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...

 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...

To screen or not to screen for prostate cancer, that is the question. Or is it?

A report from the venerable United States Preventive Services Task Force (USPSTF) made it to the media yesterday--a bit ahead of schedule--and it not only says we aren't certain whether a man should get a PSA test to find prostate cancer early, it came flat out and said, effectively, "Don't do it!"

Now that is a recommendation that is going to create a good deal of discussion, I would think. More...

I wasn't going to write this blog.   But after listening to some of the reports on the news yesterday (while I was trying to stay healthy on my elliptical) I realized I had to say something, if for no other reason that to provide some context on an interesting and important piece of clinical research.

This week's Journal of the American Medical Association has a report indicating that many women no longer need to have the lymph nodes under their arm removed during breast cancer surgery-even if cancer is found in the single "sentinel lymph node" frequently removed as part of the surgical procedure.

This is one more piece of the puzzle that has been answered by clinical researchers and patients over decades, namely whether or not women diagnosed with breast cancer had to undergo radical disfiguring surgery to control their disease.

Now, this research shows that even less surgery is "more" when it comes to benefitting the patient.

The real question (which is the practical and important question) is whether doctors are going to listen to what the research tells them.  My concern-unfortunately-is that there are those docs who are simply going to ignore this report, and continue to go on doing what they have already done.  We want to believe that evidence guides medical practice, and in some places it does.  But in far too many institutions in this country "What I think" outweighs "what they know." More...

In early June I appeared on a nationwide news show and in a very brief comment indicated that I thought a new approach to radiation therapy in the treatment of primary breast cancer was "not ready for prime time."  Subsequently, later in the month, I wrote a blog on the treatment-called TARGIT-where I further outlined my concerns.  My primary issue-among some other more technical matters--were that the results of the trial were being promoted to suggest that the treatment was "ready" for moving into clinical use.  I wasn't so certain.

During this period of time, I was contacted by someone affiliated with the company that manufacturers the machine used to deliver the radiation, and offered an opportunity to have a discussion with some of the researchers involved in the clinical trials of TARGIT.  We accepted their offer.

Last week we had our follow-up call, and I think now is a good time to offer some information regarding that discussion.

More...

It all started typically enough a couple of weeks ago, with a request to review and comment on a study presented at the recent cancer meetings involving a new radiation therapy technique for the treatment of early stage breast cancer.

My comments-which were broadcast on a widely watched network evening news program-were reasonably straightforward: the study was interesting, but the treatment wasn't ready for widespread use until more information and longer follow-up was available.

Shortly afterwards, I got a phone call from someone representing the company concerned about my statements and offering further information about the study.  Now, I find myself trying to figure out how to sort through the research results and match what I have learned to what I think is the premature promotion of a potentially valuable new technique in the treatment of breast cancer for some women.

More...