Monday, September 29, 2014

PROGRESS ON THE PANCREATIC FRONT

Mid 1980's
Kristen and Linda celebrate after just having jogged to the bottom of the Grand Canyon, and back
 
Within the last several years pancreatic cancer has taken two people highly important to me: A man I greatly admire but am glad I never worked for, Steve Jobs; A colleague of mine in the geology department, our “soft-rock” specialist, Dr. Chris Suczek.  Both were diagnosed after unmistakable symptoms arose, which equates to “too late”.  The life expectancy of a late-stage pancreatic cancer victim usually is measured in months, or at most a few years.  However, it is my understanding that pancreatic cancer can be eliminated, in many cases at least, if detected soon enough.  What is needed, obviously, is an inexpensive, simple, reliable blood test – to catch the damned thing while it’s still young and vulnerable.   None exist at present, but there is some hope on the horizon.  Here is all I know about it: http://www.cbsnews.com/news/scientists-detect-early-sign-of-pancreatic-cancer/
Apparently a special class of amino acids become elevated in many pancreatic cancer victims several (to 25!) years before the cancer becomes mature enough to cause symptoms.   As always, of course, much more work needs to be done, but…..  I will do a little more research on this topic, and if I stumble over important things that I can comprehend I will add them as a Comment.
Let us  all now join in a thunderous cheer:  Go, Seamus!  If you are one of my faithful “readers” from Poland and the Ukraine, you may not know what I’m alluding to.  If so, you should actually read my blog, don’t just let your computer scan them for key words!  Dammit!
 


Sunday, September 28, 2014

NOT A CURE, BUT...

Sisters, 1993
 
Sundays I usually go out to Bay View Cemetery to visit Linda.  I sweep off our stone, water her flowers, and chop back any long grass that is beginning to encroach on our territory.  I talk to her a little, usually telling her the family news and what I’ve been up to, and sometimes I give her hell for leaving me so soon - tongue-in-cheek, of course.  About then I start feeling very sad. and I promise her I will keep on fighting ovarian cancer until they carry me away.  The problem lately has been that I haven’t been going to Seattle at all regularly – to help if possible, and to get inspiration and enlightenment.  This leaves me with only my blog, and sources of cancer news I can dig up myself (with the help of several of you, of course.)  I also have been fixated on the medical miracle occurring at children’s Hospital in Seattle.  It appears that my great grandson’s (very serious) operation is a resounding success!  The whole brood will be here next Tuesday, and I am happy at the thought.  Go, Seamus!  Linebacker at U.W., then Nobel Laureate in medicine loom in the future.  Or something equally bright.
So, anyway, the NY Times carries an article about a recent clinical trial performed by the Swiss pharma company, Roche.  They call their drug Perjeta.  Bio-chemically it’s known as pertuzumab.  (You remember what “mab” stands for, right?)  It is used in the case of metastatic breast cancers, and has been shown to prolong life by some 16 months.  Sixteen months more than the heretofore standard treatment allows.  The median survival was 41 months; not a cure, for sure, but better than nothing.
Perjeta is administered together with another Roche drug, Herceptin, which has been a big winner for Roche (and for some women, I suppose).  As always there is a down side: the two drugs together cost more than $11,000 PER MONTH, in the United States.  The article makes soothing noises about this being less than some newly approved cancer drugs.  Yeah, maybe so – it’s still about $450,000 for 41 months. 
How does it work?  Well, it is a suppressor of the protein coded for by the gene HER2, which is a tumor-accelerator in some forms of breast cancer (about 20-30% of them, apparently).  Other sources describe HER2 as a “proto-oncogene”.  HER2 stands for “human epidermal growth factor 2”.  None of that explains what it really does, of course – and 30 minutes of diligent research left me in total ignorance.  I will take it on faith.  My final comment:  41 months of extended life ain’t a cure, at all – but  it’s better than nothing.


Tuesday, September 23, 2014

FINALLY, I CAN EXHALE


Seamus Barry Weise
 
The Fall edition of Quest, the Fred Hutch newsletter, is out.  Of particular interest are three very short items, written in unadorned English, without even a fleck of Bio-chemical-ese to slow the reader down.  The first article concerns high dosage estrogen-laden birth control pills; you shouldn’t take them, although the low dosage kind are okay.  The second deals with early detection of lung cancer; it is possible, and would nearly 55,000 lives per year, but would cost $9.4 billion.  Worth it, I say.  Finally, there is an interesting re-take on the question of screening men using the prostate-specific antigen (PSA).  Our old friends the USPSTF (United States Preventative Services Task Force) recommend against using it on the usual grounds: cost, over-treatment, and unnecessary anxiety.  Hutch researchers at least partially disagree.  They calculate that using PSA as an early warning signal would save between 36,000 and 57,000 deaths per year.  I repeat: damned well worth it.  The Hutch researchers do suggest discontinuing PSA and adopting the “watch and wait” approach for men over 70, because most prostate cancers grow so slowly that the carrier will die of something else before the cancer gets ‘em.  Makes sense.
This blog is notably short and perhaps unintelligible, because my mind is elsewhere.  My great, strapping, indescribably cute great grandson is just out of major surgery and currently in the recovery room.  The operation involved a seemingly impossible manipulation of his skull!  All seems to have gone well.  The work was done at Children’s Hospital in Seattle, which deserves its international reputation as a “go to” place.  Thank you Lord, Children’s, and medical science in general.  You may not know what to do about ovarian cancer, but you do get lots of things right.
 


Wednesday, September 17, 2014

THE MORE YOU KNOW, THE BETTER OFF YOU ARE. I suppose

Enjoying herself, in a small town at the top of Norway.
 
Back in the day I used to pay a lot of attention to my science citation score.  To all you unfortunate enough not to have played the academic game, a “science citation score” is the number of times that your work has been cited in the scientific literature.  The higher your score, so goes the thinking, the more important you are, or can pretend to be – in your own field, of course.  Whatever its actual meaning, a good SCS is a useful lever to pry a promotion or a sabbatical leave out of a college administration.  For a brief, glorious half decade or so I was #3, according to this measure.  Ted Irving and Rob van der Voo were ahead of me – Ted was untouchable; Rob usually within reach.  But I was #3, which, I thought, was pretty darned good.  Being the competitive sort, every few weeks I would go to the library and check the new “Science Citation Index” record.  Each time I did I would get a jolt: “my God, I’m  #2 and I’m even pushing Ted”.  But then I would remember Melinda Beck.  It happened that both Melinda and I were recorded under “M. Beck”.  After I went through the titles of the cited papers and subtracted Melinda I would find myself back at #3, and that sometimes by the skin of my teeth.  Now, of course, I must have dropped completely off the charts.  I haven’t checked, and I’m not going to.    However, I may still claim one honor: I suspect that I have written more papers that have never been cited by anyone, than anyone else in my field.

All this by way of introducing Melinda Beck.  Among other things, she is a science writer for the Wall Street Journal.  She is the author of an informative article in the Wall Street Journal, titled “It’s Time to Rethink Early Detection”.  Read it yourself at:


So, what is Melinda on about?  A short summary of a fairly lengthy article follows. You can think of her essay as reporting on a new set of skirmishes in the “early-detection: is it useful?” wars.  We have been reading a lot about this altercation lately.  It applies particularly to breast and prostate cancer, but has application across the board.

The fundamental proposition here is that early detection may catch some truly dangerous cancers, but also potentially nets schools of conditions, conventionally called cancer, that will never develop into anything bad, or will do so slowly that they can be ignored if the patient has reached  a certain age.  Medical folks can never resist an acronym: they call these things “indolent lesions of epithelial origin”, or IDLE for short.  Some of these medical folks argue that so many IDLE’s are detected, and then fussed over, that periodic screening does more harm than good.

Now, I think this reasoning is wrong, because I lost a wife to a cancer that, if detected in stage 1, might have been cured.  However, the other side has some good points.

For one thing, they call for more research on ways to determine with reasonable certainty if a newly-detected baby lesion will develop into a dangerous cancer, or into an IDLE.  That’s obvious.  They also present lots of numerical evidence to the effect that “over-diagnosis” leads to “over-treatment”, and then inevitably into unnecessary expense and anxiety.  They also call for more genetic counseling and more public education in general, which would be hard to argue against.  Moreover they point out, correctly, that some cancers are so aggressive and lethal that they will never be detected in time, absent a very short screening period.  They argue persuasively.  I am still unconvinced.

One thing seems obvious, though.  If the situation in the screening/IDLE situation is really this complicated, and the consequences of guessing wrong so dire, choice should be left entirely to the patient.   If the patient has access to and understands the facts, and if his or her doctor also is keeping up with the times and thus can give useful advice, then the patient obviously should make the decision. Government, the Health Care Establishment, Organized Religion, and Writers of Blogs - all should butt out. This sort of thinking appeals to my small government, laissez-faire, liberal (in the original sense of the word) soul.

 

 

 


Monday, September 15, 2014

CANCER CELLS SHOULD JUST GROW UP!

Mt. St. Helens, a few years ago.
If that tree is vertical, then the concrete pillar is snuzzling up to her.
Weird
 
The link above will lead you to an interesting and very informative article in the New Yorker Magazine.  It is written by a journalist who specializes in medicine and biology.  It is easy to understand.  Like all New Yorker articles it is over-long; it says in 23 pages what the Economist would say in two, and The Week might stuff into two terse paragraphs.  But read it anyway.  You will be glad you did.
I am sure that New Yorker authors are paid by the word.
The main point here seems to be that there is a new way to deal with cancer.  Mainly, of course, we try to avoid it entirely.  We stop smoking.  We have our fallopian tubes removed.  We avoid asbestos.  We stay thin.  We eat “right” (whatever that is.)  We try to avoid having a family history of cancer.  (Well, that is impossible, of course, but it would help if we could.)  But sometimes we get cancer, anyway.  Then what to do?
Well, heretofore our only recourse in that event is to kill the cancer cells.  We cut them out, poison them with chemo drugs, blast them with X-rays, and pray.  According to this article there is another route: we can teach the damned cancer cells to behave themselves.  We can persuade (trick? force?) them to grow up and behave like normal cells.  There are several drugs in clinical trial or on the market that attempt to do just that, with encouraging results.
I am going to quote from the article.  The author was once a practicing physician, specializing in blood diseases and oncology.  He  states that”
“In medical school we were taught that, although cancer comes in many forms, it has one immutable characteristic: it is composed of immature cells”.
 I underlined the word “immature” in the previous sentence because it is the cornerstone of this sort of therapy: the drugs being developed force the cancer cells to “mature”.  How they do it is interesting and complicated: I will let you puzzle it out for yourselves.  However: here is a hint.  Molecules responsible for cancerous behavior can do so because they have a certain precise shape, enabling them to glom onto other cells and shut them down, activate them, or otherwise change their behavior.  If we humans can devise other molecules with precisely the right shape to glom onto these bad actors and immobilize them before they do their damage, then – game over!  I have been gloomy lately (about cancer, that is); this article has cheered me up. 
Joanne Ingwall alerted me to this essay.  She and Dick keep me busy – for which I am very grateful.
Finally, I have recently engaged in an email exchange with a former graduate student and valued colleague, who told me that he enjoys the pictures I put in my blog.  When I thanked him and mentioned the text he said, in effect “Oh?  Is there text?”  Well, I mostly made that up, but it serves my purpose - I know many of you enjoy the picture, then say "Oh, what is he on about this time?" and cut to Facebook.  I can't really blame you, but - please read this one.  It's good.


Friday, September 12, 2014

A DOG MAY BE A WOMAN'S BEST FRIEND

Artist's Point
Quite a while ago.
 
Also in a recent NY Times was news of another front in the dogs vs. ovarian cancer war.  You should read it; it is informative, encouraging, and even a bit amusing.
It appears beyond question that some dogs, properly trained, can detect the presence of some cancers with astounding accuracy.  With regard to ovarian cancer, one reason for pessimism is the stage at which the dog could sniff out the offending growth.  Can they detect them at Stage 1, or even sooner?  If so, hooray!  But maybe not.  Scientists at U. Pennsylvania are using dogs to isolate the precise chemicals that - to the dog – indicate the presence of cancer.  Then, these same scientists hope to construct a “mechanical nose” that will, in effect, go the dog one better.  More power to them.  However, in the meantime, covering their bets, so to speak, they are honing the abilities of their canine machines: maybe even breeding good sniffers.  A warm, furry detection device with a wagging tail would beat a metal gadget, any day.
Another problem that may arise is that the dogs will detect chemicals that may be common to several different kinds of cancer.  This leaves the clinician with a big problem: where to look? 
I blogged previously about dogs and ovarian cancer*.
Ha!  Spell (& grammar) Check doesn’t know that “blogged” is a verb.  The language evolves!
 


Thursday, September 11, 2014

U.W.SCORES AGAIN


With unknown baby, in unknown venue.
When?
 
Wow!  Dick Ingwall has opened the digital horn of plenty and dumped a load of interesting cancer news onto my computer.  I will deal with a little of it here, then come back to it in a day or two.
The first bit is both gratifying and provocative.  Dr. Mary-Claire King, of the University of Washington, has been awarded the Lasker Prize, which is an enormously prestigious award for contributions to medical science.  It appears that Dr. King was the first person to recognize that a mutation of the BRCA1 gene is associated with a greatly increased risk of breast cancer (and, as it later appeared, ovarian cancer was well).  In her acceptance address she called for universal testing of women for this, and presumably other related, genetic anomalies.  We have pondered that possibility before.  The argument "for” is simple; it would save women’s’ lives, as mutation-carriers  could gthen be monitored more carefully and treated, if necessary, when the cancer is small.  The argument “against” is twofold: cost, and quality of life.  Eventually, I fervently hope, technology will reduce the cost of genetic testing to a manageable level.  However, it will remain true that such universal testing will reduce the quality of life for a substantial number of people; those women who are positive for the mutation but never develop the disease (and that would be most of them), and – of course – their families and friends.  This seems to boil down to a simple choice: is it better to scare the moderate hell out of 100 women and save one life, or leave everyone in blissful ignorance and lose that life?  To me the answer is obvious.  What do you think?
However, several things seem indisputable.  First of all, we need more access to genetic counseling.  Also, the organization called FORCE* is definitely on to something.
*I blogged about FORCE previously:
and several times thereafter.