What's different about the new prostate cancer screening guidelines?

BY MELISSA WEBER | MARCH 3, 2010

With its first update in almost a decade, the American Cancer Society today released revised guidelines for prostate cancer screening. Although some recommendations haven't changed--most notably, they still don't support routine screening for prostate cancer--the society is offering some new advice.

For men who choose to be screened, the revamped guidelines recommend annual screening for those with a PSA (prostate-specific antigen) level of 2.5 ng/ml or higher, but screening can be stretched to every two years for men whose PSA is under 2.5 ng/ml. Once the PSA level hits 4.0 ng/ml, the society recommends further evaluation or biopsy. For levels that fall between 2.5 ng/mL and 4.0 ng/mL, doctors should assess individual risk before deciding how to proceed.

The society put greater emphasis on shared decision-making, offering physicians specific suggestions, such as use of decision aids (check out the ACS decision aid), to help facilitate conversations with patients about the risks and benefits of screening. (Read about the cancer screening debate in "Life Preserver?" from the Fall 2009 issue.)

The controversy surrounding PSA screening again ignited a year ago when two studies were reported in The New England Journal of Medicine. One study found the test saved lives, while the other found it didn't. (Check out our coverage of the research.) These conflicting findings are what led the ACS to focus attention on informed decision-making in the new guidelines.

The guidelines also acknowledge the limits of digital rectal exams, stating that screening can be performed using PSA with or without the digital rectal exam.

As for community-based prostate cancer screening programs, the society discourages men from participating in programs unless they provide appropriate counseling and follow-up care to men with abnormal screening results. "Availability of follow-up care must not be an afterthought. Unless these program elements are in place, community-based screening should not be initiated," the guidelines say.

Read the complete guidelines in CA: A Cancer Journal for Clinicians.

New test available that predicts risk of colon cancer recurrence

BY MELISSA WEBER | JANUARY 21, 2010

Genomic Health announced today that its Oncotype DX colon cancer test to determine the risk of recurrence in patients with stage 2 colon cancer is now commercially available.

The colon cancer test looks at the activity of 12 genes in the patient's tumor to come up with a score that predicts how likely it is that the cancer will come back. It's this information that can help patients and doctors decide whether chemotherapy is needed after surgery.

Research will be presented this weekend at the American Society of Clinical Oncology's Gastrointestinal Cancers Symposium that suggests the test may have a potential role in stage 3 colon cancer, although further study is needed. And as we reported at last year's ASCO annual meeting, although the test successfully predicted recurrence, it did not predict which patients would benefit from chemotherapy.

A similar 21-gene test for early-stage breast cancer has been available since 2004, and Genomic Health is currently developing tests for prostate cancer, non-small cell lung cancer, kidney cancer, and melanoma.

Online tool helps narrow down treatment options for breast cancer

BY MELISSA WEBER | NOVEMBER 19, 2009

My Breast Cancer Coach is pretty straightforward: Answer a handful of questions about your type of breast cancer and in return you get a personalized report of treatment options to talk over with your doctor.

The online tool has been available for over a year, but it recently re-launched with some new features, including information for stage 0 patients, a podcast series, and a "Get Answers" page that offers Q&As with experts.

Created by the nonprofits Breastcancer.org and Breast Cancer Network of Strength as well as the life science company Genomic Health (it markets the Oncotype DX breast cancer test), My Breast Cancer Coach also offers a glossary and a list of questions to ask your doctor.

Want to know the top cancer advances for 2009?

BY MELISSA WEBER | NOVEMBER 9, 2009

Each year, the American Society of Clinical Oncology releases a report that pinpoints the top advances in cancer treatment, prevention and screening. This year, ASCO identified 15 key advances in four areas. (The advances were not ranked.)

Here's a breakdown of the findings, provided by ASCO:

1. Advances in Personalized Medicine and Targeted Therapies

Multiple trials this year demonstrated that oncology is no longer "one size fits all" medicine. Rather, increased understanding of the biology of cancer is enabling researchers to develop highly targeted drugs and personalized treatment regimens for patients. Advances in this category include:

• The targeted drug trastuzumab (Herceptin), which has been successful against breast tumors that overexpress the HER2 protein, was found to improve survival for HER2+ gastric cancer. [We'll cover this topic in detail in the Winter issue of CURE, which drops in December.]

• Researchers identified the first effective immunotherapy for neuroblastoma – chimeric anti-GD2 antibody ch.14.18.

• For the first time in 30 years, a randomized trial identified a regimen – initial chemotherapy combined with the EGFR-targeted drug cetuximab (Erbitux) – that increases survival for people with metastatic head and neck cancer.

• Researchers identified a specific subset of patients with non-small cell lung cancer (NSCLC) who benefit from first-line treatment with the targeted drug gefitinib (Iressa). [Watch for our lung cancer feature in the Spring 2010 issue of CURE, which publishes in March.]

• The FDA approved new indications for targeted drugs to treat glioblastoma and advanced kidney cancer, both highly challenging forms of cancer. Bevacizumab (Avastin) was approved as a single agent for treatment of glioblastoma and when combined with interferon, for treatment of advanced kidney cancer. Additionally, everolimus (Afinitor) was approved for kidney cancer in patients whose disease has progressed despite treatment with other targeted drugs. [Read our kidney cancer coverage here.]

2. New Standards of Care

Results from several long-awaited clinical trials this year affirmed the superiority of certain treatment regimens for biliary, lung, and prostate cancers. These include:

• The first-ever standard of care for advanced biliary cancer (cancers of the gallbladder and bile ducts) – results from the largest clinical trial to date for this disease stage showed that combination gemcitabine (Gemzar) and cisplatin treatment increases survival and slows cancer progression, compared with gemcitabine treatment alone.

• Data from a late-stage trial reporting that maintenance therapy with pemetrexed (Alimta) extends survival for patients with nonsquamous forms of advanced NSCLC – a finding that establishes a new standard and gives patients a long-term, easily-administered treatment option with low toxicity. [Watch for our lung cancer feature in the Spring 2010 issue of CURE, which drops in March.]

• Practice-changing findings showing that radiation following prostatectomy improves survival and reduces risk of metastasis for men with early-stage prostate cancer.

3. Cancer Prevention and Screening

This year, findings from large trials shed new light on widely used cancer detection, monitoring and prevention tools. Major research advances in this category include:

• Interim results from two large trials showing that routine PSA testing has a minimal effect on reducing prostate cancer mortality – findings that add new insight to a long-time debate. [Read our coverage here.]

• A large trial showing that treating relapsed ovarian cancer based on rising levels of a protein in the blood called CA125 does not improve outcomes, compared with monitoring for physical symptoms of ovarian cancer relapse. These findings will help spare women from the anxiety and costs of frequent CA125 testing, as well as the toxicity of earlier treatment. [Read our coverage here.]

• Research suggesting that more women may benefit from HPV vaccination than previously thought, based on findings showing that Gardasil reduces the risk of HPV infection, cervical cancer and other HPV-related disease in women aged 25 to 45.

4. Large Trials Settle Key Debates in Colon, Breast Cancer Treatment

The results of two closely watched studies settled major debates in the treatment of colon and breast cancers. These include:

• In the first trial to examine bevacizumab in the adjuvant setting, researchers demonstrated that adjuvant bevacizumab treatment does not prevent colon cancer recurrence in patients who have undergone surgery for their disease. [Read our coverage here.]

• Standard three-drug chemotherapy is more effective and less toxic than single-drug treatment with capecitabine (Xeloda) in women age 65 and older undergoing adjuvant treatment for early-stage breast cancer. Researchers had thought that single-drug treatment may be more tolerable for older women, but this was not found to be the case.

The full report--plus reports from previous years--is available at www.cancer.net.

PBS's Arthur and Lance Armstrong team up to help you talk to kids about cancer

BY MELISSA WEBER | OCTOBER 16, 2009

When the lunch lady, Mrs. MacGrady, gets cancer on next week's episode of Arthur, the kids unite to help her--with a little help from Lance, of course.

The Lance Armstrong Foundation partnered with the PBS children's series to create the special episode, which airs every weekday next week (check your local listings here).

Plus, free resources on LAF's website help families and teachers talk with children about cancer. Parents can download the Family Activity Booklet, and kindergarten through second-grade teachers can download lesson plans that use the Arthur episode to help children express the emotions the show portrays of knowing someone diagnosed with cancer, and what they can do to reach out and help that person.

Check out CURE's article on what kids need and want to know when a parent is diagnosed in "Straight Talk."

Breast cancer survivor tells Jon Stewart to just say no to positive thinking

BY MELISSA WEBER | OCTOBER 15, 2009

On last night's episode of The Daily Show, author Barbara Ehrenreich (her latest book is called Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America) talked about her breast cancer diagnosis eight years ago.

Instead of finding the support she needed, she was told things like "be positive" and "embrace your disease" and "you'll come out a better person." That's not what she wanted or needed to hear, she told Stewart, adding that those types of statements can do more harm than good.

In the upcoming Winter issue, we're running an article about how some survivors have found a silver lining to their cancer experience. Of course, not all survivors feel this way. Check out "Being Positive?" from a previous issue for more on this topic, and tell us what you think.

Breast cancer documentary premieres this Sunday

BY MELISSA WEBER | OCTOBER 8, 2009

Take a break from football this weekend and check out a new documentary designed to promote early cancer detection and treatment among African Americans.

TV One partnered with Susan G. Komen for the Cure to produce Breast Cancer Examined: An African American Perspective, which airs this Sunday at 7 p.m. Eastern. (If you can't catch it Sunday night, the special will re-air at 4 a.m. on Monday; October 16 at 1 p.m.; and October 18 at 4 p.m.)

Viewers go where the patients go, through the stages of treatment and survival. These personal stories allow the filmmakers to educate viewers about the different types of breast cancer, the various kinds of treatment, and survivorship. A number of celebrities appear in the film, including actor Richard Roundtree, syndicated radio personality Ebony Steele, and actresses Diahann Carroll and Gabrielle Union.

Visit www.circleofpromise.org to get details on Circle of Promise, Komen's African American breast cancer initiative, and check out the story CURE ran about how to overcome the challenges minorities face when it comes to early cancer detection and access to care.

A new resource for breast cancer patients

BY MELISSA WEBER | SEPTEMBER 30, 2009

Just in time for breast cancer awareness month comes a new DVD you might want to check out that offers insight and information from top breast cancer experts (Dennis Slamon and Patricia Ganz, along with numerous others), advice from wellness experts, and personal stories from survivors--some of whom are familiar: Christina Applegate, Sheryl Crow, and Olivia Newton-John to name a few.

Here's a quick look at some of the topics covered in Breast Cancer: The Path of Wellness & Healing:

> Risk, Detection & Diagnosis
> Personal Testimonials
> Building Your Personal & Medical Team
> Talking to Your Kids
> Surgery, Breast Reconstruction, Chemotherapy, Radiation Therapy, Hormonal Therapy, and Side Effects
> Boosting Physical Resilience With Food, Supplements, Exercise & Meditation
> Cutting-Edge Advances in Research

The two-DVD set is available on Amazon starting Thursday, and you can find details about the project at www.breastcancerdvd.org.

Does cancer screening save lives?

BY MELISSA WEBER | SEPTEMBER 17, 2009

One of the most controversial issues in cancer during recent months has surrounded the question of screening (check out my screening post earlier this summer). The question seems simple enough: Does screening save lives? Ask most cancer patients and they'll say it does, but research says not so fast.

With the exception of colorectal, cervical, and breast cancers, research shows that current screening tests don't spare lives and can even be harmful in some cases. So why don't most tests work? What's a person to do if they want to be proactive about early detection? Well, it's complicated. Before you read any further, throw conventional wisdom out the door. Then check out the fall issue's "Life Preserver?" from contributing writer Laura Beil and "Cancer Screening" by Dr. Barnett Kramer, of the National Institutes of Health.

Among other things, these articles examine a fascinating trend called lead-time bias. Put simply, we get the false impression that we're living longer because screening diagnosed cancer early, when, in fact, the date of death doesn't change. Beil writes:

"Think of it this way: Imagine an asteroid is hurtling toward Earth, with impact at noon tomorrow. Satellites from an early warning system could have discovered it a year ago and tried to destroy it, giving a year's 'survival' with the asteroid. More sophisticated technology may have found it farther out in space, say seven years ago, giving seven years of 'survival' with the asteroid. Either way--a one-year survival or a seven-year survival--still means calamity at noon. Early detection didn't mean we lived longer; it just meant we knew sooner, and tried harder to stop it. Or we were working feverishly to stop it, and some other global cataclysm occurred first."

With all the screening tests that are currently available, if we know what doesn't save lives, why not focus on finding something new that does? The Canary Foundation, a nonprofit dedicated to early cancer detection, is making some interesting headway in this area (read more about the kind of research they're doing in "Screen Savers").

For now, there are a number of resources available to help you better understand the potential benefits and harms of a variety of cancer screening tests. This is a topic many are passionate about, and we welcome your comments.

Cancer screening can do more harm than good

BY MELISSA WEBER | JULY 20, 2009

Score one against conventional wisdom: Those cancer screening tests for early detection that are constantly urged? Turns out they don't save lives in most cases.

Patients may consider them fighting words, but unfortunately, the research backs it up when it comes to most cancers beyond cervical and colorectal. In fact, research shows screening for other cancer types can wind up doing more harm than good.

In our summer issue of CURE, Dr. Len Lichtenfeld of the American Cancer Society explained the latest controversy over PSA (short for prostate-specific antigen) screening for prostate cancer. We're taking this subject a step further in our upcoming fall issue, laying out the benefits versus harms, and why in some cases screening doesn't make a difference. As for one of those reasons, contributing writer Laura Beil summed it up this way in the upcoming article:

"Screening can fail partly because of the nature of cancer, and the shortcomings of current technology. Because aggressive tumors--the ones you most want to find--tend to grow rapidly, screening is less likely to pick them up. And slow-moving tumors are generally less deadly and may never even clinically manifest during a person's lifetime."

It's a complicated (and delicate) subject. So to dig a little deeper, we asked Dr. Barnett S. Kramer, the associate director for disease prevention at the National Institutes of Health, to author the fall issue's Speaking Out column. He writes: "It has been estimated that as many as 50 percent of prostate cancers detected by PSA screening are so slow-growing that they never would have caused any medical problems, had they not been detected by screening."

Until the fall issue drops in September, check out recent coverage of the screening debate from the New York Times and Newsweek.