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...
April 21, 2015
Years ago when I first started this blog I wrote about the democratization of information, and how people would come to an era where they had ready access to information yet reserved the right to determine whether that information was valid or not.
Fast forward to today, and a company called Color Genomics announced a new genomic based profile to measure breast cancer risk. They are clearly headed into the democratization of health care, since they are pricing the test at $249 and have tried to reduce the barriers for women and men to get the test.
Inevitably, this announcement is going to fan the flames of how far we should be going to allow people to get whatever laboratory tests they would like, whenever they want them. Although a health professional must order the test, in reality doctors will be available to meet your need if you decide to bypass your personal physician. And although most professional organizations active in this field recommend genetic counseling from a qualified professional be done before such tests are done, the company says they will provide such counseling-after the test results are known. More...
January 30, 2015
This blog was originally published on the Medpage Today website on January 22, 2015. It is reposted here with permission.
Are we prepared for the genomics revolution?
The President's proposed Precision Medicine Initiative as mentioned in his recent State of the Union address suggests it's probably time to get ready for some changes in our daily routines as health professionals.
I'm not talking about the incredible information that has already been produced by researchers examining the human genome. Nor am I referring to the work that is going on in major cancer centers and elsewhere exploring how to better match patients with genomic analyses of their cancers, for example.
And I am not talking about the advances in targeted therapies associated with diagnostic tests that can help guide the treatment of patients with a variety of cancers including but not limited to lung and breast cancers as examples.
No, I am asking whether we are prepared to usher in the new era of medical practice where genomic analyses in one form or another will be a part of our everyday medical practice. It's not just about cancer, my friends. It will be coming to a primary care practice near you probably sooner than you realize -- but it is coming. More...
November 06, 2014
What if you were sitting in the room with some of the best financial and scientific minds in the country and someone asked how many of you would be willing to contribute a modest sum of money to create a company with the potential of speeding up the evaluation of drugs that could revolutionize cancer treatment?
That was the opening question of a fascinating meeting I attended recently at the Massachusetts Institute of Technology, one where I didn't want to leave my seat for a moment for fear I would miss another thought-provoking comment or idea.
The meeting was called CanceRX 2014, and for two solid days about 300 participants listened, debated, and engaged in discussion on how to make that scenario happen. No small task, to be certain. But in this era of ever increasing research discoveries of new treatment targets, it is clear that we need some innovative thinking to take what we learn in the laboratory to the bedsides of the patients we care for. And to make that happen we need as much "out of the box" thinking as we can muster. More...
October 02, 2014
It's October and that means we are about to see a lot of pink for the next 31 days. And virtually all of the work comes down to one simple -some might say overly simple-message: get a mammogram.
But as National Breast Cancer Awareness Month (NBCAM), begins, I find myself one again asking some difficult questions: Are we really looking at the right side of the equation? Is it all about mammograms? Is there more to the story? The answer is absolutely unequivocal and without a moments hesitation: YES! More...
September 30, 2014
I had an interesting day this past week. Sadly, it left me wondering why the same "hope and hype" directed at cancer patients and their families decades ago when I started my oncology career was still alive and well today. But then, maybe I am the naïve one to think that anything should have really changed.
In the morning I found out that a story I had been interviewed for a story which appeared on the Kaiser Health News website. A discussion about proton beam therapy for cancer (PBT), it basically pointed out that insurers aren't necessarily paying for the treatment and that the information supporting its use is not as definitive as some would hope or claim.
Not long after, I was informed of an online discussion on Twitter (called a "tweet chat" at #protonbeam) being hosted by a major medical institution and a well-known weekly newsmagazine on the very topic of proton beam therapy, or PBT. What I watched unfold over the hour-long discussion was what I call a "scrum" of doctors and public relations people promoting proton beam therapy as the answer to many cancer treatment dilemmas with nary a word about the limitations of our knowledge or potential problems with the treatment. It was all about "we can do it, call us and we will tell you how good we are, and insurers won't pay us." Simply stated, the "conversation" seemed to be glancing by some of the inconvenient facts surrounding what has become another poster story for how we develop and promote new treatments in medicine, let alone cancer care. More...
July 24, 2014
I had the privilege this week to serve as the keynote speaker for the 4th Summit sponsored by Latinas Contra Cancer-an organization founded and led by Ysabel Duron, a formidable cancer survivor and news media presence in San Francisco.
Bringing together members of the Latino community, researchers, community health workers, promotores (more on that later) and advocates, the summit focused on the issues facing the Latino community in increasing awareness, access to care, improved treatment and research opportunities among other topics. But what was most impressive was the spirit, engagement and commitment that permeated the room for the two days of the meeting.
I would like to share with you some of what I learned during the preparation for that lecture, as well as some observations that tie together the impact and calls to action that are relevant to the Latino community and many other ethnic and socioeconomic groups in the United States. (You may wish to refer to the American Cancer Society's "Cancer Facts and Figures for Hispanics/Latinos 2012-2014" which contains a wealth of information relative to cancer for this community.) More...
June 17, 2014
This past week I had the privilege of participating in a meeting hosted by the President's Cancer Panel on the role of social media in improving cancer control and treatment. The goal was to give advice to the Panel on a planned series of meetings they will be convening to discuss the topic. It was the range and quality of the discussion that day that left me thinking about the broader topic of social media and how it could help improve cancer control going forward. More...
June 04, 2014
As in years past, the trip home from the Annual Meeting of the American Society of Clinical Oncology in Chicago gives me a moment to reflect on what I have heard and hopefully learned over the past five days.
This meeting is a whirlwind of activity and information, far too much for any one person to absorb and process. You can be focused on one topic, you can be general, and you can hear new cutting edge research or be educated on topics of general interest in cancer. You can go to the exhibit hall and be overwhelmed by the booths and displays (I tend not to go there, but obviously many others do). I suspect you get the idea.
Ultimately for me it is the take away messages about trends in cancer research and cancer care that matter the most personally. And this year the trends appear to be somewhat similar to past years, with perhaps some new wrinkles. What is undeniable is that if immunotherapy is the queen at the ball, then "panomics" (I really like that word) holds the keys to the kingdom. More...
March 27, 2014
I had the opportunity earlier this week to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called "80 by 2018" designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths from this disease.
But I am haunted by two of the comments I tweeted during the session chat that won't leave my conscience:
"As a doc, you don't forget the patients you couldn't help. And you celebrate those you did. #CRCawareness is key #80by2018"
"Let's remember that screening doesn't help everyone, so don't forget the need for more research in understanding #CRC #80by2018"
While we celebrate the opportunity to save more lives with screening, we cannot ignore or forget those for whom screening for colorectal cancer (or other cancers, for that matter) couldn't or didn't make a difference. More...