As I write this, I am returning from a trip to Los Angeles where I participated yesterday in a panel discussion on the topic of cancer prevention and early detection. The occasion was the 2012 Global Conference sponsored by the Milken Institute. (If you are not familiar with this conference, it is probably one of the premier finance and investing conferences in the country, if not the world. And the luminaries in attendance--both as attendees and speakers--were a testament to the influence of the Institute and its founder, Michael Milken.)

I was on this panel through an invitation from the Melanoma Research Alliance and its chief executive, Wendy Selig, a former colleague of mine when she was at the American Cancer Society Cancer Action Network.  Other participants included Dr. Stephen Gruber, who is the recently appointed director for the USC Norris Comprehensive Cancer Center in Los Angeles, Dr. Sancy Leachman who is the director of melanoma and cutaneous oncology at the Huntsman Cancer Institute in Salt Lake City, and Sherry Lansing who is the CEO of a foundation of the same name and a well-known cancer research advocate (she is very well known in the entertainment industry as the former head of Paramount Pictures and one of the people who conceived of Stand Up To Cancer which has done much to transform the landscape of cancer research in this country).

What made this event more interesting was that the audience was made up of those same financial and investing folks I mentioned above. As you might imagine, almost all the sessions were devoted to topics very relevant to their professional interests. The topic of the session I participated in was a bit off the usual target of the meeting. This session was not about investing--it was about health. I must admit that I was surprised at the number of attendees who joined us for our discussion, and even more pleasantly surprised that they remained engaged throughout our 90 minutes.

In what would have otherwise been a fairly typical recitation of facts about how cancer prevention and early detection can reduce the burden and suffering from cancer, a theme emerged: we as professionals are not doing our best in clarifying our advice about the prevention and early detection of cancer through cancer screening.

When you are sitting in a room with some very intelligent people realizing that our lack of clarity and conflicting recommendations on advising people what they need to do about their health, you begin to understand that we are facing a dilemma that could have a significant impact on how successful we are going to be in getting people to take action to reduce the risk of cancer or finding it early. More...

One of the things I enjoy about what I get to do every day--besides working for a wonderful organization, committed volunteers and very special colleagues--is that I am able to get a broad overview of the world of cancer research, diagnosis and treatment, among other topics. Over time, one gets to incorporate that input into a larger vision of where we have been, where we are and where we are headed.

Sometimes that "larger vision" is challenged with new information that makes you think a bit about whether you need to readjust your thinking about the state of cancer research and treatment. Recently I attended a meeting where just such a challenge occurred.

The meeting was convened by the Institute of Medicine, and brought together stakeholders to be informed and discuss the current status of genomics and drug discovery in cancer. To a more specific point, it provided insights from a variety of viewpoints on the current status of genomics as a science and how that science and knowledge will be translated to the care of patients, with the obvious goal of reducing the burden and suffering from cancer.

What I heard--while reinforcing some of my usually optimistic thoughts--actually was troubling. As we look to the future of that translation, it was clear (at least to some of the presenters) we are headed for some speed bumps. How we handle those speed bumps could define the progress we make in cancer treatment over the next decade or even longer. More...

I have a confession to make:

As soon as I finished reading the Annual Report to the Nation yesterday as I was preparing to write my blog, I got up from my desk and took a walk for 20 minutes.

What, might you ask, compelled me to do this?

The answer is what made me take a walk is the same reason I am writing this follow-up commentary to yesterday's blog: Sitting at my desk all day may kill me. It may be doing the same for you. More...

Sometimes science is not as convenient as we would like it to be. We want answers, we want clarity, we want direction--especially when it comes to the treatment of patients with cancer.

So when I read two articles and an editorial released Wednesday in the New England Journal of Medicine, I was struck as to how studies seeking to answer similar questions could come to different conclusions. And, as I struggled to explain the research findings to reporters prior to their release to the general public, I found myself searching for words that would adequately explain the message of the research. Quite frankly, determining that message proved to be difficult. More...

Welcome to the New Year!

And as has been the case for many years in the past, the American Cancer Society takes the New Year opportunity of providing the nation with the latest estimates of cancer incidence and deaths, along with a measure of how well we are doing in reducing the burden of cancer in the United States.

The data is contained in two reports released today by the Society: the consumer oriented Cancer Facts and Figures 2012 and the more scientifically directed Cancer Statistics 2012. Both are available online. 

It is never "good news" to realize that the burden of cancer in this country is immense. And with the country gaining in population and age, the extent of that burden is inevitably going to increase. But this year's report does contain some welcome information, namely that cancer death rates have declined in men and women of every racial/ethnic group over the past 10 years, with the sole (and unfortunate) exception of American Indians/Alaska Natives. In addition, the Society now estimates that a bit more than one million cancer deaths (1,024,400 to be exact) have been avoided since 1991-1992.

That one million number is actually more significant than it seems. Many of the people in that 1 million never heard the words "you have cancer." Maybe they had a colon polyp removed before it became cancerous, maybe they stopped-or never started-smoking. Maybe they had a pap smear that found a pre-cancerous lesion. And then there are the patients who have benefitted from the advances in cancer treatment that have occurred over the past number of decades.

But the 1 million number also means that these are people who have hopefully remained active and engaged in life, loved by their families, productive in their communities. In economic terms, the return on investment on avoiding those one million deaths may likely be incalculable. In human terms, it is an amazing accomplishment. More...

The announcement today from Canada that women should severely curtail their use of screening mammograms for the early detection of breast cancer and discontinue regular clinical examinations and self-breast examinations was interesting in and of its own. But the editorial that accompanied that announcement-from a long-time avowed skeptic of the benefits of screening mammograms-took the debate to a new level. Whether that level was higher or lower is a matter of personal interpretation, but in the editorial was the statement that abandoning breast cancer screening is the most effective way we have to reduce the risks of breast cancer. The statement, highlighted in an accompanying press release (http://www.eurekalert.org/pub_releases/2011-11/cmaj-nbc111611.php) was, in short a stunner.

What is even more amazing is that there hasn't been much reaction to that statement. And keep in mind that just two days earlier, the medical journal The Lancet published a letter from an international  group of experts in breast cancer screening who raised the issue of an organized anti-mammography campaign orchestrated in part by the head of the Nordic Cochrane Centre, headed by none other than the physician who wrote the editorial. But from where I sit-a place that is usually the epicenter of these discussions-there has in fact been very little reaction. No media, no frantic calls, no running to man the barricades. Essentially, nothing.

I find that hard to understand for a story with this degree of impact. Maybe we are all just worn out from the screening debates, after several years of indecision about the benefits of mammograms, the frequency of pap tests, and the big debate recently about whether or not prostate cancer screening really saves lives.

For me and others I know, there is increasing concern that the value of screening for the prevention and early detection of cancer will get lost in the morass of conflicting comments, and that we might be at risk of turning off the public to the benefits of screening for cancer, and perhaps lives will be lost in the process. And that would be shameful. More...

To screen or not to screen for prostate cancer, that is the question. Or is it?

A report from the venerable United States Preventive Services Task Force (USPSTF) made it to the media yesterday--a bit ahead of schedule--and it not only says we aren't certain whether a man should get a PSA test to find prostate cancer early, it came flat out and said, effectively, "Don't do it!"

Now that is a recommendation that is going to create a good deal of discussion, I would think. More...

Are we the victims of our own success?

That may be an unusual-and some would say offensive-way to open a discussion of cancer survivorship. I mean it only with the best of intentions, for when it comes to cancer survivorship over the past 40 years, there is much to be grateful for. But that doesn't mean the journey has been without difficulty, and it doesn't mean that there isn't much more to do.

Last week, in Washington, DC, LIVESTRONG brought together over 120 experts on the issues surrounding cancer survivorship to do something reasonable and fairly straightforward: define the essential elements of survivorship that every cancer patient, their loved ones and caregivers should expect once the acute treatment part of their journey has been completed. What's amazing is that no one has been able to do this before.

Having those experts in one room at one place at one time brought into focus the enormous task we face in trying to define those elements, let alone how we configure our systems of care to provide those services in a world where care is becoming more diffuse and resources for anything other than the most necessary care are dwindling on an almost daily basis.

It wasn't always this way. More...

Please, please, please say it's so...

That was my initial reaction today when I saw news stories about a study presented at a breast cancer conference sponsored by a number of leading organizations with a professional interest in the diagnosis and treatment of breast cancer.

The headlines were pretty clear, to the effect that the study showed the value of screening mammography in women between the ages of 40-49. The accompanying stories suggested that this research essentially repudiated the recommendations of the United States Preventive Services Task Force initially published in November 2009.

You may remember that event, since it created a huge amount of media and public interest when the Task Force suggested that screening mammograms to find breast cancer early should not be done routinely in women between the ages of 40 and 49. This was a change from its prior recommendation, and was in conflict with the opinions of the American Cancer Society and other organizations which conitinued to endorse routine breast cancer screening in this age group.

There has been a lot of water under the dam since then, and there have been additional scientific studies reported about the value of screening mammograms, some of which support breast cancer screening and others which do not.

Enter the reports this week that a study from Michigan suggests that screening mammograms and breast self-examination in women between the ages of 40 and 49 results in earlier diagnosis and less disfiguring treatment.

When I read the headlines and the news reports, I quickly came to the conclusion that there was a possible disconnect between what the reporters concluded from the study and what I thought was scientifically valid.  Mind you, I read these things with my own bias/conflict of interest: I have been a supporter of mammograms for women between the ages of 40-49, and believe they save lives in this age group. But my problem here is whether this particular research actually supports that position, as the press reports suggested.

Guess what? I don't think it does. More...

(A letter to my newborn granddaughter)

Good morning, Rayna Analiese. Welcome to the world!

You are a teeny 8 pound 8 ounce bundle of beauty and joy who arrived yesterday afternoon at 1:32 PM CDT--100 years (almost to the very day) after one of your great grandmothers was born. 

Grandpa--who is normally not a big lover of babies--went gaga over you. "So cute! So cute!" is about all he could say as he snuggled you in his tall arms--afraid all the while that he might drop this football-size bundle of love.

You have lots of people who love you, and lots more who are going to love you--not to mention all the people who love you who haven't had a chance to meet you in person yet. You have aunts and uncles and great aunts and uncles and grandmothers and grandfathers and great grandmothers to boot--and don't forget your great-great grandmother who will squeeze you tight. You are going to have to get used to the large family feasts filled with all sorts of nasty food when you come home from time to time to parade your cute little bonnets around the many houses you will have to visit. Mom and Dad are certainly going to have fun on those trips.

But I wouldn't be me if I didn't think for a moment about what your new life means, so forgive me for a moment while I ponder the meaning you bring into our lives, especially for Grandma Sandra and Grandpa Len. More...