Headlines
As reported by The Hartford Courant, October 13, 2004.
Progress in the War on Cancer
– New Technology Poised to Join Screening in Reducing Cases and Deaths, Physician Says
By Garret Condon
Dr. Carolyn D. Runowicz is director of the Carole and Ray Neag
Comprehensive Cancer Center at the University of Connecticut Health
Center in Farmington. She is co-author of the new book "The Answer to
Cancer" (Rodale, $24.95, 304 pages) with her husband, Dr. Sheldon H.
Cherry, a clinical professor of obstetrics and gynecology at Mount Sinai
School of Medicine in New York, and with Dianne Partie Lange. Runowicz
also is the second vice president of the American Cancer Society. What
follows is an edited version of a question-and-answer session about
cancer.
Q: How is the war on cancer going?
A: Depending upon the cancer, and depending upon whether you're looking at incidence or mortality, it's a 25-to-50 percent reduction in either incidence [the number of new cases per year in a given population group] or mortality [the death rate from a particular kind of cancer]. ... We've made tremendous strides in screening and early detection, and we're, I think, poised for more progress in those two areas through new technology such as proteomics and nanotechnology.
Q: Can you describe those technologies briefly?
A: Proteomics is the study of protein patterns [in blood or urine] to look for unique patterns in a cancer for early detection and screening. Results are promising in breast and ovarian cancer. We may also be able to identify markers of response to determine if treatment is working. Genomics is studying the human genome, [which has allowed us] to identify genetic changes, for example the BRCA1 and BRCA2 genes for breast and ovarian cancer. And nanotechnology [the creation of ultra-miniaturized tools and particles] is still in its infancy, but [it] may allow us to improve drug delivery and also evaluate response to therapy.
Q: Aren't all of these technologies in early stages of development?
A: I think we're on the cusp. I think that is going to move us even further into the early-detection and screening mode. And I think that's the secret to success. I mean, our book, "The Answer to Cancer," is about prevention.
We currently have available to us, today, most of the drugs that we need to treat cancer if we can detect cancer at an early stage.
[Runowicz went on to describe results from a tamoxifen study in the late 1990s that showed "proof of principle that we have, today, drugs that can prevent cancer in a high risk group."]
Q: You don't think the use of tamoxifen to prevent breast cancer should be controversial?
A: No, I definitely don't think it should be. I think we know what it can and can't do. And for a woman who's at high risk of breast cancer, we know we can reduce her risk of breast cancer. Breast cancer, for her, is a much greater risk than the [drug's] side effects, and particularly if we give it to women under the age of 50. In the trial, when you begin to look at different groups, and different risk groups and different age groups, you see that women with the highest risk as well as women under the age of 50 had the greatest benefit with the least amount of risk.
Q: Are you suggesting that all women at high risk should be taking tamoxifen?
A: I think all women should know their risk assessments, which I think is a new paradigm in medicine. We can assess for breast cancer risk by a simple model, the Gail Model or the Claus model. And these are models that have been validated in clinical trials. If a woman has found that she has an increased risk either based on family history or based on one of these models, in my opinion, in this day and age, she needs to discuss with her physician risk-reduction strategies. And the risk-reduction strategies include weight loss, exercise, thinking twice about being on hormone replacement, thinking twice about going on a drug like tamoxifen.
Q: Is the popular perception of risk flavored by whatever the current media or public relations emphasis is?
A: If you ask a patient what her risk of breast cancer is ... they'll always predict that it's higher than it actually is. ... Risk assessment is almost a new science. It just is not well practiced and not well understood by patient.
Q: Shouldn't there be more emphasis in the war on cancer to working on diet and working on lifestyle issues?
A: There is a lot of work. We know, for example, through epidemiological research, what is good in your diet vs. that which is not good; however, it is very hard to get that message across to the American public. In my experience as a physician and in my experience with friends, you know, going out to dinner, Americans like the easy way. They like the pill that prevents cancer - as opposed to cutting back on total calories. It's not only what you eat, it's how much you eat.
Q: There are a lot of popular diets, like the Atkins diet, that may not necessarily be cancer-preventive diets. What do you tell your patients about such diets?
A: First of all, I tell them "diet" is a very bad four-letter word. Because you can't think of your lifestyle as a diet; you have to think of it as "this is the way that I eat," and forget about the word "diet." The minute you say diet to someone, they think of a six-month program, they think of a 30-pound weight loss, and what that does is give you this yo-yo effect, so they lose the 30 pounds and then put on 40 pounds. So, it's really bad, and it's bad for their heart, and it's bad for cancer risk, and long-term studies on the Atkins diet show that it doesn't - in the long run, everyone puts their weight back on. ... And it doesn't mean that you can't have a cookie. ... Everyone laughs at me, but I cut my food in half, and so I'll have a cookie, and I'll cut that piece into fours, and I'll take a little piece, and I wrap the others up, and I put it away. ... It's not like I'm starving myself or that I'm denying myself. If I want a little piece of cookie, I will eat a little piece of cookie. I won't eat the whole bag. ... Portion control is very important.
Q: There seems to be a lot of confusion about cancer screening, from mammography to the PSA test for prostate cancer.
A: Well, mammography, in my mind, the controversy has been sort of a trumped-up controversy. There were some investigators [who] decided to select three out of eight studies, so there was already a selection bias. And that really did a disservice because the message came out that mammography was bad. ... The question was [whether ]the benefit [was] as large as people thought it was. And, in my mind, when you include all of the data and you don't just self-select three studies, it's clear to me that that data, plus emerging data, show a survival benefit of 30 percent for women over the age of 40. And it makes sense - it's biologically plausible - because the smaller your cancer, the earlier it is. The earlier the stage, the higher the cure rate.
Q: For women over 40?
A: Women 40 and over. At age 40, I start yearly mammograms and I practice what I preach. I mean, I've had breast cancer, which is another reason why I wrote this book. Having had cancer was clearly, hands down, the worst experience of my life. ... I really assessed everything about me to try to make my life so that I would be practicing everything I talk about in this book. I really, religiously exercise. I watch what I eat. I eat my six fruits and vegetables. I take my calcium. I do my screenings.
Q: When did you get cancer?
A: In 1992, so that was 12 years ago. I'm 53, so I was 41.
Q: What was the treatment?
A: Everything. Unfortunately, I had a little pea-size tumor; it was 9 millimeters, and it had spread to three lymph nodes, and so I had a lumpectomy, 12 cycles of chemotherapy. Back then, that was the standard; you don't need that much anymore. But back then, there were 12 cycles of therapy, followed by radiation, followed by five years of Tamoxifen, and now I'm on Femara [letrozole], the aromatase inhibitor, which may make Tamoxifen in post-menopausal women a drug that is not as used.
Q: Isn't the flip side of pushing cancer prevention that people who get cancer will blame themselves for not having prevented it?
A: Oh, they always do. Everyone always does. It's a uniform mea culpa. And some cancers are preventable. For example, lung cancer - if a person is a smoker or was a smoker, they rightly blame themselves and that is just sort of a fact of life. There are other cancers that the person blames themselves and it's not so much that they could have maybe prevented the cancer, but they could have early-detected it and maybe prevented it. ... Now, there are other cancers, like pancreatic cancer - although there is a relationship with smoking there. But there are other cancers that we can't prevent or we can't screen for. But everybody, including myself, was, "What did I do that I got breast cancer?" You know, what was it about my life that I did? And I decided - and my doctor reinforced it - that it was the birth-control pill when I was younger. That may or may not be true. But it's one of those mea culpa experiences, and everyone does it.
Q: But it seems to me that it's not a helpful attitude at that stage.
A: It's not. And do you know what I do? I say, "Drop the guilt at the door. We've got to move on." And that's what you have to do.
Runowicz and Cherry will give a free talk Thursday at 7 p.m. in the Keller Auditorium at the University of Connecticut Health Center in Farmington. They also will sign books from 5:30 to 6:30 p.m. in the Keller Lobby. Call 800-535-6232 or 860-679-7692.