Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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Breast Cancer (109 posts)  RSS

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...

How Do Cancer Survivors Cope So Well?

by Dr. Len October 10, 2012

Last week David Sampson, who is a colleague of mine here at the American Cancer Slociety, sent me a blog written by a woman well known in the breast cancer community who days previously had been diagnosed with recurrence of her breast cancer. The blog has captivated me, perhaps more so now that I have been facing some of my own health issues. And it reminded me about how special patients living with cancer really are.

 

Lisa Bonchek Adams blogs at http://lisabadams.com/. She was diagnosed with Stage II breast cancer shortly after the birth of her 3rd child, more than five years ago. Last week she was told that her disease had progressed to stage IV, and treatment planning is currently underway.

 

What is so remarkable to me is that in the face of an overwhelming circumstance, Ms. Adams had the presence of mind to write a commentary titled, "What to do when you get diagnosed with Stage IV breast cancer: some starting thoughts...especially about children." She then proceeds to lay out in a very organized, almost dispassionate way some very practical advice on how to approach the circumstance of discussing the change in your life that happens when diagnosed with a life-threatening illness, concluding:

 

"I will be posting more tips about what I'm doing in the weeks and months ahead. Hopefully they will help you or someone you care about. There is so much you can't control during this time, and that's unnerving. Even taking steps like these can give you concrete tasks and a feeling of accomplishment that you are helping yourself and those you love." (emphasis mine)

 

 

The advice is practical, but what really got to me was how her commentary was so straightforward. And this from a lady who just heard the news no one wants to hear: your cancer has spread; the length of your years uncertain. More...

During Breast Cancer Awareness Month We Must Not Only Celebrate Our Success But Also Understand Our Limitations

by Dr. Len October 03, 2012

I find myself sitting here to write a blog in recognition of Breast Cancer Awareness month, and frankly it's not as easy as I anticipated. And I am asking myself why that is.

 

We have made considerable progress in the early detection of breast cancer. I have commented frequently about the differences in breast cancer detection, treatment and survival today and when I started my medical training and career in the 1970's.

 

Early detection is clearly a success story if the measure of success is whether or not we can find breast cancer when it is "small" in most women. Our technology lets us do that with mammography techniques that are far more accurate and sophisticated than they were a few decades ago. Much of our discussion today centers around what role newer approaches, such as MRI, ultrasound, and most recently 3-D mammography have in early detection of breast cancer.

 

Our treatments are much more refined than they were in 1970, as well. We now have lumpectomy and radiation as a valid replacement for many mastectomies. We have sentinel node biopsy instead of axillary node dissection, which for some women adds nothing but long term misery caused by swelling of the arm. We have hormone-related treatments, chemotherapies, and biologic therapies that can prevent cancer from recurring; and we have an increasing number of promising approaches to treat the disease if it does come back.

 

We have genetic tests that can help pinpoint women at higher risk of developing breast cancer, and others that can help some women and their doctors decide whether or not they need to receive chemotherapy as part of their adjuvant (preventive) treatment after primary treatment with surgery.

 

We certainly have increased awareness of breast cancer beyond anything imagined in 1970. It's hard to imagine, but back then, cancer was not discussed in polite company (really). Some women did everything they could to hide their disfigurement and even what they thought was their "shame." Today, breast cancer is discussed openly and frankly (most of the time), and the voice of advocates is being heard at levels never dreamed of decades ago.

 

So with all this progress, why shouldn't I be celebrating our successes? More...

During Breast Cancer Awareness Month We Must Not Only Celebrate Success, But Reflect On Our Limitations As Well

by Dr. Len October 03, 2012

I find myself sitting here to write a blog in recognition of Breast Cancer Awareness month, and frankly it's not as easy as I anticipated. And I am asking myself why that is.

 

We have made considerable progress in the early detection of breast cancer. I have commented frequently about the differences in breast cancer detection, treatment and survival today and when I started my medical training and career in the 1970's.

 

Early detection is clearly a success story if the measure of success is whether or not we can find breast cancer when it is "small" in most women. Our technology lets us do that with mammography techniques that are far more accurate and sophisticated than they were a few decades ago. Much of our discussion today centers around what role newer approaches, such as MRI, ultrasound, and most recently 3-D mammography have in early detection of breast cancer.

 

Our treatments are much more refined than they were in 1970, as well. We now have lumpectomy and radiation as a valid replacement for many mastectomies. We have sentinel node biopsy instead of axillary node dissection, which for some women adds nothing but long term misery caused by swelling of the arm. We have hormone-related treatments, chemotherapies, and biologic therapies that can prevent cancer from recurring; and we have an increasing number of promising approaches to treat the disease if it does come back.

 

We have genetic tests that can help pinpoint women at higher risk of developing breast cancer, and others that can help some women and their doctors decide whether or not they need to receive chemotherapy as part of their adjuvant (preventive) treatment after primary treatment with surgery.

 

We certainly have increased awareness of breast cancer beyond anything imagined in 1970. It's hard to imagine, but back then, cancer was not discussed in polite company (really). Some women did everything they could to hide their disfigurement and even what they thought was their "shame." Today, breast cancer is discussed openly and frankly (most of the time), and the voice of advocates is being heard at levels never dreamed of decades ago.

 

So with all this progress, why shouldn't I be celebrating our successes? More...

Expert Opinion: A US Perspective On Beating Cancer

by Dr. Len September 06, 2012

(Author's note: The following blog was posted today on the "Science Update Blog" hosted by Cancer Research UK, where you can read it in its entirety. My thanks to Cancer Research UK and especially to Oliver Childs who made this opportunity available.)

 

Expert opinion: a US perspective on beating cancer

Posted on September 6, 2012 by Oliver Childs

 

 

Dr Len Lichtenfeld is deputy chief medical officer for the American Cancer Society. We invited Len to share his thoughts about our shared challenge of beating cancer.

As well as giving his unique perspective on the US's "war on cancer", Dr Len writes about the similarities and differences between the US and UK in our approaches to preventing, detecting and treating the disease:

 

It has been a long slog since we started our war on cancer here in the United States in 1971.

 

At times I am not certain that this has been so much of a war as opposed to a series of skirmishes that occasionally have produced incredible moments of optimism. But there have been a fair share of frustrations as well along the way. Our science and our care have made significant progress, but sometimes we find ourselves asking, "What have you done for me lately?"

 

I think it is important to reflect on the progress that we have made on several fronts in detecting cancer earlier, treating it more effectively and providing quality of care for those who find themselves caught in the jaws of illness, especially for those whose journey has not been successful. More...

A Personal Reflection On Lance Armstrong: A Moment In Time, A Powerful Commitment To Cancer Research and Survivorship

by Dr. Len August 30, 2012

Like many of you, I have been reading the various news stories about Lance Armstrong, especially one this past weekend in a major newspaper, which went into great detail about the allegations surrounding Lance Armstrong's cycling career.

 

But what I didn't see in all of that coverage was much mention of the other side of the man, the side that I witnessed up close and personal one Friday in Texas a couple of years ago, the side that has led me to share my thoughts with you today.

 

I saw something that day that I had never-let me repeat, never-seen before. It was a moment that has forever influenced my opinion of Mr. Armstrong, even as these various charges have swirled about him these past couple of years. And the impression it created was indelible.

 

I am not here to hash/rehash the incriminations. I am here to stand up and say that no matter what the truth is regarding the allegations, this is a man who has forever changed the cancer landscape for millions of people in this country and around the world. This is a man who lent his prestige and his personal power to a cause that was dear to him, in what I believe a heartfelt and selfless effort to make the lives of others more comfortable, and more meaningful. This is a man who has offered hope to those in emotional and physical pain, and no matter what he may or may not have done, no one should ever dismiss or forget his accomplishments for our humanity. More...

Will Genomics Lead Us To A Brave New World Of Cancer Diagnosis?

by Dr. Len June 03, 2012

 

One of the things I enjoy about coming to meetings like the current annual session of the American Society of Clinical Oncology (ASCO) is that it gives me a chance to give thought to some larger questions that face cancer care. A presentation I attended Friday afternoon on the impact of genomics on cancer diagnosis and treatment in the future has offered just such an opportunity.

 

Most of you I suspect give little thought to the actual processes that we use to diagnose cancer. One has a tumor somewhere in the body, the doctors take a specimen, send it to the pathologist and the pathologist makes the diagnosis. Simple and straightforward. Get it done and get on with treatment.

 

But in fact it isn't so simple and straightforward. And in the world we live in, it is getting more and more complex.

 

Looking at cancer tissue under the microscope is something that has been done for over a century. More recently, we have seen the advent of special additional tests that tell us for example whether or not a cancer such as breast cancer is hormone sensitive or whether it has other markers such as HER2. We can send specimens of the cancer to a lab to find out whether or not it is more or less aggressive and we can even do tests to find out whether or not--for example--a woman with a breast cancer really needs to take traditional cancer chemotherapy. There are even special stains that can be applied to tumor tissue through a variety of techniques that can further refine the characteristics of a particular tumor and help us determine what kind of cancer it may be, or what subgroup of a family of cancers, such as lymphoma, a particular cancer fits in to.

 

All of that is well and good, but unfortunately that simple explanation does neither justice to how doctors diagnose cancer, nor does it say much about the problems that can occur in making cancer diagnoses, especially with all of the new tests that are available. I suspect that many physicians will agree that simply looking at the tissue under the microscope just doesn't tell us anymore all the things we should know about a particular individual's cancer. More...

A Blast From The Past Meets A Drug From The Present To Create A Vision Of The Future: A New Treatment For Breast Cancer That Makes A Difference

by Dr. Len June 03, 2012

 

This is the stuff of science fiction, a dream, something you could envision but were skeptical it could be done. But now it has been done, and raises the question of whether we are headed "back to the future" in the treatment of cancer.

 

The drug in question here is called T-DM1. It is an "antibody drug conjugate" between trastuzumab--which is a monoclonal antibody drug commonly used today to treat selected women with aggressive breast cancer--bound to a derivative of another more traditional cancer chemotherapy drug called maytansine.

 

Maytansine was a cancer chemotherapy drug evaluated in the 1970's and found to be effective in treating breast cancer, but its side effects were so severe that it could not be used clinically. As a result, it became a laboratory curiosity, banned from patient care.

 

Trastuzumab is one of the really positive stories of the modern targeted therapy era. It is an antibody drug that has effectively treated women with advanced breast cancer that is positive for HER2, which results in a protein "key" being formed on the surface of certain breast cancer cells. Trastuzumab attaches to that key and aborts the internal processes of the HER2 positive breast cancer cells. About 30% of women with breast cancer are HER2 positive, and those women tend to be younger and have more aggressive forms of the disease. Not only does trastuzumab help treat advanced breast cancer in these women, it has had a remarkable impact on reducing recurrences after primary treatment when  used as part of adjuvant therapy in HER2 positive breast cancer.

 

But there are serious side effects from the drug combinations that are used with trastuzumab in these circumstances. And then there are the limited treatment options availalable once the HER2 breast cancer recurs, which happens all too frequently.

 

Fast forward, and the chemistry wizards found a way to bind the trastuzumab to the maytansine derivative. The theory was that the trastuzumab could hone in on the breast cancer cells with the HER 2 receptor, and that the attached chemotherapy drug could find its way into the cancer cell where it could do its damage. And because the delivery of this antibody-drug conjugate was so specific to the breast cancer cells that have this HER2 receptor on their surfaces, a lot of the adverse effects previously seen in using both drugs might be reduced. Think of a cargo rocket making a delivery to the space station, then docking with the space station, and moving the cargo into the space station.

 

Sounds simple, but it's not. More...

Has Science Served Us Well When It Comes To The Prevention and Early Detection Of Cancer?

by Dr. Len May 02, 2012

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

 

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

 

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

 

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

 

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

"Data, Data, Data" Should Never Replace Care And Compassion

by Dr. Len April 30, 2012

Lessons in life rarely come at us with lights flashing and horns blaring. Such was the situation recently when I was attending a luncheon in Portland OR for some of our Strides Against Breast Cancer volunteers.

 

He was not a flashy gentleman. Most of the attendees were young women, and the conversation was very animated. He was more reserved. Older, gray hair with a worn baseball cap, jeans and a work shirt. A bit taciturn but  pleasant, and he had made a special effort to be there. Clearly he was in some personal discomfort and I realized that he needed to talk.

 

Without going into all of the details, his wife had died from breast cancer. Obviously, they had been partners for life and her loss was painful. In a sense, he appeared to have dealt with that as well as one can "deal" after the loss of someone sorely loved. As I have said for many years, the sad reality is that when we love we always know that sometime in that love there will be intense loss, and that the loss is never the end of the journey.

 

We talked a bit and the messages arrived. There were lessons he wanted me to hear, and they weren't entirely positive. 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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