EXPERT VOICES

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Durado Brooks (8 posts)  RSS

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...

Choosing the best prostate cancer treatment for you

June 13, 2013

By Durado Brooks, MD, MPH

 

Much of the recent news about prostate cancer has focused on screening. In reality, screening is only one piece of the prostate cancer picture.  More than 238,500 men in the United States will be diagnosed with prostate cancer this year. Most of these men will have to weigh a variety of treatment options and make a series of decisions about managing their disease.

So let's look at some of the important questions men need to ask when facing a diagnosis of prostate cancer, and information they can use to help make these important decisions.


Question: "Does my cancer need to be treated?"

Answer: The fact that this is even a question comes as a big surprise to many men. The idea that they have cancer - but not treating the cancer - runs counter to the widely held belief that doing something is always better than doing nothing. In fact, most prostate cancers grow very slowly, and men diagnosed with prostate cancer often have other health concerns (like heart disease or lung disease). In many cases these other health issues pose a greater threat to a man's health than does the prostate cancer. It is also clear that the most commonly used treatments for prostate cancer can all cause significant side effects and complications (detailed in the next sections) in some men. This combination of slow growing cancer + other health issues + possible treatment complications means that, many times, treating the cancer will cause harm to the man but will not improve his health or extend his life. In other words, the treatment can actually be worse than the disease for some men. More...

Does being obese cause colon cancer?

March 13, 2013

By Durado Brooks, MD, MPH


Suppose that, during your next doctor's visit, you look at your medical record and your doctor has written "53- year-old diabetic white female, here today for a check-up." Would you be bothered by that description? Probably not. Your doctor is just discussing your medical condition, right? But what if, instead of "diabetic" the note read "53-year-old obese white female?" How would you feel now? Hurt? Angry? Sad? Would you think, "Why is my doctor being so mean?"

For many, the term "obese" brings to mind a massively overweight individual (like "Fat Albert" in the old Saturday morning cartoons). In reality most obese people don't look like Albert.

Obesity is a medical term

Obesity is actually a precise medical term that is based on a measure of body fat called the Body Mass Index (BMI). The BMI is calculated from a person's height and weight. In general, a higher BMI indicates a higher amount of body fat. Adults with a BMI between 18 and 25 are in the "healthy" body fat/weight category. People with a BMI between 25 and 30 are considered overweight, and a BMI greater than 30 signifies obesity. Many people who view themselves as having a "normal weight" (or at most "pleasingly plump") are shocked when they do this calculation and realize that 180 pounds on their 5 feet 6 inch frame means they are medically obese.  

Our obsession with body image creates an emotional context for obesity that doesn't exist for most other medical issues. But make no mistake about it - obesity is a medical condition, and like other medical problems it has important long-term implications for health and well-being.  More...

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Colon Cancer | Durado Brooks

Is proton beam therapy for prostate cancer worth the cost?

February 20, 2013

By Durado Brooks, MD, MPH


Thousands of men are diagnosed with prostate cancer each month. These men and their loved ones often turn to the internet to learn about their disease and treatment options, and these searches may lead to medical centers offering proton beam therapy.  These centers espouse the benefits of this treatment approach, and some include glowing testimonials from men who have undergone the treatment.

So is proton therapy the "magic bullet" for prostate cancer? 

 

The difference between proton therapy and traditional radiation

Proton therapy is a type of radiation treatment. Traditional radiation therapy has been used to treat cancers for a century using radioactive energy rays called "photons."  When radiation is directed at a cancerous tumor inside the body the rays must pass through normal, healthy tissue in order to reach the cancer cells. In doing so, photons often cause harm to these healthy cells in their quest to get to the tumor. 

In the case of prostate cancer, the radiation beams must pass through the skin, the bladder and the rectum on the way to the prostate gland, and once they reach the gland they encounter normal prostate cells and the nerves that control penile erections.  Damage to these tissues can lead to the complications that often accompany radiation treatment for prostate cancer, including bladder problems, rectal leakage or bleeding, and difficulty with erections.

Proton therapy is a new way to deliver radiation to tumors using tiny, sub-atomic particles (protons) instead of the photons used in conventional radiation treatment. Proton therapy uses new technology to accelerate atoms to 93,000 miles per second, separating the protons from the atom. While moving at this high-speed, the particles are "fired" at the patient's tumor. These charged particles deliver a very high dose of radiation to the cancer but release very little radiation to the normal tissue in their path.  In theory, this approach minimizes damage to healthy organs and structures surrounding the cancer.  More...

Mom, Dad, Let's Talk about Colon Cancer

March 21, 2012

By Durado Brooks, MD

 

How often do you think a family conversation about cancer occurs? The truth is, not nearly often enough.


Colorectal cancer (often called simply "colon cancer") is cancer that develops in the colon or the rectum, and it's the third most common cancer in the U.S.  While most people diagnosed with colon cancer do not have a family history the disease, people who have this cancer in their family have a significantly higher chance of being diagnosed.  The good news is that colon cancer is one of the most preventable cancers, and this prevention can work even for people who are at high risk of the disease. More...

To Treat or Not to Treat Prostate Cancer: That Is the Question

January 18, 2012

By Durado Brooks, MD, MPH

 

Imagine being told by your doctor, "You have cancer."  Then imagine that their next words are "... but we probably don't need to do anything about it."  Many people would immediately start looking for another doctor. But hold on just a moment.


Last month the National Institutes of Health (NIH) brought together experts from around the world for a summit to examine the state of our scientific knowledge on "active surveillance" as a management strategy for prostate cancer. For those of you who are unfamiliar with the term, active surveillance essentially means monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed; the delay may be months, years, or forever. This summit pointed out that while there is still much we need to learn about this once-controversial approach, there is a wealth of data supporting the potential value of active surveillance for a large number of the 240,000 men in the United States who are diagnosed with prostate cancer each year.  More...

Get Past the Yuck to Help Save Lives

September 26, 2011

By Durado Brooks, MD


Has your doctor ever talked to you about collecting part of your bowel movement to be examined (referred to as a "stool test")?  If you're anything like the patients I've treated, you recoiled in shock and horror!  The idea just sounds disgusting, doesn't it?  Without getting too technical, stool tests have what we doctors call a high YUCK factor. (No, it's not an acronym; it's what patients say when we ask them to do the test: "Are you kidding, doc?  Yuck!") 


But stool tests are one of the tried and true approaches to finding colorectal (colon) cancer early and saving lives.  There are a number of different tests for colon cancer that are recommended by the American Cancer Society and other organizations, including colonoscopy, flexible sigmoidoscopy, and CT colonography (a special type of x-ray test, sometimes called "virtual colonoscopy").  But the fact is, out of all the tests that are recommended for colon cancer screening, stool tests actually have the strongest evidence that they save lives - a fact that most patients (and many doctors) don't appreciate.  More...

Never Tested for Colon Cancer? What's YOUR Excuse?

March 09, 2011

By Durado Brooks, MD, MPH


Embarrassing!  Painful!  Disgusting!!

 

These are some of the words that come to mind for lots of folks when they think about getting tested for colorectal cancer. Let's face it - this involves a part of the body and bodily functions that people don't talk about in polite conversation. Hopefully I can convince you that they (and you) need to get past this attitude and get on with testing.

Cancers of the colon and the rectum (the last sections of the digestive system) are extremely common.  In fact, they're the third most common cancer in US men and women. The good news is the rates of this disease have been falling steadily over the past 20 years, and a big part of the decrease is directly related to testing for colorectal cancer.  You see, not only can testing help find the disease early, when it's highly treatable, but testing can actually help to prevent the disease! That's because most colorectal cancers start as a small, non-cancerous growth called a polyp. Finding and removing these polyps stops cancer before it starts. 

More...

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