Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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National Minority Health Month Is A Call To Action

by Dr. Len April 18, 2013

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...

Will My Smartphone Help Me End The Purgatory Of My Groundhog Day Diet?

by Dr. Len February 04, 2013

OK. So Groundhog Day was on Saturday this year, and unlike the furry little beast what I have to say each year around this time is just as good today as him looking for his shadow on Saturday.

What is all this about, you are probably asking yourself?

It is about an annual update that I started a couple of years ago on my blog to remind myself and those who are interested that losing weight and staying healthy is a tough slog and a major commitment which too often is not successful. Like many of you out there I am not immune to all the problems surrounding diet and trying to get weight under control. Try, try, try again and again, and hopefully one day we can all get it "right." That's why I dubbed this the Groundhog Day Diet, after the Bill Murray movie of a similar name where he strikes out to relive the same day again and again until he gets it "right."

And, let's face it: I am not alone in this dilemma. Many of us are in the same boat: we keep trying, but nothing seems to work. There are temptations and messages all around us that are leading us to eat ourselves into oblivion. We as a nation are becoming larger and larger, and now there are concerns that overweight and obesity-if left unchecked, and on their current trajectory-will result in reversal of the gains we have made in extending and improving life. But maybe--just maybe--with the new techologies offered by apps and smarphones we will be able to actually take control of our lives and our eating habits and make some real progress through more awareness and information in realtime at the moment we are making our choices about our diets. More...

Filed Under:

Diet | Environment | Prevention | Vitamins

New Report On Smoking In Women Confirms That "Women Who Smoke Like Men Die Like Men"

by Dr. Len January 23, 2013

"You've come a long way baby!"

That slogan from decades ago now returns with a new meaning and a new vengeance, according to a study released today in the New England Journal of Medicine.

The report, co-authored by Michael Thun, the recently retired vice president emeritus of the American Cancer Society along with colleagues from several outstanding institutions in the United States, shows clearly and unfortunately that women who are smokers are now neck and neck with men smokers when it comes to the relative risk of dying compared to non-smokers, whether it is from all causes, lung cancer, chronic obstructive lung disease (emphysema), and cardiovascular diseases including heart disease and stroke. (See below for an explanation of relative risk)

In a somewhat unvarnished tone, the authors write, "This finding is new and confirms the prediction that, in relative terms, 'women who smoke like men die like men.'" More...

Filed Under:

Lung Cancer | Prevention | Tobacco

New Lung Cancer Screening Guidelines From The American Cancer Society: What You Should Know

by Dr. Len January 10, 2013

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...

Annual Report to the Nation on Cancer Trends: Cancer Deaths Continue to Fall, But We Can Do Better

by Dr. Len 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...

A Moment Of Reflection As The Pink Of Breast Cancer In October Gives Way To The Reality of Lung Cancer In November

by Dr. Len November 05, 2012

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...

During Breast Cancer Awareness Month We Must Not Only Celebrate Our Success But Also Understand Our Limitations

by Dr. Len October 03, 2012

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...

During Breast Cancer Awareness Month We Must Not Only Celebrate Success, But Reflect On Our Limitations As Well

by Dr. Len October 03, 2012

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...

Doctors And Their Eating Habits: Maybe It Is Time For A Change

by Dr. Len September 12, 2012

Every once in a while a medical journal takes a bit of a leap by publishing an article or opinion piece that may just be a bit out of their usual norm or comfort zone. Today's issue of the Journal of the American Medical Association (JAMA) may have done just that with a discussion of physician eating habits, and exhorting doctors to get to the heart-or should I say "meat"-of the matter and set an example for their patients.

 

Although I may sound like I am being a bit "tongue in cheek" about the article, it is actually a topic that I have thought about frequently in the past.

 

Go to a medical meeting, or for that matter to any meeting which is medically oriented or there are medical implications-and take a look at the food service and you will understand what I mean. Or perhaps your local hospital cafeteria would be a good start. Our local hospital is well-known for their fried chicken, and when it is served I understand the line goes out the door. And then look at the puny salad bar, stuck in the corner... Well, I suspect you get the picture. We medical folks just don't do a great job of setting a good example when it comes to what and how much we eat. More...

Filed Under:

Diet | Environment | Prevention

Expert Opinion: A US Perspective On Beating Cancer

by Dr. Len September 06, 2012

(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...

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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