Wednesday, January 23, 2008

A Step Forward

(This is one of several posts I wrote in the last few weeks, but never published, for a variety of reasons.)

In an ideal world (or, it could be said, a well-designed one) there'd be no cancer. Failing that, we'd have perfect treatment: one that destroyed every bit of cancer with no damage at all to normal cells and organs. That is at least imaginable at some point in the future. Even the not-too-impossibly-distant future. Meanwhile, we're stuck with imperfect treatments and we lack the ability accurately to determine who needs how much; who will get along just fine without extensive treatment (and, for that matter, who will succumb even with maximal therapy.) Recently there was news about some progress on that front.

As a surgeon who dealt extensively with breast cancer, I can say one of the most frustrating categories has been the entity known as DCIS, or "ductal-carcinoma-in-situ." It refers to the earliest possible form of breast cancer, wherein the abnormal cells are confined to the inside of the milk-ducts; as such, because it hasn't invaded across any blood or lymph vessels, it presents no danger at all, as long as it stays in that stage. A very rare diagnosis only a few decades ago, it's become increasingly discovered as mammography is more widely done and is of better and better quality. And it's become a therapeutic dilemma: how much treatment -- and what sort -- is necessary for this entity, not dangerous in itself but which has the potential to become so? As DCIS has been more and more frequently dealt with, it's become apparent that not all forms are of equal potential: some women who have it will never develop invasive cancer; others will. And whereas it's still not universally agreed what treatments are indicated for which types of DCIS in what sort of women, it looks like there's progress toward figuring out which women need treatment, and which don't. That's a good thing.

At a national meeting in San Antonio, a recently published paper was reported (by researchers at UCSF, where I learned to be a surgeon) showing that molecular markers have been discovered which can be used to predict when a given woman with DCIS will go on to develop invasive cancer, and which won't. As is the case with early results, confirmation is needed and the testing is not yet widely available. Still, it strikes me as a really significant finding -- one which will lead to much more precise decision-making, conferring confidence on both sides of the equation. Women who need treatment will really need it, and those that don't can safely be excluded. I hope it turns out to be the case; and I wish I'd had such testing available when I saw all those women, all those years.


Anonymous said...

I'm sooooo glad to see you back to blogging!!! I have been hoping you would be, as reading will certainly help me in my current A&P class. I think I've learned so far (at the risk of annoying you) that the positive feedback mechanism is why cancer grows. I am sure you comforted your patients, even if you couldn't help them.

Anonymous said...

Similar thoughts and testing seem to be happening with other cancers as well. I'am currently in a study that is taking place in over 30 states and several countries. Not for Breast cancer, but for adenocarcinoma of the esophagus.

Currently, as you know, everyone who has esophageal pre-cancer is managed the exact same way, with regular surveillance and the surveillance is pretty invasive, every year or 2. Sometimes more often. This study hopes to find evidence of defects in certain genes (P-6 and P-53 genes) that will tell them who would progress from the pre-cancer state, to full blown deadly esopahageal cancer. If this works, they could then bump up surveillance in some, or even take curative actions, and cut way back or even d/c surveillance in others.

This is good news on many fronts. Certainly, to be told you would not progress to this cancer would work to take away alot of stress for many people. Also, it would give others who most certainly would develop a horrible cancer, an opportunity to have surgery or curative procedures, so they in fact would not get cancer.

Also, this may sound morbid but it is a reality. Imagine how many ins. dollars could be saved if about 80-90% of people getting screened regularly for this cancer, could give up all that screening.

Sid Schwab said...

anonymous: I wasn't aware of that study. Thanks. It would indeed be a boon.

Chrysalis said...

Very interesting, Sid. I checked out some of the other links from that page as well. Things have changed just since I was diagnosed. I have a friend now that has had a totally different type of radiation than I was exposed to. It's interesting to see what they are coming up with in this fight.

SeaSpray said...

Good post!


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