Dr Larry Norton on The View

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Racy
Racy Member Posts: 2,651

I just saw an interview with Dr Larry Norton on Wednesday's edition of The View. I found his messages clear, sound and common sense.



If you are in the US, I believe you can watch it on The View website if you are interested.

Comments

  • hbcheryl
    hbcheryl Member Posts: 5,113
    edited October 2011

    Yes he is from Memorial Sloan Kettering and was on todays show and the interview was was very insightful worth looking at. 

  • Racy
    Racy Member Posts: 2,651
    edited October 2011

    And the View ladies didn't interrupt or rush the interview as sometimes happens, which helped him get his important points made. The questions were also good.

  • hbcheryl
    hbcheryl Member Posts: 5,113
    edited October 2011

    I agree for once there was none of that over talking that they do.

  • Racy
    Racy Member Posts: 2,651
    edited October 2011

    It's still my favourite show though; I watch every day.



    But that's another topic!

  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2011

    http://www.youtube.com/watch?v=J71ff_1mAqI

    Not a great fan of The View or Larry Norton, MD.  But above is a very recent Dr. Norton interview from MSK's website.  I question much of what he says particularly about Axillary Lymph Node Dissection AND SCREENING mammograms for certain populations....  Below is the most recent study from JAMA regarding ALND published months before the interview:



     

    Original Contribution



     

    JAMA. 2011;305(6):569-575. doi: 10.1001/jama.2011.90



     

    Axillary Dissection vs No Axillary
    Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis



     

    A Randomized Clinical Trial



     

    1.  
    Armando E.
    Giuliano
    , MD;



     

    2.  
    Kelly K. Hunt,
    MD;



     

    3.  
    Karla V. Ballman,
    PhD;



     

    4.  
    Peter D. Beitsch,
    MD;



     

    5.  
    Pat W. Whitworth,
    MD;



     

    6.  
    Peter W.
    Blumencranz
    , MD;



     

    7.  
    A. Marilyn
    Leitch
    , MD;



     

    8.  
    Sukamal Saha,
    MD;



     

    9.  
    Linda M. McCall,
    MS;



     

    10.  Monica Morrow,
    MD



     

    [+]
    Author Affiliations



     

    1. Author Affiliations: John Wayne Cancer Institute at Saint John's Health
    Center, Santa Monica, California (Dr Giuliano); M. D. Anderson Cancer Center,
    Houston, Texas (Dr Hunt); Mayo Clinic Rochester, Rochester, Minnesota (Dr
    Ballman); Dallas Surgical Group, Dallas, Texas (Dr Beitsch); Nashville Breast
    Center, Nashville, Tennessee (Dr Whitworth); Morton Plant Hospital, Clearwater,
    Florida (Dr Blumencranz); University of Texas Southwestern Medical Center, Dallas
    (Dr Leitch); McLaren Regional Medical Center, Michigan State University, Flint
    (Dr Saha); American College of Surgeons Oncology Group, Durham, North Carolina
    (Ms McCall); and Memorial Sloan-Kettering Cancer Center, New York, New York (Dr
    Morrow).



     

    Abstract



     

    Context Sentinel lymph node dissection (SLND) accurately
    identifies nodal metastasis of early breast cancer, but it is not clear whether
    further nodal dissection affects survival.



     

    Objective To determine the effects of complete axillary lymph
    node dissection (ALND) on survival of patients with sentinel lymph node (SLN)
    metastasis of breast cancer.



     

    Design, Setting, and Patients The American College
    of Surgeons Oncology Group Z0011 trial, a phase 3 noninferiority trial
    conducted at 115 sites and enrolling patients from May 1999 to December 2004.
    Patients were women with clinical T1-T2 invasive breast cancer, no palpable
    adenopathy, and 1 to 2 SLNs containing metastases identified by frozen section,
    touch preparation, or hematoxylin-eosin staining on permanent section. Targeted
    enrollment was 1900 women with final analysis after 500 deaths, but the trial
    closed early because mortality rate was lower than expected.



     

    Interventions All patients underwent
    lumpectomy and tangential whole-breast irradiation. Those with SLN metastases
    identified by SLND were randomized to undergo ALND or no further axillary
    treatment. Those randomized to ALND underwent dissection of 10 or more nodes.
    Systemic therapy was at the discretion of the treating physician.



     

    Main Outcome Measures Overall survival was
    the primary end point, with a noninferiority margin of a 1-sided hazard ratio
    of less than 1.3 indicating that SLND alone is noninferior to ALND.
    Disease-free survival was a secondary end point.



     

    Results Clinical and tumor characteristics were similar
    between 445 patients randomized to ALND and 446 randomized to SLND alone.
    However, the median number of nodes removed was 17 with ALND and 2 with SLND
    alone. At a median follow-up of 6.3 years (last follow-up, March 4, 2010),
    5-year overall survival was 91.8% (95% confidence interval [CI], 89.1%-94.5%)
    with ALND and 92.5% (95% CI, 90.0%-95.1%) with SLND alone; 5-year disease-free
    survival was 82.2% (95% CI, 78.3%-86.3%) with ALND and 83.9% (95% CI,
    80.2%-87.9%) with SLND alone. The hazard ratio for treatment-related overall
    survival was 0.79 (90% CI, 0.56-1.11) without adjustment and 0.87 (90% CI,
    0.62-1.23) after adjusting for age and adjuvant therapy.



     

    Conclusion Among patients with limited SLN metastatic breast
    cancer treated with breast conservation and systemic therapy, the use of SLND
    alone compared with ALND did not result in inferior survival.



     

    Trial Registration clinicaltrials.gov
    Identifier: NCT00003855



     

    KEYWORDS:



     Regarding SCREENING mammography, you can read my comments and the accompanying studies on the Julianna Rancic thread....

    I feel very strongly that we deserve better than listening to dogma from such an esteemed physician. My medical oncologist worked very closely with Dr. Norton on his game changing "dose dense" chemotherapy trial and he deserves to be commended for that idea since it has improved AND saved the lives of so many breast cancer patients.  However, as long as he remains firm in his ideas about other issues, it is going to be difficult to find even better methods of SCREENING and THERAPY.  Yes, SCREENING mammograms are important for women over between 50 and 69 years of age.  DIAGNOSITIC mammograms are important for ALL women.  But we need better SCREENING techniques for all of the sisters....especially for the younger women with dense breasts.  BTW....I was one of those women who went for annual SCREENING mammograms beginning at age 40.  Knew I had dense breasts and also had annual sonograms.  At age 53, my lump was found by my ob/gyn at my routine annual visit.  DIAGNOSTIC mammogram missed it.  Sonogram found it.   MRI found a drop of DCIS that both the mammogram and sonogram missed.  Go figure.

    Regarding ALND...well, now we know that many women can forgo it.  Don't understand why he didn't mention that in his interview because it was already known......

  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2011

      This was published two days ago in the Annals of Internal Medicine.  We need to see more studies like this one and more promotion of this type of screening:

      

    Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United StatesA Cohort StudyKarla Kerlikowske, MD; Rebecca A. Hubbard, PhD; Diana L. Miglioretti, PhD; Berta M. Geller, EdD; Bonnie C. Yankaskas, PhD; Constance D. Lehman, MD, PhD; Stephen H. Taplin, MD, MPH; andEdward A. Sickles, MD, for the Breast Cancer Surveillance Consortium          From University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; Group Health Research Institute, Group Health Cooperative, University of Washington School of Public Health and Community Medicine, and University of Washington School of Medicine, Seattle, Washington; Health Promotion Research, University of Vermont, College of Medicine, Burlington, Vermont; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Applied Research Program, National Cancer Institute, Rockville, Maryland.        AbstractBackground: Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice.Objective: To determine whether the interpretive performance of digital and film-screen mammography differs.Design: Prospective cohort study.Setting: Mammography facilities in the Breast Cancer Surveillance Consortium.Participants: 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen).Measurements: Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes.Results: Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P = 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P < 0.001).Limitation: Statistical power for subgroup analyses was limited.Conclusion: Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection.Primary Funding Source: National Cancer Institute

  • Racy
    Racy Member Posts: 2,651
    edited October 2011

    He mentioned in the View interview that node removal is no longer routine and digital mammography is more common nowadays. Sonogram was also mentioned in response to a question from Whoopi. He spoke in favour of annual screening from age 40 but repeatedly stressed that each case must be assessed individually. The interview also covered fertility treatments and bc, and where we are at in finding a cure.

  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2011

    Racy...I did see The View interview.  If you look at the MSK website, the interview is quite recent. I appreciate when he says that each case must be assessed individually.  However, I think he needs to join the discussion about the limitations of SCREENING mammography....The picture he presents is IMHO not that accurate and should explain how it affects the various populations. 

    Granted he has only a little time to speak, but since The View is watched by so many women, I would expect that he could clearly spell out the benefits and drawbacks of screening mammograms, so women can have an informed discussion with their physician about the best type of screening for them.

    The part about fertility treatments and bc was interesting.  I have a cousin who was diagnosed with ovarian cancer and underwent fertility treatment when she was younger.  That's another area that deserves lots of research.

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