New insights, treatments, tests in disease 'war'

Medical community is starting to believe less is more when it comes to cancer treatments 

More and more doctors and patients apparently are using less aggressive weapons to fight cancer these days.

Dr. Justin Bekelman

A story by Laurie McKinley in yesterday's Washington Post quotes Dr. Justin Bekelman, a radiation oncologist at the University of Pennsylvania, about the medical community's focus on the "war on cancer."

Historically, he says, that phrase "implied that more is better and decimation is desired."

McKinley's story contends, however, that the idea is "falling out of favor," not only because it "subtly blames patients" who die "but also because it doesn't capture a world of new biological insights, improved treatments and molecular tests that are transforming how cancer is treated."

According to Bekelman, "Knowing when not to treat" can be "great medicine" — because, the story charges, oncologists equipped with new tools and evidence can cut back on toxic and costly approaches likely do more harm than good.

Cancer, nevertheless, is not monolithic, the story indicates.

Rather, some cancers "need to be bludgeoned, but others can be treated with more tailored therapies or simply watched."

Although the latest mindset of "doing less in the face of danger" can be "emotionally difficult" for both patients and physicians, the article notes, proof that less is more has been frequently popping up lately, including a landmark clinical trial published in June that found more than "two-thirds of women with early-stage breast cancer can safely avoid chemotherapy." 

Not to mention the fact, according to the piece, that "men with early-stage, low-risk prostate cancer are rapidly embracing 'active surveillance' over surgery — and avoiding possible complications such as incontinence and sexual dysfunction," and that throat cancer caused by human papilloma virus, because it varies from other types of the disease, allows a cutback "in a brutal treatment regimen and [reduces] the risk of potentially devastating disfigurement."

The Post story also mentions the emergence of immunotherapy, usually less toxic than chemo, "as a first-line treatment for many patients," and cites a recent study showing that "people with advanced kidney cancer can skip surgery to have their kidneys removed and instead go right to drug treatment."

De-escalation isn't happening universally, however. 

McKinley contends that the "most common form of thyroid cancer, which poses little risk, is often still treated with unnecessary surgery, experts say. And some malignancies, such as pancreatic cancer, are so lethal that doctors are racing to find ways to ramp up treatment."

Details on trends and clinical trials in treatment can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

TV star joins disease-awareness initiative

Julia Louis-Dreyfus happily returns to  Emmy-winning 'Veep' role after breast cancer

Instagram selfie with 'Veep' crew.  

TV stalwart Julia Louis-Dreyfus, who'll undoubtedly remember her breast cancer diagnosis and treatments for the rest of her life, is happily back at work at HBO's satirical "Veep."

And she's also involved in her first cancer-awareness initiative.

According to an Associated Press story by Leanne Italie today, the 57-year-old star says it feels "fantastic" to be acting again.

Louis-Dreyfus disclosed her cancer diagnosis last September, shortly after having garnered her sixth consecutive Emmy Award for her Selina Meyer role.

According to the AP, the seventh and last season of "Veep," which will air in the spring, evoked this from the former "Seinfeld" co-star: "I feel good. I feel strong. I've got energy and, yeah, back o my old tricks. It feels like I never left."

Her wading into the cancer-awareness waters, the piece continues, comes through her "helping Carolina Herrera designer Wes Gordon design a flower-adorned T-shirt as part of Saks Fifth Avenue's 20th year raising money through its Key to the Cure program."

Over two decades, the program has donated almost $40 million to cancer research and treatment organizations.

All proceeds from the shirt that will sell for $35 during October, which for decades has served as Cancer Awareness Month, reportedly will go to the AiRS Foundation, which the AP describes as "a nonprofit Louis-Dreyfus supports for its work in helping women with the costs of breast reconstruction after mastectomy."

The shirt features three poppies (in red and pine tones) and a slogan: "We are fighters & we are fighting for a cure."

Noted the actor about the design process, "It was a super-fun endeavor," elaborating that she "wanted it to have a sort of femininity and a powerful message at the same time because I believe the two can go hand in hand. I liked the idea of talking about fighting."

Regarding reconstruction, she'd noted that "up to 70 percent of breast cancer survivors who have had a mastectomy are really unsure or unaware of their reconstruction options, and many of those women who desire to have surgery don't have sufficient insurance or other resources to cover it."

Regarding her participation in the awareness program, she said that while she now was "putting my whole self into Key to the Cure," she'd previously been "very careful about managing my time and conserving my energy. You can't spread yourself too thin."

After going under the knife for breast cancer, Louis-Dreyfus had been perhaps a bit less eloquent and a bit more dramatic. She'd written on Instagram, "Hoorah! Great doctors, great results, feeling happy and ready to rock after surgery. Hey cancer, f**k you!"

More details about both reconstruction and awareness can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Can electric fields tweak genes in immune cells?

Cancer treatment revolution possible via new gene-editing technique, new report says

A new rapid gene-editing method potentially could revolutionize treatments for cancer.

According to a story by Gina Kolata in recent editions of The New York Times, researchers have reported in a new scientific paper that they've found a way to tweak genes in the body's immune cells by using electrical fields.

What could happen, Kolata reports, is that genes could be removed from white blood cells and beneficial replacements inserted — "all in far less time than it normally takes to edit genes."

In addition to cancer, the method apparently could profoundly impact "infections such as HIV and autoimmune conditions like lupus and humanoid arthritis."

The journal Nature first published details of the paper, but "because the technique is so new, no patients have yet been treated with white blood cells engineered with it," the Times story indicates.

Currently, Kolata notes, "scientists attempting to edit the genome often must rely on modified viruses to slice open DNA in a cell and to deliver new genes into the cell. The method is time-consuming and difficult, limiting its use."

Fred Ramsdell, Ph.D.

The use of electrical fields rather than viruses, a process that's vastly speedier, means that "in theory a treatment could be available to patients with almost any type of cancer," her story continues. And the Times writer then quotes Fred Ramsdell, Ph.D. and vice president of research at the Parker Institute for Cancer Immunotherapy in San Francisco, as saying, "I think it's going to be a huge breakthrough."

The institute, she writes, "is working with the authors of the new paper, led by Dr. Alexander Marson, scientific director of biomedicine at the Innovative Genomics Institute — a partnership between University of California, San Francisco and the University of California, Berkeley — to make engineered cells to treat a variety of cancers."

The scientists already are conferring with Food and Drug Administration employees about using the new method to attack both solid and blood cancers.

"Our intent," says Ramsdell, "is to try to apply this as quickly as possible."

Information about other cancer research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Jury in landmark case rules against Monsanto

Court verdict awards man who claims that Roundup caused his terminal cancer $289 million

Monsanto plans to appeal a verdict that awarded $289 million to a dying man who blamed its herbicide Roundup for his cancer.

Attorneys for the 46-year-old former school groundskeeper, Dewayne Johnson, said the decision will bolster thousands of pending cases and open the door for countless people who blame their suffering on the weed killer, according to an Associated Press story by Paul Elias today.

"I'm glad to be here to be able to help in a cause that's way bigger than me," the plaintiff reportedly said about yesterday's verdict. 

The California Superior Court jury in San Francisco unanimously agreed that Johnson's heavy contact with Roundup contributed to his non-Hodgkin's lymphoma and that, the story said, "Monsanto should have provided a label warning of the potential health hazard."

The $289 million was broken down into $39 million in compensatory damages and $250 in punitive damages. Johnson's lawyers had sought a total of $373 million.

Robert F. Kennedy Jr.

Robert F. Kennedy Jr., an attorney for Johnson and the son of the late U.S. senator, declared on Twitter that the punitive damages were for "acting with malice and oppression."

He predicted that the verdict "is going to trigger a cascade of new cases."

An online Common Dreams story quoted Ronnie Cummins, international director of the Organic Consumers Association, an advocacy group and longtime Monsanto critic, to the effect that the verdict proves "there is no confusion" when "ordinary citizens, in this case a jury of 12, hear the facts about Monsanto's products, and the lengths to which this company has gone to buy off scientists, deceive the public and influence government regulatory agencies."

Robert Cummins

And, to twist the knife, he added: "This is a company that has always put profits ahead of public safety…We hope that this is just the first of many defeats for Monsanto, and that the U.S. Environmental Protection Agency will pull this product off the market."

The case was the first filed by a cancer patient against the agribusiness giant to reach trial. It was fast-tracked because of the severity of Johnson's cancer.

Elias' story quoted Brent Wisner, Johnson's lead trial lawyer, as saying that the jury has told Monsanto, a unit of Bayer AG following a $62.5 billion acquisition by the German conglomerate"
"Enough. You did something wrong and now you have to pay…There's 4,000 other cases filed around the United States and there are countless thousands of people out there who are suffering from cancer because Monsanto didn't give them a choice…We now have a way forward."

Monsanto, one of the companies that produced for use by U.S. forces in Vietnam the defoliant Agent Orange, which has been linked to cancer and other diseases, has long denied any link between glyphosate, the active ingredient in Roundup, and cancer.

It has cited hundreds of studies that glyphosate contending is safe.

Scott Partridge, a spokesman for the agribusiness giant, said the corporation will appeal "and vigorously defend this product, which has a 40-year history of safe use and continues to be a vital, effective, and safe tool for farmers and others."

Johnson had used Roundup — and a similar product, Ranger Pro — as a pest control manager at a San Francisco Bay Area school district in Benicia, spraying from a 50-gallon tank attached to a truck. During gusty winds, Wisner said, the product would cover his face — and once, when a hose broke, the weed killer soaked his entire body.

He allegedly had applied Roundup up to 30 times a year.

When Johnson contacted the company after developing a rash, the attorney added, he was never warned it could cause cancer.

His non-Hodgkin's lymphoma was diagnosed in 2014. His landmark case was filed two years later.

George Lombardi, another Monsanto attorney, said that disease takes years to develop, so Johnson's cancer must have started well before he started working at the district, the AP story notes.

"The simple fact is," Wisner told the jury (which deliberated for three days at the end of the eight-week trial) in his opening statement in July, "he is going to die. It's just a matter of time."

His doctors have indicated that that's likely to happen within two years. Whether he dies before the appeal is adjudicated is anyone's guess.

The EPA, which is the past has often favored big business and now is being gutted by the Trump administration, has said glyphosate is safe for folks using it in accordance with label directions. But the French-based International Agency for Research on Cancer, part of the World Health Organization, classified it in 2015 as a "probable human carcinogen" — and California added it to its list of chemicals known to cause cancer.

More details on disease risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPresss book I, Woody Weingarten, aimed at male caregivers.

Appeal expected on ruling on breakfast foods

Los Angeles court says industry doesn't need to put cancer warning labels on cereals 

There's a cereal war going on these days.

Between advocates of breakfast foods such as Grape-Nut flakes and Cheerios that contain whole grains and researchers who insist those cereals contain a chemical — acrylamide — that's a potential cause of cancer.

The latest shot in the skirmish, according to a story by Bob Egelko in the San Francisco Chronicle, came when a California court ruled recently that the breakfast cereals don't need cancer warnings.

The 3-0 ruling by the Second District Court of Appeal in Los Angeles said the cereals, produced by Post, General Mills and Kellogg, needn't heed Proposition 65, a right-to-know law state voters passed in 1986 that "requires businesses to notify the public when their products, or any substances they release into the environment, contain ingredients that have been shown to cause cancer or birth defects" because such labels might discourage consumers from buying healthy food.

A huge win for the cereal industry, the decision was based on 2003 and 2006 letters from the U.S. Food and Drug Administration to state health officials claiming that warning labels "would mislead consumers and lead to health detriments."

Requiring warnings on all foods containing the chemical at levels that pose any risk of cancer, the court indicated, might harm the value of "peanut butter, rye and whole wheat bread, sunflower seeds, and prune juice," according to the Chronicle piece.

Justice Chaney

Another story, by Eric Schroeder on the Food Business News website, reports that Associate Justice Victoria Gerrard Chaney had said no Prop. 65 warning "should be placed on foods, including breakfast cereals, unless and until the science supports such a warning."

The court decision observed "that when the state sought to require Prop 65 warnings on canned tuna because it may contain harmful levels of mercury, an appeals court said California law was preempted because federal health officials were already advising consumers of tuna's benefits and possible risks."

The state Supreme Court, Egelko's story continued, "followed officials' directions in 2004 by refusing to allow Prop. 65 warnings on anti-smoking patches containing nicotine, which can cause fetal damage."

An appeal of the court ruling — in which a dismissal of a suit by Richard Sowinski, a retired Walnut Creek physician who'd sought to require Prop. 65 warnings on 59 cereals — was expected.

The ruling, not incidentally, means the court has rejected arguments that Prop. 65 warnings would encourage the companies to make safer cereals.

Federal agencies have listed acrylamide as a carcinogen, and it was placed on the Prop. 65 list in 1990.

In 2002, researchers learned the chemical was "a byproduct of baking, roasting or frying carbohydrate-rich foods such as potato chips and French fries — both of which now carry Prop. 65 warning labels — and cereals," the Chronicle story stated.

Acrylamide has also been the recent focus of whether warning labels are necessary on coffee packaging.

Details on other cancer risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Health agency overrules Superior Court judge

California agency is seeking to nullify court ruling about cancer warnings on coffee packaging

Despite a court decision to the contrary, California officials have basically said coffee won't cause cancer.

That unprecedented action by the state's Office of Environmental Health Hazard Assessment last month was taken after "a review of more than 1,000 studies published…by the World Health Organization that found inadequate evidence that coffee causes cancer," according to a story by Brian Melley of the Associated Press.

The agency's mandate, implementing a law passed by voters in 1986, includes requiring warnings of chemicals known to cause cancer and birth defects. The Safe Drinking Water and Toxic Enforcement Act, better known as Proposition 65, has so far resulted in cautionary labels for about 900 chemicals.

The controversial chemical in coffee, the AP story notes, is acrylamide, "a byproduct of coffee roasting and brewing present in every cup of joe."

Judge Elihu Berle

Melley's article reports that Judge Elihu Berle had ruled, in an eight-year-old lawsuit in Los Angeles Superior Court, that warnings were required on all coffee packaging sold in the state because "Starbucks and other coffee roasters and retailers had failed to show that benefits from drinking coffee outweighed any cancer risks." 

A proposed regulation by the OEHHA "would state that drinking coffee does not pose a significant cancer risk," the agency reportedly said in a statement.

"Attorney Raphael Metzger, who won the court case on behalf of The Council for Education and Research on Toxics, said he was shocked the agency would move to nullify the court decision and undermine its own report more than a decade ago that drinking even small amounts of coffee resulted in a significant cancer risk," added the AP story. "The takeaway is that the state is proposing a rule contrary to its own scientific conclusion. That's unprecedented and bad. The whole thing stinks to high hell."

More information about cancer risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

400 lawsuits filed against Monsanto's herbicide

Is Monsanto's Roundup weed killer carcinogenic? Contentious trial underway in San Francisco  

The first court trial to determine if Roundup weed killer is likely to cause cancer is underway in San Francisco.

According to an Associated Press story by Sudhin Thanawala , the contentious trial — with a school groundskeeper dying of the disease as the plaintiff and agribusiness giant Monsanto, the hericide's manufacturer, as defendant — is expected to last about a month.

Dewayne Johnson, plaintiff

The plaintiff, Dewayne Johnson, who was diagnosed in 2014 at age 42, claims Roundup caused his non-Hodgkin's lymphoma after he sprayed it from a 50-gallon tank attached to a truck as a school district pest control manager. 

The AP quoted the opening statement of Johnson's attorney, Brent Wisner, to the effect that "when the wind was gusty, it would cover his face. When a hose broke once, it soaked his entire body."

The attorney showed jurors photographs of lesions on the body of the plaintiff, who had also sprayed with a similar product, Ranger Pro. 

Wisner alleged that between the diagnosis "and now, it's just nothing but pain."

Monsanto's lawyer, George Lombardi, countered by saying that "non-Hodgkin's lymphoma takes years to develop, so Johnson's cancer started well before he began working at the school district."

Thanawala's story notes that "many government regulators have rejected a link between the active ingredient in Roundup — glyphosate — and cancer. Monsanto has vehemently denied such a connection, saying hundreds of studies have established that glyphosate is safe."

While the plaintiff "is seeking unspecified damages against Monsanto [and] the outcome of Johnson's case will not affect the hundreds of other lawsuits in state and federal courts...it may serve as an indicator of how the others might go."

Earlier this week, a San Francisco U.S. District judge, Vince Chhabria, ruled that although evidence seems weak that Roundup causes cancer, experts still could make that claim at trial.

The main claim of the lawsuits by cancer victims and their families is that Monsanto long knew about Roundup's cancer risk but failed to warn them.

Chhabria is handling more than 400 of those suits.

The AP article indicates that Monsanto developed glyphosate in the '70s and that the weed killer is sold in more than 160 countries. "Farmers in California, the most agriculturally productive state in the U.S., use it on more than 200 types of crops. Homeowners use it on their lawns and gardens."

In 2015, the France-based International Agency for Research on Cancer, part of the World Health Organization, classified the herbicide as a "probable human carcinogen." California later added it to its list of chemicals known to cause cancer.

But the U.S. Environmental Protection Agency, according to the AP, "says glyphosate is safe for humans when used in accordance with label directions."

And in February, the story continues, a federal judge in Sacramento blocked California from required that Roundup carry a warning label, saying it would be "misleading because almost all regulators have concluded that there is no evidence glyphosate is carcinogenic."

In Johnson's case, according to an online story by Helen Christopher of Courthouse News Service, San Francisco County Superior Court Judge Suzanne Ramos Bolanos sided with Monsanto yesterday by disallowing testimony of an cancer-risk expert. The ruling came on a technicality after the corporation's lawyers accused the plaintiff's legal team of trying to sneak into evidence information about the amount of exposure Johnson experienced.

Much more information about cancer causes can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Is 'co-testing' for disease on the way out?

HPV tests may replace Pap smears regarding cervical cancer changes, study suggests

Pap smears may be on the way out, replaced by a test for HPV, when it comes to detecting cancerous cervical changes.

At least that's what a new decade-long study involving some 19,000 women suggests might happen (because the Human PapillomaVirus test apparently is more sensitive and more accurate).

The study, published yesterday in the Journal of the American Medical Association, was reported in a Laurie McKinley story in The Washington Post.

Dr. Gina Ogilvie

Dr. Gina Ogilvie, a professor at the University of British Columbia in Vancouver and lead author of the study, has cited a particular benefit — the research showing "women who received HPV testing have more reassurance with a negative test and can likely get screened less frequently."

Mark Schiffman of the National Cancer Institute, an HPV researcher himself, confirmed "that it's important to move from the Pap smear to the HPV test alone," according to the Post article. 

He also reportedly maintains that the Pap smear, which he calls "crude and inaccurate," worked only because women were tested often and because cervical cancer grows slowly.

HPV, the Post piece says, "is the most common sexually transmitted infection and is usually eliminated by the immune system. But when an infection persists, it can cause cellular changes that develop into precancerous lesions and eventual malignancies."

McGinley's story notes that "about 13,240 new cases of invasive cervical cancer will be diagnosed in the United States in 2018, according to the American Cancer Society. About 42,000 women will die of the disease."

In recent years, the article continues, "most medical groups have recommended that women in the United States get both the HPV test and the Pap smear — a practice called 'co-testing.'"

Now, however, many experts are saying the Pap smear should be dropped. That position is still challenged by others who claim "that the Pap smear can catch a small number of cases of abnormal cells that might be missed by the HPV test."

The conventional Pap smear has already been replaced to a large degree by liquid-based Pap cytology tests.

The Post piece contends that "most medical groups," including the American Cancer Society and the American College of Obstetricians and Gynecologists, urge "that women of average risk get both HPV tests and Pap smears every five years between age 30 and 65, though they say a Pap test alone every three years is an acceptable alternative."

McGinley's story also notes that "about 80 million people in the United States are infected with HPV [although] most never develop any health problems because most infections go away by themselves, according to the Centers for Disease Control and Prevention."

Doctors have long urged children and young adults be vaccinated against HPV with a shot approved in 2006 by the Food and Drug Administration.

More details about cancer research can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.