Where Will That Stimulus Money Go for Cancer Research?

There's a fascinating article today in the Wall Street Journal (online version, click here) that talks about how money spent on cancer research hasn't saved a single life.

Since President Obama's stimulus package is ready to dump more millions into cancer research, it's urgent, says the author, to figure out where that money should go, instead of down a "thousand rat holes."

The article also gives a handy-dandy catch-up on where we are now in cancer research.

HRT Doubles Risk of Breast Cancer

There was an article in the Oakland Tribune (February 16, 2009) -- on the front page, no less -- which claimed that hormone replacement therapy can double a woman's risk of breast cancer every year.

Two new Stanford University studies show that using long-term hormone replacement therapy (HRT) poses a far greater risk of cancer than previously thought.

The research concludes that a woman who stays on the therapy for at least five years doubles her risk of breast cancer every year. This risk is far greater than the 27 percent described in the hallmark 2002 Women's Health Initiative report, the first such study to establish a link.

But there was good news. No risk was established when women took HRT less than five years. And for women who continued beyond the five years, continued taking hormones, risks dropped when they stopped.

Marcia Stefanick, a professor at Stanford University School of Medicine and a co-author of both the 2002 and present study, added, "I would encourage women to try and make it through menopause without starting hormone treatment."

B Vitamins Could Lower Risk of Macular Degeneration

We know that Vitamin B has not been shown to prevent cancer. But apparently it has another healthy application.

A study at Brigham and Women's Hospital in Boston indicates that taking B vitamins could lower the risk for a leading cause of blindness in older Americans. USA Today (February 24, 2009) reported on the study.

"This is the first randomized trial to indicate a possible benefit of folic acid, B-6 and B-12 vitamin supplements in reducing the risks of age-related macular degeneration," said study author William Christen.

Christen and his team "collected data from a cardiovascular disease trial involving more than 5,200 women over 40 who reported they did not have macular degeneration at the study's start.... At study's end, 55 cases of age-related macular degeneration were confirmed in the vitamin group, and 82 were confirmed in the placebo group. Those who took the supplements had a 41% lower risk of being diagnosed with the disease."

The study appears in this week's Archives of Internal Medicine.

The Difference Between Angina and Heart Attack

The below is from RemedyLife:

"Nearly 7 million Americans have angina. William E. Boden, M.D., clinical chief of cardiovascular medicine at the University of Buffalo schools of medicine and public health, explains.


What is angina?

Angina is not a disease but a symptom that occurs in those with narrowed coronary arteries (atherosclerosis). A person with arteries that are at least 70 percent blocked is likely to experience angina when the heart works harder than usual, such as during physical exertion, stress or sexual activity. The heart can’t meet the extra demand from heightened activity because an increase in blood flow is restricted by blocked arteries.

What does it feel like?

Angina typically presents with tightness and pressure—an oppressive sensation. Patients sometimes describe feeling as if an elephant were sitting on their chest. I always ask patients to distinguish between pain and pressure. Less typical symptoms are shortness of breath, nausea, vomiting and sweating.

Atypical symptoms tend to be more prevalent in women, which explains why women are diagnosed less frequently.

How do angina and heart attack differ?

A heart attack is a more catastrophic complication of atherosclerosis, associated with a complete blockage in a coronary artery, which acutely obstructs blood flow. Symptoms are more severe and prolonged (usually 20 minutes or longer) and can come on suddenly. Angina typically lasts 5 to 10 minutes and subsides when the activity that triggered it is curtailed or stopped.

What are the risk factors for angina?

The four main risk factors are diabetes, high blood pressure, smoking and abnormal cholesterol levels. Other risk factors include family history, obesity and sedentary behavior.

How is angina treated?

Standard treatments include drugs such as beta blockers, calcium channel blockers, statins and nitrates. Sometimes angioplasty or bypass surgery is indicated.

When should emergency help be sought?

Usually, people who have had angina can predict what will set off an attack. If the usual pattern changes, especially if symptoms persist after 15 to 20 minutes of rest or occur abruptly at rest or in the middle of the night, the best advice is to call 911 and get to the ER.


Microvascular Angina

Microvascular angina, according to Dr. Boden, is a type of angina that has been identified in the past 5 to 10 years and is much more common in women than men. “People with microvascular angina can have normal major coronary arteries (where blockages cause heart attacks) but narrowings in the very small arteries supplying blood flow to the heart muscle, which can cause chest discomfort,” he explains. Those with microvascular angina rarely have heart attacks."

If You Do Research, You're More Likely to Get the Newest Drugs

There's an article in USA Today that talks about "cancer patients who research treatment options are three times more likely to get the newest drugs...."

"Patients who sought information from the internet, newspapers and magazines were more likely than others to have heard of the 'targeted' therapies cetuximab, sold as Erbitux, and bevacizumab, sold as Avastin. But those who pursued second opinions from doctors as part of their research were the most likely actually to be prescribed these drugs, says the study led by the Dana-Farber Cancer Institute in Boston and published online today in Cancer."

Each Cancer Is Different

The San Francisco Chronicle (through the Associated Press) had a great article today on cancer care.

"The days of one-size-fits-all cancer treatments are numbered: A rush of new research is pointing the way to tailor chemotherapy and other care to what's written in your tumor's genes."

I'm not surprised that we finally wised up and figured out that each cancer is different, and maybe even that even cancer in individuals is different, but that the answer lies in tailoring gene therapy. Wow.

I find this of particular interest: every patient with advanced colon cancer is supposed to get a genetic test that will tell them whether further treatment will do any good. Researchers found last month that Erbitux and Vectibix, cancer drugs which are rather expensive, won't work in 40 percent of patients.

There are currently studies going on regarding genetic testing for breast and lung cancer as well.

All of this work points to the fact that cancer medications don't work for about half the patients, patients who have to suffer through sometimes horrific side effects and financial impact with no benefit.

For the entire article, take a look at the San Francisco Chronicle, February 17, 2009.

Chemotherapy Resource

Women and Cancer magazine clued me into the chemotherapy.com website.

The website is great especially if you just started treatment.

You can also get a free copy of Women and Cancer magazine on that page as well.

Diabetes Cases Have Doubled in the Past 10 Years

The rate of new cases of diabetes in the U.S. nearly doubled during the past decade, according to the CDC.

The problem is greatest in the southern states, which also have the highest rates of obesity, which is a major risk factor for Type 2 diabetes. 90% to 95% of all cases in this country are Type 2. Moreover, while about 25 million Americans have diabetes, about 54 million, or one in every four adults, have pre-diabetes. Most people who have diabetes know it, but fewer than one-sixth of those with pre-diabetes are aware of it, according to another recent CDC report.

Source: University of California, Berkeley Wellness Letter, February 2009

Many Cancer Patients Suffer Financial Toll

There was a great article on the front page, no less, of the San Francisco Chronicle yesterday about the financial toll cancer can take on a patient and their family. No kidding.

And some of these patients even have health insurance, good health insurance.

A report released last week by the American Cancer Society and the Kaiser Family Foundation found that even those cancer patients fortunate enough to have health insurance suffered severe challenges paying for their treatments.

Among the challenges the article listed: hefty out-of-pocket expenses, high cost-sharing requirements, caps on benefits and lifetime maximums on some policies. Imagine your health insurance policy telling you that you've been sick enough in your lifetime, and they're not going to pay any more.

In 2008, about 684,850 patients under age 65 were diagnosed with cancer, according to the American Cancer Society. Imagine the challenges they face.

Link on "San Francisco Chronicle" above to see the whole article.

Justice Ginsburg Has Cancer

I heard today that Supreme Court Justice Ruth Bader Ginsburg has pancreatic cancer.

Forgive me, but the first thing I thought of was, "Oh, my God. She's going to die."

Turns out they think they caught it early. The very fact that they operated to remove a small tumor told me that they think she has a good chance of recovery. My father had pancreatic cancer, and, like so many struck by this mostly fatal disease, he died from it a month after discovery. Because they usually find it late.

Here's what the L.A. Times said: "The cancer is one of the most lethal of diseases, but the fact that the Supreme Court justice underwent surgery is encouraging, a doctor says. Supreme Court Justice Ruth Bader Ginsburg underwent surgery for pancreatic cancer today. The court said the cancer, which is one of the most lethal of diseases, was in its early stages."

We wish Justice Ginsburg luck. We know she has the best medical care possible.

Cut Out the Steak

I've decided to do something about my meat intake. It's actually more about bringing in fruits and vegetables than about cutting out meat. But my new plan is to have one day a week where I don't eat any meat, but when I saturate my diet with fruits and veggies.

Several things propel me toward this decision, and here's one of them: the mounting evidence that the intake of meat leads to cancer.

The Duke Medicine newsletter (Feb 2009) tells us "to reduce your risk of renal cell carcinoma (RCC), the most common type of kidney cancer in Americans, decrease your intake of all meat, red meat, poultry and processed meat preserved by salting, smoking or adding nitrates.

"Scientists analyzed 13 case-control studies that examined the association between RCC and meat consumption. Eating all meat (defined as "total meat," or as a nonspecified type of meat) was associated with a 27 percent increased RCC risk, while red meat consumption had a 30 percent higher risk. Poultry and processed meat were also indicted, with a 20 to 22 percent increased greater risk of RCC in those consuming the greatest amount of poultry and processed meats compared to those consuming the least. The study appeared January 22 in Cancer Causes & Control."

1,000 Views!

Touched by Cancer, my health blog, just passed 1,000 views on the counter!

Thanks to all of you who have taken a look!

Should I Take Aspirin?

Nobody ever told me to take aspirin. I mean, none of my health providers ever did, even in spite of all the evidence I've read over the last two decades, about how it seriously prevents heart disease and heart attacks.

I took it by myself, buying it over the counter, for about six months -- this was about 5 years ago -- but stopped because, well, it's one more pill to take. I take enough pills, thank you, without throwing another one in.

But, suddenly, last month my doctor asked me if I was taking it. No, I replied. She said, "You should. And with this new medication I'm prescribing for you, you'll want to. The aspirin reduces the flush effect of the med." The medication is Niaspan, and apparently, a large percentage of users report heavy flushing of the face as a side effect. (As it turns out, I never encountered that side effect even though I'm still taking Niaspan.)

So, thirty minutes before I take the rest of my nighttime pills (including the orange Niaspan tablet), I take the low-level aspirin (81 mg), otherwise known as "baby aspirin."

Parade magazine (parade.com) had an article on "Should Women Take Aspirin" last Sunday (February 1, 2009). "While aspirin seems to be a kind of wonder drug when it comes to reducing the risk of heart attacks in men, it doesn't deliver quite the same protection for women. Low doses do reduce the risk of stroke in healthy women, but a 2006 report in the Journal of the American Medical Association showed the aspirin does not reduce women's risk of heart attack."

The article goes on to say that specific women should take aspirin each day: those over 65 who are healthy, and all women over 45 with cardiovascular disease risk factors.

And the reason is an eye-opener: "Despite the findings on heart attacks, a 2007 study in the Archives of Internal Medicine of women taking aspirin reported a 25% reduction in death from all causes," including a "38% reduction in death from cardiovascular disease." In particular, "women with high-risk factors (such as smoking, being overweight, or having high cholesterol) experienced the greatest effect."

Good enough for me. Add a baby aspirin to my list of nighttime medications.

Recognizing Lymphedema is Vital in Assisting Oncology Patients

From Medscape Medical News 2009 (Jan 21, 2009):

Oncologists who are alert to the signs and symptoms of cancer and cancer-treatment-related lymphedema can have a large impact on its course, because the chronic condition can be minimized if recognized and treated early, according to a review article on lymphedema published in the January/February issue of CA: A Cancer Journal for Clinicians.

However, oncologists are generally too busy to oversee the care of lymphedema themselves, and hence should become familiar with resources that can help connect patients with lymphedema-management specialists, said lead author Brian D. Lawenda, MD, clinical director of radiation oncology at the N aval Medical Center, in San Diego, California.

"We don't have the time to manage the care for lymphedema. Therefore, my colleagues and I recommend that clinicians be aware of referring specialists in their area who are experts in the diagnosis and management of lymphedema," Dr. Lawenda said in an interview with Medscape Oncology.

Dr. Lawenda also noted that oncology patients at risk for lymphedema should receive pretreatment evaluation that includes baseline girth and volume measurements of limbs. He emphasized the importance of prevention education, which includes a discussion of risk factors, and arm and leg care guidelines.

Pretreatment patient evaluation and education are not well utilized by clinicians, suggested Dr. Lawenda.

"Oncology patients are left with a lot of side effects of treatment. We commonly see lymphedema, but unfortunately it does not get a lot of discussion [by oncologists]. As result, it can be a surprise to patients," he said.

The most common causes of lymphedema in the United States are surgery and radiation therapy for the treatment of cancer. The most common etiology is the impaired flow of lymph fluid through the draining lymphatic vessels and lymph nodes, write Dr. Lawenda and his coauthors, Tammy Mondry, DPT, a physical therapist at N ew Horizons Physical Therapy, in San Diego, and an expert on managing the condition, and Peter Johnstone, MD, chair of the Department of Radiation Oncology at the Indiana University School of Medicine, in Indianapolis.

Lymphedema is most commonly reported after breast cancer treatment, but can result from the treatment of cervical, endometrial, vulvar, head and neck, and prostate cancers, and of sarcomas and melanoma. Lack of standardized definitions and measurement techniques for the disorder make an accurate incidence rate of cancer-treatment-related lymphedema difficult to determine, say the authors.

However, the likelihood of lymphedema by cancer type and related treatment has been established.
For instance, with regard to breast cancer, the frequency of breast edema ranges from 6% to 48% when surgery and radiation therapy are combined. The frequencies tend to be at the higher ends of the range when a lymph node dissection and radiation therapy are performed.

Increased body mass index and tumor location in the upper outer quadrant are other factors that have been reported to significantly increase the risk for breast lymphedema. Also, 1 study (Lymphat Res Biol. 2005;3:208-217) found that women older than 60 years had a higher likelihood of lymphedema (41.2%) than women younger than 60 years (30.6%). Approximately 15% of patients with a bra cup size of A or B developed breast edema, whereas approximately 48% of patients with a bra cup size of C, D, or DD presented with edema.

In general, patients tend to be at highest risk for cancer-treatment-related lymphedema when a large number of lymph nodes are removed, radiation and surgery are combined as treatment, or an infection in a limb that has been operated on develops, said Dr. Lawenda.