After years of declining rates of colorectal cancer (CRC), a new study from the American Cancer Society raises the specter that not all is going as well as we would have hoped, especially among younger folks born since 1990. And that raises the question of what the future holds for this frequently preventable form of cancer, including a possible reexamination of when it is appropriate to start CRC screening for people at average risk of developing the disease.
The research, published today in the Journal of the National Cancer Institute looked at the rates of colon and rectal cancer diagnoses from 1974 through 2013 in several parts of the country. The researchers were particularly interested in changing patterns of CRC in people 20 years of age and older who were diagnosed with invasive CRC from 1974 through 2013.
There is a lot of complexity in the published results, so let’s focus on the main messages of the study:
- After decreasing since 1974, colon cancer incidence rates increased by 1% to 2% per year from the mid-1980s through 2013 in adults ages 20 to 39. In adults 40 to 54, rates increased by 0.5% to 1% per year from the
… Continue reading →
I am devoted to my fitness tracker, having used it for several years to remind me to be active, monitor my diet and improve my sleep. Now the New York Times tells me it doesn’t make a difference, at least when it comes to the weight loss part of the program. And I might agree, if only the evidence they relied on told the whole story. In my opinion, it did not.
Unfortunately, some of the science on which the Times’ reporter based his comments had a possible flaw that may influence the conclusion that fitness trackers not only don’t encourage weight loss, but improbably may lead to less weight loss when using the device.
That, my friends, would be a real bummer. However, if you had evaluated that research closely you may have been aware of the problem. From where I sit, I don’t think many folks have made that effort. And I remain unconvinced that the research supports the conclusion that fitness trackers–when used in typical real-life situations–don’t make a difference in keeping us engaged in our health including as an adjunct in weight loss programs.… Continue reading →
A report in this week’s Journal of the American Medical Association (JAMA) shows that too few women with recently diagnosed breast cancer and at high risk of a BRCA genetic mutation received appropriate genetic counseling and testing for the mutation—a missed opportunity not only to improve treatment for these patients, but also to prevent some breast, ovarian and other cancers in the first place.
This study makes the difficult point that when it comes to routine screening for genetic abnormalities in women (and men, for that matter) who may be at increased risk, we simply aren’t doing the job. The situation may well be worse than this report suggests, especially considering that in some areas of the country Medicare doesn’t even cover preventive testing for the BRCA mutation. And this is more than 20 years after the test was first discovered and placed into clinical practice.
I guess sometimes it takes a long time for the way we care for our patients to catch up with the science that we know works. But twenty years??? Uh, that seems like a long, long time.… Continue reading →
Right now, when we want to know everything we can about a tumor, we do surgery: a biopsy to take a sample of it and look at it under a microscope and determine as best we can how to treat it. But what if instead you could get a blood test, and learn even more. That’s the promise of the relatively new science of what is called cell free DNA (cfDNA). It holds the hope of helping us better understand cancer, its behavior in our bodies over time, and even offering clues on how to better treat cancer in ways we would never have imagined even a few short years ago.
It was an important area of discussion at the American Society of Clinical Oncology meeting this week. It’s a meeting where, every year, we get a sense of the future of cancer treatment before it becomes a reality. From genomics, to immunotherapy, to targeted therapies–you name it—promising areas appear on the scene, then either become part of our reality or lose luster as the process unfolds over the course of several ASCO annual meetings. This year, several studies presented on the topic of the so-called “liquid biopsy” illustrate how … Continue reading →
Here at the at annual meeting of the American Society of Clinical Oncology in Chicago, we are beginning to see the future of cancer therapy—and it raises a provocative question: will precision medicine become so precise, we risk turning off the much-needed investment of human, intellectual and financial capital that keeps progress flowing?
The sheer number of new drugs and new combinations of drugs being reported here at the world’s biggest, and most relevant cancer conference is staggering. Not all of them are ready for prime time, and some may never be successful in the clinic for large numbers of patients, but it is clear the era of old fashioned chemotherapy is diminishing and newer forms of therapies (targeted and immunotherapies among others) are on the rapid ascent.
But with progress, it’s becoming clear that a changing paradigm in cancer care that was predicted a number of years ago is now coming to life.… Continue reading →
I just noticed this blog celebrated its 10th anniversary this September. So I hope you won’t mind me taking this opportunity to share some observations and reminiscences of what it’s been like to document by blog a decade of the changing landscape of cancer.
The first blog was published on September 9, 2005 when I introduced the blog and my vision for what i hoped it would represent.
The blog originated with a concept developed by our media relations team. Social media was just coming into prominence, and the Society was looking at ways to get into this space. Bob Lutz, a senior executive at General Motors at the time, was the model: he wrote a regular blog himself, and was pretty open in sharing his thoughts. It was clearly not one of those ghost written, pre-packaged types of things. How he found the time to do a blog was an interesting question, but the concept was intriguing: if we could have one of our senior folks write something similar, perhaps it would get some recognition in this rapidly expanding means of communicating.
So we ventured into the space and I started writing “Dr. Len’s Blog”. One of … Continue reading →
The recent announcement by a California company offering DNA blood tests (also known as “liquid biopsies”) for the early detection of cancer takes us to a place most of us expected we would get to, but much earlier than we are prepared for. Simply stated, our technology and rush to get new tests to market-even before we have a basic understanding of how to use those tests to improve the health of consumers–has outstripped our scientific understanding, and we ignore the implications at our own peril. [more]
First, some history:
The concept of having a blood test to diagnose cancer early is not new. In fact, I recall an international meeting about a decade ago where a lecturer predicted the diagnosis of cancer through a simple finger stick that would be sent to a lab for analysis.
Fast forward to June of 2009 when I was a guest on the Today Show and was asked to offer a closing thought telling viewers something they didn’t know about cancer. My comment was to the effect that one day in the not too distant future we would be able to find cancer cells circulating in the blood in people who didn’t … Continue reading →
(The following blog was originally posted on MedpageToday on August 3, 2015. It is reprinted here with permission.)
Genomics and its impact on clinical medicine appear to be the topics du jour. The science is rapidly advancing, but our ability to understand and apply that science may not be keeping pace. The question is whether expectations will meet the promise, and are we wise enough to navigate the maelstrom and bring true benefit to our patients and consumers in general?
Three recent research reports highlight how fast some of this discovery is moving. Two reports focused on the use of cell-free DNA fragments extracted from the blood and saliva to identify cancer related markers in patients with pancreatic and head and neck cancer. The other reported discordance in DNA from mothers and their fetuses discovered when prenatal blood tests were done, again using cell-free DNA. In short, the researchers reported on situations where a prenatal screen showed abnormal DNA, the fetus was tested and showed normal DNA which then led to the discovery of cancer in the mother.
To be certain, there are many similar research reports. But they all point in the direction that we are soon … Continue reading →
It’s no secret that genomics is cutting edge science. It is exciting, it is changing the way we think about ourselves and the medical care we receive. But with all the “gee whiz” aspects of what we are discovering every day about our genetic code, it may be surprising to learn that one of the most important parts of our new tool kit may be sitting right there in front of us gathering more dust than attention.
This revelation came while attending a conference this past week sponsored by a group called HL7. HL7 develops standards for the exchange, integration, sharing, and retrieval of electronic health information in the healthcare setting. They convened this particular meeting to better understand how we can more effectively integrate genomic data into health care delivery and research so we can full advantage of the information from genomic-derived science that is coming at us like a tsunami.
What stood out amidst all of the topics discussed-and what achieved the greatest consensus among the conferees-was the role that the tried-and-true basic family history can play in helping us understand how the information provided by genomics fits together with real life. That’s correct: the old fashioned … Continue reading →
When it comes to personalized/precision medicine we should never forget it’s all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.
That was the message from a discussion I had the privilege to moderate on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO), now wrapping up in Chicago.
There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.
Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually … Continue reading →