Not Buying Into It

LizinKS

Briilliant and well-said,AMP47!! It is a new normal that is far different from the normal we knew before cancer. 

konakat

I have to agree with Otter on the stats.  I've heard this 0% or 100% before and it seems to me to be a silly thing docs say to ease the worries of a patient. Statistics are useless when the pool of data is just one person -- it's either you do or you don't.  It's when you look at a much larger pool of patient information that you can calculate meaningful statistics.  

For example, for Stage IV people like me, taking into account all the people that have come before me, the probability of me reaching 5 years is 20%.  Sure, I either make it or I don't -- 0% or 100%.  What use is this to me?  Maybe I'll be dead next month.  Maybe I'll live for another 5 years.  Who knows?  But at least I have some meaningful statistics so I can be more closely grounded in reality and know what my chances are.  That's what the stats mean to me.  But if you prefer the 0% or 100%, go with it.

Elizabeth

crazy4carrots

Statistics are useful when deciding on treatment.  No doctor can promise complete and enduring remission, but statistics are the only useful instrument the onc has in his/her doctor bag in providing information on what works/doesn't work (or what may work/may not work).  I had a choice about whether or not to take chemo.  Didn't want to, so I (naturally) asked my onc "What are my chances if I don't?"  She wasn't about to say that it makes no difference -- even though that might be true.  She simply laid out the "statistics", based on all the factors of my particular BC in comparison to that of others with similar factors.  What else could she do? She's a doctor, not a soothsayer!

As Elizabeth says -- if you prefer 0% or 100%, go with it.

flash

Hey Pompeed.

thaks for the info on Rick's.  Hope all is going better at the moment.

Lowrider54

I have to join with KK and otter - at stage iv also, KK says it best - it is whatever works for you and statistics are only a 'guide'.

I would like to add that AMP47 does make a good point and one I am inclined to believe - there is no hard and fast, black and white with this - this disease is so differnent in everyone, while I know we are all screaming for a cure...how on earth can one be created that works for all of us when not one treatment works the same or has the same results for all of us? 

I have gained a new respect for the research community in the time I have spent on these boards - reading and posting stories - always it is said "This is what has worked for me".  Same treatment, same age, weight, ethinticity, family history, same pathology, same everything - different outcome.  Healthy, unhealthy - gets breast cancer.  Caught early, caught late - gets mets - some sooner, some later, some never.  Why?  Don't know. 

One of the reasons that I tend to follow the 'trigger' theories and the 'on/off' cell research is that I think it holds the most promise in more targeted treatments and the potential for the ability to allow that breast cancer cell to be manipulated into growing into or returning to a 'normal' cell thus halting the disease.  I honestly believe drilling down to this very base level is the only way to be able to find the cure for the great majority of us or hopefully, all of us.  Given all the variables that occur with the disease once activated, I just can't envision a cure all.  Halting it at its very inception where it has not had time to mutate and adapt to an individual has to be the answer.

In the meantime...what works for me is living the best I can - could be dead tomorrow or live to see 90 - I choose living with cancer and I look to January to see our 17 year post mets dx gal post that it is now 18 years post mets! 

It can happen...why not for me?

allalone

Pompeed:
In your profession, you stated that you refer clients you can't help to people who can assist them, so don't physicians have a legal responsibility to do likewise and are behaving unethically when they set a cancer patient adrift?

On the rads forum, Hlilly asked a question which may concern all "opt-outers": "will (my surgeon and others) continue to take good care of me when I don't want to go with the standard tx she recommends?" and MarieKelly answered "Any physician who refuses to care for you ..... isn't worth having as your care provider. Find one, preferably an oncologist, who will respect your right to make treatment decisions."

I know one lady who *was* refused care for opting out and is having a lot of trouble finding a new monitoring physician (apparently, they all know one another in her area and appear to have blackballed her). How scary is that!!

Another ethical dilemma:
Does anyone suspect that the pink campaign push to reduce bc deaths *may* lead some treating teams into making tx recommendations deleterious to the pre-existing health conditions of patients (i.e. increasing their risk of catastrophic injury or premature death from a pre-existing condition, but downplaying these risks because their entire focus is on bc)?

pumela115:
I don't know why they tested you either!  Maybe your team was leaving no stone unturned, had a huge budget to blow or simply had a sweetheart deal with the testing lab.

lago:
Yes, I knew that being Ashkenazi and having family history were factors, but age and ER/PR status surprised me. (I was clutching at straws because my family history was iffy, but just today I've definitely ruled out that factor - so 99% I would have tested negative too).

lowrider54:
Could be dead tomorrow or live to 90 - exactly - and applies to everyone w/o bc. Live life to the full, girl, and why aim for 18 years - go for the limit (I think the oldest living woman was 122).

3jaysmom

allalone.. i for one, don't wanna live to 122 but i agree with the attitude of live life to its' fullest. i admire all the late stage sistahs in their fighting this BEAST..!!     love ya Low Rider!        3jays

Titan

The Cleveland Browns beat the Patriots!  (from a Northeast Ohio football fan!)

Ha Ha Heidi..you knew I had to say something didn't you?

Sorry..off topic.

misfit

allalone - I've often thought the same thing about the pink campaign. The center where I'm being treated supposedly has the best numbers in Canada, but I wonder why that is. The same drugs are being used here as they are elsewhere, as far as I know. I've never been given any information or guidance on complementary medicine. Are they just being really aggressive with conventional treatments? I had some minor (hopefully) heart issues prior to my diagnosis - preventricular contractions and high blood pressure - but when I expressed concern about this they kind of brushed it aside. I was about to start AC and would be getting Herceptin so I thought I had reason to be a bit worried. Everything seems to be okay but my onc (who I do quite like) is finally going to refer me to a cardiologist just to be sure. It really does seem to be all about bc, but that's just my own experience.

hopefortomorrow

Heidi-Your pups are adorable!

hopefortomorrow

There is one thought I have always had about the 'pink campaign'. I really don't want to be ripped up by everyone, maybe they already do this and I am not aware of it. I have always thought that the BC pink campaign gets lots of attention (which is great) but I feel sorry for the more rare forms of cancer- like maybe some of the proceeds from Pink should help the other forms of cancer?

Anonymous

TITAN----YOU HAD TO FIND ME ON THIS THREAD TO SAY THAT? AND THAT WAS AGES AGO! YOU ARE A VERY BAD GIRL (so I had to shout at you)

Don't worry though--- they will kick the Bears derrieres on Sunday (I hope). See you over on our regular thread....

hope- thank you! We like them too!

Mazy1959

Hope,

Honestly I would not like it if I gave money for specifically breast cancer and it was given to another form of cancer. It may sound selfish to some but I dont think it is. And I cant help but wonder how those who donate on my behalf would feel if they found out their money did not go where they specified. Many people give to certain forms of cancer because it runs in their family or they are close to someone who has it. We dont have a cure for breast cancer and we still have fund raisers for research, etc and I think the funds should go where they were solicited for. Its nice of you to thnk of others and I do too but I give seperate to those. Hugs, Mazy

Titan

Hope..I agree with you about the donations to rare forms of cancer.  It is just a very difficult situation....I guess the money goes to where it can help the most people.   It may not be right but I'm certainly thankful for it...

1Athena1

I think there is much too much attention on breast cancer at the expense of other cancers, and on early stage "survivability" at the expense of metastatic treatment. I don't think we bc-ers even benefit that much from all the attention, because our cause becomes such a money maker that a cure becomes an economic liability for all of these interests. Where would all the pink kitsch go?

AMP47

Athena you could not be more correct.  

Cancer is big business.  A close friend of mine revealed how much a doctor made on each of his chemo patients.  His profit margin was between 40 and 50% profit depending on the drug used.  

Drug companies spend billions of dollars in development and want their drug promoted or given to patients.  So, as and incentive to use their drug, the doctors is given a share of the proceeds.  Sometimes, it may not be the right drug for your disease. 

Case in point: a woman who I knew disagreed with my oncologist as to the right drug to use on her cancer.  She had done extensive research, contacted two well known cancer hospitals and was informed that the drug recommended to her has not been used in many years to treat her cancer.  She changed oncologist and went with the current drug used to treat her type of cancer.  This ethical question was touched on in an earlier post by allalone.   

My diagnosis is a low level money maker for a doctor.  His only chance of making money on me is an office visit.  Or a recurrence that might put me in the chemo pool-maybe.  

My surgeon sent me to the high dollar partner in the firm, his friend.  Instead, with my diagnosis and no chemo, I was given the new guy on the block.   

In addition to making money on the chemo, most doctors are partners in their practise and make money off of how many patients are assigned to them.  

A good analogy would be likened to how many shares you own in a corporation.  The more shares you own the higher your dividend payment will be at the end of the year.  The more patients you have the more money you make.  

Just being diagnosis with early stage and good prognostic tumor characteristics, I immediately felt like a number on a "profit and loss statement" -the number to the right of the decimal.  

Since my friend was the oncology nurse for a large oncology practise, her information, to coin a phrase, was "right from the horses mouth". 

lago

To be honest I do not feel my doctors look at me with dollar signs. My BS is so busy that not only does it take 3 weeks to get an appointment but he can be an hour late with seeing you because he spends as much time as needed with his patients. He actually suggested that any patient that was having difficulty with any wait time see his partner… and he will talk with his partner. (Not recommending but suggesting).

My Onc also spends as much time as I need with her. Finally my PS discounts his fee for breast cancer patients (covers his costs). He makes his money on the non insurance procedures and the reconstruction he does is his way of giving back.

Yes there are bad doctors, unethical ones and ones focused on their wallets. When you see that it's time to find another doctor.

------------------------------------

As far as the pink awareness being big business, yes I see that especially with Komen but at the same time they do lots of good things. To be honest I am really impressed with the American Cancer Society. No one charity is going to be perfect for anyone, they will have their flaws but they are doing the best they can with what they have. Without them we would be in worst shape with research dollars and support.

Pompeed

Allalone:

I don't know a lot about med mal.  But I do know this much: it is legally negligent to abandon a patient's care.  Which isn't the same the doc saying the doc will not provide care.  That's the doc's option: not to treat and give the patient notice of that choice.  But once the doc treats, the doc cannot abandon the patient, i.e., just disappear.  The doc can limit treatment once started and refer the patient to someone else for further treatment.  What's critical in that process of limiting treatment is notice to the patient.  Without notice, the doc may well be in ethical trouble for abandoning a patient.

Note too: there's a distinction between what's ethically required of a professional and what's legally required.  There's an obvious overlap in a lot of instances especially if the conduct is egregious.  But what a professional may be legally liable for to the client / patient may not trigger a professional ethics inquiry by the licensing authority. 

allalone

Pompeed:
Thanks for that info. So, in the case of the lady I mentioned, refusing her as a new patient is the doc's call (neither unethical nor illegal); and, because her treating doc gave her *notice* that he can no longer treat her as she had refused his tx regime, he, too, is acting within ethical/legal guidelines - and, presumably, had *no* responsibility to refer her to someone who may be able to monitor her (which, in her case, turned out to be nobody in her local medical community because they're all on the same page).

Wow, what a grim scenario. Submit or we won't monitor you. To me, that's unethical, no matter what the guidelines say. No wonder so many cancer pts end up in the hands of quacks.

AMP47 and lago:
As in the above case, pts in big cities have wider options re sympatico docs than those who live elsewhere, and all the advice we dispense about 'change your doc!' is easier said than done for some.

3jaysmom:
Many diseases have been eradicated, it's cancer's turn next - it better be! - and with all sorts of meds and ops becoming available to keep us looking good and feeling well way into our 100s there will come a time, hopefully *soon*, when you really will be wanting to live to 122 - even 222!

misfit:
Whether your center gets the best numbers in Canada by being more aggressive with conventional tx or by being highly selective in the pts included in the stats - e.g. including only dx early stagers or those of a certain age, or excluding those with pre-existing diseases and all those who died of causes other than bc (hastened by bc tx) - is something only the center's statistician can answer.

You're lucky your onc didn't brush aside your heart issues like the others did. Sounds like he's guided by *you* not his pushy colleagues; doesn't want *any* complication/death on his hands; believes that deliberately complicating pre-existing diseases in order to push the center's aggressive bc protocols is unethical; and doesn't adhere to the mantra that any death is acceptable during bc tx just as long as it's *not* from bc. Hang on to him!

Pink Barf:
Agree with all above, and wonder if any study has been done on the effect of the pink juggernaut on little girls. I can only imagine how scary it is to be a pre-teener today, being constantly bombarded with pink bc awareness messages everywhere. Has it reached their magazines yet? Are they recommending self-examination as soon as breasts appear?  Is there a BC Barbie? (OMG, better not give them any more barfy ideas).

AMP47

Allalone

Unfortunately, for women who develop this disease, in the town I live within, there is only one option for an oncologist: the doctor your surgeon assigns you to.   Or, you can drive three hours one way to see another oncologist.  

I posted earlier about a women who objected to the chemo drug her oncologist selected to use to treat her disease. She had extensive research skills and found two respected cancer treatment centers associated with very prestigious University of medicine that told her the drug would virtually be ineffective against her cancer.  The drug recommend had not been used in over 10 years.  They provided the name of the drug currently being used with good success and she presented the information to her oncologist.  

She talked with the doctor about her concerns. He refused to treat her if she did not accept his treatment plan. She ask for another oncologist and was refused that option. 

In order for her to change to another oncologist with in the firm, a corporate meeting had to be scheduled which had to include the patients ombudsman, the patient, evidence supporting her argument and the other partners within the firm.  Well-the good old boy next work was well established in this firm.  She was denied her request,  was denied treatment. and was ask to sign a document holding the medical firm harmless. ( a hold harmless agreement)  

Her lawyer wrote a letter to the firm asserting that he would file a suit against the firm for refusing her treatment using the treatment plan recommended by the  two prestigious cancer center recommendations citing the drug her oncologist recommended had not been used for over 10 years  and could, in effective , result in her untimely demise.  In addition to the letters from the University's, the medical firms ombudsmen agreed to testify on the patients behalf.  

Took a very quick emergency meeting of the board and she was assigned another oncologist, a female, who agreed with the patient 100% but never spoke up in her defense.  The result, she received treatment and her cancer is in remission and no further lesions have been found anywhere in her body.  

When you say" it is easier said than done" to change your doctor - my friend experience was an eye opener for me.  The skirmish never made news in the medical community - "mum was the word".  The oncology nurses knew the story. In order for them to keep employment, the "devil in the details", could never be  traced back to them.

Pompeed

Allalone wrote:

"Thanks for that info. So, in the case of the lady I mentioned, refusing her as a new patient is the doc's call (neither unethical nor illegal); and, because her treating doc gave her *notice* that he can no longer treat her as she had refused his tx regime, he, too, is acting within ethical/legal guidelines - and, presumably, had *no* responsibility to refer her to someone who may be able to monitor her (which, in her case, turned out to be nobody in her local medical community because they're all on the same page)."

Whoa!  Runaway stage coach!  Stop those horses!  It isn't useful to speculate and draw conclusions and apply presumptions from the second hand facts which I was given and the lack of knowledge I have in this area.

This much is the general law: no one, regardless of profession or vocation, is legally obligated to provide services to anyone else. That's slavery and that's been outlawed since the Civil Way. 

There are special rules for MDs in emergent circumstances but cancer treatment isn't emergent, i.e., the vitcim stumbles through the doors of the ER with a gunshot wound to the gut and falls onto the floor unconscious.  That guy is going to be treated now and all questions will have to be asked of him later.

An MD is not obligated to take or keep a patient who is disinterested in following his medical advice.  And an MD is not obligated to take on a patient whose illness is beyond the scope of his knowledge.  An MD whose speciality is pediatrics is not obligated to treat an adult with breast cancer.  It's an extreme example and obvious to some but it makes the salient point.  This is often how the quack MDs get into trouble: they take on cases where they lack the necessary expertise. 

Whether the MD pediatrician has an ethical duty to refer the patient to a breast surgeon is a question which has to be analysed by reference to state ethical rules. I would guess -- and it's only a guess -- that the pediatrician has no obligation to even examine the adult and speculate about the adult's medical troubles much less come to a definitive diagnosis. 

I turn prospective clients away all the time.  Because they come with legal problems I do not wish to get involved with or they come with legal problems I do not have the expertise or experience to address.  For everyone which is turned away, a subsequent letter goes out with the proper warning and notice on it, i.e., "you need a good attorney and you need one by XYZ time or you may lose your rights, I cannot help you with the problem you presented to me and no attorney / client relationship was established between us by virtue of the conference in my office on ABC date." 

When one is a professional, taking on things one doesn't have the skill or expertise to handle is an invitation to a lawsuit from a disappointed client/patient and an ethical complaint too when things go awry.  I can understand the prosition of an MD who doesn't wasnt to use a particular therapy because he/she has no experience using it with other patients.  On the other hand, if there are no other reasonable options -- the next oncologist is three hours away -- those facts may well have a significant impact on the outcome in terms of getting an MD to treat.  All to say: facts matter.  A lot.  And because they matter so much -- thanks, Justice Brandice -- one can get into a speculation muddle pretty quickly when all of the facts are not known.

I understand that it might leave the patient in a pickle but I see the MDs point of view too.  From the patient's point of view, however, if the MD isn't comfortable doing something that patient wants, perhaps the patient should see the MDs reluctance and refusal as a benefit and not a slur on the MD. 

One doesn't ever want to be the patient whose MD says, "Well, I've never seen anything like this before."

AMP47

Apr 4, 2010 06:52 pm wallycat wrote:

Not sure if this is of value, but thought I'd share it....this is why it's so freaking hard to figure out where someone stand on recurrence/mets.

 The Mathematics Of Cancer--from Forbes Magazine, march 15, 2010
Robert Langreth, 03.15.10, 6:00 PM ET

Larry Norton sees some of the toughest cases as deputy physician-in-chief for breast cancer at Memorial Sloan-Kettering Cancer Center. He has access to the most advanced imaging machines, the best surgeons and numerous new tumor-fighting drugs. But often the fancy technology helps only temporarily. Sometimes a big tumor will shrink dramatically during chemotherapy. Then all of a sudden it comes back in seven or eight locations simultaneously.

Norton thinks adding more mathematics to the crude science of cancer therapy will help. He says that oncologists need to spend much more time devising and analyzing equations that describe how fast tumors grow, how quickly cancer cells develop resistance to therapy and how often they spread to other organs. By taking such a quantitative approach, researchers may be able to create drug combinations that are far more effective than the ones now in use. "I have a suspicion that we are using almost all the cancer drugs in the wrong way," he says. "For all I know, we may be able to cure cancer with existing agents."

His strategy is unusual among cancer researchers, who have tended to focus on identifying cancer-causing genes rather than writing differential equations to describe the rate of tumor spread. Yet adding a dose of numbers has already led to important changes in breast cancer treatment. The math of tumor growth led to the discovery that just changing the frequency of chemo treatments can boost their effect significantly.

In the future Norton's theorizing may lead to new classes of drugs. Researchers have always assumed tumors grow from the inside out. His latest theory, developed in collaboration with Sloan-Kettering biologist Joan Massagué, asserts that tumors grow more like big clusters of weeds. They are constantly shedding cells into the circulatory system. Some of the cells form new tumors in distant places. But other wayward cells come back to reseed the original tumor, making it grow faster. It's like hardened terrorists returning to their home villages after being radicalized abroad and recruiting even more terrorists, says Massagué, who in December showed that the self-seeding process happens in laboratory mice. If this model works in humans, it will open up new avenues for treatment. It suggests that to cure cancer, doctors need to come up with drugs that stop the seeding process. These drugs may be different from the current crop of drugs, which are designed to kill fast-dividing cells.

Among other mysteries, self-seeding may explain why tumors sometimes regrow in the same location after being surgically removed: not necessarily because surgeons failed to remove part of the original tumor but because some itinerant cancer cells returned later to their original home to start a new tumor in the same place.

Norton, 62, got a degree in psychology from the University of Rochester, then an M.D. from Columbia University. For a while during college he thought he would make a career as a saxophonist and percussionist. The remnant of that dream is a vibraphone in his office in Memorial's new 16-story breast cancer center.

Ever since he was a fellow at the National Cancer Institute in the 1970s he has been trying to come up with mathematical laws that describe tumor growth. He treated a lymphoma patient whose tumor shrank rapidly during chemotherapy. A year later the cancer returned worse than ever. The speed with which the tumor grew back didn't jibe with the prevailing notion that most tumors grew in a simple exponential fashion.

Working with NCI statistician Richard Simon, Norton came up with a new model of tumor growth based on the work of the 19th-century mathematician Benjamin Gompertz. The concept (which other researchers proposed in the 1960s) holds that tumor growth generally follows an S-shape curve. Microscopic tumors below a certain threshold barely grow at all. Small tumors grow exponentially, but the rate of growth slows dramatically as tumors get bigger, until it reaches a plateau. A corollary of this: The faster you shrink a tumor with chemo, the quicker it will grow back if you haven't killed it all.

Based on these rates of growth, Norton argued that giving the same total dose of chemotherapy over a shorter period of time would boost the cure rate by limiting the time tumors could regrow between treatments. The concept got a skeptical reaction initially. "People said it was a total waste of time," he recalls. It took decades before Norton was able to prove his theory. But in 2002 a giant government trial showed that giving chemotherapy every two weeks instead of every three lowered the risk of breast cancer recurrence by 26% over three years, even though the two groups got the same cumulative dose.

Special Offer: Free Trial Issue of Forbes

Today Norton's "dose-dense" regimen is common practice for certain breast cancer patients at high risk of relapse after surgery. Timing adjustments are also showing promise in other tumor types. Last October a Japanese trial found that ovarian cancer patients lived longer if they received smaller doses of chemotherapy weekly rather than getting larger doses every three weeks, according to results published in The Lancet.

"Larry has been one of the real thinkers in this area," says Yale University professor and former NCI head Vincent DeVita. But designing better treatment schedules doesn't get as much credit as the glamorous business of inventing drugs.

Norton's latest theory about how tumors grow is derived from Massagué's pioneering research. It is consistent with Gompertz's growth curves and ties together two essential features of cancer that researchers had long considered separate--cell growth and metastasis.

Their collaboration started five years ago, when Massagué called Norton and shared a startling finding that was emerging from his laboratory. Massagué was studying how tumors spread from an organ such as the breast to the lungs, brain and other faraway places. He took human breast tumor cells, implanted them in mice and waited for metastases to occur. He analyzed cells that had metastasized to see what genes were overactive. None of the genes implicated in the spread of cancer to distant organs had to do with excessive cell division, it turned out. Instead, they all related to the ability to infiltrate and adapt to new environments.

The finding seemed to contradict doctors' impression that the fastest-growing tumors are also the most likely to spread. Pondering how to reconcile the two ideas, Norton and Massagué theorized that tumor cells released into the bloodstream sometimes are attracted back to the original tumor and help it expand.

Self-seeding may explain why large tumors tend to grow (in percentage terms) more slowly than small tumors: It could be that growth is a function of surface area rather than volume. Tumors that are efficient seeders may kill people by promoting the seeding process, not because they have a higher exponential growth rate.

It took Massagué four years of work to prove that self-seeding occurs in laboratory mice. Now comes the tricky part: coming up with drugs that block tumor seeding. Massagué and Norton have identified four genes involved in seeding and are testing for drugs to block them. Convincing drug companies to go along could be difficult; it's easier to see whether a drug shrinks tumors than to see whether it stops evil cells from spreading. But Norton believes that doing this hard work may be the key to a cure.

AMP47

Apr 5, 2010 10:29 am mymountain wrote: <table width="100%"><tbody><tr><td>

  

  Found this on self seeding

  

  

  

  

Press Releases

</td><td><table><tbody><tr><td></td><td></td><td></td></tr></tbody></table></td></tr></tbody></table><table height="400" width="580"><tbody><tr><td>

Self-Seeding of Cancer Cells May Play a Critical Role in Tumor Progression

December 24, 2009

NEW YORK, NY - Cancer progression is commonly thought of as a process involving the growth of a primary tumor followed by metastasis, in which cancer cells leave the primary tumor and spread to distant organs. A new study by researchers at Memorial Sloan-Kettering Cancer Center shows that circulating tumor cells - cancer cells that break away from a primary tumor and disseminate to other areas of the body - can also return to and grow in their tumor of origin, a newly discovered process called "self-seeding."

<table width="100%"><tbody><tr><td>"These results provide us with opportunities to explore new targeted therapies that may interfere with the self-seeding process and perhaps slow or even prevent tumor progression." -- Joan Massagué, PhD, Chair of the Cancer Biology and Genetics Program at Memorial Sloan-Kettering and a Howard Hughes Medical Institute investigator</td></tr></tbody></table>

The findings of the study, published in the December 25 issue of the journal Cell, suggest that self-seeding can enhance tumor growth through the release of signals that promote angiogenesis, invasion, and metastasis.

"Our work not only provides evidence for the self-seeding phenomenon and reveals the mechanism of this process, but it also shows the possible role of self-seeding in tumor progression," said the study's first author Mi-Young Kim, PhD, Research Fellow in the Cancer Biology and Genetics Program at Memorial Sloan-Kettering.

According to the research, which was conducted in mice, self-seeding involves two distinct functions: the ability of a tumor to attract its own circulating progeny and the ability of circulating tumor cells to re-infiltrate the tumor in response to this attraction. The investigators identified four genes that are responsible for executing these functions: IL-6 and IL-8, which attract the most aggressive segment of the circulating tumor cells population, and FSCN1 and MMP1, which mediate the infiltration of circulating tumor cells into a tumor.

The findings also show that circulating breast cancer cells that are capable of self-seeding a breast tumor have a similar gene expression pattern to breast cancer cells that are capable of spreading to the lungs, bones, and brain, and therefore have an increased potential to metastasize to these organs. Additional experiments revealed that self-seeding can occur in cancer cells of various tumor types in addition to breast cancer, including colon cancer and melanoma.

"These results provide us with opportunities to explore new targeted therapies that may interfere with the self-seeding process and perhaps slow or even prevent tumor progression," said the study's senior author, Joan Massagué, PhD, Chair of the Cancer Biology and Genetics Program at Memorial Sloan-Kettering and a Howard Hughes Medical Institute investigator.

The concept of self-seeding sheds light on clinical observations such as the relationship between the tumor size, prognosis, and local relapse following seemingly complete removal of a primary breast tumor. "We know there is an association between large tumor size and poor prognosis. This was always thought to reflect the ability of larger cancers to release more cells with metastatic potential. But this association may actually be caused by the ability of aggressive cancer cells to self-seed, promoting both local tumor growth and distant metastases by similar mechanisms," said study co-author Larry Norton, MD, Deputy Physician-in-Chief for Breast Cancer Programs at Memorial Sloan-Kettering.

This work was funded by grants from the National Institutes of Health, the Hearst Foundation, the Alan and Sandra Gerry Metastasis Research Initiative, and the Department of Defense.

---

</td></tr></tbody></table> dx5/08 ILC 1cm/dcis in margins stage l grade ll 0/3 nodes er+pr- her2-,mast/diep recon

hopefortomorrow

AMP- Thank you for posting. Interesting reading.

allalone

AMP47 and Pompeed:
I suppose some could argue that if pts can access the type of tx they want by taking a 3 hr trip then as long as the inconvenience and expense isn't unbearable it's more reasonable for them to do that than bring in the legal guns - but the bottom line is that ideally pts should have choices within their own community. Also, while I fully understand that docs have rights, too, and are not our slaves, I'm just sad, I suppose, that the profession has become so bogged down with legalities, protocols and deals with drug companies that values such as compassion, integrity and good old common sense are being compromised. I suggest that if all else fails, go see a vet.

Pompeed

Ideally, every patient who needs a good MD will have one of the patient's own choice no more than a short drive or an easy train ride away.  That's true in a lot of Europe where spaces are small and public transportation is exceptional.  But the geography of the US is not like Europe.

I think that that problem of access is far more complicated than what's suggested.  As an example, MDs with top line training and the debt which that training cost hanging over their heads are not going to set up a practice in a tiny community hospital out in the middle of range country where ranches are 100,000 acres in size, it's twenty miles to the nearest paved road and the population is so sparce that there aren't enough patients to keep a general practice MD busy much less keep a specialist busy.  I don't think these facts on the ground have much to do with lack of compassion or lack of integrity or lack of common sense. 

I do see the MDs point of view: the MD has gone to medical school and then trained in oncology.  And it may not be ethical for that individual to do what a patient with an seventh grade education insists be done to him because he read something about the therapy on the Internet.  The patient may not be competent to decide that the therapy the patient wants and the therapy which may be best for the patient's situation are not one and the same.  Knowledge is a good thing but sometimes a little bit of knowledge can be very dangerous.

To have choices of MDs within one's community, that community has to be of sufficient population size to support multiple professionals of the same speciality.  And even if there is a sufficiently large population to support multiple professionals, there's no guarantee that any one of them will practice medicine according to a patient's dictates and desires.  Frankly, I would not leave my medical care to a physician who does what I say rather than giving me his best professional judgment. 

My clients don't run my law practice or dictate to me how to manage their cases and I'd be a fool and a really incompetent attorney if I let them.  If the client wants to run the litigation because he thinks he knows more than I do, he doesn't need an attorney: he can represent himself.

Pompeed

Seems to me that there's increasing proof that what's in the "neighborhood" around maverick cells and how the neighbors react to maverick cells behaving badly is a very promising area for cancer therapy. 

1Athena1

AMP - thank you for some very interesting articles. I still think it's a fool's paradise to try to mathematically "outrun" the weeds (cancer cells). I would prefer a systemic approach that creates a hostile climate for cell growth, and doesn't just continue this numbers game.

I believe in the less is more approach to cancer, but the concept of re-seeding may change the way we look at cancer. I tend to think that the more they find out, the more they may realize that cancer is a sort of very sophisticated virus.

otter

(Where's that darn "like" button?)

Pompeed, I really liked your most recent post.

allalone, you said, "I suggest that if all else fails, go see a vet."  Most of the vets I know (and I happen to know a few) would eventually refuse to treat an animal whose owner repeatedly declined the vet's medical advice and who insisted on using unconventional treatments that, in the vet's judgment, were not in the pet's best interests.  Some vets will entertain "alternative" therapies; some vets even subscribe to them.  It does tend to be a regional philosophy (more common on the Left Coast, for example).  Vets in my area would probably walk away, shaking their heads.

Just for fun and as an example, take a look at this:  http://www.youtube.com/watch?v=PYqzT1zaZVE

otter

FireKracker

I have been away for a while and im glad to be back. the tone of this thread is so nice now.Its about time.The posts are wonderful.Thanks to all my sistas for all the great info.God bless all of us who are fighting this giant monster.bc suks.huggggggggggggs K