Cancer Decisions - Free Newsletter

HERE AT THE MOSS REPORTS

Few cancers have been so conclusively tied to a single cause as lung cancer has to smoking. Indeed, the two are so closely associated with one another in the public mind as to be almost synonymous. Many people are not even aware that non-smokers are at appreciable risk for the disease. Yet the number of new lung cancer diagnoses among those who have never smoked - they're referred to in the medical literature as "never smokers" - is large, and rising steadily. This year in the US, 30,000 new cases of lung cancer will be diagnosed in people who have never smoked. That's 10 percent of all lung cancer diagnoses.

Another unusual and disturbing aspect to these figures is that almost two thirds of these non-smoking related cancers will be diagnosed in women. Twenty percent of all lung cancer diagnoses are in women who have never smoked. (In men, the proportion is significantly lower: around 8 percent of all men diagnosed with lung cancer are never smokers.)

The reasons for this marked gender disparity are not clear. It has been suggested that because more men than women smoke, women are more likely to be exposed to secondhand (passive) smoke. Women who live with a spouse who smokes are also at heightened risk, as are women whose occupations expose them to passive smoke in the workplace. But passive smoke exposure is clearly not the whole story. Lung cancers in never smokers are typically of a different cellular type and display distinct biological differences from those that develop in habitual smokers. Never smokers also respond differently to treatment for the disease, and have a slightly more favorable prognosis than do patients with smoking-related lung cancer.

Sometimes it is anomalies such as this that hold the key to a deeper understanding of a disease process. The unusual, the atypical, the cases that run counter to established patterns - these can be a powerful spur to research and can ultimately create fundamental change the way a disease is treated.

Thinking Outside The Box

Here at the Moss Reports, challenging conventional wisdom and re-examining cherished assumptions are the cornerstones of our philosophy.

For more than thirty years I have been studying the medical literature critically and questioning the basis for cancer treatments, many of which have become universally adopted without ever having been shown to prolong life. I have written and published extensively on the subject of cancer and its treatment, including compiling a comprehensive series of individual reports on more than 200 different cancer diagnoses - The Moss Reports - each one of which provides a thorough overview of the standard treatment options that are likely to be offered for a particular cancer diagnosis, and the possible alternative and complementary approaches to that disease.

If you would like to order a Moss Report for yourself or someone you love, you can do so securely from our website, www.cancerdecisions.com, or by calling 1-800-980-1234 (814-238-3367 from outside the US).

I also offer phone consultations to clients who have purchased a Moss Report on their particular cancer type. A phone consultation can be enormously helpful in drawing up an effective treatment strategy and getting one's options clearly prioritized. To schedule an appointment, please call 1-800-980-1234 (814-238-3367 from outside the US) or send an email to Jacquie@cancerdecisions.com.

A Moss Report client expressed her appreciation this way:

"Following my diagnosis of stage IV breast cancer and prior to deciding on my first courses of treatment, I found educating myself on cancer and my possible treatment options overwhelming. I researched many sources of information and have found Dr. Moss's books and newsletter the most informative and current. Even more so was the benefit gained from my telephone consultation. Dr. Moss helped me weed through all the non-pertinent issues regarding my particular type of cancer and saved me immeasurable time and effort. I have truly benefited from Dr. Moss's exceptional education and experience, and from the professional and courteous service afforded me by the entire staff at Cancer Decisions." - I.T.

We look forward to helping you.

CURRENT TOPICS

Recently we launched a new report in our popular Current Topics series - "On Guard - Gardasil" - focusing on the controversial new anti-cervical cancer vaccine, Gardasil. This report, and the others in the series (listed below), can be purchased for $9.95 each and downloaded directly from our Web site, www.cancerdecisions.com:

On Guard - Gardasil
Mammography, Biopsy and the Diagnosis of Breast Cancer
Herceptin or Deceptin? (An evaluation of the use of Herceptin in breast cancer)
Avastin: Your Money Or Your Life. (A clear-eyed look at the targeted drug Avastin)
Do Antioxidants and Chemotherapy Conflict?
The Politics of Hope: Andrew von Eschenbach and the Decline of the National Cancer Institute
The Mexican Cancer Clinics in the Era of Evidence-Based Medicine

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STUDIES QUESTION ACCURACY OF MANY COLONOSCOPIES- PART II

(Last week, I began a two-part discussion of some of the inaccuracies that can reduce the effectiveness of colonoscopy as a screening method for colorectal cancer. I conclude that discussion, with references, this week.)

Ideally, performing all colonoscopies in the morning might reduce the number of patients needing a repeat procedure. However, this is not feasible given the huge number of patients undergoing the procedure. (The last time I had a colonoscopy, patients were lined up on their gurneys like airplanes waiting to leave O'Hare airport.) The study's authors suggested that one way to counteract the increased afternoon failure rate would be to ensure that any patients who are known to be at higher risk for colon cancer were tested in the morning rather than the afternoon.)

Slow Down - You Move Too Fast

A third study found that even among experienced colonoscopists, the rate of discovering tumors varies greatly. The time devoted to examining the mucous lining of the colon - which is performed during the withdrawal of the instrument - appears to be crucial to the successful detection of abnormalities.

Researchers monitored outcomes among 12 board-certified gastroenterologists. Data from a total of over 2,000 colonoscopies were evaluated. Gastroenterologists varied in how long they took to remove the instrument. Some took as little as 3.1 minutes, while others took as much as 16.8 minutes - more than five times longer.

The authors saw what they called a "striking, seemingly linear relationship" between withdrawal time and the rates of polyps and cancers that were detected. The overall rate of detection of polyps among operators who had relatively slow withdrawal times was nearly four times as great as the rate among those who had relatively fast withdrawal times. Slow workers were about three times more likely to find an abnormality than fast workers.

The author of this study (which was published in the New England Journal of Medicine) concluded that "a minimum adequate amount of time for colonoscopic withdrawal can be equated with quality of colonoscopy" (Barclay 2006).

Recommendations

Here's a reminder that readers who are over 50 (or 40, if you have exceptional risk factors) should not neglect having regular colonoscopies. They are at present the most reliable and safest way of determining the presence of polyps that can lead to colon cancer. But there are some uncertainties raised by these three studies. If you are at increased risk of colorectal cancer you might consider going on a three-year or even two-year schedule. If the procedure is done sloppily, five years might be too long to wait.

Also, choose your endoscopist carefully. As a general rule, pick only a board-certified gastroenterologist, not a family practitioner, internist or general surgeon. Make sure to have the procedure done in a hospital, not a doctor's office, and insist on having the procedure done in the morning, not in the afternoon.

As to getting your doctor to slow down and take his or her time in examining each patient, it is hard to know how laypeople can exert much influence in that direction. But the next time I go for a colonoscopy I intend to tell my gastroenterologist that I have read these three papers, particularly the New England Journal of Medicine article showing that slower procedures yield more accurate outcomes. I shall ask him politely to not rush things and to do the most thorough job possible, even if it takes more time. Hopefully Dr. David Lieberman's heartfelt call, in an accompanying New England Journal editorial, for endoscopists to take this message seriously, will have gotten through by then.

My gastroenterologist has an odd penchant for blaring the Rolling Stones into the operating room while doing these procedures. It's a bit unnerving to go under anesthesia to the refrains of Paint It Black. Next time, however, I think I will suggest Simon & Garfunkel's more appropriate 59th St. Bridge song:

"Slow down, you move too fast,
Gotta make the morning last..."

In fact, perhaps that groovy song might become the colonoscopists' professional anthem.

--Ralph W. Moss, Ph.D.

References:

Barclay RL, Vicari JJ, Doughty AS, Johnanson JF, Greenlaw RL. Colonoscopic withdrawal times and adenoma detection during screening colonoscopy. N Engl J Med 2006;355:2533-2541,2588-2589.

Bressler B, Paszat LF, Chen Z, Rothwell DM, Vinden C, Rabeneck L. Rates of new or missed colorectal cancers after colonoscopy and their risk factors: a population-based analysis. Gastroenterology 2007;132:96-102.

Douglas D. Colon cancers missed more often in office setting. Reuters Health, February 23, 2007. Available at:
http://www.nlm.nih.gov/medlineplus/news/fullstory_45711.html

Lieberman D. A call to action - measuring the quality of colonoscopy. N Engl J Med. 2006 Dec 14;355(24):2588-2589.

Sanaka MR, Shah N, Mullen KD, Ferguson Dr, Thomas C, McCullough AJ. Afternoon colonoscopies have higher failure rates than morning colonoscopies. Am J Gastroenterol 2006;101:2726-2730.

Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283(3):373-80.

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IMPORTANT DISCLAIMER

The news and other items in this newsletter are intended for informational purposes only. Nothing in this newsletter is intended to be a substitute for professional medical advice.