EXPERT VOICES

Timely insight on cancer topics from the experts of the American Cancer Society

American Cancer Society Expert Voices

The American Cancer Society

How I talk to patients about clinical trials

December 02, 2013

By Fadlo R. Khuri, MD, FACP

 

As a physician focused on the treatment of patients with cancer, many of whom face a potentially incurable disease, I make 3 promises to my patients:

1) We will always tell them the truth.

2) We will always do our very best for them, placing their interests and those of their families above all others.

3) We will never abandon them. 

These are important words to relay to a patient, particularly those who are considering participating in clinical trials.  The question, then, is, "Why should cancer patients participate in clinical trials?"

Cancer clinical trials are one of the most important methods we have to move the field forward. After all, it was through clinical trials that we have developed cures for childhood acute leukemia, Hodgkin disease, and testicular cancer, how we developed long-term highly effective therapies for chronic myeloid leukemia and breast cancer, and how we created personalized genetic therapies for lung cancer, melanoma, and other diseases. Cancer clinical trials also let us know how patients are feeling about their care, and can improve approaches for the treatment, prevention, and cancer screening tests for cancer patients. 

One of the first things I do as the treating physician is to complete a history and physical exam of the patient. The information I gather helps me form an opinion, and it helps me gain the trust of the patient and his or her family. 

After obtaining the history and physical information that I need, I discuss standards of care and explain why this care, like radiation or chemotherapy, might work (or not work). It is important to acknowledge our limits while reassuring patients of our considerable experience in treating others with a similar disease. I have occasionally seen physicians who rush to discuss the clinical trial before going through the full range of standard treatment options available. Identifying the standards of care and presenting them as a viable option for patients is far more likely to reassure patients that all options have been carefully considered. More...

Filed Under:

General

What really works to help you quit and avoid tobacco?

November 17, 2013

By Thomas J. Glynn, PhD


The American Cancer Society's first Great American Smokeout was celebrated November 18, 1976. Gerald R. Ford was President of the United States, the "War on Cancer" had begun just a few years before, Barack Obama was 15 years old and, according to a Gallup Poll taken that year, 37% of American adults smoked cigarettes.

This year, the 37th anniversary of that first Great American Smokeout, the percentage of Americans who smoke has nearly been cut in half, to 19%. And, those who do smoke use far fewer cigarettes than in 1976, from about 4,000 cigarettes per year for every U.S. adult then, to about 1,200 now.

Certainly, we know that any cigarette smoking is dangerous to the smoker and non-smokers who inhale cigarette smoke. We also know that far too many Americans continue to smoke - 44 million, at last count. Still, astounding progress has been made in combatting what is the nation's largest cause of preventable death and disability.

How do we know what works?

How was such progress made? What actions were taken to achieve such significant changes in the face of the tobacco industry's relentless, illegal, and well-funded efforts to addict men, women, and children to their deadly products? There is no easy answer to that question. But we do know that, over the past 37 years, a wide range of interventions - in communications, education, policy change, and medicine - have been undertaken. Interventions in all of these areas have been effective, but some have been more effective than others. More...

Stigma presents an extra burden for many lung cancer patients

October 28, 2013

By J. Lee Westmaas, PhD

 

Some of us, at some point in time, have felt judged negatively by others or discriminated against because of some personal characteristic or behavior. Researchers refer to this as feeling stigmatized, and lung cancer patients report feeling this way more than patients with other types of cancers.

Many individuals with lung cancer fear that others will react to their diagnosis with blame, exclusion, rejection and/or discrimination. Many actually experience this as well.  A primary reason is that smoking is so strongly linked to lung cancer.

Blaming the victim


Lung cancer was one of the first diseases to be identified as caused by smoking. Smoking rates have decreased dramatically since the 1960s due to laws to restrict smoking, greater publicity on the many harms of smoking, and a change in public attitudes toward smoking. More...

Filed Under:

J. Lee Westmaas | Lung Cancer

Should women at high risk for breast cancer take drugs to prevent it?

October 14, 2013

By James C. Salwitz, MD


Breast cancer will kill more than 450,000 women worldwide this year, and in the United States alone, 232,000 will be newly diagnosed. Two important recent events shift the conversation from disease treatment to prevention. The most public was the stunning statement of actress Angelina Jolie that she had both her breasts removed because she carried a breast cancer gene (BRCA1). This announcement served to greatly increase awareness and discussion of choice in preventing the disease. 

Second, was the decision by the U.S. Preventative Services Task Force (USPSTF) to recommend the use of medications for prevention of breast cancer in women who are at increased risk.

Many factors influence breast cancer risk


In order to prevent breast cancer, we must first understand its causes. While we do not know all, we do understand that certain factors increase the chance of getting breast cancer. Some of these risk factors can be reduced through improved lifestyle, but not all.

Most breast cancer occurs not because of known genetic mutations, but because of a combination of risk factors. One important risk factor is increasing age, with most breast cancers occurring in women 55 years of age and older.

Some risk factors include an early age for a first period (start of menses), a late first pregnancy, and no pregnancy at all. Breast-feeding decreases cancer rates. Prescription estrogen replacement, especially after menopause, increases breast cancer risk. The more alcohol a woman drinks, starting even with small amounts, the higher her chance of getting the disease. Obesity and low amounts of exercise increase the chance of developing breast cancer, too.

If a woman has increased breast density on mammogram, this increases the chance of being diagnosed with breast cancer. If a woman has any breast biopsies, particularly if the biopsies showed benign growth of the lining of milk ducts ("proliferation"), this increases risk. Certain benign duct changes, such as hyperplasia or atypia, greatly increase risk. Also, ductal or lobular carcinoma-in-situ (DCIS and LCIS) greatly increase the chance of developing invasive breast cancer.

Finally, family history, even without a defined cancer gene like BRCA1 or BRCA2, increases the likelihood a woman will get breast cancer. Each first-degree relative (mother, sister, daughter) who has breast cancer increases further the chance of breast cancer. The younger the breast cancer occurred, the greater the risk to the patient. More...

Why are black men negatively affected by prostate cancer more than white men?

September 24, 2013

By Durado Brooks, MD, MPH


When the US Preventive Services Taskforce (USPSTF) made their startling recommendation against screening for prostate cancer last year there was a widespread outcry from prostate cancer doctors and patients. Resistance was especially strong among black prostate cancer survivors and the doctors who care for them, arguing that the scientific studies that led to the USPSTF recommendation did not include many black men. Is this simply another case of "political correctness?" Isn't prostate cancer colorblind? Doesn't cancer behave the same in all men, regardless of race?  

In reality there are a number of differences in how prostate cancer impacts black men compared to men of other racial and ethnic backgrounds. Black men are 60% more likely than white men to be diagnosed with prostate cancer during their lifetime, and are more than twice as likely to die from the disease. Black men are also diagnosed at a younger age (about 3 years younger on average) and are more likely to have "high grade" tumors - the kind of tumors that grow rapidly, spread to other parts of the body, and often cause death. Research has given us some insights on why these differences exist and what they mean for black men who face decisions about prostate cancer screening and treatment. More...

What is Blue Button?

September 16, 2013

[Ed. note: This guest post by Lygeia Ricciardi of the Office of Consumer eHealth, Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services, explains how the Blue Button can help you access and use your healthcare records.]

 

Wouldn't you like to have key information about your health or the health of a loved one safely and easily accessible via mobile phone or computer?

Think of Blue Button as an easy way for you to get your health records securely and electronically. It won't magically fix everything, but it's paving the way for a more personalized, convenient, and higher quality healthcare experience for patients and their families by putting vital information at their fingertips.

The Blue Button symbol is now appearing on health-related websites nationwide. Click it to get key information from your personal health records securely and electronically from your doctor, insurance company, pharmacy, or lab. You can check your information, share it, and use it to manage your health... and make your life easier. More...

Filed Under:

General

Menthol cigarettes - what's the big deal ?

August 28, 2013

By Thomas J. Glynn, PhD


The discussion around whether the U.S. Food and Drug Administration (FDA) should keep or ban menthol-flavored cigarettes has produced a number of news headlines in recent weeks, because in July the agency released a report reviewing current science around these cigarettes. This science will inform many of the decisions the agency may make about menthol cigarettes, and the millions of current and potential smokers who will be affected by those decisions. But the menthol story goes back much further than just the past few weeks.

Menthol and cigarettes: a brief history


Menthol is an organic compound which can be made in a laboratory or derived from mint oils, and has a distinctive and, for most people, pleasant odor and taste. It is used to enhance the flavor, popularity, and ease-of-use of many food products, candies, and medications.

As a medication, it can be used as a mild local anesthetic, counter-irritant, and, more specifically, for the relief of minor throat irritation. That is why menthol was first introduced in cigarettes in the 1920's and gained broader popularity with the introduction of a filtered menthol brand, Salem, in the mid-1950's.

Over the years, largely because they mask the harsh taste and/or throat-irritating properties of inhaled tobacco smoke, mentholated cigarettes have gained a wide audience, such that about 30% of all 44 million smokers in the U.S. now identify menthols as their preferred cigarette. This is especially true among African American smokers, about 80% of whom are menthol users. More...

New cancer genes: should I run to be tested?

August 07, 2013

By Mia M. Gaudet, PhD


Scientists have long cautioned that a family history of cancer increases your personal risk of cancer. Some genetic changes (mutations) that are found in only a few families but tremendously increase risk of cancer (e.g., BRCA1/2) have been known since the 1990s.  These mutations are already used by doctors to identify high risk men and women. However, there is still much of the genetic component of cancer that is unknown. Advances in genetics and technology now allow scientists to look at common changes in the genetic code to see if these changes are related to risk of cancer. 

Researchers are trying to answer these questions. Recently, an international group of cancer investigators linked 74 genetic regions to cancer. These newly identified genetic regions contain common changes in their code (called polymorphisms) that have only small effects on the risk of cancer. But when you combine many polymorphisms, that risk increases.

These new polymorphisms were found by studying the genetic make-up of more than 200,000 people. Women with and without breast cancer, women who had mutations in BRCA1 or BRCA2, women with and without ovarian cancer, and men with and without prostate cancer participated in the studies. More...

Can your sunscreen pose a health risk?

July 22, 2013

By Kenneth Portier, PhD

 

Recently, manufacturers have introduced new sunscreen products that use titanium dioxide, a typical ultraviolet (UV) radiation blocker found in many sunscreens, formed into tiny nanoscale particles. Why use nanoscale titanium dioxide? Because at this small size the particles do not block visible light, and therefore the sunscreen is invisible when applied to the skin and at the same time provides protection from cancer-causing UV radiation.

Titanium dioxide is an excellent UV-blocker, but there has been some concern about its safety because in dry powder form, titanium dioxide is highly toxic when inhaled. The International Agency for Research on Cancer (IARC) classifies the dry powder form of titanium dioxide as possibly carcinogenic to humans.

It's not yet clear, though, whether other forms of titanium dioxide, such as the nanoparticles used in sunscreen, also pose a risk. More...

Filed Under:

Skin Cancer

Does drinking alcohol increase the risk of cancer?

June 26, 2013

By Susan M. Gapstur, PhD, MPH


Do you enjoy an occasional, or even a daily, glass of wine, beer, or other drink that contains alcohol? Many adults do. Indeed, 37% of adults in the U.S. report drinking low to moderate amounts, which is, on average, up to 1 drink per day if you are a woman, and 2 drinks per day if you are a man. Another 28% of adults drink more each day, which is considered heavy drinking. A drink of alcohol is generally defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits.

Modest Benefit but Many Risks Associated with Alcohol Drinking


While low to moderate alcohol consumption is linked to a reduced risk of heart disease, drinking too much alcohol can increase risk of high blood pressure, heart failure, sudden death and stroke. Overall, alcohol consumption is one of the top 10 contributors to sickness and death from injuries, motor vehicle crashes, homicides and suicides, sexual assaults, sexually transmitted infections from unsafe sex, falls, birth defects, depression, disorders of the gastrointestinal tract, and sleep disorders.

Additionally, there is a lot of evidence that drinking alcohol increases the risk of several cancers. In 2007, a working group of experts convened by the World Health Organization's International Agency for Research on Cancer (IARC) reviewed the scientific evidence on alcohol and cancer risk for 27 different anatomic sites. They found sufficient evidence that alcohol drinking is a cause of cancers of the mouth, pharynx, larynx, esophagus, liver, colon, rectum, and female breast. And for cancers of the mouth, larynx, and esophagus, when people drink and use tobacco, the risks are combined to be greater than either tobacco use or alcohol use alone! More...

Filed Under:

Diet/Exercise | General

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