Is our evolution becoming a revolution? Am I in danger of becoming a victim of the same "hope and hype" that I derided as a young oncologist in the 1970's and 80's and is currently the focus of some vocal critics of recent glowing media reports on the successes of cancer research and treatment?

Those are the questions I am asking myself as I reflect on the experiences I have had over the past two weeks. And although I may be proven wrong, I am becoming even more convinced that we are truly at the tipping point, the place where the sweat and tears of failure and slow progress give way to truly significant change in how we view, diagnose and treat cancer. More...

I was sitting in a large lecture hall with about 1000 of my oncology colleagues this past week when I had one of "those moments." It wasn't a spectacular moment, and I doubt that anyone else in the room really paid much attention to the moment, but for me it was a significant moment--and frankly a bit chilling if not frightening.

In short, in answer to an audience response question--which admittedly is not a scientifically valid survey--over 1/3 of the oncology professionals sitting in the audience would have prescribed a treatment for advanced colon cancer that not only has been shown not to work, but also shorten lives. At that moment, I became very concerned about the implications of that response and what it may mean for patient care.

Maybe I am overdramatizing this a bit, but what happened pointed out to me that we may have a serious problem in cancer care, and it is imperative that we do something about it. More...

Here's an insightful comment from me: Social media has gripped our world, the way we live, the way we interact, what we know and influences what we do. (OK, stop laughing: I'm not a Luddite, but needed somewhere to start this conversation.)

At times, I wonder where all those folks (usually young folks) find all that interesting stuff they send to each other on a such a constant basis that it seems their smartphones are a direct extension of their fingertips. So much to say right now! I can't imagine there being that much that is so important that people walk down the street mesmerized by those things.

But maybe that is just my ignorance and my difficulty "engaging" in this new social sphere. For me, it has to be something useful to say, something useful to know, something that is going to impact my life. That's where I find all of the social media and instant access to information so helpful. Make me smarter, keep me in touch with what is important, broaden my horizon on topics of interest to me. Then you have me engaged as well.

For cancer patients-especially newly diagnosed cancer patients-and their families, loved ones and caregivers, the situation is more serious--a lot more serious. They need help,  understanding, explanation, and lots of care and compassion. The devastation of a new cancer diagnosis or a worsening cancer or the ravages of treatment can leave even the most informed person desperate to understand what is happening to them, what is happening to their lives, what they can expect to happen next. And filtering through all of the material now available with a click on the web can be overwhelming, especially when one considers that some of the information may be reliable and some of it not so reliable. Think of that recent ad which extols the virtues of the internet with the tagline, "If it's on the internet, it must be true." Right.

So where do you turn for help? Where do you reach out to people who are just like you: same age, same disease, same questions, same experiences?

The American Cancer Society has a web-based social network called "WhatNext". Developed in part with the help of the Society, WhatNext is designed to bring people together to share information about their experiences with cancer. Based on a number of factors including diagnosis and disease status, the site aims to link people and help them share insights that may be of mutual interest, such as the side effects of a treatment, what to expect from treatment, and experiences with a shared cancer diagnosis. (The proactive matching is what makes WhatNext different from our other online community, Cancer Survivors Network.) The information is all public except for the person's name, so others can learn as well. Through this community of learning and sharing, there is much we can learn about what to expect, what we need to know, and how we can build on common interests when it comes to understanding the cancer journey. 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...

(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...

Earlier this week I had the opportunity to attend and participate in a conference "Turning the Tide Against Cancer Through Sustained Medical Innovation" in Washington DC. . The conference organizers brought together a stellar list of experts (present company excepted) to discuss the coming revolution in cancer care through personalized medicine, as well as the barriers and risks we face as science moves us forward towards what I consider a brave new world of cancer research and treatment.

With all of the intellect that was present at that meeting-and there was a lot-there was a theme that crystallized for me and others as the day progressed: we have developed incredible science and incredible opportunities to understand and treat cancer. But with all of the issues that have to be dealt with, the reality is that there is no singular leader-organization or individual-who has the clout and the heft to accelerate all the changes that need to happen if the vision of personalized medicine is going to be a success. More...

I had trouble sleeping this morning, so I got up and took a look at the tweets on my smartphone that focused on yesterday's sessions at the annual meeting of the American Society of Clinical Oncology in Chicago.

There were literally hundreds of bits of information that covered the span of sessions, from science to quality of life to other topics of interests. I wondered how much of the information we have heard over the past several days will actually make a difference in the lives of cancer patients in the days and months ahead. And while sitting in a less well-attended session hearing an update on another once promising approach, the sad reality struck me squarely: not much.

This is the premier clinical cancer meeting in the country, if not the world. Thousands of doctors and researchers come to this meeting to learn the latest information about clinical cancer research and cancer treatment. There are thousands of abstracts presented and discussed, and constant chatter about the newest drug or the newest test or the newest way to diagnose cancer. The drug companies, the lab test companies, the computer companies are all here to advance their drugs and their tests and their wares. There are receptions, dinners, private meetings all over the place. There are sessions where literally thousands of doctors sit and listen to the top ranked research presentations, which represent the best of our science. There is certainly no lack of buzz, or excitement, or opportunity to learn. This is truly a festival of information about what is new in cancer treatment.

And then I go to a session late on Monday afternoon tucked in a back corner of this vast complex known as McCormick Place and hear a group of presentations reflecting on ten years experience with drugs that we thought blocked blood vessel growth to tumors. There are a couple of hundred people in the room, and the presenters acknowledge that the initial promise of those drugs hasn't been realized. In fact, they note, there are even still controversies over how the drugs actually work. But no one is there to give the story prominence, since it is "yesterday's news."

I can't help but think about the excitement that surrounded these drugs ten years ago when they were to "great new thing." I recall sitting in one of those megasessions where thousands hung on the words that one of these drugs significantly prolonged survival in colorectal cancer. Then, the news was greeted with sustained applause. Today, there is barely a whisper among those listening to the latest information. More...

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...

Every year at this time cancer specialists and researchers from around the world descend on Chicago for the annual meeting of the American Society of Clinical Oncology (ASCO) to hear the latest breakthroughs in cancer research and treatment.

Through all the fog of all the information--which is impossible for any one individual to evaluate much less comprehend--there is always the search for the "buzz," or the next "big thing" that will make a huge impact on cancer treatment and the lives of the patients we care for and the people we love who are affected by cancer.

This year, it is apparent already that one of this year's "big things" are the reports of new success in an old and ongoing effort to harness the body's own defense mechanisms to fight cancer. And--being the skeptic that I can be at times--I will throw my hat in the ring that maybe this is going to be one of those events that truly will impact cancer care. But despite the enthusiasm, we must always temper our expectations with reality and lessons we have learned from the past that early success doesn't always tell us the whole story.

Without going into great detail here, the reality is that in early stage trials an antibody drug now called "BMS-936558" produced significant responses in a number of patients who had certain advanced cancers and had failed multiple prior treatments. In these studies, patients with melanoma, kidney cancer and non-small cell lung cancer showed responses to this new drug and some of those responses lasted for over a year.

When you see these kinds of results in cancers that are ordinarily difficult to treat, and in patients who have failed multiple other therapies, that becomes news. More...

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...