Monthly Archives: March 2007

Let’s Get It Right About MRI In Breast Cancer

An article in a major newspaper this morning confirmed a concern that I had regarding how the media might interpret the guidelines the American Cancer Society released today regarding the use of MRI as a screening tool for women at high risk of breast cancer.

The headline said that women at high risk of breast cancer should use MRI as a screening tool instead of mammography.

Simply stated, that is not correct.  MRI is intended to be used in addition to mammography to screen women at high risk of breast cancer.

I quickly checked someof the articles that appeared in other newspapers, and they got the story right.  But I remain concerned that the continued importance of mammography as a screening tool in women at high risk will get lost in the discussion.

So, let’s be clear: the American Cancer Society is not recommending that MRI be used in place of a mammogram in women at high risk, but is to be used as a complementary test in this situation.

I hope this information is helpful in understanding the continued importance of mammography in addition to MRI as a screening tool in women who are at high risk of breast cancer, as detailed in the … Continue reading →

MRI In The Early Detection Of Breast Cancer


Two reports—one in the New England Journal of Medicine and the other in the American Cancer Society’s CA A Journal for Clinicians—have been published that will go a long way towards helping patients and doctors make reasoned recommendations regarding the appropriate use of MRI as a screening tool for breast cancer. (Links for these articles were not available at the time this blog was posted.)


We have known for some time that mammography has its limitations, especially in the evaluation of certain groups of women.  We have also known that MRI, which is an expensive and occasionally distressing test, can sometimes pick up early breast lesions that might otherwise be missed by conventional mammography, even when done by very competent radiologists.


As good as MRI might be, it also has significant limitations.  Chief among those limitations was the fact that MRI picks up many lesions in the breast that turn out not to be cancerous, requiring additional biopsies that may otherwise have been avoidable.


Although the increased risk of what we call a false positive lesion might be acceptable in some women at high risk of breast cancer, it would not be acceptable if … Continue reading →

Tony Snow: The Impact Of Recurrent Colon Cancer

This has been a week notable for people in the public eye who have had a recurrence of cancer.


Last week, as widely reported, Elizabeth Edwards was diagnosed with recurrent breast cancer.


No sooner had that announcement swept through the media than Tony Snow, the President’s press secretary, announced that tests revealed he also may have a recurrence of his recently diagnosed and treated colon cancer.


The information released Friday by Mr. Snow indicated that follow-up studies had shown a small area of possible cancer recurrence in his abdomen. 


Through an abundance of aggressive caution, as he put it, he announced that he was going to undergo exploratory abdominal surgery on Monday to take a closer look at whether or not this in fact was a recurrence.


This morning we heard that in fact his cancer recurred and involved his liver. 


I decided to wait until this evening to find out if more information was forthcoming.  In fact, that is about all that we know.


I made a comment last week about Ms. Edwards that what we know is what we know, and we don’t know everything.

 Continue reading →

Elizabeth Edwards: Information About Statistics

There is some significant misinterpretation by the media with respect to the survival data for women with stage IV breast cancer.

In light of the importance of this to Senator and Ms. Edwards, as well as everyone interested in her story, I want to make certain that you understand that the numbers being quoted as coming from the American Cancer Society do not relate to Ms. Edwards situation.

We publish a monograph every year called Cancer Facts and Figures. In that booklet, we provide a wealth of information regarding cancer incidence, mortality, prevention and early detection along with a considerable number of statistics  related to cancer in the United States.

In that booklet there is a table titled “Five-Year Relative Survival Rates by Stage at Diagnosis, 1996-2002.”

In that table, the five year survival data for breast cancer is listed as:

All Stages:      88.5%

Local:              98.1%

Regional:          83.1%

Distant:            26.0%

Local disease is confined to the breast, regional disease includes the breast and adjacent lymph nodes, and distant disease includes the spread of breast cancer to other organs, including the bone.

This data is obtained from a comprehensive cancer statistical database called SEER, which is published by the National Cancer Insitute in conjunction with … Continue reading →

Elizabeth Edwards: What We Know And What We Don’t

Since arriving in the office this morning and learning of Elizabeth Edwards’ breast cancer recurrence, I have been trying to piece together the story of what happened and what the impact may be on Senator Edwards’ presidential campaign.


I have been fascinated (if that is the correct word) at the guessing games that have been going on both about her health and his campaign.


Now that I have had a chance to see the news conference, it is clear that all of this speculation about the Senator suspending his campaign was way off the mark.


In the same vein, I think it is important from a medical point of view that we bring a sense of rational discussion to the situation surrounding Ms. Edwards’ disease and her potential treatment.


A high profile person in the public spotlight always has to deal with the issues of health, especially when there are serious illnesses involved.  I have learned from experience that trying to guess about a particular person’s situation is a dangerous game, and frequently incorrect.


One also learns to respect the privacy of celebrities when it comes to matters of their health.  Should they … Continue reading →

Aranesp & Procrit: What Is The Danger?

It started as a report in a cancer professionals’ “insider” newsletter.  It is becoming one of the most important cancer stories of the past several years.


It is a story that has already affected how patients with cancer are treated, and is destined to shed light on how drug companies reveal information about the side effects of their drugs, how insurers and Medicare make their decisions about paying for drugs, and perhaps how doctors are reimbursed for their treatments.


It is about to enter the national spotlight through a Congressional inquiry.


The story is about a class of drugs called erythropoiesis-stimulating agents, which increase red blood cells in our bodies. 


You are most likely familiar with them through their trade names Procrit and Aranesp.  The generic names of these drugs are epoetin alfa (Procrit) and darbepoetin alfa (Aranesp).  They are commonly used in cancer treatment to reverse the anemia that results from chemotherapy and radiation therapy, as well as the chronic anemia that is related to the cancer itself.


If you watch TV regularly, it would have been difficult to miss the direct to consumer advertising over the past couple … Continue reading →

Is Tykerb A Major Advance, A Step Forward Or Both?

The media is abuzz today about the approval of Tykerb (also known by its generic name “lapatinib”) by the Food and Drug Administration (FDA).


Reporters are asking about how important this new targeted therapy really is and what will be its impact on the treatment of women with breast cancer.


The answers we provide to these questions today are fairly straightforward.  But the impact over time is a bit more uncertain.


Breast cancer is not one single disease.


When breast cancer is diagnosed, the doctors examine the cancer specimen for several different markers which give us clues as to how the cancer will behave, and what treatments may be helpful in preventing its recurrence.  These tests also provide clues as to what treatments may be most effective if the breast cancer relapses.


For many years, we have measured hormone receptors (estrogen and progesterone) in the breast cancer tissue, and more recently have added another genetic marker called HER2.


When this HER2 marker is present in the cancer tissue (as is the case in approximately 20% of the estimated 178,480 invasive breast cancers that will be diagnosed in women in the United … Continue reading →

Should We Screen For Lung Cancer, Or Not?

It wasn’t but a couple of months ago that an article was published in the New England Journal of Medicine that claimed spiral CT scans for the early detection of lung cancer could significantly decrease deaths from this disease.


Now, a study reported in this week’s Journal of the American Medical Association says that there is no evidence screening for lung cancer with chest CT scans does anything to reduce deaths from lung cancer.  In fact, this study claims, it substantially increases the number of cancers detected, the number of surgeries performed, and exposes patients to significant risks for no net gain in survival.


Why all the confusion?


This past October, as discussed on this blog, the New England Journal study indicated spiral CT scans were in fact able to reduce deaths from lung cancer by finding nodules early.  The survival of the patients where lung cancers were found had been outstanding, according to the report—much better than had ever been seen previously.


Although hailed by many experts and advocates as the answer to our prayers to reduce the suffering and loss of life from this terrible disease, there were those … Continue reading →

Virginia Is For Smokers, Not Lovers


A simple moment last week made me realize that I really don’t appreciate having cigarette smoke along with my lunch.


Maybe I’m just getting older and, in some ways, a bit less tolerant.  But this little episode reminded me how far we have come in terms of our expectations regarding second-hand smoke in public places.


As I have mentioned before in this blog, my wife and I travel quite a bit for various professional and personal activities. Last weekend, we happened to be in Pentagon City, Virginia while she was attending a medical organizational meeting.


On Sunday, we were caught in the middle of an ice and snow storm.  Although seated on the plane at 6AM, the flight was cancelled because of the weather and we trooped back to the hotel to wait out the storm.  The hotel happened to be attached to a large shopping mall.


That afternoon, we decided to go to lunch at a well-known chain restaurant which was located in the mall.


When we were seated, we asked for a non-smoking section, knowing full well that Virginia is far behind other states when it comes to … Continue reading →