`No progress in cancer care? Really?
That’s the question I am struggling with following an interview I did with a radio network last week, and which will likely be released a couple of weeks from now. I was asked to respond to the premise offered by a book author who is a well-known professor at a major academic medical center, exclaiming that our treatment for cancer is based on “Slash, burn and poison” and that our cancer research efforts are currently substantially misdirected.
Instead, the professor says, we should admit that we have not made meaningful progress in treating cancer, and that our research is too directed to the end of the cancer cycle (namely a couple of months improvement in life expectancy for those with cancer) and in fact should be focused on the “first cell.”
It’s a refrain I have heard before, as early as my beginning engagement in treating patients with cancer in the 1970s. “Slash, burn and poison”—or similar words—were legion at that time. Surgery, radiation and chemotherapy were toxic, had substantial side effects, often ineffective and not offering much hope beyond a small number of cancers such as Hodgkin Disease which was showing excellent responses … Continue reading →
Sometimes it all depends on your point of view when it comes to areas of divergent opinion about the value of certain medical tests and procedures.
So it should be no surprise that the release earlier this week of the United States Preventive Services Task Force draft statement of their new updated recommendations on the use of the PSA test to screen men for prostate cancer has generated some controversy of its own.
However, this time around it’s not just the advocates or the detractors aiming their fire at the Task Force—it’s journalists and bloggers battling over how media reports and headlines portrayed the impact and ultimate meaning of that draft report (I emphasize “draft” with more on that later). The report basically took the PSA test out of Task Force purgatory by changing the prior recommendation from “don’t do it at all” to a more permissive “have a discussion and make a decision if it’s right for you.”… Continue reading →
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 →
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?
- 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 →
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 →
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 →
I had an interesting day this past week. Sadly, it left me wondering why the same “hope and hype” directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.
In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren’t necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.
Not long after, I was informed of an online discussion on Twitter (called a “tweet chat” at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a “scrum” of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the limitations of our … Continue reading →
News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to “watchful waiting” after they were diagnosed.
But guess what? There’s a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the “watchful waiting” as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. [more]
The study was performed in Sweden, Iceland and Finland. Between 1989 and 1999, 695 men were entered into the study after they were diagnosed with prostate cancer. Half were assigned to undergo a radical surgical removal of the prostate gland, and half were assigned to “watchful waiting.” Now, watchful waiting today means we watch, and if a patient’s prostate cancer changes its characteristics, … Continue reading →
We’ve all heard the phrase, “When you come to a fork in the road, take it.” Well, that saying may hold particular relevance while reviewing a new research report published today in the New England Journal of Medicine.
The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of the drug finasteride could reduce the incidence and deaths from prostate cancer. The study was called the Prostate Cancer Prevention Trial and when it was initially reported in 2003 it showed that the drug could reduce the incidence of prostate cancer by almost 25%. However, there was a catch: there was actually an increase of almost 27% in the number of high grade-or more serious-prostate cancers in the group treated with finasteride compared to those men who did not get the drug. The men in this trial were followed very closely. Since this trial was done in an era when PSA testing to find prostate cancer “early” was part of routine care, these men were screened regularly with the PSA test.
The originally reported results of the trial meant two things to the researchers: first, finasteride was successful … Continue reading →
Coming to an office near you: a new test that can “confidently” predict whether or not you need to have aggressive therapy for your newly diagnosed prostate cancer.
That’s what the press reports would lead you to believe. And it’s really going to catch your attention if you’re one of the tens of thousands of men who will have to decide what to do if you are diagnosed with prostate cancer that has what we call “favorable characteristics.” And with the test coming to market, you would assume that your doctor would have a good understanding of whether or not it works based on the available studies and information. But guess what? The likelihood of that is pretty low, because your doctor has probably been reading the same press reports as the rest of us, since the scientific studies that doctors should rely on to make decisions about this test are simply not available. But the website promoting the test is there for all to see.
Do I sound a bit skeptical? Well, maybe I am. Because if the PSA experience has taught us anything about testing for prostate cancer, it is that we should learn the evidence before … Continue reading →