BRCA1 tests increase but results are questioned

Did Angelina Jolie op-ed in N.Y. Times help women find breast cancer gene mutations?

Angelina Jolie

Although celebrities can spur women to gather information about breast cancer, the question remains how valuable resultant data will turn out to be.

Angelina Jolie is a case in point.

According to a story by Carolyn Y. Johnson this week in The Washington Post, a new study published in the British Medical Journal has indicated that additional thousands of women in the United States were tested for breast cancer gene mutations right after the actress went public about her decision to get a double mastectomy.

Her choice was based on the fact that she had BRCA1, one of the mutations that increases chances of developing breast and ovarian cancers.

The Post piece noted that "testing rates increased 64 percent in the three weeks after Jolie's [op-ed in The New York Times went viral in 2013].

But that stat, based on research at Harvard Medical School, also showed it cost about $13.5 million to do the additional 4,500 genetic tests.

Unfortunately, researchers concluded, "mastectomy rates among women who had a genetic test actually declined after the [New York Times] piece was published, suggesting the women who got the tests done weren't as likely to have the mutation."

More information about the BRCA1 and BRCA2 genes 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.

18 million premature deaths predicted

Number of smokers dips again, but addiction is now linked to 40 percent of all cancers

Smoking has now been linked to 40 percent of all cancers despite the number of smokers continuing to decline dramatically.

Malignancies, in addition to lung cancer, include throat, stomach, pancreas and liver, according to a recent story by Laurie McKinley in The Washington Post.

Tom Frieden

McKinley quotes Tom Frieden, director of the Centers for Disease Control and Prevention, as saying that although smoking rates are "at all-time lows…nearly half (the current 36 million smokers) could die prematurely from tobacco-related illnesses, including 6 million from cancer."

The article also quotes the CDC's Morbidity and Mortality Weekly Report to the effect that the number of smoking adults declined 1.7 percent last year — down to 15.1 percent.

In 2005, there were 45.1 million adult American smokers.

Ernest Hawk, vice president for cancer prevention at MD Anderson Cancer Center in Houston, also was quoted by McKinley: "Smoking is more than just a habit. It's an addiction, and it's very hard to get off any addictive substance."

I cerainly know all about that — I smoked more cigarettes than I care to remember. 

For more than 30 years.

When I finally quit, I dug a hole in my back yard, inserted an unfinished pack of Pall Malls, and declared to the skies, "I'm burying these cigarettes so I can live."

The American Lung Association, by the way, has called on Congress "to fully fund smoking-cessation efforts in states," according to the Post story.

"Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at caregivers, details a vast variety of cancer causes, proving that cancer is hardly monolithic.

Hallucinogen aids 80 percent, two studies signal

Clinical tests of shrooms show psilocybin can ease depression and anxiety in cancer patients

The salient ingredient of "magic mushrooms," it's just been discovered, can ease depression and anxiety in cancer patients.

In a story by Jan Hoffman in last week's editions of The New York Times, two studies of psilocybin are cited.

The hallucinogen, it said, significantly reduced both psychological disorders in about 80 percent of the 80 cancer patients studied.

With minimal side effects.

The response, according to the story, was "sustained some seven months after the single dose."

In both clinical trials, the Times piece indicated, "the intensity of the mystical experience described by patients correlated with the degree to which their depression and anxiety decreased."

The studies, published in the Journal of Psychopharmacology, took place at New York and Johns Hopkins universities.

Psilocybin's been illegal in the United States for more than four decades. But trials of the substance — "for alcoholism, tobacco addiction and treatment-resistant depression" — are underway in both the United States and Europe.

Trials of other illegal drugs are also underway.

Just this week, the Times said, "the Food and Drug Administration approved a large-scale trial investigating MDMA, the illegal party drug better known as Ecstasy, for post-traumatic stress disorder."

Cancer-related psychological distress, "which afflicts up to 40 percent of patients, the story went on, "can be resistant to conventional therapy."

Hoffman's article also stated that "in the 1940s and 1950s, hallucinogens were studied in hundreds of trials. But by 1970, when those drugs were placed in the most restricted regulatory category, research ground to a near halt."

However, "since about 2000, investigators have begun studying them [again], mostly with private funding."

Dr. Stephen Ross

Dr. Stephen Ross, the lead investigator and chief of addiction psychiatry at NYU, was quoted as saying, "Cancer patients with anxiety and depression need help immediately, especially if you consider that they are at elevated risk for completed suicide."

According to the Associated Press, Dr. Roland Griffiths of Johns Hopkins said "it's not clear whether psilocybin would work outside of cancer patients, although he suspects it might work in people facing other terminal conditions."

But Dr. George Greer, co-founder of the Heffter Research Institute, which funded the two studies, apparently doesn't see a commercial use for psilocybin, which is also called shrooms, purple passion or little smoke, "because these patients needed only one dose."

Instead, according to The Times, "he envisions a nonprofit manufacturer, with distribution restricted to specialized clinics."

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

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.