Monday, May 25, 2015

AN INDECENT PROPOSAL

Mildred and Billie
Welcome to life, little guy.  You may be four hours old.
 
Deer report:  I guess my yard was the obstetrics ward but not the neo-natal nursery.  I have seen neither hide nor hair of Mildred and her two tiny fawns since the day fawn #2 (Willie) was born.  I feel bereft and slighted, but I will bear up   and continue to look out the window every 30 minutes are so).  The camera remains at the ready.
So, while I wait to go to Iceland I am re-watching a Teaching Company course What Science Knows about Cancer.  The teacher is a geeky looking guy (Hey, he’s an academic.  We are supposed to look geeky) but he really knows how to package the info and pass it on to you painlessly.  It comes pretty fast, but – since the lectures are on DVDs, they are repeatable – in whole or in part– as often as needed.  I’m not supposed to do this, but I will:  Who wants to borrow the course?  It consists of 18, 30 minute lectures.  I will mail it to whoever wants it, and applies first, to mebeckjr@gmail.com.  Then, when #1 is done with it, he/she must promise to mail it to #2, etc, etc, until it wears out.  I will give the appropriate addresses.
Now, come on!  Here is your chance to prove to me that you do more than just look at the pretty pictures I post.  Sure, some of you will have a good reason to refuse this splendid offer.  I give you a sampling:
1)      I don’t own a TV, or a DVD player.
2)      I cannot possibly look at a geeky guy with a clownishly long necktie for 30 minutes
3)      I have a Ph.D. in medical oncology.
4)      I can’t sit still for 30 minutes at a crack.
5)      I live in Alaska, and we don’t have either mail service or electricity.
6)      I cannot afford the postage to send it on to the next guy on the list
7)      I think your blog is dumb, but it’s the only thing my computer can manage to find
8)      Etc.
Okay, here’s your chance.  Give me a shout.


Friday, May 22, 2015

FOUR YEARS AGO

Linda at a quilting retreat, 2008
Cancer might take her hair, but it couldn't touch her smile.
 
Four years ago today ovarian cancer took my wife Linda, robbing all of us  of a woman of kindly good humor, gentle wit, and radiant beauty.  Linda is gone, but ovarian cancer is still here, as lethal as ever.  During these last four years important advances have been made in understanding the basic biology of ovarian cancer, but a cure still eludes us.  About 14,000 American women will die of ovarian cancer this year – essentially the same as a decade ago.  Really, this is inexcusable.  I somehow believe that a cure is close, but we must keep the pressure on.  Ovarian cancer deserves to become a footnote in books on medical biology.  Please do what you can.



Tuesday, May 19, 2015

MORE ON EARLY DETECTION

Nice picture
I wish I knew where it was
It is sunny today here in Bellingham, with a high supposedly approaching 700.  I had intended to drive to the Skagit Flats nature spot, to look at birds.  However, I have been outside planting more pole beans for my back yard deer to eat, and it was uncomfortable – there was a cold wind a-blowing out of the frozen  wastelands north of Blaine, so I wimped out and tackled ovarian cancer instead. 
I uncovered two articles of interest.  One concerns ROCA- I wrote about that several times before.  ROCA is a screening protocol, involving monitoring changes in the bio-marker CA 125, together with ultrasound in suspicious cases.  It has been shown to be twice as effective as competing method.  If you are lucky enough to live in the U.K. you will be able to get this monitoring for as little as 150 Pounds ($232.5).  The company that offers this service is called Abcodia.  Apparently, at present the test will be out-of-pocket; however, Abcodia hopes to persuade the NHS to pay for it.  Abcodia will offer the service in the U.S. in the next year or two; I foresee a great and bloody struggle to get it approved and routinely offered here.
Apparently ROCA detects only 85% of all OVCA cases; work is underway to find something for the remaining 15%.  Maybe the next article will help.
The second article concerns work at Arizona State University which indicates that three distinct autoantibodies, if found in a patient’s blood sample, may prove to be a reliable marker of ovarian cancer.  Some quick definitions are in order.  An “antibody” it a molecule that is generated by the immune system to attack an “antigen” – the name antigen merely means something that will provoke an antibody attack.  In general, antibodies are benign, as they are directed at malicious invaders – bacteria and their ilk.  Autoantibodies, on the other hand, are molecules that attack “self” - indigenous proteins. Autoantibodies can be bad news; for instance, they are the cause of auto-immune diseases, such as Lupus.  However, certain kinds of autoantibodies apparently are generated to fight cancerous cells; these are the kind that the ASU people are investigating. 
As always: How early can these methods detect ovarian cancer, and what do we do about it once it’s detected? 
Here are the two URLs
 


Saturday, May 16, 2015

SGO: The good guys


Linda and Whiskers
Long ago
There exists an outfit called the Society of Gynecological Oncology.  This learned assortment of scientists has recently published, in the journal Cancer, a review of the etiology of ovarian cancer and suggestions for the prevention of the disease.  I am tempted to acquire a copy of that issue, but I am reminded of how little I normally understand of literature written for cancer professionals.  So, I will summarize what I have tracked down and aimed at folks like us who do not understand medical Lithuanian.  Here are some web addresses for you to read at your leisure:
So, here are the highlights, in no particular order.  Much of this reinforces previous suggestions forcefully  advanced previously in this series of blogs.
The median age at diagnosis (of ovarian cancer) is 63; the lifetime risk of contracting ovarian cancer is 1.3%.  (I assume that’s 1.3$ of women, not of everybody.)
Most epithelial ovarian cancer arises in the fallopian tubes, not the ovaries.  No sense having your ovaries removed without taking the fallopian tubes too.
As we have discussed many times before, association and correlation do not establish causation.  Only a “prospective* randomized controlled trial” can establish causation.  Many studies that lack this level of sophistication have subsequently been proven false.  (Enter Dr. Ioannidis, stage left, bearing a laptop:  http://ljb-quiltcutie.blogspot.com/2014/04/metrics-scourge-of-sloppy-science.html )
Use oral contraceptives for as long as possible.
Have your fallopian tubes removed after you hatch your family.
Find out if you are high-risk for ovarian cancer.  See a genetics counselor.  Get your genome investigated for suspicious mutations.
Don’t expect your primary care physician to up to snuff on ovarian cancer.  Take responsibility yourself.  And how do you do that?  By reading my blog, not just enjoying the pictures!
*”Prospective” means that you select a group of people and then follow them for many years.  This is in contradistinction to “Retrospective”, wherein you keep records of a bunch of people throughout  some (long) period of time and then, knowing how they prospered (or didn’t prosper),  go back and see what the differences may be. 


Tuesday, May 12, 2015

"SURVIVAL" vs "CURE"

Linda and Canada jay
Our skiing years, sometime in the 90s
Somewhere in southern Canada
 
The NY Times has published a thoughtful little essay by an oncology doc, on the difference between “survival” and “cure”.  Here it is; read it:
As I read this essay, I couldn’t help but think of what an awful job these oncologists have.  I don’t think I would have had the strength.  I would love to have been a cancer researcher, but the necessity of telling people they are about to die would have killed me.  I guess I am a wus.
By the way, this essay seems to contain one arithmetic mistake.  First person who spots it wins a beautiful ovarian cancer awareness car magnet.
For my trip to Iceland I have bought a fancy camera, and have spent many hours trying to figure out how it works.  Apparently it can do many things that I have never heard of.  Explanations are couched in language I don’t understand, using undefined terms and acronyms.  What in hell is IPO, anyway?. 


Thursday, May 7, 2015

IBM goes for the Nobel

Linda in Ireland, at 21
As a college senior she did a "If today is Thursday then we're in Brussels" whirlwind tour of Europe
Long ago I read a science fiction story consisting of a single “scene”, if you will – the presentation of the Nobel Prize in medicine to the curer of cancer.  Turned out to be a computer.
Well, now we know that there will never be a single cure for “cancer”, because each individual tumor is unique, with its own cause and potential cure. (Well, maybe they’re not all literally unique, but there are a heck of a lot of variations within the disease we call cancer.)  Targeted therapy is becoming the rage; deduce what’s wrong by sequencing some genes, then design a cure.  This requires enormous computing power.  And who’s got that?  IBM, of course.  A news item
describes how IBM is partnering with 14 cancer centers (Yale and the Mao Clinic were mentioned) to develop analytical techniques  that will enable doctors and medical scientists to build the correct designer drugs.  This sounds like progress to me, but I suspect it will be expensive progress.  I keep worrying that the cost to society of these new medical miracles will turn out to be more than society is willing to pay.
But, anyway – maybe a collection of computer algorithms, not the machine they run on, will get that Nobel.


Tuesday, May 5, 2015

ROCA: Can't help but help.


What the hell - this is supposed to be downtown Colorado Springs!
 
"Ho hum.  Myrl's got us lost again"
 
Fox News, that much maligned conservative news organization (“Friends Don’t Let Friends Watch Fox News”) has, despite its perceived imperfections, published an important news article on ovarian cancer.  Here it is:
This concerns a massive study conducted in the U.K. that has lasted 14 years so far, and counting.  It is a test of the ROCA (Risk of Ovarian Cancer Algorithm) predictive technique.  ROCA uses CA 125, long known to be elevated in ovarian cancer.  The most common use of CA 125 consists of a simple threshold measure – if CA 125 > 35, get an ultrasound.  (Linda when first tested was over 600.)  The problem with this is that the normal CA 125 level varies from woman to woman.  ROCA overcomes this by establishing a baseline for each individual; markedly elevated readings relative to this baseline triggers ultrasound and other tests.  From the U.K. study results, ROCA would seem to be about twice as effective as other methods.  ROCA is similar to the method recommended by my Hutch group involving Bayesian mathematics.  I suspect that ROCA will win out in the end, if only because it is easier to remember. 
Unanswered so far: how early will ROCA catch the cancer?
I have written about ROC before:
By the way:  Feliz Cinco de Mayo a todos.