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5/1/03: A new way of understanding cancer?
I was intrigued by a wee article in U.S.A. Today about a month back (I forgot to note the date). It says that by scientific meandering (doodling) doctors may have discovered a new way to look at how cancer is caused—and can potentially be cured. The info comes from Richard Stone, the clinical director of the adult acute leukemia project at the Dana Farber Cancer Institute in Boston, as reported in the New England Journal of Medicine.
The article was exceptionally complex and involved a blood disorder (hypereosinophilic syndrome, abbreviated as HES) that appeared to respond to Gleevec, which was developed for an altogether different condition, chronic myelogenous leukemia (CMI). Since the account was anecdotal, a treatment study was begun at Dana Farber while D. Gary Gilliland and Jan Cools “led efforts at Brigham and Women’s Hospital to determine what causes HES at the cellular level and why Gleevec might work.” (It was indeed effective in nine of 11 HES cases, effective meaning a positive response lasting more than three months.)
The article describes the results better than I can: “Gilliland discovered that HES arises when a piece of genetic code in bone marrow stem cells, which are the raw material for making all types of blood cells, is deleted between genes. The deletion causes a new abnormal gene, with a different set of instructions, to form. (This is analogous to deleting words in this sentence from what is left. If you delete ‘analogous’ through ‘from,’ the new sentence reads ‘This is … what is left,’ which has a different meaning.)
“The abnormal gene creates a new genetic code that instructs cells to make a substance called tyrosine kinase, which triggers the overproduction of eosinophil cells and results in HES.
“CML arises when a specific chromosome breaks and attaches to another one, forming a new gene. The new gene instructs cells to make tyrosine kinase, resulting in the overproduction of granulocytes.
Gleevec was developed to shut off abnormal tyrosine kinase signaling in CML. The study shows that it also inactivates tyrosine kinase signals triggered by other underlying genetic causes.”
What’s new? “Cancer researchers can now look for processes similar to the one that causes HES, raising the possibility that those diseases will also respond to Gleevec.”
My medical friends tell me that that is big stuff and could have huge
7/01/02: Aspirin and lung cancer risk.
At our age lung cancer, like breast cancer, is a major concern. So it’s
good news to see that a New York University School of Medicine study of
14,000 women reveals that while smoking was the biggest factor in developing
the disease, women who took aspirin regularly had less than half the normal
risk of suffering from the most common form of lung cancer. The study in
the current British Journal of Cancer says that aspirin is also
proven to relieve headaches and help prevent heart attacks and strokes.
7/01/02: Finally, breast cancer not linked to birth-control pills.
For years there has been the niggling fear (and several confirming smaller studies) that the 80% of women born after 1945 who took oral contraceptives were increasing their breast-cancer risk. So the federal government sponsored a major new study involving 9,257 women to again study the link. The results are conclusive and good news.
There is no link whether the women took birth-control pills as teenagers or adults, the pills were high or low in estrogen, they were taken for months or years, the taker was white or black, or even if there was a family history of breast cancer.
“Every which way you look at it … there’s no risk” of breast cancer associated with birth-control pills, according to Kathy Helzlsouer, an epidemiologist at Johns Hopkins University who co-wrote the commentary accompanying the findings in the June 27, 2002 New England Journal of Medicine.
Alas, taking the pills isn’t totally neutral regarding women’s health. Oral contraceptives reduce the risk of ovarian and endometrial cancer and may increase the risk of cervical cancer. They also increase the risk of blood clots in the legs and lungs, strokes, and liver cancer, although such events are rare. In women over 35 who smoke, they also increase the risk of heart attacks.
6/15/01: Cancer less a problem in the future...
If we're looking at a 30-year window for life planning, it's almost certain that cancer will no longer be the health scourge in the future that it is now. The brightest prospect is that cancer may even be curable and/or totally treatable within our lifetime. The most optimistic seems to be Dr. Michael Gordon, a cancer specialist at the University of Arizona, who says: "Cancer treatment has always been a satisfying profession. But now it's truly exciting. I've been wondering to myself where I will be in 20 to 25 years, and I'm thinking that I might just be out of a job. And that will be great."
The newest "miracle cures," like Gleevec so prominent in the news these days, have brought a lot of press attention to the "state of the art" in cancer. The best (easiest to grasp yet complete) article I've seen was in the May 28, 2001, issue of Time Magazine.
Let me summarize what I'm reading to help understand it from a second life planning perspective.
If you have cancer now, there is more hope of its being curable or treatable (and thus long-term livable, like diabetes or high blood pressure) than ever before. Of course, the earlier it was or is detected, the better the chance that it can be reversed or held in check. Details in a minute.
And there's no longer any reason to scoff at future planning because "whatever I do I'll get cancer like my Uncle Freddy and be dead in six miserable months." You are less likely to "get" cancer but, should you, it probably won't be fatal (and may be totally cured), you should live far longer even if it's just controlled, and advances in other aspects of medicine have almost always reduced or eliminated the anguish and pain.
The most important advice still hasn't changed:
* Prevent it from occurring at all
stop smoking* Get a regular checkup
stay out of the sun or use sufficient sun blocker
avoid cancer-causing chemicals
Simply act as an agent to stop any cancer from getting a foothold. Then if it does, don't panic or hide: there are too many good things being developed that can give you a full second life...
Thirty years back President Nixon began the concerted effort to "cure cancer." The path has been strewn with false starts, but today a rush of new approaches has oncologists and others in the cancer field full of hope. The back side is that treatments are very expensive so the cost factor must also become as much a part of the "war" as the new processes.
The number of new cases and deaths has steadily dropped since 1992, though a few less common cancers are increasing, like adult leukemia, melanoma, liver cancer.
Most cancers are still treated through surgery, radiation, or chemotherapy. The future will see less invasive means. Dr. Mendelsohn hits it on the nose: "The dream is that if Mrs. Smith gets a breast biopsy, we'll be able to say, 'Here are the four genes that are abnormal in her tumor,' pull out a drawer, pick out the antibodies or small molecules designed against the abnormal products of those genes, and give her a cocktail targeting the genes that caused her cancer."
There are six approaches being taken today that give rise to such hope.
Most attention seems to be directed at (1) attacking the cancer cell itself, usually through microdesigned drugs. Some of those drugs work on the individual cancer cells: inhibitors that limit their growth, make them self-destruct, or block enzymes needed for the development. In this category are the monoclonal antibodies designed to block pathways needed for the cancer's development and growth and the antiangiogenesis drugs that stop the tumors from building their own blood supplies.
Other approaches (2) recruit the body's own immune system to reject the cancer; (3) seek and destroy renegade tissue; (4) detect the cancer even earlier to increase the chances of controlling it, like the PSA test; (5) prevent cancer from developing at all, with drugs like the COX-2 inhibitor, and (6) encourage people who have been afraid of cancer to now come forth with the increased hope that they may not only survive, they will enjoy longer, less restricted lives.
Most of the advances come from a greater understanding of two elements: cancer itself and the body, through DNA decoding and subsequent, related research.
Short of living in a world without pestilence and pain, things are getting better every year where cancer is concerned. The BIG "C" is becoming a little "c," and may eventually become a pesky inconvenience like canker sores, the croup, and corns. If we don't see that, our kids probably will.
Alas, for specific information should you have or suspect cancer, see your physician promptly.
10/15/01: Good news about the fear of breast cancer!
Almost half of the women in America think their risk of developing breast cancer is 30-50%, while two-thirds think the risk is greater than 20%, according to the American Cancer Society. In fact, a woman’s lifetime risk is about 11%. (Which, of course, is about 11% too high.)
Women also mistakenly believe that the risk is greatest from 30-49. The risk actually increases with age.
The most important thing one can do to reduce its severity? Regular
self-examinations, and a check by the doctor at periodic health exams.