Monthly Archives: October 2005

Early Detection for Breast Cancer: No More Doubts

No sooner had I posted my Tuesday blog on the role of tamoxifen in the adjuvant treatment of women with breast cancer than the New England Journal of Medicine comes out with an article detailing the benefits of screening and adjuvant treatment.  In my opinion, this is a very important if not momentous article summarizing the real advances in the treatment of breast cancer that have been made over the past 30 years.


 


Let’s try to put this in perspective (it may be worthwhile to go back to my posting of 10/12/05, where I talk about the real measure of progress in the treatment of breast cancer). 


 


In the past, I used to give talks to doctors and occasionally patient groups about the treatment of breast cancer.  What confounded me and my audience during those talks was the fact that despite our best efforts to provide mammography and adjuvant treatment to women with breast cancer, we didn’t see any decrease in the rate of death from the disease going back, many, many years.  The death rate remained flat on the graph, meaning no improvement despite all of the advances we thought we were making.… Continue reading →

Tamoxifen and Adjuvant Therapy for Breast Cancer

An article was just released yesterday by the journal Cancer, which is published by the American Cancer Society.   It deals with the question of whether or not adjuvant therapy with tamoxifen extends the lives of post-menopausal women treated with tamoxifen after primary treatment for breast cancer.


 


Ordinarily, I wouldn’t have paid much attention to the article for a variety of reasons, some of which are noted below.  But several calls in response to a press release from the journal prompted me to take a closer look. 


 


Tamoxifen is a drug that has been around for many years.  I recall in the mid 1970’s when it first became available for the treatment of postmenopausal breast cancer.  It was the first real alternative to estrogen therapy.  Yes, you read that correctly:  high dose estrogens were one of the primary hormonal treatments for women with breast cancer.  And, they were effective although they did have side effects.  We also used progesterone, and, not infrequently, prednisone.  All of these were effective, and all had limiting side effects.


 


Then, along came tamoxifen.  For oncologists at that time, it was close … Continue reading →

Saving Lives, Saving Worlds

I attended a meeting today where there was discussion between American Cancer Society staff and an outside organization with whom we work very closely.  The purpose of the meeting was to review a number of projects we work on together, and review the progress being made on those projects.


 


I was struck during that meeting about how much cooperation has to occur in so many ways in order to make progress in reducing the burden of cancer.  I was also impressed about how necessary it is to pay attention to so many details and so many programs and opportunities, if we are going to be successful in our efforts.


 


It is sometimes difficult to get one’s arms around all of the different elements that must come together in order to do something successfully.  This isn’t a concept unique to the American Cancer Society.  You can probably relate to this in your daily work or other activities.  You have an idea, you develop the idea, you get buy-in, and that’s only the beginning.  The road to successful implementation is arduous and frequently the barriers can overcome the good intent.


 


It’s no different … Continue reading →

Herceptin (Again) and the News is Still Terrific

The American Society of Clinical Oncology held its annual meeting in Orlando this past May.  There were a number of papers presented that were very interesting, especially in the area we call “targeted therapies.”  My impression of that meeting was that we had finally reached a watershed moment in cancer treatment, and in fact had seen the validation of these targeted therapies as a legitimate, effective new treatment strategy for patients with cancer.


 


But one session in particular was, to say it mildly, incredible.  I have attended these meetings since the early 1970’s.   I had never seen anything like I saw that day in Orlando when there were presentations by several research groups describing the results of their clinical trials with a drug called Herceptin.  I have been to concerts and theaters in the past, and the exultation of the audience following each of these presentations was hard to believe for a medical research meeting.


 


What these various research groups had done was to treat women with a particularly aggressive form of breast cancer with a targeted therapy called Herceptin as a preventive therapy.  Their studies showed that the use … Continue reading →

Tobacco and Smoking: It Just Won’t Quit

It just won’t go away, this tobacco thing.  I wish there was something else as interesting to write about today, but I guess this is probably as important as it gets.


 


My day started out at breakfast with a newspaper article discussing the Supreme Court ruling indicating that the tobacco companies once again escaped the noose.  They are off the hook for $280 billion in potential damages for their past wrongs.


 


The CEO of the American Cancer Society, Dr. John Seffrin, said it well: “Tobacco companies must be held appropriately responsible for deceiving the American public about the health risks of smoking and exposure to secondhand smoke, the addictiveness of their products, and their marketing to children.”


 


How many lives, how much in wages, and how many years of life and love lost do we need to make us get this right?  $280 billion, believe it or not, probably wasn’t enough given the magnitude of the problem.  And now that opportunity is lost on a legal ruling.


 


But that isn’t the only issue that got my attention today. 


 


For example, there was the story in USA Today about the Continue reading →

Measuring Quality: It’s About Time

A research article recently appeared in the journal Cancer (which is published by the American Cancer Society) which reviewed errors in cancer diagnosis.  The research, performed at four reputable hospitals, made an effort to determine the number and impact of errors in cancer diagnoses made by pathology labs in those hospitals.


 


The title of the article was “Clinical Impact and Frequency of Anatomic Pathology Errors in Cancer Diagnoses.”  The authors went on to say that about 300,000 patients were harmed as a result of basically botched diagnoses.  In fact, they said that if different parameters were used to calculate the error rates, the number of people harmed would be much greater.


 


This is the type of article that points up several of the flaws in our medical care system, and highlights the difficulties the media has in trying to make sense of a complex story in the limited amount of space or time they have to provide their reports.


 


Basically, what these researchers did was look at the diagnoses that resulted from a cytology (think Pap smear) or needle biopsy specimen, and compared them to  subsequent surgical specimens biopsied from the … Continue reading →

The Real Measure of Progress in Breast Cancer

I had the opportunity to appear on MSNBC yesterday.  The topic was Breast Cancer Awareness Month, which the American Cancer Society sponsors along with other organizations every October.


 


The interview dealt with several questions, including common misconceptions about breast cancer, whether women under the age of 40 are at risk for the disease, and how to get information about breast cancer.


 


What I didn’t have a chance to say is what I think is the key message women at average risk for breast cancer need to hear loud and clear:


 


All of the advances in screening, all of the research, and all of the new treatments don’t mean a thing unless you get screened for breast cancer every year—every 12 months—if you are a woman age 40 or over.


 


That simple message and that simple commitment is the key to taking advantage of everything we have learned about this disease, and how to have the best chance of curing it.


 


As you may know by now, I like to reflect on the relatively recent past (which simply stated is the duration of my medical training and medical career) as a measure of the … Continue reading →

Vaccines in Melanoma: Perhaps Some Success At Last

A number of years ago, when I began my training as an oncologist, I had a special interest in the treatment of patients with metastatic melanoma and non-small cell lung cancers.


 


Both of these diseases were difficult to treat with chemotherapy, and even modest success with treatment was elusive.  One of my younger colleagues turned to me one day, and in a moment I haven’t forgotten, asked me if I had some sort of need to give hope where none existed.


 


Today, not much has changed.  For melanoma, there hasn’t been much material progress in the treatment of advanced disease.  Despite much effort, as noted on the NCI website, we have only a handful of treatments for patients with advanced disease and those treatments haven’t been particularly effective.  Survival for patients diagnosed with Stage IV melanoma remains dismal.  (It should be noted where we have made progress is in the early detection of melanoma.  That is a topic for another day.)


 


Parallel to my interest in melanoma was the development of vaccines to treat patients with cancer.  Because we could identify tumor antigens on melanoma that theoretically could stimulate the … Continue reading →

The Vaccine for Cervical Cancer: What It Means

My entry yesterday about information, how it is acquired, judged and utilized in advancing medical treatments mentioned the conservatism factor.  This is one of the reasons that it takes such a long time for information to get “from the bench to the bedside”, to borrow a professionally popular description.


 


No sooner had I completed the entry than I received a news release about Merck’s new vaccine for cervical cancer.  Although I had planned on continuing a general discussion of information and how it is used in medicine to move treatments forward (or not, as the case may be), I quickly decided that the cervical cancer vaccine should be today’s topic, since it is both of interest to many of us as well as an excellent example of how information flows.


 


The reduction in the incidence and deaths from cervical cancer in the United States is one of the true medical and cancer-related success stories of the past 40+ years.  The development of the Pap smear, which was until recently the standard test to detect cervical cancer and its precursors, has been the hallmark example of what can be accomplished through appropriate cancer screening.


 Continue reading →

Information: How We Get It and How We Use It

One of my colleagues asked me the other day to prepare some comments regarding the American Cancer Society’s role in disseminating results of research, and how we impact the movement of research information into clinical practice.


 


This is no small task. I could write a lot about this issue, since “information” is one of our organization’s nationwide priorities as well a longstanding key competency of the Society. 


 


We live in a world of information.   There is an ad currently playing on television which shows the old fashioned version of information where the newspaper delivery boy delivers the single daily paper.  Then, as the ad progresses, it shows literally hundreds of different types of information and entertainment being thrown at the house.  This is a very clear, effective example that shows how our lives have been changed by the information revolution and the impact computers and broadband have had—and will increasingly have—on our way of life.


 


What has also changed, as your kids can show you, is that there is an increasing expectation of access to information at little or no cost.  We’ve gone through the Napsterization of our information and entertainment, with … Continue reading →