Monthly Archives: November 2009

Misplaced Outrage – The New Breast Cancer Screening Guidelines

Outraged breast cancer survivors were heard loud and clear this past week – they weren’t happy with the new breast cancer screening guidelines.  But why the outrage against guidelines based on evidence and science?  Because of deeply held beliefs that have been rigorously promoted and marketed for financial gain. You can’t get out of the grocery store in October without hearing the message – early detection saves lives.

The truth is all breast cancers are not the same, and we don’t have the tools to detect the lethal ones early enough.  Some breast cancers are slow-growing and won’t be lethal, whether found small or large.  Others are aggressive, and fast-growing, and lay the groundwork for metastasis, or spread to other parts of the body, before any of our methods can detect these cancers.

A woman who found a cancer in her 40s by a mammogram can’t know if it saved her life.  She could have found it a year later while getting dressed, and if her cancer is responsive to treatment, would have had the same prognosis.  Or, she could have had a slow-growing tumor that would never have been life threatening.  Or, stray tumor cells may be lying dormant to reappear in five or ten years and still be life threatening.  We can’t know the truth about breast cancer and the effectiveness of screening and treatments by relying on stories and beliefs.  The only way to get to truth is to follow the evidence, the large, randomized, clinical trials of hundreds of thousands of women.

That’s what the Task Force did.  They systematically reviewed all relevant, clinical trials on mammography and breast self exam. After a thorough review of clinical trials and statistical models on risks vs. benefits, they concluded:

To recommend against screening mammography in women aged 40-49

To recommend  every other year screening for women aged 50 to 74

To recommend against teaching breast self examination.

The new guidelines really aren’t so shocking.  The American College of Physicians made similar recommendations a few years ago.  An NIH consensus panel came to similar conclusions in the 90s, but politicians got involved and the consensus panel was overruled by the Senate.  The National Breast Cancer Coalition has been saying for over ten years that we don’t have good evidence to support broad public health policy on breast cancer screening.  NBCC has always said that women deserve the facts, and should have the freedom to make their own decisions regarding screening.

So why the outrage at a panel of prevention experts?  Why not outrage at all those institutions that promoted a simple but false message for financial gain?  Why not outrage that we could have made more progress over the last twenty years if we hadn’t accepted faulty screening as our answer to this disease?  Why not outrage that 40,000 women keep dying of this disease every year?

Maybe, just maybe, this firestorm over the new guidelines will expose the deeply ingrained falsehoods about breast cancer and screening, and allow us to move forward and push for the screening and diagnostic tools that will work, and finally make some progress in eradicating this disease.

Change and progress are often messy and painful, but if we get where we need to go in the end, it will all be well worth it.

To learn more about the guidelines and the science behind them, read NBCC’s analysis.

Progress Means Following the Science

There is so much to say about the new US Preventive Services Task Force Recommendations on breast cancer screening that I hardly know where to begin.  And I know you all will have things to say too and I look forward to your comments.  It may take us several days to get through all of the issues.  But I encourage everyone to stop, take a deep breath, and really look at what the Task Force has to say, and then let’s think about what is best for women.

I want to start by saying there can be no advancement in curing disease without paying attention to the science.  What we wish may be true is one thing, but looking at the evidence and acting on it has always been what brings progress in curing disease.

We have to face the fact that 40,000 women keep dying each year from breast cancer, despite the current screening practices.  We need to figure out what will really have an impact and make a difference – better screening, better treatments, better prevention – but we need to acknowledge that we just haven’t figured it out yet.

Back when mammography was first introduced, everybody assumed breast cancers were all the same.  And that they grew in a linear course, first growing large, then spreading to the lymph nodes, then on to the rest of the body.  Finding it “early” would mean it could be prevented from spreading and taking a life.  We now know differently.  There are several kinds of breast cancers.  Some are slow growing and non-threatening, whether they are found small or large.  Others are so aggressive and threatening, it doesn’t matter how small they are when you find them.  We don’t have the tools to find these aggressive cancers early enough.  We don’t know what makes these tumors lay the groundwork for metastsis or spread of the cancer, or how to stop it.

We need progress.  We need much more research.  And accepting the current screening methods as acceptable and even good, when the scientific evidence shows that they are not  is preventing us from getting that progress we need.

Tomorrow I will look at the new recommendations and discuss the scientific basis for the changes.

 

Still Blogging (and more!) for Change

Some of you may have wondered where I disappeared to this week – where was I when everyone else was talking about breast cancer and screening in newspapers, on radio, on networks, cable shows and even Larry King Live!  Well, I was talking too.  And talking.  And talking.  Just not blogging.  I didn’t have a spare moment to blog.

In some fateful, strange twist of timing, I began working for the National Breast Cancer Coalition as Research Manager on Tuesday, just hours after the new breast cancer screening recommendations were released.  The release caused an immediate media firestorm.  Rather than filling out paperwork and finding the bathroom on my first day of work, I spent the day on the phone doing live radio shows, filming local TV spots in front of the building, and rushing between studios for national TV appearances.  Whew!  And that was just the first day!  The issue didn’t go away during the week but rather seemed to gain momentum.  I finished the week with an appearance on MSNBC’s Dr. Nancy Snyderman Show.

I like blogging much much better than TV and radio shows.  I like being able to control my own words and keep them IN context.  But I do love my new job.  My passion for eradicating breast cancer and my understanding that we can’t do it without following the science made the National Breast Cancer Coalition a natural fit for me.  They’ve been pushing for the right research for years to fulfill their mission of eradicating breast cancer.  I plan on continuing to blog from my new position with NBCC.  But I’m thrilled to have the opportunity to have influence and bring the change we need through more than just blogging.   Stay tuned.  Tomorrow I will blog about the new screening recommendations and address some of the misinformation out there.   And look for daily updates from the San Antonio Breast Cancer Symposium – the largest national meeting on breast cancer research – in just a few weeks.

Let Me Have My Genes Back!

brca_trialMyriad Genetics owns the rights to some of my DNA – the BRCA 1and 2 genes.  The genes associated with hereditary breast and ovarian cancer.  By owning the patent on these genes, the company not only has a monopoly on the test for the mutations, which costs about $3000, but also has the right to prevent anyone else from studying, testing, or even looking at the BRCA genes.

And this isn’t the only part of my DNA “owned” by industry or academic centers – apparently 20% of our DNA has already been patented.  This is absurd.  Scientific progress should not be sacrificed so a few people can make a buck.  And those at risk of medical disease should not be at the mercy of monopolized prices for the medical tests they need.

Fortunately, the patenting of the BRCA genes, and of genes in general, is being challenged in the court system.

A federal district court ruled last week that patients and scientists can challenge patents on human genes in court, allowing a lawsuit challenging patents on BRCA 1 and 2 to go forward.

The lawsuit was originally filed in May by the American Civil Liberties Union (ACLU) and the Public Patent Foundation (PUBPAT).  They say that the patents are illegal and restrict both scientific research and patients’ access to medical care.  They also assert that patents on human genes violate the First Amendment and patent law because genes are “products of nature.”

The defendants, the U.S. Patent and Trademark Office, Myriad Genetics, and The University of Utah Research Foundation, had asked the court to dismiss the case but the November 2 ruling by the U.S. District Court for the Southern District of New York will allow the case to go forward.

Association for Molecular Pathology, et al. v. U.S. Patent and Trademark Office, et al., was filed on behalf of 20 breast cancer and women’s health groups, individual women, geneticists and scientific associations representing approximately 150,000 researchers, pathologists and laboratory professionals.  Several major organizations, including the American Medical Association (AMA), the March of Dimes and the American Society for Human Genetics (ASHG), filed friend-of-the-court briefs in support of the lawsuit.

“We hope this challenge is the beginning of the end to patents on genes, which limit scientific research, learning and the free flow of information,” said Chris Hansen, a staff attorney with the ACLU First Amendment Working Group. “No one should be able to patent a part of the human body.”

An ACLU video on the case:

I doubt I have this mutation.  Though I was diagnosed with breast cancer before 50, I don’t have any relatives with breast or ovarian cancer.   But I’ll be rooting for the plaintiffs in this case so that those who are at risk can have a fair price for the test, can get a second opinion if they want, and researchers will be free to study the genes and perhaps find ways to interrupt the family history of breast cancer in these families.

Lab-on-a-Chip

lab-on-chip

Our methods for detection and treatment of breast cancer still seem so crude.  We can’t really detect breast cancer until it’s been around for several years, and for treatment we remove body parts and give harsh treatments like chemotherapy and radiation.  Then cross our fingers and wait.  And to top it off, our methods of detection and treatment can lead to more cancer!

We need to do better.  It’s time for cancer detection, monitoring, and treatment to enter the 21st century.  But there is hope.  Knowledge from different disciplines, such as physics, chemistry, and computer technology, are meeting up with medicine and biology to create new advances.  One such advancing technology that may mean progress for breast cancer is the Lab-on-a-Chip.

Researchers in Toronto have developed a palm-sized lab-on-a-chip that can measure small amounts of estrogen in blood and tissue.  Estrogen levels of breast tissue have not been routinely measured because doing so with conventional methods required large amounts of tissue.  But the new device, using technology called microfluidics, can analyze the estrogen in samples that are 1000 times smaller than those needed for conventional methods.  Enough breast tissue can be obtained with a small needle prick.

Knowing the levels of estrogen in the breast could be an early indicator of breast cancer risk or of early breast cancer.  Being able to measure levels of estrogen could also provide a sophisticated method for assessing prevention or a method for monitoring of anti-estrogen treatment in breast cancer patients.

The device is in early development and might not be ready for “prime-time” for at least five years, according to Dr. Aaron Wheeler, the research chair of bioanalytical chemistry at the University of Toronto and a co-author of a report on the device published in the debut issue of Science Translational Medicine.  Dr. Wheeler and his colleagues reported using the device to accurately analyze tissue from two postmenopausal breast cancer patients.

Even though it is early, we may be on the verge of an explosion in knowledge and advancements with this technology.  Lab-on-a-chip technology is being developed for many areas of cancer detection and monitoring.  These devices perform different functions on minute droplets of fluid and cells on the surface of a microchip.  Many different lab functions are integrated together onto the chip and results can be ready in a few minutes.

For example, researchers at Johns Hopkins are looking at a chip to measure cancer cells’ ability to “detach” and migrate or metastasize.  Other researchers at the University of California Berkeley are using the technology to carry the vast new knowledge on genetics and cancer to the next level with study of the proteins involved (proteomics).

Let’s hope these advances get translated from benchside to bedside and help bring cancer detection and monitoring into the 21st century.