Prevention

Cancer And The “Cure”

Words have meaning. And when it comes to cancer, especially advanced cancer, there aren’t many words that have more meaning than the word “cure.” Yet it is that very word and concept that is top of mind for some of us these days.

We clinicians are guilty as charged when it comes to reluctance declaring those who have had a remarkable response to treatments for advanced cancer “cured.” Experience has taught us over decades that we have misused the word and overpromised those we cared for. Our patients and loved ones have paid a price for our over optimism. Consequently, our culture has taught us to avoid the word, lest we be shown to have been less-than-truthful when a cancer returns with a vengeance.

And yet our world is changing: we are now seeing long term responses to treatments in diseases where until recently we had little hope of such success.

Recent reports of rapidly declining mortality in melanoma, normal life spans for many people treated for previously fatal diseases like chronic myelogenous leukemia, and the potential for impressive gains in outcomes for people with lung cancer are but a few examples that suggest we are indeed in … Continue reading →

What Will It Take To Shake The Tree And Save More Lives From Lung Cancer: A Report From ASCO 2019

Every year, the annual meeting of the American Society of Clinical Oncology is unmatched in bringing forward the latest advances in cancer care. It is a time to learn about important—and usually– incremental advances in cancer research and cancer care, and every year has some of us, especially those of us with some years under our belts, thinking about big picture themes in cancer: where we’ve been, where we are, and where we’re going.

For me, today’s theme is lung cancer and the sad fact that our care for those at high risk and those  diagnosed with the disease is far from what it should be. But more than I ever, I am convinced the future holds hope.… Continue reading →

The Remarkable Story No One Is Talking About: The Substantial Decline In Deaths From Advanced Melanoma

Here is some news about cancer that isn’t widely known and is hiding in plain sight: Deaths from melanoma—a skin cancer that has lethal potential—have declined dramatically over the past several years. And while that fact alone is surprising, so is the reason behind the drop.

Let’s make something clear at the outset: too many people die from melanoma. It is not the most common skin cancer (the American Cancer Society estimates 96,480 people in the United States will be diagnosed with melanoma in 2019, and 7,230 will die from it), but it is much more likely to spread and lead to death than most other much more common forms of skin cancer. And it has too frequently been a fatal disease.

That is now beginning to change, thanks in part to public awareness and earlier diagnosis. However, we can’t ignore what may be the most important factor: much better treatments. In fact, improvement in treatments with targeted drugs and immunotherapies have now begun to have a considerable impact saving lives for those with advanced melanoma.… Continue reading →

The American Cancer Society Sets A Goal To Reduce The Burden Of Cancer: Are We Up To The Challenge?

Ever wonder what would happen to cancer in this country if we all did better at what we do every day?

The American Cancer Society has an answer in a recently published paper in our journal CA: A Cancer Journal for Clinicians, and it may surprise you what we could accomplish if we set our minds to the task.

We recently reported that between 1990 and 2015, the cancer death rate declined by 27%. That’s a remarkable accomplishment. However, we still have a long way to go. Too many of us experience the burdens and losses from cancer. All of us want to see this disease in its many forms vanquished.

Our researchers looked at what would happen if all of us had the same cancer risk as college graduates in the United States, then came up with an estimate of how that would impact deaths from cancer from 2015 and 2035.

The answer: we could reduce deaths from cancer by close to another 40% beyond what we have already accomplished. That would be a total of over 54% from 1990. And it would mean 1.3 million fewer premature deaths from cancer between 2020 and 2035. Remarkably, it would mean … Continue reading →

Cancer Statistics 2019: Cancer Death Rates Have Declined 27% In 25 Years, And We Still Have A Long Way To Go

Good news is always welcome, especially when talking about something as serious as cancer. And there is plenty of welcome information in the American Cancer Society’s release today of our annual report on “Cancer Statistics, 2019” and its accompanying consumer-oriented version of “Cancer Facts & Figures 2019.”

Among the good news in this report: A significant decline in death rates from cancer—especially among some of the most common cancers, significant improvements in early detection and treatment of cancer, and a decrease in the disparities in death rates between African-Americans and whites.

Despite the good news, unfortunately, there are also pieces of the puzzle that have not been solved. And to ignore that information is a disservice to those who struggle with cancer and those who have passed because of this dread disease. The reality is we can—indeed, we must—do better. And that fact is an equally important part of the information contained in this report.… Continue reading →

Times Change, Our Bodies Change, And Now The Body Mass Index (BMI) Guidelines May Change Too

A recent news story in the Journal of the American Medical Association (JAMA) reminds me that lots of things in our lives are changing these days, not the least of which is the shape of our bodies.

Oh, my. This aging thing isn’t so easy, and that is really the message behind Rita Rubin’s timely piece about shifting body mass and muscle as we age and its implications. Although focused on women, I can attest personally that men fall into the same trap as well. That 250 pounds when you are older simply is not the same 250 pounds when you were in college. Now 250 pounds looks more like 280—even though the scale still says 250. Go figure…

Although I may be trying to provide a little humor to the subject, the reality is it’s not humorous when it comes to our health. As we age, muscle turns to fat. In a process called “sarcopenia,” muscle begins an inexorable march to become fat, and for most of us it doesn’t make too much difference how much we try to forestall the shift. It is programmed into our bodies, and although exercise might help, Mother Nature simply doesn’t … Continue reading →

Chewing Gum To Detect Cancer: Reporting The Hype, Diminishing The Facts

Sometimes It’s important to know the news behind the news: the comments and the cautions that don’t get into the article that the public gets to read. It’s the sort of thing that keeps me up at night: trying to convey the reality, while realizing what most people want to hear is the hope.

That’s the problem I have with a story posted on a major news network website yesterday, where I have a brief quotation that failed to capture the thoughts I tried to express at the time of the interview. The reporter had very limited time, and the information I wanted to provide was complicated. Instead of the caution I tried to convey to counter the potential “hype” about chewing gum to find cancer early, the report suggests that this is a test that will be available soon—while failing to inform how complicated it would be to achieve that goal.… Continue reading →

Few Boomers Get Hepatitis C Test Even Though It Can Save Lives

Are you a baby boomer? Have you been tested for hepatitis C virus (HCV)? Do you know why you should be tested for hepatitis C? Do you even know what hepatitis C is?

According to research published today by my colleagues from the American Cancer Society in the American Journal of Preventive Medicine, the odds are overwhelming that if you are in the boomer generation you have not been tested for the virus, and that has me wondering why that is the case. Could it be that we don’t know about hepatitis C? Could it be that our health professionals aren’t recommending testing? Could it be that the costs of treatment may be seen as a barrier to care?

Why is this important? Because if you do have hepatitis C you are at risk of dying from liver cancer and other diseases. The kicker: the deadly results of hepatitis C can be prevented with an effective, albeit expensive treatment. Deaths from liver cancer in the United States are increasing more rapidly than any other type of cancer, according to a recent report. And even when localized at diagnosis, liver cancer is most often fatal.

It doesn’t necessarily have … Continue reading →

Mark Cuban Asked And I Respond: Will This Company Transform The Economics and Results of Healthcare?

It’s not often you are asked publicly to comment on a particular investment by an entrepreneur as well-known as Mark Cuban. And although I don’t usually offer such advice, this one piqued my interest—more so because of a larger story than the particular company itself.

Mr. Cuban wrote that he is “really excited about changing the economics and results of healthcare with this one.” I don’t doubt his sincerity, however may I suggest there are some much bigger problems that need to be addressed to meet that noble transformative and audacious goal?

The company in question is called LungDirect. They offer a program that gathers information on CT scans performed for the early detection of lung cancer, analyzes the data and facilitates reports required by the Centers for Medicare and Medicaid Services (CMS) for payment under the Medicare program (more about that below). In short, it’s a sophisticated approach to what we call a “medical registry.”

I can’t comment here nor do I know whether their tool is any better or any worse than other similar programs. What I do know is that although registry reporting can be complex, creating technology that assists in tracking patients, collating, … Continue reading →

What Do We Do Now That Colorectal Cancer Rates Are Increasing For Younger People?

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
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