Monthly Archives: February 2006

Prostate Cancer Dilemma: To Treat or Not To Treat?

A couple of years ago I participated in a small group discussion as part of a larger conference on the problems of getting more people to take cancer screening seriously.


 


During the course of that discussion the topic turned to prostate cancer early detection, a topic that I have covered previously.


 


I distinctly remember the comment of one of the members of the group, who happened to be the director of a large national employer based group interested in health care issues.  This representative, who happened to be very knowledgeable and very influential, was also very direct.


 


Her comment was to the effect that when it came to prostate cancer screening there were so many different recommendations and so much “noise” that it was confusing to her constituents, not to mention their employees as to what the right thing was to do with respect to prostate cancer screening.


 


Get your messages straight, she said, and then we (the employer community) will know what to do.  In the meantime, don’t blame us if we don’t seem too enthralled with encouraging prostate cancer screening.


 


You may or may not agree with such a blunt assessment, … Continue reading →

HPV Vaccine and Cervical Cancer Revisited

Not so long ago I commented on a study that demonstrated the effectiveness of a vaccine against the human papilloma virus, or HPV, that is now considered responsible for causing almost all cases of cervical cancers here in the United States and throughout the world.


 


What was exciting about the research report that prompted the blog entry was that the vaccine, tested in other countries in young women, was 100% effective in preventing HPV infection.  In addition, although the duration of the study was short, there was already a discernible decrease in the number of vaccinated women who developed cervical cancer compared to those women who did not.


 


At that time, it was apparent to most folks that the company that had sponsored the clinical trial and who had developed this particular vaccine was probably going to move quickly to get the vaccine approved by the FDA.


 


The company, Merck, did in fact submit a new drug application to the FDA in late 2005, and the approval process is moving forward.  Merck has recently announced that the vaccine has been given a priority review status with an anticipated decision by June 8.


 Continue reading →

Calcium/Vitamin D and Colon Cancer: No Answer Yet

This week we had another report from the Women’s Health Initiative (WHI), a federally sponsored long term study which has looked at a number of issues, such as hormones, diet and cancer prevention. 


 


This report, appearing in the New England Journal of Medicine, studied the value of calcium and vitamin D in the prevention of colorectal cancer. 


 


Last week, I was less than enthusiastic about their research report on the value of a low fat diet in reducing the risk of breast and colorectal cancer.


 


This week, different scenario, but the same conclusion.  


 


Once again, we will not have the answer to the specific question about whether or not calcium and vitamin D reduce the risk of colorectal cancer.  And this is after many, many years of study, in a research program that one of my colleagues called “the Rolls Royce of studies”.


 


I don’t mean to sound critical.  These are very well designed studies, by leading investigators who have contributed a heck of a lot more than their time to this effort for the past 15+ years.  These researchers are highly regarded, and are very knowledgeable. 


 Continue reading →

A True Victory: Fewer Deaths From Cancer

There is some considerable excitement at the American Cancer Society.   


 


For the first time since 1930, when statistics measuring the number of deaths from cancer in the United States were started, the actual number of people dying from cancer decreased from one year to the next.


 


I think that bears repeating so it is very clear: fewer American died from cancer in 2003 than in 2002.


 


That is a historic milestone.


 


I try not to get caught up in what I refer to as the “hope and hype” cycle of reporting cancer related news and information that has been so prevalent in the past When you deal with a life threatening illness, however, it’s hard not to grab on to bits of good information and try to make them sound better than they really are.


 


This is no such situation, so let’s try to put it into perspective.


 


We have known that since the early 1990s there has been a slow, steady decline in the rates of cancer deaths. For some of the major cancers, there has been a steady decline in the rate of death from those specific cancers, such … Continue reading →

What You Eat and What You Weigh Still Count

There is little doubt that two articles and an editorial just published in JAMA about the lack of benefit of a low fat diet in reducing the risk of breast and colorectal cancer in post-menopausal women are going to make big news. 


 


The media is already in a frenzy, ready to trumpet the information that watching your diet, if you are a post menopausal woman, doesn’t make any difference in the chance that you will get breast or colorectal cancer.


 


On the other hand there are a lot of people active in the cancer prevention, epidemiologic, and nutrition communities among others, who are afraid that the message the study appears to send will derail years of efforts to get people more involved in their diets and their lifestyles as they relate to the prevention of disease.


 


And there are some who are wondering how we ended up with a study that has been about 15 years in the making, involved almost 50,000 women, and didn’t give us a definitive answer to a very important question.


 


I still recall back in the very early 1990’s, as I attended a number of medical meetings and heard the presentations … Continue reading →

Cancer Screening: It’s Time to Make The Commitment

Every year the American Cancer Society releases an update to our guidelines for the prevention and early detection of cancer in our journal CA: A Cancer Journal for Clinicians, and this year is no different.


 


As far as our guidelines are concerned, there are no new or revised guidelines this year. 


 


But there are some interesting bits of information in the text of the article that bear emphasis, if for no other reason than they provide a “state of the nation” on where we are with respect to how well we are doing getting folks screened for cancer.


 


When you look at the data as to how many people are getting screened for cancer, you can see that we do a pretty good job of screening women for cervical cancer, and not so good for colorectal cancer.  You can also see that for some cancers, in particular breast cancer, the screening rates have actually decreased a bit for reasons that are not clear.


 


My colleagues who are the experts in this area tell me they aren’t certain if this is a leveling off for mammography, or reflects an actual trend downwards.  Either … Continue reading →