Something Evil This Way Comes

This news story is all over the internet today. This is the Globe and Mail’s version of the story. I gotta say, I am relieved that cancer researchers have finally decided to work *together* and share their research results so maybe we could make some headway with this nasty business.

Here’s how the Globe said it:

Ten countries co-ordinate cancer fight

CAROLYN ABRAHAM

Globe and Mail Update

April 29, 2008 at 12:14 PM EDT

Research groups from 10 countries are announcing today an unprecedented global effort to combat cancer, one of the world’s leading killers.

The collaborative project, dubbed the International Cancer Genome Consortium, will hunt the genetic mutations that drive 50 different types of cancer – from breast to bone. The consortium, in which Canada will play a lead role, plans to share results rapidly, widely and freely so scientists can quickly develop new diagnostic tests and treatments to counter them.

Each member country plans to spend roughly $20-million (U.S.) tackling at least one subtype of the disease, collecting specimen samples from 500 patients, and studying the genetic glitches they find in their cancerous cells. With 50 cancers to be studied, not all of them have been assigned a country yet.

But China, for example, intends to study liver cancer, since the country has particularly high rates of that disease. Japan will take on gastric cancer. India has an interest in oral cancers, France in sarcomas – cancers of the bone and connective tissue. Several countries will focus on breast cancers, including Britain and the United States, where research groups are also interested in brain and colon cancers.
Internet Links

* International Cancer Genome Consortium Popup
* ICGC Goals, structure, policies and guidelines (pdf) Popup

The Globe and Mail

Canada, which is to store, crunch and share all the data collected, will take on the pancreas.

”We picked a hard one,” said Dr. Tom Hudson, scientific director of the Ontario Institute for Cancer Research in Toronto, which will be the project’s home base as the ICGC Secretariat. ”There’s been research (into pancreatic cancer) but not much success. There’s just no survivor community.”

Dr. Hudson, who has helped to spearhead the consortium, noted pancreatic cancer is the 12th most common form of the disease, but one of the deadliest. More than 98 per cent of patients die within six months after diagnosis.

”In 2008, there will be 3,800 new cases and 3,700 deaths in Canada,” Dr. Hudson said. ”It’s almost always found too late.”

The consortium has come together in a whirlwind of meetings, conference calls and funding commitments during the past six months, driven by swift advances in computing technology that allow researchers to rapidly and cheaply read DNA. It is expected to amass 25,000 times more data than the international Human Genome Project, which produced the first draft sequence of human DNA in 2001.

DNA, the three-billion-chemical base-pair code that contains the operating instructions for human life, can be found in the nucleus of nearly every cell in the body. In cancer cells, however, that genetic code can be riddled with hundreds of mistakes, spawning cells that can multiply madly into deadly tumours.

”We know when you look at cancer cells, there can be thousands of mutations in that tumour cell…that were not inherited,” Dr. Hudson said. Specifically, he added, scientists are chasing the ”driver mutations” that allow a cancer to grow and spread and these are often different in different types of cancers.

Certain mutations have already proved worthwhile targets for treatment. Dr. Hudson pointed to the successful drug Gleevec as a prime example that has triggered remission in many patients. First approved to treat chronic myeloid leukemia, Gleevec works by blocking the abnormal version of a protein that a certain gene produces in the leukemia patients.

The treatment, which has since also been approved to treat a form of gastric cancer, represents a new class of drugs that selectively kill cancer cells without harming healthy ones. The lauded breast cancer drug Herceptin is another example of a therapy that selectively targets a specific molecule over-expressed in malignant cells.

There are few other examples, however, of such effective therapies, Dr. Hudson said, largely because it has been slow and expensive to find targets. He estimates that the consortium will run a 10-year effort, but ”we don’t have to wait 10 years (for a result), we will release it as we find it.”

The results will be made available to researchers worldwide and all those involved in the consortium have agreed ”not to file any patent applications or make other intellectual property claims on primary data from ICGC projects.”

The Ontario Institute for Cancer Research, with a five-year, provincially funded budget of $347-million, plans to spend $30-million on the project. At a press conference Tuesday morning, however, Ontario Premier Dalton McGuinty said the province will also contribute an additional $10-million to fund the OICR’s role as Secretariat.

Mr. McGuinty noted that Ontario, as a sub-national government, beat out the United States and Britain to lead the ICGC, and is essentially punching above its weight.

”Cancer is devastating to families and that’s why we’re doing all we can to help save lives,” Mr. McGuinty said. ”This investment puts Ontario at the forefront of international research that will save lives around the world.”

The money has so far allowed the institute to purchase 10 ultra-fast DNA-sequencing machines and lure top talent from the United States to take on the task. Among those recruited for ICGC job to Toronto, Dr. Hudson said, are Lincoln Stein, a pathologist turned bio-informatics ”guru” from Cold Spring Harbor, N.Y., and John McPherson, a Canadian scientist returning home from Baylor College of Medicine in Houston after 20 years in the United States.

Dr. Hudson said it is hoped the federally funded Genome Canada will contribute more money for the project, which would allow Canadian researchers to study other cancers, namely those of the brain and ovaries.

”We don’t want the pancreas to be the only one we do,” he said. Dr. Hudson is no stranger to science on a massive scale, having played an early role in the human genome project, and the international Hap Map, which was the first effort to chart genetic differences between four of the world’s major ethnic populations.

Duplicating efforts by studying the same cancer types in different countries is crucial, Dr. Hudson said, because ”tumours of the colon look different in Singapore than they do in Toronto.”

Researchers suspect environmental, dietary and genetic differences can impact the way cancers develop in different regions of the world.

More countries are expected to join the consortium in the coming months. The list so far includes: Australia, Canada, China, Europe, France, India, Japan, Singapore, the United Kingdom and the United States.

April is cancer month in the life of Spike so today I spent a lot of time exposing myself to necessary doses of radiation and talking to folks in lab coats and walking back and forth, from the clinic to my truck, from my truck to the clinic, lather, rinse, repeat.
I’ve mentioned before how I feel like I am a part of something when I am at the cancer agency.
And how there ain’t really anywhere else where I do feel a part of something anymore.
Strange, but true.
The one beautiful thing about the cancer agency is you never get tossed out because you have fallen from grace.
And much as it sort of sucks to feel like you belong somewhere like the cancer agency, at least it’s an important place to belong.

But in cancerland there is a fork in the road and, so far, I have stayed on the healthy side of that old fork.
And when I see folks at the cancer agency who are clearly in the middle of their treatment, I feel for them. I feel for them like I feel for no other carbon based life forms. They got sent down the other fork in the road.
So today I walked back and forth, back and forth, and I saw so many people who were clearly in the middle of treatment. People in bad wigs, people dragging their O2 around behind their wheelchairs. And that doesn’t even address the folks there who are not sporting the visible signs of distress from their treatment.
I spent about two hours, clomping back and forth, between my doctor’s office and the parkade and back again.
And as much as my life has sucked big time over the last four years, I realized I was one of the lucky ones.
Seriously.
For sure I would have liked to have sidestepped some of the heartache of the last couple of years. But I am not in a wheel chair, with an oxygen can and a bad prognosis.
And on that level, I am extremely lucky.

The whole thing went like this….

I went out with some friends from work. They went outside to smoke a cigarette. I stayed behind, having given up that vice a couple of years ago. I decided to read the local free rag while they smoked.
Savage Love is a column in that paper.
Savage Love is the column I read while my friends smoked.
Savage Love is the column that made me all weepy and misty-eyed in a far from strategic setting.
The story is here:

For those of you too weary to click the link, and also somewhat curious about copyright law and whether I might get tonked, here is the text.

At a Loss
April 3, 2008
By Dan Savage

I thought I could bang out a column today—a regular column, a column about my readers’ problems and their freaky fetishes and all those asshole politicians out there. You know, the usual.

The day my son was born, I managed to slip out of the maternity ward and write a column; I wrote one the day I was indicted by the state of Iowa for licking Gary Bauer’s doorknobs. (I was actually indicted for voter fraud—on a trumped-up charge, your honor—but Bauer’s knob needs all the attention it can get.) I’ve written columns on days that I was dumped and on the morning of 9/11. So I figured that I could bang out a column today.

I opened my laptop and started reading your letters. I love reading your letters—I do. But I couldn’t get into it. I just don’t have a column in me this week. I’m disappointed in myself. I write this column at Ann Landers’s desk, for crying out loud, and the old lady banged out a heartbreaking, truncated column when her marriage collapsed. If Landers could bang one out under that kind of emotional strain, then I could damn well bang one out, too. Just do it, right? Just fucking do it. But I just fucking can’t.

My mother died on Monday.

Perhaps a sex-advice column isn’t an appropriate place to eulogize an articulate, elegant woman, a practicing Catholic named for the patron saint of hopeless causes and, perhaps consequently, a Cubs fan. I mean, really. Eulogizing my mother back here with the escort ads? So let’s not think of this as a eulogy. Let’s think of it as a thank-you note, the kind of nicety that my mother appreciated.

Forgive the cliché: My mom gave me so much. She gave me life, of course, and some other stuff besides: her sense of humor, her bionic bullshit detectors, her colossal sweet tooth. She also gave me—she gave all four of her children (Bill, Ed, Dan, Laura)—her unconditional love. Long after I came out, she told me she always suspected that I might be gay; I was the quiet one, the boy who liked Broadway musicals and baking cakes and shared her passion for Strauss waltzes. When I asked my parents to take me to the national tour of A Chorus Line for my 13th birthday, that should have settled the matter. Your third son? Total fag, lady. But my parents were Catholic and religious and it somehow still came as a shock when I told them. My mother came around fast and she came out swinging—rainbow stickers on her car, a PFLAG membership card in her wallet, and an ultimatum delivered to the whole family: Anyone who had a problem with me had a problem with her.

But the real reason I feel compelled to thank her in this space, back here with the escort ads, is because I wouldn’t have this space if it weren’t for her.

My mother, as my brother Bill likes to say, made friends like Rockefeller made money and George W. Bush makes mistakes—and she was that friend you confided in and went to for advice. I was a mama’s boy—hello—and I spent a great deal of time in my mother’s kitchen listening to her tell her friends exactly what they needed to do. Sometimes gently, sometimes brusquely, always with a dose of humor. My mom liked to say that her son got paid to do something that she did for free—and isn’t that the way the world works? Women cook, men are chefs; women are housewives, men are butlers; she gave advice, I got paid to give advice. (And for a few years, she did too; my mother and I wrote a joint column for a couple of websites in the 1990s.)

So I want to thank my mom. I wouldn’t be writing this column today if it weren’t for her gifts and her ability to find the humor in even the most serious of subjects.

Even death, even her own.

After a long struggle, we had to go into my mother’s hospital room and tell her that nothing more could be done. She didn’t go into the hospital expecting to die and she was not ready to go. But she took the news with her characteristic grace. She said her farewells, asked us never to forget her (as if), and paused for a moment. Then Mom lifted an eyebrow, shrugged, and said…

“Shit.”

My mother wasn’t crude; I didn’t get my foul mouth from her. She used profanity sparingly and then only in italics and quotation marks. When she said “shit” on her deathbed, we understood the joke. What she meant was this: “Now, the kind of person who casually uses profanity might be inclined to say ’shit’ at a moment like this. But I’m not the kind of person who casually uses profanity—and certainly not at a moment like this. But if I were the kind of person who casually used profanity, ’shit’ might be the word I would use right now. If I were that kind of person. Which I’m not.”

Everyone gathered around her bed—my mother’s husband (my son has two fathers and so do I), my sister, my aunt—knew what Mom wanted: She wanted us to laugh. This woman, so full of life, who wanted so badly to live, having just been told she would not, she was trying to lift our spirits. (”Shit,” for the record, wasn’t her last word. Those were just for the family.)

Anyway, my mom is dead, and I am not in the mood, as she used to say. (”You are so,” one of us kids would usually respond. “You’re in a bad mood.”) So I’m going to take a week or two off, from the column and the podcast, hang out with the boyfriend and the kid, and burst into tears in coffee shops and grocery stores. I’ll run some greatest hits in this space while I’m away—I’ll find a column or two featuring Mom—and then I’ll be back, just as filthy minded as ever. In lieu of flowers, please send pictures of your boyfriends’ rear ends. (Lesbians may send flowers.) If you’re the donation-making type and you’re so inclined, my mother would be pleased to see some of your money flow to PFLAG (www.pflag.org) or the Pulmonary Fibrosis Foundation (www.pulmonaryfibrosis.org).

Oh, one last thing: I was supposed to take my mother to see the national tour of The Drowsy Chaperone in Chicago this Friday, April 11. It was her birthday present. I got us great seats: seventh row, on the aisle. But I won’t be able to use our tickets now. Not because it would be too depressing to go without my mother—not just because—but because, as rotten, stinking fate would have it, I’m going to be at my mother’s wake on Friday night.

But I’m practical, like Mom, and I’d hate to see perfectly good tickets to a national tour of a hit Broadway musical go to waste. And it occurs to me that there has to be a teenage boy out there—in Chicago or close enough—who likes musicals and has a mother who loves him for the little musical-theater queen that he is. If you know that boy or you are that boy or you were that boy a decade ago or if you’re that boy’s mother or grandmother, send me an e-mail and I’ll arrange to get these tickets to you.

Like I said, they’re great seats. I would go if I could. But I can’t.

Shit.

mail@savagelove.net

If Dan Savage wants to sue me for copyright violation, I guess he and I can duke it out at the orphanage.

April seems to be cancer month for me. I saw my gyno-oncologist yesterday and in a couple of weeks I will see the folks to care about my mutant-ness and keep an eye on where that old BRCA 1 mutation is going. While it may have happened before, on some level I feel overwhelmed by the huge cancer focus that is April of this year.
But it’s okay.
I mean, weird, but okay.
It’s a funny thing, but it seems like the death of my parents and a few other unhappy events have actually flipped me back to the beginning; back to trying to make sense of thinking I was all young and alive and…. ooops, you have cancer.

Like, life has been a shit sandwich for the last few years but to make sense of it, I have to begin at the beginning.

I was trying to explain to someone earlier today that going to the cancer agency for me is both weird and good. And maybe in ways you wouldn’t imagine.
But as strange as it might be to say, I think being in the cancer agency makes me a better person. When I am there, I feel pretty lucky. You walk in those doors and you can’t help but see people who are having a much harder time of things that I had or than I have.
There is nothing that stops me in my tracks like being in the cancer agency and seeing someone who is struggling.
And I confess, every single cell in my body starts to cheer for them, to urge them on. Cuz to me, we are very much on the same side.
Which leads to my second point.
When I finished chemo, probably the most important thing to me, aside from a list of things that were actually unattainable, was to grow my hair back.
As I have mentioned before, I could never have anticipated what a huge loss it was to lose my hair.
And thanks again to the friends who shaved their heads when I shaved mine. It meant the world.

So, when I passed a woman in a toque, it took me a second to connect the dots and then I felt this swell of emotion. And then I realized that she has no idea the depth of feeling she stirs in me.
Maybe it’s all too sappy to explain.
But as completely emotionally bankrupt as I am, I would do anything I could to help a cancer patient make it through their storm.

And, that said, the man in the lab coat showed up sans lab coat. Instead he was sporting a suit he bought when he was on sabbatical. We made jokes about his suit.
I like him a lot.
Which is good because he “tests” me in ways I am not prepared to discuss right here. But for me, right now, with this set of circumstances, he is the best doctor I could imagine having.
And for the folks keeping score at home, he says everything is fine and we will check back in a few months. And that’s a huge relief.
And in a couple of weeks, I will get my upper body tune-up, so fingers crossed for that.

But today, or really yesterday, I got reminded of how much worse it could all have been, past or present tense.
And I have been whining a lot lately, mostly because I think I have a lot to whine about. And I do.
But I remember how much worse it could be, and I feel for the folks who have to be there and who are there. And if I could do something to make any of it better, I would. Because at the end of the day, as much as any other group, those cancer peeps are my people.

I just found this post on the Best of Craigslist.
Sort of a primer for how to deal with people with cancer.

http://www.craigslist.org/about/best/pdx/465030621.html

Over the last few years I have been exploring the delights of the graphic novel and recently, at my beloved neighbourhood branch of the local library, I stumbled upon a graphic novel called “Cancer Vixen” by a woman named Marisa Acocella Marchetto.

Now, at first glance, me and Marissa couldn’t be more different.
She lives in the heart of the chaos and glamour of NYC. Suffice to say that I do not.
She is a cartoonist for The New Yorker. Not wishing to disappoint, but I am not this.
She is quite clearly heterosexual. Absolutely, without a doubt, I am not.
She describes herself as a “shoe crazy, lipstick-obsessed, wine-swilling, fashion fanatic, single-forever-about-to-get-married with a fabulous life finds… a lump”
Of the above, I can only kinda sorta claim one of those descriptors as coming close to me and my experience.
So, yeah, she is a living the high life, life full of glamour straight girl who finds a lump in her breast and then talks about what comes after.

And the thing with cancer is, if your identical twin had the same sort of cancer that you had, God forbid for both of you, you would each have wildly different experiences.
What is freaky for me about this graphic novel is the ways we had very similar experiences, in spite of our crazy differences.
She got engaged to be married and then got diagnosed with cancer. Me too.
She, and this is almost too much for my tiny brain to cope with, got diagnosed within two days of me. It’s actually possible we were diagnosed on the same day. And on some level, that makes sense, if you think about how many people in this big old crazy world have the unpleasant experience of being told they have cancer, well, for sure, some of us mouthy ones are bound to overlap with each other and then blab about it publicly. Still. To see in print that some gal got that soul crushing news on the same calendar day as you, well, it messes with your head.
She had breast cancer. I had ovarian cancer.
Hers was in the 1st stage. Mine was 3 C. Pretty different.
She was self employed with no health insurance. I was looked after by my government’s healthcare plan, my extended benefits and a bunch of people who cared about me.

Here’s a confession.
I am not sure anyone who has had cancer, no matter what its outcome, can accurately explain that experience to anyone who hasn’t stared at the ceiling of their room, wondering how it might work out and if they are gonna croak, right in that room, sometime far too soon.

I may be wrong. I would be happy to be wrong. My opinion is far from carved in stone. But I think that, really, at the end of the day, cancer is the thing that everyone fears and, when someone tells you that you have it, you become a wee bit different than regular people. I may be wrong about all that. But I don’t think so.
So, in spite of our many and significant differences, me and old Cancer Vixen had some freaky areas of overlap.
Or perhaps it would be more appropriate to say that she, more than anyone else I have read to date, captures some of the crazy, deep, chasms of emotion one explores when you parachute in to cancer land.

Marisa Acocella Marchetto does a great job of describing those moments where you feel crippled with guilt because your loved ones are going to panic, so you try to make it all be okay, cuz it feels awful to cause so much pain and stress to the people that you love but you can’t do jack to make it different and neither can they.
She talks about the terror and the grief you feel when you think, “Ah, right, I was supposed to get married but it looks like I will just my love on an amazing hellride instead. Buckle up, baby, the road gets bumpy ahead.”
The “wow, my life was actually bordering on being perfect and then this crazy shit happened to me.”
She does a great job of portraying the way some people just jump up and want to do whatever they can to help.
She does an equally great job of explaining how some seemingly well intentioned people can say all the wrong ‘blame the victim’ sort of things and all you can do is paste a smile across your sickly hairless head.
She talks about how hard it is to lose your hair.
Let me just say, for me, as a big bad dyke, I didn’t think it would be as bad as it was for other people, especially other women. Plus a handful of friends came by and had their heads shaved on the same day I did mine.
Thanks. My eternal thanks to that group who stepped up and tried to make that easier for me.
Because it was really awful. I thought being all queer and outside of the box in every sense, it would be okay. But it was such a huge issue for me. Being hairless was the equivalent of being the modern day eunuch and it almost killed me, from an ego point of view.
So when a shoe loving, fashion-diva straight girl talks about her struggles, I say, “Oh yeah, sister.”
She also, bless her highly fashionable boots for this, talks about chemo brain and memory loss.
I have googled ‘chemo brain’ and come up with squat.
But here’s the thing, a very candid moment….
Chemo ate my memory, there is no doubt about it in my mind.
But my mom died of Alzheimers’, so, when I don’t remember to hand in an assignment or that I should meet you at the movies and didn’t show up or that we already had this stupid conversation and you can’t believe I don’t remember that, I don’t always know which to chalk things up to.
But I do know, on a core level, that losing your memory sucks like few other things.

Anyway, you should read this book. I think you should.
If you can’t get it from your local library, it’s only 11 bucks from the dreaded and diabolical Amazon.ca

Rodger Dodger
over and out

Spike
spewing out 3 posts over 4 days… but don’t get used to it, folks, I’m just not that reliable.

** This post was generously sponsored by the words “freaky” and “crazy”.

Filed under the heading of

“Oh crap, sorry about that.”

ANDRÉ PICARD

From Wednesday’s Globe and Mail

February 27, 2008 at 9:51 AM EST

Drugs commonly given to cancer patients because they are anemic after chemotherapy appear to increase their risk of dying, according to a new study.

The research, published in today’s edition of the Journal of the American Medical Association, suggests that the drugs, called erythropoiesis-stimulating agents (ESAs for short), may actually provide fuel to cancerous tumours.

“It’s troubling that 15 years after the drug came out, we finally came to this realization,” said Charles Bennett, an oncologist at Northwestern Memorial Hospital in Chicago and lead author of the study.

He said accepted practice is that using ESAs in moderation is safe but the new research challenges that view, “raising the concern that the drug may be stimulating cancer and shortening cancer patients’ survival.”

The new study is a meta-analysis, a compilation and analysis of previously published research. A total of 51 studies were included with 13,613 patients.

The analysis showed that patients who received ESAs to treat anemia had a 10-per-cent increased risk of death compared with cancer patients who did not receive the drugs.

Anemia is a common side effect of chemotherapy. Chemotherapy helps kill cancer cells, but it also eliminates good, healthy ones such as blood cells. It can decrease red blood cell levels, causing anemia and exhaustion.

Anemia can be treated with blood transfusions, but, in recent years, it has become common practice to treat the condition with one of two drugs, erythropoietin or darbepoetin, which stimulate production of red blood cells.

Last year, the U.S. Food and Drug Administration issued a public health warning about ESAs, particularly their use in cancer patients not undergoing chemotherapy.

Safety concerns are related to the fact that these drugs can cause life-threatening blood clots.

The new study confirms that concern, showing that patients receiving ESAs see their risk of blood clots in the legs or lungs jump by 57 per cent.

About 7.5 per cent of cancer patients treated with ESAs developed blood clots compared with 4.9 per cent who took placebos in the study. Dr. Bennett said that the increased rate of death does not appear to be due to blood clots, but rather by a return of cancer.

Another researcher involved in the study, Stephen Lai, an assistant professor at the University of Pittsburgh Medical Center, did laboratory work that showed cancer cells were stimulated when he exposed them to ESAs.

“We saw dramatic change,” he said. “Giving cancer patients EPO [a type of ESA] for their anemia may actually cause their tumours to progress.”

Dr. Bennett said he believes the findings should have an influence on clinical guidelines and oncologists should rethink their use in cancer patients.

“If I had cancer and needed a blood transfusion, I would be much more conservative about taking ESAs,” he said.

ESAs such as darbepoetin (brand name Aranesp) and erythropoietin (brand names Epogen and Procrit) are used to treat kidney disease as well as chemotherapy-related anemia.

According to the paper, ESAs generate sales of more than $6-billion (U.S.) annually in the United States.

This just in from the Scientific American

Breast cancer gene carriers need dual screening

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Among women with BRCA1 gene mutations, which are known to increase the risk of breast cancer, annual screening with both mammography and MRI is associated with better survival when compared with screening with either method alone, new research indicates.

The trade-offs, however, are a high rate of false-positive results, which lead to unnecessary biopsies.

The findings were based on data from 22 studies that included 8,139 women who carried the BRCA1 gene. In addition, the researchers developed a prediction model based on data from the Surveillance Epidemiology and End Results (SEER) Program (1975-1980) and the Breast Cancer Surveillance Consortium.

The results indicated that annual combined screening with mammography plus MRI increased the average life expectancy by 1.38 years compared with follow-up only without screening tests (clinical surveillance). The false-positive rate was 84.0 percent.

“For women who carry BRCA1 gene mutations, adding annual MRI to annual mammography has a clear benefit in terms of projected life expectancy and breast cancer mortality reduction,” lead author Dr. Janie M. Lee told Reuters Health. “Whether the trade-offs related to MRI screening are acceptable to women at increased risk of developing breast cancer is still being investigated.”

In the general population, the lifetime risk of breast cancer for women is 13 percent. In BRCA1 mutation carriers, by contrast, this risk can be as high as 80 percent. Strategies to reduce this high risk have included preventative mastectomy, removal of the ovaries (to lower levels of estrogen which can encourage breast cancer growth), preventive chemotherapy, and more frequent office visits, according to the report in the journal Radiology.

Younger women, especially those of childbearing age, are often reluctant to undergo preventative mastectomy, the investigators point out. Preventative chemotherapy might be a suitable choice, but unfortunately no studies to date have shown it to reduce breast cancer mortality. That leaves increased surveillance.

According to the report, mammography is not nearly as sensitive at detecting breast cancers in BRCA1 mutation carriers as it is in the general population. Previous research has shown that MRI can achieve higher sensitivity than mammography, but whether this translates into reduced breast cancer mortality is unclear.

Due to the long length of follow-up and the large number of patients required, the authors note that it is unlikely that any trial will ever investigate whether MRI screening can reduce breast cancer mortality. This prompted Lee, from Massachusetts General Hospital in Boston, and colleagues to conduct the current decision analysis.

The average life expectancy was 71.15 years, the report indicates, and with clinical surveillance alone, the average diameter of breast cancers at diagnosis was 2.6 centimeters. Using annual screening with mammography, MRI, or both, the average tumor diameter at diagnosis fell to 1.9, 1.3, and 1.1 centimeters, respectively.

Compared with clinical surveillance, all three imaging-based screening strategies increased life expectancy and reduced mortality from breast cancer. Again, the most pronounced benefit was with mammography plus MRI.

In addition to the high false-positive rate seen with mammography plus MRI screening, nearly one in three women underwent one or more biopsies for what turned out to be benign disease. The false-positive rates and negative biopsy results with the other screening strategies were also increased, but not as high as that seen with the combined approach.

More research is required to find the optimal sequence and frequency for screening tests for breast cancer, and to “minimize the potentially negative effects on women’s health-related quality of life when screening with increased intensity is pursued,” Lee noted.

She added that her team is “currently working to extend our model of breast cancer natural history and screening in BRCA1 gene mutation carriers to women who carry BRCA2 mutations, and women whose lifetime risk of breast cancer exceeds 20 percent — these women are defined by the American Cancer Society as being at ‘high-risk’ of developing breast cancer.”

SOURCE: Radiology, March 2008.

http://www.sciam.com/article.cfm?id=breast-cancer-gene-carrie

Hope for a reliable, early detection test

Phase III evaluations have begun on a blood test developed by
researchers out of the Yale School of Medicine. So far the test has
detected newly diagnosed ovarian cancer with 99.4 percent accuracy by
using six protein biomarkers. “We hope this test will become the
standard of care for women having routine examinations,” says lead
author Gil Mor, M.D., associate professor at the department of
Obstetrics, Gynecology and Reproductive Sciences at Yale.

The test requires further study and extended follow-up with more
patients, however the news represents an encouraging development in the
search for a reliable, early detection test for ovarian cancer. Results
from the phase II clinical trials were published in the February 15
issue of the journal Clinical Cancer Research.

I’m not really sure I can nail down a starting point for this post. But I just received an e-mail, reminding me that a year ago one of my OVCA buddies died. She was one of those online support comrades, another one I never met in real life and another one who died too soon. This online support thing is a bit strange to me, because the wellbeing of a bunch of people I have never met means so much to me. It’s a good thing, it just continues to surprise me with its intensity.

There has been a lot of death and grief in my life over the last couple of years and there is not much I can do about those circumstances except try to maintain some sort of point of view that allows me to squeeze out some smidgen of something positive. Often, I fail miserably at this goal. But one thing that is important to me is that we remember the people we have lost.
So, today, I thought I should do something to remember Heather MacAllister. This is a snippet from what I wrote a year ago.

“Heather was a Fat/Social Justice Activist and the founder of the Fat Bottom Revue, a burlesque troupe full of really hot fat grrrls.

The thing Heather wanted to say, that message she wanted to leave us with, is that we should love our bodies, just like they are and appreciate all they do for us, and that we should love each other.”

How about we all try that? How about that for a post-Valentine’s Day idea?

So, in anticipation of Valentine’s Day, how about we all do like she says and try to, you know, love one another or at least be more kind to each other. What could it hurt?

It certainly has been a wild ride these last few years and I find myself becoming reluctant to talk about any of the details of my ever so melodramatic life because it all seems so very over the top. It’s been hard. I guess I am just paying in advance for the salad days that are just over my horizon. When my address changes to “General Delivery, Easy Street, Vangroover, BC Canada”
I’d like to believe that.

Anyway, not to come out and sucker punch folks now that I have you thinking about other stuff but my dad died last week.
I haven’t really been talking about it because I can’t really think of anything to say about it. It’s all sort of surreal, and then that sounds like a stupid thing to think since the man has been dreadfully ill for the last couple of years. I sort of think that since my mom died, he didn’t think there was so much left to fight for. I dunno. I do tend to believe that he finally gave himself permission to let go, but I wasn’t there and I don’t really know what happened inside his head.

Anyway, he’s gone.
And she’s gone.
I confess, I don’t harbour images of a verdant and pastoral place where they are goofing around now, but I’d like to. If he threw in the towel because the woman he loved his whole life was gone, then I hope that somehow, they get to be 18 and together again.

Rodger Dodger
over and out.

Since I am going on and on and on about my mom these days….

My mom was under 5 feet tall.
My mom never weighed more than 100 pounds in her life. Like, really. Even if she was on anabolic steroids, she wouldn’t have touched 100 pounds. (Though I shudder to think of her with a neck as big as my thigh.)

When I was a teenager, Randy Newman had an actual hit on the AM airwaves with his song “Short People”.
My mom thought that was one of the most brilliant pieces of satire, a well aimed poke at our inclination to persecute the “other”, all packaged up in hatred towards short people.
It baffled me at the time that she wasn’t offended, she thought it was a great social critique.

My mom rocked.

“They got little baby legs that stand so low
You got to pick them up just to say hello
Well I don’t want no short people
Don’t want no short people
Don’t want no short people
round here.”

It’s just on my mind tonight.

Yesterday was, or depending on your perspective, would have been my mom’s birthday. One of the strange things that comes up around my mom’s death is which tense to use in which situation. Like, was yesterday her birthday? Do dead people have birthdays? I really don’t know.

It’s also strange because my parents’ house is being put on the market. Now, I stumble when I say “my parents’ house” because it seems to me I really should have erased my mother from that equation and updated it to “my father’s house”. Except the ironic part is, my father hasn’t even been in that house since my mom died. And on that technicality, I feel I am allowed to continue referring to it as my parents’ house.

It’s also strange because my mother spent a lot of time telling us, her three kids, which bits of Harris treasure we would get or inherit when the time came. Well, the time has come. What is it they say about the best laid plans?

We ain’t no kin to the Rockefellers but when my parents bought something, which wasn’t that often, they bought good stuff. We had a very nice dining room suite that was promised to my brother. As a kid, it always annoyed me that he got the most cherished chunk of the inheritance pool. Now it’s time to move all that stuff from my parents’ home, and my brother has no room for that dining room suite. In a different life, I would love to have it, but simply don’t have the space and I shudder to think what my cats would do to it. My sister also is suffering from space restrictions.

It’s just a very strange feeling to have been told for your whole life that one day you will own this thing. And the thing has been assigned value by the very act of someone wanting to pass it along; of making a point of passing it along, because it mattered to them. And now there is nowhere for it to go, except maybe to an auction house. It’s caused me to look around my place and imagine what bits of stuff that I have that might get passed on to someone else, and what parts will end up in the landfill cuz most of us have very little room for more stuff.

So, my parents’ home has to be emptied out so someone else can move into it. And while I have never lived in that house, I still feel a strange loss. It’s not the loss of “my home”, per se. Only twice in my life have I felt like the house I lived in was “my home” and this house doesn’t qualify. But there is the loss of some sort of safety net. I suppose it’s another step in finalizing the growing up thing. There is absolutely no safety net anymore. That’s okay, it’s just a new feeling.
I try to imagine what it will be like, in the future, to drive along that highway and *not* take the exit that leads to my parents’ home, to just keep on driving till I land in a motel room further on up the road.

It also means facing the fact that lots of things that were important to my mom have no place to go and so they will probably go to the Goodwill or to the dump. That process, the throwing away of something she valued and in many cases made by hand, that’s the part that almost kills me.

Sometime in the next month or so, between work and school, I will go and help my siblings empty out my parents’ home. And I feel an astounding level of dread whenever I think about that, for quite a few reasons. A big one is that emptying out the house, the house I don’t care about, will bring a whole new level of finality to the situation. It feels a bit like closing a door on my parents.

I’m still working through it all.

It’s been a typically long while since I last posted. Someone left me a little nudge in my comments section and the light went on. The magic one that appears above my head in my more animated moments.

See, it’s a weird thing with we cancer bloggers that if you don’t post for some chunk of time, people begin to worry. It’s a strange kinship. But it’s also a very good thing. It’s an experience unlike any other that I have had. I have become part of a secret club that nobody would ever wish to join, but now that we are here so we do our best to help each other and keep an eye on each other and share information about treatment and surviving in general. And in many cases we could pass on the street and not know each other. But, I am deeply affected by the good things and the bad things that happen in the lives of these folks and I suspect others have the same experience.
It’s strange, but a very good sort of strange and I am awfully glad that folks are out there, doing those things.
I’m also glad for my local face to face comrades. We all share something and, not to be all Sesame Street about it, but the sharing is good.

So, how’ve I been?
You know, I really couldn’t say. Which isn’t a very helpful response because you’d think me, of all people, ought to be able to at least fudge an answer.
But I think my mom’s death sort of hip checked me into some new and different frame of mind. It’s difficult to describe and mostly I am still trying to figure it out.
Some wee snippets of it are things like…. at Christmas this year, I had this small but constant sadness that I would never get a Christmas present from my mom ever again. Now, the reality is, my mom hasn’t been able to participate in Christmas for about 5 years. And I was not someone who believed she would ever have a miracle recovery from Alzheimers and we would all slide back to happier times. But it was the absolute finality of it that kept nipping at me.
And it wasn’t about needing or wanting some more stuff. It was a sense of missing how my mom used to put a lot of care and attention into the presents, and the wrapping itself was a work of art.

When my dad had to step up and take over that detail there was a marked change in the whole deal.
My dad, who has non Alzheimer’s related memory problems in that he just plain spaces things out, would send us each a smoke detector, some wrenches and a few screwdrivers all with their Canadian Tire price tag still on it. Often there would also be a one pound can of beer. Like I said, memory problems.
And I don’t mean to take away from the things my dad did. Because they are sweet in the way he tried so hard to do this thing, a thing he had never done before and here he was, an all grown up man, having to learn how to do the Christmas shopping for his grown kids. And are there any people more difficult to shop for than your adult relatives?
But I digress.

I tried pretty hard to do the ‘it’s just another day’ version of Christmas this year. But on the inside, it was a pretty introspective time. Which is okay. There are far worse ways of spending Christmas than being introspective, and I am guessing at least a few people reading this had them. It’s a tough time for lots of people. This year was tough, but not as tough as I had expected.

Okay, so Christmas is over.

It seems the current plan in family-land is to sell my parents’ home, though I guess I should say ‘my dad’s home’, but right now, I don’t feel like it.
And that creates another strange set of emotions. My dad is now enjoying all the mod-cons of a care facility and no longer needs a house. It all makes sense. So the siblings, and myself if I can squeeze in the time between work and school, will go to that wretched town and empty out my parents’ home and then it will be sold.
Now bearing in mind that this house is not one I have ever lived in myself. And that I hate hate hate the town my dad lives in. I still have this eerie feeling that there will no longer be that home base, that spot you can always sneak back to if the spit hits the spam in your life. The old safety net.
Given that I have never really used it as a safety net, it’s not so much of a loss in real terms. It was some strange under-utilized form of stability so, I suppose I should go create its replacement, though I don’t have a clue what that will mean or what it will look like.

That’s about it for now. Things are different. Still strange, still difficult more often that I would wish for (but who can’t say that?) but in a calm sort of way.

And to leave this on a trashy pop culture up-beat note, I am currently smitten, in a movie-star smitten sort of way, with Helena Bonham Carter. I watched the 5th Harry Potter movie one day last week and saw Sweeney Todd the next. Helena Bonham Carter does evil so good.

Last Saturday night, I had intended to be hanging out at an apres Hallowe’en “Day of the Dead” party but about the time the doors were opening for that event, my mom took one final lung full of breath and then cashed in her chips.
I’ve spent the last week in a town that I hate, burying a woman that I love and hanging on to a very delicate thread that ties me to sanity and the big picture. Okay, it slipped away more than once.

I expect I will feel a lot of things about my mom’s death over the next little while. There hasn’t been much time to just sit and let the reality wash over me. I’m sure that will come, and at all the least convenient times.

Here’s the thing.
I am a mix of good things and bad things. Somedays I am hard pressed to know what the good things might be, especially lately.
Whatever good there is in me got planted there by my mom.
When I was a kid, my mom wouldn’t let me watch Hogan’s Heroes. She said Nazi concentration camps/POW camps weren’t funny.
When I came home at age five and said someone had ‘jew’ed’ me out of something, she sat me on a stool and told me why I shouldn’t talk use expressions that justified treating other people atrociously.
When I came home at age six and said someone ‘gyp’ed’ me out of something, I got the same conversation, this time about the persecution of the gypsies rather than the Jews.
When I have acted like a dope, my mom could tell me to grow up and get over it and…. I would. More often than not.
I have always held my mom, and her opinion of me, in very high regard.

My mom died of Alzheimers, but more to the point, she died from isolation. When she was in her fifties, she and my dad moved to a town where she had to start all over again. And that was just too hard. It was too hard for her to find a job at that age and her social circle was vaporized, so that her only friends were the wives of my dad’s friends. And that didn’t actually click.
I feel bad about the loneliness my mother lived with for the last chunk of her life and I find myself wondering if there was anything I could have done better to support her.

My mom was smart and funny and ethical. She tried very hard to be fair, and I try to do the same.

It’s been a long time since my mom and I could have a conversation. She stopped knowing who her kids were about 3 years ago. And yet, she knew we were all there sitting with her right before she died. Something was different, her eyelids would flutter when one of us would talk. I dunno, but I know she knew we were there and I know that it mattered for her. And then she died.
If you knew how completely unlikely it is for me and my siblings to all be in the same room at the same time, you, like me, might think that she had actually died of shock.

So… my mom is dead.
Because it’s been so long since she participated in her life, I convinced myself it was just sort of a technicality. But I sat in the car and wept when we drove to the hospital to tell my dad that the woman he married 57 years ago had died.

The funny, not ha-ha funny but kick you in the ass funny, part is that everyone in my family has been having kittens about my dad and his crap-tastic health and his not-long-for-this-astral-plane future, and then my mom goes and sucker punches all of us and I think, “Good for you, mom. Good for finally getting some tiny shred of the attention you deserved.”

If there is one decent thing about my mom and Alzheimers, it’s that she was completely unaware of my whole cancer process, chemo and all its vile side effects. I am glad she never had to watch me go through that.

So, R.I.P. Mom.
Thanks for doing all you could to make me a decent person and the world a decent place.