Dramatic jump expected in HPV-linked cancers

Prediction: Big increase seen in human papillomavirus-related throat cancers for males

The number of middle-aged men who'll get HPV-related cancer is expected to experience a big jump in the near future.

HPV is human papillomavirus, the same virus that causes cervical cancer in women.

Dr. Maura Gillison

According to a recent story by Peter Jared in the AARP Bulletin, otherwise healthy men in their 40s, 50s and 60s "are showing up with a form of throat cancer that targets the tonsils and the back of the tongue, an area called the oropharynx."

Each year, the article notes, "oropharyngeal carcinomas are diagnosed in more than 15,000 men and women in the U.S. [but] public health experts warn that the number of cases in men over age 50 will rise dramatically in the coming years."

Men with the cancers already outnumber women by a 4 to 1 ratio, the Bulletin reports.

Dr. Maura Gillison, Ohio State University Comprehensive Cancer Center oncologist, was one of the first researchers to determine HPV was the cause of some throat cancers. In 2007 she found, according to the story, "that those with head and neck cancer were 12 times more likely to be infected wth HPV in their mouths and throats than healthy individuals."

The story goes on to say that "shockingly, HPV-positive oropharyngeal cancer is projected to overtake cervical cancer by 2020."

Details on medical and research trends and projections 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.

Debate rages on life following breast cancer

More women choosing to 'go flat,' skip reconstructive surgery after mastectomies

Many more women are now opting to forego reconstructive surgery after having their breasts removed.

Even though insurance would pay for the operation.

Even though reconstruction long has been the standard, with more than 60 percent of eligible women choosing it (106,000 of the procedures were done last year). 

And even though, according to an article by Roni Caryn Rabin in The New York Times last week, most "plastic surgeons and oncologists aggressively promote breast reconstruction as a way for women to 'feel whole again.'" 

"Going flat" certainly has become a more publicized choice.

Why? 

Dr. Deanna J. Attai

The Times article quotes Dr. Deanna J. Attai, a past president of the American Society of Breast Surgeons (ASPS), to the effect that "Reconstruction is not a simple process. Some women just feel like it's too much: It's too involved, there are too many steps, it's too long a process." 

The "nascent movements to 'go flat' after mastectomies," the piece continues, "challenges long-held assumptions about femininity and what it means to recover after breast cancer" — and flies in the face of the fact that "women's health advocates fought for and won approval of the Women's Health and Cancer Rights Act of 1998, which requires health plans to cover prosthetics and reconstructive procedures."

Rabin's story contends that "up to one-third of women who undergo reconstruction experience complications."

And that "a systemic review of 28 studies found that women who went without reconstruction fared no worse, and sometimes did better, in terms of body image, quality of life and sexual outcomes."

According to the article, Dr. Clara Lee, an associate prof of plastic surgery at Ohio State University who performs the procedure, says "the dirty little secret of breast construction" is that the "risk of a major complication is higher than for the average elective surgery."

In contrast, Dr. David H. Song, chief of plastic surgery at the University of Chicago and the immediate past president of the ASPS, is quoted as saying that focusing on the risk of complications is like focusing on plane crashes when millions of flights land safely.

Both pros and cons of reconstructive surgery are touched upon in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Are younger men shunning intercourse?

Men's oral cancer risk leaps 61 percent in four years — because of a shift in sexual habits

The risk of oral cancer in men has jumped dramatically.

Insurance claims from "a database of more than 21 billion privately billed medical and dental claims" show the reasons, according to an article this week by Ariana Eunjung Cha in The Washington Post.

With one of the main causes being "the cascading effect of human papillomavirus (HPV) in the United States."

The American Cancer Society has estimated some 50,000 Americans will be infected this year, with 9,500 dying from the disease.

The Post story, citing a report published by FAIR Health, disclosed that the increase in oral cancer from 2011 to 2015 was a startling 61 percent.

With the biggest increases coming in throat and tongue cancers.

During the period studied, those cancers were three times as prevalent in men as women, the Post piece noted.

In the past, oral cancer was linked mainly to smoking, alcohol use or a combination.

Now, the Post article maintained, changing sexual habits are a problem, with surveys showing "younger men are more likely to perform oral sex than their older counterparts and have a tendency to engage with more partners."

Dr. Gypsyamber D'Souza

According to Gypsyamber D'Souza, PhD., an associate professor in the Viral Oncology and Cancer Prevention and Control Program at the Johns Hopkins Bloomberg School of Public Health quoted by the Post, "These differences in sexual behavior…explain…why the rate of this cancer is increasing."

The Centers for Disease Control and Prevention earlier this month recommended preteens 11 or 12 get vaccinated against HPV, noting that more teenagers and young adults "are engaging in oral sex than vaginal intercourse under the assumption that it's safer."

It's not, of course, unless only the possibility of pregnancy is being considered.

Information about disease prevention 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.

Clinical trial on lymphoma is suspended

Cancer researcher's work put into question by his failure to file timely report on deaths

It's no secret that new research can frequently contradict old — even when the latter has only been public for a few days or weeks.

But now comes a new wrinkle: Researchers may be invalidating their work by failing to file appropriate reports.

Or, at best, bringing their tests into question.

Case in point: An early-stage clinical trial sponsored by the National Cancer Institute on an experimental drug, ibrutinib, that involved lymphoma of the central nervous system, a blood cancer that to date had no effective treatment and was often deadly.

According to a story this week by Laurie McGinley in The Washington Post, the lead researcher failed to tell authorities in a timely manner that "two patients had died of fungal infections that might have been caused by the experimental treatment."

That failure, which led to the researcher being suspended "until he undergoes additional training," meant the trial was suspended — despite what McGinley's story called its "impressive results" in which eight of the 18 patients enrolled in the study "continue to be in complete remission, including six whose disease had not responded to previous treatment — a situation that usually causes death within a matter of months."

Dr. Francis Collins

The reporting lapses were reported by Dr. Francis Collins, National Institutes of Health director; Dr. Doug Lowe, NCI director; and other officials.

The study, which was begun in 2013, centered on ibrutinib being used in conjunction "with a cocktail of chemotherapy medications. In addition, steroids were used to reduce swelling in the patients' brains."

The principal investigator, Kieron Dunleavy, had reported concerns — after the second fatality — and "ordered CT scans in other patients in the trial to try to catch fungal infections early, before they became deadly," but he allegedly delayed filing "an official 'unanticipated problem' report" for months.

That kind of report is supposed to be filed within 24 hours of suspecting a problem caused by the treatment.

When the Federal Drug Administration — which regulates trails — learned of the problem, it "conducted a review that concluded there also were several other adverse events that weren't promptly reported," McGinley's story indicated.

Collins said "that it appeared that the combination of ibrutinib and steroids 'seemed to place patients, many of whom have compromised immune systems, at an enhanced risk of infection,'" the article said.

Information on research, and how it often flip-flops, can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a book I, Woody Weingarten, aimed at male caregivers.

Overdiagnosis worries research project leader

New study renews the question of whether mammograms provide more benefits or harms 

A new study has led to amped up questioning of mammograms as appropriate breast cancer screenings.

The study, published this week in the New England Journal of Medicine, heightens discussions of recent years of whether the screening benefits outweigh the harms.

Clearly the jury's still out.

Dr. H. Gilbert Welch

According to an Associated Press story by Marilynn Marchione about the study, Dr. H. Gilbert Welch of the Dartmouth Medical School, a leader of the research project, said whether to have a mammogram "is a close call, a value judgment."

The study, the AP wrote, had concluded that women were "more likely to be diagnosed with a small tumor...not destined to grow than she is to have a true problem spotted early."

Many experts believe that improved treatment has rendered early detection less important, and that screenings are worth it only when they detect life-threatening cancers whose treatment would increase survival rates beyond what would occur if the disease were treated only when it became absolutely necessary.

The new thinking, advocated by Welch, is that many early cancers will never grow or spread or become a health threat.

Screenings can lead to overdiagnosis and overtreatment.

Welch, in fact, was the lead author of a recent book titled "Overdiagnosis: Making People Sick in the Pursuit of Health." And the new study, Marchione's story says, "parallels work he published from the same data sources four years ago."

At least one aspect of the new study — its assumption that there's been no change in cancer incidence — has been severely challenged by Dr. Robert Smith, American Cancer Society vice president of cancer screenings, who says cases have increased.

His perspective, according to the AP story, is that "when we find breast cancer early, women have a much, much better prognosis."

The study, the article continues, applies only to screening mammograms when a problem is suspected.

More details about the long-running mammogram controversy can be found in "Rollercoaster: How a man can survive his partner's breast cancer," the VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

Column talks of cancer's fiscal, emotional costs

NBC newscaster Tom Brokaw reveals what it's like living with an incurable blood cancer

Tom Brokaw

Tom Brokaw has used The New York Times as a bully pulpit by writing an op-ed column titled "Learning to Live with Cancer."

In today's piece, the NBC special news correspondent talks of being diagnosed, three years ago at age 73, with "an incurable [blood] cancer called multiple myeloma" and a statistical probability of five years to live.

He's since had "chemotherapy, a spinal operation…infusions of bone supplements and drugs to prevent respiratory infection" that put the cancer into remission.

At a cost. 

Financially and emotionally.

"Combating cancer," he writes, "is a full-time job that, in my case, requires 24 pills a day, including one that runs $500 a dose."

Still, the bone damage "brought persistent back pain and unwelcome muscle deterioration."

And, of course, there's the content fatigue. 

But he also talks of befriending others (in person and via email) with terminal diagnoses, some of whom have already died — but focusing on one in particular who's "doing well" 14 years after then-new treatments were applied.

Last year, Brokaw published a book, "A Lucky Life Interrupted," that he said he hoped would help others battling the disease that affects some 27,000 Americans annually.

To learn more about having cancer and aiding a patient with it, consider reading "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Risk factors: aging, estrogen, excess weight

2,600 men are facing diagnosis of breast cancer this year, nonprofit says

Politically, the phrase "top 1 percent" has become important — and again was cited recently by Hillary Clinton regarding the imbalance of wealth in our country.

A different 1 percent is equally important.

That's the amount of breast cancers occurring  in men — with about 2,600 expected to be diagnosed with the disease this year, according to the Pennsylvania-based nonprofit, breastcancer.org.

That figure puts the lifetime risk at 1 in 1,000 — small, indeed, but not insignificant.

And life-threatening, perhaps, if you happen to be in that 1 percent.

Because, unlike their female counterparts, men tend not to be screened regularly, the disease is likely to be more advanced when first detected.

Risk factors, according to the breastcancer.org website, can include aging itself (the average diagnosis for men is 68), high estrogen levels resulting from taking hormone meds, being overweight or being a heavy alcohol user.

Or having a strong family history of the disease or a genetic mutation (such as BRCA1 or BRCA2).

Treatments may include surgery, radiation, chemo or hormonal therapy.

Dr. Marisa Weiss 

Experts cited by breastcancer.org include a radiation oncologist, Marisa Weiss of Lankenau Hospital; a surgeon, M. Lisa Attebery of Paoli Hospital; and a Ph.D., Jennifer Harned Adams of the University of Texas.

Another expert, Gerry Bourguignon of Mill Valley, California, one of the regulars in my weekly drop-in breast support group, Marin Man to Man, has also been trying to spread the word about male breast cancer for years.

He, himself, is a survivor.

Want more information about the disease? Consider reading "Rollercoaster: How a man can survive his partner's breast cancer," the VitalityPress book I, Woody Weingarten, aimed at male caregivers.

For 1st time, mammogram doesn't scare survivor

Breast cancer anxieties of 'Rollercoaster' author's wife vanish — after only 23 years 

Cancer-free Fox and Weingarten

My wife, Nancy Fox, wasn't at all afraid.

For the first time in 23 years.

She'd previously been nervous each time she'd gone for a mammogram, fearful the test would show her breast cancer had returned.

This go-'round, just last week, no anxiety — probably because she'd been cleared by her gynecologist two days before.

The follow-up letter from her primary physician confirmed the good news:

"No signs of breast cancer."

The letter also reprinted a statement required by California law that her dense breast tissue "can make it harder to evaluate the results of your mammogram and may also be associated with an increase risk of breast cancer."

But even that didn't scare her.

Her current emotional stability and mine clearly are far from the emotions I detailed more than two decades ago about having to let go "of my anger at doctors for not having instant answers, at pharmaceutical companies for manufacturing life-extending but not necessarily life-saving drugs, at myself for not having a magic wand."

Yes, I'd initially been petrified "breast cancer would be my wife's killer," but I also was thrilled to note more than two decades later that "she's flourishing today, as am I."

Specifics on how I, Woody Weingarten, and my wife managed the ups and downs of the diagnosis, treatments and aftermath can be found in "Rollercoaster: How a man can survive his partner's breast cancer," my VitalityPress book aimed at male caregivers.