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 →
(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 →
It’s no secret that genomics is cutting edge science. It is exciting, it is changing the way we think about ourselves and the medical care we receive. But with all the “gee whiz” aspects of what we are discovering every day about our genetic code, it may be surprising to learn that one of the most important parts of our new tool kit may be sitting right there in front of us gathering more dust than attention.
This revelation came while attending a conference this past week sponsored by a group called HL7. HL7 develops standards for the exchange, integration, sharing, and retrieval of electronic health information in the healthcare setting. They convened this particular meeting to better understand how we can more effectively integrate genomic data into health care delivery and research so we can full advantage of the information from genomic-derived science that is coming at us like a tsunami.
What stood out amidst all of the topics discussed-and what achieved the greatest consensus among the conferees-was the role that the tried-and-true basic family history can play in helping us understand how the information provided by genomics fits together with real life. That’s correct: the old fashioned … Continue reading →
Fate can work in mysterious ways.
A couple of months ago I was invited to participate in a symposium conducted by the National Cancer Policy Board at the Institute of Medicine in Washington DC. The topic was cancer in dogs, and how we might find ways to benefit dogs, their owners and science to better inform the treatment of cancer in humans through what is called “comparative oncology”. It was an unusual topic in my experience and that of my colleagues, so I eagerly anticipated learning about something I hadn’t given much consideration to in the past.
Little did I know at the time how personal this journey was going to be for me and my family.
Shortly after I accepted the invitation, we received sad news: our Golden Retriever Lily-who has been a member of our family for 11 years-developed swelling in her face. Our vet saw her the next day and told us she had lymphoma. The outlook without treatment wasn’t good, and with treatment wasn’t much better.
Tears flowed in our home that evening.
A week later we found a mass on Lily’s back leg. Another trip to the vet, another needle biopsy, and another … Continue reading →
When it comes to personalized/precision medicine we should never forget it’s all about the people, particularly the cancer survivors whose very lives depend on us getting it done quickly and getting it right.
That was the message from a discussion I had the privilege to moderate on Monday evening with cancer survivors and representatives of advocacy organizations, professional associations, government agencies, and industry at a session held in conjunction with the annual meeting of the American Society of Clinical Oncology (ASCO), now wrapping up in Chicago.
There has been an incredible amount of big science presented at this meeting that relates very directly to the care we provide cancer patients. Some of that science has immediate application to cancer care. On several occasions, acknowledged experts opined in front of thousands of physicians, other scientists, and health professionals that new treatments-particularly immunotherapy-were new standards of care in the management of patients with certain cancers.
Running in parallel to the development of new approaches to the treatment of cancer is the science that is helping to define and personalize which patients would benefit most from which treatments. As an example, for the new immunotherapy drugs there are biomarkers that may eventually … Continue reading →
Question: What do all these cancers have in common: Melanoma, lung, kidney, bladder, ovarian, head and neck, Hodgkin lymphoma, stomach, breast (and others)?
Answer: They have all shown evidence of meaningful, durable responses when treated with one or more of the new immunotherapy drugs. And that is truly amazing-not to mention very unexpected, even by the experts who know this stuff.
That’s the message that is coming out of the 2015 annual scientific meeting of the American Society of Clinical Oncology, where thousands of doctors, researchers and others from around the world make the annual trek to Chicago to share and learn the latest advances in cancer treatment.
The journey to this point has been fascinating. [more]
I personally had some interests in immunotherapy research back in the 1970’s when I was at the National Cancer Institute. We knew that our bodies’ immune systems could recognize some cancers as “foreign”, particularly melanoma and kidney cancer. Even though we had evidence that our bodies could recognize these cancer cells weren’t normal, our natural, “built-in” defense systems sometimes didn’t attack those cancers. The goal was to figure out how to make the immune system wake up and do its job. We … Continue reading →
It’s that time of year again, those months we all look forward to when life (sometimes) gets a little bit slower, the days a bit longer, and many of us take (yes!!!!!) a vacation. It’s also time for Don’t Fry Day, which is the Friday before Memorial Day. That’s the day when organizations including the American Cancer Society and led by the National Council on Skin Cancer Prevention remind you to be sun safe, and know what to do to protect the skin you are in.
From an American Cancer Society perspective, the rules are pretty straight forward and easy to remember:
- Slip! (on a shirt)
- Slop! (on the sunscreen)
- Slap! (on a wide brimmed hat), and
- Wrap! (on a pair of UV protective sunglasses)
I could go through a long list of what you should do and how you should do it to protect your skin, but it’s easier to go to our website or to the National Council on Skin Cancer Prevention website for that information. You should take the information to heart. Skin damage isn’t a walk in the park (or on the beach, for that matter)-either now while you may be on vacation, or years … Continue reading →
This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.
Are we prepared for the genomics revolution?
The President’s proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it’s probably time to get ready for some changes in our daily routines as health professionals.
I’m not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.
And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.
No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It’s not just about cancer, my friends. It will be coming to a primary care practice near … Continue reading →
The numbers about skin cancer incidence and costs in the United States are worse than anyone expected.
That’s the message that comes from a report published recently in the American Journal of Preventive Medicine on research from the Centers For Disease Control and Prevention, the Agency for Healthcare Research and Quality and the National Cancer Institute.
The researchers took a look at the number of skin cancers–both melanoma and non-melanoma–that were diagnosed in the United States for two different periods of time, from 2002-2006 and 2007-2011. They also examined the total cost of care for the treatment of those patients.
The staggering reality is that the average number of skin cancers diagnosed in this country in people 18 and older went from 3.4 million per year during the first time frame to 4.9 million in the second period. That means through 2011 that close to 5,000,000 (yes, 5 million) adults have a skin cancer diagnosed every year-and today that number may even be higher. [more]
In specific groups of people analyzed in this report, the researchers found the percentage of men age 65 and over diagnosed with a skin cancer in any given year went from 7% to … Continue reading →
(Note: This blog was originally published on another American Cancer Society website on July 29 because of technical problems on this site. Those have now been resolved and it is now reposted here. We appreciate your understanding.)
That was the core message that came out of the introduction Tuesday morning of the Surgeon General’s Call to Action to Prevent Skin Cancer at a meeting held at the National Press Club in Washington DC.
There were some other messages that now raise skin cancer awareness and prevention high on the public health awareness list, such as the fact that over 5 million people every year have a diagnosis of skin cancer (and many have more than one skin cancer), and that we are spending over $8 billion dollars treating the disease. But most important is the fact that this is one of the most preventable cancers, and if current trends are any indication we are not getting the job done when it comes to decreasing the number of skin cancers and saving lives. [more]
Acting Surgeon General Boris Lushniak MD and Assistant Secretary for Health Howard Koh MD were masterful presenting the evidence contained in the report, and … Continue reading →