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...
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...
March 29, 2012
I have a confession to make:
As soon as I finished reading the Annual Report to the Nation yesterday as I was preparing to write my blog, I got up from my desk and took a walk for 20 minutes.
What, might you ask, compelled me to do this?
The answer is what made me take a walk is the same reason I am writing this follow-up commentary to yesterday's blog: Sitting at my desk all day may kill me. It may be doing the same for you. More...
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...
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...
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...
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...
April 26, 2011
On March 11 I wrote a blog about caregivers. That blog ("The Coach And The Critic: Stories Of Caregivers Where 'Kill Me' Is Not An Option") focused on a session I had attended at the annual meeting of the National Comprehensive Cancer Network devoted to caregivers. But the impact of that experience was far greater than I could ever hope to capture in my writing that day.
Now, the panel is available online for you to see for yourself. It has been posted on the NCCN website in two different formats: in one, you can see the entire session which runs for a considerable period of time. In the other, it has been broken into shorter segments around a specific question or topic of discussion.
For me, it's a no-brainer: watching the whole show is worth the effort to get the full impact of what the panelists had to say that day. But we live in a sound-bite world, so for many of you it may be the short versions that work. And for those of you who don't have more than a few seconds of attention span to devote to online content, this probably isn't going to be for you. And that's a shame. More...
March 23, 2011
Oh, vitamin D, where have ye gone? We miss ya!!
That might be the refrain of many who have labored so long to promote awareness of vitamin D as a possible cancer prevention agent for the past number of years.
Not that the advocates have lost their faith-a recent article from Dr. Cedric Garland, who is an expert on vitamin D as a case in point-but a report from the Institute of Medicine (IOM) has thrown a bit of a damper on the unbridled enthusiasm that vitamin D was the answer to cancer prevention that many have been seeking for some time.
No, the IOM did not endorse vitamin D as a cancer prevention agent. And based on what they could say from the literature, the panel did endorse the concept that vitamin D is important for bone health, while blood tests that reportedly showed substantial deficiencies throughout the United States were in fact not being appropriately interpreted.
Now, in a "Perspective" piece in this week's New England Journal of Medicine, three of the IOM panel members share their thoughts with the public as to why the panel did not reach the conclusion that vitamin D decreases cancer risk. And, while they support that conclusion, they also don't lose sight of the possibility that there may just be some truth behind the claims-bit it hasn't been proven just yet. More...
March 11, 2011
Cancer is emotional. It is emotional for patients, families, friends and colleagues. And there are few moments that are more touching to the human soul than hearing their stories recounting their journey, whether it is a success or unfortunately not. These stories are frequently incredible accounts of human spirit.
Yesterday--in a room of 1200 cancer professionals at the annual meeting of the National Comprehensive Cancer Network in Hollywood, Florida--there were stories told that left no one untouched. A moment when you could hear a pin drop, and see tears in the eyes of professionals who have seen so much heartache you would think they were used to it by now.
There was the football coach almost everyone knows who said that although he had been a leader all of his life and was expected to have the answers, when his wife was dying from cancer and he was all alone what he valued most was having someone to talk to who could be honest with him while he was being optimistic and hopeful for his family and friends.
And then there was the moment when the wife of a cancer survivor who is known to many of us was talking about her husband's treatment, choked up, stopped her words, wrote something on a paper, then said to the audience that when her husband was at his lowest moment and couldn't speak (as a result of his extensive surgery), he wrote something on a piece of paper which she had reproduced as she was making her comments. She held up the paper to the audience. The words he had written at the time and she wrote at the moment of her comment were chilling: "Kill me." And how she responded to those words offer all of us the insight into what so many survivors and their loved ones find within themselves at the worst moment of their lives. More...