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...

So May is skin cancer awareness month. No time like the present to come out with the news: I have been diagnosed with skin cancer.

There really isn't much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those "simple" surgeries--as I have learned from my own experience--can be a bit problematic.

Occasionally it helps to find some humor in difficult situations, and this is one of those times. And since I am generally pretty open about what goes on in my aging body--in an effort to help others understand that they are not alone on some of these issues--I have to hold myself out as an example of what NOT to do when it comes to taking care of yourself.

You see, I am supposed to know this stuff about skin cancer. I know the risks, I know how to prevent it, I know what it looks like, and I know what we are supposed to do when we see a suspicious lesion. Not only do I know these things, I talk and write about them frequently. I am supposed to have a certain level of expertise about skin cancer. In fact, this very month if you happen to be in a doctor's office and they have a closed circuit program from CNN's Accent Health, you will see my smiling face telling you what you need to know about skin cancer.

And if you look closely at my chin in that segment, you will see the little nodule on the left hand side that I chose to ignore--until some friends of mine would not let me ignore it any longer. More...

Coming to an office near you: a new test that can "confidently" predict whether or not you need to have aggressive therapy for your newly diagnosed prostate cancer.

Really?

That's what the press reports would lead you to believe. And it's really going to catch your attention if you're one of the tens of thousands of men who will have to decide what to do if you are diagnosed with prostate cancer that has what we call "favorable characteristics." And with the test coming to market, you would assume that your doctor would have a good understanding of whether or not it works based on the available studies and information. But guess what? The likelihood of that is pretty low, because your doctor has probably been reading the same press reports as the rest of us, since the scientific studies that doctors should rely on to make decisions about this test are simply not available. But the website promoting the test is there for all to see.

Do I sound a bit skeptical? Well, maybe I am. Because if the PSA experience has taught us anything about testing for prostate cancer, it is that we should learn the evidence before we leap. And in this current circumstance, we don't have much-if anything-to learn from outside of company press releases and promotional materials and media reports coming from the scientific meeting where an abstract (#2131) of the research supporting the test was presented this week. More...

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...

Lung cancer is the leading cause of cancer deaths in this country. In 2012, the American Cancer Society estimates that there were about 226,000 people newly diganosed with lung cancer, and 160,000 deaths. If there is good news here-and unfortunately there isn't much good news when it comes to lung cancer-it is that deaths from this dreaded disease have been declining in men and women, since fewer people are smoking. But there is much we have to do to improve this picture.

That's one of the reasons the American Cancer Society is releasing new guidelines on screening for lung cancer. After carefully reviewing the available research, the Society has concluded that there is good evidence that lung cancer screening saves lives by reducing deaths from lung cancer (20% in largest carefully controlled study) in people at high risk when the screening is done by experienced, high-volume lung cancer screening programs.

So who should be screened? Who is at high risk?

According to the guidelines, those for whom lung cancer screening with low-dose chest CT scans are appropriate are people who are between the ages of 55 and 74 and who have smoked 30 pack years (a pack year is one pack of cigarettes a day for one year) or more or who have smoked 30 pack years in the past and quit within the last 15 years and are now within that age range. Those individuals who meet those criteria-should they choose to be screened-should have a low dose chest CT scan every year until age 74.

However, this isn't a blanket recommendation. There are other cautions in the guidelines that you should know about. More...

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...

 We are on a search for truth, but will we ever find it? That summarizes how I feel after reading an article in today's New England Journal of Medicine, which once again raises the question of how much screening mammography contributes to the progress we have made in reducing deaths from breast cancer in the United States, and by inference, in other parts of the world.

The research paper-written by Dr. Gilbert Welch and Dr. Archie Bleyer, two highly regarded researchers-concludes that over the past 30+ years, screening mammography has contributed modestly, at best, in the progress we have made in decreasing death rates from breast cancer.  In contrast, based on their analyses, the doctors conclude that much of the gains we have seen are due to better treatment. An additional observation is that 31 percent of the women diagnosed and treated for breast cancer in 2008 - that's more than 70,000 women - were in fact treated unnecessarily, since if left alone or not diagnosed their cancers would never have caused them a problem during their lifetime. In contrast, they say, these women have endured surgery, perhaps radiation and chemotherapy, all of which have serious consequences and in fact did not contribute to their health or their longevity.

 This is not the first research that has been done on this very important-and very emotional--topic nor is this the first time that the question of "over diagnosis" and "over treatment" of breast cancer has become part of the national debate over the value of early detection of breast cancer.

 As the authors acknowledge, there has been a considerable body of research that has tried to answer the question regarding the value of mammography, and assess the "harms" of screening mammograms (which, for the patient may include repeat examinations such as additional mammograms, ultrasound and MRI, and for some women, breast biopsy in order to determine whether or not a suspicious lesion is in fact cancer). There have also been a number of studies-some of which are included in an online table which accompanies the Welch and Bleyer report-which try to determine how many women were treated for their breast cancer without health benefit.

 So let's acknowledge two basic principles:

 One: Many experts agree with the principles espoused in this current report. Yes, some women do have to undergo additional studies to determine if something seen on a screening mammogram is in fact a cancer.

 Two: many experts acknowledge that we do treat some women who would otherwise have done perfectly well had we not found their breast cancers in the first place. More...

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...

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...

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...