Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

The American Cancer Society

Trans Fat: To Ban Or Not To Ban?

by Dr. Len September 28, 2006

No sooner did the American Cancer Society release its revised guidelines on nutrition and physical activity for the prevention of cancer than New York City once again stepped up to the plate and announced another stunning proposal for the health of its citizens.


The headline on the news release reads, “Health Department proposes two changes to city’s health code for pubic comment: first, to phase out artificial trans fat in all restaurants; second, to require calorie labeling in some restaurants.”


As reported in the media this morning, not everyone is in agreement that this first recommendation is such a good idea.


Fundamentally, some are asking, is this the beginning of the feared Twinkie police starting to tell us what to eat, or is it in fact a valid proposal that will have significant benefits for the health of the citizens of New York?


New York has certainly set its mark as a leader in important health initiatives, especially since Mayor Bloomberg took office.


The citywide smoking ban that took effect three years ago is exhibit #1. 


Roundly criticized at the time as being unworkable, unenforceable, and economically destructive, the measure is now considered by many to be a success.  Financial doom and gloom predictions, for the most part, proved incorrect.  People are able to eat and drink in peace, knowing that they are not getting more than they bargained for (read that: secondhand smoke and the hazards it represents) when they go to a public restaurant or bar in our nation’s largest city.


But the trans-fat issue some would argue is a bit more complex.


For example, as I heard one citizen comment during an interview on CNN this morning, “If I want to eat fat, why shouldn’t I be able to eat fat?  Fat makes the food taste good.” 


Others suggested that trans-fats cannot easily be replaced in cooking processes and that recipe redesign and implementation will be an overwhelming burden. 


This morning’s Wall Street Journal had an interesting piece reviewing the topic. 


I consider the comments by the owner of the Carnegie Deli, a well-known New York restaurant, as reflective of the dilemma many folks—both consumers and restaurant owners alike—face regarding this issue.


In the press release from the Health Department, the owner of the restaurant says, “We have been using 100% Canola Oil for 20 years because it has a better taste and is better for customers.  It’s easy to replace artificial  trans fat, it costs the same, and the food tastes great. Our cakes and other baked goods are already trans fat free.  If we can do it, so can other restaurants.”


In the Wall Street Journal today, the same person is quoted as saying, “I don’t think it should be a mandate by the city to tell someone how to run their business.”  The owner goes on to say that he supports the idea of eliminating trans fat, adding that he doesn’t cook with them at the deli, but that it should be up to consumers “to decide what they want to eat.”


I can agree with the latter part of that statement.  On this particular subject, people should be able to make choices.


But we also need to recognize that in many restaurants and baked goods, we have no choice.  We get trans fat whether or not we want it.  There are no donuts at the coffee shop that say “baked in trans fat” and another donut next to it that says “not baked in trans fat.”


Why all of the hullabaloo?


We know trans fats are bad for us. They increase the risk of heart disease. 


We know there are options to replace trans fat in cooking, although it is not as clear as one would like that other fats can be easily exchanged for another. (The McDonalds’s french fry saga is an example of where a company made a public commitment to eliminate trans fat from its cooking processes, but has yet not delivered on that promise, reportedly because of technical problems reproducing the taste and texture of their big-selling product.)


The FDA has stepped forward to have companies label trans fat content on package labeling in the grocery store, and that has accelerated some change in the industry.


But you don’t know when you walk into a restaurant in New York City or anywhere else for that matter whether or not you are putting your health at an even greater risk beyond eating the food (as you are scarfing down a pastry or some other fried edible that you probably shouldn’t be eating in the first place anyway).


From the American Cancer Society point of view, we are not aware of any evidence that there is a link between trans fat and cancer risk, aside from the indirect relationship that trans fat increases calorie intake, and that leads to overweight and obesity problems which in turn increases the risks for several cancers.


But that doesn’t mean we stop at a line and say it doesn’t matter.  It does matter, and we recommend that people do everything they can to reduce trans fats in their diets.


The bottom line for us is that it is plain and simple a good health practice to avoid trans fat.


But if you don’t know it’s there, how can you avoid it?  And if you are looking for a French fry in New York or anywhere else for that matter I suspect it would be difficult to find one that is cooked in non-trans fat oil (except perhaps at the Carnegie Deli).


So, back to the original question: is banning trans fat a good idea or not?


The medical evidence suggests clearly that it is.  The culinary evidence suggests that it can be done, at some cost and some inconvenience.  For the people, I suspect they will be able to retain their right to consume fat, but in a safer form (if there is such a thing) than by subjecting themselves to something that doesn’t have to be there in the first place.


The New York City Health Commissioner, Dr. Thomas Frieden, has said, “New Yorkers are consuming a hazardous, artificial substance without their knowledge or consent.  Trans fat causes heart disease.  Like lead in paint, artificial trans fat in food is invisible and dangerous, and it can be replaced.   While it may take some effort, restaurants can replace trans fat without changing the taste or cost of food.  No one will miss it when it’s gone.”


Another highly regarded expert in epidemiology, Dr. Walter Willett from the Harvard School of Public Health said that if New Yorkers replaced all sources of artificial trans fat, at least 500 deaths from heart disease would be prevented in New York each year.


So, the gauntlet has been thrown down and it is up to the people of New York to decide if they are going to take another bold step forward to protect the public health.


The discussion to follow is going to be interesting, and without doubt will have widespread impact nationwide as other communities consider similar regulations.


But sometimes it takes bold actions to get bold results.


As the Commissioner noted in the press release, all the past jawboning has not prodded the restaurant industry in New York to move forward voluntarily, despite an education program to make them aware of the risks of trans fat. 


No one likes more laws, rules and regulations. 


Unfortunately, sometimes that is what it takes to make things happen.


When it comes to our health, maybe that is what is necessary for us to understand that these are real issues with real impact in our everyday lives.


Filed Under:

Diet | Prevention

Diet, Exercise And Cancer Prevention

by Dr. Len September 28, 2006

The American Cancer Society has just released its 2006 update of our guidelines on nutrition and physical activity for cancer prevention.


I’m sorry to tell you that if you like to sit in front of your television watching reality shows, or enjoy those huge double-thick burgers at the local fast-food emporium, you are plain out of luck.


On the other hand, if you watch your weight, eat a healthy diet and exercise regularly, you are taking some of the steps needed to reduce your risk of cancer, according to the guidelines.


My first reaction as I read this informative document was that there simply is no fun left in the world. Then I realized that many of us—including yours truly—have had to modify our “lifestyle” behaviors, increase our exercise, decrease our calories, and pay attention to what we eat. 


Despite those restrictions, we still find plenty of things to eat and plenty of things to do that we enjoy.  And, most of all, we can take comfort in the fact that we are able to take some degree of control over our lives, improve our health, and give our best effort to staying active, mobile and alive.


Of course, there are no guarantees in life.  But knowing that you are doing the best you can do for yourself and your family is--in my humble opinion--reward enough.


If you are interested in knowing what science has to say about diet, exercise and their impact on the risk of developing specific types of cancer, you can find the information you are looking for in this very well written, easy-to-understand publication which is available online.


So what are the core recommendations?


For individual choices:


      • Maintain a healthy weight throughout life


      • Adopt a physically active lifestyle


      • Consume a healthy diet, with an emphasis on plant sources


      • If you drink alcoholic beverages, limit consumption


For community action:


      • Public, private and community organizations should work to create social and physical environments that support the adoption and maintenance of healthful nutrition and physical activity behaviors



There is obviously more to these guidelines than just these five bulleted points.


For example, one of the additional pieces of information is that if you are overweight and obese, you should lose weight.


We have developed evidence over the past several years that strengthens the association between being overweight and obese with an increased risk of developing several types of cancer. 


As pointed out in the article, 14-20% of all cancer deaths are related to overweight and obesity. 


As the country continues to march on to increasing levels of obesity (2/3 of the people in the United States are overweight or obese; 1/3 of all cancers can be tied to factors related to nutrition and physical activity), we face an increasing cancer risk—not to mention the well known associations with hypertension, diabetes, and heart disease among other travails.


What we have not known is whether or not losing weight can decrease that risk.


The guidelines point out that there are now studies which suggest that some cancer risks, particularly for breast cancer, may be reduced with weight loss.


The evidence can only be considered suggestive at this time, but it is sufficient in the opinion of the committee that drafted the guidelines to make a recommendation to lose weight and possibly reduce your risk of developing one of these weight-sensitive cancers.


Exercise is also a very prominent component of these recommendations.  And we aren’t talking about a couple of minutes a day.  We are talking about a significant commitment here if we are to gain the benefits that exercise offers for our general health, as well as reducing our risk of cancer and other diseases.


If you are an adult, then the guidelines recommend at least 30 minutes of moderate to vigorous exercise BEYOND USUAL ACTIVITIES 5 or more days a week.  They go on to say that 45 to 60 minutes is preferable. 


For children and adolescents, the recommendation is at least 60 minutes of moderate to vigorous physical activity at least 5 days a week.


That is quite a bit of exercise, and I emphasized above that we are talking above and beyond our usual daily routines. 


If you are a farmer, you are probably getting enough vigorous exercise in your daily routine.


On the other hand, if you are an executive sitting at a desk 8 or 10 or more hours a day, you probably don’t get enough exercise.


Many of us have our daily conflicts with kids, work, after-school activities and whatever that we claim interferes with our ability to meet this goal.


Let me share with you that my wife and I are probably as busy as anybody out there, and we manage to incorporate this recommendation into our daily lives on a fairly regular basis.


It takes some doing—like getting up at 5:30 in the morning—but it can be done.  And always look for those opportunities to work in some extra walking, such as parking further from the store, walking in the airport instead of taking the train between terminals, climbing the stairs at work, and so on.  For my wife and me, a 5 mile walk on a beautiful canopy road early Sunday mornings is something we look forward to whenever our travel schedule provides the opportunity to be home on the weekends.


Ultimately, what all of these diet and exercise recommendations are about is changing the balance between what we take in (as food) and what we put out (as exercise).  As a nation, we have too much of the former and too little of the latter.


The report also emphasizes how important it is for us to give our children a good example and education for their own diet and exercise programs.  What they do as kids will follow them for a lifetime, and if we are going to solve this complex problem, we need to start with our young folks.


There are a number of specific food-related do’s and don’ts in the report, and far too many for me to review in detail here.


But as you might suspect, the recommendations reinforce that we need to eat more fruits and vegetables (no, potato chips are not a vegetable), watch the calorie contents of our foods, avoid red meats, and avoid refined grains and sugars.


Fruits and vegetables are, in the words of the report, complex.  As noted by the authors, each type of fruit and vegetable contains “numerous potentially beneficial vitamins, minerals, fiber, carotenoids and other bioactive substances, such as flavonoids, terpenes, sterols, indoles, and phenols that may help prevent cancer.”


I will admit I am not familiar with several of the items mentioned above.  What I do know is that fruits and vegetables work in our bodies in ways that we still don’t understand, so there is no shortcut or substitute for eating the real thing if we want to get the benefits of what they have to offer.


As the report points out, for most substances, getting it in its natural form as opposed to a pill or other supplement is probably preferable, due to all of these complex components and their interactions.  In fact, in some circumstances—particularly beta-carotene supplements—studies have found an increased risk of cancer when taking the pill as opposed to eating the carrot.


Processed and red meats are another no-no, except in very limited amounts.


One of my colleagues, who happens to be a lead author of this report, has a special aversion to bacon, which she describes as “pure fat.”  (I didn’t bother to educate her about fat back, a real “pure pork fat” ingredient in some Southern diets.)


What we do know is that red meat (defined as beef, pork, or lamb) and processed meats (defined as cold cuts, bacon, hot dogs, etc.) increase the risk of cancers of the colon and rectum and prostate, and possibly for other sites as well.


If you like alcohol, you should limit your intake, according to the guidelines.  And, if you don’t drink alcohol, don’t start. 


That said, limited quantities of alcohol consumption do decrease the risk of heart disease, and studies have shown people who are modest drinkers do live longer than those who don’t consume alcohol or those who consume too much.


What is the right amount?  For men, two drinks a day; for women, one.  And, if you are concerned regarding your risk of breast cancer, you probably should eliminate alcohol from your diet.


A serving, by the way, is 4 ounces of wine, a 12 ounce beer, or 1 ½ ounces of 80 proof liquor (that’s about a shot glass).


These are just some of the highlights of the report.


The authors go on to detail what evidence exists or doesn’t exist regarding the relationship of diet and exercise to specific cancers, as well as provide answers to frequently asked questions about various foods, vitamins, and supplements in relation to what we know about their effects on various types of cancer.


One of the interesting and important points the authors make is about the impact of new research reports on the public’s knowledge about their impact on cancer risk.


We all know how difficult it can be to understand and assimilate this mass of information into our daily lives and behaviors.  If we listened to every new nutrition or physical activity “breakthrough” with respect to cancer, we could potentially be overcome with “analysis paralysis.”  That, in turn, might lead us to throw up our arms in disgust and walk away from our commitment to do what we know we need to do.


So what are we supposed to do?


As the authors write:


“Because people are interested in the relationship that specific foods, nutrients or lifestyle factors have to specific cancers, research on health behaviors and cancer risk is often widely publicized.  Health professionals who counsel patients should emphasize that no one study provides the last word on any subject, and that individual news reports may overemphasize what appear to be contradictory or conflicting results.  In brief news stories, reporters cannot always put new research findings in their proper context.  The best advice about diet and physical activity is that it is rarely, if ever, advisable to change diet or activity levels based on a single study or news report.”


That is why, in this day of the information age and rapid reporting of new information, it is important to know where to go to get reliable, accurate and actionable information.


This report on nutrition and physical activity to reduce the risk of cancer is an important one.  It is a place you can go to get the information you need, confident in the knowledge that the experts who have contributed their time and knowledge have provided information that  represents the best anyone can offer on this complicated topic.


No hype, no sugar-coating (pardon the pun).  Just some good, honest advice on what you need to do to take care of yourself and your family.


As I have written many times before, there is no time like the present to make the commitment to do better when it comes to lifestyle changes. 


This report provides you with the information and recommendations that you need to know.


Making the change is up to you.





Filed Under:

Diet | Exercise | Prevention

The Real Celebration on the Hill: Epilogue

by Dr. Len September 21, 2006

It is now the morning after Celebration on the Hill 2006.  I am sitting in the airport, beginning a new day.


By now, I expect the workers have started to deconstruct of the tents on the mall and the Wall of Hope.  Some folks next to me are talking about their experiences of the past two days as they prepare for their own journey home.


I can’t stop thinking about what I saw and experienced yesterday, and I can’t ignore the impact that it has had on me personally.


I consider myself reasonably knowledgeable about “petitioning the government,” or more plainly stated, trying to influence legislative and regulatory policies and actions.  After all, I have been engaged in this process in one way or another for the past 25 years.


But nothing that I have done in this arena affected me to the degree that I experienced on the Mall yesterday.


To see so many people come together, committed to making a statement and impacting our legislative process was in itself a major feat.


These were folks who were focused on their goal.  They were well briefed, well intentioned, well behaved and very effective.


Several of my colleagues from across the country shared my observation that we are fortunate to be in service to such a special constituency.


The immediacy of the camaraderie, the genuineness and openness of the discussions, the instant recognition of a friend based on a shared life event all blended together yesterday in Washington, DC. 


You could see it and you could feel it in your heart and in your soul.  It was a moment to treasure, especially since we don’t have many of these moments in our hectic-paced, impersonal lifestyle environment.


It was as though we plucked a day out of our schedules, put our other concerns aside, and concentrated on what was truly important in our lives.


The key goal of the day was to make a statement to Congress and influence its decision making process. 


I would offer that the real outcome was the creation of a bond that will create memories for a lifetime.


To those who created Celebration on the Hill and made it happen, my congratulations on a job very well done.


Our presence on the Mall, with the various state and “special interest” tents (meaning activities such as our Cancer Survivor Network, and the recruitment tent for our CPS3 study) as well as the incredible Wall of Hope, was enormous.


Using the trading cards to get people talking with each other was another innovative idea that worked well.  Even into the waning hours of the evening people were standing around, trading their cards, and completing their collections in their notebooks.  The trading cards worked so well to get people talking and sharing.  They created the spark that started the bonding of people who had come from so many places and so many backgrounds.


The entertainment was wonderful, and kept a lively pace to the day (I especially liked the enthusiastic Cha-Cha lessons).  So many of the entertainers had their own stories or their own lyrics to share with us.  They were very much a part of the event and the spirit present in our place.


The Wall of Hope brought tears to peoples’ eyes as they read the stories of sadness, and smiles when they read the stories of hope.


But nothing—nothing—prepared me for the luminaria ceremony that evening.


We had all been walking, talking, working and cajoling legislators all day.  As the sun set over the Capitol dome, a chill came into the air (and the Relay store ran out of sweatshirts).


People started gathering around the reflecting pool, searching for their candle which represented hope for some and sadness for others. 


The survivors wearing their sashes were among us, and I realized that although I wanted to believe that all were well and all were happy, many of them were not well and many were facing their own struggles even as we gathered.  But you would never have known it or suspected it from the looks on their faces, the animation in their voices, and the stature and grace of their gait.


And then, when darkness set, the candles were lit.  The bagpipes played, and then came the song, “This little light of mine, I’m going to let it shine”.  Small glow sticks filled the night, and moved slowly back and forth in time with the music.


In that moment, silence set over those gathered around the pool. 


There were tears and sadness and hope present in that place, all shared by thousands of people who had come together to join in an experience for which words are not adequate to describe.


In that moment of silence, we all knew why we were there and what was most valuable to us in our lives.


I stayed for a time, watched the faces, listened to the music and reflected on my own losses, hopes and prayers.


My walk back to the hotel was a lonely one. 


There was a feeling of belonging to something unique and special, and as I left the Mall, I knew that the experience and the feelings would be difficult to recreate again in my lifetime. 


I called my wife, and shared my thoughts.  I told her I love her, and that I wished she had been with me to share that very special moment.


I know the primary reason the American Cancer Society and the Cancer Action Network produced Celebration on the Hill was to boost our influence in Washington and impact on  the legislative process.   That in itself is an important and worthy goal in a political world.


But the ultimate result of Celebration on the Hill was much more than that for many folks, including myself.


For one day, 10,000 people came together to share, to learn, to influence, to bond, perhaps to cry, but ultimately to promote the value and importance of life.


As we scurry about our daily lives, we don’t have many opportunities to do that—to make the clock stop for just a day, when we can honestly reflect on who we are, and what we mean to each other.


That, my friends, is truly worthy of a Celebration.

Filed Under:

Cancer Care | Prevention | Research

Celebration On The Hill: The Survivors

by Dr. Len September 20, 2006

This has been one incredible and emotional day.


As I write this, I am sitting by the reflecting pool on the Mall in Washington, looking up at the Capitol dome bathed in sunlight, listening to a singer on stage singing “This land is your land, this land is my land, one day this land will be cancer free.”


People are walking by.  Their spirit and their animation are infectious.


What really impresses me are the smiles on so many faces.  People wearing survivor sashes, walking with their friends and their families on their way to another gathering.


For me, this is also a time of reflection, for I am sitting across the way from luminaria candles that are dedicated to the memory of my mother who survived her colon cancer and died years later from other causes, to the memory of my father-in-law who died from colon cancer, and in honor of my mother-in-law who is a cancer survivor.


As with so many people participating here today, my family too has been touched by cancer. 


What you discover at moments like this is that the emotions are really never far from the surface.   Today is no exception.


For those of you who have never participated in a Relay for Life event, you are likely not familiar with luminaria and their significance.


Luminaria are candles placed in a paper bag with the name of a loved one or friend on the outside of the bag.  These candles are dedicated to the memory or honor of the person named on the bag, who is usually a cancer victim or a cancer survivor.


When the sun sets, the candles—which are usually placed around a track or path at the Relay event—are lit.  And those who participate in Relay search out the candles they have donated.


There is no way to describe the emotions that come out around those candles.  People sitting, standing, hugging, crying—the feelings run the gamut.  It almost seems at that moment that these are very special—even blessed--places.


Rationally, these are only candles in bags.  But the memories are clearly there in that place, and it is difficult not to be touched deep inside.


Tonight, when the sun sets here in Washington and as our Celebration On The Hill 2006 draws to a close thousands of candles will be lit around the reflecting pool, bathing the Capitol in their light.


There are going to be many folks standing by their candles and sharing some very intense moments.


Even today when I was doing an interview, the topic turned to the luminaria ceremony, and what it means.  And there I was, in the middle of the interview, talking about the importance of this event.  I started to feel tears coming to my eyes as I thought of those past times when I stood by our candles at our Relay event in our hometown, and the lives those candles represented.


You may heal, but you never forget.


And I guess that is the essence of today.


Many of us have been touched by cancer, either personally or in our families. 


As I watch these survivors walk around our site here in Washington, I recognize the tremendous personal commitments they have made to themselves, their families, their friends and to our American Cancer Society. 


Their being with us today in Washington is, for many of them, no small effort.


Many people here in Washington today have traveled from around the country to share their dreams and our dreams.


The survivors are the folks who have traveled the most. 


They are the ones who have heard the words “I’m sorry to tell you, but it is cancer.”  They are the ones who have endured the treatments, the complications, the recoveries and the relapses.  They are the ones who have had to dig deep inside of themselves to move on with their lives.


As I sit here writing this, I am touched by their smiles and their vitality.   These are not smiles of pity, and they are not smiles of sadness.  They are smiles of some very special people who have faced challenges in their lives that I can’t begin to imagine.


Tonight, I will stand in front of some candles, and I will cry a bit.  I have comfort in knowing there are many others here with me who will share the same feelings. 


I suspect there will be many here tonight who have their names on their own candles.  And for them, words can’t express how much admiration I have for them, and what they have achieved. 


These are the folks who know and appreciate the value of life.


They have inspired us, and they have graced us with their presence here in Washington today.

Filed Under:

Cancer Care | Prevention | Research

Celebration On The Hill: Congress and Commitments

by Dr. Len September 20, 2006

Sometimes you see things you don’t expect at events like Celebration on The Hill.


For me, one of those “little moments” was a tent near the top of the mall as you enter the line of state volunteer booths.


The program being provided in the tent is called “Democracy Live.”


The presentations going on during the day at that location provide information about different aspects of government, how government works, and how people can influence the processes of government.


In other words, the focus is on improving the information knowledge of those who want and need to be informed.


There were a number of catchy slogans on billboards outside the tent that also caught my attention.  Some samples:


·        The most common way citizens in any democracy relinquish their power is by thinking they don’t have any


·        Too many people expect wonders from democracy, when the most wonderful thing of all is just having it


·        There can be no daily democracy without daily citizenship


·        It is not the function of our government to keep the citizen from falling into error; it is the function of the citizen to keep the government from falling into error.


·        The stakes…are too high for government to be a spectator sport.



We tend to forget sometimes that we really CAN influence our legislators and what they do.


Too often I have been part of campaigns that have tried to influence the legislative process.  We implore people to write letters or emails to their legislative representatives.  The yield is so low sometimes as to be pitiful. 


Many people think their voice doesn’t count.  And yet I know from past experience that even one voice can make a true difference.  Legislators (usually) do listen to the people who vote to put them in office.


Fortunately, that doesn’t seem to be the case here at Celebration 2006.


Here we are, at the foot of the Capitol, with 10,000 volunteers who are occupying a space of several city blocks along the Mall between the Capitol and the Washington monument. 


We are difficult to miss, to be honest.


And our legislators have noticed.


It isn’t easy at time to talk to these elected folks.  Intimidation is a big factor for many ordinary  people when asked to engage a Congressman or a Senator in a rational discussion regarding something the constituent is passionate about. 


That’s why the Ambassadors and other volunteers attending this event have been provided background on the issues and how to frame their arguments.


But I wasn’t prepared for what I saw happening at several state locations on the Mall this afternoon.


In one instance, a volunteer who was also a cancer survivor was lecturing a congressman from Ohio on the importance of  various issues.  And she wasn’t about to take no for an answer.


I was impressed by her knowledge and her commitment to the cause.  The Congressman was not going to get off easily this time, and that was obvious.  So, into the Ohio tent he went to sign the pledge and make his own commitment to our cause.


And that was only one example of many similar instances I have witnessed this afternoon.


So what are we asking our Senators and Congressman to commit to?


In 2005, 92 Senators and 280 Members of Congress signed a letter to the President in support of the national challenge goal of eliminating suffering and death due to cancer by the year 2015.


As we note in our document entitled “The Congressional Cancer Promise for the 109th and 110th Congresses,”  this 2015 goal is not one that can reached with certainty.  However, it is now possible to envision this goal because of our past commitments to cancer research and programs.


The document goes on, “The conquest of this disease is within our grasp  if we adopt bold new policies and make the investments necessary.  The opportunities to beat this disease demand our focused attention and there are steps we can take to jumpstart our progress toward to 2015 goal.  Our nation’s current health care system is not up to this challenge.  If we are to ultimately conquer cancer our system must ensure that all Americans have access to high quality care.”


The Congressional Cancer Promise goes on to detail several goals, including:


  • Make health system reform a priority


  • Elevate prevention, early detection and survivorship


  • Increase our commitment to research


  • Expand access to care


The Promise provides detailed recommendations as to how we can achieve each of these goals.


In a democratic society, there are always going to be competing commitments that need to be addressed.  That’s what our government is about.  Making those decisions and allotments is not an easy task, and I don’t envy those who have to make those decisions.


By the same token, we—like everyone else—have an obligation to state our case and hold our elected leaders accountable to accomplish our goals.


The American Cancer Society, the Cancer Action Network, and the thousands of volunteers representing thousands of communities nationwide are here to let their representatives know that we believe this commitment—this Congressional Cancer Promise—is important to ensure the future health of our nation.


To accomplish that goal requires people who are educated and aware of the issues.  It requires volunteers like the Ohio survivor who can poignantly and personally deliver the message and not take no for an answer. 


As noted on a handout from the Democracy Live tent, “An Informed Citizenry is the Cornerstone of Democracy.”  We have a lot of folks here today who have taken that motto to heart, and are making democracy in action a reality many times over.


Newt Gingrich summed it up well last night that we need to be doing more to save lives and not doing more to build bridges that go nowhere.


I suspect there are 10,000 folks here today who feel exactly the same way.  And they don’t seem to be shy about letting their legislators know precisely how they feel about the issues.


Filed Under:

Cancer Care | Prevention | Research

Celebration On The Hill: The Wall Of Hope

by Dr. Len September 20, 2006

I started my morning today sitting quietly among the Wall of Hope banners thinking about the importance and meaning of this day.


Now, in the early afternoon, I am sitting here once again regathering a bit, thinking still about what I have seen and heard over the past several hours.


As you walk along the Wall of Hope, you see 4200 banners that have been assembled into an area on the Mall in Washington DC that is about 2 blocks long.  At the center of the Wall is a spotlight aimed to the sky which will shine tonight for the last time, to let everyone know we are here, and remind them of our message.


Each of these banners represents a community, and there over one million signatures in all, representing messages of hope and memory from many people touched by cancer.


Lining the grass walkway of the wall are some other very special banners.  Each of these has a picture and a message.  Some are about people who have been diagnosed with cancer and survive.  Others are stories about folks who have lost their battle.  Others are about doctors and researchers whose commitments to the fight against cancer are the focus of their professional careers, and others are from people who volunteer for the American Cancer Society and what that means to them in their personal lives.


I can’t begin to recount all of the stories and all of the messages.  I hope that one day someone will assemble these stories and these pictures and put them together in a book or on the web, because in each of these messages is something that is so important to who we are, and what we believe in.  They capture something magnificent in the human spirit that is difficult to convey in these words.


As I was sitting here typing this blog, two ACS volunteers from New York told me the story of someone who worked in a nearby office and decided to take some time to walk through the Wall of Hope during her lunch hour.


“We found her crying at the entrance,” they told me.  She told these volunteers that she had just taken some time from lunch to see what was going on, but she never thought the stories on the Wall banners would have such a deep and emotional impact on her.


In response, they offered her a hug.  She accepted.


I assure you there are lots of hugs occurring today along the Wall of Hope.


There are three stories in particular that have touched me personally, and I would like to share them with you.  For two of them, I have copied the language verbatim off of the panels and offer it to you here as a reminder of why we give so much of ourselves to this effort.


One is the story of Andrew Jackson and his father Ron.  Ron is a colleague and friend of mine who works at our National Home Office in Atlanta.


The banner tells the story of Andrew who was diagnosed just after his second birthday with rhabdomyosarcoma. 


The picture on the banner is of Andrew and his dad, and what is notable is that neither of them has any hair—a testament of a dad’s love for his son, and how he let his son know that he was not in this battle alone.


Ron, his wife, and his family are devoted to Andrew and his care.  Those of us privileged to work with Ron at our home office know this because he has shared his story and his thoughts with us so poignantly on many occasions.


And every day, many of us pray for Andrew and his good health, and for his family who is an important part of our family.


Then there is this poster from Kansas:


For 11 years, Norma Jean Leff has been living with ovarian cancer—and she puts the emphasis on “living.” She has tried 15 different cancer drugs and four clinical trials.


For eight years, Norma Jean has been volunteering for the American Cancer Society in Topeka, Kansas.  She gives 20 hours per week fitting wigs, talking to newly diagnosed patients, acknowledging memorials, answering phones and, as Norma Jean says, “stuffing many an envelope.”


“Maybe there’s a reason I’ve lasted so long, with a disease that should have killed me long ago,” Normal Jean remarks.  “One of those reasons is my work at ACS—I have something to give.”


Last November, Norma Jean was told there are no more treatments for her.  She’s resigned to the fact that, for the first time in 10 years, she’s not fighting cancer with treatment.  But she is fighting it with her spirit.  “I know I’m on a slippery banana peel,” Norma Jean says smiling, “but I’ll continue to do what I can for ACS.  I’m happier here than anywhere else.”


At the right hand corner of the banner, someone has placed a bouquet of fresh flowers on a stand in the shape of a heart.  Pasted on the banner behind the heart is the following poster:


“In loving memory of Norma Jean Von der Au Leff who lost her battle with cancer on Saturday, August 12, 2006.”



There is another poster a short distance up the walk.  This one is about a young boy from Idaho:


Izeyah Yenter was only 10 when he passed away from cancer but he was wise beyond his years.  He wrote a poem entitled “I Wonder Why…,” and entered it in the Parent Teacher Association’s Reflections program.   One month after his death, the poem won the Outstanding Interpretation award  from the national association.  Izeyah spent two months working on the poem, which helped him face his disease.  Izeyah was diagnosed on October 31, 2004 with a brain tumor.


“I Wonder Why…”

By Izeyah Yenter


I wonder why He chose me,

A cell growing out of control so rapidly.

I wonder why He chose me,

A tumor on my brainstem that nobody could see.

I wonder why he chose me,


A year to live, it just can’t be.

There are so many things that I still want to be,

I wonder why He chose me.

Hospitals, doctors MRI scans, and shots,

The pills I can swallow, the Thick-It I can not.

I wonder why He chose me,


To teach me and the world that only He holds the key,

To miracles, cures, blessings and love,

God holds the keys to all of the above.

I no longer wonder why He chose me,

I live everyday as if it is my last

And be the best I can be.




No more need be written here.




Filed Under:

Cancer Care | Research

Celebration On The Hill: The Volunteers

by Dr. Len September 20, 2006

Celebration on the Hill, as I noted in my previous blogs today, is very much an event focused on advancing the mission of the American Cancer Society.


But I am also reminded that this Celebration is much more than that.


As I walk around the various state tents I am struck by the sheer energy and involvement of the volunteers who are the core of the success of Celebration on the Hill 2006. 


Without volunteers, this event would not be the success that it is, and without volunteers the American Cancer Society could not move forward with its life-saving mission to reduce the burden and suffering from cancer.


There are volunteers here from across the country, and from every congressional district.   But beyond that, it is truly amazing to watch them all interact and engage with each other.


To me, that is what makes this event so meaningful.  It is not about one person, one goal, one idea or one commitment.  Each of these volunteers brings there own stories and their own reasons for being here with us today.  


But given that, they are all reaching out to each other with the knowledge that they share something special.


They have done something interesting here that I have not seen before.  Each volunteer has been provided with a set of “trading cards” that represents their individual states.  They also have received notebooks with pages where the cards can be inserted.


The goal, apparently, is to share cards and obtain one from each of the various states represented here today.


What you see is people going from tent to tent, sharing cards, and sharing stories.


The result is a quick sense of belonging and camaraderie that is unique in my experience.  It is that same openness that these volunteers bring to their efforts on behalf of the American Cancer Society and for that we are very grateful.


I just did an interview for someone, and was asked a question about the importance of volunteers and the donations they make to the American Cancer Society.  “What about those  bake sales and small contributions that people make in their own communities?”, I was asked.


The reality is that those small contributions are vital to the success of this organization.  Those gifts and donations mean a great deal to us, and I suspect that folks don’t realize that it is those small contributions, given by so many, that enable us to do what we do.


So that’s the “human” side of what I have seen here today. 


It is those countless hours of time and effort, those countless donations from all manner of people giving in all manner of ways that help us advance this cause, which is so important to so many.


And, ultimately, the reward is seeing these folks join together in this Celebration, joining old friends and meeting new ones, and letting the world know that they will be heard, and that their voices—and their lives—count for so much.


Filed Under:

Cancer Care | Prevention | Research

Celebration On The Hill: The Message

by Dr. Len September 20, 2006

I don’t recall ever being involved in an event quite like Celebration on the Hill 2006. 


I have been engaged over the years in a number of advocacy related initiatives here in Washington and in various state capitols, but this one is way beyond what I have participated in previously.


It is somewhere between a county fair, a rock concert and a political convention all rolled into one.


The opening ceremonies are about to get started, and people are migrating to the main stage, just next to the reflecting pool here on the Mall in front of the Capitol.  Rolling Stones’ music is coming from the loudspeakers, and the chatter of the crowd is nonstop.


But all of that is merely a part of a much larger picture. 


There are tents scattered around the mall from every state, and each one is filled with American Cancer Society volunteers spreading the word about why they have come here today to make their voices heard.


Ultimately, we want to hear from our legislators that they understand the importance of our message, and what must be done to sustain the progress we have made against cancer over the past many years since the War on Cancer was declared by then President Nixon in 1971.


If we do not maintain our commitment to continue the significant advances that have been made in cancer research and cancer treatment, we will see erosion in our progress.  And that is not acceptable, and certainly not acceptable to those gathered here today.


The opening ceremonies have begun as I write this, and I must admit to a sense of awe standing here listening to the Star Spangled Banner, looking up at the Capitol beyond the stage in front of me.


People are decked out not only in their American Cancer Society Cancer Action Network T shirts, but in all sorts of adornments and hats of various types.


Folks from New York are passing by me carrying signs saying, “I love New York, but I hate cancer!”


The opening speeches by our national American Cancer Society board chair Sally Ann Brooks and Society president, Carolyn Runowicz MD (who herself is a 14 year breast cancer survivor) hammered home the message that we care about cancer and we will be heard.


We can’t forget, they emphasized, that we are here to get lawmakers’ pledges to sign the cancer promise and make their commitment to support the continued fight against cancer.


As Ms. Brooks noted, “We have what it takes to defeat cancer in our lifetime.”


This isn’t just an American Cancer Society message.  It is a message of support to increase the budgets of the National Institutes of Health, the National Cancer Institute and the Centers for Disease Control and Prevention.


These are the organizations that have the national and international clout to marshal the forces necessary to lead this fight.  And we need to be here to support their needs, otherwise we will lose ground and possibly some of the incredible progress that we have been making in this battle.


Dr. Runowicz pointed out that the Wall of Hope consists of 4200 banners from communities across this country, and contains the signatures of over 1 million people (that’s a bit more than I estimated in my earlier blog today).  If stretched end to end, the panels would be 5 miles in length, or 85 times taller than the Washington monument.


But nothing is more inspirational than the survivors’ lap that is so much a part of our national Relay for Life events.  And this event is no exception.


As Dr. Runowicz noted, the survivors’ lap is a celebration of survivorship.


“We walk to remind lawmakers, policy makers, media and others that we will not give up until the fight is done,” she said.  And, as cancer survivors have increased in numbers because of our successes at early diagnosis and treatment, they have developed into a formidable array of advocates that has become a grassroots army to win the war on cancer.


One thought that did bother me a bit was the fact that, here in Washington—and elsewhere—we have to make our argument in terms of economics.  Return on investment is one of the points that Dr. Runowicz that had to deliver today.  She pointed out that because of improved cancer survivorship, the economy is benefiting to the tune of trillions of dollars.


If that is what our lawmakers want to hear, so be it. 


But what they need to hear is that investing in cancer research and treatment is the right thing to do. 


It is right because of all the personal stories here in Washington today and the personal stories of Americans throughout this country who are alive, productive and living life because of the investments we have made.


As Dr. Runowicz concluded, “It is about living well with cancer and after cancer.” 


That is what this day is about, and that is the message that our legislators need to hear. 


Filed Under:

Cancer Care | Medicare

Celebration On The Hill 2006: A Special Day

by Dr. Len September 20, 2006

As I write this, I am sitting in a very special place: the Wall of Hope that has been constructed by the American Cancer Society’s Cancer Action Network on The Mall in Washington as part of our Celebration on the Hill 2006.


The Wall of Hope is more than a piece of construction.  It represents the sentiments of thousands of Americans who have signed on to the commitment to reduce the burden and suffering from cancer.


But nothing says it better than the sign that is placed at one of the entrances on 7th Street:


“This monument serves as the voice of millions of Americans whose lives have been affected by cancer.  Relay for Life expresses the hope that those lost to cancer never be forgotten, that those who face cancer will be supported and that one day cancer will be eliminated.”


If you have any doubts about Americans’ commitment to share in the American Society’s mission to reduce the burden and suffering from cancer, you should be in Washington DC today.


A literal army of volunteers has come here from across the country to speak with a single voice, to support the Society’s mission, and to make their requests heard in our country’s capital.


The downtown hotels and streets are filled with people decked out in purple and blue shirts whose enthusiasm is high and commitment is palpable.


They have come to Washington to meet each other, share their stories of hope and courage, and to persuade our elected representatives that they must do more to continue support of our efforts to reduce the threat of cancer to our citizens and to the world.


There are some very specific “asks” as part of this Celebration:


  • Support the National Breast and Cervical Cancer Early Detection Program, which provides breast and cervical cancer screenings to low income, uninsured women in the United States.  Current funding allows the program to reach only one in five eligible women.


  • Increase research funding by at least five percent annually for the National Cancer Institute to sustain our progress in life-saving research.


  • Congressman and Senators need to sign the ACS Cancer Action Network Congressional Cancer Promise, which outlines specific legislative actions that will put the fight against cancer back on track by:


  • Elevating prevention


  • Increasing research funding


  • Expanding access to care


How are we accomplishing these tasks on this special day in Washington?


The Celebration on the Hill includes 10,000 cancer advocates.  4000 of those folks are Ambassadors, and they come form every part of this country, and from every walk of life.


They are meeting with their congressman and senators to deliver the message, and their legislators are coming to them to make their commitments.


Last evening, we heard from several of them, including Senators Obama and Harkin, as well as former Speaker Newt Gingrich.


All gave stirring talks that resonated with the crowd.  All are committed to the fight against cancer.


Senator Harkin’s comments were particularly poignant, recounting that of six brothers and sisters, only two are alive today.  The other four have died from cancer.


Speaker Gingrich had the message of the day when he told us that when a legislator says there is no money to support increases in funding for cancer research, the response is a direct look in the eye with the rsponse that we need to spend our funds on saving lives, not building more bridges to nowhere.


So here we are at the beginning of what undoubtedly will be a very exciting and memorable day that will last well into the evening hours. 


As I sit here writing this, surrounded by the banners that tell the stories of survivorship and commitment, and the wishes of all those who, over the past many months, have signed the banners that make up the Wall of Hope, I can’t help but feel a bit overwhelmed by the emotions and thoughts that those simple messages represent.


We are here to make a statement, we are here because of our commitment, and we will be heard.




During the day I will be posting additional blogs recounting some of the day’s activities.


If you want to see more about what is happening, we have postings on the internet at www.celebrationonthehill.org.



Filed Under:

Cancer Care | Medicare | Research

The Amazing Analysis of Genes That Cause Cancer

by Dr. Len September 13, 2006

I recently posted a blog about a potential new therapy for melanoma and other cancers using genetic engineering to enable our own lymphocytes to recognize and destroy cancer cells.


No sooner had the intense interest in this story calmed down, than another article appeared in the same journal, ScienceXpress, describing what one news release described as “Genome code cracked for breast and colon cancers.”


It is no secret to readers of this blog that I believe we are moving forward rapidly with respect to new discoveries in basic cancer knowledge, and this knowledge has the potential in the very near future to move us much closer to our goal of diminishing the burden of cancer.


This new research report brings us even closer to that goal.  And, as we approach this new era we need to start thinking in terms of scientific and technologic convergence.  This convergence, which I will discuss later in this entry, has the potential to unlock the mysteries of cancer, and further advance our early detection, treatment and prognostic capabilities.


The goal of the researchers in the present study, from several medical institutions and companies led by Johns Hopkins, was to identify the mutations in tissue taken from samples of colon and breast cancer and determine which mutations actually were associated with these two cancers.


Knowledge of gene mutations in cancer is not new.  There are several types of mutations that are already known, and there are a few—such as BRCA 1 and BRCA 2—which can be found in some women with breast cancer for which laboratory tests have been developed to identify women who are at high risk of developing ovarian and breast cancer.


But it is also no secret that researchers have thought there must be other mutations that could similarly “type” various cancers, and that if we knew more about these mutations we could then develop various tests that might enable us to find cancers early, determine what treatment targets might be available in a particular cancer, and offer us other information such as how aggressive a particular cancer may be and whether or not it may need closer therapeutic scrutiny.


We have also known that in certain cancers, such as colon cancer, we have been able to determine several genetic changes that must occur for a cancer to develop.  Colon cancer is an excellent example, because several stepwise changes have been identified which occur as a colon polyp develops and transforms to cancer.


But what we did not know was how many of these mutations, and what type of mutations, were present in certain cancers.  Basically, we were being “teased” to find out the rest of the story.


As technology in the area of genetics has rapidly advanced over the past couple of decades, we have finally been able to decode the entire set of genes for humans.  This was a major, painstaking effort when it was completed recently. 


Fortunately, technology has advanced rapidly in the past several years and our ability to decode genetic material has improved considerably.


Now the researchers had the capability to take a closer look at the genetic material of selected cancers, and find out where the genetic messages went awry.


As noted by the authors, “Comprehensive genetic analyses of human cancers could lead to discovery of a set of genes, linked together through a shared phenotype, that point to the importance of specific cellular processes or pathways.”


To accomplish this, the researchers followed a very rigorous protocol.  They concentrated on colon and breast cancer since these account for a significant number of cancer cases worldwide.  They then selected a reference standard of normal genes against which the cancer genes could be compared.


They took gene samples from 11 cases of colon cancer, and a similar number of breast cancer cases. 


Although the number of cases is obviously very small, the reality is that the number of analyses that had to be performed was immense.  We must remember that this is a starting point in this type of research, so even a small number of well studied cases can provide clues which may be applied to much larger numbers of cases at a later date.


Their first analysis provided over 800,000 genetic changes in the 22 samples.  Through a series of “filtering steps” (such as recognizing certain changes did not in fact impact the actual gene function) they were able to narrow the suspect genetic changes to almost 30,000.


Through further analysis, the researchers focused in on 1,307 changes and 1,149 genes in the tumor samples.


Eventually, through multiple processes of elimination and validation, the researchers confirmed 122 genes in breast cancer and 69 in colon cancer that they defined as “CAN-genes”, or what they called candidate cancer genes.


In the breast cancer specimens they analyzed as part of this study, they found anywhere from 4 to 23 of these mutated CAN-genes and an average of 12.  In the colorectal cancer specimens they found 3 to 18 abnormal genes, with an average of 9 in each cancer specimen they analyzed.


They also pointed out that each cancer had a unique gene signature, and no cancer shared more than 6 gene mutations with any other cancer in the study.


The process was validated in a sense when they found evidence of genes that were already known to be mutated in certain cancers.  They also found genes that had been suspected to be abnormal.  But, and this is the truly important part of the study, they also found genes that were not previously known to be mutated in breast or colorectal cancer.


The researchers were also able to sort the variant genes into functional categories, meaning they could develop some idea of what abnormal processes occurred in the cell as a result of the observed mutations. 


What did they consider the key findings of their study?


The researchers pointed out that this study demonstrates that previously unknown gene mutations could be discovered by careful analysis.


Second, the number of mutations that occur as cancer develops are much greater than previously thought.  For breast cancer, they estimate that the average number of mutations in typical case of colorectal cancer is 81, and for the typical breast cancer 105 mutant genes are present.   14 and 20 of these genes, respectively, are the previously described CAN-genes.  And there may be more.


The third major finding from the study, as noted by the authors, is that there are significant differences in the genetic signatures between breast and colorectal cancer.  The details are too advanced to explain here (frankly, even I have difficulty understanding some of this material), but the fact remains that—as suspected—the mechanisms that lead to the development of colorectal cancer are different from those that lead to breast cancer.


What this means is not only that cancers from different organs are different, but cancers that develop in the same organ in different people are different as well.  This is further evidence that cancer is unique for each person in terms of the genetic alterations that lead to the development of the cancer in the first place.


However, despite this uniqueness, the end result for the mutations may be the same.  What this means is that although the genetic changes may be different in specimen A vs. specimen B, they still may occur in locations that result in similar disruption or accentuation of a cancer cell’s function.  Different mutations may have the same effect on the cell, in other words.


“Our results suggest that many genes not previously implicated in cancer are mutated at significant levels and may provide novel clues to pathogenesis.  From these data, it would seem that large scale unbiased screens of coding genes may be more informative than screens based on previously defined criteria.


“For epidemiology, the remarkable difference in mutation spectra of breast and colorectal cancers suggests the existence of organ-specific carcinogens...For diagnostics, the CAN-genes define a relatively small subset of genes that could prove useful as markers for neoplasia.  Finally, some of these genes, particularly those on the cell surface or those with enzymatic activity, may prove to be good targets for therapeutic development.”


Which brings me back to the topic of convergence.


Think of what is happening in home media.  We used to have televisions, record players and radios.  Now we have devices that provide any or all of these options, and if we don’t have them today we will have them in the near future.  The line between television and computer is blurring.  That is convergence.


In cancer research, we have a number of initiatives ongoing at any one time.  We have developed powerful genetic analytic tools as outlined in this blog.  We have new targeted therapies that have produced, in some instances, remarkable therapeutic responses.  We have intense interest in nanotechnology and the identification of proteins present in minute quantities in the blood which may help us detect cancer at the earliest moment, monitor its treatment, and offer reasonably accurate prognostic information.


All of this is the result of convergence of our science. 


This study is an excellent example of how fundamental biologic knowledge has advanced to the point that it opens multiple new opportunities to understand the cancer cell processes by which a cancer cell becomes cancerous.


It will give us new information not only about the development of cancer, but where to look—and how to look—for genetic markers that will tell us who is at high risk of developing cancer and other diseases.


It will offer new targets to explore for possible new and novel therapies.


I could go on and on.  But I do believe you would have to be an exceptional skeptic to deny the importance or the value of this research.


And I suspect the next couple of weeks will likely bring us more reports of similar advances.


As I have said, these are exciting times in oncology research and treatment, and the discoveries cannot come soon or fast enough.

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.