#sciencesunday -“little gods with your little inaccurate machines…”

You may have read a headline or two in recent years in regards to whether mammograms actually save lives or do more harm than good as they often lead to overdiagnosis. I touched on this just last week (item #3).

One of the problems is breast cancer doesn’t always present in a nicely diagnosable way. Some cancers grow rapidly, presenting and doubling in size between routine screenings (hi, that would be mine).

Some breast cancers present as a rash, which can turn out to be Inflammatory Breast Cancer, a rare and very aggressive type.

10-15% of breast cancers are Lobular. This type is much harder to see on a mammogram. In addition, it tends to form a thickening instead of a discernible lump. When this “journey” (gag) began, I was convinced to act immediately because of a blog I found of a 29-year old who was diagnosed Stage IV from the start due to misdiagnosis – and she had lobular breast cancer.

Lobular actually tends to be very responsive to hormonal therapy and has a slightly better prognosis than the much more common ductal in the early stages. But many cases are misdiagnosed until they are more advanced. My roomie from the MBC conference two years ago has lobular and was misdiagnosed for FOUR years despite getting screened at a high-risk clinic.

Over the weekend, I received a copy of a letter from my cousin that was written by my Grandma de Fiebre to her doctor back in the 1980s. Her story strongly mirrors the story of my blogger friend mentioned above. Grandma’s cancer as far as we know, never metastasized, although she was in pretty bad shape when she died 15 years later, both because of Parkinson’s and because of the long-term effects of the cancer treatment. The shameful thing to me is that in the 30 years that transpired between Grandma’s diagnosis and my blogger friend’s, there have been far too little awareness among medical professionals as to how different breast cancers present.

Am I saying don’t get mammograms? Of course not! It’s the best we have and they probably save some lives, if not the majority. But we should also be pushing for better screening AND better treatment for those who screening fails for. We should stop putting all our faith in one screening tool. And we should be stopping the blame game of those whose cancers are not detected early.

Grandma’s letter. She was a cancer badass. I clearly got it from her.

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#sciencesunday – World Cancer Day

It is World Cancer Day and bit by bit I’m going to rip into this overly simplistic, happy rah-rah article about why we are winning the war on cancer. Yes, we are making progress, but its not coming nearly fast enough, the drug development process and mired in bureaucracy and cancer is just really fricking hard to cure.

So here I go…my comments in italics.

1. We know the main risk factors

Everyday, doctors and scientists around the world are discovering more about the human body and the diseases that affect it. For example, we now know that there are certain lifestyle choices that can increase our risks of developing cancer. While genes also play a significant role, not smoking, leading an active lifestyle and eating a well-balanced diet have all been found to decrease our risks of developing the disease.

The decrease in lifestyle-related cancers is best reflected in the case of lung cancer, where deaths rates fell 23% in the past 20 years, mostly due to less people smoking. But these are US stats. Lung cancer is a growing problem and cause of mortality in Asia. Also troubling is the growing incidence in lung cancer among young adults who have never smoked. We have not been able to explain that fully yet.

Although there’s lots of talk about whether toxins/hormones/plastics/diet/booze/weight/etc cause breast cancer, there is still no overarching proven cause. In addition, there may be different risk factors among pre and post menopausal women. For example, some studies have shown being overweight as a risk factor for post-menopausal breast cancer but not for premenopausal.

2. Survival rates are improving

Cancer survival rates have been improving steadily for about 30 years, albeit unevenly among different forms of cancer. In the UK, for example, cancer survival rates have doubled since the 70s, largely because of wider access to screening tests, new treatments, and better awareness of a range of health risks such as smoking and obesity.

Early-stage survival rates are improving. That is partly because of better treatments such as targeted therapy and immunotherapy. But overdiagnosis also plays a role, especially in breast and prostate cancers.

However, metastatic cancers are mainly still averaging survival rates in the years, months or even weeks. Death rates from advanced lung and breast cancer have not changed meaningfully in decades.

And while targeted and hormonal therapies have changed the landscape of breast cancer treatment, a lot of the standby chemo drugs, which are the only option for some, are the same drugs that were used 30 years ago. (I have wondered if Grandma de Fiebre was treated with the same chemo back in 1984 that I was treated with during my initial treatment.)

3. It’s being caught early

Some examples of screening tests include widespread breast screening for women, catching breast cancer in its early stages. Cancer Research UK states that 78% of those who experience breast cancer survive for 10 or more years after treatment, and the overall survival rates for the disease has doubled in the past forty years. Colonoscopies have a dual-benefit of also identifying early-stage colorectal cancer and even avoiding cancer altogether by identifying pre-cancerous growths called polyps.

The mantra of “early detection saves lives” in regards to breast cancer is a major annoyance of mine. I would never tell someone to not get mammograms, but I will say that it is well-documented to have major limitations. For one, they don’t help men or those under 40 who are not being screened. They have limited effectiveness in women in their 40s who tend to have denser breasts and more aggressive tumors. A type of breast cancer, lobular, is much more difficult than other types to be seen on a mammogram. And aggressive cancers can pop up and spread between mammograms. I can’t count the number of times I’ve heard “three months after a clean mammogram, I found a huge lump…”

And if someone is a lucky one with grade 1 or 2, Stage 1, or even 0, node negative cancer? It can still come back. The risks are less but still present. And the patients have to live with that albatross around their neck for the rest of their lives.

4. It’s being prevented

Preventive measures include the HPV vaccine, which has been revolutionary for cervical cancer, and even proper food preparation, which has been shown to remove bacteria that can increase the likelihood of stomach cancer. As mentioned above, increased awareness is also encouraging people to lead healthier lifestyles – a major factor when it comes to lowering cancer risk.

Look, I am all for the HPV vaccine. I did a presentation on it in college and then got it myself. I also am a big fan of colonoscopies because thanks to them, an aunt of mine had precancerous polyps removed before they became cancerous (however that only works if you are of colonoscopy age, ie 50 or older).

But as I pointed out above, there’s lots of cancers we don’t know the direct causes for and therefore we don’t know how to prevent. And while not smoking, limiting drinking, maintaining a healthy body weight, eating veggies and exercising are good health habits in general, plenty of people do everything right get cancer. And how do you explain childhood cancers where the patients aren’t even old enough to have developed bad habits?

5. New treatments are being developed all the time

There are over 200 forms of cancer, and each patient has different circumstances, so treatments methods are always tailored to a patient’s individual needs. The most common cancer treatments are surgery, chemotherapy, and radiotherapy. And these well-known methods are now joined by newer treatments like immunotherapy and targeted therapies.

As scientists continue to make progress against cancer, side effects from treatments become more manageable. And when a patient doesn’t react positively to one course of treatment treatment, there are now many other treatment options available for patients to keep cancer at bay.

OK, I’m really psyched about precision medicine, as you know if you’ve been reading my previous blogs. But it still has quite a way to go. Meanwhile, I watch friends go through 10-15 treatment options and have them all fail. And what about the cancers that don’t even have that many treatment options? What about rare cancers? What about P53 mutated cancer (that would be mine). What about Glioblastomas?

I have high hopes for a number of things in development in cancerland. I think positive changes are coming. What is more uncertain – will these changes come in time to help me?