April 09, 2013
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...
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...
June 04, 2012
Yesterday I wrote a blog discussing how meetings like the current annual gathering of the American Society of Clinical Oncology (ASCO) gives me a chance to think about big picture questions.
Well, there is another side to the experience that is also interesting and important, such as getting information that helps put together pieces of a larger puzzle, and perhaps even gives closure to a nagging question. When you have one of those "Aha!!!" moments, it can truly solidify your thoughts and maybe even save a few lives in the process. In this case, the same presentation that led to yesterday's comments about the emerging complexities of the diagnosis of cancer also produced another enlightening moment.
Dr. Levi Garraway is a highly regarded genomics researcher from Dana Farber Cancer Institute in Boston who presented a lecture on the topic of how genome sequencing is bringing new insights to the biology and treatment of cancer. As part of his presentation, Dr. Garraway offered information on areas where genomics has already offered us definitive information that has direct implications in understanding cancer.
The #1 item on Dr. Garraway's list was a topic of intense interest to me and several of my skin cancer colleagues.
According to Dr. Garraway, genetic analysis of cancers from patients with melanoma show an overwhelming number (my words) have a signature genetic marker proving their melanomas were caused by ultraviolet (UV) radiation. He elaborated that there have been questions in the scientific literature as to whether or not this was the case, and acknowledged that we have had to rely on relatively indirect research to prove the case that melanoma is caused by UV light. However, he continued, because of genomics it is now essentially "case closed" and essentially proven: melanoma is caused by exposure to UV light. 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...
June 02, 2012
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...
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...
November 18, 2011
Today the Commissioner of the Food and Drug Administration, Dr. Margaret Hamburg, announced that the FDA is withdrawing approval of Avastin® (bevacizumab) for the treatment of metastatic breast cancer.
This announcement culminates a highly watched process where the FDA determined that although it had granted accelerated approval for the use of this drug in treating breast cancer, subsequent studies did not demonstrate in any group of women that Avastin® actually helped patients in any meaningful way, while causing significant harms-including death.
In the accelerated approval process, the FDA permits a company to market a drug for a specific indication, usually in a life threatening disease, while allowing the company to perform additional trials to confirm the value of the drug. After those trials are done, under this form of approval, the FDA reserves the right to revoke that approval if the original promise of the drug is not confirmed. That is what has happened with Avastin® in breast cancer.
As difficult as this decision has been for the FDA, it is even more difficult for women (and their loved ones and their doctors) who believe that Avastin® has saved their lives. The Commissioner emphasized that she was acutely aware of that concern in making her determination, but she underlined the fact that when the science was carefully reviewed, there was no evidence of meaningful benefit of Avastin® in breast cancer treatment.
The full impact of this decision is difficult to determine at this time. More...
November 17, 2011
It's that time of year again.
Thanksgiving is just a week away (go turkey!!!), which means today is the American Cancer Society's annual Great American Smokeout (or GASO for short). In fact, 2011 is the 36th year for the Smokeout, which makes it a longstanding (and successful) tradition in our world.
What, you may ask, is GASO?
Well, GASO is a day to focus on the opportunity--if you are a smoker or know someone who is--to make a commitment to quit, or perhaps a day to choose as your "quit day" if you were alert enough to plan ahead. It is a day when you can take a step that could be one of the most important ones you can make, a pledge to do something which could be the single greatest thing you can do for your health, a day to reduce your risk of death from cancer and many other diseases related to smoking.
Quitting isn't easy. We all know that. Cigarettes and other forms of tobacco are among the most addicting substances we can take into our bodies. And the sad reality is that if you decide to smoke, the chances are about 1 in 2 that smoking will have a role in causing your death. And to make matters even worse, that death is likely to be premature.
In fact, every year in this country, 443,000 people die from tobacco related illnesses. More...