Monthly Archives: April 2007

Some Thoughts While Traveling

My travels over the past several days have taken me to a number of cities to participate in various meetings and speak before several groups on the topic of cancer care and cancer prevention.


Although the schedule has been a bit hectic, it has provided a number of opportunities to reflect on a variety of issues that are important to me personally and may be of interest to you as well.


This week I spoke at the annual meeting of the Oncology Nursing Society in Las Vegas (where there is still smoking on the casino floor, by the way.  See my prior blogs for additional comments on this particular topic).


I gave a lecture at one of the sessions on the high costs of cancer drugs. I couldn’t avoid the opportunity to reflect with those in the audience on how far this profession has come over the past 35 years since I first began my training and practice in clinical oncology.


When I started my own practice in Baltimore in 1977, there was no such specific designation as an oncology nurse.


Certainly there were nurses who cared for cancer patients.  But … Continue reading →

The New Prostate Cancer Test: A Major Advance?

An article in the current issue of Urology illustrates some of the hopes and barriers related to advancing our abilities to diagnose prostate cancer accurately through screening tests, at the earliest possible time.


This particular article reports information about a prostate cancer protein found in the blood called EPCA-2.


The research, performed at Johns Hopkins in Baltimore—which is recognized as one of the leading prostate cancer treatment and research centers in the world—demonstrates that this new marker appears to be more sensitive and specific in detecting prostate cancer compared to the widely used PSA test.


But the question remains whether or not this is a major advance in the screening and diagnosis of prostate cancer.


The problem with the PSA test—which the article notes has been around and widely used for over 25 years—is that although it does detect prostate cancer through a fairly simple and routine blood test, it nonetheless is not particularly specific for prostate cancer.  That means that it frequently picks up other prostate conditions such as benign, or non-cancerous, enlargement of the gland.


Another issue with the PSA test is what is normal and what is abnormal in terms … Continue reading →

What Caused The Sudden Decline in Breast Cancer?

In December 2006 I discussed a paper presented at a national breast cancer meeting in San Diego which reported that there had been a dramatic decrease in the incidence of breast cancer between 2002 and 2003.


At the time, the authors indicated they thought the decrease was due to the fact that women had stopped taking their hormone replacement therapy medications in 2002 in response to a warning from the Women’s Health Initiative (WHI).  This large, nationwide study reported that combined hormonal replacement therapy (HRT) with estrogen and progesterone in post-menopausal women increased a woman’s risk of developing breast cancer.


My response was that I wasn’t so certain that stopping HRT was the complete explanation for the observed decrease in breast cancer cases.


Now, with the publication of a more detailed paper in the current issue of the New England Journal of Medicine, I must admit that I am still confused as to all the factors that contributed to the decline.


Like any puzzle, this one may yet turn out to have many complexities that have to be solved before we get to the conclusion.


In doing an analysis of breast cancer cases … Continue reading →

Senator Fred Thompson and Indolent Lymphoma

News today that Presidential candidate and former United States Senator has been treated for indolent lymphoma adds to the visibility and impact of cancer diagnoses and treatment in the current Presidential campaign.


First, we wish Senator Thompson well in his journey with his illness.  He is another example of how people with cancer continue to live their lives with vigor and expectations. 


As with the recent announcements from Elizabeth Edwards and Tony Snow, we once again see someone who is determined to move forward with life despite their illness, just as millions of people surviving cancer do every day in this country.


The American Cancer Society estimates there will be 63,190 cases of non-Hodgkin lymphoma diagnosed in the United States in 2007.  An estimated 18,660 people will die from this disease.  The International Lymphoma Classification Project estimates that about 22 percent of lymphomas are of the follicular variety, the one most likely associated with Senator Thompson’s illness.


Not all non-Hodgkin lymphomas are the same.  Some are more aggressive, some less so.  Some can be treated for cure; others are less responsive.  In one particular paradox, treatments for the … Continue reading →

Mammograms Still Count For Women In Their 40s

I returned from vacation this past Monday to a slew of headlines and media commentary about newly released guidelines from the American College of Physicians suggesting that women in their 40’s should reconsider the routine recommendation for screening mammograms in that age group.


The headlines were very specific, such as “Benefits of Mammography For Women In 40s Challenged” (Washington Post) and “Mammograms Under 50 Optional for Many Women: Group” (Reuters).


A press release from the College noted that the guidelines were evidence-based and advised women to become part of the decision making process.  The risks of mammography included “false-positive results, possible treatment for lesions that would not have become clinically significant, and radiation exposure.”


I have waded through the three articles and an editorial that comprised the report in the current issue of the Annals of Internal Medicine, and I am wondering if the media—and some of the experts who have been quoted—have actually read the articles. 


On top of that, I doubt that many have taken the time to actually look at the data in the United States, which has shown a clear decline in mortality from breast cancer in women in their 40’s … Continue reading →