cancer

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Life on the Street: Homeless Vietnam Veteran Fights Cancer

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John Buckingham, 62, a homeless Vietnam veteran, stands outside of a San Francisco grocery store. He lives on the streets and is fighting cancer. (Nick Arce/KQED)

Editor’s Note: For the nearly three million Americans who served in Vietnam, more likely than death in combat was a post-war life on the street. On a single night in 2013, more than 15,000 homeless Californians were veterans, many of whom served in Vietnam. As part of our ongoing health series called Vital Signs, we’re spending the month hearing from homeless Californians. John Buckingham is a 62-year-old homeless Vietnam vet living with cancer on the streets of San Francisco. He talks to us about his battle with illness. Reporter: Nick Arce

By John Buckingham

You know, I can be walking and all of a sudden I’ll get this real heavy pain in my body. I mean, like an earthquake hitting the ground and my whole body shakes. And then, all of sudden, I won’t feel so hot. I’ll feel like these cold and hot flashes. And I’ll see things.

It’s all because of the war. Because of Agent Orange.

Continue reading

Cutting Down on Cancer Overdiagnosis: National Panel Weighs In

Ductal carcinoma in situ seen under a microscope. While doctors also call it Stage 0 Breast Cancer, in an article Monday, doctors argue it should no longer be labelled "cancer." (Ed Euthman/Flickr)

Ductal carcinoma in situ as seen under a microscope.  Doctors also call D.C.I.S. “Stage 0 Breast Cancer.” But in an article Monday, a panel of national scientists argue it should no longer be labelled “cancer.” (Ed Euthman/Flickr)

What power does a word have? If the word is “cancer,” for most people it packs a wallop of emotion ranging from general anxiety to abject terror. For the last 30 years, a large industry has grown and developed with a focus on awareness and screening. The goals were laudable: get screened; catch cancer early; early diagnosis means patients dodge a death sentence.

There’s just one problem. It’s not working. This notion of screening was dependent upon the understanding of cancer 30 years ago: that cancer started from a tiny seed and steadily grew and spread until – without treatment – it killed the patient.

But today scientists know that not all cancers behave this way. Some are fast-growing, some may grow slowly, but progressively. But others are “indolent,” so slow-growing, they will never cause the patient harm.

So what certain cancer screening tests have wrought (think mammography, PSA tests) is a dramatic increase in diagnosis of early-stage disease without a corresponding decline in death rates from cancer or diagnosis of late-stage disease. Many of these early stage patients are likely “overdiagnosed” and then “overtreated” — for cancers that may never have grown and spread.

“We terrify (women) with D.C.I.S. thinking they have cancer. We could wait six months to see if something changes without making people hysterical.”
Against this backdrop, the National Cancer Institute called together a group of nationally recognized cancer doctors and researchers to review the evidence on overdiagnosis. In a Viewpoint published Monday in JAMA, the panel calls for major changes in the way the medical world classifies and thinks of “cancer” and the way screening programs are designed.

“This article is really critical for laying the ground work for introducing what I hope will be groundbreaking changes in screening and prevention,” said lead author Dr. Laura Esserman, director of the breast care center at UC San Francisco. Continue reading

No Evidence of Benefit from Routine Pelvic Exams

Women can add pelvic exams to list of medical tests they may not need as often — or at all

(Maigh/Flickr)

(Maigh/Flickr)

First, let’s review. We’ve been getting a lot of updates to cancer screening tests lately.

Pap Smears, a screening test for cervical cancer, were recommended to be done annually, until a group of experts in prevention concluded that every three years was equally effective. Most medical groups, including the American Cancer Society, agree on this one.

Then there’s mammography. I think everyone knows the debate around that. Every year or every other year? Starting at 40? or 50? The evidence points to every two years after age 50, although many doctors maintain younger and more often is better.

Women get them annually, even though we “lack data” that they do much for us.

But this latest one — about pelvic exams — caught me by surprise. It turns out there’s really not a whole lot of evidence that doing an annual pelvic exam makes any difference to a healthy woman’s continuing good health. (Again, we’re stressing healthy women. Women having symptoms are definitely candidates for a pelvic exam).

Here’s what the American College of Obstetricians and Gynecologists (ACOG) says about the pelvic exam, after recommending it be done annually: Continue reading

The Good and the Bad of Cancer Care in California

By Rachel Dornhelm

The California HealthCare Foundation issued a new report on cancer in the state. (Flickr: briannaorg)

More than a million Californians are living with cancer, and a new report from the California HealthCare Foundation (CHCF) takes a look at how the disease has affected the population over time.

Stephanie Teleki, senior program officer at CHCF, says some of the most welcome news is about childhood cancers. While the likelihood of a child developing cancer has crept up, the rate of children in the state who die from cancer each year has decreased 21% over the last two decades.

Overall — looking at kids and adults — cancer mortality rates have fallen 22 percent since 1989 and rates of new cancer diagnoses have dropped 9 percent.

On the more sobering side, the report found persistent disparities across race. For instance the mortality rates in California for African Americans were 30 percent to 90 percent higher than in other groups for all cancers. And despite the fact that whites are more likely to be diagnosed with breast cancer, African Americans’ death rate from the disease is 40 percent higher. The inequity holds for prostate cancer, too: black men are two times more likely to die from that disease than whites. Continue reading

FDA Warns California Clinics of Fake Avastin

By Kamal Menghrajani

(Courtesy: Genentech)

(Courtesy: Genentech)

A counterfeit version of the cancer drug Avastin may have made its way into clinics here in California. The medicine is used to treat colon, lung, and other cancers, but several physicians may have unwittingly been giving patients a useless knock-off.

You may remember Avastin because it was considered a blockbuster drug for breast cancer treatment. That was until November of last year, when the Food and Drug Administration (FDA) pulled its approval for treating the disease. However, Avastin is still widely used for other types of cancer.

Earlier this month, the FDA sent letters to 19 doctors around the country warning that they may have fake Avastin. Sixteen of these physicians are here in California, all of them in Southern California.

The FDA says these clinics purchased the medicine from a foreign supplier under the names “Quality Specialty Products” or “Montana Health Care Solutions.” Volunteer Distribution, a company based in Tennessee, funneled the fake vials out to clinics. The company was not licensed by drugmaker Genentech to provide Avastin, and some doctors’ offices were fooled. Continue reading

A New Voice for A Cancer Patient

Cancer survivor Rene Foreman (right) with her daughter, Michelle. (Photo: StoryCorps)

Cancer survivor Rene Foreman (right) with her daughter, Michelle. (Photo: StoryCorps)

As I got in my car to go work this morning, I switched on NPR. Instead of the predictable sounds of host/reporter/interviewee, I was confused by what sounded like a computer talking.

Then I was riveted.

What I was hearing was the story of Rene Foreman, an Orange County woman, who had lost her voice box to cancer in 1999. Foreman’s piece is part of the StoryCorps project. As NPR reports, Rene now uses an electrolarynx. It’s a small device that Foreman holds against her throat to produce her voice, electronically.

Yes, initially she sounds something like a creature from Star Wars, but right away, I got past the strangeness. Foreman says she’s happier without her voice now than she was with her voice. She says, “it’s a small price to pay for being alive.” In addition, she enjoys the distinction that her unusual “voice” provides:

“People are really very kind, once they realize what the situation is,” she says. “I may go into a restaurant once, and if I go back there a year later, and it’s the same woman at the front desk, she’ll say, ‘Where have you been? We haven’t seen you for a while.’ So, I feel like a movie star.”

You have to listen to this remarkable woman speak to get the full impact of her story. The NPR feature is not even three minutes long. I guarantee if you hear five seconds of Foreman talking, you’ll be hooked.