Dr. Len's Cancer Blog

An article in a major newspaper this morning confirmed a concern that I had regarding  how the media might interpret the guidelines the American Cancer Society released today regarding the use of MRI as a screening tool for women at high risk of breast cancer.

The headline said that women at high risk of breast cancer should use MRI as a screening tool in place of mammography.

Simply stated, that is not correct.  MRI is intended to be used in addition to mammography to screen women at high risk of breast cancer.

Two reports—one in the New England Journal of Medicine and the other in the American Cancer Society’s CA A Journal for Clinicians—have been published that will go a long way towards helping patients and doctors make reasoned recommendations regarding the appropriate use of MRI as a screening tool for breast cancer.

We have known for some time that mammography has its limitations, especially in the evaluation of certain groups of women.  We have also known that MRI, which is an expensive and occasionally distressing test, can sometimes pick up early breast lesions that might otherwise be missed by conventional mammography, even when done by very competent radiologists.

As good as MRI might be, it also has significant limitations.  Chief among those limitations was the fact that MRI picks up many lesions in the breast that turn out not to be cancerous, requiring additional biopsies that may otherwise have been avoidable.

This has been a week notable for people in the public eye who have had a recurrence of cancer.

Last week, as widely reported, Elizabeth Edwards was diagnosed with recurrent breast cancer.

No sooner had that announcement swept through the media than Tony Snow, the President’s press secretary, announced that tests revealed he also may have a recurrence of his recently diagnosed and treated colon cancer.

The information released Friday by Mr. Snow indicated that follow-up studies had shown a small area of possible cancer recurrence in his abdomen. 

Through an abundance of aggressive caution, as he put it, he announced that he was going to undergo exploratory abdominal surgery on Monday to take a closer look at whether or not this in fact was a recurrence.

This morning we heard that in fact his cancer recurred and involved his liver. 

There is some significant misinterpretation by the media with respect to the survival data for women with stage IV breast cancer.

In light of the importance of this to Senator and Ms. Edwards, as well as everyone interested in her story, I want to make certain that you understand that the numbers being quoted as coming from the American Cancer Society do not relate to Ms. Edwards situation.

Since arriving in the office this morning and learning of Elizabeth Edwards’ breast cancer recurrence, I have been trying to piece together the story of what happened and what the impact may be on Senator Edwards’ presidential campaign.

I have been fascinated (if that is the correct word) at the guessing games that have been going on both about her health and his campaign.

Now that I have had a chance to see the news conference, it is clear that all of this speculation about the Senator suspending his campaign was way off the mark.

In the same vein, I think it is important from a medical point of view that we bring a sense of rational discussion to the situation surrounding Ms. Edwards’ disease and her potential treatment.

It started as a report in a cancer professionals’ “insider” newsletter.  It is becoming one of the most important cancer stories of the past several years.

It is a story that has already affected how patients with cancer are treated, and is destined to shed light on how drug companies reveal information about the side effects of their drugs, how insurers and Medicare make their decisions about paying for drugs, and perhaps how doctors are reimbursed for their treatments.  

The story is about a class of drugs called erythropoiesis-stimulating agents, which increase red blood cells in our bodies. 

You are most likely familiar with them through their trade names Procrit and Aranesp.  The generic names of these drugs are epoetin alfa and darbepoetin alfa.

The media is abuzz today about the approval of Tykerb (also known by its generic name “lapatinib”) by the Food and Drug Administration (FDA).

Reporters are asking about how important this new targeted therapy really is and what will be its impact on the treatment of women with breast cancer.

The answers we provide to these questions today are fairly straightforward.  But the impact over time is a bit more uncertain.

It wasn’t but a couple of months ago that an article was published in the New England Journal that claimed spiral CT scans for the early detection of lung cancer could significantly decrease deaths from this disease.

Now, a study reported in this week’s Journal of the American Medical Association says that there is no evidence screening for lung cancer with chest CT scans does anything to reduce deaths from lung cancer.  In fact, this study claims, it substantially increases the number of cancers detected, the number of surgeries performed, and exposes patients to significant risks for no net gain in survival.

A simple moment last week made me realize that I really don’t appreciate having cigarette smoke along with my lunch.

Maybe I’m just getting older and, in some ways, a bit less tolerant.  But this little episode reminded me how far we have come in terms of our expectations regarding second-hand smoke in public places.