Prostate cancer treatment and Alzheimer’s

Once again the treatment for a cancer can have cruel results. This will not be good news for a lot of people.
From the NY Times:

Hormone therapy, a common treatment for prostate cancer, is associated with an increased risk for Alzheimer’s disease, a new study has found.

The goal of hormone therapy, also known as androgen deprivation therapy, is to lower the level of male sex hormones, or androgens, that stimulate the growth of prostate cancer cells.

Researchers used records of 16,888 people with prostate cancer, of whom 2,397 were treated with hormone therapy. Over a median follow-up of 2.7 years, there were 125 new diagnoses of Alzheimer’s disease.

Over all, those treated with hormone therapy had an 88 percent increased risk of Alzheimer’s compared with other patients. The longer the hormone treatment, the more the risk increased, and patients with at least 12 months of treatment had more than double the risk. The study is in The Journal of Clinical Oncology.

The finding persisted after adjusting for race, smoking, cardiovascular disease, diabetes, prior cancers and other factors.

“It would not be appropriate to change the way we treat patients now,” said the lead author, Dr. Kevin T. Nead, a resident in radiation oncology at the University of Pennsylvania. “Androgen treatment is life-extending treatment, and very important. We found an association, but there is no evidence that hormone therapy causes Alzheimer’s.”

Androgens have been shown to affect the accumulation of amyloid plaques, one of the features of Alzheimer’s disease, and this may be one mechanism that could explain the finding.

The Scar Project: breast cancer is not a pink ribbon

The best explanation of the scar project comes with the second link below. I’ll try to give some background first.

Breast Cancer in young women is very worrying. The statistics put the chances of death within the standard 5 and 10 year markers quite high when compared to the rates of death in older women. In addition to this very scary fact, a cancer victim, young or old, typically ends up with surgery and other treatments, such as radiation, and may be left seriously scarred and even infertile. For many cancer victims, the cancer is fueled by estrogen, and it may make sense in some cases to have one’s ovaries removed.

Nonetheless, the beauty and dignity of cancer victims is very obvious, as the scar project is meant to show us in the young victims of this disease. I am going to link to an NY Times article and a clip about the project. There is also a video from youtube.You’ll be looking at the aftermath of surgery. Some women have had lumpectomies and others mastectomies. You may find the pictures difficult to look at, though my own squeamish self had no problem at all. Still, it seemed better to link to these pictures.

NYTimes article by Susan Gubar,

Clip linked to from the NYT,


Breaking news on breast cancer

One of the most frightening facts of breast cancer is that two people may have the same diagnosis at the same stage, get the same treatment and then have remarkably different outcomes. One consequence of this is that while there is a lot of talk about cures for breast cancer, many women regard the diagnosis as a conditional death sentence.

An article published today online in Nature looks as though it will give us the tools to understand why outcomes vary and what different treatments can help those headed toward a worse outcome. The findings seem also to be well explained in the New York Times.

Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not.

The genetic analysis divided luminal cancers into two distinct subtypes. The luminal A subtype had good prognoses while luminal B did not, suggesting that perhaps patients with luminal A tumors might do well with just hormonal therapy to block estrogen from spurring their cancers while luminal B patients might do better with chemotherapy in addition to hormonal therapy.

In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”

“We are really getting at the roots of these cancers,” he said.

It looks as though there are going to have to be clinical trials, but there are a number of breast cancer types with discouraging statistics, and now we can hope those can be much more effectively treated soon. As far as I can see, these include ones for which some women have prophylactic mastectomies, since if you carry the gene for them having your breasts removed may be the best option.

academic mobbing (and cancer)

The topic of academic mobbing really deserves more than one post. This post is mostly about what mobbing is. The material also answers a very puzzling question asked in a post about cancer patients; hence, the word in parentheses.

Addition: in the light of comments 3,4 and 5, let me suggest it is important that readers add up in their minds what’s going on in mobbing. It can end your chances of advancement and wreck your health. In addition, as the comments below indicate, you can end up isolated from the community. Perhaps worse, mobbers may feel free of any constraints of humanity in dealing with you. What are we to say of people who do this? Evil? Very ill? Lacking in an important kind of reflective self-awareness? Probably many different kinds of things, but one element (that Naomi Zack pointed out to me with regard to a specific case) is an unblinking determination to preserve or enhance a current distribution of power.

In the next post on mobbing, i’ll look at what we know about what can be done.

What is academic mobbing? You can think of mobbing as group bullying, but in the work place it can take on its peculiar characteristics. It also goes far beyond typical school bullying. For example, it can encompass obstructing any promotion chances you have, spreading rumors about the quality of your work and the ethics of your motivations. Perhaps you did fund raising that brought in several hundred thousand dollars; mobbers may well tell your dean that actually the fundraising was done by someone else, and you are simply making empty boasts when you claim you did it. Perhaps you work in a fairly cutting edge areas; they will tell people not in a position to judge (e.g., the upper administration, the board of regents) that you are selling out in a way that harms the university.

Of course, letter writing is a great pastime, and mobbers may write to your professional friends with their own made up accusations. You will not be told, of course, that this has happened. Thus those targeted in this way are often denied procedural fairness and natural justice (see link immediately below). Mobbers charges are often based on little more than fantasy, but they are not about to ask the victim for confirmation.

Why in the world would anyone do that? The profiles of the victims are interesting, and indicate that those at high risk are most likely to be:

* Change agents
* High achievers
* Enthusiastic (eg those who volunteer)
* Those with integrity
* Those with ethical standards
* Promoters of human rights, dignity and respect

It is a good guess that those targeted for the first two reasons are very threatening, particularly since faculty are quite notorious for not liking change or challenge. It is far easier to believe the work is fraudulent in some way than to believe it is better than yours. If you are very surprised at that, then it is quite possible you are just very far from the type of person who would mob. As far as I can see, part of what explains the latter characteristics causing scorn is that mobbers, like most of us, use themselves as models for understanding others; as a consequence, they cannot believe that people are motivated by anything other than self-interest, because that is their principal motive. You may think you are lobbying the board of regents at some personal risk because you think a great injustice has been done; they cannot believe that, and so they assume you actually have an entirely different agenda that has to do with self-promotion.

Denise Dellarosa Cummins raised the topic of mobbing in a discussion on a post a couple of weeks ago, and she mentioned three articles:

Since you or someone you know may be mobbed, it is well worth your while to look it. Mobbing is not just an inconvenience; approximately 12% of mobbed adults commit suicide. Many get heart trouble, ptsd and other very serious health problems. Around 30% of people in a mobbing-prone organization will get mobbed, and universities are mostly mobbing prone.

Now, onto the puzzling question.

I found a question raised in here, important and puzzling. It raises the question of why anyone would want to cause great and unnecessary stress to a cancer patient undergoing pretty dire treatment. Given people do sometimes cause great stress to cancer patients, it is important.

What is so puzzling is the news that anyone would. Suppose you have an obnoxious neighbor whose even more obnoxious pet armadillo has been burrowing in your yard. Your neighbor is bad but you frankly hate the animal, because it is messy, dirty, destructive and very, very smelly. So you think you will petition the community board to get permission to relocate the thing. But suppose you find the person is receiving life-threatening treatment for cancer, with perhaps an attendant brain fog. Surely that would change your plans. You can wait on their pet armadillo.

Now there may be many different reasons why some people would go ahead. But mobbers have a distinctive kind of reason. Mobbers strike when one gets sick, a lot of research confirms. Thus a mobber would see the neighbor as vulnerable and so affording an opportunity for action. Asking why a mobber would do something that causes great and unnecessary distress to a cancer patient is like asking why the buglers stole your briefcase the one time you forgot to lock your car. These are people waiting for the opportunity.

(I owe the views about the undesirability of armadillos as pets to a recent “This American Life.” I do not recommend listening to that episode. In fact, the armadillo, Otis, comes off well; the humans not so much.)

Dress Code After Mastectomy

Jodi Jaecks is a Seattle woman, a breast cancer survivor who underwent a double mastectomy. She needed to swim for her recovery. A bathing suit top caused her pain.  She had no breast tissue and asked for permission to swim topless.

Jaecks, who has neither breasts nor nipples, says she wasn’t looking for a fight, simply a way to be active and perhaps get some temporary relief for her chest pain.

She was denied.

Why?  There are some clothes that women are just supposed to wear:

“And that’s when they said it was a policy that they required gender-appropriate clothing … regardless if I had nipples or whatever,” Jaecks said. 

And of course, there are the children to think of:

“We’re trying to protect children,” Potter [spokeswoman for the Seattle Parks Department] said. “A public pool isn’t necessarily the place to be carrying out an agenda.”

Eventually, Jaecks was granted an exception to the policy, during adult swims.  The Seattle Times says,

Jaecks says that’s not good enough. She wants the dress code changed for all women with mastectomy scars. She’ll keep on pressing for such a policy change, she says, and Wednesday night was not sure whether she would take advantage of the decision in her favor.

“It’s absurd and ludicrous that they would give one person permission because it puts the onus on a specific person to ask for permission individually,” Jaecks said. “It’s going to be harder for a more reserved, self-conscious woman to have the guts to stand out and be different.”

According to Jaecks

“It started as a personal fitness issue but once they said no to me, it became a far greater overarching political issue,” she says. “I’m hoping this will change their policy,” she told the paper. “Ultimately, I want to remove the stigma that women with breast cancer have to endure. We should be so far beyond that at this point.”

Mistreating cancer patients: how about not making us sicker?

I asked a friend who specializes in medical history what it is about cancer patients, and the way they get attacked psychologically. She says there is a huge stigma about lung cancer, but she didn’t think it was true for other forms. So that leaves us without an answer to the question, How can anyone think it is a good idea to deal someone a blow at as they are goiing through treatment for cancer? And, believe me, they do all too often.

There are pretty bad figures about the national complaints, but there is also tons of anecdotal evidence that I’ve heard at my cancer center. Maybe part of it is that a lot of cancers occur when people might want to get rid of you and put a younger person in your place. But whatever it is, research is now making it completely clear: Stress can affect ways in which cancer cells grow and spread.

One of the US’s main cancer center just sent around the following:

there is growing scientific evidence that considerable psychological distress can affect the immune system, cancer specific biological pathways, and treatment recovery.

Some kinds of cancer love to spread; in fact, that’s often what makes them lethal. And they can create their own pathways. Stress can help them get the needed ingredients. It really can shorten lives and do so in very awful ways. Metatasis to the brain can lead to WBR, or whole brain radiation. There’s no way that’s something you want to do unless your life is at stake. You really, really don’t want to worry of you helped cause that because of your hostile behavior, however self-righteous you may have felt at the time. So concentrate on healthier people, OK? Not some experiencing an awful and still fundamentally mysterious disease.

Health care cost skyrocket, recommendations for screening women reduced

From the NY Times:

For nearly three generations, women have been taught that annual Pap smears, mammograms and visits with their doctor were essential to good health.

Now all that is changing. National guidelines are urging less frequent screening for breast and cervical cancer. The declining use of menopause hormones means that older women no longer need to check in with their doctors to obtain annual refills. Women are delaying childbirth, and some birth control methods are effective for five years, giving women even less incentive to schedule a regular appointment.

I have very mised feelings about this.  I’d love to know what others think.

I do think that the early introduction to the gynocologist that so many young women experience can easily become part of the pathologizing of the female body.  There are so many bits, and they need constand vigilance because they can turn against you at any monent.  And that’s just day to day life; if you become pregnant, little choices you make can ruin two lives, or indeed more.

On the other hand, I do not really understand the argument that the yearly screening is bad because there are a number of false positives that cause a lot of stress.  Doesn’t a human life typically involve facing the possibility of really bad news?

For example, at the age of 16 children’s brains are  not yet developed enough to give their owners the self control that adults more typically have.  And that’s when they can get control of a car to drive around.  Now there’s stress.  Or how about the stress of having a mean boss or getting demoted, turned down or even ridiculed in a social context.  What’s worse:  getting a really nasty review or having to go back to have the mammo redone just in case?  Or even having a biopsy because there is a lump.

And then there’s the suspicion that the reductions are occurring just when health care costs are receiving so much attention.

So what do you think?  I’m really interested in hearing what people think about the early pathologization of the female body.  It would also be great to hear from people not from the medically self-conscious USA.

I do remember Michael Dummett claiming that American concerns with, e.g., smoking argued a national narcissism about perfecting the individual.

Please let us know your views.

An important message but …

This picture is making its way around the ‘net. Just about any message that points out the great injustice of our health care system gets positive points from me. But I’m a bit worried about the accuracy of his message. For why, see below:

So what worries could one have?  Actually, the flaws in the picture seem so obvious, that I’m having trouble believing they are real.  I mean, it would be pretty easy to get someone who actually looked like they had chemo, or at least the guy could have shaved and they could have hidden his hair under a cap. 

Here are some worries, then, given that his rads and chemo ended in August and his surgery was in May, and judging from my own case.  All I’m supposing is that the picture was taken after the rads and chemo. 

1.  If that scar is from a May operation then it looks way too red.   Four months after surgery about half my scar is now back to my normal skin color.

2.  Chemo really does a job on hair, including eyebrows and beard.  How long it takes to grow back varies, but it takes a long time just to get fuzz.

3.  That does not look like a recently radiated nipple to me.  Radiation changes the color of that  tissue and it takes some time to recover.  Plus, it is surprising the nipple was left; that’s not too unusual, but that “incision” is pretty big and would indicate the cancer wassignificant.  It’s often safer to take the nipple.

4.  Cancer does not automatically make one unemployed, contrary to what he seems to suggest.  It certainly can, but it is far from automatic.

One lesson here:  if you think someone at work is wearing a wig, don’t assume it is from superficial vanity.  They may be one of the employed cancer patients.

Further, the person at work may be hiding the cancer.  It is unbelievable how badly some people treat cancer patients.  Many, many people have very bad experiences.