A Game of Chance…Not Entirely

A Game of Chance…Not Entirely

Earlier this month the New York Times ran an article titled “Cancer’s Random Assault.” It described the results of a study published in Science Magazine that proposes the majority of cancer can be chalked up to random bad luck.

The authors of the study; Dr. Christian Tomasetti, a mathematician, and Dr. Bert Vogelstein of John Hopkins School of Medicine; reported that approximately ⅔ of the cancers they studied were due to random genetic mutations and only about ⅓ were due to hereditary or environmental causes. In other words, ⅔ of the cancers studied were due to bad luck and the rest was due to things we can control or prevent.

My initial reaction was a defensive one. Surely these scientists were not proposing that cancer was due to having been dealt a poor hand at life’s game of cards. However, upon reading the article I understood the quest they had proposed.  They were merely asking the question, “How much is due to chance? Is it just some bad statistical lottery?” The results were provocative and surprising.

Many people want to know what they can do to prevent cancer. Many who have cancer are filled with the guilt that they have possibly contributed to their disease. The more we know and understand the forces and circumstances to cancer development the better position we are in to prevent or cure the disease.

We have known for some time now that cancer is driven by cell mutations. Basically, when healthy cells divide, errors occur. Sometimes errors can lead to uncontrolled cell growth and ultimately cancer.  Statistically speaking, the more cells that divide and copy, the more likely a cell will make an error that leads to cancer. For example, people who are repeatedly exposed to cigarette smoke have increased lung cell injury. This leads to increased cell division to repair the damage. Over time, the increased cell division increases the likelihood a mutation will occur that may lead to a lung cancer.

But not all tissues are as cancer prone as others. The large intestine is more prone than the small intestine. The lungs and skin are more prone to cancer than say, the spleen. Why is that? Why do some people get cancer and others do not?

Their research more clearly defines just how much cancer development is due to environmental and hereditary factors. The rest is due to presumably random complex genetic functions. This highlights the need for more research in areas such as genetic profiles and stem cell growth, repair and patterns.  It is this direction that holds the future of cancer cure and prevention.

It important not to take away the message that “Gee, getting cancer is just bad luck!” We have the ability to improve our chances; our luck if you will. Between ⅓ to ½ of all cancers can be prevented by lifestyle modification. That’s a lot!

If I can improve my odds of not getting cancer as much as 30 to 50%  by behaviors I choose; maintaining a healthy diet and weight, not smoking, and wearing sunscreen; and the actions I take; regularly undergoing cancer screening for breast, colon and skin cancer; I will take those odds.


Why Clinical Trials?

Why Clinical Trials?

Clinical trials are essential to the improvement and advancement of medical care. Research studies explore whether a medical strategy, treatment or device is safe and effective. Ultimately, it is objective evidence that helps guide our decisions toward strategies and treatments that work best.

Many of my patients express fears or concerns about participating in clinical trials. Most initially say they dislike the idea of being randomized or taking a placebo (sugar pill) drug, or they don’t want to travel to another institution. Most say “I don’t want to be a guinea pig.”

What patients and lay people often don’t know are the real benefits that come with participating in a trial such as access to promising treatments before they are available to the public. These treatments are often free or subsidized by the trial. While a patient is enrolled in a study, a research team closely monitors both care and side effects.

NO clinical trial is going to withhold the gold standard treatment option for a patient. Many trials are just surveys asking about your experience. Some trials ask to use your tumor tissue to look for new clues to fight cancer. In trials that do involve treatment, the trial often consists of using the recommended treatment option and combining it with new drugs or using it in new ways to try to improve the way it works.

Not every doctor or hospital has access clinical trials. Those who do offer trials are usually recognized by the experts in the field and are part of leading health facilities.

In 2002, the NCI (National Cancer Institute) chose a select few oncology groups around the country to bring clinical trials to smaller communities. Green Bay Oncology was one of the chosen few. Green Bay Oncology works closely with academic centers such as UW- Madison, Froedert in Milwaukee and Mayo Clinic to bring trials close to home so patients do not have to travel hours or across state lines to have access to cutting edge medical treatments.

Today there are more than 130 active clinical trials through Green Bay Oncology. For over 10 years we have been able to offer these options to our patients.

Remember that everything we as physicans recommend to you regarding your diagnosis, prognosis and treatment is based on someone before you having participated in a clinical trial. I hope you will consider and encourage those you know with cancer to find out if there is a clinical trial that might be right for them.


How Does Cancer Occur?

How Does Cancer Occur?

Understanding the advancements in cancer means having an understanding of how cancer starts and how it is treated.

Basically cancer is a broken cell. At one point the cancer cell was a normal cell, but somewhere along the way its internal mechanism became broken or abnormal.
We call that event a mutation. From that event on, the cell is never the same and doesn’t do its job right. It either grows too fast, multiplies too often, or spreads to a place it doesn’t belong. Fundamentally, it just doesn’t die. A cancer cell can arise from any cell: a breast cell, colon cell, prostate cell, or a blood cell. It multiplies and multiplies until instead of 2 abnormal cells you now have 2 billion abnormal cells in the form of a tumor or cancer.

Now I separate cancer into 2 broad categories: solid cancers and liquid cancers.

Solid tumors are easier to visualize. Say a breast cell or a colon cell mutates and begins to multiply. It eventually grows into the form of a solid mass or tumor.
Liquid tumors are pretty much the same. These are cancers like leukemia, lymphoma, multiple myeloma. These cancers start out as a liquid blood cell, immune cell or a protein that floats in our blood stream. These cells can mutate too and eventually multiply and spread throughout the bloodstream taking over organ function and stealing the resources that healthy cells need to survive.

The key to successful cancer treatment and cure is to identify these mutations, or triggering events that make these once healthy normal cells behave so badly, multiplying and surviving until they become a tumor or cancer.

In some unique cancers, it is as simple as identifying the one mutation and designing a drug that can turn off that event and stop the cancer cell from living, growing and spreading. Other cancers (most cancers) are much more complex, but the concept is still the same. We look for the triggering events or mutations that are present and try to turn them off through treatments that can either cure the cancer or prevent it from returning.