Dr. Len's Cancer Blog

Expert perspective, insight and discussion

Dr. Len's Cancer Blog

The American Cancer Society

Research (80 posts)  RSS

A New Genomic Test To Guide Prostate Cancer Treatment: What We Know And What We Don't

by Dr. Len May 09, 2013

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...

Is Cancer Research and Treatment Moving From Evolution To Revolution?

by Dr. Len 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...

For Cancer Patients, It's Not Just About What's Now But Also What's Next--And We Can Help Answer That Question

by Dr. Len March 06, 2013

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...

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...

Breast Cancer Screening: The Search For Truth

by Dr. Len November 21, 2012

 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...

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 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...

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...

A Personal Reflection On Lance Armstrong: A Moment In Time, A Powerful Commitment To Cancer Research and Survivorship

by Dr. Len August 30, 2012

Like many of you, I have been reading the various news stories about Lance Armstrong, especially one this past weekend in a major newspaper, which went into great detail about the allegations surrounding Lance Armstrong's cycling career.

 

But what I didn't see in all of that coverage was much mention of the other side of the man, the side that I witnessed up close and personal one Friday in Texas a couple of years ago, the side that has led me to share my thoughts with you today.

 

I saw something that day that I had never-let me repeat, never-seen before. It was a moment that has forever influenced my opinion of Mr. Armstrong, even as these various charges have swirled about him these past couple of years. And the impression it created was indelible.

 

I am not here to hash/rehash the incriminations. I am here to stand up and say that no matter what the truth is regarding the allegations, this is a man who has forever changed the cancer landscape for millions of people in this country and around the world. This is a man who lent his prestige and his personal power to a cause that was dear to him, in what I believe a heartfelt and selfless effort to make the lives of others more comfortable, and more meaningful. This is a man who has offered hope to those in emotional and physical pain, and no matter what he may or may not have done, no one should ever dismiss or forget his accomplishments for our humanity. More...

Who Will Lead Us As We Embrace Personalized Medicine And Cancer Care And Turn The Tide Against Cancer?

by Dr. Len June 14, 2012

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...

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.

MORE »

 

Recent Comments

Comment RSS