Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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Cervical Cancer (23 posts)  RSS

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...

Weight And Inactivity Are Threatening To Overtake Tobacco As Risk Factors For Cancer According To Annual Report To The Nation

by Dr. Len March 28, 2012

The "Annual Report to the Nation on the Status of Cancer" was released this afternoon as has been the case every year since the first report was issued in 1998. And, like many of the reports previously, we are fortunate to continue to see declines in the rates of deaths for many cancers along with a decrease in the frequency of some cancers.

 

However, the news is not all good.

 

Unfortunately, the incidence of some cancers continues to increase. And, as explained very clearly in this excellent report, this nation continues to suffer from an epidemic of overweight, obesity and physical activity that the authors suggest-but don't actually say-has the potential to overcome the favorable impact of declining smoking and tobacco use on cancer incidence and deaths. The implication is clear that if we don't do something-and do something quickly-to reverse the trend we will see incidence and deaths from certain cancers continue to increase in the future.

 

And I would stress the point that it is no longer just being oversized that increases your risk of cancer, but also sitting all day on the job (like I am doing right now) as another factor that plays into your cancer risk, independent of how large or small you may be. More...

Surgeon General's Report On Preventing Tobacco Use Among Youth and Young Adults: So If We Know What To Do, Why Aren't We Doing It?

by Dr. Len March 09, 2012

I had the opportunity yesterday to attend the event marking the release of the 31st Surgeon General's report on tobacco and smoking.

 

What struck me about this report-which focuses on tobacco use in youth and young adults--is that although we have made progress in the tobacco wars, we presently seem to be in a holding action. We are not making advances in reducing the incidence of smoking and use of smokeless tobacco products, although we are all well aware of their risks and harms.

 

The fundamental question remains: Although we have a pretty good idea of what works, when are we going to start reinvigorating our efforts to reduce the use of these killer products among our children?

 

As I have said many times before, tobacco is the one product readily and legally available in the United States that when used as intended will kill half the people who use it. 443,000 deaths a year, 1200 a day, $96 billion each year in direct medical costs and $97 billion in lost productivity. Those, my friends, are big numbers. And they are not just numbers: they are people. They are the people we love, the people we know, the people we work with. More...

Cancer Facts and Figures 2012: One Million Cancer Deaths Averted, But We Still Have A Long Way To Go

by Dr. Len January 04, 2012

Welcome to the New Year!

 

And as has been the case for many years in the past, the American Cancer Society takes the New Year opportunity of providing the nation with the latest estimates of cancer incidence and deaths, along with a measure of how well we are doing in reducing the burden of cancer in the United States.

 

The data is contained in two reports released today by the Society: the consumer oriented Cancer Facts and Figures 2012 and the more scientifically directed Cancer Statistics 2012. Both are available online. 

 

It is never "good news" to realize that the burden of cancer in this country is immense. And with the country gaining in population and age, the extent of that burden is inevitably going to increase. But this year's report does contain some welcome information, namely that cancer death rates have declined in men and women of every racial/ethnic group over the past 10 years, with the sole (and unfortunate) exception of American Indians/Alaska Natives. In addition, the Society now estimates that a bit more than one million cancer deaths (1,024,400 to be exact) have been avoided since 1991-1992.

 

That one million number is actually more significant than it seems. Many of the people in that 1 million never heard the words "you have cancer." Maybe they had a colon polyp removed before it became cancerous, maybe they stopped-or never started-smoking. Maybe they had a pap smear that found a pre-cancerous lesion. And then there are the patients who have benefitted from the advances in cancer treatment that have occurred over the past number of decades.

 

But the 1 million number also means that these are people who have hopefully remained active and engaged in life, loved by their families, productive in their communities. In economic terms, the return on investment on avoiding those one million deaths may likely be incalculable. In human terms, it is an amazing accomplishment. More...

A Declaration for the World, A Noble Mission For All

by Dr. Len September 20, 2011

There are few times in life when one gets to watch history being made. Today is one of those times.

 

I am in New York with a number of colleagues from the American Cancer Society and other committed organizations to observe a UN High Level Meeting which will--at long last--put non-communicable diseases on the international agenda. The impact of the decisions made here over the next two days can indeed change the face of global health forever. More...

Cancer Facts and Figures 2011: Poverty is a Carcinogen. Does Anyone Care?

by Dr. Len June 17, 2011

"Poverty is a carcinogen."

 

Those were the words of Dr. Samuel Broder when he was director of the National Cancer Institute in 1989.  

 

As amply documented in the annual "Cancer Facts and Figures 2011" released today by the American Cancer Society, cancer shows that poverty remains one of the most potent a carcinogen-rivaling tobacco and obesity-as we have ever seen.

 

We have heard lots and lots about how cell phones and Styrofoam cause cancer.  But do you hear anyone talking about the huge impact of poverty and limited education on cancer?

 

If you don't hear anything about a true carcinogen that statistics show causes 37% of the deaths from cancer in people between the ages of 27 and 64, then maybe you have the answer to a very important question: If we are serious about reducing the burden and suffering from cancer, why aren't we paying attention to those most in need? More...

Cancer Survivors Are (Fortunately) Very Much A Part Of Our Lives

by Dr. Len March 10, 2011

An article just released by the Centers for Disease Control and Prevention in their weekly publication "Morbidity and Mortality Weekly Report" provides an assessment of the progress we have made in the diagnosis and treatment of cancer.

 

Clearly, since 1971, we have made substantial advances in the cancer treatment.  We have become a larger and older nation.  We have pushed the threshold for the diagnosis of cancer, with breast and prostate cancers as leading examples.

 

The result is that we have many millions more people alive with cancer today than was ever the case in our history.

 

But with the progress also comes cautions about what the data means, and where our journey must go if we are to address some of the key issues reflected in these statistics. More...

World Cancer Day: The World Does Not Have To Go Where We Have Already Gone

by Dr. Len February 04, 2011

As I write this, I am en route to New York to participate in the lighting of the Empire State Building tonight in honor and recognition of World Cancer Day.

 

Spearheaded by the Union for International Cancer Control (better known as UICC)--an international organization devoted to reducing the burden of cancer worldwide--and vigorously supported by the American Cancer Society and many other notable organizations, people, and governments worldwide, World Cancer Day is intended to highlight the growing number of cancer cases and deaths around the world and the need for us to pay serious attention to the problem and institute measures to reduce that burden.

 

As part of World Cancer Day, the American Cancer Society is releasing the second edition of Global Cancer Facts and Figures, a monograph that assembles in one place what we currently know about the worldwide burden of cancer. A special section in the booklet highlights the growing cancer burden in Africa, and what needs to be done to address what could well become an epidemic of cancer on that continent.

 

When you look at cancer globally, you begin to realize there are several parts to understanding and addressing the problem. And although the increasing number of cancer cases and deaths is universal, the solutions are local. More...

The 2010 Statistics Are Out, And 767,000 People Have Celebrated More Birthdays

by Dr. Len July 07, 2010

Every year the American Cancer Society provides a report that is one of the most widely quoted scientific articles in this country.  This year's "Cancer Statistics, 2010" report was released this morning, and provides a considerable amount of information regarding the burden of cancer in the United States, such as the expected number of new cancer cases and number of cancer deaths in the United States in 2010.

 

As part of the same report, my colleagues at the American Cancer Society also dissect the numbers and provide insight into the trends in cancer incidence and deaths, what is happening and perhaps why it is happening.  Statistics--no matter how good you are at writing reports--are always somewhat droll and boring.  But there are the occasional pearls that leap out at you from time to time, especially if you are interested in this particular subject (which obviously, I am).

 

Some good news is that--as we have seen in recent years--the death rates from cancer in this country continue their steady decline since the early 1990's.  For men of all races, death rates from cancer have fallen 21% between 1990 and 2006, the latest year for which accurate information is available.  Most of that decline can be explained by decreases in deaths from lung, prostate and colorectal cancer which account for 80% of the observed fall in cancer deaths in men.  For women, the data show a 12.3% decrease in cancer death rates over the similar period of time with most of the decrease coming from falling breast and colorectal cancer death rates.  For women, unfortunately--as has been the case for the past several years--lung cancer deaths have remained steady.

 

These changes from the early 1990's through 2006 have occurred slowly, year over year over year.  But when looked at in total, you begin to understand the impact of this accumulated progress. My colleagues estimate that over this period of time, 767,000 deaths from cancer have been avoided.

 

More...

A New Vaccine Holds Promise For Women With VIN

by Dr. Len November 04, 2009

An article in today’s New England Journal of Medicine reports some interesting and intriguing research that may help some women with a not uncommon pre-cancerous lesion of the vulva called vulvar intraepithelial neoplasia, or VIN.

 

By using proteins found in the cancer-causing human papilloma virus type 16 (HPV-16), the researchers were able to make a vaccine that actually led to an effective treatment for a small group of women with VIN, resulting in complete disappearance of the lesion in almost half of the women they treated.

 

You may have heard of HPV infections.  These are the viruses that cause cervical cancer.  Two of these viruses—types 16 and 18—are responsible for the majority of cervical cancers in the United States.  They are also the viruses targeted by currently available vaccines which prevent infection with HPV thus reducing the risk of developing cervical cancer.

 

It turns out that the same viruses are also related to VIN, especially type 16 which causes over 75% of VIN. (VIN is a superficial lesion on the vulva which can actually last for many years.) 

 

The problem is that the treatments for VIN are sometimes unsatisfactory, and the lesions can recur frequently after treatment.  Topical medicines, surgery and laser treatments are commonly used.  More recently, an antiviral medicine called imiquimod has been reported to be effective and less irritating.  About 1 out of 65 VIN lesions can resolve spontaneously.

 

And, just like what can happen in the cervix where the HPV infection progresses on to cervical cancer, untreated VIN can become an actual vulvar cancer.  Fortunately, this is uncommon.

 

In this current report, the doctors made a vaccine using cancer-causing proteins from the virus.  They treated women with advanced pre-cancerous VIN by giving them the vaccine under the skin of the arm or leg every three weeks for a total of three to four injections.  Side effects were tolerable, and frequently included a local reaction at the vaccination site in addition to flu like symptoms, chills and tiredness.

 

The responses in some of the women were remarkable: At one year, 6 of the 19 patients had a partial response to the vaccine. 9 of the patients (47%) had complete disappearance of the VIN, which lasted for at least another 12 months.  As a result, 79% of the women responded to the vaccine.  This compares to a complete response rate of 35% for lesions treated with imiquimod, according to the report.

 

Unfortunately, not all of the women had such positive responses to the vaccine.  Two of the participants went on to develop cancer, and one of those women had shown a previous partial response to the vaccine.

 

The researchers also measured whether the women’s immune systems responded to the vaccine.  All of the women in the study did have a response, and those with a complete resolution of their VIN at 3 months after treatment had much stronger responses compared to women who did not have a complete regression.

 

What’s interesting to me about this research is that it seems to work in a way that is different from what we have seen before.

 

We are all familiar with the typical types of vaccines, where the vaccine contains a protein from a virus or bacteria that is given to us when we aren’t sick with an infection and then prevents us from getting the same infection at a later date.

 

Here we have a situation where the woman is already infected with the virus, and her body has either not developed a response to the infection or become “tolerant” to the virus.  That’s usually a situation where vaccination doesn’t work.  Think of having the flu, then getting the flu vaccine.  Basically, it’s too late. 

 

That same theory carries over to the currently available cervical cancer vaccine.  If a woman has already become sexually active and infected with HPV, then giving her the preventive vaccine isn’t going to be effective in reducing her risk of cervical cancer.

 

But, for some reason, in this trial giving a piece of the virus to stimulate the immune system after the infection had set in did work. What I don’t understand is how that happened.  It just is not what one would ordinarily expect based on the science.

 

These doctors weren’t interested in making a prevention vaccine.  What they developed, as they report, was a therapeutic vaccine.

 

Maybe I shouldn’t be so worried about how this happened, and just be glad that in fact it did happen. 

 

The implications of this research are significant. 

 

First, it may mean that this vaccine will be studied further (this was a very small, early stage trial) and eventually be available for wider use in the treatment of women with VIN.

 

But—perhaps more importantly—it raises the question of whether a similar approach could be used in women who have advanced pre-cancerous lesions in the cervix.

 

These researchers have actually previously reported studies using the same vaccine in women with either advanced or treated cervical cancer.  In one study, they vaccinated women who had cervical cancer that was successfully treated surgically, and were able to induce an immune response to HPV-16 using this vaccine. 

 

As they stated in that article, the results of the study “indicates the potential of this vaccine for the immunotherapy of HPV 16-induced progressive infections, lesions, and malignancies.”

 

In plain language, if this vaccine is effective in VIN, and it can demonstrate the ability to cause an immune response in women who have already been diagnosed with cervical cancer, then maybe it can also be effective in treating women who have pre-cancerous cervical lesions as well.

 

I suspect it will be some time before we know the rest of the story as to whether this vaccine is truly effective in treating women with VIN or whether it can improve the treatment for women with pre-cancerous lesions of the cervix.  Patience is clearly going to be part of the process.

 

But if this theory holds up, then this report could be the foundation of a new approach to treating some not-uncommon pre-cancerous diseases.  And that is very exciting news indeed.

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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