Dr. Len's Cancer Blog

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Dr. Len's Cancer Blog

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The FDA Lays Down The Law About The Dangers Of Indoor Tanning

by Dr. Len May 29, 2014

In what has to be considered a major victory for those concerned about the proliferating use and risks of tanning beds, the Food and Drug Administration this week issued a final rule requiring devices used for indoor tanning to meet very specific requirements before they can be marketed to the public. And in what is probably an even more important part of the rule, they now instruct those who market tanning devices to consumers to warn them clearly about the very real and serious risks of indoor tanning. More...

We Need A Sense Of Urgency To Assure The Safety Of Health Information Technology

by Dr. Len May 16, 2014

This was the dream: we would use technology to create a seamless healthcare system, one where people, computers and machines would work together to improve patient care in many different ways. Health care would be more efficient, it would be safer, it would be less expensive, we would be able to transfer health-related information quickly and accurately.

After spending three days at a meeting this past week with some of the top experts in the field, I am not so certain that the dream is going to come true anytime soon. Perhaps more concerning, the problems--including patient safety issues--that are cropping up in so many areas are very troubling. More...

The Haunting Memories When Screening Doesn't Work

by Dr. Len March 27, 2014

I had the opportunity earlier this week to participate in a Twitter chat on the topic of colorectal cancer awareness. The chat was intended to bring attention to a nationwide campaign called "80 by 2018" designed to increase colorectal cancer screening rates to 80% of the population over the next 4 years. If it is successful, we should see a decline in both incidence and deaths from this disease.

But I am haunted by two of the comments I tweeted during the session chat that won't leave my conscience:

"As a doc, you don't forget the patients you couldn't help. And you celebrate those you did. #CRCawareness is key #80by2018"

"Let's remember that screening doesn't help everyone, so don't forget the need for more research in understanding #CRC #80by2018"

While we celebrate the opportunity to save more lives with screening, we cannot ignore or forget those for whom screening for colorectal cancer (or other cancers, for that matter) couldn't or didn't make a difference. More...

Progress In Colorectal Cancer Not Shared By Everyone

by Dr. Len March 19, 2014

An article published this week in the American Cancer Society journal CA: A Journal for Clinicians received a lot of media attention. The report showed dramatic declines in the rate of people being diagnosed with colorectal cancer, as well as decreases in the rates of colorectal cancer deaths over the past number of years.

But the press didn't say much about the fact that not everyone has benefitted from the progress we have made in the prevention, early detection, and improved treatment for colorectal cancer. It is a sad but very real commentary on how we approach health care in this country that African Americans have not benefitted equally from this progress in treating a cancer that for many people can be prevented or effectively treated when found before it spreads to other parts of the body.

As a nation, I believe it is incumbent that we address this glaring health disparity. To do less is unacceptable. More...

It Helps To Know What Watchful Waiting Really Means In Prostate Cancer Treatment

by Dr. Len March 06, 2014

News reports covering a prostate cancer study this week in the New England Journal of Medicine have all pretty much come out with the same message: men diagnosed with prostate cancer who had radical surgery did much better than men who were assigned to "watchful waiting" after they were diagnosed.

But guess what? There's a critical fact that seemed to be missing in much of the coverage I saw. And that fact is this: the men who were given the "watchful waiting" as described in the study never received any curative treatment. Let me repeat: No curative treatment. That is a much different approach to watchful waiting than we currently recommend in the United States, where watchful waiting after a diagnosis of prostate cancer usually means offering curative treatment when the prostate cancer changes its behavior. More...

One Doctor's Confession: Basal And Squamous Cell Skin Cancers Are NOT Benign

by Dr. Len January 07, 2014

I have made a resolution for 2014: I will never, never, never again call basal and squamous skin cancers "benign" cancers.

Why would I make such a strange commitment? The explanation is simple:  I spent 4 hours on New Year's Eve sitting in the surgeon's chair getting a skin cancer taken off my nose. Nothing about the experience fits the "benign" label so many professionals, including yours truly, have used:  routine; easy to treat; nothing to worry about.  Friends, after this experience, which left me looking like a tall, white-haired Rudolph the Reindeer, I am here to tell you these cancers are not to be trifled with, and are worth every effort you can make at preventing them by reducing exposure to UV radiation. More...

The Flu Is One Gift That We Don't Have To Keep On Giving For People With Cancer

by Dr. Len December 17, 2013

 

It's the holiday season, a time of reflection, celebration and for many, giving gifts. But there is at least one gift that no one wants to get, and certainly no one wants to give: the flu. And for people with cancer, and those they come in contact with, the flu can be a very serious event. For that reason and many more, people more than 6 months old-and especially those in contact with people who have serious illnesses like cancer-should get vaccinated against the flu.

Too many of us think the flu is a minor inconvenience. But that is almost certainly because we confuse the typical cold or upper respiratory infection, which usually means discomfort and maybe a day or two off work.  Influenza is a much different and much more dangerous animal, especially to people with chronic diseases.

Over time we have become somewhat immune to the messages about the dangers of the flu, now that we have vaccinations and medicines which can treat the illness. Few are alive who remember anything about the great influenza pandemic of 1918:

"The influenza of that season, however was far more than a cold...The flu was most deadly for people ages 20-40...It infected 28% of all Americans (Tice). An estimated 675,000 Americans died of influence during the pandemic, ten times as many as in the world war. Of the US soldiers who died in Europe, half of them fell to the influenza virus and not the enemy (Deseret News) An estimated 43,000 servicemen mobilized for WWI died of influenza (Crosby)."

We have been fortunate not to have a repeat of that pandemic. But for some of us, the flu remains a deadly possibility, one that we might be able to prevent if we take the precaution of getting a flu shot.

People with cancer are among the groups at especially high risk of getting the complications of flu. And also let's not ignore the "risk pool" of people who live with patients with cancer and those who care for people with cancer. We tend to forget that those healthier folks who help people with serious illnesses can be the transmitters of this potentially serious and life-threatening infection.

Because of those risks, people with cancer and those they come in contact with really need to understand their options about getting vaccinated against the flu, and-assuming they don't have specific contraindications to the vaccine-if at all possible get it done. It is still not too late to get this year's flu vaccination. No one can predict when the vaccine "season" will peak or how serious it will be in any given year. But waiting until the last minute, when the story is all over the news, is not a good idea and it's not good medicine. And worse, it doesn't work. More...

Personalized Medicine Revolution Will Require Revolutionary Changes In How We Care For Cancer Patients

by Dr. Len October 18, 2013

I attended a meeting in Washington this past Wednesday that got me to thinking about the fact that as we revolutionize cancer research and treatment, we are also going to have to revolutionize cancer care. And that  may prove to be an even more daunting task than finding new treatments for the disease itself.

The meeting was sponsored by a collaboration called "Turning The Tide Against Cancer". The organizers brought together experts from a variety of disciplines ranging from insurance companies and economists to advocacy groups and highly regarded cancer specialists to discuss policy solutions to support innovation in cancer research and care. Walking in, I anticipated this was going to be another one of those sessions where we talked about funding for research, bringing research into clinical trials, and having patients get access to new drugs. But I was wrong. The discussions quickly steered into a different direction: what do we need to do to make the cancer care system work for patients?

Of course there were the continuing themes of "big data" and the impact of genomics on drug development and patient care, but a surprising amount of the discussion centered around new payment models, quality of care, and fundamental redesign of medical care to become more patient centric. And although we talked a lot about data gathering and analysis, what stuck with me was the redesign piece. I thought the discussion around redesign would focus on personalized medicine, but we spent a lot of time on changing the fundamental structure of cancer care and payment.

How are those two linked? Did we miss our focus?

The answer? If we don't change the way the system is working, we won't realize the promise of personalized medicine. Seems pretty simple and straight forward until you start thinking about the implications. More...

If PSA Tests Don't Impact Survival, Why Do Insurance Companies Do The Test Without Your Knowledge?

by Dr. Len August 21, 2013

A discussion on Twitter caught the eyes of my colleagues yesterday, and raised a very interesting question: should insurance companies be allowed to do PSA testing to detect prostate cancer on men as a condition of getting insurance?

What started the discussion was a blog post by a well-known and respected medical blogger who goes by the name "Skeptical Scalpel." In his blog he detailed the saga of a 56 year old man who had a pre-employment physical in order to be covered by his new company's health insurance plan. He was not informed that he was going to have a PSA test. It was just done as part of the process. No informed consent, no nothing, just stick out your arm, have blood drawn, and register your surprise that the test was done once the results come back.

The United States Preventive Services Task Force recommends against any man having the test to detect prostate cancer. Even among those who say the test is an option, -including the American Cancer Society-recommend that a man have a full, informed understanding of the pros and cons of PSA testing before getting the test, given the uncertainties of whether it really saves lives and the known frequency of side effects associated with treatment for prostate cancer. None of those recommendations were part of the consideration for this man when he was examined for his insurance plan.

You can imagine what happened: his PSA was slightly elevated at 5.9. He was "rated" by the insurer, charged an extra $200 a month for his health insurance, and may well have to have a number of additional studies. Not to mention that he may have prostate cancer, and may undergo more treatments-as a result of a test that is of uncertain value for most men. And, by the way, the odds are overwhelming that the gentleman in question does not have prostate cancer, but will have to go to considerable lengths (and some risk) to find out. Because he had not discussed the test, he did not have the opportunity to prepare for it correctly, so his reading may have been falsely high; we'll never know. And, if he does have prostate cancer, as reflected in the USPSTF recommendations, he has a significant chance of having long term side effects from the treatment, but little proven benefit in terms of saving his life. More...

New Update On Prostate Cancer Prevention With Finasteride Creates A Dilemma For Patients

by Dr. Len August 14, 2013

 

We've all heard the phrase, "When you come to a fork in the road, take it."  Well, that saying may hold particular relevance while reviewing a new research report published today in the New England Journal of Medicine.

The report is an important one. It is an 18 year follow-up of a study designed to show whether the use of the drug finasteride could reduce the incidence and deaths from prostate cancer. The study was called the Prostate Cancer Prevention Trial and when it was initially reported in 2003 it showed that the drug could reduce the incidence of prostate cancer by almost 25%.  However, there was a catch: there was actually an increase of almost 27% in the number of high grade-or more serious-prostate cancers in the group treated with finasteride compared to those men who did not get the drug. The men in this trial were followed very closely. Since this trial was done in an era when PSA testing to find prostate cancer "early" was part of routine care, these men were screened regularly with the PSA test.

The originally reported results of the trial meant two things to the researchers: first, finasteride was successful in reducing the frequency of prostate cancer, but most of that decrease was in the lower grade, less harmful forms of the disease, and second, it raised the question of whether the drug actually promoted more serious forms of prostate cancer. Some experts argued that in fact there weren't more numerous high grade tumors, only that finasteride made it easier to find them thanks to the fact that it shrinks the prostate.

The debate on the relative merits of using finasteride has continued since. Suffice to say, the use of the drug didn't get much traction. In 2011, the Food and Drug Administration added information to the drug label that finasteride and similar drugs could increase the frequency of more lethal forms of prostate cancer and that the drugs were not approved for prostate cancer prevention.

Meanwhile, organizations such as the American Cancer Society have suggested that men should make an informed decision as to whether or not they really want to be screened for prostate cancer with PSA testing, and the United States Preventive Services Task Force recommends that men should not be screened at all for the disease. But the impact of finasteride on reducing the incidence and deaths from prostate cancer and "the rest of the story" remained unanswered. At least until now. 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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