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August 2009 Archives

Four New Targets Found for Breast Cancer
Protein Receptors, Enzyme Often Over-Produced

 Three protein receptors and an enzyme that often are over-produced in several types of cancer also play roles in breast cancer.

A team of researchers, led by scientists at M. D. Anderson, reported its findings on lysophosphatidic acid (LPA) receptors (LPA1, LPA2, and LPA3) and the LPA-producing enzyme, autotaxin, in the June edition of Cancer Cell.

"Lysophosphatidic acid is the single most potent cellular survival factor," says
Gordon Mills, M.D., Ph.D., professor and chair of M. D. Anderson's Department of Systems Biology and senior author on the paper.


Variation in Gene May Increase Risk of Bladder Cancer
Prostate Stem Cell Antigen (PSCA) Is a Factor

Researchers have pinpointed a specific gene variation that causes increased risk of urinary bladder cancer.

In the future, scientists hope the results of this large, multicenter international study may help determine who is at high risk for this deadly cancer, which may lead to improved screening and targeted chemopreventive interventions.

"With this research, we found a novel specific gene and a functional variation that are independent of the previous suspects," says Xifeng Wu, M.D., Ph.D., professor in M. D. Anderson's Department of Epidemiology, the lead and corresponding author.


Five Gene Variations Raise Risk for Brain Tumors
Study Is First to Discover Glioma Risk Factors

Variations in five genes may raise a person's risk of developing glioma, the most prevalent type of brain tumor.

This study, the first to suggest risk factors for any type for glioma, was the largest to date of a rare cancer. The international research team, led by scientists at M. D. Anderson and the Institute of Cancer Research in the United Kingdom, reported its findings online in Nature Genetics.

"This is a groundbreaking study because it's the first time we've had a large enough sample to understand the genetic risk factors related to glioma, which opens the door to understanding a possible cause of these brain tumors," says co-senior author Melissa Bondy, Ph.D., professor in M. D. Anderson's Department of Epidemiology.
Video - Genetic Variants Linked to Brain Tumor Risk


Cancer Newsline Audio Podcast Series

Anal Cancer
Cathy Eng, M. D., associate professor in the department of gastrointestinal medical oncology explains risk factors and treatment options for anal cancer.

Treatment Options for Lymphedema Patients
David Chang, M.D., explains what lymphedema is and discusses treatment options including lymphaticovenular bypass surgery.


By Bayan Raji, Staff Writer

Questions about treatment options and resources often accompany a cancer diagnosis, and many people look for answers on the Internet.

While it is home to numerous reliable, informative sites, the Internet also contains misleading or unreliable sources. Sometimes it's difficult to know where to turn for accurate answers to difficult questions.

Service provides reliable information

AskMDAnderson puts the front door of M. D. Anderson only an e-mail or a phone call away. This reliable source of information has helped more than 700,000 people since it was established in 1995.

AskMDAnderson can help prospective patients:

•    Find accurate cancer information
•    Make an appointment
•    Understand treatment options
•    Learn about research studies
•    Navigate M. D. Anderson's Internet site
•    Learn about and use patient resources
•    Locate community cancer resources

Accurate info is key

AskMDAnderson representatives are trained by an oncology educator, and they take part in regular training to keep up to date on treatment options and clinical trials.

"Patients are much more informed when they go into their first appointment than they were 10 or 15 years ago," says Jennifer Kennedy-Stovall, associate director in the Public Education Office at M. D. Anderson and head of askMDAnderson. "We help educate people by being a trustworthy source of information about potential treatments and options."

AskMDA2.jpgAnswers ease treatment

Kennedy-Stovall says the most common question askMDAnderson specialists hear is, "How do I become a patient at M. D. Anderson?"

"It's important for people to contact us in the very beginning because we can make sure they get to the next step in a timely manner," she says. "We can get them to the right place and answer questions they have along the way. If we don't know the answer to something, then we'll find out."

Prospective patients can call askMDAnderson at 1-877-MDA-6789, Monday through Friday, from 8 a.m. to 5 p.m. Central Standard Time (CST). Questions also can be submitted online and are answered in a timely manner.


M. D. Anderson resources:

askMDAnderson

Frequently Asked Questions

Gateways to Care (Conquest magazine)


African-Americans die of cancer at much higher rates than any other racial or ethnic group in the United States. Cancer's toll on African-Americans is particularly high for cancers of the lung, colon and rectum, female breast, prostate and cervix.

The American Cancer Society estimates that about 152,900 new cancer cases will be diagnosed and 62,780 cancer deaths will occur among African-Americans annually. In Texas, African-Americans' cancer mortality rates are 38% higher for men and 22% higher for women, compared to non-Hispanic Whites.

The reasons behind African-Americans' higher rates of cancer occurrence and death are still largely unknown. Large cancer prevention studies, which can help identify specific risks for different populations, often have very low participation from minority communities. This limits the ability of researchers to understand whether the risks that are found for the entire population are the same for specific groups, such as African-Americans.

To reduce the burden of cancer in the African-American community, researchers and the community need to join forces to conduct focused research and to promote activities that will reduce cancer risks. Effective cancer prevention activities for African-Americans need to take into account not just their social situation and the environment they live in, but also their life priorities and concerns.

The African-American Cancer Prevention Project (AACPP) is a collaborative study between the Department of Health Disparities Research and Windsor Village United Methodist Church in Houston, home to the largest African-American Methodist congregation in the United States. This type of study, known as a cohort study, follows healthy individuals over time to see how behavioral, social and environmental factors (such as weight management, cigarette smoking, cancer screening, health care, work and financial issues, neighborhood environment and mental health), contribute to cancer risk for African-Americans.

To date, 1,500 individuals have been enrolled in the study and they will be followed for three years, receiving periodic health assessments, as well as programs and services designed to address concerns such as stress, smoking, and exercise and fitness. Participants also receive help to navigate health and cancer screening and treatment services.  

Open and continuous communications, a lengthy history of community support and the full backing of church leaders have enabled the study to successfully reach its recruiting goals on time. Information gathered from the study will help to increase our understanding and ability to assess cancer risks in African-Americans, as well as identify areas that both M. D. Anderson and the community can focus on to reduce the burden of cancer for African-Americans.

Other Resources
Minorities and Health Disparities (CDC)

African American Health (MedlinePlus)


By Dawn Dorsey, staff writer

Being an accomplished researcher demands painstaking adherence to detail and a firm grasp of the scientific method. But success also requires qualities more difficult to quantify -- independent thinking, integrity, and respect for science and people.

XIU_Li.jpgWhen he mentors a budding scientist, Keping Xie, M.D., Ph.D., associate professor in M. D. Anderson's Departments of Gastrointestinal Medical Oncology and Cancer Biology, models and nurtures these traits. As a staff research scientist in Xie's lab, Qiang Li, Ph.D., has learned his lessons well.

Li, who recently was first author on a paper in Cancer Research, received his doctorate this spring from The University of Texas Graduate School of Biomedical Sciences at Houston (GSBS). The GSBS is a joint program of M. D. Anderson and The University of Texas Health Science Center at Houston.

A pivotal study

Li's study examined the role of transcription factor FoxM1b (mammalian forkhead box) in gastric cancer. Transcription factors are proteins that bind to DNA and control the transfer of genetic information.

Among the findings was a strong correlation between FoxM1b and gastric cancer in humans. In mouse models, over-expression of FoxM1b significantly promoted growth and metastasis of gastric cancer cells, whereas decrease of FoxM1b expression by small interfering RNA had the opposite effect.

Although gastric cancer, also known as stomach cancer, is not common in the United States, this dangerous cancer is the second most prevalent around the world. In this country, 21,130 new cases of stomach cancer will be diagnosed this year, and 10,620 people will die from the disease.

"The underlying mechanism that causes gastric cancer is still unknown," Li says. "There is no effective therapy, especially for advanced disease. It's very important to identify why this cancer starts and grows and to develop drugs to treat it."

"These are very interesting findings," Xie says. "We suggest FOXM1b has a molecular connection with gastric cancer and drives it from low malignancy to high. In the future, this information may be a prognostic and diagnostic factor and provide a targeted therapy."

Personal traits are key

Xie says it's not enough for a researcher to know how to go through the motions of investigation.

"A scientist isn't just a machine that does experiments," he says. "A good scientist has to be a good person -- caring, honest, respectful, a team worker and a good leader. Integrity is the foundation."

Li, who received his master's degree from Shangai Medical University, was drawn to Xie's lab because of ample opportunity to be involved in a broad variety of translational research projects. He's worked in Xie's lab for six years and will remain for six months to finish his research and, he hopes, publish another paper.

"Dr. Xie is a role model to me," Li says. "He has given me a lot of inspiring guidance. We communicate a lot about my projects, and he is always available to answer questions or discuss ideas I have."

Independence sets him apart

Xie has been impressed with Li's work ethic, but he's even more pleased that Li shows independence and initiative.

"He's the No. 1 worker in the lab, and he knows how to design and perform research," Xie says. "But more importantly, he has good ideas and proposes projects. Independence is an essential quality. A lot of people can be researchers, but very few qualify to be principal investigators."

Experts say that 1 in 8 women will develop breast cancer in their lifetime. Taken as a whole, the odds for long-term survival are good -- nearly 90%. For a subset of these women, the future is not so hopeful. These are women with the most aggressive form of breast cancer, called inflammatory breast cancer (IBC).

For women with IBC, the odds are much less optimistic -- a five-year survival rate of 40%; no better than a 10-year survival rate of 25%. According to published epidemiologic data, IBC represents from 1% to 6% of breast cancers. While other breast cancers have been on the decline, IBC has been on the rise.

Where do the numbers come from?
Hospitals around the world track detailed cancer data. Major hospitals participate in national tumor registries, which in turn feed international databases. From these data repositories, valuable population-based information can be gleaned.

In the United States, our cancer registry is the National Cancer Institute (NCI) Surveillance Epidemiology and End Results (SEER) Program. This organization, with advisors from professional medical societies, determines what criteria will be used to code each type of cancer.

How reliable are the numbers?
Inflammatory breast cancer is primarily a clinical diagnosis, dependent upon the expertise of the health professional. That means that the physician differentiates between IBC and other breast cancers based on how the breast looks upon examination, how the symptoms started and how quickly it progressed.

Pathology reports based on tissue samples are able to confirm the presence of cancer cells. That's absolutely necessary to rule out other causes of the physical symptoms of IBC. Especially in IBC, getting a good specimen can be tricky. IBC is on the skin and in the lymph system and rarely forms a lump. Further complicating the pathologic diagnosis is that there's no way to tell IBC from any other type of breast cancer. That brings us back to the clinical diagnosis.

In 2007, SEER implemented a change that has the potential to adversely affect the number of IBC cases. The new rule states that inflammatory carcinoma of the breast should only be recorded in the registry if the final diagnosis of the pathology report specifically states inflammatory carcinoma. These guidelines have been adopted by all state cancer registries and the National Cancer DataBase (NCDB) of the American College of Surgeons, as well as the SEER registries. This change means many cases diagnosed after Jan. 1, 2007, will not be tagged as IBC. This may lead to false conclusions about the incidence of IBC.

Last year, data were presented at the International Inflammatory Breast Cancer Conference that examined the impact of the new SEER coding criteria on IBC cases documented in M. D. Anderson's tumor registry over the last few years. It showed that if the coding criteria were applied to the 247 IBC cases, only 30% of them would be classified as inflammatory breast cancer. This means that current statistics underestimate the incidence of IBC.

Why are numbers important?
Because of the relative rarity of inflammatory breast cancer, little emphasis has been placed on developing drugs that work specifically for IBC. Until very recently, research dollars have been hard to come by. Pharmaceutical companies, not perceiving a large market, are reluctant to fund clinical trials.

Despite the lack of resources, more and more women are becoming aware of "the breast cancer without a lump," also dubbed "the silent killer." Thanks to advocacy groups such as the Komen Foundation and the Inflammatory Breast Cancer Foundation, their voices have become loud enough to be heard. Clinics and hospitals are beginning to dedicate resources to develop treatments and look for causes.

We can't go back. We can't give up. Without a more accurate picture of the number of cases, the risk of IBC being once again relegated to the untreated and unknown looms large.

Our center, for one, will continue to classify IBC based on clinical observation. At the same time, we will continue to explore better methods of diagnosing IBC, including looking for specific characteristics of IBC cells, developing advanced imaging techniques so that our doctors can "see" the cancer and, ultimately, identifying the markers of IBC that can be detected by a simple blood test.

We have a long way to go, but we are determined to "teach it, treat it and beat it."

By Mary Brolley, Staff Writer
Recently, the Public Education Office at M. D. Anderson hosted an event on healthful cooking featuring Scott Uehlein, corporate chef at the Canyon Ranch Health Resorts. For those who missed it, "Cooking Healthy: An Evening with Canyon Ranch Chef Scott Uehlein" is now available online.

canyonranchvideo.jpgFor 30 years, the chefs and nutritionists at Canyon Ranch have created tempting dishes to nourish body and soul. So Uehlein, in collaboration with Rachel Murphy, R.D., senior clinical dietitian in the Department of Clinical Nutrition at M. D. Anderson, provided the tools and inspiration to create delicious, healthy recipes. He cooked, using recipes from his new book, "Canyon Ranch Nourish," now available in stores and online.

The goal was to educate attendees on how their diets can help prevent cancer.

Topics included plant-based diets, low-fat cooking, reducing trans and saturated fats, and the importance of fruits and vegetables in a healthful diet.

Tune in to watch Uehlein and Murphy demonstrate how to cook healthier meals or download the event on iTunes University.

Cyclists from Cheniere's "Making Cancer History Race Across America" team celebrated Christmas in July with pediatric cancer patients from the Children's Cancer Hospital. Former RAAM team member Kirk Gentle and the cycling team's pedal partner and neurofibromatosis patient Emily Parker were at the celebration to encourage the young patients. 


Race Across America is one of the most challenging endurance races in the world, as a symbolic demonstration of how teamwork, research, persistence and ingenuity can triumph over obstacles such as neurofibromatosis. This year's effort was part of an annual campaign that coordinates multiple fundraising events in support of cancer research, treatment and education at M. D. Anderson.

Phyddy_reading.jpg"I work all the time, but still feel like I'm behind."

One of the chief concerns of caregivers is fatigue, both physical and emotional. Many caregivers complain of sleep deprivation. Because of the all-encompassing duties that caregivers must absorb, fatigue and self-doubt may set in. The more tired caregivers begin to feel, the more they may question their ability and self-confidence.

If this fluctuating sense of physical and emotional fatigue has happened with you, don't lose heart. This has been the experience of many caregivers. It's important to take care of yourself during these difficult times, even for small blocks of time.  


Which of the following thoughts of self-doubt can you most identify with?

• Why can't I keep up?
• Why can't I do everything that needs to be done?
• Why can't I get him/her to eat? To drink? To walk?
• Is there something wrong with me because I can't get him/her better?
• Why doesn't he/she talk with me?
• Why can't I control things?
• I'm working as hard as I can and he/she still feels bad.
• I don't have time for anything.
• I feel defeated and burned out.
• My loved one is so irritable with me, I just don't know how to handle it.
• My loved one doesn't want anyone else to care for him/her other than me. I'm getting worn out.
• My loved one won't follow my advice.
• I let picky things get to me.

In my next post, I'll discuss the emotions of caregiving.

If you're visiting M. D. Anderson and you have time, I invite you to join me for our weekly "Caregivers, I've Got Feelings, Too!" support group. It's held on Thursdays, noon-1 p.m., at Place ... of wellness, Main Building. Call 713-794-4700 to reserve a spot. Oh, and we serve lunch.

By Patricia Wells, program director, Family-Centered Care, Department of Pediatrics

In a story about patient safety concerns that was released last week by Hearst Newspapers, the reporter discussed how hospitals are "slow to adopt life-saving practices." The statistics are startling and the solutions seem clear cut, but the fact remains that caring for patients in a busy hospital or medical center is stressful and complex, and even the best hospitals fall short.

Every hospital stay is managed by a team of professionals, but the most important member of your health care team is YOU, the patient and your family.  

Patients and family members who become active partners in health care can help prevent medical errors. In 2002, the Joint Commission launched the national "Speak Up" initiative to urge patients to take a role in preventing health care errors by becoming active, involved and informed participants on the health care team.

Here are a few simple things you can do as you become a more active member of your own health care team:

•    Ask questions. Every question about your health is important. If you still don't understand, ask again.
•    Write down your concerns and take them with you to your doctor visits. Keep a diary or journal of how you're feeling.
•    Know your medications. Whether you are home or in the hospital, know your medications -- the names and what they do. Every time a physician writes a prescription or a nurse brings in a medication, ask what it is and what it's for.
•    Know who is entering your hospital room. Know the members of your health care team -- who they are and what they do.

While it's clear that advances like electronic prescription pads, bar-coded patient ID bracelets and electronic medical records will be an important step in helping reduce hospital errors, nothing takes the place of your active participation in your own health.

Resources

More tips on Surviving your hospital stay (CNN)

The Joint Commission Speak Up initiative

AARP My Personal Medication Record

mkd_cancerwise.jpgBy Mary Brolley, Staff Writer
Nearly 10 years after her diagnosis with breast cancer, Mary Kay Dauria vividly remembers her 7-year-old daughter's reactions to her illness. When friends or acquaintances saw Dauria after the diagnosis, they'd hug her, sometimes crying, and say, "I am so sorry."

"My daughter was watching all that, and she got very worried," Dauria recalls. "She asked me, 'Mommy, are you going to die?'"

"So I began to tell those who expressed condolences, 'Don't take me off your Christmas card list. I'm not going anywhere,'" she laughs.

And, just like every year since her diagnosis, Dauria will attend Anderson Network's Living With, Through and Beyond Cancer patient and caregiver conference Sept. 10-12 at the Houston Marriott Westchase.

A member of and volunteer for Anderson Network, Dauria chaired the conference in 2008. After a 25-year corporate career, she now works with nonprofits managing fundraising events and other projects.

This year's conference theme, "The Strength Within," acknowledges the inner resources and grace cancer patients and survivors like Dauria find essential for their journey and recovery. It also offers participants the opportunity to learn more about the issues cancer survivors face, meet and share with others, take wellness classes and have fun.

Speakers include NBC co-anchor and breast cancer survivor Hoda Kotb, M. D. Anderson clinical professor and cancer survivor Martin Raber, M.D., and humorist Charles Petty, Ph.D. The popular medical panel on Saturday morning will be led by M. D. Anderson President John Mendelsohn, M.D.


The conference is open to all cancer patients, their families and caregivers, regardless of where treatment has been received.

A sampling of the nearly two dozen conference breakout sessions includes:

  • Navigating the world of health insurance
  • Dermatology issues
  • Fear of recurrence
  • Young adult survivors
  • Proton therapy
  • Caregiver issues
As always, a number of complementary and integrative modalities are offered by Place ... of wellness: tai chi, qigong, music therapy, aromatherapy, journaling and safe massage techniques.

And_NtwrkJoinUs.jpgThanks to M. D. Anderson, conference sponsors and individual donors, the cost of the conference is just $75, which includes all meals, activities and self-parking.
Registration is available online until Sept. 4.

For more information or to register, visit the Web site at www.mdanderson.org/patientconference or call 713-792-2553 (Houston) or 800-345-6324 (toll-free).

Anderson Network, an organization with support and educational services for patients/survivors, their families and caregivers, is a program of the Department of Volunteer Services.

A carefully controlled program of progressive weight training benefited women with lymphedema, a study out today in the New England Journal of Medicine reports.

Clinical trial results out of the University of Pennsylvania offer hope for women with the debilitating condition that arises after surgery or radiation therapy for breast cancer. When lymph nodes are removed or blocked during treatment, lymph fluid can build up in the upper arm, causing pain and swelling.

The study is a substantial contribution to the accumulating evidence for weightlifting, a reversal in conventional wisdom that women with lymphedema should avoid such activity, notes Wendy Demark-Wahnefried, Ph.D., professor in M. D. Anderson's Department of Behavioral Science in the Division of Cancer Prevention and Population Science.  

Demark-Wahnefried's accompanying editorial in the New England Journal of Medicine notes that women have been advised to avoid any vigorous, repetitive arm movements (scrubbing, pushing, pulling or hammering) or lifting more than 15 pounds. "But what should a woman do if, after her treatment, she returns home to a houseful of toddlers or has to push a mop for a living?"

The Penn study, distinguished from previous research by its larger size and longer duration, compared patients receiving usual care with women who followed a specific workout twice a week while wearing a custom-fitted compression bandage over the affected arm. All patients had a history of breast cancer treatment and clinically confirmed lymphedema.

Those in the weightlifting program reported improvement in their lymphedema symptoms and demonstrated increased lower and upper body strength, without a significant increase in arm swelling.

Cost analysis was not part of the study, Demark-Wahnefried writes, but weightlifting has the potential for cost savings by reducing direct health care costs, potentially reducing the risk of disability and  allowing women to return to work full time, whether in or outside of the home.

Lymphedema results when the lymph nodes are removed or blocked due to treatment and lymph fluid accumulates causing chronic swelling in the upper arm.
    
 

Athena_200.jpgDid you know that Mentor, the teacher of Telemachus, Odysseus' son, was actually Athena in disguise? I didn't, until my friend and colleague, Janis Apted, and I were discussing a mentoring talk I was preparing and she related this startling factoid.

The story goes like this. Mentor was an old friend of Odysseus. When Odysseus joined the alliance that sailed against Troy, he left Mentor in charge of keeping his household safe. Several times during that period, Athena assumed the shape of Mentor and became the guide of Telemachus, giving him prudent counsel. Since then, wise and trusted advisers have been called "mentors."

This made me reflect on the times through the ages when women have disguised themselves as men, both literally and figuratively, so they could be taken seriously as professionals. And we're still doing it today.


business suits.jpgRemember the blue suits and little bow ties that professional women wore? When I started my career, I told my mother not to buy me anything for work that did not have a jacket. I never presented a talk in anything but a suit. And although things have changed for women in all fields, there's still a sense that we must disguise ourselves -- how we look, how we speak and how we act.

Take for example the photo below of the 26 authors in our book, "Legends and Legacies." These are accomplished women. They're physicians, scientists, department chairs, division heads, vice presidents. However, many of them thought we should dress professionally, in suits and lab coats, to take this photo. But Maria Dungler, the artist behind the book, convinced me and then them, to be seen as women -- and physicians and scientists -- and we produced the Annie Liebovitz-type photo you see here.

Legends and Legacies Authors640.jpg





I'm so glad that no longer does Athena have to disguise herself as a man.

facebook_icon_15.jpgLegends and Legacies on Facebook

Younes_August.jpgTwitter still has no business model. I've heard this before. But somehow, it seems that everyone is on Twitter these days.

Some are tweeting serious stuff with helpful links that can provide important information, like The New York Times, The Wall Street Journal, the National Cancer Institute and M. D. Anderson. Others broadcast to the world every detail of their personal lives, like a New Yorker who felt we needed to know that she was at the supermarket buying lettuce.

In a Twitter community that has no boundaries, anyone can follow anybody and say anything. Therefore, it's not surprising that many remain confused about the real value of Twitter. There are those who find tweeting is a new communication opportunity, while others feel that it's a complete waste of time. Users of Facebook claim that their social media  outlet has more value as they connect with selected old and new friends to share information. Before you know it, the world is becoming polarized between Twitter and Facebook aficionados. We've seen this polarization before: Mac vs. PC and iPhone vs. BlackBerry.

So, what's the best social media outlet to share medical information with the general public? I previously explained why I use social media to share educational materials on lymphoma.  The advantage of Twitter is that you're reaching millions of people anytime, anywhere in the world. There's no question that Twitter can be a powerful tool to spread certain information to the masses. Look at what happened in Iran recently. The disadvantage is, if those millions aren't connected at the same time or they aren't interested, the tweet can indeed be a waste of time.

But for the medical professional like myself, how useful is Twitter? Is it better to tweet to strangers or broadcast to a few selected friends on Facebook? And what about good old Google? Many of us use the Google search engine to find certain information on the web.

So, do we really need to spread the word on social media, or is it better to write a blog post and let people find the information through search engines? I don't think anyone has a simple answer. But I know that Googling a topic isn't good enough.

Have you tried lately to look for information on lymphoma or find a clinical trial for lymphoma on Google? There are endless listings of clinical trials that not only are confusing, but many also are outdated. Also, there's inaccurate information out there. Because of that, my first piece of advice to my web-savvy patients is "do not look for information on the web." I encourage them to ask me the questions, and if they ask for additional information, I provide them with reliable references. In contrast, my tweets provide reliable medical information with up-to-date links in real time. 

I must admit that despite this effort and good intentions, I'm unable to accurately measure the value of my use of social media. However, I know it's adding value. As I pointed out in my previous blog post, our YouTube segment was associated with an increase in referrals to clinical trials at our center. Patients told us so. Since I started tweeting four months ago, the viewers who watched the YouTube video increased from about 5,000 to more that 9,500. Viewers could be anywhere from Japan, Kenya, Russia or the United States. If someone is viewing this, then the message is being spread.

As many medical organizations are now also using social media outlets, there's a flood of medical information on Twitter and Facebook, creating uncertainties on which one, if either, is the way to go. So, for now, and until someone declares victory, I'm using both. And, by the way,  I also use a Mac and a PC, and own a BlackBerry and an iPhone.

By Michael M. Frumovitz, M. D., M.P.H. Assistant Professor, Department of Gynecologic Oncology

There will be almost 11,000 cases of cervical cancer and over 330,000 cases of high-grade cervical dysplasia (or "precancer") in the United States this year. Almost every one of these cases will be a result of exposure to the human papilloma virus or HPV. The health industry will spend almost $4 billion this year to treat HPV and HPV-associated diseases, a huge amount of money not mentioned often in the current health care debate.

There are currently two HPV vaccines manufactured. Both vaccines are virtually 100% effective in preventing HPV transmission if administered prior to exposure to the virus. Cervarix (GlaxoSmithKline) is a bivalent vaccine that prevents cervical dysplasia and cancers caused by the HPV subtypes 16 and 18. These two are the most common high-risk or "oncogenic" subtypes and account for almost 70% of all high-grade dysplasia and cervical cancers. Gardasil (Merck) is a quadrivalent vaccine that also prevents HPV 16 and 18 infections as well as infections with HPV 6 and 11, the two subtypes that account for almost 90% of benign genital warts.


In the United States, only Gardasil is FDA approved and commercially available with Cervarix's approval by the FDA seemingly imminent. Since approval in the late spring of 2006, Gardasil has had less uptake in the United States than originally anticipated. This low penetration into the general population has been seen even after the Centers for Disease Control recommended routine vaccination for all girls and women ages 9-26 through its Advisory Committee on Immunization Practices in the summer of 2006.

A recent study suggests that physicians may be one of the reasons why this important vaccine is not more widely accepted. Less than half of the physician respondents said they recommend the vaccine to all their female patients who are candidates for it. Ideally, this vaccine should be given prior to sexual debut as it only prevents transmission in girls who have never been exposed to HPV. In the United States, 25% of girls will be sexually active by the age of 15 and almost 50% of HPV exposure occurs within the first 18 months after sexual debut. Therefore, it's important to vaccinate girls ages 11-12, as the CDC recommends.

Some physicians are reluctant to discuss it with young girls and their parents since these often can be awkward conversations, as you can imagine. A study by our department, however, showed that more than two-thirds of parents said they would accept the vaccine for their daughters if it was offered to them (Slomovitz BM, Sun CC, Frumovitz M, Soliman PT, Schmeler KM, Pearson HC, Berenson A, Ramirez PT, Lu KH, Bodurka DC. Are women ready for the HPV vaccine? Gynecol Oncol. 2006 Oct;103(1):151-4.). 

Maybe if more physicians knew that parents understand the importance of these vaccines and expect their children's doctors to discuss it with them, physicians would be less hesitant to do so.


Resources
HPV Vaccine - Questions & Answers (CDC)
HPV (Human Papillomavirus) Vaccines for Cervical Cancer (NCI)


By Bayan Raji, Staff Writer

Cancer among elderly people and minority groups is expected to increase dramatically over the next 30 years, precipitating a need for increased research in two groups that often are under-represented in clinical trials.

The study by researchers at M. D. Anderson, published in the June issue of Journal of Clinical Oncology, predicts cancer diagnoses over the next 30 years.

Population, cancer cases will grow

To conduct their research, the team looked at U.S. Census Bureau statistics, updated in 2008 to project population growth through 2050, and the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) database.

They found:
•    The U.S. population is expected to grow from 305 million in 2010 to 365 million in 2030
•    The total number of cancer diagnoses per year will increase from 1.6 million in 2010 to 2.3 million in 2030
•    In 2030, 70% of cancers will be diagnosed in the elderly
•    In 2030, 28% of cancers will be diagnosed in minorities

The study highlighted three important issues:
•    Clinical trial participation
•    Increasing cost of cancer care
•    Expected shortage of oncologists

Groups face challenges

From 2010 to 2030, the rate of cancer is predicted to increase:

•    65% in elderly people
•    100% percent in non-white people

These groups are under-represented in clinical studies and are vulnerable to sub-optimal cancer treatment.

"The fact that these two groups have been under-represented in clinical research participation, combined with the groups' rapid growth in cancer diagnoses, reflects the need for clinical trials of new therapies to be more inclusive and to address issues that are relevant to both populations," says Ben Smith, M.D., adjunct assistant professor in M. D. Anderson's Department of Radiation Oncology and the study's senior author.

Screening, prevention crucial

Cancer rates will increase by:

•    31% in whites
•    64% in blacks
•    76% in American Indian-Alaska Natives
•    101% in multi-racial people
•    132% in Asian-Pacific Islanders
•    142% in Hispanics

Screening and prevention will become essential tools to help prevent a similar growth in cancer deaths. However, no easy answer exists, according to Smith.
"There's no doubt the increasing incidence of cancer is a very important societal issue," Smith says. "There will not be one solution to this problem, but many different issues that must be addressed to prepare for these changes."
Changes take toll on system

The cost of cancer care continues to grow at a rate that's not sustainable for patients.

"As we design clinical trials, we need to seek not only the treatment that will prolong survival, but prolong survival at a reasonable cost to patients," Smith says. "These are two issues that oncologists need to be much more concerned about and attuned to."

A shortage of medical oncologists will have an impact on the health care system by 2020, according to the American Society for Clinical Oncology (ASCO).  

Smith says ASCO and other professional medical organizations beyond oncology are aware of the problem and are trying to increase the number of physicians, nurse practitioners and physician assistants.

More research needed

Unless specific prevention and treatment strategies are discovered, cancer death rates will increase dramatically, according to Smith.

"It's alarming that a number of the types of cancers expected to increase, such as liver, stomach and pancreas, still have tremendously high mortality rates," he says.

M. D. Anderson resources

Audio Interview with Dr. Smith about Cancer Rate Growth (Cancer Newsline)

Cancer Incidence Rates Among Minorities Expected to Increase (David Wetter, Ph.D)

Division of Radiation Oncology


Other resources

Cancer Health Disparities (National Cancer Institute)



How Common Is Use of Off-Label Drugs in Breast Cancer?
Many Patients Receive Legal But Non-Approved Drugs

 More than one-third of breast cancer patients receive chemotherapy drugs that, while approved by the U.S. Food and Drug Administration (FDA), have not been vetted specifically to treat the disease.

The use of drugs for conditions other than those for which they were approved is legal, and, according to a study by M. D. Anderson researchers, prevalent in breast cancer treatment. The study was presented at the American Society of Clinical Oncology's (ASCO) annual meeting in May.

Vaccine Gives Hope Against Advanced Melanoma
First-of-Its-Kind Study Shows Benefit

Patients with advanced melanoma, one of the most dangerous cancers, showed improved response to treatment and length of progression-free survival when a vaccine was added to their treatment with the immunotherapy drug interleukin-2 (IL-2).

Results from the Phase III clinical trial - the first of its kind in melanoma and one of the first in any type of cancer - were presented by M. D. Anderson researchers at the American Society of Clinical Oncology (ASCO) annual meeting in May.

Two-drug Combo Shows Benefit in Lung Cancer
Targeted Agent, Chemotherapy Slow Cancer Growth

When combined with the standard chemotherapy drug Taxotere® (docetaxel), the oral targeted therapy Zactima® (vandetanib) improves progression-free survival for patients with advanced non-small cell lung cancer.

Researchers from M. D. Anderson presented the findings of the first-of-its-kind, international Phase III trial at the American Society of Clinical Oncology's (ASCO) annual meeting in May.

Cancer Newsline Audio Podcast Series

Hodgkin's Lymphoma Treatment Anas Younes, M.D., Professor of the Department of Lymphoma/Myeloma discusses frontline, pre-transplant, and post-transplant treatment options for Hodgkin's lymphoma.

Ways You Can Help Without Giving Money: Donate Blood
Andrea Johnson, Community Representative for the University of Texas M. D. Anderson Blood Bank, discusses the challenges blood banks face when getting blood and platelets for their patients and explains how you can help.

By Bayan Raji, Staff Writer

Americans are crunching budgets and cutting back on expenses, and millions have lost their jobs in recent months. But, cancer hasn't taken a break because the economy is in a rut.

Want to help but don't have the funds to make a monetary donation? Here's a list of ways to help a stranger, friend or relative with cancer.

For a stranger:

•    Donate blood - Many cancer patients need blood transfusions for different reasons, including surgery or a low blood cell count. Donating is a quick and free way to save a life.

•    Volunteer at a hospital - Extra hands often are needed to run gift shops, assist in outpatient facilities or run errands.

•    Get a haircut - Several non-profit groups, such as Locks of Love  and Pantene Beautiful Lengths , donate hair to people who lose their hair as a result of cancer or cancer treatment.

Some salons may provide a discount or even a free hair-cut, but hair donations must meet specific criteria. Ask a stylist for more details.



•    Make Search to Fight http://www.searchtofight.org/ your Internet homepage - On this search engine, Yahoo contributes portions of advertising revenue to the fight against cancer when users click on contributing sponsor links.

•    Donate an old car - Have an old car you'd like to give away? Donate it to the American Cancer Society Cars for A Cure program and proceeds will fund cancer research or other initiatives to fight the disease.

For a friend or loved one:

•    Offer to keep a blog - Many cancer patients use the Internet to keep others up to date on their condition or treatment. A Web page or blog reduces the number of times they have to repeat the same information. It is important not to provide personal information without obtaining permission first.

•    Clean - Treatments such as chemotherapy or radiation dramatically reduce the energy level of most cancer patients. Lend a hand by offering housekeeping services, such as cleaning the bathroom or vacuuming.

•    Cook - Make a meal at home and drop it off. Don't feel offended if you aren't asked to stay. Entertaining guests may take too much energy.

•    Go shopping - Buying provisions for someone in a financial struggle is a nice gesture if you have the money. Taking time to pick up groceries is just as good. It saves a friend or loved one time and energy and shows you are thinking of them.

Resources
CarePages - Stay connected with family and friends
M. D. Anderson Blood Bank
M. D. Anderson Volunteers

A Phase I clinical trial enrolled its first patient only two days after U.S. Food and Drug Administration clearance of the experimental drug for a first-in-human cancer trial -- a milestone that normally takes 3-6 months.

Investigators from M. D. Anderson and pharmaceutical company AstraZeneca have reported their work in the Journal of Clinical Oncology

The joint effort, dubbed Project Zero Delay, is part of a strategic collaboration between the two organizations designed to safely accelerate development of new cancer drugs. In many cases that process takes about 12 years, and the cost of bringing a new drug to patients has been estimated at around $1.3 billion.



"Project Zero Delay demonstrates how we can shrink the time it takes to bring new drugs to cancer patients," says Robert Bast Jr., M.D., vice president for translational research at M. D. Anderson and the paper's senior author. "We need to find out as promptly as possible whether new therapies will help. Zero Delay is a significant step in that direction. Close cooperation allowed us to eliminate unnecessary delays, while fully meeting regulatory requirements for scientific and human safety review."

The key to Zero Delay was performing most tasks in parallel instead of sequentially, according to Razelle Kurzrock, M.D., professor and chair of M. D. Anderson's Department of Investigational Therapeutics. In addition, tasks usually completed after FDA clearance of an investigational new drug (IND) application were instead done in advance. No administrative steps were skipped.

This approach can be applied in other areas of drug development and by other institutions willing to closely cooperate, the authors note.


By Deborah Thomas, Staff Writer

Awareness of your body's movement and how it communicates with your brain are the main foci of the Feldenkrais Method®. This healing art and movement education process may help people deal with cancer treatment-related side effects.

Method retrains body

The Feldenkrais Method was conceived by Moshe Feldenkrais (1904-1984), a physicist and martial artist, mainly to recover from his own sports-related knee injury in the 1920s. He learned to decrease pain and improve performance when he paid attention to how his body moved.

Prior to his findings, most people believed it was difficult to retrain the body to do an already-learned activity once a person reached a certain age. But, Feldenkrais concluded the brain continues to develop throughout life and retains the ability to relearn. His findings have been confirmed by research in neuroscience.



Movement is relearned
MaryBeth Smith, director of the Feldenkrais Center of Houston, teaches free Feldenkrais Awareness Through Movement classes for patients and caregivers at M. D. Anderson's Place ... of wellness.

When she works with a student, Smith says, she doesn't dwell on what hurts or what obstacles are in the way. Instead she discovers what brings pleasure to that person. Through being aware of movement, the student learns to perform everyday actions (for instance, gardening, singing or just being comfortable) using a new pattern that works better with current life circumstances.

Best way to move is individual
"Feldenkrais is different from physical therapy," she says. "We're not trying to fix something that is 'wrong' or to conform to an ideal.

 "We gently assist the person to find his or her own best way to move, and it may not be like anyone else's. Improvement in strength, flexibility and range of motion often result." Once the student finds the ideal movement for what he or she is trying to accomplish, the activity is relearned and incorporated into everyday living.

Awareness Through Movement at Place ... of wellness is underwritten by the C. G. Jung Educational Center, Houston, through funding by The Houston Endowment.



M. D. Anderson resources
Place ... of wellness

Integrative Medicine Program at M. D. Anderson


Additional resources
The Feldenkrais Center of Houston

The Feldenkrais Method of Somatic Education (The Feldenkrais Education Foundation of North America)




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