As I write this, I am returning from a trip to Los Angeles where I participated yesterday in a panel discussion on the topic of cancer prevention and early detection. The occasion was the 2012 Global Conference sponsored by the Milken Institute. (If you are not familiar with this conference, it is probably one of the premier finance and investing conferences in the country, if not the world. And the luminaries in attendance--both as attendees and speakers--were a testament to the influence of the Institute and its founder, Michael Milken.)

I was on this panel through an invitation from the Melanoma Research Alliance and its chief executive, Wendy Selig, a former colleague of mine when she was at the American Cancer Society Cancer Action Network.  Other participants included Dr. Stephen Gruber, who is the recently appointed director for the USC Norris Comprehensive Cancer Center in Los Angeles, Dr. Sancy Leachman who is the director of melanoma and cutaneous oncology at the Huntsman Cancer Institute in Salt Lake City, and Sherry Lansing who is the CEO of a foundation of the same name and a well-known cancer research advocate (she is very well known in the entertainment industry as the former head of Paramount Pictures and one of the people who conceived of Stand Up To Cancer which has done much to transform the landscape of cancer research in this country).

What made this event more interesting was that the audience was made up of those same financial and investing folks I mentioned above. As you might imagine, almost all the sessions were devoted to topics very relevant to their professional interests. The topic of the session I participated in was a bit off the usual target of the meeting. This session was not about investing--it was about health. I must admit that I was surprised at the number of attendees who joined us for our discussion, and even more pleasantly surprised that they remained engaged throughout our 90 minutes.

In what would have otherwise been a fairly typical recitation of facts about how cancer prevention and early detection can reduce the burden and suffering from cancer, a theme emerged: we as professionals are not doing our best in clarifying our advice about the prevention and early detection of cancer through cancer screening.

When you are sitting in a room with some very intelligent people realizing that our lack of clarity and conflicting recommendations on advising people what they need to do about their health, you begin to understand that we are facing a dilemma that could have a significant impact on how successful we are going to be in getting people to take action to reduce the risk of cancer or finding it early. More...

Lessons in life rarely come at us with lights flashing and horns blaring. Such was the situation recently when I was attending a luncheon in Portland OR for some of our Strides Against Breast Cancer volunteers.

He was not a flashy gentleman. Most of the attendees were young women, and the conversation was very animated. He was more reserved. Older, gray hair with a worn baseball cap, jeans and a work shirt. A bit taciturn but  pleasant, and he had made a special effort to be there. Clearly he was in some personal discomfort and I realized that he needed to talk.

Without going into all of the details, his wife had died from breast cancer. Obviously, they had been partners for life and her loss was painful. In a sense, he appeared to have dealt with that as well as one can "deal" after the loss of someone sorely loved. As I have said for many years, the sad reality is that when we love we always know that sometime in that love there will be intense loss, and that the loss is never the end of the journey.

We talked a bit and the messages arrived. There were lessons he wanted me to hear, and they weren't entirely positive. More...

I have a confession to make:

As soon as I finished reading the Annual Report to the Nation yesterday as I was preparing to write my blog, I got up from my desk and took a walk for 20 minutes.

What, might you ask, compelled me to do this?

The answer is what made me take a walk is the same reason I am writing this follow-up commentary to yesterday's blog: Sitting at my desk all day may kill me. It may be doing the same for you. More...

The "Annual Report to the Nation on the Status of Cancer" was released this afternoon as has been the case every year since the first report was issued in 1998. And, like many of the reports previously, we are fortunate to continue to see declines in the rates of deaths for many cancers along with a decrease in the frequency of some cancers.

However, the news is not all good.

Unfortunately, the incidence of some cancers continues to increase. And, as explained very clearly in this excellent report, this nation continues to suffer from an epidemic of overweight, obesity and physical activity that the authors suggest-but don't actually say-has the potential to overcome the favorable impact of declining smoking and tobacco use on cancer incidence and deaths. The implication is clear that if we don't do something-and do something quickly-to reverse the trend we will see incidence and deaths from certain cancers continue to increase in the future.

And I would stress the point that it is no longer just being oversized that increases your risk of cancer, but also sitting all day on the job (like I am doing right now) as another factor that plays into your cancer risk, independent of how large or small you may be. More...

Sometimes science is not as convenient as we would like it to be. We want answers, we want clarity, we want direction--especially when it comes to the treatment of patients with cancer.

So when I read two articles and an editorial released Wednesday in the New England Journal of Medicine, I was struck as to how studies seeking to answer similar questions could come to different conclusions. And, as I struggled to explain the research findings to reporters prior to their release to the general public, I found myself searching for words that would adequately explain the message of the research. Quite frankly, determining that message proved to be difficult. More...

Welcome to the New Year!

And as has been the case for many years in the past, the American Cancer Society takes the New Year opportunity of providing the nation with the latest estimates of cancer incidence and deaths, along with a measure of how well we are doing in reducing the burden of cancer in the United States.

The data is contained in two reports released today by the Society: the consumer oriented Cancer Facts and Figures 2012 and the more scientifically directed Cancer Statistics 2012. Both are available online. 

It is never "good news" to realize that the burden of cancer in this country is immense. And with the country gaining in population and age, the extent of that burden is inevitably going to increase. But this year's report does contain some welcome information, namely that cancer death rates have declined in men and women of every racial/ethnic group over the past 10 years, with the sole (and unfortunate) exception of American Indians/Alaska Natives. In addition, the Society now estimates that a bit more than one million cancer deaths (1,024,400 to be exact) have been avoided since 1991-1992.

That one million number is actually more significant than it seems. Many of the people in that 1 million never heard the words "you have cancer." Maybe they had a colon polyp removed before it became cancerous, maybe they stopped-or never started-smoking. Maybe they had a pap smear that found a pre-cancerous lesion. And then there are the patients who have benefitted from the advances in cancer treatment that have occurred over the past number of decades.

But the 1 million number also means that these are people who have hopefully remained active and engaged in life, loved by their families, productive in their communities. In economic terms, the return on investment on avoiding those one million deaths may likely be incalculable. In human terms, it is an amazing accomplishment. More...

The announcement today from Canada that women should severely curtail their use of screening mammograms for the early detection of breast cancer and discontinue regular clinical examinations and self-breast examinations was interesting in and of its own. But the editorial that accompanied that announcement-from a long-time avowed skeptic of the benefits of screening mammograms-took the debate to a new level. Whether that level was higher or lower is a matter of personal interpretation, but in the editorial was the statement that abandoning breast cancer screening is the most effective way we have to reduce the risks of breast cancer. The statement, highlighted in an accompanying press release (http://www.eurekalert.org/pub_releases/2011-11/cmaj-nbc111611.php) was, in short a stunner.

What is even more amazing is that there hasn't been much reaction to that statement. And keep in mind that just two days earlier, the medical journal The Lancet published a letter from an international  group of experts in breast cancer screening who raised the issue of an organized anti-mammography campaign orchestrated in part by the head of the Nordic Cochrane Centre, headed by none other than the physician who wrote the editorial. But from where I sit-a place that is usually the epicenter of these discussions-there has in fact been very little reaction. No media, no frantic calls, no running to man the barricades. Essentially, nothing.

I find that hard to understand for a story with this degree of impact. Maybe we are all just worn out from the screening debates, after several years of indecision about the benefits of mammograms, the frequency of pap tests, and the big debate recently about whether or not prostate cancer screening really saves lives.

For me and others I know, there is increasing concern that the value of screening for the prevention and early detection of cancer will get lost in the morass of conflicting comments, and that we might be at risk of turning off the public to the benefits of screening for cancer, and perhaps lives will be lost in the process. And that would be shameful. More...

Today the Commissioner of the Food and Drug Administration, Dr. Margaret Hamburg, announced that the FDA is withdrawing approval of Avastin® (bevacizumab) for the treatment of metastatic breast cancer.

This announcement culminates a highly watched process where the FDA determined that although it had granted accelerated approval for the use of this drug in treating breast cancer, subsequent studies did not demonstrate in any group of women that Avastin® actually helped patients in any meaningful way, while causing significant harms-including death.

In the accelerated approval process, the FDA permits a company to market a drug for a specific indication, usually in a life threatening disease, while allowing the company to perform additional trials to confirm the value of the drug. After those trials are done, under this form of approval, the FDA reserves the right to revoke that approval if the original promise of the drug is not confirmed. That is what has happened with Avastin® in breast cancer.

As difficult as this decision has been for the FDA, it is even more difficult for women (and their loved ones and their doctors) who believe that Avastin® has saved their lives. The Commissioner emphasized that she was acutely aware of that concern in making her determination, but she underlined the fact that when the science was carefully reviewed, there was no evidence of meaningful benefit of Avastin® in breast cancer treatment.

The full impact of this decision is difficult to determine at this time. More...

Please, please, please say it's so...

That was my initial reaction today when I saw news stories about a study presented at a breast cancer conference sponsored by a number of leading organizations with a professional interest in the diagnosis and treatment of breast cancer.

The headlines were pretty clear, to the effect that the study showed the value of screening mammography in women between the ages of 40-49. The accompanying stories suggested that this research essentially repudiated the recommendations of the United States Preventive Services Task Force initially published in November 2009.

You may remember that event, since it created a huge amount of media and public interest when the Task Force suggested that screening mammograms to find breast cancer early should not be done routinely in women between the ages of 40 and 49. This was a change from its prior recommendation, and was in conflict with the opinions of the American Cancer Society and other organizations which conitinued to endorse routine breast cancer screening in this age group.

There has been a lot of water under the dam since then, and there have been additional scientific studies reported about the value of screening mammograms, some of which support breast cancer screening and others which do not.

Enter the reports this week that a study from Michigan suggests that screening mammograms and breast self-examination in women between the ages of 40 and 49 results in earlier diagnosis and less disfiguring treatment.

When I read the headlines and the news reports, I quickly came to the conclusion that there was a possible disconnect between what the reporters concluded from the study and what I thought was scientifically valid.  Mind you, I read these things with my own bias/conflict of interest: I have been a supporter of mammograms for women between the ages of 40-49, and believe they save lives in this age group. But my problem here is whether this particular research actually supports that position, as the press reports suggested.

Guess what? I don't think it does. More...

The votes are in, and the Food and Drug Administration's Advisory Committee said unanimously that the approval of Avastin (bevacizumab) for the treatment of metastatic breast cancer should be withdrawn.

The decision did not go down quietly, with women loudly voicing their disagreement, and one saying that this shouldn't be happening in the United States of America. I could not sit there and hear the cries without feeling their pain and anguish. More...