Len Lichtenfeld

Len Lichtenfeld, MD, is deputy chief medical officer of the American Cancer Society. Send House Call questions to editor@curetoday.com.

CURE: There has been a lot of debate about the recent changes to the American Cancer Society’s guidelines for mammography screening for breast cancer. What are your thoughts on this issue?

The attention to mammography as a result of the American Cancer Society’s newly updated breast cancer screening guidelines for women at average risk has left me reflecting on a longheld concern about how we approach breast cancer awareness, detection and treatment in this country. In particular, reducing the burden of breast cancer must be about more than just mammograms. As important as they are in saving lives, they are but one piece of a much larger puzzle.

There is so much more we could do to make the pieces come together. Think about what we could accomplish if we were to effectively and passionately approach breast cancer as a truly coordinated nationwide effort:

We would help women understand their individual risk of getting breast cancer in the first place. And when the situation dictated, we would have potentially high-risk women seen by professionals well-versed in understanding genetic diseases, who would order the appropriate tests. We would counsel women at high risk of breast cancer about their options for risk reduction with more sophisticated and frequent screening, as well as offering options to reduce their risk.

We would make quality mammography available to everyone, especially women in need. We would make mammograms available at locations and hours convenient for women, including those with no mammography offices in their neighborhoods. We would help women understand the benefits and limitations of mammograms, and help them determine the right course for them personally regarding early detection, in part buttressing those discussions with information and understanding of their personal risk and core beliefs about early detection.

We would get women with suspicious or proven findings on a physical examination or screening mammogram followed up promptly, using the most appropriate test. And if breast cancer was found, we would use navigators to help get them to and through their treatment. After initial treatment, we would help answer women’s questions and make certain they continued to get appropriate health care.

Those are just a handful of my thoughts on what we could do better when it comes to our understanding and approach to breast cancer. We also need to realize that breast cancer is about more than pink ribbons and mammograms. It’s about empowering women to be the drivers of the discussion and offering them the greatest chance for outcomes that are best for them.

So let’s make the discussion about breast cancer more inclusive — inclusive of the women we serve and the care we offer. Let’s make certain all the pieces of the puzzle are put into place. Only then will we be able to say we truly are doing everything we can to diminish the impact of breast cancer for everyone throughout our great nation

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House Call with Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society.

In Approach to Breast Cancer, Consider More Than Screening Guidelines

Len Lichtenfeld, MD, is deputy chief medical officer of the American Cancer Society. [Photo Courtesy of Len Lichtenfeld, MD]

Q: How much can doctors figure out about our cancer status just by analyzing our blood? Shouldn’t the answers be right there, without more invasive testing, if we just knew how to find them?

 About 10 years ago I attended a cancer conference where one of the speakers talked about the future of cancer care and mentioned “diagnosis on a chip.” An intriguing idea at the time bordering on science fiction, he predicted that within the next decade we would be able to take a drop of blood at home and send it for analysis to a lab that would screen for cancer and other chronic diseases.

Now, according to several reports appearing recently in medical journals, it looks like that brave new world may not be far off.

Researchers have reported they have been able to detect what are called “cell free DNA” fragments in the blood of patients with head and neck cancer and pancreatic cancer. Another report detailed how testing the blood of pregnant women for birth defects in their offspring found evidence of cancer in the mothers — sometimes even before that cancer had been detected clinically. And yet another researcher briefly mentioned, at a meeting I recently attended, that a pharmaceutical company was monitoring DNA signals in the blood of patients participating in an early-stage drug trial, finding evidence of how the patients’ cancer cells were mutating in real time to evade the new targeted therapy under investigation in the trial.

This is all truly amazing research. But before we get carried away, it is important that we pay attention to what we know — and what we don’t know &mdash; about this new frontier in screening and treating cancer.

First and foremost, this research is still in very early stages when one considers its applications to cancer care. Researchers have shown they can find the DNA signals in the blood and other bodily fluids. That does not mean that such tests are ready for widespread use. Then there are the studies that must be done to determine how to best use this information to inform the care that we offer our patients. It is likely to take much more effort and perhaps a number of years before we have widely available clinical applications for these exciting discoveries.

As always, caution is the word. There will always be someone out there who wants you to believe they have a test that is better than what everyone else can offer. That rarely is the case. Before we start using this technology to screen or diagnose or treat cancer, we need to make certain we understand not only the power of the science, but its limitations as well

House call with Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society.

Len Lichtenfeld

In Approach to Breast Cancer, Consider More Than Screening Guidelines

Diagnosis on a Chip? No Longer Science Fiction

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