Deflation

Here's another exciting new headline: Unlikely drug may block breast cancer in high-risk women. But then as you read it, you end up feeling deflated. Why? Because you find out at the end that it will take 10 years before the results of clinical trials will be available. And that it is based on a very small research pool. 

But here goes. So a drug, denosumab (or Prolia) used to to treat osteoporosis appears to prevent growth of breast cancer in high risk (read BRCA1+) women. This could be a prevention strategy for this group of women. This sounds like fantastic news. 

"For the study, 33 samples of breast tissue with no BRCA1 mutations and 24 samples of breast tissue with the mutations were analyzed."

So its a little tiny group. I am not sure that I am too impressed with the size of this group. And that the results were published based on such a small group. 

You would think that since the drug is approved already it would be fairly quick to be available for this use but since the clinical trials will take so long to see if cancer growth is prevented it will take ten years to get through trials and then FDA approval, and then finally available. 

As the article concludes it might be a solution for future generations. I am just a little deflated as I went from high expectations to a long wait.

Family History

I do not have a family history of cancer. My father was diagnosed with lymphoma at age 85. A maternal aunt died of a blood cancer at age 78. Both my grandfather's died of cancer - one of prostate cancer and one of gall bladder cancer, in their 80s. Some of my great aunts and uncles who smoked died of cancer as well. But none were very young and they were smokers. 

The definition of family history of cancer is:

"You may have a strong family history if any of the following situations apply to you:

• More than 2 close relatives on the same side of your family have had cancer – the same side of your family means either your father’s relatives or your mother’s relatives
• The relatives have had the same type of cancer, or different cancers that can be caused by the same gene fault
• The cancers developed when the family members were young, below the age of 50
• One of your relatives has had a gene fault found by genetic tests

It is important to remember that cancer is most common in people over the age of 60 and is rarer in young people. So cancer in older people is less likely to be due to an inherited cancer gene."

Then along came me: first cancer at age 19 and second at age 45. How did that happen? Who knows. The one thing I have learned, through lots of therapy and support groups, is that I can't beat myself up about it.

(It is important to remember in life that nothing that happened can be undone, and unless you intentionally did something, do not blame yourself. You can blame your lung cancer on your chain smoking or your skin cancer on your tanning bed addiction but otherwise skip the self blame.)

But I digress. Most cancers are not from family history. Despite all the publicity about the BRCA genes, something like less than 10% of breast cancer cases are attributed to them. There is also an obscure genetic mutation called Cowden's Syndrome, which has thyroid cancer and breast cancer as symptoms. But I don't have that.

So basically I do not have a family history of cancer and some how I got the short straw. We have no idea how I ended up this (un)healthy. I don't really care how this happened and I am not going to waste any more energy on stressing about it. The unfortunate part is that I now have an increased risk of getting another cancer.

I did inherit other things from my parents. I have my father's hair - his is not yet completely gray at almost 88, and I get to gloat at my siblings and their gray hair. But I did also get my mother's rheumatoid arthritis. Damn.

American Cancer Society's 2016 Outlook

Earlier this week, the ACS released its new outlook for 2016 for cancer death rates in the US. As part of this, they provided four essential cancer charts. I found them very interesting, and hopeful. The first chart deals with cancer death rates over decades.

And the answer is they are going down. Look at the changes since 1990 or so! Look at the declines. The point is there, the death rates are lower than they were 25 years ago. Modern medical research has made a big impact on cancer deaths in case you were wondering why we spend so much is spent on it.

The next chart deals with types of cancer being diagnosed each year. I am very disappointed to see that thyroid cancer has made it into the top 5 types of cancer diagnosed for women each year.

The third chart shows us where lifestyle related cancer causes are highest. No surprise there - the deep South where obesity and poverty rates are highest also has the highest cancer rates. The healthiest people are in the West.

Finally, this is the chart that strikes the deepest chord with me. Look at how the rates of thyroid cancer have increased in recent decades.

Thyroid cancer used to be very rare. Not so much any more. More on these charts is available here.

Those pesky breast cancer screening recommendations

Can I ask who is confused over the 'revised' breast cancer screening guidelines? Or should I just ask who isn't confused? Yes, no, yes, maybe, no one, everyone? How old? Not that young, should be older. Well maybe not. Not for everyone. Wait, oh just test everyone. No only for some people, talk to your doctor. That's a lot of different answers.

And in both my cancers I was clearly not a candidate for hitting the so called criteria for any testing. So I just ignore all the comments about too young or too old. Those really should be less likely or more likely instead of age related if you ask me. But they didn't ask me.

Anyway, so the USPTF (US Preventative Task Force) released a clarification on their breast cancer screenings earlier this week. They also claim they were misunderstood. And they want to clear up confusion. Well maybe the confusion was because what they said back in 2009 concerned everyone.

"The U.S. Preventive Services Task Force (USPSTF) released its final recommendations for breast cancer screening Monday in an attempt to clear up some of the confusion.

The group recommends that women at average risk for breast cancer should have a mammogram every other year beginning at age 50 up to the age of 74. Women in their 40s are advised to make an individual decision in partnership with their doctors, since the likelihood of benefiting from screening is lower for women in that age group.

Though this is an update from the group’s 2009 recommendations, the guidelines remain largely unchanged and a draft was released earlier this year.

The report, published in the Annals of Internal Medicine, also concluded that there’s not enough evidence to determine if newer 3D mammography is a good option for routine screening, or if women with dense breasts need extra testing.

The group’s 2009 report drew controversy for questioning the usefulness of mammograms for women in their 40s. But the task force says their words were widely misunderstood."

Blah, blah, blah. So in their clarification here they state that a mammogram every other year is all that is needed starting at age 50 if you have average risk. Let me ask all my friends in their 40's with breast cancer what they think if they had waited until 50 for a mammogram.

Okay, so medically maybe there is some logic in their plan. Or maybe not. If you look at breast cancer occurrence rates (from Cancer.gov):

Age 30 . . . . . . 0.44 percent (or 1 in 227)
Age 40 . . . . . . 1.47 percent (or 1 in 68)
Age 50 . . . . . . 2.38 percent (or 1 in 42)
Age 60 . . . . . . 3.56 percent (or 1 in 28)
Age 70 . . . . . . 3.82 percent (or 1 in 26)

It sees clear that most breast cancers occur after the age 40. So I don't understand this wait until 50 business at all. Now I am even more confused.