go back to school, leaves turn color and it is time to think about your immunization against winter viruses.

What, if any shots should you get?

Influenza is not “just a bad cold.” Influenza lays you out with hacking cough, fever and muscle aches. While it rarely kills healthy young adults, it can, and it certainly kills frail elders and small children. Even young healthy people can be laid up for a week or more.

We never know how bad a flu season iwill be until it is upon us, and everyone should get an annual flu shot, which you can get at your doctor’s office, many pharmacies and local town-run clinics. The standard shot is fine for most. People over 65 or those with weakened immune systems should get either the “high dose” formulation or the new mRNA shot (which may not be as readily available this season).

What is most exciting about the mRNA flu vaccine is that in future years, it will allow the virus to be targeted much more accurately. The way flu shots are now made requires the manufacturers to commit to a flu virus target well in advance of the season. Sometimes the experts nail it while other times the shot is not a great match for the circulating strain. The new technology will shorten development from 6 months to six weeks, allowing manufacturers to adjust the shot if the virus mutates.

COVID is still with us, and yes, you should get a booster. The current shot is quite different from the original one, though not very different from last fall’s.

The FDA prioritizes those over 65, but there is no reason why anyone except perhaps young healthy men should not get one. (For reasons not fully understood, adolescent and young adult males are most prone to serious side effects such as inflammation of the heart, though even in that group, the heart damage is self-limited and benefits outweigh risks.)

While the COVID shot is only modestly effective at preventing infection and mild illness, it is very effective at preventing serious illness and death.

If you are over 75 and/or have bad lungs, get a one-time RSV (respiratory syncytial virus) shot. If you have had one, you do not need to repeat it.

Women in late pregnancy during the fall and winter should get immunized to protect their infants; RSV is a major illness for newborns. If the mother is not immunized, infants can be protected by a shot of monoclonal antibodies.


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