Setbacks in the Fight Against Breast and Prostate Cancer
Two news articles this week cast a cloud on the fight to reduce incidence and improve survival rates for metastatic breast cancer and prostate cancer
Metastatic Breast Cancer Project vs. Electronic Records
A New York Times story by Gina Kolata sheds light on how paperwork is getting in the way of finding potentially life-saving treatments for women with metastatic breast cancer. The article featured a years-long effort by Nikhil Wagle, an oncology researcher at Dana Farber Cancer Institute in Boston who specializes in breast cancer.
Wagle is trying to build a huge database that links cancer patients’ medical records, treatments and outcomes with their genetic backgrounds and the genetics of their tumors, but has run into difficulty. The database would also include vital information from their patient records—how ill did they feel with treatments, what was their quality of life—and tease out patters that would help doctors choose the right treatments.
The Metastatic Breast Cancer Project began in 2015 and patients and advocates alike have responded enthusiastically. There are currently over 4,000 women enrolled in the project. Determining their genetic sequences was the easy part, but gathering the medical records has presented numerous hurdles. The data exist in all kinds of formats and the providers holding the records have not always released them. Some medical records can be up to 300 pages long, and extracting crucial information and entering it into their database can take days.
Kolata’s article underscores the inherent difficulties in personalizing therapies despite the tremendous strides we have made in profiling tumors and tailoring treatments that target mutations found in those tumors.
Streamlining medical records seems like a fixable problem and translating them into forms useful to researchers seems like a fixable problem thus far—and certainly easier to solve than cancer itself—but this article shows how far we have to go before can leverage data to improve treatment outcomes.
Prostate Cancer Rates
The US National Cancer Institute published data this week in the American Cancer Society’s journal Cancer that shows the death rate for prostate cancer has stopped decreasing for the first time in 20 years, and the incidence of advanced disease is rising.
While it is unclear what is driving these trends, the fact that they appeared to coincide with a decline in screening for prostate cancer is accelerating debate over the prostate-specific antigen or PSA test, which a federal advisory committee discouraged men from using six years ago because the harms of aggressively treating some early-stage malignancies outweighed any benefit. While doctors once urged patients to undergo immediate, aggressive treatment for early-stage malignancies, many now recommend “active surveillance,” or close monitoring, for indolent cancers, The Washington Post reported this week.
But the NCI’s discouraging findings, which were released as a companion study to the latest “Annual Report to the Nation on the Status of Cancer,” is sure to spark more heated debate over the value of PSA screening.
What’s clear is that consensus will need to be reached on how best to screen men for this kind of cancer, which is the second leading cause of cancer death in American men.