SURVIVAL vs MORTALITY

Linda at the humble log cottage built by Daniel Boone in his later years

 

That ponderous rag, the NY Times, has printed a very interesting  article on cancer statistics and how we can use them to fool ourselves about progress in the War on Cancer.  As you may already know, there are two “metrics” to describe such progress: survival rate, and mortality rate.  To illustrate:  Survival rate in ovarian cancer is measured by how many women are still alive  five years after diagnosis.  This has increased from roughly 33% in 1975 to 45% in 2010, a substantial gain, although in my opinion pitifully inadequate.  Mortality rate over that period also improved, from 10 per 100,000 women to 8; also progress.  Although in this case the two metrics yield similar results, in other cases they don’t.  Here is why:

Mortality rate can be affected only by changes in such factors as disease prevention and cure.  Survival rate, on the other hand, also is influenced by early diagnosis.  If early diagnosis doesn’t contribute to more effective treatment, all it will do is inflate the survival rate – without making a bit of difference in mortality.  Conversely, if it leads to more effective treatment – as is often the case – it will influence both survival and mortality. The Times article givers a clear example involving a mythical malady called thumb cancer.  You should read it; it will demystify cancer statistics to a degree.  Here is the article:

http://www.nytimes.com/2015/04/14/upshot/why-survival-rate-is-not-the-best-way-to-judge-cancer-spending.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0

This short essay  was brought to my attention by Dick Ingwall, who generously took time off from the celebration of his 69^th birthday to send it to me.  Thanks, Dick: welcome to middle age.

Maybe some of you would be interested in a convenient source of cancer statistics furnished us by the NCI.  Play around with this web site 

http://seer.cancer.gov/faststats/selections.php?

 

 



BRCA MUTATIONS

On a beach somewhere, 1987

It’s funny how cancer news comes in “clusters.”  In a recent blog I described how Angelina Jolie’s brave public discussion of her medical problems and her chosen solution to them had resulted in a cluster of articles about detection and prevention of OVCA and BRCA.  Now comes a half-dozen pieces on what appears to be the same study, by researchers at the Perlman School of Medicine at the University of Pennsylvania, which discusses the probability of getting either of these cancers if you have mutations in either or both of the BRCA  genes.  The project involved over 33,000 (nearly all white) women from 33 countries, which I guess should yield reliable statistics.  A woman with a mutation in BRCA1 has a 46% chance of developing breast cancer, 12% chance of developing ovarian cancer and 5% of  encountering both.  This leaves 37% cancer free.  In the case of a BRCA2 mutation the odds were 52% for breast cancer, 6% for OVCA, and 2% both; 46% got off scot free.  (Note that a statistician might quibble with my interpretation of these data; I got scorched once before, long ago, for making a similar interpretation.  Nevertheless, if you read the article you will agree.)

So, the obvious conclusion:  If you have any reason to suspect that you have either of these mutations, get tested.  Good reason for such suspicion would be a first degree relative – mother, sister, daughter – who had either type of cancer.   At the very least, ask your gynecologist, and insist that he/she give the matter some deep thought.  Gene sequencing is no longer the bank-breaker  it once was, especially since the outfit that had a patent on the technique was forced to cough it up.  Insurance companies should be required to cover this species of diagnosis, at least for women with elevated risk.

If you read the article, below, you will be tripped up and disconcerted by discussion of something called “clusters”.  Don’t bother to Google this concept; you will get everything you didn’t want, and nothing else.   Both BRCA1 and 2 genes are thousands of “letters” (nucleotides)  long, and apparently the disabling mutations tend to occur in discrete sections of the gene.   The practical significance of this discovery is not explained, but – as I’ve said many times before – the more we learn about this (you supply the adjective) killer, the better off we are.  Also mentioned is something called “mutations with nonsense-mediated decay” which, despite its humorous name, is bad.  I will try to figure that one out.

Here is the link:

http://www.healio.com/hematology-oncology/breast-cancer/news/online/%7B565b2918-c2eb-4b7e-9deb-25f024cf9a0d%7D/breast-ovarian-cancer-risks-vary-by-brca-mutation-location-type?sc_trk=internalsearch 



CANCER AND THE STOCK MARKET

Bryce Canyon National Park

Early 1980s

 

It is pretty interesting how many “alerts” to OVCA articles turn out to be in business/financial/stockmarket publications.  I guess it is obvious why this should be; any pharma company that is likely to bring  a “breakthrough” drug to market is a hot commodity on the Street.  This annoys me somewhat, but irrationally.  Yes, Jesus kicked the money-changers out of the temple, but what if they were making change for people who wanted to donate?  Profit isn’t always bad, no matter what you think.

However, the article that inspired this rambling, which appeared in TheStreet.com, has some interesting news.  It appears that Clovis Oncology (NASDAQ: CLVS) has a drug called rucaparib that is sufficiently promising that it has been awarded the designation of Breakthrough Therapy by the FDA.    (What that means doesn’t seem to have been explained, but I’ll bet it’s good).  Rucaparib is an oral PARP inhibitor (you remember those guys, right?).  It seems to be used with good effect on cancers caused by BRCA mutations.  And, of course, it merely prolongs life – it isn’t a cure.  But what the hell, it’s progress.

Read the article, but don’t buy the stock.

http://www.streetinsider.com/Corporate+News/Clovis+Oncologys+(CLVS)+Rucaparib+Receives+FDA+Breakthrough+Therapy+Designation+as+Ovarian+Cancer+Monotherapy+Treatment/10435403.html



MEA (dadburnit) CULPA!

Tucson sabbatical, early 80s

I dropped the ball.  Back on January 20^th I wrote that Ken Burns was doing a documentary based on the book The Emperor of All Maladies: A biography of cancer, which I have written about in several blogs.  I promised to let you know when to look for it.  Well: look for it a few weeks ago.  As I said, I dropped the ball.  I have managed to see  most of it, courtesy of Carolyn, Linda’s sister, who recorded it.  It is excellent, although tough going in places.  Try to find it; it will repay the effort



AN EARLY-MORNING EXERCISE

 

Linda and quilt

first chemo

 

I know, I’m supposed to be on a long hiatus, but the Kelly ladies (three generations of them) are sleeping in and I am trying to be quiet.  I haven’t even made coffee yet, for fear of disturbing their well-deserved slumbers.  One of them is an 18-month-old, so sleep is a rare and treasured commodity.

A recent NY Times issue contained an interview with Harold Varmus, retiring director of the National Institutes of Health, and a past winner of the Nobel Prize.  The title of the article is The Condition Cancer Research Is In.  Varmus thinks it’s in pretty good shape, but bemoans recent budget cuts (as, of course, you would expect him to do.)  According to his calculations we now (2015) have about 25% less funding, in real dollars, than we did in 2003.  He speaks at some length about the importance of fundamental biological research, which – he says – has shown the complexity and heterogeneous nature of cancer and thus illustrated the need for what he calls precision medicine, which I take to be equivalent to shaping the therapy to the individual cancer  .I agree, with reservations.  All this is good stuff, if you can do it – and, of course, afford it.

So, my early-morning take on this:

Thanks, Dr. Varmus. I am sure you have been a powerful weapon in our War on Cancer.  Enjoy your retirement.

It is true that cancer funding is down, in real terms.  Cuts should be restored.  However, I also think that we could be far smarter in how we distribute these funds.  Business as usual isn’t working.  See my blog The truth in small doses, and of course Clifton Leaf’s book of the same title.

And, finally, although we may be making progress against cancer in some areas, in several which concern me – pancreatic and ovarian – we are lagging pitifully.

The Kellys are up, and another hot day commences.

http://nyti.ms/19qcEB3

 

LONG BLOGGER HIATUS

I am about to enjoy a visit from part of my Alaska family, then immediately split for the land of moisture and cool air. (It has been over 90 here in Borrego Springs for at least a week.) On the way I will stop and see Carolyn, then after getting home I will spend a day or so petting my remaining cat. Then I will start blogging again. Hope you can get along without me for several weeks. Oh, yes -- I have a great picture of my cat Sea biscuit and me, but Blogger won't let me add it. Maybe someday I will figure out what I am doing wrong - but, don't hold your breath. I WILL TRY AGAIN.

See, when I try to add the picture, I get this kind of garbage!!!

GO LIE ON AN ANT HILL

Linda and the Singing Memnon

 

Did you know that people use stinging nettles to treat ailments like excess water, joint pain, urinary tract infections, hay fever, insect bites, and miscellaneous aches and pains?  Well, they do – or at least they formerly did.  Modern science has determined the active ingredient here is formic acid, also found in ants.  (Next time your rheumatism flairs up, go lie on an ant hill.)

Well, it turns out that formic acid may be useful in cancer therapy, as well.  Researchers at the University of Warwick, in the UK, seem to have shown that formic acid in moderate doses greatly enhances the efficacy of the drug JS07.  JS07, it seems, somehow disrupts the energy-generating mechanism of cancer cells, causing them to die a hideous (I fondly hope) death.  JS07 is described as a “metal-based (ruthenium) cancer drug.”  Apparently this metal-based stuff is combined with something called E-237, which is sodium formate, derived from formic acid.   One can greatly increase the effectiveness of JS07 by repeatedly renewing the supply of sodium formate.  Or so it seems.  Frankly, this article was hard for me to understand.  Read it yourself, and explain it to me.

http://www.medicalnewstoday.com/articles/291216.php

Anyway, it is said to be particularly effective against ovarian cancer.