Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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Breast Cancer Screening: The Search For Truth

by Dr. Len November 21, 2012

 We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in today's New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in the United States, and by inference, in other parts of the world.

The research paper-written by Dr. Gilbert Welch and Dr. Archie Bleyer, two highly regarded researchers-concludes that over the past 30+ years, screening mammography has contributed modestly, at best, in the progress we have made in decreasing death rates from breast cancer.  In contrast, based on their analyses, the doctors conclude that much of the gains we have seen are due to better treatment. An additional observation is that 31 percent of the women diagnosed and treated for breast cancer in 2008 - that's more than 70,000 women - were in fact treated unnecessarily, since if left alone or not diagnosed their cancers would never have caused them a problem during their lifetime. In contrast, they say, these women have endured surgery, perhaps radiation and chemotherapy, all of which have serious consequences and in fact did not contribute to their health or their longevity.

 This is not the first research that has been done on this very important-and very emotional--topic nor is this the first time that the question of "over diagnosis" and "over treatment" of breast cancer has become part of the national debate over the value of early detection of breast cancer.

 As the authors acknowledge, there has been a considerable body of research that has tried to answer the question regarding the value of mammography, and assess the "harms" of screening mammograms (which, for the patient may include repeat examinations such as additional mammograms, ultrasound and MRI, and for some women, breast biopsy in order to determine whether or not a suspicious lesion is in fact cancer). There have also been a number of studies-some of which are included in an online table which accompanies the Welch and Bleyer report-which try to determine how many women were treated for their breast cancer without health benefit.

 So let's acknowledge two basic principles:

 One: Many experts agree with the principles espoused in this current report. Yes, some women do have to undergo additional studies to determine if something seen on a screening mammogram is in fact a cancer.

 Two: many experts acknowledge that we do treat some women who would otherwise have done perfectly well had we not found their breast cancers in the first place. More...

In A Moment of Despair, A New Appreciation Of The Strength Of Cancer Survivors

by Dr. Len November 06, 2012

This past Saturday I was sitting on an airplane on my way to a far off destination for a meeting preceded by a couple of days of rest and relaxation.

In and of itself, nothing particularly special about that except that maybe a couple of folks will be jealous. But to me, right now it is an incredible moment, the culmination of a lot of hope and a lot of prayer that I would get to this place on this day. And with that hope and prayer, there is a lot of life-learning that got me here.

About two months ago I wrote a somewhat tongue in cheek blog about being back at work. I had some surgeries to replace several joints (three, in fact) and was thrilled to be back at work, pain free and functional.

But as life would have it, my joy was premature. Shortly after I wrote that blog, I began a journey that I hope few will have to travel. And it isn't over yet. More...

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Cancer Care

A Moment Of Reflection As The Pink Of Breast Cancer In October Gives Way To The Reality of Lung Cancer In November

by Dr. Len November 05, 2012

Now that we are saying goodbye to the pink of October as we move onward from breast cancer awareness month, let us welcome the month of November, when we will shift our attention to lung cancer.

An article I read this past week posted on "Fair Warning" highlighted these issues, using breast cancer and lung cancer as a frame of reference. It carefully and in my personal opinion very professionally looked at the differences. Not casting blame, not failing to report both sides of the story, the author concisely pointed out how the way we relate to these two cancers is so fundamentally different.

In October we are awash in pink. Sometimes it seems the whole world is "pinked."  Breast cancer is a passionate and compassionate topic, one that touches so many aspects of our sensitivities and sensibilities. It is a disease which frightens many women. It is a disease worthy of our efforts to find a preventive strategy that is acceptable and a treatment that will provide a cure. It is a disease which in our minds is almost always curable, if only we find it early. And-please keep this in mind-it is a disease where the perception is common that women (and the rare man) didn't do something specific to cause in the first place, other than occasionally to have the unfortunate fate of having been born to parents who carried a genetic trait that increased their risk.

Although lung cancer is a disease that merits our concern and our focused and committed efforts to reduce its incidence and impact on our lives, our families and our society, the reality is that how we talk and act about lung cancer is eons away from how we approach the topic of breast cancer. After all, lung cancer is in the minds of many a disease that people bring on themselves. If only they didn't give in to tobacco. If only they had stopped when they knew the real risks. If only, if only, if only...

Lung cancer is almost always a fatal disease. It is a disease that frequently strikes in the later years of life, when other diseases are also prevalent, and those other diseases (think heart disease, diabetes, and lung disease) can substantially impact the ability to treat lung cancer. It is a disease where screening has proven to be successful, but we forget that the vast majority of people screened for lung cancer still died and a significant number of folks who were screened but didn't have lung cancer died from the investigations needed to prove they didn't have lung cancer in the first place.

Breast cancer touches almost everyone, and the survivors (fortunately) are legion. They carry the flag to promote early detection, research into treatment, political attention to issues of interest (think mammography and more recently breast density), and fundraising for the cause.

Lung cancer is, in comparison, much more hidden, even perhaps shunned and shamed, since it is perceived as a disease of blame. There is no army of survivors. Much less is spent on lung cancer research compared to breast cancer. Lung cancer does not get a lot of political attention unless we are talking about laws to decrease smoking (which are not bad in and of themselves). But when you think about it, many of those laws are backed not by the smokers-who still want the right to expose themselves to second hand smoke in the last refuges available, such as bars frequented only by adults-but rather by the legions of people who understandably will no longer tolerate the true evils of second hand smoke where they work, where they play and even where they live (smoking in communal buildings such as apartments and condominiums is becoming a hot topic). 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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