There is a front page story in the NY Times today showing how although death rates from heart disease and stroke have plummeted by more than 50% since 1950 the death rate from cancer has dropped by only 5%. This belies the much touted “war on cancer” which has been trumpeted in the media and amongst our leading medical institutions. I have long been annoyed by the cancer medical machine. The thing the bothers me the most about it how much people out and out lie (doctors, journalists, healthcare administrators) about the effectiveness of their treatments and so-called progress in this field. America spends more on cancer research and treatment than any other country. The result? Cancer death rates essentially unchanged, our healthcare outcomes second worse in the industrialized world. Surprised?

I guess we can blame the marketers who want to sell us low fat diet/breakfast cereals/high fiber/vitamins/etc, none of which have been shown to prevent cancer. And I have written here before about the lack of utility of breast and prostate screening although many readers have publicly and privately thrown eggs at me. Back then I wrote about studies showing that breast and prostate cancer screening only decrease your risk from that disease by 1 in 10,000 screened and don’t reduce overall mortality. Unless you are from France. So you can wear your pink ribbon if you want but it won’t necessarily do much good. Sorry to be so negative. 

Fact is that if you have metastatic cancer from whatever you can’t get rid of it, unless it is testicular or thyroid or some types of lymphoma. The treatments only slow down the progression. The “statistically significant improvements in survival” mean that if you take toxic chemotherapies you might live 12 weeks instead of 10. With more nausea and vomiting. Big deal.

[addendum: Fellow MD blogger (”Critical Condition“) Rick Lippin MD sent me this letter to Sen. Specter:

Classification: UNCLASSIFIED

Caveats: NONE

Doug

Thanks

Here is what I wrote in my blog-Open letter to my Senator who was instrumental in obtaining funding to continue this “failed war”

Feel free to circulate

(PS- America seems to have a penchant for declaring war on a number of things and then failing- War is our chief metaphor)

Rick Lippin

Senator Specter,                          Re “CURING CANCER”

Since I heard you make a similar comment I want to express my objection to your and  President Obama’s  use of the phrase “we need to cure cancer in our lifetime”

This phrase is not consistent with what experts know about the biology of cancer- over 200 different types I might add.

Senator -There is no “cure for cancer”.  Just like there is no “cure” for aging. We can cure individual patients with certain types of cancer thank goodness but indisputably the greatest risk factor for most cancers is cellular and bodily aging.

Declaring we “need to cure cancer” is well intentioned but naïve – harkening back to President Richard Nixon’s failed war on cancer from the 1970’s.

We must continue to chip away at the many factors that contribute to cancers but to suggest we will “cure” all is completely unrealistic and is actually irresponsible.

I share your interest in these diseases and applaud your own personal triumphs and political leadership in this arena.

Sincerely,

Richard A Lippin MD

Southampton,Pa

March 2009

A certain SOMEONE that I know who is a healthy middle aged woman had to undergo a colonoscopy cuz her gynecologist came up with a positive guaiac test (screening for internal bleeding). Only AFTER the scope did I start to wonder about if there could be false positives, and me ‘n goolgle learned that if you eat a lot of tomatoes you can come up false positive, and since she is Yugoslavian (har, har) she eats a lot of tomatoes. Her physician SHOULD HAVE warned her of that. Doh! Now her mammogram got flagged for additional testing and I am starting to wonder (yup) could it be false positive?

That is why an article in this weeks’s bmj about breast cancer screening caught my eye. Current recommendations state that women over 50 should get yearly mammograms, and pamphlets say that screening will save lives and decrease mastectomies, which, alas, is apparently not true. The article shows that one in 10,000 women will be saved from a death related to breast cancer if they get yearly mammograms. However, 5% of mammograms come up as false positives, meaning that women will have to wait for months with anxiety, coming back in for more painful and expensive tests, all for nothing. And what is more, over a ten year period there is a 50% chance of a false positive. That means that women getting mammograms as recommended can flip a coin; heads you get a false positive reading, tails you don’t.

And what is worse, if you are found to have a cancer in situ, which constitutes 20% of cases, that will likely lead to radiation, even though less than half of these cases will progress to a spreading cancer. Obtaining this information was described as lilke “trying to uncover a closely guarded state secret.”

Which brings us to the fact that breast cancer screening has not been shown to have any effect on mortality. The implication is that for each life saved from breast cancer, there is one life lost due to the effects of radiation treatment for something like cancer in situ that would never have progressed anyway.

In other words, breast cancer screening is of little substantive value.

Arghhh!

Let’s start making our list of useless screening procedures.

Hat tip to the Gary Schwitzer Health News Blog.

I don’t care if it may give me breast cancer or heart disease. Thanks, APHRODITE Study Team!!

APHRODITE Study Team? ROTFL!!

I SWEAR TO GOD I am not making up this goofy study name.

I wonder if the study investigators ever got horny at one of their research meetings? Or by looking at their data?

Anyway, seriously folks. The results of the “A Phase III Research Study of Female Sexual Dysfunction in Women on Testosterone Patch without Estrogen (APHRODITE)” study published in the NEJM today showed that if post-menopausal women who have a loss of libido put a testosterone patch on their arms that they will have satisfying sex once a month more than they are currently having, although there may be a risk of breast cancer or cardiovascular disease [read on]

I’ve got a tip for the marketers of this testosterone patch. If the women are having satisfying sex only once a month, and now they have it twice, why don’t you say that the drug results in a 100% increase in satisfying sex!!!

Ha ha ha ha ha!

OK folks all fun aside lets look at the data. In this study Davis et al (Davis SR et al NEJM 2008; 359(19): 2005-2017. November 6 2008) studied 814 women treated for 52 weeks with 300 or 150 microgram testosterone patches or placebo patches. There was an increase in “satisfying sexual episodes” of 2.1 in treated versus 0.7 for placebo, an increase that was statistically significant. There was about a 10% difference in scores on a sexual pleasure scale. 30% grew unwanted hair v 23% for placebo. Breast cancer was diagnosed in 4 out of 527 treated women and in none of the women on placebo.

That’s right folks, sex once a month. And possible risk of getting breast cancer.

And a beard.

Nonconclusive results about cancer you say. And Mrs Robinson asks if she has anything to worry about.

Well a recent study by Tamimi et al (J Natl Cancer Inst 2007; 99(15): 1178-1187) found that women who naturally had the highest testosterone levels (top 25%) had a two fold increase in breast cancer compared to women in the lowest 25%.

And another study by Maturana et al (Metabolism, 2008; 567 (7):961-965) found that postmenopausal women with elevated testosterone had increases in markers of inflammation and endothelial dysfunction, C-reactive protein (CRP) and endothelin, that have been associated with increased risk of atherosclerosis.

And let’s not forget the increased risk of heart disease and cancer associated with hormone replacement therapy (HRT) which I have written about before, and testosterone has to have a suspicion of similar risk.

The authors of the current study point to the fact that about a third of post-menopausal women have sexual dysfunction, and imply that even the meager gain they eak out with their patch is worth it in terms of keeping their mans happy. However they need to provide evidence for their implied claim that libido is killed by menopause and that women need to use a hormonal patch for that. They seem to hark back to the physician author of Feminine Forever, who implied that menopause was a disease to be treated with HRT, and that women became old crones, wrinkled and ugly, nasty, and incapable of sex, and that they needed HRT to treat this malady. Well I won’t belabor that now, and you can follow the links on this web site if you want to learn more about HRT, but I can tell you that controlled studies show it has no effect on libido, and only increases risk of cancer and heart disease. So there.

The authors imply that menopause is associated with an inevitable decline in libido for women, and that they need to take a drug to correct that. But I am not aware of any literature to support this conclusion, and if anyone has something, let me know. I mean, Mrs. Bremner seems to be doing OK so far.

As far as I know these testosterone patches are approved for hypogonadism in men with low testosterone, but are widely used off label for loss of libido in men and women. The APHRODITE study results may be used to promote off label use of the patches. Stay tuned.

The FDA posted some slides on this topic here.

Thanks to Marilyn Mann for sending me articles and comments on this topic.

[originally posted on November 6, 2008]

Therapy Patient wrote on November 12, 2008

What always bothers me about many studies (such as this one) is that they don’t seem test moderate treatments. Why would women be treated with JUST testosterone? That is not a treatment designed to bring a woman back to her former natural state. My female gynecologist, a UC San Francisco Medical Center clinical faculty member, Dr. Rikki Pollycove, recommends very low dosage hormone replacement. I am on Divigel (estradiol gel) 0.5mg which keeps me just barely out of the range of having hot flashes plus 25 mg. per day of DHEA (dehydroepiandrosterine) which I understand is a testosterone replacement. The DHEA DID increase my libido, but it wasn’t absent before I took it. However, the DHEA makes me think about sex in a way I had not done in a number of years (age 57 female). I’d be ready once or twice a day for sex if I had a ready partner. I found HRT difficult to adjust to due to side effects which for me are swollen, painful breasts, plus occasional hot flashes (which I do NOT have off HRT). On the positive side I think I have younger looking skin than my peers, and my vaginal tissue is moist and pliant rather than dried, and I have more sexual interest and ability. I am hoping it helps put off cognitive decline of aging, also.