Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

The American Cancer Society

Genomics May Be The New Frontier, But Knowing Your Family Medical History Is Still Very Important

by Dr. Len July 29, 2015

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 family history that you occasionally fill out in the doctor's office that neither you nor your health professional usually pay much attention to.

Perhaps that needs to change.More...

Meeting A Stem Cell/Bone MarrowDonor Reminds Me About Ordinary People Doing Something Extraordinary

by Dr. Len July 19, 2015

As I have mentioned previously, I travel quite a bit. And sometimes during those trips something interesting and unexpected can happen. That was the case a couple of weeks ago, when I was on a flight from Atlanta to Washington. And it impacted me in a way I could not have anticipated.

The flight was routine. Sitting next to me was a young man, likely in his 30's, sitting next to someone he was obviously related to and quite a bit older. It was clear he was pretty excited about the trip, and I couldn't help but overhear him say this was one of his first travels on an airplane.

I had a bit of work to do to prepare for a conference the next day, so I wasn't particularly chatty during the flight. But I thought the older gentleman sitting next to the window could have been a veteran (which it turns out he was). Having been present when a number of the Honor Flights returning from Washington to Chicago on a Friday night at Midway Airport (when we usually get into town for a medical meeting), I was aware that a lot of veterans have never seen the monuments and museums in Washington celebrating their service. So, I made the assumption that such was the case: the younger man was accompanying the older gentleman to see the sights.

As we landed and I put my work away, I thought I could give them a bit of a tour of what they were seeing as we landed in DC (yes, I have taken the flight too many times). So I asked them if my assumption was correct about the reason for their trip. And, to my surprise, I was wrong. More...

Some Of The Answers To Cancer Care May Be Found With Our Companion Dogs Walking Right Beside Us

by Dr. Len June 10, 2015

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 cancer, this time a sarcoma. The prognosis was even worse. Lily likely had weeks to live.

Lily fortunately didn't suffer, and died peacefully last week.  Our local vet and my newly acquainted veterinary oncologists from Purdue (who were part of the conference faculty) became our trusted guides through a journey about which we knew precious little.

And now I found myself offering a presentation as the last speaker at the symposium, discussing our journey and what I have learned from the conference. Getting past the tears of our loss wasn't easy. More...

The Survivors And Advocates Highlight That Personalized Medicine Is About All Of Us

by Dr. Len June 02, 2015

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 predict who is going to respond better to which medicine. And frequently during the research presentations there was evidence that the more a cancer cell had mutated the more likely it was to respond to these new drugs.

But it was the survivors who touched my heart, my thoughts and my hopes.More...

Father Knows Best As Immunotherapy Takes Its Place As A Pillar Of Cancer Care

by Dr. Len May 30, 2015

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...

Advancing The Tenet That In Cancer Care We Need To Embrace Curing When We Can And Comforting Always

by Dr. Len May 29, 2015

It was the title of an article in JAMA Oncology that captured my attention this past week: "Advancing a Quality-of-Life Agenda in Cancer Advocacy: Beyond the War Metaphor." That and, the fact that two of the authors (Rebecca Kirch and Otis Brawley) are my colleagues from the American Cancer Society.

As the American Society of Clinical Oncology (ASCO) convenes its annual scientific meeting in Chicago--where thousands of participants from around the world gather to learn about the latest advances in cancer research and treatment--we should not lose sight of the fact that the quality of life for patients during cancer treatment and survival is a critical part of what we must address as part of a holistic approach to the cancer care paradigm.

For decades cancer prevention and treatment has focused on the war metaphor: fight cancer, beat cancer, fight hard, whatever. The reality is that not infrequently people do everything right and they still die from this dread disease. Does that mean they didn't fight hard enough? I don't think so, and I suspect many of you agree.

But there is a yawning gap, and that is that we don't pay as much attention to the quality of life of cancer patients, their families and those who care for them. We can and must do better. That is the core of the message my colleagues delivered in their article. More...

Laboratory Tests And Disruption In Medical Care: A New Frontier

by Dr. Len May 29, 2015

(This blog was originally published on Medpage Today and is presented here with permission)

 

Disruptive innovation is a relatively new term that refers to dynamic changes in how we live our lives. Think of your smartphone and you have a good example of disruptive technology; one that replaces old tools. Who even takes pictures with a point and shoot camera any more, or uses a map to find their way? But the rise of disruptive technologies in medicine to me raises some difficult questions.

The recent announcement by a company called Color Genomics which will provide a 19 gene assay to help women assess their risk of breast and ovarian cancer could be called a disruptive innovation. For $249, a woman can have this panel of tests done at her request so long as she has a health professional order it.

And if she doesn't have a health professional readily available, the company will be glad to provide one.

Oh, and by the way: they don't accept insurance. They reason: the company says the cost is so low that insurance companies shouldn't come between women and the test. And if you want genetic counseling, they will provide that too but only after the test is done -- which clearly contravenes the recommendations of a number of professional and voluntary health organizations.

Another example of disruption in the laboratory world is the anticipated onslaught of direct consumer availability of laboratory studies based on minimal amounts of blood, possibly at a pharmacy near you. It is not clear for now whether a health professional will be an intermediary, but the end goal is pretty clear that patients will have the opportunity to order their own labs when they want to get them. More...

Don't Fry Day Reminds Us To Stay Safe In The Sun

by Dr. Len May 20, 2015

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 later when you deal with the delayed effects such as skin aging, wrinkles, and-yes-skin cancer.

You can't be expected not to enjoy the outdoors. That's part of a healthy lifestyle. Staying inside day in and day out just isn't fun. Unless there is a reason you can't go out of doors, you should spend time outside. It's how you spend that time that can make all the difference. More...

The Fault In Our Stars: When Celebrity Health Advice Conflicts With Our Science

by Dr. Len May 14, 2015

Dealing with a diagnosis of cancer remains a very scary, emotionally charged experience. That experience is not helped by the addition of conflicting advice, especially advice based on opinion and not evidence. And once in a while, that's what happens when a celebrity is the source of the information, as has now occurred with Sandra Lee. But this time reporters are stepping up to address the issue on the record.

Many of you are familiar with the now widely available interview Ms. Lee gave with ABC's Good Morning America anchor Robin Roberts, herself a cancer survivor who has openly shared her journey with the public. Ms. Lee told the nation that she has breast cancer, that a lumpectomy had positive margins, and that her doctors recommended a double mastectomy since she was a "ticking time bomb" in her words.

What the nation also knows is that Ms. Lee at the age of 48 was critical of guidelines that-in her words-tell women to wait until they are 50 to get a screening mammogram. She also recommended that women of all ages, even in their 20s and 30s, call their health professional now and get a mammogram. In short, all women "need to know" whether or not they have breast cancer.

A diagnosis of breast cancer is traumatic. A positive mammogram that turns out not to be cancer--what doctors call a "false positive"--is also traumatic, especially if a women has to endure the uncertainty of follow-up tests including additional x-rays and biopsies, which are certainly uncomfortable at the least and disfiguring at the worst. Younger women have a greater number of false positive mammograms, in part because their breast tissue is more dense making the reading of a mammogram more difficult.

People are entitled to their opinions. But when personal thoughts turn into public pronouncements it can create a sense of fear and a sense of panic that may not be warranted. Often, listening to what the science tells us can help us confront some of that fear. In this case what the science tells us is that screening women in their 20s and 30s who are at average risk of breast cancer would cause a great deal of harm and not much benefit. More...

What We Can All Learn As New Orleans Shows The Way To A Healthier, Smoke-Free City

by Dr. Len April 24, 2015

 

It's a headline that I suspect many thought would never be written, but it was-in the New Orleans Advocate on April 22:

"Harrah's Casino in New Orleans gives patrons lollipops as it introduces smoking ban"

Six months ago, there weren't many who thought this could happen, that the City Council of New Orleans would pass and the Mayor would sign a smoke-free bar and casino ordinance in New Orleans. But pass it they did, and now it's the law.

The lesson from this incredible feat is that when we are committed to making our lives healthier and safer we can make it happen. It may be through smoke-free legislation or it may be through increasing tobacco taxes. But these laws and regulations make a difference for so many, from workers who work in these establishments, to those who patronize them and to those entertain us there such as the musicians in New Orleans, who were so much a part of making this happen.

However, we can't forget that while successes are wonderful to celebrate much remains to be done. And that is why I continue to work closely with the Society's advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) to advocate for proven tobacco control measures that will help people quit and discourage kids from ever picking up the deadly habit. More...

About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.

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