Cancer is Political

Cancer is Political

Why? Well, first of all, people die from cancer. It’s the second leading cause of death in the US.

Second, it can happen to anyone. Cancer is extremely common. If they live a normal lifespan, half of women and a third of men will get it. And if you’re thinking it can’t happen to you, well—neither did the last few thousand of my patients.

Yes, we can tempt fate and increase our risk by bad lifestyle choices: alcohol, tobacco, and obesity are big risk factors. But a great many cases happen because of genetics or just bad luck. Doesn’t matter who you are, or how you vote.

Though it’s more common as we age, it can strike at any age. And it starts getting more frequent just as people enter the last decade of their working lives.

Third, it’s expensive. Though two of the most common types, breast and colon cancer, for instance, are very curable, the treatment may take 6-12 months, often interrupts work, and comes with significant out-of-pocket expenses even for those with insurance. A cancer diagnosis in the United States causes 60% of patients to have to deplete their savings, and increases the risk of bankruptcy 2 1/2 times.

So…

  • Common
  • Expensive
  • Life & Death

That’s political dynamite.

Cancer’s been overtly political since President Nixon signed the National Cancer Act in 1971, setting in motion a half-century of public investment in cancer care.

Green Bay Oncology was founded five years after that. And we’ve seen first-hand what our citizens have gotten in return for that investment. 

At a recent round table of our doctors (some retired and some still practicing), we compared life expectancies for several different cancer types from the 70s to now. Let’s consider the examples of stage 4 melanoma, kidney cancer, and colon cancer—we see they’re still uniformly fatal, but patients survive them much longer.

DISEASE1970sNOW
Colon Cancer< 6 months2-4 years
Melanoma< 6 months2-5 years
Kidney Cancer< 6 months2-4 years
Myeloid Leukemia2 yearsNormal lifespan
Promyelocytic Leukemia< 2 weeksNormal lifespan
Myeloma1 year8-10 years
Source: Green Bay Oncology Physicians’ Roundtable, 8/2022

But several former death sentences can now be substantially delayed or cured altogether. 

Next, let’s compare the patient experience of one of the most common types—breast cancer—from then until now. We can see how we’ve learned to treat it with less surgery, less side effects, and less hospitalization.

EXPERIENCE1970sNOW
Mastectomy> 90%< 30%
Receiving chemotherapy> 75%< 25%
Duration of chemo6 months2-3 months
Vomiting after chemo> 75% < 20%
Hair loss after chemo> 50%< 20%
Hospitalization after chemo> 50%< 10%
Source: Green Bay Oncology Physicians’ Roundtable, 8/2022

That’s a lot of lives, workdays, and wages saved.

Almost all of this progress has been the result of publicly-funded research that started back in the 1970s. It takes a long time. We know this because besides our clinical work, Green Bay Oncology devotes significant time and resources to help test new treatments through clinical trials. Our doctors, like the people of Wisconsin, are “get involved” kind of people, and that’s why our practice is able to achieve a 17% clinical trial enrollment rate—far above the national average of 2%. This research is happening right here in our hometown.

But not all of the benefits I just described are accessible to all the people of Wisconsin. Rural people, for instance, many of whom live fifty miles or more from cancer clinics, find the frequent travel a significant burden. It’s expensive and time consuming, at a time when they already don’t feel their best. Because cancer patients in rural Wisconsin have to spend more money traveling for care, they tend to forego screening and delay diagnosis. These delays cause rural cancer patients to be sicker, with more advanced disease when they finally do walk in the door—with worse survival rates as a result.

Sources: WI Office of Rural Health JCO Oncology Practice, Levit et Al, 7/6/2022 Health Services Research, Holmes et Al, 4/2006

Green Bay Oncology is well aware of this because we’ve driven to the moon and back—quite literally the distance from the earth to the moon, and back—taking cancer care closer to rural residents, so they can have a fair share of what they’ve already paid for with their tax dollars.

What Green Bay Oncology, in partnership with the American Cancer Society Cancer Action Network asks of our lawmakers is this:

  • First, acknowledge the scope of the problem and the breadth of the people affected.
  • Second, stay invested in the long game. From the frequent advertisements for new immunotherapy drugs you see on TV, you might get the impression that immunotherapy is a new idea, but I can tell you…immunotherapy for cancer was a hot topic all the way back when I was an undergraduate in the 1980s. All of today’s progress is a result of decades of basic science research – most of which was publicly funded. So mistrust anyone who promises quick results on the cheap.
  • Third, don’t lose patience with the complexity of the problem. Yes, there are fantastic opportunities for private capital and public investment to work together, and yes—there’s a role for research and regulatory reform. But there’s no single, simple solution. We need public funds to support endeavors with little profit potential, and we need oversight and accountability anytime one group of people are tasked with spending other people’s money. The key is balance, and balance is complex—not simple. Sensible, incremental change and progress gets the results. Slow and steady. That requires patience and persistence. Mistrust anyone shilling simple solutions.
  • Fourth, let us help lawmakers identify and promote the most impactful reforms, and help craft a winning message to garner public support for the effort. The American Cancer Society Cancer Action Network and Green Bay Oncology understand that we only succeed together—lawmakers and healthcare leaders.
  • Fifth, keep the door open for rural people, who cannot bridge the gap without expanded access to care.

Only working together—clinicians, activists, and lawmakers—can we keep cancer treatment within reach of all the people of Wisconsin—rural, urban, or suburban. Much has been gained since the 1970s, and the people of Wisconsin have helped pay for that progress with their taxes. They rightly own a share of the returns.

Cancer Lobby Day

Cancer Lobby Day

If you’ve attended any local cancer event in the last twelve years—we’ve probably met.

My passion is connecting our community with their cancer doctors. This led me to serve on The American Cancer Society Wisconsin Leadership Board and to become an Ambassador Constituent Team Lead with The American Cancer Society Cancer Action Network.

While in DC for Cancer Lobby Day, we asked three important things of our Wisconsin lawmakers. Here’s why it’s important and how it will impact cancer care in our hometown.

  1. Support increased funding for cancer research & prevention programs.
    • The medical science can only advance as fast as people are willing to participate in trials. And Wisconsinites participate in cancer research at a 17-20% rate, consistenly outpacing the national average of only 2-4%. Our citizens know the currently available treatments are only good enough for yesterday—not tomorrow. They stand ready and able to carry the nation’s progress in cancer treatment forward.
  2. Co-sponsor the DIVERSE Trials Act
    • This would increase diversity in clinical trials and make it easier for all people with cancer to participate by reducing financial barriers to enrollment. 
    • This legislation allows trial sponsors to reimburse patients for non-medical costs associated with their trial participation, including parking, food, or lodging. It provides the necessary technology to facilitate remote participation. It also requires the Department of Health and Human Services to create guidance on the use of decentralized trials to increase diversity.
  3. Co-sponsor the Medicare Screening Coverage Act
    • This would create a pathway to allow Medicare to cover multi-cancer screening tests once they have been approved by the FDA. 
    • It’s widely accepted that public investment in cancer prevention and screening is good and necessary. But there’s another reason: the worsening shortage of U.S. oncologists. The Journal of Clinical Oncology estimated a shortfall of 3,800 cancer physicians in 2020. And we’re already experiencing the pinch, right here in rural Wisconsin. We must reduce the number of advanced cancer cases, and develop better, less burdensome treatments to relieve the strain on our health system. Because sooner or later cancer comes for all of us, or those we love.

The week ended with a Lights of Hope walk to remind everyone why we continue to come to DC year-after-year. Over 60,000 candlelit bags lined the pond at the Washington Monument and were dedicated to someone impacted by cancer.

For more ways to be involved, check out: ACS-Cancer Action Network

Cancer Action Network – Wisconsin Team

BREAKING: e-cigarettes pulled from shelves

BREAKING: e-cigarettes pulled from shelves

BREAKING: The FDA announces all JUUL e-cigarette products, including menthol-flavored e-cigarettes, must be pulled from shelves across the U.S.

E-cigarettes have been touted as a “safer” version of tobacco products. This may be true in regards to lung toxin exposure but many of the same and even new risks remain. Nicotine, the main active ingredient increases risk of cardiovascular events including heart attack and stroke, similar to traditional cigarettes. Thus, making e-cigarettes just as addictive as traditional ones.

In addition, e-cigarettes are not the best tool for tobacco cessation, essentially tobacco users are replacing one evil with one slightly less toxic one. Most concerning is the use among teenagers and young adults. E-cigarettes, especially flavored products, have attracted a population that may have never used tobacco products if e-cigarettes did not exist.

American Cancer Society Cancer Action Network – ACS CAN

Public health is paramount when regulating tobacco products—especially a product proven to be driving the country’s youth e-cigarette epidemic. 83% of youth e-cigarette users say they use flavored products like JUUL. In 2020, 1.3 million kids were frequent or daily users of e-cigarettes.

ACS CAN commends the FDA for this decision and for doing the right thing to protect public health, especially for our kids. We urge the agency to enforce this decision swiftly and we remain committed to working with Congress, state, and local lawmakers to end the sale of all flavored tobacco products.

Can prostate health be found in a bottle?

Can prostate health be found in a bottle?

There are many different names for products that manufacturers are hoping you think that if taken as recommended will lead to a “healthy prostate”.  You have most likely noticed them in the store or online with names ranging from Prostate Defense to Super Beta Prostate Support. Other than a high price tag are they really any better or even just as good at enhancing men’s health than what we can ingest naturally in our food?

There is significant evidence that focusing on a plant based diet contains the necessary nutrients to promote prostate health. Diets that a rich in fruit, vegetables, whole grains, fish, and healthy oils provide an appropriately balanced amount of these nutrients that you would unlikely even need a multivitamin. 

Specific nutrients that may help decrease the risk of prostate cancer include isoflavones including soybeans, tofu, and edamame beans. Green tea also includes flavonoids which act as an antioxidant which may prevent precancerous growths from beginning cancerous tumors. Antioxidant properties can also be found in red fruits such as watermelon, pink grapefruit and tomatoes, or vegetables such as broccoli, cauliflower, kale, and brussel sprouts.  

The supplement of magnesium is fairly easy to get in your diet. Sources of magnesium include fruits, veggies, whole grains, nuts, seeds, tofu, and dark chocolate.  

When considering whether to reach for a pill it is also important to realize that your body tends to absorb food nutrients better than supplements in the form of a pill. Furthermore, many of these products include higher levels of certain supplementation that are not needed or used by the body or may actually be dangerous for certain men.

If you make the above food choices in your daily diet, you will both save money and enjoy a healthier lifestyle.

Remission in Every Patient

Remission in Every Patient

Promising clinical response for rectal cancer patients

This weekend, Green Bay Oncology providers attended ASCO in Chicago where the results of a phase II trial was discussed involving patients with mismatch repair deficient locally advanced rectal cancer. These patients received treatment with PD-1 blockade, dostarlimab, and had a complete clinical response. This is exciting news for this subgroup of cancer patients.

Typically, locally advanced rectal cancer is treated with combination chemotherapy and radiation therapy followed by surgical resection. The standard approach does demonstrate a reasonable overall positive response but can have permanent effects of fertility, sexual health and bowel and bladder function. The implications of this study are quite profound and may lead to a remarkable change in our treatment approach.

The results are preliminary, and the long-term follow-up has not been completed to define if the responses are durable. However, with all these caveats, it is still quite impressive.

It encourages us to be relentless in research. Patients willing to participate in clinical trials are the hope for improving long-term survival and overall quality of life.

Dr. Tony Jaslowski

NY Times Article
New England Journal of Medicine Study

Male Breast Cancer

Male Breast Cancer

Men absolutely get breast cancer. It happens here in Green Bay.

I’ve treated it. So it’s absolutely a thing.

But men get breast cancer about 100 times LESS often than women do, for a very simple reason:

Most breast cancers develop from abnormal cells in the ductwork of the breast. But men have less breast ductwork to begin with – so they get breast cancer less often. It’s kinda the same reason you see fewer cheesehead hats in Florida…there are fewer Packer fans in Florida to wear them.

Since cancer screening only works in a high-risk population, and the risk for breast cancer in most men is so low–screening for breast cancer with breast exams and mammograms and such isn’t usually recommended (or even a good idea) for most men.

The exception is men who carry mutations that increase the risk of cancer, such as the BRCA mutation (specifically, the BRCA2 mutation). There are other mutations that also increase breast cancer risk, but that’s the most relevant one for men. The association between BRCA mutations and male breast cancer is so strong that having a male relative with breast cancer is usually a good enough reason to consider getting tested for the mutation.

Having said all that, once a man gets breast cancer–the treatment for it is remarkably similar to the treatment for women. This is because these cancers, whether they appear in a man or a woman, are driven by similar biological mechanisms, tend to spread in similar ways, and tend to respond to the same kinds of drugs.

One caveat to that general rule of treatments being more alike than different for men and women is that most men need mastectomy (removal of the whole breast) rather than lumpectomy (removing only the affected part of the breast) – but this is simply due to the fact that men generally have less breast tissue to work with than women do.

Estrogen blockers (like tamoxifen and aromatase inhibitors like arimidex and letrozole) work in most male breast cancers as well as they do for most female breast cancers. That surprises people because we tend to think of estrogen as the female hormone and testosterone as the male hormone, and tend to forget that both men and women have lots of both. It’s just the relative mix of the two hormones that’s different between the sexes–and that mix changes as we age.

COVID-19 and Cancer

COVID-19 and Cancer

Does Cancer put me at higher risk for COVID-19?

If you have cancer currently, your body is probably more susceptible to COVID-19 infection and more likely to become seriously ill from COVID-19 if you get it. This appears to be true whether you’re currently receiving cancer treatment or not. Having a previous history of cancer that’s either in remission or cured doesn’t appear to carry the same risk.

How is COVID-19 transmitted?

If you have cancer currently, your body is probably more susceptible to COVID-19 infection and more likely to become seriously ill from COVID-19 if you get it. This appears to be true whether you’re currently receiving cancer treatment or not. Having a previous history of cancer that’s either in remission or cured doesn’t appear to carry the same risk.v

Are masks helpful?

Masks reduce (but do not completely eliminate) the number of droplets expelled by people when they breathe or speak. They also appear to reduce (but not completely eliminate) the number of droplets you inhale from others. The type of mask, how tightly it fits, and its condition affects how well (or poorly) it does all these things. Single-layer cloth masks provide the least protection, and professionally-fitted N95 masks provide the most protection.

Should I be wearing a mask?

If you live in an area with a high rate of active COVID infection, wearing a mask while indoors with other people is recommended whether you’re vaccinated or not. But if you’re vaccinated and the area you live in has a low rate of active COVID infections, then wearing a mask while indoors with others probably isn’t necessary.

Should I take the vaccine?

Yes.

Should I still get the vaccine even if I’ve had COVID-19 before?

Yes.

Is the vaccine dangerous?

There appear to be very few short-term risks. Though longer-term risks won’t be clear for some time, nothing in how the vaccine is made (or what it’s made from) is thought to pose significant long-term dangers to humans.

Should I prefer one vaccine manufacturer over another?

At present, all the provisionally-approved vaccines are reasonably effective and reasonably safe against COVID-19. There are some slight differences among them in the exact degree of protection and also in the potential side effect profile, but the differences seem very small. It’s unclear at this time if there are differences in the long-term protection provided by the different vaccines.

Can the vaccine make me sick?

Most people experience a few days of inflammatory symptoms (e.g. fatigue, fever, soreness) after any vaccine of any kind, and the COVID-19 vaccine is no exception. Though serious illness and death from the COVID-19 vaccine do occur (as they do with all vaccines), these severe bad effects are extremely rare.

Can I still get COVID-19 if I get the vaccine?

Yes, but the risk you’ll get it (or get seriously ill from it) will be much lower if you’re vaccinated.

Will the vaccine still work if I have cancer or am getting chemotherapy or radiation therapy?

If you’re on any medications that suppress your immune system (such as steroids, immune suppressants, and many cancer chemotherapies) then the vaccine may be less effective–but it still appears to offer significant protection, as post-vaccination infection rates in at-risk individuals are low, and vaccinated individuals who do get COVID anyway seem to have a much lower rate of severe illness resulting from the infection.

Should I be concerned about the Delta (and other) variants?

Every living thing is constantly growing and adapting and viruses are no exception. We have to remember that new variants (or entirely new viruses) might rewrite the rules at any time–just like COVID-19 did in 2020. So yes, new variants are a concern and could change the rules for what’s safe (and what isn’t). It isn’t yet clear how effective the current vaccines are against the DELTA variant, or whether previous COVID infection offers any protection from it.

Why do the recommendations keep changing? Why can’t the experts get it right?

There was a time in history when “the facts” were that the earth was the center of the galaxy. But as we learned more, we had to admit our initial impression was wrong and that the earth in fact orbits the sun. An honest expert who weighs new data as it comes in will very often have to admit that things aren’t as we initially thought. With COVID-19 for instance, airborne transmission wasn’t initially thought to be important so masks weren’t recommended – but a lot of unhelpful things like scrubbing public surfaces regularly were. We’ve learned more since then, and have had to change our thinking. Having to change our minds is often a sign that science is doing its job well, and providing new knowledge at a fast rate.

Should I be afraid?

Though we think it’s unwise to live without sensible precautions and without regard for a global pandemic that’s taken millions of lives, we also think it’s unwise to live paralyzed by fear. Humans should never expect permanent health or freedom from all illness, but we shouldn’t lose sight of how fortunate we are. Our world has significant hazards, but our society suffers less from premature illness and death than any humans in history ever have. Many of our most common ailments are the result of excess, rather than deprivation.

TRUSTED SOURCES:

HEALTH SYSTEM INFORMATION:

Has COVID-19 lost us the war on cancer?

Has COVID-19 lost us the war on cancer?

For several months in the spring of 2020, clinics and hospitals across the United States temporarily suspended routine cancer screening during the early phase of the COVID outbreak. Patients we’d reminded by mail and phone not to forget their mammograms or colonoscopies or PAP smears were suddenly told to cancel them and sit tight.

Most places have now resumed routine cancer screening, but the pause understandably raised lots of questions:

  • “Did the delay put me in danger?”
  • “Will there be a spike in advanced cancer cases now?”
  • “If this was so important, why was it delayed in the first place?”

A recent article in the Milwaukee Journal Sentinel suggested the delay might have cost us the chance to cure people. But there’s reason to doubt this.

Cancer screening depends on—and only works for—cancers that grow and spread slowly in the early stages. The most common types of breast, colon, lung, and cervical cancer take a few years to become dangerous. This long lead time is the very reason screening is possible. It’s also why it’s hard to see how a 3-6 month screening delay could be enough to allow a significant number of early-stage cancers to become incurable.

Right now you’re probably asking, “don’t some cancers appear more quickly and spread more aggressively than the usual type?”

Yes, there’s an exceptional minority of cancers that can appear and spread rapidly, sometimes within a few months. But screening doesn’t work for these aggressive cancer sub-types, and it never has. Cancer screening was never designed with this tragic minority in mind, since we have so little power to alter their clinical course.

I’m not worried about the brief interruptions in cancer screening we experienced earlier this year, since services have mostly resumed and we’re able to get back on track. I’m more worried that many of us will conclude cancer screening couldn’t have been important in the first place, if we can safely pause it—and that patients won’t reschedule. I fear that public skepticism and reactive rhetoric might interfere with cancer screening long enough to matter.

If we lose the war on cancer over this, it’ll be because we surrendered what cancer screening had already won for us.

The Other Side

The Other Side

I have been at Green Bay Oncology caring for patients for nearly eleven years. I am used to being in charge, having the answers, the results, the plan.

Since I have always been a perfectionist and need to control things, part of empathizing with my patients is treating them the way I’d want my family treated. I love dotting the i’s and cross the t’s for them.

I have had some pretty emotional days at work. Lots of them, in fact. But despite delivering hard news to countless others, I still never thought I’d be on the other side with my father getting this news.

But now I know the other side is filled with emotions one can only explain when they’ve been there. There’s overwhelming worry. Tears consume quiet moments in the car. But there’s also the battle to stay positive, to not worry, and to balance faith, hope, and reality. And there’s that darkness back there where you don’t want to go…the worse case scenario.

This is the struggle, the minute by minute, day to day of what being on the other side is like.

And though all I really want to do is control everything, I realize there is really nothing I can control. Suddenly the bloodwork, talks of scans, pathology, biopsy… are all so fast. These words are common to me, they are my everyday lingo. It is getting thrown at him so fast but he doesn’t understand what the biopsy means? Who cares about the grade? What the hell is adenocarcinoma anyways? We review the guidelines…then the real question, “Can it be cured?” he asks “How will this change me and how will my life be different?”.

But you know what? I really just want to be his daughter. I want to pretend everything is ok.

The fact is that we really haven’t even started treatment yet, and there are way too many uncertainties about the future. But I know everything has changed. I have been walking around in a “bubble” thinking it couldn’t happen to us. Well, here we are, on the other side. The side where you have very little control of anything. The side where you don’t really sleep well anymore. The side where your brain makes you come face to face with possible loss and the perpetual “What if?”. The side where you choose hope and faith EVERY TIME because it’s really the only thing you have.

I have learned a lot from this moment on the other side. Even when he beats this, we will still have appointments, labs, “stuff” that will forever make us to some degree worry about cancer.

As I treat patients, I will always try to remember what it is really like to be on the other side.

COVID Testing in Brown County: Why You Should Bother

COVID Testing in Brown County: Why You Should Bother

The Wisconsin Department of Health Services has recommended COVID testing for all persons who live and work in Brown County.

The testing centers have a pretty convenient registration and drive-through process, but it’s still about a half hour of your life spent waiting.

“But I feel fine, and I’ve barely been out of my house! I don’t need a test!” you might be saying. And you’re right…you personally don’t need one, just like you personally don’t need census data.

But it’s still important to do it.

Asymptomatic testing ain’t about you. The data isn’t for you. It’s for the health departments and the epidemiologists who are still trying to get a better estimate of what the virus has done, is doing, and can do.

After everything COVID has already cost us all – the fear, the disruptions, the jobs, the isolation and boredom, and the growing mistrust in our public servants – another ask for the greater good seems like a lot.

But think back to all those numbers you heard early in the pandemic about transmissibility, the high number of asymptomatic carriers, and the estimated death rate…all those numbers you used to decide how scared (or not) to be, and how seriously (or not) to take the isolation recommendations. Those figures didn’t come from nowhere. They came from countries that were already grappling with COVID-19 and had some clumps of data to work with.

Yes, some of the numbers we’ve heard haven’t always been very accurate. But the only way they get more accurate is with better measurement, and that means a lot more data points…like yours.

Better numbers will hopefully help us make smarter decisions about when we can go back to something like normal life, and what we do (and don’t) need to do when COVID breaks out again. Maybe it’ll be less than we’ve done, maybe it’ll be more.

But wouldn’t it be better not to have to guess?

FAQ – Testing in Brown County