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...

One of the things I enjoy about what I get to do every day--besides working for a wonderful organization, committed volunteers and very special colleagues--is that I am able to get a broad overview of the world of cancer research, diagnosis and treatment, among other topics. Over time, one gets to incorporate that input into a larger vision of where we have been, where we are and where we are headed.

Sometimes that "larger vision" is challenged with new information that makes you think a bit about whether you need to readjust your thinking about the state of cancer research and treatment. Recently I attended a meeting where just such a challenge occurred.

The meeting was convened by the Institute of Medicine, and brought together stakeholders to be informed and discuss the current status of genomics and drug discovery in cancer. To a more specific point, it provided insights from a variety of viewpoints on the current status of genomics as a science and how that science and knowledge will be translated to the care of patients, with the obvious goal of reducing the burden and suffering from cancer.

What I heard--while reinforcing some of my usually optimistic thoughts--actually was troubling. As we look to the future of that translation, it was clear (at least to some of the presenters) we are headed for some speed bumps. How we handle those speed bumps could define the progress we make in cancer treatment over the next decade or even longer. More...

Sometimes you have the opportunity to be educated, or to learn a bit more about a topic of importance. Yesterday was one of those opportunities.

Attending a meeting (as an observer) of the National Cancer Institute Director's Consumer Liaison Group on the issue of cancer drug shortages, there were some messages delivered that provided a bit more clarity surrounding a very complex problem. And there were messages delivered that had even me sit up and take notice, and frame the seriousness and depth of the problems that confront patients, their families and those who treat them. The observations were--to say the least--very unsettling. More...

Does it get much worse than this?

A story in the New York Times last week highlights the dwindling supply of the drug methotrexate, which is vital in the treatment of a form of childhood acute leukemia. The closure in November of a key manufacturing plant-without other readily available sources of the drug-means that children with a very treatable form of leukemia may go without a drug that can make a difference in their lives. And there are no immediately obvious solutions to the problem.

This is-unfortunately-only the latest chapter in a saga that has been unfolding over the past year. For a variety of reasons, the supplies of vital drugs necessary to treat cancer and other diseases have been in various periods of short supply, and we as a nation have been unable to find answers that make sense.

Maybe, just maybe, it's time to take the actions necessary to deal with the problem. Too many lives are at stake to expect otherwise. 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...

As you know, my posts to the blog have been missing in action for the past several weeks. Nothing bad or wrong, mind you. Just lots of travel, lots of meetings, lectures and getting to know some very wonderful people across the country.

So I am sitting here on a Sunday afternoon, trying to catch up on emails while attending yet another meeting (yes, on a Sunday. Maybe it's time to get a life). And I came across the message below about our Hope Lodge in Manhattan which celebrated its fourth anniversary this past week. And when you think about it, it is a very special story: More...

To screen or not to screen for prostate cancer, that is the question. Or is it?

A report from the venerable United States Preventive Services Task Force (USPSTF) made it to the media yesterday--a bit ahead of schedule--and it not only says we aren't certain whether a man should get a PSA test to find prostate cancer early, it came flat out and said, effectively, "Don't do it!"

Now that is a recommendation that is going to create a good deal of discussion, I would think. More...

There are few times in life when one gets to watch history being made. Today is one of those times.

I am in New York with a number of colleagues from the American Cancer Society and other committed organizations to observe a UN High Level Meeting which will--at long last--put non-communicable diseases on the international agenda. The impact of the decisions made here over the next two days can indeed change the face of global health forever. More...