Breast Cancer Blog

Submitted by The Stupid Cancer Blog

Marcia! Marcia! Marcia!
Cure! Cure! Cure!

By Matthew Zachary

Life is about choice. Remission is not a cure. Survivorship is all that matters.

So the new hotness in cancer care is young adults affected by cancer, aged 15-39. Why? Because survival rates have not improved in 30 years (source: NCI, Closing The Gap) and, for the large part, *all* of the strides, progress and advancements we’ve made since Elvis died do not benefit this oft-forgotten orphan generation of patients, their families and caregivers. Granted it’s only 6% of all incidence and 10% of all survivorship (source: NCI SEER 2006) but we’re people too. And we vote. (For Sanjaya perhaps but we vote, dammit!)

To point out a possibly lesser understood factoid, it should be noted for the record that this population of “young adults” encompasses not just people diagnosed in their late teens, 20s or 30s, but long-term childhood cancer survivors as well, who comprise almost 1/3 (roughly 350,000) of the current young adult survivorship population (~1,100,000) currently living with, through and beyond cancer in the United States. In fact, if you add to this, current boomers and seniors who *were* diagnosed under 40, we’re looking at about 3M people.

Why include long-term pediatrics? Because they’re people too!

Seriously, though… while progress in pediatric cancer has been made in the past 20 years, it has also failed miserably and is only now – in contribution, support and execution of recent staggeringly shocking public health reports – getting it’s head in the game and seeing cancer no longer as a death sentence but for what it really is for children; a life sentence with no real “cure” in the traditional “magic bullet fairy dust” sense.

People like to say “cure with consequence” or “cure’s collateral damage” but, for many long-term pediatric survivors, when the doctor says, “You’re cured. Go home.” - that’s not the end of the story – a euphemism I use repeatedly.

This life sentence is, of course, better than the death sentence it used to be but with progress comes consequence. Article after article in national press continues to expose the notion that “cure” is not the end of the story. Yet somehow, that message isn’t seeping down to the general public who continue to let us survivors know as a matter of course that “It’s Over! You’re Finished! Get on with your life and stop complaining!” Ain’t that the truth?
Survivors in their late teens, 20s and 30s, whether you’re a long-term survivor or newly diagnosed, are not like Aunt Sally and Grandpa Sam, who successfully completed their 30-year studied, age-appropriate, clinically-trialed-to-death adjuvant cancer treatment, slapped on their pink ribbons, free t-shirts and wristbands, raced/walked/strode for a cure, sat around a pale hospital support room in a circle of chairs with other boomers and seniors of their same cancer type and Kum Ba Yah’d themselves in perpetuity to closure.

No, we’re different. Much, much different.

So here we are. Young adults are finally the buzz in onco-town. Woo hoo! Now what? No one knows. It’s one thing to put out all these great - but scary as hell - public health reports about these gross inequities facing young adults across all verticals within the cancer continuum but it’s an entirely different thing to act on them.

The aforementioned “cure” which now appears for many to be more about quality of life and not quantity of life is changing the way we think about cancer and demanding semantic accountability on behalf of the organizations who keep promising us Disney World in a syringe. This Cinderella “cure” is – now more than ever (think how Pinkishly nauseating October is getting) – shoved down our throats, promoted and preached by “establishment” cancer groups who either (1) don’t get it, (2) don’t want to level with their donors, (3) don’t know how to talk truth to the public or (4) live in a multicolored, perfume-scented and robust fantasy land with unicorns and rainbows like it is the year 1977.

Racing for the Cure. Relaying for the Cure. Golfing for the Cure.

Cure! Cure! Cure!

The problem is that no one defines what “cure” means.

I’ve said this over and over and over and no one has stepped up to the plate. Get in the “hot seat” and tell us! It’s almost an embarrassing comment on a broken system that continues to dupe the ever more financially compromised pockets of the American donor.

Yes we want a “cure.” Who doesn’t want to see epidemic diseases marginalized, eradicated and tossed the way of polio and small pox. (What do you mean polio and small pox are still around?) Crap. We’re screwed.

Well, at least if they’re still here, are they killer diseases or, like allergies, asthma, diabetes, glaucoma and HIV, are they chronic conditions that enable us to not die right away but perhaps enjoy a somewhat compromised-yet-tenable quality of life? They’re not? Good.
So how is this any different than cancer? It’s not. Cancer is a chronic condition. This is not just my personal opinion - it’s public health data.

Cancer is now actually considered a chronic condition by the National Cancer Institute and the Centers For Disease Control and Prevention.

Whoop dee doo. Does this matter? Somewhat. Should you care? Maybe.

The definition of chronic condition means “no cure.” Live with it, make the most out of it and focus on quality and not quantity.

I’ve said it before and I’ll say it again: Getting cancer and not dying is not a “cure.” Surviving cancer only to hope you don’t get it again (whether a recurrence or secondary) is not a “cure.” Being disease free is not a “cure.” Which brings up the elephant in the room and a topic surely destined for an entirely different tirade – is that we continue to treat the symptoms of cancer but never actually address why we get it in the first place. Environment, pesticides, hormones, pollutants, toxins, blah blah blah. If you ask me, cancer is here to stay. It’s not something we can stop, only something we can manage.

And on that positive note, I shall conclude this tirade with an excerpted quote of a partially-great article published in 2005 by author Mike Adams entitled, “The Cure Con: how you’re being deceived by charities that claim to be racing for the cure for cancer and other chronic diseases.”

“Everywhere you go, someone asks you for money to help find the cure for some disease. It’s the race for the cure! It’s the telethon for the cure! It’s the walk or run for a cure! At grocery stores, cashiers ask if you want to donate a dollar to help find the cure. Other retailers want to sell you fashion-minded colored bracelets that raise money to find the cure. There’s always someone who wants your money in exchange for the hope that your dollar will somehow help them “find a cure” for some awful disease.

“I have a very big question to ask about all of this. This has literally been going on for decades. Researchers have been searching for a cure for cancer since the late 1960s, and for other diseases since at least the 1970s. At that time, they said cures were right around the corner; it was just a matter of a few more dollars; then they would have the cures available. Well, here we are, 30 or 40 years later, with still no cures. We’ve been running this race for decades, funding it with literally billions of dollars. If all this money has gone to the race to find cures for these diseases, then where are the cures?”

Stupid Cancer. Survivors rule. Remission is not a cure.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

Many oncologists believe that we can cure more patients’ cancers if we can just give the patients high enough doses of chemotherapy. For years, it has been a maxim in oncology that the more chemotherapy you give, the more cancer you kill. A colleague of mine, who didn’t believe this, compared this theory to the situation of a person in a foreign country trying to make himself understood by shouting instead of speaking the native’s language.

This week’s Journal of the National Cancer Institute carried an article written by European investigators that confirmed my colleague’s skepticism. The researchers treated patients with a type of lung cancer called small cell cancer, with very high doses of chemotherapy and compared them with a group that received standard doses. By the end of 4 years, over 80% of patients in either group were dead. The only thing the high dose patients got out of their treatment was more toxicity.

Small cell lung cancer is a type of lung cancer that is very different from the garden variety that we usually see. It comes from a different cell than the typical lung cancer (adenocarcinoma or squamous cell) and only about 10-15% of lung cancer patients have this type. It is also special in that it almost always spreads from the moment it begins. This means that surgery is generally not helpful, because it will likely come back somewhere outside the lung. Treatment is usually with chemotherapy and radiation therapy. Although the cancer usually comes back in spite of all this, some patients whose cancer is found early are cured.

My colleague’s sense that you need to use chemotherapy that “spoke” to the cancer reminds me of an elderly patient I saw with small cell lung cancer. He certainly would not have been a match for high doses of chemotherapy so I treated him with the gentlest regimen that in good conscience, I could give him. After 2 years, there was no sign of the cancer. The chemotherapy spoke the right language to his cancer.

High dose chemotherapy was once the darling of the field. About 15 years ago many patients with breast cancer were treated with massive doses of drugs. The doses of the drugs were so high that the patients needed to have their bone marrow cells saved and given back after the treatment or they would have died of bone marrow failure. Physicians and patients alike were so passionate about the procedure that insurance companies were sued if they refused to pay for this very costly ($100,000) procedure. Then the clinical trials were completed and showed that high dose chemotherapy was no better than the standard regimens.

Still, hope springs eternal in oncology –after all without hope, many of us would have dropped out of the field. Now, breast cancer patients are given “dose dense” treatment. This means that the patients receive standard doses of chemotherapy, just more often. So far, over 3-4 years, it looks like this treatment has a slight edge over conventional treatment, but at a big expense in both money and toxicity.

Is this the final answer? A little better – or perhaps not better at all?

I suspect my skeptical colleague would say that maybe we’re not speaking louder, just speaking faster and that doesn’t work either.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

Pennsylvania Patient Builds Machine Harnessing Radio Waves To Attack CellsFor most, a cancer diagnosis can be devastating. But, as CBS News contributor Benno Schmidt reported on The Early Show Monday, for John Kanzius, it was a call to action. Kanzius isn’t a doctor. He doesn’t even have a college degree. Yet, observes Schmidt, the device he invented has impressed a notable researcher and inspired his hometown, Erie, Pa., to the point where it gave him a key to the city in April. Asked by Schmidt what made him think he could cure cancer, Kanzius replied with a laugh, “What made me think I couldn’t cure cancer? Nobody else was doing it!” A former radio and TV engineer and one-time station owner, Kanzius, who suffers from leukemia, hated his chemotherapy and saw its devastating effect on others. “I ran into some of the same patients over and over again and, to see their smiles disappear within a few weeks, and then watch their hair disappear and then, clinging to their mothers asking, ‘What’s wrong with me?’ was heartbreaking.”

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

The Stupid Cancer Fund is a national campaign supporting the I’m Too Young For This! Cancer Foundation and it’s mission to end isolation and improve quality of life for young adults affected by cancer. The past 30 years of “progress” have failed our generation so there’s no reason to think the next 30 years will be any different unless change happens now. We’re too young for this! Are you in? Take care of your own and give!

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

A few days of fasting might help protect patients from some unpleasant and dangerous side-effects of cancer chemotherapy, researchers reported on Tuesday. The researchers stressed that people should not try this on their own yet but said the findings might lead to a way to use chemotherapy to more effectively kill tumors while sparing healthy cells

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

It must be frustrating for a woman with breast cancer to learn that after she has had surgery, she is only part way through her treatment. Often there will be hormone treatment or chemotherapy or both; and, if she has had a lumpectomy (about half of all women), she will also need radiation to the breast.

Why do we give radiation to the breast if the cancer has been removed? It’s because the cancer often will come back in the breast and radiation cuts the chances of this happening by half. Clearly, in some women – about 5-10%, some cancer cells have dodged the surgeon’s knife.

So traditionally, radiation oncologists have treated the breast with radiation 5 days a week for 5 to 6 weeks. That’s a lot of time out of a woman’s life and many doctors have wondered whether the radiation could be given over a shorter time with fewer treatments.

There have been a few studies that show that this can be done and now a really good study has come out of England that proves it. Several radiation centers participated in treating a little over 2000 women after their lumpectomies for breast cancer. Half the women received the usual 25 treatments over 5 weeks and another half got a slightly higher dose of radiation each time but only 15 treatments in 3 weeks.

Five years later, the women who got the shorter treatment had no more recurrences in the breast than did those who received the traditional 25 treatments over 5 weeks. In fact, their recurrence numbers (2.2%) were lower than the women with the longer treatment schedule (3.3%). And the concern that slightly higher doses over a shorter period would damage the breast (the breast can become scarred and hard) turned out to be unfounded. Actually the women with the shorter treatment tended to end up with better looking breasts. The researchers actually took pictures of all the women for comparison.

So why are we in the U.S. still using the older longer regimen? One reason is that there are a lot of radiation facilities in the U.S. and we don’t want them to stand idle. Treatment schedules tend to conform to capacity. That’s why most of the studies of shorter treatments come from Canada and Great Britain where the supply of radiation facilities is limited.

Still, that doesn’t mean a woman should spend her time going to radiation treatments if it isn’t necessary. Nor should they (or their insurance companies) have to pay more than necessary – 15 treatments are cheaper than 25).

It’s time for radiation oncologists to discard their traditional approach and give these women a break.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

I have been mulling this question over in my mind for years. I’ve never felt the evidence was that convincing. I’ve known of people who had the procedure and quickly crumped. Also, maybe the results look good because the people who go to these centers for the transplant have to be in pretty good shape just to get there.

All this came to me today as I read of the death of the actor Roy Scheider, who made it big as the sheriff in the movie “Jaws” but who I admired as the Bob Fosse character in the movie “All That Jazz”. He died of multiple myeloma at the University of Arkansas Medical Center in Little Rock, only, I read, 3 years after his diagnosis. This is a major center of myeloma treatment and one where the stem cell transplant has been a favorite. In fact, these people have been its champions, so I suspect he had the procedure.

Now the truth is that the procedure really isn’t a transplant. A patient’s own cells, not someone else’s are used. The way it goes is this. First the patient with myeloma gets standard chemotherapy to control the myeloma and get rid of as many of the cancerous myeloma cells as possible. Then his blood is filtered in special machines to remove the blood-forming stem cells. These are stored while the patient then gets massive doses of chemotherapy, often along with some radiation to kill most of the rest of the myeloma cells. At the same time, this treatment kills all the patient’s blood-forming cells. That is why they need to be replaced. Once the chemotherapy and radiation are finished, his blood-forming stem cells are transfused back into him and they head for the bone marrow where they will start making blood cells again.

This treatment isn’t curative and isn’t for everyone. It is quite toxic; most centers use this only for patients younger than 65. That leaves out two-thirds of myeloma patients. Also, I’m not sure that today it is the best treatment available even for younger patients. When the transplants first were developed, they did seem a little better than the usual treatment according to the studies at that time. In these early trials, half the patients got the high dose chemotherapy and perhaps radiation followed by the stem cells, while the other half received the standard treatment of that time. In those studies, the high dose chemotherapy patients appeared to live a little longer.

But the standard treatments in those studies aren’t the standard ones today. New drugs have been developed. In fact, new myeloma drugs have been some of the hottest items in cancer therapy in the last few years.

Just this week I read of a report of a totally new combination treatment of three drugs to treat myeloma. These are Biaxin, Revlimid, and dexamethasone. The first two are new and the last an old-timer. The overall survivals in the myeloma patients who received these were as good as we see with transplants. And, although some of the patients did get high dose chemotherapy and transplants after this treatment, they didn’t do any better than patients who didn’t get the high dose chemotherapy and transplant. In fact many of these other patients were also supposed to get the high dose chemotherapy and transplant, but were feeling so good, they passed.

With all these new drugs we need new studies to see if transplants are still number one. Until then, I’d be awfully cautious about going for the transplant when there are so many good drugs around.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

Being a cancer survivor does not significantly decrease the chance of becoming a parent, according to studies that followed cancer survivors who were diagnosed with cancer between the age of 15 and 35. By mid-30s, men had the same chance of becoming a parent as a contemporary who had never been diagnosed with cancer. For women, the odds were slightly lower but not enough to rule out motherhood.

Norwegian Radium Hospital and the Norwegian Institute of Public Health (NIPH) researchers attributed the success of young cancer patients going on to become parents later in life to fertility-protecting treatment for young cancer patients adopted in the mid-80s.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

What is “chemobrain”?

“Chemobrain” is another side effect of chemotherapy, which has only recently been recognized. It develops in some people after they have had chemotherapy. Their major complaint is that they have trouble thinking clearly. Most of the studies have been in women who have received chemotherapy after breast cancer surgery. The main finding in these women has been trouble with memory although other problems have also been described. The existence of “chemobrain” is still not settled, because some of these symptoms may actually be caused by the cancer itself. Some people with cancer have been shown to have memory problems even before they receive chemotherapy.

But, more and more, doctors are recognizing the fact that “chemobrain” is real. Careful testing of memory and other brain functions have shown that women who receive chemotherapy after curative surgery for breast cancer will have definite changes in their though processes. And special studies such as MRIs and PET scans have confirmed that there is something wrong, compared to normal people. When the women are asked to think or remember something, the wrong areas of the brain show too much activity while the areas supposed to show activity, seem to be turned down.

This memory problem doesn’t go away very quickly. One study found changes as far out as 5-10 years after the chemotherapy. So what to do? The first step is to recognize it. Not everyone develops this problem and of those that do, many aren’t bothered. But if you need your memory to be first rate, especially if you are in a high-functioning job, help is available.

Doctors have reported successful treatment of women with this condition. No they didn’t fix their brains. But what they did do was train the women to deal with their losses. This was all done at a rehabilitation unit. The procedure was called Memory and Adaptation Training. Basically the women were given memory training and taught how to recognize situations that needed extra efforts. Relaxation training was also included. The women would attend sessions where they received their training and then would practice between visits.

All in all, the program succeeded. At the end of 6 months, the women were able to function better and were more satisfied with their lives.

So if you are receiving chemotherapy or have received it – this is something to think about.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

“I’m a pediatric neurosurgeon. I’ve done that for a long time. But I’ve always felt that my true calling was the stage. The only problem is that I really have virtually no talent whatsoever,” says Chief of Pediatric Neurosurgery at Rainbow Babies and Children’s Hospital in Cleveland and Elvis impersonator Dr Alan Cohen.

According to Dr Cohen, pediatric brain cancer is the number one cause of cancer death for children and it is his job to save lives. But he goes one step further in calming nerves and inspiring hope for his very young and very frightened patients. One of his former patients said, “When I came here I was so scared, like I was probably gonna die and he was able to calm me down and realize I was gonna survive and I was gonna be able to live again.”

Once word got out that Dr Cohen was a fan of the King, people started sending him Elvis memorabilia. Now, each year on the anniversary of Elvis Presley’s birthday, Dr Cohen does his best Elvis impression and gives a concert as Elvis. Video of ABC Good Morning America features Dr Cohen in Surgeon Rocks to Elvis in OR is available online here.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by The Stupid Cancer Blog

Twelve states have made medical marijuana use legal, but it appears the law that protects does not extend to the workplace. The California Supreme Court has ruled a medical marijuana user can be fired from their job for failing a company mandated drug test.

Medical marijuana use is a complicated and contradictory issue. Legal in 12 states. Illegal in other states. Illegal on the federal level, the US Supreme Court has stated the Bush administration can prohibit the backyard cultivation of pot for personal use, because marijuana use has broader social and financial implications, according to CNN. A federal appeals court stand is medical marijuana users can be subject to arrest and marijuana confiscation.

Medical marijuana is prescribed for a number of conditions. The side effects of slash and burn chemotherapy can be debilitating, and some cancer patients report marijuana relieves nausea and the resulting lack of appetite associated with chemotherapy treatment when traditional anti-nausea drugs fail. As with any drug, a compassionate ruling would not make criminals out of those who suffer. Your thoughts?

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

What if there were a pill that women who had surgery for breast cancer could take that would lower their chances of dying from the cancer? And what if the pill had few side effects and that after 5 years the women could stop taking it? Who wouldn’t go for it?

Guess what? Lots of women won’t take the pill. The pill is a kind of drug called aromatase inhibitor or AI for short. It is given to women who have had breast cancer surgery to prevent the cancer from returning. It is only used in women who are past the menopause and works by blocking the production of the small amounts of estrogen that post-menopausal women normally make.

Because most cancers in post-menopausal women feed on this estrogen, most oncologists prescribe AIs to prevent the cancer’s recurrence. In the past, oncologists recommended tamoxifen, which has probably saved the lives of hundreds of thousands of women with breast cancer. Now studies have shown that AIs are more effective by as much as 25% and have fewer side effects, so they has become the choice of almost all oncologists.

A “no brainer”, right? I think so and that is why I was so startled to read in a recent issue of the Journal of Clinical Oncology that a lot of women aren’t taking the drug even though it has been prescribed.

The researchers looked at pharmacy databases and identified women who were prescribed one of the three different brands of AIs, called anastrazole. By looking at how often a woman refilled her prescription, they could tell if she was taking the drug on schedule or missing doses. By the way, the woman was considered to be taking the drug regularly if she missed no more than 20% of her doses.

In spite of this loose definition, the researchers found that by the end of the first year of treatment, about one-fourth of the women weren’t taking the drug properly. By the end of 3 years, this number grew to 40%. That means that 2 out of every 5 women who were prescribed this potentially life-saving drug weren’t taking it or at best taking less than 80 percent of their prescribed doses.

Why did this happen. The researchers talked about the possibility of side effects, recurrence of the cancer, other diseases, or that women didn’t believe in the value of the drug. I’m not baffled. The other day, I saw a 50 year old man with super high blood pressure who wasn’t taking his pills. Didn’t he know that he is asking for troubles - a heart attack or stroke? I gave him my lecture, including simulating what he might look like if he had a stroke, but I’m not sure I did much good.

It’s the same for these women even though this is CANCER! No woman wants it to come back and this is their best chance to prevent it. But, like my patient with the high blood pressure, people aren’t into prevention. That is why we often eat an unhealthy diet, don’t exercise, don’t buckle are seat belts, and don’t take drugs that might prevent cancer from returning. It is so sad.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

Today, I read two articles that connected these two. The first was in today’s LA Times and talked about the controversy over Provenge, a new treatment for advanced prostate cancer. The FDA has held up its approval in spite of a study that showed that patients who received the treatment lived, on average, 4½ months longer. Many prostate cancer patients are protesting this decision and asking that it be overturned. There have even been death threats against members of the committee that made the decision.

The second article was in the January 1 issue of the Journal of Clinical Oncology. It reported on the negative results of a study using high dose chemotherapy and stem cell replacement treatment for widespread breast cancer. The patients didn’t live any longer, in spite of this extremely toxic treatment. The theory behind the treatment is that if patients are given massive doses of chemotherapy, this can wipe out the cancer cells.
The chemotherapy also wipes out the blood-forming cells in the bone marrow, so these have to be replaced. Before the chemotherapy, blood-forming stem cells are taken from the patient either from their bone marrow, or more commonly, from their blood stream. These are given to the patient after the treatment to allow them to begin making blood again.

There was a time, when there was little information on the outcomes of this treatment and women who had advanced breast cancer, in desperation, asked for it even though it hadn’t yet proven itself. If insurance companies denied the treatment because it was not proven effective and, by the way cost around$100,000, the women would sue the insurers. They usually won so that eventually many insurers gave in and paid for the procedure. Eventually, the outcome data rolled in and it became clear that the treatment didn’t work. Today’s JCO article just verifies this.

The same thing is happening with Provenge for prostate cancer. Patients, in desperation, are clamoring for its approval. Didn’t it prolong lives by 4.5 months, they ask? Yes it did, but if you read the article closely you see that the cancer grew just as quickly in the Provenge-treated patients as in those given a placebo. There’s a disconnect here. If the cancer grows as quickly in one group as in another, shouldn’t the cancer take its toll just as quickly? That is what most cancer specialists assume to be true. For a treatment to really help, it has to slow down the growth of the cancer. But it didn’t in this case and that is why the FDA has asked for more studies. The results just don’t make sense.

But patients with advanced prostate cancer are desperate for treatment, as were women with breast cancer in the past. But the FDA has the job of preventing ineffective treatment that may be toxic and certainly very expensive. So, let us hope that people have the good sense to wait for more information before going overboard with death threats and protests.

Visit 1800blogger to see all of our industry leading blogs.

Submitted by Dr.Kattlove’s Cancer Blog

The FDA advisory committee has recommended against Avastin for use in women with advanced breast cancer. Are they depriving these women of a life prolonging treatment? The simple answer to this question is no.

Avastin is a drug that treats cancer by blocking the blood supply to the cancer. This way, the cancer starves to death because it is deprived of nourishment from the blood. For many years, scientists have known that one of the main steps in a cancers growth was the formation of new blood vessels to supply it with nutrients. Avastin, also known as bevacizumab, prevents this new blood vessel growth.

Researchers have been attracted by the concept of treating cancer with blood vessel-blocking agents. It makes sense. Starve the tumor. But, in practice this hasn’t worked that well. The drug has had a little success in treating widespread colorectal cancer and lung cancer but only when combined with chemotherapy.

It also seems to slow the progression of widespread breast cancer – also combined with chemotherapy. That is why it was brought up for FDA approval. The FDA advisory committee was bothered by the fact that the drug didn’t prolong the lives of the women, it cost a lot ($100,000/year), and it caused a lot of toxicity (holes in the intestines, bleeding into the lungs).

And there is another issue that was mentioned. We already have a lot of drugs that are effective in treating breast cancer. My own experience was that there was always another drug to treat patients with widespread breast cancer after the last one failed.

The problem is that after a woman has been through treatment with several different drugs, her cancer usually doesn’t respond to anything anymore. And also, she is generally not strong enough for another round of chemotherapy. So having a drug like Avastin, which would be the most toxic and expensive of all drugs used for breast cancer, would not help much.

We don’t need another drug that helps a little. We have lots of those. We need one that can hit a home run.

I think the FDA is becoming suspicious of all these drugs with only marginal benefit after being burned by the overuse of erythropoietin – a very expensive drug that stimulates blood production. After that drug was approved, the manufacturer, Amgen, marketed it like it was running for president. And so oncologists, like everyone else, susceptible to marketing messages, and seeing a profit in providing the drug, gave it to everyone. The bill for cancer care went up, but patients weren’t helped much. In fact, people may have been hurt – see my other blogs (5/10, 8/4) on the subject. Now the government, through Medicare, and private insurers, are limiting the use of the drug.

Perhaps the FDA advisers saw this as a potential problem with Avastin. Its manufacturer, Genentech, would market it to everyone, including patients. It would be given to lots of women with widespread breast cancer, and the cost of medical care would inch up.

So congratulations to the FDA advisory committee for a wise decision. To the women with widespread breast cancer, you will not lose by this. Indeed, you will gain less toxicity and get to keep some of your hard-earned dollars.

Visit 1800blogger to see all of our industry leading blogs.

An FDA panel will meet on Wednesday to determine whether the labeling for the drug Avastin can now include breast cancer. Although the drug is approved in Europe to treat breast cancer and doctors use it in the United States to treat some breast cancer on an off-label basis, data from an Avastin study did nothing to show regulators that the drug improves the overall survival. In fact, the recent study concluded that the drug improved the all important “overall survival” less than a month.

This panel vote will help guide the administration when they decide in February whether to extend the label for the drug. Avastin has been on the U.S. market since 2004 and is approved to treat colorectal and lung cancers.

An analyst at Credit Suisse said he expects the Advisory Panel to recommend approval.

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.

Visit 1800blogger to see all of our industry leading blogs.

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.

Visit 1800blogger to see all of our industry leading blogs.

According to the results of a new study released during a meeting of the American Society for Therapeutic Radiology and Oncology, 20% of black women diagnosed with breast cancer are under 40. The incidence of breast cancer for white women under 40 is 12%.

According to the data, black women are also more likely to have large tumors.

2400 women with breast cancer were followed over a 30 year period

Most breast cancer survivors will tell you that a good support system was essential to a successful treatment. However, as in most cancers, early detection increases the odds of a successful treatment.  Remember, early detection starts with a self-examination. Here are the symptoms.

·  New lump in breast or under arm pit

·  Thickening or swelling of part of breast

·  Irritation or dimpling of skin

·  Redness or flaky skin in nipple area of breast

·  Pulling-in of nipple or pain in nipple area

·  Nipple discharge other than breast milk, especially blood

·  Any change in size or shape of breast

·  Pain in any area of breast

READ ON

Bristol’s Ixempra (Generic: ixabepilone) was approved for sale by the United States Food and Drug Administration and will be available for sale in the United States within a few days.

The chemotherapy drug is approved for a stand-alone treatment for patients with advanced tumors that do not respond to Xeloda or other drugs with the anthracyclines or taxanes categories.

Two ongoing trials are expected to determine by late 2008 whether Ixempra actually extends survival.

 The overall cost of treating a typical breast cancer is $50,000 and can even exceed $100,000 in some cases.

Here is some data that really tells the story on how the burden of paying for cancer treatments is really affecting some American families.

33 percent of cancer patients have trouble paying medical bills and 43 percent report skipping payments or not filling prescriptions because of the cost.

A recent conversation that I had with a doctor who treats breast cancer regularly at one of the world’s most respected medical institutions indicated that many cancer treatments are unnecessarily aggressive. In fact, he went as far as saying that many double mastectomies are not necessary.

It kind of makes me think whether some patients are undergoing unnecessary treatment. A new European study concluded that women under 40 with breast cancer who have chemotherapy in addition to lumpectomies or radiotherapy may not realize any additional benefits from the chemotherapy.

The best way to understand the field of epigenetics is to truly understand its relationship to genetics. If genetics is the printed words and sentences that make up a book, epigenetics is the interpretation of those words and sentences when read by multiple beings.

Epigenetics is the study of heritable changes in gene function without changes in DNA sequence. Scientists have discovered certain epigenetic signatures in certain types of cancers. Scientists are now searching through the genetic codes of breast cancer sufferers for a common signature.

Scientists warn that a test could be years away because even if a reliable signature is discovered, a test still needs to be developed that would identify the signature in blood earlier enough in the pathogenesis of the disease.

Still, another said that this could make a difference in the lives of women with breast cancer.

Personalized medicine is the antithesis of the one shoe fits all approach. For years, patients with similar diseases have received similar treatment. But why is the same treatment that’s successful for one patient unsuccessful for another? The simple answer is that those patients don’t have the same physical and biochemical makeup and probably have different gene sets. At its most basic definition, personalized medicine refers to using information about a person’s genetic makeup to tailor strategies for the detection, treatment, or prevention of disease based on what we know has worked for similar gene sequences in past patients. That may sound like a straightforward task, but it actually poses major scientific challenges when one considers that there are 3 billion letters in the human DNA code.

However, scientists are making great strides including the discovery of two genes that can identify which breast cancer cells will respond to a common chemotherapy drug and which will not have been revealed by Aberdeen University staff.

The breast cancer cells that were used in the study were grown in the laboratory. Now, scientists will investigate whether the genes identified behave the same way in the human body.