Why Steve Jobs' Magic Doesn't Work In Medicine

A very beautiful article that explains why medicine does not work the way technology works.

http://www.forbes.com/sites/matthewherper/2011/10/31/why-steve-jobs-magic-doesnt-work-in-medicine/

Cancer Care in India: Patented Cancer Drugs or Basic Radiation Therapy Units?

Rising cost of cancer treatment in India due to lack of generics for third generation wonder drugs  to treat cancer has recently initiated an interesting debate. See this:

http://www.nature.com/news/india-spurns-cancer-patents-1.13552


To me, this debate does not make any sense. Advocating for cheaper Trastuzumab for these unfortunate cancer patients from India sounds like crusading for a delicacy such as 'foie gras' for those who do not even have access to a piece of bread to get rid of hunger. Most of Indian cancer patients die of cancer even without being officially diagnosed with this disease. However, majority of the cancer patients are not dying because they can not afford to buy fancier third generation drugs such as lapatinib or trastuzumab, rather it is lack of basic infrastructure for cancer treatment such as availability of team of specialists including surgical oncologists, medical oncologists, experienced histopathologists (to make diagnoses on tumor biopsies), radiation oncology units with state-of-art equipments in every district level cities/towns in India. Most of the cancer patients in India are being diagnosed with it by general surgeons on the operation table while being operated for some other or associated benign conditions. 

Real journey of turmoil starts now for the families of these cancer patients when (with immense fear of losing their relative, compounded by their inability to arrange finances to be able to travel to one of those few metropolitan cities which is where cancer hospitals/centers are) they start searching for a good cancer center where they could manage to travel to and live within their meager resources for their patient's treatment. Getting their patient admitted in those cancer hospitals itself is a herculean task for these families. It is hard to believe that Uttar Pradesh, most populous state of India, does not have a single medical oncologist in the entire state. Cancer care in the state of Uttar Pradesh is totally in the hands of a few radiation therapists (~20 radiation therapists for a population of 20 million people) residing in < 4-5 functional radiation therapy units, who are over burdened with cancer patients. Most of these patients do have to wait for 2-3 months for their turn when their first radiation therapy session starts. On top of this, most of these sessions are often not complete either due to interruption in power supply in the middle of a session or radiation equipment being broken, making their cycle of therapy sessions incomplete or ineffective. 

Radiotherapy (RT) is one of the major modalities of cancer treatment and about 60% of these patients, no matter which type or stage of cancer they have, will require RT as curative or palliative (reducing symptoms of the disease) intent. International guidelines recommend one megavoltage therapy equipment for every 1,20,000 population, for every 250 new patients providing about 6,250 treatments per year. These calculations are based on the assumption that 50% of the patients could be treated for cure (30 to 40 increments) and 50% of the remaining, for palliation (10 to 20 increments). Therefore, 125 patients × 35 treatments (4375) and 125 patients × 15 treatments (1875), respectively, totaling to 6250 treatments. Taking all types of patients treated and various type of treatments, the above number appears legitimate for planning treatment facilities in an RT center (Ravichandran et al., 2009).

Many cancer centers in India still lack capabilities of simple techniques for tumor localization such as iso-centric simulator x-ray machines, treatment planning systems, 3D imaging capabilities, and mould room facilities. In India, for a population of about 1.1 billion, at the cancer incidence rate of 70 per 100,000 population, 60% of them requiring radiation therapy, they would need about 1155 machines assuming a load of 400 per treatment machine annually. Presently, there are only 400 Cobalt-60 teletherapy

machines (very basic first generation radiation therapy machine which is no more used in any developed country), about 25% of them served more than 10 years (which is way beyond their normal age; 5-7 years) needing urgent replacements, thus making majority of them non-functional, or even non-effective. Availability of only 1/3 rd number (half of that 1/3rd number of available units are non-reliable too boot) of machines compromises with the quality of patient care which may have implications in the optimal outcome. This grim scenario definitely needs improvement.  

As mentioned earlier, Cobalt 60 unit which is what is most commonly used radiotherapy equipment available in India, has become obsolete and has been long replaced by Linear Accelerator (Linac) machines in developed world. Cobalt 60 units provide relatively high energy gamma rays for radiotherapy which are ideally suited for treatment of head and neck cancers and other superficially located tumors such as breast cancers. They are not adequate for treatment of deep seated tumors and have the added disadvantage of decreasing output with decay of source and the need for source replacement within 5-7 years. Disposal of decayed source is another major concern. The edges of the radiation beams coming out of a Linac machine are much more sharply defined than those of a cobalt machine, allowing additional precision in dose delivery. The dose rate per minute is variable and can be turned up very high allowing the patient to be located at substantial distance from the machine in order to create large fields necessary for total skin or total body irradiation while still maintaining adequate dose rate. With cobalt, the rate is determined by the amount of cobalt source in the machine and cannot be regulated. This is why Linac machines are safer and cause lesser side-effects which is a very important considerations for Indian patients most of whom especially women patients are malnourished and can not survive the side-effects of radiotherapy given by Cobals 60 machines. 

Building basic infrastructure for effective and functional radiotherapy units for the whole country will have long term economical impact as well for the general health of a country like India where more and more people are going to live longer, owing to the recent advances in bio-medical sciences such as better immunization programs, availability of life saving medicines and enough food to feed more people than ever in the past. Radiotherapy is not even expensive, especially considering the size of budget India allocates for buying new military gadgets, and their ambitious project to go to the moon in near future. Most of us will be surprised to note that the cost of ~1 military jet fighter is almost comparable to the entire cost for radiation therapy for most average sized countries. In fact, together with surgery, radiotherapy still remains the most cost-effective way of curing cancer. 

I am not against making third generation wonder drugs (which are still covered by foreign patent laws) cheaper for developing countries like India, but focusing solely on this aspect is going to serve only a minority of patients and distracts from the real issue of building basic infrastructure for cancer care. Also, these 3rd generation drugs are not the permanent cure, all they do is probably add few months to few years in the life of a cancer patient. Better attention to basic research to find out etiology of many unique cancer types prevalent in Indian patients, developing prevention strategies, new clinical trials, opening new and more cancer care centers in every district level towns, and most importantly training new generation of physicians in several sub-specialties of oncology is the key which could enable Indian health-care system to fight cancer. 

Bibliography: Ravichandran R. Has the time come for doing away with Cobalt-60 teletherapy for cancer treatments. J Med Phys. 2009 Apr;34(2):63-5.

Visual Inspection with Vinegar (VIN) Based Cervical Cancer Screening Significantly Reduces Cancer Deaths

Few weeks ago Angelina Jolie made it big news by revealing her prophylactic mastectomy. Whether or not you agree with her decision of going through mastectomy just because of those silly genes, one thing you would not be able to disagree on that she prompted general public worldwide to google these exotic sounding words “BRCA1 and BRCA2” genes (now better known as “Angelina Jolie genes”) which so far used to be the part of only scientific discussions confined within the fraternity of cancer researchers. Kudos to Angelina Jolie and her celebrity power that this subject is now being discussed among women worldwide who indeed need to know about it all more than anyone else. I can’t help but believe that yesterday’s Supreme Court (US) decision to wipe patents on Angelina Jolie genes (BRCA1 and BRCA2) was also somehow got positively influenced by the debate recently initiated by Angelina Jolie’s revelation, otherwise this legal battle was ongoing in the courts for years with no conclusive outcome as it happened this yesterday. Irrespective of your quest for findings elements of right or wrong in this landmark decision, people of all walks of life, especially scientists and cancer patients have welcomed this court ruling with equal applause. I will discuss this issue later in my future postings.

Today, the topic that brought me here is very close to my heart for several reasons including a personal one. From last week’s breaking advances in the field of cancer research, I thought of picking this piece of research work, because I consider it as a big feat achieved by scientists from India, a third world country, where even a thought of having an standard cancer care infrastructure seems to be a luxury, given the dire need for general physicians and infrastructure to treat bacterial and viral diseases. This was one of the highly talked about and praised research work recently discussed at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago last week, in which over 26,000 cancer scientists and clinicians attended this meeting and thousands of research studies, small and large were reviewed by the scientific fraternity. Because ASCO is the world’s most dominant oncology specialty group, the discussions and recommendations set the standard for cancer care in the world. 

Well, a research team led by Surendra Srinivas Shastri, MD, a professor of preventive oncology at Tata Memorial Hospital (oldest and probably single dedicated cancer hospital and research center in India, a country of 1.25 billion people) in Mumbai, India, developed a simple screening technique using an inexpensive chemical agent, vinegar or acetic acid, dramatically reduced deaths related to cervical cancer in a large population of Indian women. This powerful study shows that how just “visual inspection with acetic acid or (VIA)”, conducted by non-medical personnel trained to deliver basic healthcare (paramedical staff), could cut the death rate by 31%.

One of the most important aspects of this finding lies in the fact that this strategy is highly effective and can be implemented on a broad scale in low-income countries. "There was almost no overdiagnosis, it doesn't require a laboratory, and it can be widely implemented in the lowest-resource settings, such as India," said lead study author Dr. Shastri. "If implemented at national level in India, it could prevent 22,000 cervical cancer deaths," said Dr. Shastri, who presented the findings of this large randomized trial during a plenary session at the 2013 Annual Meeting of ASCO in Chicago. He went on to say that "if taken globally to the lowest-resource countries, this method could prevent around 72,000 deaths in the developing world."

Cervical cancer is the leading cause of cancer-related mortality in women in many developing nations, where access to Pap test screening (gold standard screening method for diagnosing early stage cervical cancer) is very limited or nonexistent. Widespread Pap test screening in high-income countries has significantly reduced the incidence and subsequent death rate from cervical cancer by 80%. Unfortunately, from my own experience of talking to Indian women (I am originally from India, and keep visiting India almost every year) in my own extended family and friends, my impression is that even educated women have not heard of Pap test screening methods, let alone thinking of asking their primary care physicians to write a pathology test for this.   

Apart from lack of awareness about health issues among common people in India, "There is no cervical cancer screening program in India because it is not feasible," explained Dr. Shastri. "There is inadequate infrastructure, a lack of trained human resources, logistic difficulties, and a relatively high cost."

Therefore, the researchers looked at VIA, which is a simple visual test that can be done without laboratory support. "It consists of an application of 4% vinegar to the cervix, and the results are available in 1 minute," Dr. Shastri explained. "Paramedical workers can be trained in 4 weeks."

VIA screening method is validated

Another cancer researcher and leader in the field and also discussant for the study during the plenary session, Electra D. Paskett PhD, professor of medicine at the Ohio State University Comprehensive Cancer Center in Columbus is very enthusiastic about this pioneering study, “What is unique about this study is that it was conducted in the slums of Mumbai in an unscreened population, and participation was high and the size of the sample was large. What is essential here is the fact that both diagnostic and treatment services were available to women in both arms without any charge."

Dr. Paskett also pointed out that there are several take-home messages from this study; 1) that the VIA method has been validated, 2) it has been accepted, 3) it is inexpensive, 4) can be used in low-resource areas, and 4) can save lives.

Study Details

In this clinical trial, VIA screening technique was performed by community-based nonmedical primary health workers trained to provide basic healthcare services in regions that lack physicians and nurses. The researchers had to pass through several layers of community barriers, such as community leaders and religious leaders, before being able to speak with the women. It is noticeable that India is home to several religiously conservative communities and preventive measures in the past such as polio vaccination program had to face a lot of resistance in these communities.  "We involved the community, giving them a sense of participation, and we were able to create as sense of community ownership," Dr. Shastri said. "This ensured better participation."

Dr. Shastri and colleagues initiated this cluster randomized controlled trial in 1998 to evaluate the ability of VIA screening to reduce cervical cancer mortality. The participants were 35 to 64 years of age and had no history of cancer. The study design involved 20 clusters, with an average of 7500 eligible women in each cluster. Ten such clusters served as the screening group (n = 75,360) and 10 served as the control group (n = 76,178). From statistical point of view, this is one of the very large and powerful research studies in the history of recent clinical trials.

Primary health workers or paramedical staff did conduct 4 rounds of cancer education and VIA screening at the intervals of 24 months in each screening group. In the control group (a group of people, which was not screened by VIA, usually having such population groups are part of standard study method to conduct a scientific experiment and used as population to compare the results against), cancer education was offered once at recruitment.

Reduction in Mortality Rate

Although the researchers had planned for a 16-year study, they analyzed results at 12 years. Compliance was high, with 89% participation in screening and 79% compliance with postscreening diagnostic confirmation. The researchers note that the quality of screening performed by the primary health workers or paramedical health care workers was almost comparable to that of an experienced gynecologist.

The incidence of invasive cervical cancer was very similar in the screening and control groups (26.74 vs 27.49 per 100,000). However, for those with invasive cancer, treatment compliance was higher in the screening group than in the control group (86.34% vs. 72.29%). In the screening group, there was a 31% drop in mortality related to cervical cancer, compared with the control group (P = 0.003).

In addition to the decrease in deaths related to cervical cancer, there was also a 7% reduction in all-cause mortality (RR, 0.93; P = .41), possibly due to the fact that these patients enrolled in VIA screening program had better/timely access to medical interventions.  

On the basis of these results, the Indian health officials in the state of Maharashtra, a western province of India, where the trial was conducted, are preparing to train primary health care workers to provide VIA screening to all women 35 to 64 years of age at 24-month intervals. In addition, the Indian government is working to implement nationwide VIA screening, and is planning to reach out to other low- to moderate-income countries to share these results and offer assistance with training.

Interestingly this study was financially supported by the National Institutes of Health (NIH), USA, and Women's Cancer Initiative. Just confirms the belief that science does not care of physical boundaries, it helps humanity in general.

Take home message – while developments in state-of-art biomedical technologies are certainly needed to keep this fight alive against this dreaded disease cancer, we must not ignore the power of old fashioned scientific methods such as visual inspection with acetic acid (VIA) which can significantly reduce the death rate by cancers in the major part of the world. 

http://cancerconversations.uchospitals.edu/voices/asco-day-2-the-yin-yang-in-cancer-treatment-costs/

Very Inspiring Story

Just gives a glimpse of the lives of scientists about we do in our laboratories, and how our determination to do what we do everyday is strengthened by incidences that touch our own lives. Kudos to Dr. Igor Astsaturov (a former colleague, philosopher, and friend for me) who, I am confident, will soon be able to help other patients with pancreatic cancers with his newly identified drug...!!

http://www.huffingtonpost.com/jessica-wapner/driven-by-love-a-step-for_b_3396927.html


   

Endometrial Hyperplasia

When a relative of mine got diagnosed with a condition called “Endometrial Hyperplasia” and she and others among family and friends became curious about it, I thought of providing some basic information regarding this condition:    

What is endometrial hyperplasia?

 

Endometrium, is the tissue that lines the UTERUS. Endometrial hyperplasia occurs when the endometrium, the lining of the uterus, becomes too thick. It is not cancer, but in some cases, it can lead to cancer of the uterus. Endometrial hyperplasia is indeed a precursor to the most common gynecologic cancer diagnosed in women, which is “endometrial cancer” of endometrioid histology. It is most often diagnosed in postmenopausal women, but women at any age with unopposed estrogen from any source are at an increased risk for developing endometrial hyperplasia.

How does the endometrium normally change throughout the menstrual cycle?

The endometrium changes throughout the menstrual cycle in response to hormones. During the first part of the cycle, the hormone estrogen is made by the ovaries. Estrogen causes the lining to grow and thicken to prepare the uterus for pregnancy. In the middle of the cycle, an egg is released from one of the ovaries (ovulation). Following ovulation, levels of another hormone called ‘progesterone’ begin to increase. Progesterone prepares the endometrium to receive and nourish a fertilized egg. If pregnancy does not occur, estrogen and progesterone levels decrease. The decrease in progesterone triggers menstruation, or shedding of the lining. Once the lining is completely shed, a new menstrual cycle begins.

What causes endometrial hyperplasia?

Endometrial hyperplasia most often is caused by excess estrogen without progesterone. If ovulation does not occur, progesterone is not made, and the lining is not shed. The endometrium may continue to grow in response to estrogen. The cells that make up the lining may crowd together and may become abnormal. This condition, called hyperplasia, may lead to cancer in some women.

When does endometrial hyperplasia occur?

Endometrial hyperplasia usually occurs after menopause, when ovulation stops and progesterone is no longer made. It also can occur during perimenopause, when ovulation may not occur regularly. Listed as follows are other situations in which women may have high levels of estrogen and not enough progesterone:

•        Use of medications that act like estrogen

•        Long-term use of high doses of estrogen after menopause (in women who have not had a hysterectomy)

•        Irregular menstrual periods, especially associated with polycystic ovary syndrome or infertility

·         Obesity

What risk factors are associated with endometrial hyperplasia?

Endometrial hyperplasia is more likely to occur in women with the following risk factors:

• Age - older than 35 years

• White race

• Never having been pregnant

• Older age at menopause

• Early age when menstruation started

• Personal history of certain conditions, such as diabetes mellitus, polycystic ovary syndrome, gallbladder disease, or thyroid disease

• Obesity

• Cigarette smoking

• Family history of ovarian, colon, or uterine cancer

 

What are the types of endometrial hyperplasia?

Endometrial hyperplasia is classified as simple or complex. It also is classified by whether certain cell changes are present or absent. If abnormal changes are present, it is called atypical. The terms are combined to describe the exact kind of hyperplasia:

• Simple hyperplasia

• Complex hyperplasia

• Simple atypical hyperplasia

• Complex atypical hyperplasia

 

What are signs and symptoms of endometrial hyperplasia?

The most common sign of hyperplasia is abnormal uterine bleeding. If you have any of the following, you should see your obstetrician–gynecologist:

• Bleeding during the menstrual period that is heavier or lasts longer than usual

• Menstrual cycles that are shorter than 21 days (counting from the first day of the menstrual period to the first day of the next menstrual period)

• Any bleeding after menopause

 

How is endometrial hyperplasia diagnosed?

There are many causes of abnormal uterine bleeding. If you have abnormal bleeding and you are 35 years or older, or if you are younger than 35 years and your abnormal bleeding has not been helped by medication, your obstetrician–gynecologist may perform diagnostic tests for endometrial hyperplasia and cancer.

Transvaginal ultrasound may be done to measure the thickness of the endometrium. For this test, a small device is placed in your vagina. Sound waves from the device are converted into images of the pelvic organs. If the endometrium is thick, it may mean that endometrial hyperplasia is present.

The only way to tell for certain that cancer is present is to take a small sample of tissue from the endometrium and study it under a microscope. This can be done with an endometrial biopsy, dilation and curettage, or hysteroscopy.

 

What treatments options are available for endometrial hyperplasia?

In many cases, endometrial hyperplasia can be treated with progestin. Progestin is given orally, in a shot, in an intrauterine device, or as a vaginal cream. How much and how long you take it depends on your age and the type of hyperplasia.

Treatment with progestin may cause vaginal bleeding like a menstrual period.

If you have atypical hyperplasia, especially complex atypical hyperplasia, the risk of cancer is increased. Hysterectomy usually is the best treatment option if you do not want to have any more children.

For more details, please read this review article:

http://utilis.net/Morning%20Topics/Gynecology/Endometrial%20Hyperplasia.pdf

 

What can I do to help prevent endometrial hyperplasia?

You can take the following steps to reduce the risk of endometrial hyperplasia:

• If you take estrogen after menopause, you also need to take progestin or progesterone.

• If your menstrual periods are irregular, birth control pills (oral contraceptives) may be recommended. They contain estrogen along with progestin. Other forms of progestin also may be taken.

• If you are overweight, losing weight may help. The risk of endometrial cancer increases with the degree of obesity.

 

Technical Terms:

Cells: The smallest units of a structure in the body; the building blocks for all parts of the body.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

Dilation and Curettage: A procedure in which the cervix is opened and tissue is gently scraped or suctioned from the inside of the uterus.

Endometrial Biopsy: A test in which a small amount of the tissue lining the uterus is removed and examined under a microscope.

Endometrium: The lining of the uterus.

Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus.

Hormones: Substances produced by the body to control the function of various organs.

Hysterectomy: Removal of the uterus.

Hysteroscopy: A procedure in which a slender, light-transmitting device, the hysteroscope, is inserted into the uterus through the cervix to view the inside of the uterus or perform surgery.

Intrauterine Device: A small device that is inserted and left inside the uterus to prevent pregnancy.

Menopause: The time in a woman’s life when the ovaries have stopped functioning, defined as the absence of menstrual periods for 1 year.

Menstruation: The monthly discharge of blood and tissue from the uterus that occurs in the absence of pregnancy.

Ovulation: The release of an egg from one of the ovaries.

Perimenopause: The period preceding menopause that usually extends from age 45 years to 55 years.

Polycystic Ovary Syndrome: A condition in which levels of certain hormones are abnormal and small growths called cysts may be present on the ovaries. It is associated with infertility and may increase the risk of diabetes mellitus and heart disease.

Progesterone: A female hormone that is produced in the ovaries and that prepares the lining of the uterus for pregnancy.

Progestin: A synthetic form of progesterone that is similar to the hormone produced naturally by the body.

Transvaginal Ultrasound: A type of ultrasound in which a transducer specially designed to be placed in the vagina is used.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

 

                                                                                Courtesy: The American College of Obstetricians and Gynecologists

Bruce Alberts on Future of American Science

“I have seven grandchildren, and I worry about their future. The nation that I was raised in, the United States, has clearly lost its way at a time when the world badly needs wise leadership. Nations with a long-term view are making huge investments in their infrastructure—transportation, water, energy, waste, and recreation. And they have a laserlike focus on supporting science and engineering research with government resources. As examples, Germany, China, and South Korea come to mind. Meanwhile, the United States is living off its past. Not only do we face a crumbling infrastructure but our federal investments in fundamental long-term R&D have been stagnant, dropping from 1.25% of the gross domestic product (GDP) in 1985 to 0.87% in 2013.† Now, on top of that comes a mindless budget "sequester" that will make the situation considerably worse, causing the U.S. National Science Foundation to announce last week that it may award 1000 fewer research grants in 2013 than it did in 2012.”

                                                     - Bruce Alberts (Science 15 March 2013)

 

This is not a thought of an average US citizen. Dr. Alberts, a past president of National Academy of Sciences, Editor-in-Chief of famous journal “Science”, is also a path breaking scientist in this own right, a leader, and visionary in American Science. Almost everyone in our generation of molecular biologists grew up reading his classic book during our college days that inspired us making our career in this field. His concerns seem quite genuine.

 

One study predicts that 2023 may be the year that America loses its global Research & Development (R&D) leadership.

China is on its track to overtake the U.S. in spending on research and development in ~ 10 years, as federal R&D spending (in the U.S.) either declines or remains flat.

 

However, it should not be forgotten that the United States still maintains a large lead in R&D spending over China, with federal and private sector investment expected to reach $424 billion next year, a 1.2% increase.
 

By contrast, China's overall R&D spending is $220 billion next year, an increase of 11.6% over 2012, a rate similar to previous years, according to the 2013 Global R&D Funding Forecast prepared by Battelle, a research and technology development organization, and R&D Magazine. "The U.S. still has a significant lead and advantage in R&D over all of these countries," said Martin Grueber, one of the authors of the report and a lead researcher at Battelle, "but the concern is R&D is a long-term investment, and as these other countries continue to grow their R&D capabilities ... how long can we maintain that advantage?"

 

A major share of R&D research in the U.S. is funded by the federal government, which is expected to budget $129 billion for R&D next year, a decline of 1.4%. This figure could decrease even further if Congress does not resolve its budget impasse.
 

Government R&D spending is considered significant as  because, unlike the private sector, it funds basic research. This is research that often takes years or decades to yield results, but it can also lead to new industries and jobs. Basic research is the back bone of industrial growth in any economy.

Other emerging economies, besides China, are also spending more on R&D. India, for instance, will invest about $45 billion next year in R&D, an increase of just over 12%.
 

President Obama has called for national R&D expenditures equal to 3% of GDP, which includes private and government investment. The forecast for next year is 2.66% of GDP, according to the Battelle forecast.

The White House also believes that China may overtake the U.S. in R&D spending.

"China's investment as a percentage of its GDP shows continuing, deliberate growth that, if it continues, should surpass the roughly flat United States investment within a decade," said the President's Council of Advisors on Science and Technology.

One significant but often ignored aspect of R&D operations conducted by U.S. is offshoring, which according to the White House report, "has negative long-term consequences for the United States."

The report also said that R&D returns to the U.S. economy are "likely highest when the research is both generated and used within the United States."
 

With a battery of talented scientists, engineers, medical doctors, present in the country, future of American excellence in Science and Technology is still bright, provided political leadership is honest and strong enough to resolve this issue sooner and act faster. Unfortunately, this is the most disheartening part – US Congress does not appear likely to take steps in the near term to improve R&D spending. Hope they are listening to what Dr. Alberts is echoing in his editorial piece this week.  

 

Some 2,000 odd men each year are diagnosed with breast cancer

When we think of breast cancer we always typically think of women, but it is true that approximately 2,000 men per year are diagnosed with this disease in the United States alone. Yes, breast cancer may develop in men at any age but it has typically been seen in men between 60 and 70 years of age. While male breast cancer is still a rare type of cancer as it makes up less than 1% of all cases of breast cancer worldwide, it is worthwhile to understand what it is all about.

There are several types of breast cancer found in men:

·         Infiltrating ductal carcinoma: Cancer that has spread beyond the cells lining ducts in the breast. Most men with breast cancer have this type of cancer.

·         Inflammatory breast cancer: A type of cancer in which the breast looks red and swollen and feels warm.

·         Ductal carcinoma in situ: Abnormal cells that are found in the lining of a duct; also called intraductal carcinoma.

·         Paget disease of the nipple: A tumor that has grown from ducts beneath the nipple onto the surface of the nipple.

One of the common types of breast cancer found in women is Lobular carcinoma in situ (abnormal cells found in one of the lobes or sections of the breast); this has not been seen in men.

Difference between Male and Female breast cancers

 

Male breast cancer seems to behave similarly to female breast cancer, and the disease in men is treated more or less similar to female disease. One difference between the two is in the timing of when men present with the disease, as versus when women seek care for the issue. Women typically undergo mammographic screening, bringing tumors that are not palpable to the attention of a doctor. Men do not undergo such screening because they usually have far less breast tissue and most tumors in the breast can be felt. Unfortunately however, while women are well aware that a breast lump is a concerning sign that should be brought to the attention of a doctor, many men still feel either embarrassed about seeking care for a breast lump, or are incredulous at the idea that they could have breast cancer or a serious illness that has become symptomatic. The consequence is that men tend to present to their doctors at a later stage, initially ignoring the finding more frequently than women do. When you compare the genders however, men do as well as women, stage for stage.

 

Risk factor for male breast cancer:

·         Being exposed to radiation.

·         Having a disease related to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder.)

·         Having several female relatives who have had breast cancer, especially relatives who have an alteration of the BRCA2 gene.

·         Male breast cancer may sometimes be caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups. Men who have an altered gene related to breast cancer have an increased risk of developing this disease.

 

Men with breast cancer usually have lumps that can be felt.

Lumps and other symptoms may be caused by male breast cancer. Other conditions may cause the same symptoms. Check with your doctor if you notice a change in your breasts.

 

Treatment for male breast cancer

The typical treatment for men having breast cancer is a mastectomy, because there is little breast tissue to save, and resecting the tumor completely with “negative margins” (a margin of normal tissue surrounding the tumor, showing that it has been completely removed) may be more difficult.

 

In women, the cosmetic and sexuality issues surrounding the breast prompted investigation of lumpectomy with radiation as an alternative to mastectomy, and has been found to be equally safe. In men this has not been investigated sufficiently in trials to date to conclude this is safe. Men therefore have mastectomies as standard surgical treatment, along with assessment of lymph nodes.

 

When a man develops a breast lump, it is consequently important that he seek evaluation by a physician. While most lumps tend to be benign, a breast surgeon is best qualified to determine if this is something that may be normal or should be further assessed to rule out breast cancer.

Never ignore such a finding, and certainly don’t be embarrassed to seek advice from your doctor. Better to “overreact” and get attention of your doctor for something that’s benign, than ignore the problem and find out too late that it could have more easily been addressed earlier.

 For details, read following publication:

 

http://www.ncbi.nlm.nih.gov/pubmed/22987302