Breast Cancer

When It Comes To Breast Cancer, Doing More Tests Doesn’t Necessarily Mean Better Outcomes

When it comes to our health and our health care, we love the numbers. Sometimes, we even fall in love with the numbers, assuming that the numbers tell us the whole story when in fact that may not be the case. Cholesterol numbers, blood pressure numbers, body mass index, whatever. As patients and consumers, we are frequently defined by our numbers.

But what happens when those numbers and other medical tests such as CT scans really don’t tell the story we think they do? The recent evolution of prostate specific antigen (PSA) is a case in point: for decades we believed the numbers saved many lives. Turns out PSA did save some lives, but not as many as we thought and at the considerable financial and human expense of treating many men who probably did not benefit.

So in that vein an article and editorial in a recent issue of the Journal of Clinical Oncology makes the point that just because we have numbers does not really mean they offer us the scientific certainty about the course of cancer we may think they do.… Continue reading →

We Are Beginning To Realize The Promise Of Cell Free DNA In Cancer Care

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 →

Precision/Personalized Medicine: Can We Afford Our Success?

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 →

Need To Balance Innovation, Benefits and Restraint When It Comes To The Rising The Costs Of Cancer Drugs

Cancer drugs—especially the new targeted and immunotherapies—are very, very expensive.

No doubt about that, and there is also no lack of effort trying to cast blame on who bears responsibility for those costs. There is even a recent article in the British Medical Journal that analyzes the size of the vials those drugs come in and suggests for some companies at least that may be a strategy to increase costs even further. What most experts can agree on is that this is a complicated problem for which there are no easy solutions.

I recently wrote a short commentary on the issue which appeared in Healio’s “HemOnc Today.” Although not exhaustive in terms of analyzing the issue, it does point out that we need to find a balance that continues to provide the incentive to innovate and bring new treatments to the care of cancer patients, while maintaining some degree of restraint given the reality that these costs simply cannot continue to increase without limit.… Continue reading →

Keeping A Cool Head On Cold Cap news

The Food and Drug Administration this week approved a device to reduce hair loss in women receiving chemotherapy for the treatment of breast cancer. The media attention has been extensive and highly favorable. But taking a closer look at this, there are a couple things, as yet unreported, that have me more than a little concerned.

The machine is a form of a cold cap, and is designed to reduce the blood circulation to the scalp while a woman receives treatment to either reduce the risk of breast cancer returning, or to treat recurrent disease. The theory—which has been around for decades—is that if one reduces the circulation of blood to the scalp you also reduce the circulation of the drugs that can cause hair loss to the hair follicles. The result is that the hair doesn’t fall out, a common and very sad side effect of some chemotherapy drugs.

It is that same phenomenon, reducing chemo’s attack on the hair follicles that has always been the concern, as well: by preventing the chemotherapy from reaching the scalp, are we creating a “safe haven” for tumor cells that may cause a problem years or even decades later?

But that’s only … Continue reading →

The Updated Breast Cancer Screening Guideline From The American Cancer Society

The American Cancer Society has now released its newly updated Breast Cancer Screening guideline in the Journal of the American Medical Association

This guideline—which was last updated in 2003—reflects the American Cancer Society’s best thinking on breast cancer screening for women at average risk of breast cancer. They are not intended for women at high risk, such as those with genetic abnormalities (BRCA as an example), a personal history of breast cancer or a history of radiation therapy prior to age 30.  That guideline is available on our website at www.cancer.org.

So let’s get right to the heart of the matter: what are the new recommendations?

  1. Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 (Strong recommendation*)

          1a) Women aged 45 to 54 years should be screened annually (Qualified       recommendation*)

          1b) Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually. (*Qualified recommendation)

          1c) Women should have the opportunity to begin annual screening between the ages of 40 and 44 years (Qualified recommendation*)

2) Women should continue screening mammography as long as their overall health is good and they have a life Continue reading →

10 Years And Half A Million Words…

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 →

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 →

Genomic Testing Reaches The Clinic: How Much Is Hope–And How Much Is Hype?

(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 →