Breast Cancer Blog

Submitted by Dr.Kattlove’s Cancer Blog

I thought of this when I read a paper that reviewed 93 articles that looked at the success rate of blood tests to detect colorectal cancer. So far no breakthroughs.

We’ve been looking for a blood test to find cancer early for many years. And, many have been found that will spot different types of cancer, but almost never in its earlier stages. The first test that gained wide use was the CEA (carcinoembryonic antigen). CEA is a protein made in excessive amounts by the cancer cell. At first, it was found to be elevated in the blood of people with widespread colorectal cancer. But then researchers learned that its blood level can be high in people with many other types of cancers.

Specific blood tests have been sought for other cancers. Probably no cancer has been scrutinized more than ovarian cancer, mainly because this cancer tends to grow in women without producing symptoms until it is usually too late to be cured. Ovarian cancer does produce a marker, called CA-125, that appears in the blood. Unfortunately, when it does, the cancer is usually too advanced to be cured. Many studies have tried using this as a screening tool, but the test is not sensitive enough to find the cancer in its earliest stages.

A few years ago, researchers from the National Cancer Institute in the U.S. came up with a “proteonomic” test for ovarian cancer. Proteonomics looks at the patterns of proteins in the blood. It is kind of complex and requires elaborate testing. But, these NCI researchers seemed to find abnormalities in the blood of women with early stage ovarian cancer and it looked like a major breakthrough. But others couldn’t replicate their results. Also, it turned out that the original researchers had patented their test and started a company to market it. Several years later, we still haven’t heard from them. Good marketing, bad science, it seems.

Blood tests for cancer are useful though. If someone has a cancer that has spread and is being treated, following the blood test often tells us whether the cancer is responding. This is a lot easier than CT scans and other cumbersome tests. But sorry to say, these are only worth doing in people with advanced cancer. They have little use in its earliest stages.

So, keep up the screening tests like colonoscopy, pap smears, mammograms and try to stay healthy.

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Submitted by Jayne’s Breast Cancer Blog

Breast cancer Survivor Annette Pashayan wrote a series of poems about her cancer experience and teamed up with composer Ella Milch-Sheriff. The result is called “Songs from the Edge.”

Watch a video clip.

Read an article.

Check out Ella Milch-Sheriff’s website.

Cool Project!

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Submitted by the stupid cancer blog

Ever tried to get health insurance from someone other than an employer? Then you know that the system f***ing sucks. Every state is different, every company is different, the rules are completely obtuse and the market for self-insured people is so small that we all get screwed on options and pricing.

read more | digg story

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Submitted by Dr.Kattlove’s Cancer Blog

I remember an uncomfortable incident early in my practice when I was the weekend on-call doctor and seeing the hospitalized patients. One of them, an elderly lady with advanced cancer, asked me her diagnosis. Evidently, she hadn’t been told and her highly protective family didn’t want her to know. Being clueless, with a disturbing tendency toward truthfulness, I spilled the beans. That afternoon, my phone didn’t stop ringing with calls from outraged family members.

This memory brings up a major problem that all oncologists face. How much should they tell the patient about their outlook? In general, unless the patient is quite sick and not going to undergo any treatment, I suspect nearly all oncologists tell their patients their diagnosis and how advanced the cancer is.

The big issue is prognosis. How much does a patient want to know about his survival chances? Some, mostly younger people, want to know. In my experience, the younger a person is, the more likely it is that he will want to know all about his cancer. I think it is the basic optimism of younger people along with little experience of dying people that leads them into frank discussions about their disease.

But, in my practice, the older that patients were, the less they asked. And this was the dilemma. How do I get people to understand the seriousness of their cancer, especially if it looked like they were going to die in a year or two or even sooner? Some people asked. Usually these were more educated types, people alone, or successful business people. They were either used to dealing with hard facts or wanted to be able to plan.

But even in these situations, I needed to be very careful. Blurting out “Mr. Jones, you have about 3 months to live” can devastate anyone. So I would give ranges. “It could be long – maybe a year or two, but it could also be short – as short as 3 months. So you should plan for the worst, but hope for the best.” This, or some variant, was my usual message (confession – oncologists almost invariably overestimate a patient’s survival- you have to be an optimist to go into this business).

But what if a patient with advanced cancer didn’t ask. This happened most of the time. I wanted my patients to understand the seriousness of their cancer, but I didn’t want to devastate them with information they didn’t want. So, if they didn’t ask, I didn’t tell. I would always tell their spouses or closest family members, but if the patient didn’t ask, I kept quiet.

Was I right? I don’t know. Several recent articles in the Journal of Clinical Oncology suggest that somehow the oncologist should initiate a discussion by asking patients how much they want to know. Perhaps that is best, but, truthfully, this makes for such stressful situations for the oncologists, myself included, that we would rather avoid this issue if possible. It isn’t much fun to tell people they are going to die. Life as an oncologist is tough enough without discussing dying all day long. So often, oncologists wait for patients to start the conversation.

The most recent article, in the November 20 JCO, described how people who were over 70 felt about this issue. About half said no when they were asked if they wanted information about how long they could expect to live. And these were people who were searching out the best and had come to one of the world’s major cancer centers, Memorial Sloan Kettering. They were seeking what a major cancer center could offer and were not representative of people seen in my office in a corner of Long Beach, California. These patients came to me with no knowledge of my abilities. They came to me because their local doctor referred them. I think they seldom asked, because they weren’t seekers.

There is no correct answer for oncologists about what to tell. If you as a patient want to know how long you are expected to live, ask. If you don’t, that’s OK also. And if your doc is like me, if you don’t ask, he or she won’t tell.

But there is a problem in not knowing your outlook for survival. It can be tough on your loved ones, especially if you are not expected to live very long. They will know the truth and want to begin saying goodbye. This will be very important to them, but difficult if you are clueless. Lots to think about.

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Submitted by the stupid cancer blog

Our friend and fellow young adult breast cancer survivor Jill Zocco has been a long-time fan of i[2]y and, especially, the Stupid Cancer Show, our live, weekly radio webcast. Each week, I mention how us young adults deal with all sorts of crapness in our lives but we’re cool with the whole survivorship thing and try to make work as best we can. Well, Jill is also an awesome writer, journaler (is that a word?) so I encouraged her to start her own blog and she did.. And so it is my pleasure to present you with Jill Zocco’s awesometastic new blog, “Sharing My Cancer Crapness.”. Rock on Jill! Stupid cancer. Survivors rule!

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Submitted by the stupid cancer blog

Adolescent and young adult cancer patients are experiencing a reduced survival rate because they are failing to be involved in clinical trials, a meeting of national cancer experts will hear today.

read more | digg story

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Submitted by Dr.Kattlove’s Cancer Blog

Fatigue was one of the most distressing symptoms that my patients complained of. Many of us feel tired some of the time, but usually a brief afternoon nap can handle the problem. Not so with cancer patients – especially those on chemotherapy. Their fatigue is bone deep and doesn’t get better with sleep. It pervades.

I remember a small article written by a young man who was a resident in surgery in Boston about his fatigue during chemotherapy for lymphoma. He described a fatigue that was so intense that even usual activity like going up stairs became challenging. He felt so bad that he thought that the lymphoma must have been progressing. Months later, he was free of cancer and slowly recovering.

Many times the fatigue doesn’t always go away. Near the end of my practice, a patient who I had treated with chemotherapy for Hodgkin disease many years before, called me. He wanted to know if there was something wrong with him because he still felt tired all of the time. I reassured him that this was, unfortunately, normal. Many people, who received treatment for Hodgkin disease or other lymphoma, experience fatigue many years after the treatment has ended.

Chemotherapy isn’t the only villain. Radiation therapy will cause fatigue, especially if a large part of the body is being radiated. Just having cancer is sometimes enough. Of course, if the cancer has spread, that almost guarantees that fatigue will develop.

What to do? The National Comprehensive Cancer Network, a coalition of the major cancer centers in the U.S. has published some recommendations at www.nccn.org. They first recommend that doctors ask about fatigue. My advice for patients is not to wait to be asked. Speak up.

Sometimes – maybe often, the problem is depression. Having cancer and being in treatment is not a happy event. But, antidepressants don’t help and the NCCN recommends avoiding them. Also, taking another drug along with chemotherapy is a recipe for trouble. Certainly it is important to face the problem and understand it. Cancer treatment is not a walk in the woods. Talking with someone may help with depression and of course taking it easy instead of fighting your fatigue is also good for your attitude.

This doesn’t mean becoming a couch potato, just knowing your limits. The NCCN recommends some exercise to keep fit. Most people feel less fatigued on an exercise program. Another aid for some is stimulants. Drugs like Ritalin or Dexedrine can help some people. A few years ago, a pediatrician with advanced lung cancer wrote an article on how much Ritalin helped him recover some semblance of a normal life. It doesn’t work for everyone, but worth a try.

The drug company Amgen has made a fortune selling erythropoietin, a drug that can boost red blood cell counts in anemic people. But there is little proof that this works. Before the time of erythropoietin, I would try blood transfusions if a patient receiving chemotherapy was anemic. I was never convinced it helped those with mild anemia. Although many cancer patients, especially those on chemotherapy have mild anemia, it doesn’t account for the fatigue. And, there are lots of fatigued patients with normal blood counts.

Final message. Fatigue is normal for cancer patients, especially those on chemotherapy. Talk to your doctor and perhaps a psychotherapist if you are depressed – or just for comfort. Exercise. Try Ritalin. And, don’t give up. If the cause is chemotherapy, the fatigue will get better although it might not disappear completely.

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Submitted by the stupid cancer blog

Yesterday significant progress was made in passing the Conquer Childhood Cancer Act of 2007 (S.911). After minimal discussion or debate, it passed unanimously. The bill now needs to either pass by unanimous consent of the full Senate or be voted on by the full Senate, in which case, 60 Senators are required for the bill to pass. The bill will then need to be passed by the House and signed by the president (we can only hope). The legislation authorizes $150 million over five years to expand childhood cancer research, create a national childhood cancer registry to track pediatric cancer and enroll patients in research studies, and increase services to patients and families affected by the disease. Thank you Senator Jack Reed for helping to make this happen – permalink

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Submitted by the stupid cancer blog

What if they found a cure for a cancer that afflicts half a million people, but a combination of stupid bureaucrats and greedy doctors kept patients from getting it? (Editor: Please take a minute to read this, and pass it on to everyone you know.)

read more | digg story

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Submitted by Jayne’s Breast Cancer Blog

Once upon a time there was a young woman with a good job. The job paid quite well and was reasonably fun. It also required that the young woman own a lot of suits. She preferred Ann Taylor suits over all others.

Slowly but surely, things changed in the young woman’s life. Things happened in the corporate arena and her personal life and the young woman ended up becoming a Stay-at-home-Mom. This paid nothing of course, but it was reasonably fun. Her suits gathered dust and slowly went out of style. Yes, even classic garments have limited life spans.

Years passed and the woman became not-quite-so-young. She also moved many times. Slowly the suits were given away.

This past April the woman needed a suit for a trip to Washington DC. She was very excited about this trip - she was going to do some breast-cancer-public-policy volunteer work. But of course because it was volunteer work it pays nothing. She did not buy a suit from Ann Taylor. No, she bought a suit from the clearance rack at a nondescript department store.

While trying on this suit, an elderly woman (who was also trying on suits) gave the forty-something woman a hard time. The elderly woman chastised the forty-something woman for buying a trendy suit.

“You shouldn’t buy that suit. That little ruffle is too trendy.”

The forty-something woman ignored the elderly woman’s advice, and has worn the suit several times now. Her career has been ramping back up and the suit has come in quite handy. The trendy little ruffle has actually received several compliments. Right now, the skirt is a wee bit tight on our main character and this has put her in a funk - but that is a story for another day.

The End.

The Trendy Little Ruffle

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Submitted by the stupid cancer blog

Lending a whole new meaning to phrase ‘Jack In The Box’, the Live:On kit represents a collaboration between Cryogenic Laboratories, Inc., Fertile Hope, and the Lance Armstrong Foundation. Cryogenic Laboratories, Inc. will donate part of the proceeds from Live:On to Fertile Hope and the Lance Armstrong Foundation. Man I wish I had this option 12 years ago. – permalink

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Submitted by the stupid cancer blog

The War on Cancer set out to find, treat, and cure a disease. Left untouched were many of the things known to cause cancer, including tobacco, the workplace, radiation, or the global environment. Proof of how the world in which we live and work affects whether we get cancer was either overlooked or suppressed. This has been no accident. The War on Cancer was run by leaders of industries that made cancer-causing products, and sometimes also profited from drugs and technologies for finding and treating the disease. (Editor: sounds like someone’s pissed) read more | digg story

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Submitted by Dr.Kattlove’s Cancer Blog

I used to smoke. I started when I was 16, continued through college and med school. I stopped for the first time in 1963 when the Surgeon General’s report came out on the harmful effects of smoking. Of course, I already knew smoking was harmful. My dad, a long time smoker, had emphysema. But, in 1963, I was a doctor and felt I couldn’t tell my patients to stop if I was smoking.

About 2 years later, I started again. I thought I could smoke at parties or after meals, but soon the habit returned although I wasn’t smoking more than 5-10 cigarettes a day. I kicked the habit a couple of times more after that and finally became smoke-free in my mid 30s.

Whenever I tried to stop smoking, I would take up cheap cigars to help me. After a couple of sickening weeks of those, I was ready to forego all tobacco. I thought that I was weaning myself (literally) off the sucking sensation. I thought that was the main attraction of smoking. Now I know better.

Nicotine is addictive. That’s why the cigars helped wean me off. When I worked for the American Cancer Society, which is dedicated to eliminating tobacco use, I learned a lot about smoking. One fact that has stuck with me is that nicotine is one of the most addictive substances we know. I also learned that teenagers, like myself when I started, are the age group most susceptible to becoming addicted to nicotine and thus tobacco.

All this came to mind when the Centers for Disease Control published the recent figures on how many people in the U.S. smoke. The sad news is that after a continued drop in smoking rates through the early part of this century, in the last 2-3 years the rates haven’t budged. A little over one-fifth of adult Americans smoke. This number is a little higher in young adults and drops in the elderly – probably because of all that coughing and their doctor’s advice after the heart attack.

Other interesting numbers published by the CDC is how many people with chronic illnesses smoke or used to smoke. For example over 80% of people with lung cancer smoke or smoked in the past.

A little known fact – nearly three-fourths of people with other kinds of cancer are or were smokers. Smoking increases the chances of getting other cancers. All those carcinogens get into the blood stream after they are inhaled and wreak havoc with the DNA of lots of our cells. Cancers such as acute myeloid leukemia, cervical cancer, colon, and stomach cancer are also increased in smokers. A big one is bladder cancer. All those bladder-lining cells are just bathing in tobacco carcinogens. And, the list goes on and on.

As we all know smoking is the leading cause of preventable death in the U.S. and probably throughout the world. Unfortunately, the tobacco companies are relentless. They aim their marketing message at the most susceptible group – teenagers. So, if the smoking rate in the U.S. is going to drop, we will have to block their messages and protect our teenagers. But the tobacco companies are a formidable enemy and after losing smokers for many years, they have begun to fight back successfully. Beating them will take a major decision by this country to eliminate this health hazard. So far, the most successful approach has been to raise the price (taxes). Yes, this places an undue burden on a lot of adult tobacco addicts, many of whom are in lower economic classes. But, studies have shown it will dissuade cash strapped teenagers

The big question is do we have the will? Legislation needs to be passed and the tobacco companies won’t go quietly into the night.

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Submitted by the stupid cancer blog

i[2]y blogger Akiva Zablocki “a.k.a. Eye-Patch Man” just passed the two year marker and in putting finger to keyboard, his xi extruded a magnificent tome entitled “Jump”. “I stood at the edge of the cliff. Looking down I could see nothing by the mist far below. “He will be back soon” I thought to myself. “I have no other choice but to jump.” So I did.” – permalink

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Submitted by Dr.Kattlove’s Cancer Blog

That is the question many oncologists ask when they wonder why more women at high risk of breast cancer avoid taking drugs that may prevent the cancer. Many studies have shown that if a woman takes tamoxifen for 5 years, she can lower her risk of developing breast cancer by 50%. If she takes drugs called aromatase inhibitors, she will also lower her breast cancer risk, perhaps by more. Aromatase inhibitors prevent a menopausal woman (but not a premenopausal women) from making the small amounts of estrogen she normally produces and which can support the growth of breast cancer.

But, in spite of the proven benefit of these drugs, they haven’t met success in the marketplace of women with a high breast cancer risk. Very few women who are at high risk of breast cancer either because of family history or other reasons take the drugs. One study found only 10% of high risk women taking them. And we don’t know for how long. Once side effects begin to develop many women drop out.

Did I say side effects? That’s the problem. Although the drugs have been shown to prevent breast cancer, they really haven’t been shown to save lives, because the breast cancer that the drugs prevent is often the slow growing type, which is easily treatable and, because these women are aware of their risk, usually found early.

And then there are the side effects. Read the article in the October 20 Journal of Clinical Oncology entitled “Comparison of menopausal symptoms during the first year of adjuvant therapy with either exemestane or tamoxifen ….” Exemestane is an aromatase inhibitor. In the article the authors detail all the side effects of the drugs. About half had decreased libido and trouble sleeping (probably not related to each other). Approximately 40% had vaginal dryness and worst of all, 60% reported muscle and bone aches. And don’t even ask about hot flashes. Nearly off the scale.

Now, many of the women would have had these menopausal symptoms anyhow, but making them worse, which the drugs do, is not an attractive proposition. Even women who had breast cancer surgery and are taking these drugs to prevent the cancer from recurring have enough side effects to make at least 10-15% of them drop out.

Also, did we talk about the increased risk of uterine cancer for women taking tamoxifen and osteoporosis in women taking aromatase inhibitors?

So what do women want? To feel good and not have a lot of side effects. Probably a big reason these drugs haven’t been a big hit in women at high risk of breast cancer.

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Submitted by the stupid cancer blog

A diagnosis of cancer in your 20s or 30s comes at a time when you least expect to be worrying about your health. At CancerCare, you can speak one-on-one with a social worker or get connected to a group of other young adults facing similar concerns. It’s important to be able to talk with people who understand your unique challenges and concerns. CancerCare knows that this is a crucial period in your life and support for your specific cancer issues is critical. Officially endorsed by i[2]y – permalink

Submitted by the stupid cancer blog

In response to the Institute of Medicine’s recent report “Cancer Care For The Whole Patient“, WebMD’s Medscape released it’s own review and evaluation of this document which discusses the notion that quality cancer care is not just about quantity-of-life, it’s about quality-of-life. Yes, the notion of cancer survivorship (around since 1985) has finally become a public policy suggestion. Yay government! Of course now that we’ve already learned that attitude isn’t everything, we might as well wait until the polar ice caps melt and drown us all with dignity. permalink (pdf)

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Submitted by the stupid cancer blog

i[2]y artist, young adult cervical cancer survivor and all around rock star Christine Baze scored some amazing props getting ranked as one of Shape Magazine’s 2007 Women Who Shape The World!!! In the company of Heather Graham and Tyra Banks, it’s no wonder they picked Christine to embody how young adults affected by cancer get busy living, make it hip to be a survivor and poke a stick at stupid cancer. Rock on CB! permalink (pdf)

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Submitted by the stupid cancer blog

By i[2]y’er and young adult brain cancer survivor Robin Pelka, “We need funny stories, warm blankets, and magazines, just to keep our minds from focusing on the waiting room, the gateway to chemo land. It must be different for other kinds of patients – nurses and doctors don’t necessarily remind them of death…” permalink

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Submitted by the stupid cancer blog

Children stricken at some point in their lives with the same cancer as their parents are also likely to share a similar rate of survival, according to a study released Friday. I call ’shopped, pwned and wtf.

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Submitted by Jayne’s Breast Cancer Blog

Anita DuJardin Hockers, author of Breastless But Still Breathing, was kind enough to do an email interview with me. I was really curious about her writing experience.

So here is the interview, with Anita’s comments in italics:

When did you start writing your book? Right after radiation treatments, 8 months after diagnosis.

How long did it take you? Crazy…but it only took about 6 months to have a book ready to be published. My editor/publisher was fabulous and I guess I had a hidden talent for writing.

Did you have journals to help you remember details? I did not journal. Hard to believe. I did keep a calendar of all my appointments. When I decided to write it all down, I opened up the calendar and tried to remember everything about every appointment I had had.

I’d imagine that going through the writing process would invoke a range of emotions. What was that like for you? Very emotional. The truth…I hated reliving it. I did it because I wanted to remember and to have something concrete for my daughter. I also wanted to help the Ribbon of Hope foundation.

Toward the end of the book, Anita wrote that “I never thought I would say this, but I recommend that anyone going through a rough time in life should write about it. Writing this book made me aware that we as humans have to let go of things in order to move on.” I asked her to elaborate:

I was never a believer in writing things down. Never journaled. But after I put it all on paper, I realized that it can only help someone else going through this and after all, isn’t that what it is all about.

Writing a book was not the goal to me. The goal was to help other women in my shoes understand that they can beat this. They can move on.

Thanks, Anita. I hope this blog post inspires someone to get busy writing!

Links:

Breastless But Still Breathing,

Ribbon of Hope

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Submitted by the stupid cancer blog

The general story is that there is a conspiracy by the established medical industry to keep the cure for cancer hidden. This is the “cancer conspiracy” discussed on this page. Personally, it is this blogger’s opinion that the only conspiracy is that there isn’t one. –

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Submitted by Dr.Kattlove’s Cancer Blog

Many years ago, I treated a young man with an uncommon cancer called islet cell cancer of the pancreas. Unlike the usual pancreas cancers, which begin in the ducts that carry pancreatic juices into the intestine, this cancer starts in the insulin producing cells of the pancreas. Often these are slow growing cancers. Although they can be fatal, they are usually not as deadly as they typical pancreatic cancer.

This young man and his wife were sure that they would easily beast the cancer because he had a positive attitude and was going to fight hard. I wasn’t so sure. His cancer was larger than the typical islet cell cancer and was growing pretty fast. Unfortunately, I was right and the cancer took him away from his wife and children in a matter of months.

This lack of benefit from a positive attitude has always been my experience. A positive attitude is no defense against an aggressive cancer. Optimistic or pessimistic, your survival depends on the cancer and its treatment. Now a study has been published that confirms my feelings. The study included over 1000 patients who were being treated for head and neck cancer (somewhere in the mouth, pharynx or larynx). They were all given a questionnaire that looked at their emotional state. They were asked about whether they were sad, pessimistic or optimistic, depressed, etc.

The researchers simply counted the number of people who died and looked to see whether when they began treatment whey had positive or negative moods. Of course there were a lot of in-betweens that were also included. Their mood didn’t affect their survival. Pessimists were just as likely to be cured, and optimists no less likely to succumb.

Although these results may not seem important, because we really can’t control our moods, it can make a difference. Many people blame themselves if their cancer doesn’t improve. Now we can say it is not their fault. They needn’t feel guilty. Being a happy positive person wouldn’t have helped.

In my own experience there was one advantage to being optimistic and positive – it made the treatment go easier and patients were less likely drop out of treatment and would tolerate the most aggressive (and hopefully most curative) approach. So, happy or sad, the most important thing you can do when getting cancer treatment is to just show up.

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