Google Science Fair 2012 Winners

I remember participating in science fairs when I was a kid. In fact, now that I have the opportunity to interview high school students who are applying to MIT, I hear about all types of science fair projects.

In case you didn't know, Google also has a science fair and this year the winning project was an impressive project titled, "Global Neural Network Cloud Service for Breast Cancer" by 17-yr-old Brittany Wenger. Global Neural Network Cloud Service for Breast Cancer successfully detects 99.11% of malignant breast tumors. You can learn more about this fascinating project here.

The winner in the 13-14 age group was Jonah Kohn who had a project called, "Good Vibrations: Improving the Music Experience for People with Hearing Loss Using Multi-Frequency Tactile Sound." You can learn about his project here.

It's certainly encouraging to see these young innovators applying their creativity to health care issues. We're living in a very exciting era where we'll bound to see a wide range of truly innovative discoveries in the world of health care!

9th Annual The Best of San Antonio Breast Cancer

If you're near Chicago, don't miss this complimentary CME event this Saturday!

9th Annual The Best of San Antonio Breast Cancer

Saturday Feb 4, 2012
Chicago, IL

Program Director:

Kathy S. Albain, MD, FACP
Professor of Medicine
Division of Hematology/Oncology
Loyola University Chicago Stritch School of Medicine
Director, Breast Clinical Research Program
Director, Thoracic Oncology Program
Cardinal Bernardin Cancer Center
Loyola University Medical Center
Maywood, IL

This educational program is directed toward medical, surgical, and radiation oncologists interested in the treatment of patients with breast cancer. Fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other health care professionals interested in the treatment of breast cancer are also invited to attend.

More information here.

3-D mammography (Selenia Dimensions System)

Last week, the FDA approved the first 3-D mammography system called the Selenia Dimensions System by Hologic Inc.

The Selenia Dimensions System, an upgrade to Hologic’s existing FDA-approved 2-D system, can provide 2-D and 3-D X-ray images of the breasts. The 3-D images may help physicians more accurately detect and diagnose breast cancer.

“Physicians can now access this unique and innovative 3-D technology that could significantly enhance existing diagnosis and treatment approaches,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health.

Now, the combination of the Selenia’s 2-D and 3-D images doubled the radiation dose the patient received. However, it also improved the accuracy with which radiologists detected cancers.

TSA security and medical privacy - where do we draw the line?

Two recent stories related to the new TSA security procedures have been on my mind recently. First, the story of Tom Sawyer, a 61-year-old retired special education teacher. He is a bladder cancer survivor who wears a urostomy to catch his urine. During a routine "pat-down," the TSA agent broke the seal of the urostomy, covering Sawyer in urine. "I was just so embarrassed, so humiliated," Sawyer also told The Detroit Free Press. The head of the TSA John Pistole apologized to Sawyer and Sawyer has graciously accepted the apology.

Now, what if that wasn't a urostomy bag? What if it was a colostomy bag instead? I'm sure everyone on the flight would have appreciated that.

Then, there's the story of Cathy Bossi, a flight attendant who has a removable breast prosthesis because she's a breast cancer survivor. During her screening, this is what happened:

She says two female Charlotte T.S.A. agents took her to a private room and began what she calls an aggressive pat down. She says they stopped when they got around to feeling her right breast… the one where she'd had surgery."She put her full hand on my breast and said, 'What is this?'. And I said, 'It's my prosthesis because I've had breast cancer.' And she said, 'Well, you'll need to show me that'." Bossi was asked to show her prosthetic breast, sticking her hand down her own shirt and removing the prosthesis from her bra.

Will we continue to hear more crazy stories from travelers who have a history of cancer?

Then there's the story of Amy Ascher Linde, an Atlanta mother and businesswoman who was born without a left hand and has worn a prosthetic since she was 11. For her to remove her prosthetic hand, she'd have to remove a significant amount of clothing.

Finally, there's the question of TSA agents patting down kids. Although some kids may not mind the pat down, others may have a history of sexual abuse and these types of pat-downs by strangers could trigger significant emotional trauma. I'm not sure what constitutes an "aggressive" pat-down vs. a regular pat down.

FDA approves Halaven (eribulin mesylate) for the treatment of metastatic breast cancer

The U.S. Food and Drug Administration today approved Halaven (eribulin mesylate) to treat patients with metastatic breast cancer who have received at least two prior chemotherapy regimens for late-stage disease.

Halaven is a synthetic form of a chemotherapeutically active compound derived from the sea sponge Halichondria okadai. This injectable therapy is a microtubule inhibitor, believed to work by inhibiting cancer cell growth. Before receiving Halaven, patients should have received prior anthracycline- and taxane-based chemotherapy for early or late-stage breast cancer.

Halaven is marketed by Woodcliff Lakes, N.J. -based Eisai Inc.

Read more on the FDA website.

Increasing confusion about mammograms

Everyone is getting confused about mammogram guidelines. The U.S. Preventive Services Task Force (USPSTF) recently came out with new guidelines and these cancer screening recommendations are quite different from those published by the American Cancer Society (ACS). Now, the Senate is dealing with amendments of amendments. What do I mean by that? There was an amendment by Mikulski. Then, there was one by Vitter. Then the Murkowski amendment got rejected (I'm not sure if all this chronology is correct, but I think you get the picture). Soon, we won't remember what the original amendment said.

So what's with all these amendments? One key question is: how will insurance plans (including a possible public option) pay for screening mammograms? Who will need to pay a copay? What is the appropriate age to start breast cancer screening? 40? 50? How often should women get a mammogram?

I've heard some people argue that the USPSTF came up with these revised guidelines to reduce the number of mammograms the government would need to cover under the proposed public option. Does this make sense? Well, if the government can find a way to reduce health care costs, it would be to eliminate expensive tests. A mammogram isn't super expensive, but if you could stop all those women who are ages 40-49 from getting a mammogram, you would save a huge amount of money.

Are screening guidelines published to save costs or save lives? Where do you draw the line to declare that a screening test is indeed "cost effective?" How is that term even defined? At this point, I think that most of us have more questions than answers.

Wait until 50 for mammograms

We seem to make cancer screening recommendations only to realize that we are wrong. Breast self-exams are not beneficial so we should not be telling out patients to do them. Mammograms should start at age 50, not 40. False positive results end up leading to further unnecessary tests, biopsies, etc. However, what about those few people who get diagnosed with breast cancer early? At what point is screening "cost-effective?" That's a critical question since screening tests cost money.

So, who do we follow? The U.S. Preventive Services Task Force (USPSTF) or the American Cancer Society (ACS)? Who's right? Could they both be right?

As these issues are debated, patients and health care professionals will be left confused. Without the presence of a clear consistent message, people will be left to interpret things for themselves and we will end up with chaos.

Were these U.S. Marines poisoned?

Breast cancer doesn't occur in men very frequently, but when you have a group of 20 U.S. Marines who develop breast cancer after being stationed at Camp Lejeune, North Carolina, you have to wonder if there might be some common association. You have to read this story on CNN titled, "Poisoned patriots? Stricken Marines seek help with illnesses."

One really sad part about this story is that these Marines are not able to receive breast cancer care through the VA system. Why? According to the story:

the men are denied treatment by the Department of Veterans Affairs, which says it can't treat them for a condition that hasn't been shown to have been "service-related."

Now, there's a website called The Few, The Proud, The Forgotten (http://www.tftptf.com) where you can learn more about this story.

Another potential way to reduce breast cancer risk: breast feeding

"Breast-feeding may protect at-risk women from breast cancer"

CNN STORY HIGHLIGHTS:

• Study: Nursing cut the risk of breast cancer in half for high-risk women
• Researchers followed 60,075 women for more than nine years
• Breast-feeding's effect was similar to taking tamoxifen for five years
• Breast-feeding didn't affect risk for women who didn't have breast cancer in family

We all probably know someone who has been affected by breast cancer. Fortunately, treatment is quite effective if the cancer is diagnosed and treated.

This new research sounds quite promising, but we probably still don't have enough evidence to make any claims about causality. We know that there is an association, but that's about it because this was a prospective cohort study. I don't think we're ever going to see any randomized controlled trials evaluating this clinical question, so this may be the best type of evidence we get.

Click here for the story on CNN.
Click here for the abstract from the Archives of Internal Medicine.

Does Lantus (insulin glargine) increase the risk of breast cancer?

We've seen some troubling information emerge in the world about diabetes. We now have controversy regarding the saftey of Lantus (insulin glargine). With the heading, "Lantus insulin: a possible link with cancer which requires further investigation," we see a press release from Diabetologia titled, "Possible link between insulin glargine and cancer prompts urgent call for more research." The next line says: "But experts stress patients should not stop using insulin and consult their doctor if concerned."

The press release starts with: "The European Association for the Study of Diabetes (EASD) today makes an urgent call for more research into a possible link between use of insulin glargine (an insulin analogue, brand name Lantus) and increased risk of cancer, following evidence from studies in Germany, Sweden and Scotland. However, until this further research becomes available, these experts are stressing that patients with diabetes taking Lantus should continue to do so, although some might wish to consider alternative types of insulin. The studies are reported in Diabetologia (the journal of EASD)."

What were the findings? "Professor Edwin Gale, Editor of Diabetologia, and Professor Ulf Smith, President of EASD, realised the significance of these findings but wanted them replicated in other studies from other European countries before announcing them formally. Studies were thus carried out using databases from Sweden, Scotland, and the UK.

• The Swedish study found that compared with patients on insulins other than Lantus insulin, patients on lantus insulin alone had double the risk of breast cancer.
  
• The Scottish study found a non-significant increased risk for breast cancer specifically.
  
• The UK study found no link between insulin glargine and cancer."

Yet these studies have some significant limitations:

• Although the data were adjusted for a number of variables, the characteristics of the groups of patients taking lantus insulin alone (generally older, higher blood pressure, more overweight) were different to those on other forms of insulin. Thus any difference in cancer risk could be attributed to the pre-treatment characteristics of the groups, rather than the treatment itself.
• The numbers of cases of breast cancer in the Swedish and Scottish studies were very small, meaning the findings could have occurred due to chance.

So, how does that make you feel? Maybe if you're Swedish or Scottish, you may feel concerned. If you're British, you may feel relieved. Sounds silly, doesn't it? When we have conflicting data, the topic becomes a controversy. We have no causal data. We have no consensus statements. We have no definitive stances from major diabetes associations. What does the American Diabetes Association (ADA) have to say about this? We don't know yet. Hence, we now have a controversial topic on our hands. The investigators recognize that this is a controversy and they stress (once again) "that patients should not stop using insulin and consult their doctor if concerned."

The EASD released a statement, which reads: "These studies are described and commented on in greater detail in the webcast by Professor Ulf Smith (University of Göteborg, Sweden), and Professor Edwin Gale (University of Bristol, UK). EASD emphasises that the studies reported are far from conclusive, but they do indicate the need for further investigation of this issue..."

To read the full press release on Diabetologia, click here.

New cancer drug has few side effects

There's an interesting article in the New England Journal of Medicine (NEJM) that talks about a novel new cancer agent called olaparib. In a phase 1 study, this drug was found to have few adverse effects (compared to conventional chemo) and displays antitumor activity in certain tumors. Here's the brief conclusion: Olaparib has few of the adverse effects of conventional chemotherapy, inhibits PARP, and has antitumor activity in cancer associated with the BRCA1 or BRCA2 mutation.

Technology Review has a nice article on this titled, "New Drug Kills Cancer with Few Side Effects." Sounds simple, doesn't it?

Compare that to the NEJM title: "Inhibition of Poly(ADP-Ribose) Polymerase in Tumors from BRCA Mutation Carriers." Did you catch all that? What's PARP?

Did you learn about PARP in medical school? The inhibition of poly(adenosine diphosphate [ADP]–ribose) polymerase (PARP) is a potential therapeutic strategy for the treatment of cancers with specific DNA-repair defects, including those arising in carriers of a BRCA1 or BRCA2 mutation. Olaparib (AZD2281) is an orally acting PARP inhibitor.

As cancer therapy becomes more tailored in our evolving world of personalized medicine, it's exciting to see all this research that combines molecular biology, genomics, and targeted therapies. Advances in medical technology and drug development are leading to innovative treatments in the world of oncology.

Olaparib (AZD2281), previously known as KU-0059436, began to be manufactured by AstraZeneca after the company acquired KuDOS Pharmaceuticals.

Breastlight and Breast Self-Exams

Medgadget has a story on a fancy flashlight-type medical device called the Breastlight. It shines a light through breast tissue so that you can almost see inside your breasts and look for suspicious areas that might suggest breast cancer. This device is produced by PWB Health Ltd out of Dumbarton, UK, and was developed by Highland Innovation Centre (Inverness , UK). Looks like a very interesting product, but I wonder if it will do more harm than good. What do I mean by that? Well, let's consider what's happening in the world of breast self-exams (BSEs). Are BSEs even recommended these days? Let's see:

• The 3rd US Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to recommend for or against BSEs. That's very helpful.
  
• In 2003, the American Cancer Society (ACS) changed its previous recommendation in favor of monthly BSE to a recommendation that women be educated about the benefits and limitations of BSE by their healthcare provider. Once again, that's very decisive, isn't it?
  
• The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers routinely teach patients about BSE.

So, we should all teach patients about BSE, but should we be telling them that it's helpful or that it's harmful because it may lead to false positives and more invasive tests? Do BSEs really reduce mortality caused by breast cancer? What about other countries doing?

• The Canadian Task Force on Preventive Health Care concluded that "there is fair evidence to recommend that routine teaching of BSE be excluded from the periodic health examination of women aged 40 to 49 (grade D recommendation)" because of excessive work-ups for false-positive examinations and lack of firm evidence that BSEs decrease breast cancer mortality. Now, we finally have someone taking a stand instead of straddling the fence!
  

• The Advisory Committee on Cancer Prevention in the European Union states that there is "no convincing evidence for the effect of screening based on breast self-examination or clinical breast examination."
  

So where does this leave us on BSE? How will this new Breastlight impact breast cancer screening? I don't suggest that you share this device with hypochondriacs. To read the full article, click here. Image source: Medgadget

Last Day of ASCO 2009

Today is the last day of the 45th Annual American Society of Clinical Oncology® (ASCO) meeting in Florida. Some exciting clinical findings have emerged on breast cancer, prostate cancer, lung cancer, HER2+ gastric cancer (yes, this is not a typo. I mean gastric cancer and not breast cancer), and many other malignancies. It's also exciting to see advances in drug therapy, new agents, pipeline drugs, and novel deliver formulations (such as the application of nanotechnology, pegylation, etc.).

As we discover more advances in medical science and technology, I hope we find a cure for cancer someday. Perhaps when we're all old and gray, we'll tell our children and grandchildren about the "old days" of using chemotherapy and radiation therapy (of course, finding a cure for cancer may put some people out of work).

Is Breast Cancer a Different Disease in Young Women?

We often think of breast cancer as primarily being a disease that affects older individuals. However, there are many cases of young, healthy women developing breast cancer and most of them have positive genetic markers to genes like BRCA1 and BRCA2. These genes are currently implicated in the majority of inherited breast (and even ovarian) cancers.

When breast cancer hits a really young woman (say in her early 30's), is it an entirely different disease? This seems to be an area that causes confusion in the oncology community. In a recent CME-certified activity titled, "Breast Cancer in Women Under 40," Jeffrey Peppercorn, MD, MPH discusses this issue. He remarks how breast cancer in women under 40 are more likely to be:

• estrogen receptor-negative (or ER negative)
  
• higher grade
• HER2-positive

Plus, he indicates that "young African-American women are more likely to have triple-negative breast cancer (estrogen receptor–negative, progesterone receptor–negative, and HER2-negative)."

Advances in medical science are helping us understand the disease process of cancer as researchers explore different treatment options including chemotherapy, hormone therapy, radiation, and other modalities. With all these advances in medicine and technology, will we ever find a cure for breast cancer?

Speaking of breast cancer, one topic I don't think anyone really understands is the spontaneous regression of tumors (when tumors disappear by themselves). It's very rare, but it does occur. Miracle healings! One minute you're told you have a tumor, the next minute it's gone! Do modern day miracles still happen? I believe they do. Scientists have postulated various mechanisms by which tumors may disappear by themselves. One researcher lists these possible explanations: "immune mediation, tumor inhibition by growth factors and/or cytokines, induction of differentiation, hormonal mediation, elimination of a carcinogen, tumor necrosis and/or angiogenesis inhibition, psychologic factors, apoptosis and epigenetic mechanisms." The list doesn't include supernatural healings, but psychologic factors? I'm not so sure about that.

If we can gain a better understanding of why certain tumors may disappear by themselves, then this information may someday lead to a cure for cancer. I'd like to see more research on the topic of spontaneous regression.

Chemotherapy in Older Women with Early Breast Cancer

There aren't that many clinical studies that include older women with early breast cancer. Plus, older women are more likely to be treated with lower doses of chemotherapy than younger women. So, it becomes difficult to know how they should be treated if they present with early breast cancer.

Fortunately, the NEJM has an interesting article about the use of "Adjuvant Chemotherapy in Older Women with Early-Stage Breast Cancer." Here's the conclusion: Standard adjuvant chemotherapy is superior to capecitabine in patients with early-stage breast cancer who are 65 years of age or older. In this study, standard chemotherapy was either cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide plus doxorubicin. Capecitabine is marketed by Roche under the trade name Xeloda.

So what does all this mean? Here are some of the highlights from the discussion section of the article:

The authors note that "the choice of chemotherapeutic agents, dose, schedule, and dose modification should be based on the treatment plans in published reports." There are significant toxicities associated with certain chemotherapy agents and many older patients are unable to tolerate such regimens.

The authors also write that "patients in this trial had an excellent performance status and no major organ dysfunction. The toxicity of these regimens in vulnerable or frail patients is probably greater than the toxicity observed in the patients in this study, and they should be administered with caution or not at all in such patients."

The ACLU Sues Over Patents on Cancer Genes

CNN: "Patents on two human genes linked to breast and ovarian cancers are being challenged in court by the American Civil Liberties Union (ACLU), which argues that patenting pure genes is unconstitutional and hinders research for a cancer cure." According to the ACLU, "Myriad's patents give it exclusive right to perform diagnostic tests on the genes -- forcing other researchers to request permission from the company before they can take a look at BRCA1 and BRCA2."

What do you think about this?

Scientists are identifying more cancer genes all the time. We already know that several forms of breast and ovarian cancers are linked to specific genes (like BRCA1 and BRCA2) that can be detected through special genetic tests. Oncologists and geneticists often struggle with the ethical dilemmas that frequently complicate genetic testing. Image source: CNN