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 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...
August 09, 2013
A newspaper story last week caught my eye when it headlined: "Senators Revive Push for End-of-Life-Care Planning." It reported on new legislation making the rounds in Washington to address care planning for those with advanced illnesses.
You remember "end of life care planning," don't you? It was part of the Affordable Care Act debate several years ago, and quickly became translated into "death panels" where opponents made the argument that the government wanted to help people decide not to receive needed treatment. That was a moment that will live in my memory forever, and it's not a pleasant memory.
So here we are with this new bill, and a headline that suggests we may be headed down the same path once again. This time, however, I hope we can have a more rational and appropriate discussion about an issue that is rapidly evolving in cancer care, supported by medical evidence and medical professionals, not to mention organizations like the American Cancer Society who believe the time has come to engage our patients, their families and caregivers, and the nation at large in understanding the need for compassion as we care for patients with serious illness, including cancer. More...
June 03, 2013
As we walk the halls and sit in the lectures at the annual meeting of the American Society of Clinical Oncology, there's an elephant in the room. It is right there in front of us, but not many of us seem willing to talk about it. Fewer still are making any commitments to do something about it.
So what is this ubiquitous juxtaposition that is right in front of us but we can't seem to see?
It is the contrast between incredibly sophisticated science and computer data that will help us understand cancer and its treatment vs. the reality that we can't have medical records that really work. It is the fact that we have million dollar machines to treat cancer but we have tens of thousands of lives lost to cervical cancer in underdeveloped and underserved countries that could be saved with saved using vinegar. It is cancer care's version of the "guns vs. butter" debate of the 1960s. More...
May 22, 2013
One hundred years.
That is a long time. And although thriving, remaining relevant and engaged for 100 years is a remarkable accomplishment for any organization, the American Cancer Society today takes pride not only in reflecting on the accomplishments of the last 100 years but also in our commitment to continue the fight, and make this century cancer's last.
A lot will be written about the remarkable accomplishments of the Society over the past century. The American Cancer Society takes pride in the fact that it has been able to serve millions of people during that time. It has put its mark on numerous improvements in the science and treatment of cancer. We have made incredible strides in understanding cancer, what causes it and what influences it, including the role of tobacco and overweight/obesity. We have funded 46 Nobel Prize winners at some time during their careers, frequently when they needed a start to develop their theory which led to great discoveries. And we have funded numerous investigators who have made other important and lifesaving contributions to understanding cancer and reducing its burden.
But the list is not complete. There is still too much we don't understand about cancer, its causes, and its impacts on patients, their families, their communities. We have come to a "tipping point" in the cycle where we have unlocked the genetic code of cancer and are just beginning to transform that information into lifesaving treatments. We wrestle with the early detection and prevention of some cancers, at a time when we thought--incorrectly, as it turns out--that simply finding cancer early was enough. We struggle with finding a way to get access to lifesaving or life comforting treatments to those who are diagnosed with cancer but don't have the resources to follow their journey in the best way possible. We have millions of survivors, yet understand too little about the problems they face long term, let alone being able to provide them with a system of care to respond to their needs. We have made remarkable progress in keeping children with cancer alive, free of disease into adulthood, but we haven't acknowledged the terrible price some of them have to pay from the side effects of their treatments. More...
April 18, 2013
April is National Minority Health Month.
That's the "dry" statement. The impact statement is that-unfortunately-for many in this country, this is more than a phrase. It's a reality that their health and their health care are in crisis. And the sooner more of us understand this, the sooner we can make a genuine effort to implement effective strategies that will address the sad state of affairs many people find themselves in when it comes to their health, and preventing and appropriately treating their diseases.
This is about more than high blood pressure and diabetes. It's about heart disease and stroke and cancer and the list goes on. This is about neighborhoods were residents don't have a place to walk or may even have fear of walking outside their homes. This is about people living in communities where they can't find affordable, fresh vegetables and healthier foods. This is about not having access to a regular source of medical care, or getting timely treatment for conditions such as breast cancer which many of us take for granted. It is about assuring equitable and quality treatment once diagnosed. This is about the lack of trained health professionals from these communities who have roots and understanding of their cities, towns and neighborhoods where they might be able to make a real difference in the lives of so many people. More...
January 07, 2013
The positive news continues: cancer death rates have continued to fall in the United States, for men and women, maintaining a trend that began in the early 1990's. That's the essence of a report released today by the American Cancer Society, the National Cancer Institute, the Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries in the Journal of the National Cancer Institute.
The report, titled in part "Annual Report to the Nation on the Status of Cancer, 1975-2009" also features a special section on the burden and trends in Human Papilloma virus (HPV) associated cancers and HPV vaccination coverage levels. Unlike the continuing decline in cancer deaths in the United States, we could be doing a much better job of getting young folks vaccinated against HPV and reducing the incidence and death rates from several HPV-associated cancers, according to the authors of the report and an editorial that accompanied the report.
This report comes out every year. It is a summation of what we know about the trends in incidence rates for the most common cancers in the United States among both men and women as well as the trends in death rates from those cancers that lead to the highest mortality in the general population as well as specific ethnic groups. It is in a real sense a report card on our progress, which in large part is good but in a number of cancers, not so good.
The good news is what we have come to expect: since the year 2000, the overall cancer death rates have continued to decline 1.8% per year in men, 1.4% in women and 0.6% per year in children. That may not sound like much, but when you consider the fact that this is an average change seen every year, those numbers begin to add up. More...
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...
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...