Monthly Archives: November 2005

Smoking and a Cancer Diagnosis Don’t Mix

I was asked the other day to provide my perspective for an article published in the medical journal Cancer which discussed the harms of smoking after the diagnosis of cancer.


 


My first reaction was some degree of disbelief that an article would be published on that topic.  My second reaction, after reading the article, was quite a bit different.


 


Maybe my response initially was in part due to an underlying personal bias dating from my days as a medical student and when I was in training.  Perhaps, as was common among young doctors and my colleagues at the time, there was a degree of “the blame game.” 


 


After all, smokers got themselves into the dire situation they found themselves in, and now they had a predictable consequence of their action.  So why should they consider stopping once they have a diagnosis of cancer?  What difference could it possibly make? 


 


As it turns out, quite a bit of difference as very nicely presented by the authors in the journal article.


 


My bias is in no small part was rooted in my years of training to become an oncologist, and my … Continue reading →

Small Changes, Large Impacts: Colon Cancer

Last Thursday and Friday I had the opportunity to speak at a meeting in Chicago regarding colorectal cancer (CRC) screening. From my perspective, it turned out to be one of the more important lectures I have given over the past several years.


 


This is not a new topic for me.  I have written previously about the importance of cancer screening, and colorectal cancer screening in particular.  What distinguished this talk for me was the reason we had the opportunity to make the presentation, the partnership that got us there, and the impact it may have.


 


We are making new discoveries in the treatment and management of patients with cancer every day.  What is less well known is that we could save many lives every year if we only did what we already know.  Diet, lifestyle, alcohol and smoking are significant factors in the incidence of cancer in this country.  Modifying those behaviors could have a huge impact on the incidence of cancer in this country and in the world.  Screening for colorectal, cervical, breast and prostate cancer also contribute substantially to reducing the burden of cancer.


 


It comes as no … Continue reading →

Great American Smokeout: To Your Success!

Tomorrow is the 29th Great American Smokeout, an event that I can’t let pass without a comment.


 


Growing from the thoughts and efforts of a handful of people, the Smokeout has grown over the years into a signature event of significant importance and national interest.  It is part of the reason that today there are more former smokers living than current smokers.  It is part of the reason that many people have been able to quit smoking, and it is part of the reason that many needless, premature deaths have been avoided as people heeded the message and actually stopped smoking.


 


This is not just another “Day” that has some recognition.  It is a signal, perhaps a call, to those who want to stop smoking.  Having a plan to quit smoking is one of the crucial components that helps people to actually stop smoking.  Part of that plan includes a specific quit date. 


 


You don’t just decide to stop smoking one day and move on the next.  Yes, we all know people who are able to quit “cold turkey.”  But those folks are in the minority.


 Continue reading →

Vaccine in the Treatment of Pancreatic Cancer

A paper being presented today at an international conference is receiving a substantial amount of interest from the press, likely because of what appear to be excellent results from a new treatment for pancreatic cancer, a disease that is notoriously difficult to treat and has poor 5 year survivals.


 


There are 32,000 cases of pancreatic cancer that will be diagnosed in the United States this year.  Close to 32,000 people will die of this disease.  It affects women and men about equally, and is the fourth most common cause of death from cancer in men and women combined.


 


For years, doctors have tried to find ways to diagnose pancreatic cancer earlier.  The problem has been that it is generally a silent disease, and doesn’t present itself until it is too late to do curative surgery.  A patient presenting with painless jaundice (yellowing of the skin from bile backing up throughout the bloodstream) is pancreatic cancer until proven otherwise.


 


Because of this late presentation, most patients are beyond the opportunity for surgical cure.  Chemotherapy and radiation therapy may be helpful, but in reality there is no very effective chemotherapy for this disease.  Continue reading →

Screening for Lung Cancer: Why Not?

For those of you who may not be aware, ABC News is running a one month series on World News Tonight called Quit to Live.


 


As part of this series, they are producing several topical stories each week, as well as advertising and a website devoted to this effort to help people quit or not start smoking in the first place.


 


Born out of their grief over the death of Peter Jennings, who was highly regarded and respected by his colleagues, the staff at ABC set out to do something in his memory that would have an impact on smoking and health.  It is apparent from what I have seen so far that they deserve commendations for their efforts and their commitment.  In this day and age, nothing can influence behavior more effectively than the media, and their willingness to do this is invaluable.


 


I had the opportunity to appear on this series last evening to discuss the position of the American Cancer Society regarding screening for lung cancer. The question I was asked, and one which we are asked frequently, is “Why not screen for this disease?”


 


After all, lung cancer is a … Continue reading →

The Challenge of Surviving Cancer

Several months ago at the annual meeting of the American Society of Clinical Oncology there was an abstract presented which discussed the medical problems faced by cancer survivors.  In particular, this research looked at children who had been successfully treated for cancer, and the illnesses they developed as adults.


 


The news was not pleasing to hear.  These adults had more complicated medical histories and illnesses when compared to their siblings who had not had cancer.


 


The report got the attention of the press, and resulted in a number of articles and media presentations.  Unlike many similar types of press reports, this one actually resulted in several phone calls to me personally asking for information or help from a number of different people. 


 


One call in particular came from a lady who had Hodgkin’s disease in her teens, and was now in her 40’s.  She indicated that she had been receiving her routine medical care from the same oncologist who had been treating her all of this time.  But she sensed she wasn’t getting the right answers to her questions about the various problems and symptoms she was having.  Although she … Continue reading →

Would a Cancer Patient NOT Take Their Medicine?

I attended a two day meeting this past week which turned out to be more interesting than I had originally anticipated.


 


The title of the meeting was “Compliance Strategic Initiative”.  The primary purpose of the gathering was to discuss the issue of patient compliance with oral medications in women with breast cancer who use adjuvant hormonal-type therapy to prevent recurrence of their breast cancer.   The meeting was sponsored by the American Cancer Society, CancerCare, the National Surgical Adjuvant Breast and Bowel Project (NSABP), and Y-ME National Breast Cancer Organization.


 


A bit of background about the issue is probably in order.


 


I have written previously about tamoxifen, a drug that first became widely used and available in the mid-1970s.  We didn’t have many oral drugs available at that time to treat cancer.  Tamoxifen, oral cytoxan, chlorambucil and busulfan were a few that come to mind as I write this.


 


What was novel about tamoxifen was that it had few side effects compared to the injectable chemotherapy drugs that we were using.  That didn’t mean there were no side effects—just fewer of them.  To oncologists and their patients, this … Continue reading →

Your Support Makes a Difference: Prostate Cancer

There was an elegant research article published in Science last week that garnered a fair amount of attention.


 


This article discusses a research effort that identified a genetic abnormality in specimens of prostate cancer tissue.  This abnormality was found in 23 of 29 prostate cancer samples that were tested, so it wasn’t 100%.  But it still was exciting in the sense that it provided the first clues of how researchers might go about finding similar types of abnormalities in other common cancers, such as colorectal and lung cancer.


 


Why is the research important?  We know that there are events that happen in normal cells that turn them from benign to malignant.  Prior research has suggested that actually several such events have to occur before a cell actually becomes cancerous and can multiply into other cells and form the tumor many of us are familiar with as “cancer.” The best example I can think of is the series of genetic changes that occur in the usual case of colon cancer.  It takes many years for these changes to occur in most colorectal cancers, which in turn leads to the formation of a benign polyp … Continue reading →