Survivors

Is It Appropriate To Offer The Public “Liquid Biopsies” For the Early Detection Of Cancer?

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 →

New Research On Ductal Carcinoma In Situ (DCIS) Brings Knowledge–Now We Need Understanding

It has been said that with knowledge comes understanding.

A research paper and editorial published in this week’s issue of JAMA Oncology may have brought knowledge, but if you read various media reports I am not so certain it has clarified understanding. And the distinction is important, because when a woman is confronted with the diagnosis of a “Stage O” breast cancer (aka ductal carcinoma in situ or DCIS), the decisions she makes about treatment can have far-reaching and long lasting impact for her and those who care about her. [more]

First, some brief background: DCIS was rarely diagnosed before the advent of mammographic screening for breast cancer. Perhaps it was found incidentally when a breast biopsy was done for another reason, or perhaps a woman or her physician felt a mass that turned out to be DCIS. Once mammography became more widespread in the 1970’s, we began to see a marked increase in the number of women diagnosed with DCIS. Today, the American Cancer Society estimates that in 2015 slightly more than 60,000 women in the United States will be diagnosed with this lesion (compared to 234,190 women who will have a more typical invasive breast cancer).

The situation … Continue reading →

Genomics May Be The New Frontier, But Knowing Your Family Medical History Is Still Very Important

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 →

Meeting A Stem Cell/Bone MarrowDonor Reminds Me About Ordinary People Doing Something Extraordinary

As I have mentioned previously, I travel quite a bit. And sometimes during those trips something interesting and unexpected can happen. That was the case a couple of weeks ago, when I was on a flight from Atlanta to Washington. And it impacted me in a way I could not have anticipated.

The flight was routine. Sitting next to me was a young man, likely in his 30’s, sitting next to someone he was obviously related to and quite a bit older. It was clear he was pretty excited about the trip, and I couldn’t help but overhear him say this was one of his first travels on an airplane.

I had a bit of work to do to prepare for a conference the next day, so I wasn’t particularly chatty during the flight. But I thought the older gentleman sitting next to the window could have been a veteran (which it turns out he was). Having been present when a number of the Honor Flights returning from Washington to Chicago on a Friday night at Midway Airport (when we usually get into town for a medical meeting), I was aware that a lot of veterans have never seen the … Continue reading →

Meeting A Stem Cell/Bone Marrow Donor Reminds Us All About Ordinary People Doing Something Extraordinary

As I have mentioned previously, I travel quite a bit. And sometimes during those trips something interesting and unexpected can happen. That was the case a couple of weeks ago, when I was on a flight from Atlanta to Washington. And it impacted me in a way I could not have anticipated.

The flight was routine. Sitting next to me was a young man, likely in his 30’s, sitting next to someone he was obviously related to and quite a bit older. It was clear he was pretty excited about the trip, and I couldn’t help but overhear him say this was one of his first travels on an airplane.

I had a bit of work to do to prepare for a conference the next day, so I wasn’t particularly chatty during the flight. But I thought the older gentleman sitting next to the window could have been a veteran (which it turns out he was). Having been present when a number of the Honor Flights returning from Washington to Chicago on a Friday night at Midway Airport (when we usually get into town for a medical meeting), I was aware that a lot of veterans have never seen the … Continue reading →

Some Of The Answers To Cancer Care May Be Found With Our Companion Dogs Walking Right Beside Us

Fate can work in mysterious ways.

A couple of months ago I was invited to participate in a symposium conducted by the National Cancer Policy Board at the Institute of Medicine in Washington DC. The topic was cancer in dogs, and how we might find ways to benefit dogs, their owners and science to better inform the treatment of cancer in humans through what is called “comparative oncology”.  It was an unusual topic in my experience and that of my colleagues, so I eagerly anticipated learning about something I hadn’t given much consideration to in the past.

Little did I know at the time how personal this journey was going to be for me and my family.

Shortly after I accepted the invitation, we received sad news: our Golden Retriever Lily-who has been a member of our family for 11 years-developed swelling in her face. Our vet saw her the next day and told us she had lymphoma. The outlook without treatment wasn’t good, and with treatment wasn’t much better.  

Tears flowed in our home that evening.

A week later we found a mass on Lily’s back leg. Another trip to the vet, another needle biopsy, and another … Continue reading →

The Survivors And Advocates Highlight That Personalized Medicine Is About All Of Us

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 →

Advancing The Tenet That In Cancer Care We Need To Embrace Curing When We Can And Comforting Always

It was the title of an article in JAMA Oncology that captured my attention this past week: “Advancing a Quality-of-Life Agenda in Cancer Advocacy: Beyond the War Metaphor.” That and, the fact that two of the authors (Rebecca Kirch and Otis Brawley) are my colleagues from the American Cancer Society.

As the American Society of Clinical Oncology (ASCO) convenes its annual scientific meeting in Chicago–where thousands of participants from around the world gather to learn about the latest advances in cancer research and treatment–we should not lose sight of the fact that the quality of life for patients during cancer treatment and survival is a critical part of what we must address as part of a holistic approach to the cancer care paradigm.

For decades cancer prevention and treatment has focused on the war metaphor: fight cancer, beat cancer, fight hard, whatever. The reality is that not infrequently people do everything right and they still die from this dread disease. Does that mean they didn’t fight hard enough? I don’t think so, and I suspect many of you agree.

But there is a yawning gap, and that is that we don’t pay as much attention to the … Continue reading →

Are We Ready For Inexpensive, Patient Directed Genetic Testing For Breast Cancer?

Years ago when I first started this blog I wrote about the democratization of information, and how people would come to an era where they had ready access to  information yet reserved  the right to determine whether that information was valid or not.

Fast forward to today, and a company called Color Genomics announced a new genomic based profile to measure breast cancer risk. They are clearly headed into the democratization of health care, since they are pricing the test at $249 and have tried to reduce the barriers for women and men to get the test.

Inevitably, this announcement is going to fan the flames of how far we should be going to allow people to get whatever laboratory tests they would like, whenever they want them. Although a health professional must order the test, in reality doctors will be available to meet your need if you decide to bypass your personal physician. And although most professional organizations active in this field recommend genetic counseling from a qualified professional be done  before such tests are done, the company says they will provide such counseling-after the test results are known. [more]

When it comes to expert opinion about … Continue reading →