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Democracy Now





San Francisco, CA, USA

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Dr. Glaspy 7, Dr. Ganz 7, Us 6, Dr. Bernstein 6, Ms. Coscarelli 5, United States 4, Dr. Slamon 3, China 3, Ucla 3, Dr. Henderson 3, Online 2, Doreen Gerber 2, Harold Varmus 2, Jonsson 2, Herceptin 2, Taiwan 2, Southern California 1, Menarche 1, Koreans 1, Asia 1,
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    April 18, 2013
    3:00 - 3:59pm PDT  

narrator: it's a rdict no one wants to hear. doctor: the tests came back positive. you have cancer. woman #1: i got kind of hysterical. woman #2: i believed i was going to die. woman #3: you talk about being scared, yeah, i'm terrified of the idea. but today, a cancer verdict need not be a death sentence... especially if the disease is caught in its early stages.
cancer. disease thatas probably touched your life some y. more than 40 percent of americans will be diagnosed with cancer during their lifetime, and more than 20 percent will die from it. when we talk of cancer, we often refer to it as if it were a single disease. but in reality, it is many diseases. one of the women i was counseling today had a family member who had uterine cancer, one had breast cancer, one had colon, one had cervix. i had to try to explain to her that these diseases were cancer, but were not all related. the cause of each was very different. cancer is a general name
for more than 100 different diseases. but what all cancers have in common is uncontrollable growth of cells. cells are the building blocks of all organisms-- they all grow and divide, but as a rule, only when the body needs new cells to stay healthy. but once cells become cancerous, they reproduce indefinitely. cancer develops in cells that have damaged genes, or mutations. harold varmus: human cancer is a genetic disease in an unusual way. some altered genes are inherited but that's an uncommon event. much more commonly our genes undergo changes in only a few cells during the course of our lifetime. and certain constellations of changes predispose a cell to becoming a runaway-- a maverick cell that we know is a cancer cell. this is the way that we look at people's dna. dna is much too small to actually see, even under a high powered microscope.
but, we can use biochemical reactions to amplify the dna. successive mutations to the hereditary material of certain cells produce oncogenes-- "on" switches that accelerate cell growth. tumor suppressor genes, "off" switches that restrict growth, may also mutate or... become lost from the hereditary makeup of a cell. when this happens, a cell can make billions of copies of its abnormal self. the excess tissue forms a mass-- a tumor. some tumors are benign... they don't invade nearby tissue or spread to other parts of the body. but a malignant tumor is cancer. its cells can invade and destroy healthy tissue, and spread to other parts of the body through the blood and lymph system. when we get that tumor and we look at the molecular changes in the tumor, we're kind of looking at the end stage.
it's not the end stage of the disease for the patient but it's kind of the end product. what we really need to understand is, what is the first mutation that allows that cell to have slight growth advantage? in other words, the cell is unstable, and what exposures link to that mutation, that next mutation that might be acquired to do this? this carrier type represents a cell from a malignancy-- a leukemia. and instead of the normal number of chromosomes there are now 47 chromosomes in this cell. there are three copies of chromosome eight, instead of the normal number of two copies of chromosome eight. dr. ganz: and again, if we understand what the risk factor is or the environmental hazard or what the exposure is that leads to a specific mutation, then we can begin to link interventions in terms of reducing the risk of cancer. successive genetic changes must take place for a normal cell to change into a cancer cell. that's why the chances of developing cancer increase with age and with exposure
to cancer causing substances, or carcinogens. harold varmus: obviously, environment also contributes to function and disease but knowing what genes are inherited by any organism is essential to a full understanding of how they operate and how they misfunction when disease occurs. only five to ten percent of all cancers are thought to be inherited. for instance, women with mothers or sisters who have breast cancer are at increased risk for developing the disease. i'd get it very early, and be very treatable... i wasn't surprised because both my mother and my grandmother had-- my maternal grandmother, had had the same kind of late onset. and i had helped them both through their bouts with it. and so i knew when i saw the irregularity in my breast line what it was, and just moved forward from there.
the ucla breast center, a unit of the jonsson cancer center, specializes in treating and counseling women at high risk for breast cancer. experts from a variety of fields work with patients. a nurse practitioner takes the patient's history... a nutritionist with a special interest in breast cancer talks about the role good nutrition plays in combatting the disease. an exercise specialist introduces the idea of regular exercise and strength training. patients also learn the proper way to perform a self-breast exam. if you felt down in here, you'd feel this just like a marble,
only it's usually jagged. and it's very, very hard. the ones that move around usually are benign. the ones that are fixed in the skin are usually malignant. one of the team members is a psychologist who will then go in and actually do a pretty detailed psychological consultation, talking about her individual perception of her risk, her relationship to the members of her family who may have had breast cancer, how she dealt with that, particularly if that member of the family had died from the disease. the kind of counseling i do is more related to the epidemiological risk factors that we know about breast cancer, such as a woman's reproductive history, her biopsy history, mothers and sisters and daughters with breast cancer, whether she has had a pregnancy or not. and all of these factors relate to doing an estimation of her potential risk of breast cancer. and this is where your first level of risk comes in, which is your mom who had breast cancer diagnosed at age 58...
i try to reframe what seems like an ominous or threatening situation where gee, you know, so many members of my family have had cancer, it's going to hit me next-- to being an opportunity to take charge and be empowered and to remind them that they, unlike the 80 percent of women who get breast cancer and have no family history and think it's never going to happen to them, they have this opportunity to say, gee, you know, someone in my family has had this. it could happen to me. i need to do some things that might help me minimize my risk. most women are very interested in strategies that they can take to prevent or reduce their risk of cancer. but what of those other 80 percent of women who are stricken with breast cancer and have no family history of the disease? what contributes to their susceptibility? one risk is age.
breast cancer is rare in women under 20, but increases from age 20 to 45 or 50 years. in fact, breast cancer is a major cause of death for women between the ages of 35 and 45. after the age of 50, risk still increases with age, but not as dramatically. one day i felt a lump in my breast and it felt a little different than the general lumpiness that i was used to. i spoke to my mother who assured me that it was nothing and so i didn't do anything about it. i felt it again a few months later and mentioned something to my friend who said, "why don't you have it checked?" i was 36 at the time, and i gave it some passing thought. another factor appears to be a woman's cumulative exposure to ovarian hormones, particularly estrogen. early menarche, late menopause,
or just not having children places a woman at greater peril. but like other factors related to cancer, a woman's genetic blueprint also exerts a major influence. if you get two genes in the same estrogen production pathway, with two copies that lead to more estrogen, then at the extremes, one group of women is making quite a bit more estrogen over her life than another woman. and those women turn out to have quite different risks of breast cancer. yet, just because a woman is at risk doesn't mean she will develop breast cancer. and, not having risk factors does not mean that she is safe from the disease. lauren: i was brought up to be very academic and very intellectual, which was an incredible gift from both my parents. but as an adult, i discovered how much i love sports.
and so i've been, or until recently was, a nationally ranked competitive power lifter. i'd always been aware of cancer sort of peripherally. my father was a specialist in liver cancer research and unfortunately he died of cancer in a very abrupt way when i was around 30. and so i was, partly because of my sport and partly because of that, fairly vigilant about how to take care of myself. and we had been admonished from a young age, never to smoke. i'm pretty much of a cheap date so i didn't drink very much because of my athletics. i was very good about my diet. but in terms of cancer, a healthy lifestyle may not be enough. it's also important to be aware of cancer's warning signals... and to check out anything that seems suspicious.
early detection is key to cancer survival. lauren: there was a coupon for a cheap mammogram in the l.a. times. and i thought, well... i'm going to have a baseline fairly soon anyway so i might as well save myself a hundred bucks and i'll go do this. breast cancer has shifted dramatically in terms of the kinds of patients we're seeing over the last 20 years. from a women with relatively advanced disease to a very early disease which has resulted not just in less surgery and better cosmetic outcomes but much higher survival rates. and the vast amount of the credit for that can be laid at the feet of mammography and the discovery that it really does alter the outcome of breast cancer in a population, if properly applied. i was called in to have magnification studies and as i left the building, they recommended i see a surgeon the next day. so i kind of panicked. i came rushing home and through some fortuitous good luck was put into the brand new ucla breast clinic
that had a really wonderful woman as its director and a multidisciplinary clinic so they looked at all aspects of treatment. she sent me right in for a biopsy, which, of course, unfortunately proved positive and i was diagnosed with stage iii lobular breast cancer at the age of 36 or 37. cancer detection methods vary depending on the location of a suspected cancer. oral cancers, for example, can be detected by visual examination. some cancers are found by collecting cells from microscopic examination. this is what happens when a woman gets a pap test for cervical cancer. colon cancer and stomach cancer can be identified
we all have ways of trying to organize what happens to us in a cause/effect relationship in our minds. and that leads us constantly to the same conclusions that if something bad happened to me, there must be some very simple linear explanation in my life for what happened, that this particular lifestyle, this stress at work, this or that is the reason i got sick. what causes genes to mutate? are there factors that set such events in motion? answers to these questions could lead not only to a cure for certain types of cancers, but also to prevention strategies that would lessen the impact of the disease. dr. ganz: it's complicated because risk factors for one disease may not be the same for another. i think there are a group of them where we know that diet and lifestyle make a difference. we know that for a group of cancers, cigarette smoking makes a difference. dr. glaspy: the lung cancer epidemiology story
has been relatively easy to dissect and figure out what the lessons are. with respect to some other cancers, there are similar epidemiologic data but we don't understand why. pieces of the puzzle, however, are being extracted from epidemiological data-- particularly detailed studies that record the incidence of cancer, and how it relates to the racial, ethnic, geographic, and lifestyle characteristics of its victims. leslie bernstein: we have a program here at the university of southern california called the cancer surveillance program. this is one of a number of population based cancer registries around the country. a population based cancer registry defines geographic boundaries of a population and then collects information on cancer that develops in the population living within that geographic boundary.
dr. henderson: there was a friend of mine working in taiwan at the time who published an elegant study showing that hepatitis b virus looked like a common explanation in taiwan for liver cancer. so we did studies with them, collected blood from about 10,000 people, tested the blood back here in the united states, and followed them and demonstrated that the same virus was causing liver cancer in china. and from that evolved a series of national vaccination programs. it's just such breakthroughs that have intensified data collection efforts around the world. dr. bernstein: we collect information on the type of tumor and all of the characteristics of the cancer, the stage, the cell type, the extent of disease,
laterality, anything we can get about that. we also collect information about the individual who is diagnosed with cancer-- their gender, male or female, their race or ethnic background, their age, where they were born, if we can get that information, what their last occupation was. we're able then to look at patterns of cancer in the population over time. looking at this data over the last 25 years has revealed some significant differences among populations of people. in a western society, the important cancers are cancer of the prostate gland for men, breast cancer for women. lung cancer for both men and women, colon cancer. when you look at countries like china or other less developed countries in asia,
what you tend to see are greater importance for liver cancer, cervical cancer for women and esophageal cancer being very important cancer. what we haven't been able to do yet, in general, is translate that epidemiological data into insights into what causes the higher rates of cancers in some countries compared to others. we know now why lung cancer varies from country to country. we know why melanoma-- this is the bad kind of skin cancer-- why its patterns vary regionally, having to do with sun exposure, but we don't understand why women in japan have lower breast cancer incidences than women in the united states, and in men, prostate cancer follows a very similar pattern.
that's a clue that a lot of people are trying to follow up on to see if we can't a: figure it out and then b: see what that teaches us about the biology of how we get prostate cancer or breast cancer and if it's something that we can intervene with. what about variances among racial and ethnic groups? dr. bernstein: we believe much of that is not genetic differences but more exposure differences, lifestyle differences, environmental differences. one example is very typical nasopharyngeal cancer-- very rarely do we see such a cancer in the white population or in the african american population but it is a cancer that is important for chinese, vietnamese and koreans. we've studied this greatly here at the university and feel that dietary patterns
may have some impact on the incidence of this cancer and in fact, a particular food, chinese salted fish, seems to be very predictive that the amount of consumption of this salted fish, this product, is predictive of future risk of this disease. but even if the cause and effect is not clear, cancer is a disease that is influenced by lifestyle choices. some researchers claim that eating right, staying physically active, watching your weight, and not smoking could reduce your cancer risk by 60 to 70 percent. but even with this information, how many people are willing to make lifestyle changes? dr. glaspy: we've seen a little bit less lung cancer in men but that's been made up for by lung cancer in women. and that's been kind of a failure, not as a medical profession but as a society,
for us to translate our discoveries of what causes lung cancer into an effective prevention strategy that people adopt. i think we really have to persuade the public, and i think we will in the future, of the long natural history of cancer-- i again try to explain to people that often why we get cancer in our 50s or 60s may be an exposure when we were young. the sunburn that we had on the beach when we were a teenager may lead to the melanoma or the other skin cancers that we have in our 40s or 50s. and to try and connect those thing may be very difficult in an individual person but it's our whole way of life over a long period of time when we're not even thinking about it. dr. bernstein: my mom says to me, you know, what's the point in living? everything i do, everything i eat, everything i don't eat, every vitamin i take or don't take, the air i breathe, the clothes i wear,
there's a risk and a benefit to it and it's all so very confusing. there are some choices that people can make, however, that have the unanimous support of the medical community. dr. bernstein: the first thing i would say is don't smoke anything... because smoking increases the risk of lung cancer. it's associated with increased risk of esophageal cancer, laryngeal cancer. it's associated with bladder cancer, so getting rid of smoking, i mean, that would be number one. dr. glaspy: they probably should avoid secondhand smoke to the extent possible. and then i think their dietary manipulations ought to be aimed at the prevention of heart disease for a little while longer because we understand how that works. heart disease is a more common disease than cancer and it makes more sense to focus your diet there. probably when the dust settles,
those diets are going to be the ones that turn out to lower cancer risks as well. dr. bernstein: i would probably suggest getting lots of exercise... or making exercise a regular lifestyle habit, because there are certain cancers where we know that the exercise reduces your risk. exercise does definitely reduce your risk of colon cancer. we see it in studies of men. we see it in studies of women. i think obesity is related to risk of several cancers so people who are extremely heavy have higher risk of certain cancers. i want to mention that i'm very excited about the potential that we're on the brink of having medications that dramatically lower cancer risks.
and i would predict that in the next five or ten years, we will have recommendations that people take a certain type of pill after a certain age that lowers the potential to develop cancer because we'll understand which cell processes, as a background noise, contribute to the genetic mutations that cause cancer, and have effective treatments for them. we're probably never going to be able to eradicate all cancers. i think it's going to be very unlikely. so we have to use these other strategies of prevention and that's why in my midlife, i really began to take this on as a passion in terms of what we need to do, in terms of thinking about the ten or 20 years before we even diagnosed that first cancer-- what can we do to change behavior, lifestyle and identify people who are at high risk so that we can somehow modify that risk and actually prevent the disease from occurring? and that's i think the challenge of the 20th--
21st century in terms of moving ahead. we still need to work on the front of curing more people but the power of prevention is enormous. lauren: you know, in a split second, one word can change everything. maybe i can't presume that i've got ten, 20 years left. maybe this is my last year. dr. ganz: life changes once somebody tells you, you have cancer. their perspective on life changes, their sense of vulnerability changes. and that's why i see prevention not only important in terms of reducing death rates and improving and enhancing well being, but preventing that crossing of that line from the world of the well to the world of the sick, which i think most people would like to avoid if they can.
the human condition is a 26 part series about health and wellness. to purchase video tapes or supplementary materials... call 1-800-576-2988 or visit us online at...
narrator: cancer, the number two killer in the united states. but, over the last ten years, death rates from cancer have been decreasing. today, more than half of all americans with cancer are being cured. and experts now believe that we are on the verge of important new breakthroughs in the war against cancer.
people who have been diagnosed with cancer are often overwhelmed by the medical decisions that need to be made... in what seems like a relatively short period of time. cindy lauren, an avowed health enthusiast, was only 36 years old when she was diagnosed with stage iii lobular breast cancer. cindy: i was very unprepared. i didn't know the vocabulary. i didn't know the treatment protocols. ould i have a mastectomy cindy: i was very unprepared. or lumpectomy and radiation?ry. should i have chemo, and how aggressive chemo? i think in many ways, in cancer treatment we're ahead of other diseases that are treated and studied. because when i, for instance, counsel a woman who's newly diagnosed with breast cancer,
i'm able to pull off from the literature, from studies, that have just been completed or historic studies, statistics that can give them a very accurate appraisal of their likely benefit or their risks for taking certain treatments. and there are very, very few other kinds of diseases where we have that kind of information available. nowadays, treatments have changed a lot, and one of the things that have changed about it is that cancer has become more of a chronic illness than it ever was. and, as a result of that, people live with cancer over a long period of time which means that they may have many different kinds of treatments from surgery, radiation, experimental kinds of treatments and it may become an integrated part of their life. surgery, chemotherapy and radiation... still today, the principle forms of cancer treatment. during surgery, physicians remove a localized cancer...
cutting it away from healthy tissue. since microscopic pieces of cancerous tissues are hard to detect, the surgeon usually removes tissue beyond the obvious cancer to increase the chances that all the malignant cells are removed. cindy: if i jokingly say that surgery is the easiest part of it, it's still hard on your body. i had three surgeries. radiation every day for eight weeks. go to the hospital... get tired. chemo for seven months, and everything that brings. i don't think you can go through anything like that without it having a very profound effect on your life. chemotherapy is used most often when cancer has spread to various regions of the body. patients are given anticancer drugs which destroy the cancer cells, or inhibit their ability to reproduce.
because of the toxicity of the drugs, patients may experience side effects. cindy: suddenly my body was called upon to deal with drugs that were going to kill something that wanted to kill me. i fought pretty hard, but eventually i had to come to the conclusion that i was not made of iron. i was made of some cells, and some of those were a little sensitive to... toxic stuff. but, it was really tough for me. i lost about twenty-five pounds. losing my hair was more traumatic than i could have ever conceptualized. radiation therapy is also used to treat localized cancers... alone or in conjunction with surgery and chemotherapy. concentrated doses of high-energy particles target the cancerous tissue... killing malignant cells, and stopping their spread.
healthy tissues nearby receive only slight doses of radiation, and generally recover quickly. this is particularly true when proton therapy is used. because the stream of positively-charged, subatomic particles can be focused more precisely, there is little damage to surrounding cells. still another approach is to implant tiny radioactive beads within the malignant tissue for several weeks, and then remove them. compared to cho, everyone sort of feels that radiion is a walk in the park and most of the time, that's true. i found radiation was a pain in the butt because you have to go to the hospital every day, five days a week. you have to go down there, it really doesn't take very long but if somebody's late, if the machine has to cool down, so you can't really gauge your time. it made me really tired, and it...
for me, i got a third degree burn underneath my breast where i guess one or two beams intersected. i had an open wound. that burn has still been the single most painful experience i've ever had in my life. these more traditional forms of cancer treatment are not the only options to be considered. dr. john glaspy: there are many instances where cancers don't need treatment, where we can just watch... and because we know the natural history of the disease, we know that you don't need treatment right now, or that treatment won't help you right now. doing no specific therapy is an option that ought to be talked about with many kinds of cancers that we deal with. second on the list would be good, meticulous attention to non-cancer medical care: management of pain, management of fatigue which is a huge problem for cancer patients,
and limits the quality of their remaining lives -- and for them, and for their families. we're just now figuring that out, even though the patients have been telling it to us for a long time. cindy: i was tired. i was stunned at how things i used to take for granted... were difficult. it's hard to get across a crosswalk, when just as you get two feet into it, the "don't walk" thing starts blinking, and you're like, "that's a mile away." "i can't go any faster." or, i'd go for a bike ride and i'd feel pretty good, but all of a sudden, i'd be too tired... i'd have to stop and rest before i went home. that's probably one of the single, most profound legacies that any -- i think, any cancer treatment probably leaves you, is you're just -- it takes a tremendous amount of energy. dr. glaspy: treating low blood oxygen levels with oxygen, making sure that people are as nourished as they can be,
making sure pain is well-controlled. all of those are part of what we have to offer. good, general medical care. a lot of times, these things get -- don't get talked about, or don't get focused upon, and they are extremely important parts of the armamentarium. what you have run in this lane, here... is the sample from the normal cells? - and this would be the tumor sample? - that's right. in the last few years, a new breed of treatment has emerged in the fight against cancer -- the manipulation of the body's own immune system to rid the body of its cancer. the umbrella term for these new, and generally experimental methods, is "biomodulation". one such treatment includes the use of gene therapy. dr. glaspy: there's tremendous progress being made now with gene therapy, which has tremendous technical limitations associated with it, that are just now being overcome by the engineers who work on these things. ovarian cancer is a particularly promising target.
when traditional treatment methods failed to stop the advance of ovarian cancer, doreen gerber became part of an experimental study at ucla's jonsson cancer center. in this study, doctors are replacing a defective gene that is thought to cause ovarian cancer in about half of all the women with the disease. the study is designed to test this new gene therapy technology head to head against standard therapy. it's the first study of its kind in ovarian cancer. healthy genetic material is injected directly into the abdomen, carried into the system by a disarmed cold virus. side effects appear to be minimal. doreen gerber, patient: i certainly feel so much better after these treatments. i didn't lose all my hair. i'm not bloated any more. so far, the results of this experimental genetic study are encouraging.
dr. pegram: we see no evidence of recurrence of the ovarian cancer following her gene therapy treatment. but patients will continue to be monitored to determine the long-term results of this new treatment technology. another class of drugs, known as angiogenesis-inhibiting drugs, also hold great promise in the ongoing battle with cancer. these drugs cut off the blood supply to tumors, depriving them of the nouriment necessary for growth. dr. glaspy: the angiogenesis-inhibiting drugs... there are a lot of them out there. some of them have exciting pre-clinical data. they're in early clinical trials, and they may sort of change this gameboard a lot for us. then we... get into the realm of experimental treatments, drugs like herceptin, which... attack something
that's different about a cancer cell, and make that cell either stop growing, or make it more sensitive to treatment with the other modalities. in 1986, the scientific community learned that a gene involved in regulating cell growth had been discovered -- her2/neu. about the same time, dr. dennis slamon and his team of researchers were extracting dna from discarded cancer tissue, looking for genetic alterations that might be linked to the disease. these are the pieces of the breast tumors. dr. slamon: about 30% of patients who had breast cancer had this particular gene altered, and we recognized that it wasn't something inherited, but it was something that was occurring during the life of the individuals. in a normal cell, there are two copies of the her2/neu gene. they control the production of a protein found on a cell's surface
that acts like an antenna, receiving signals to grow. if the gene mutates, and multiple copies are made, the additional protein that is produced calls for too much cell growth. this results in an aggressive cancer that grows and quickly spreads. but what if researchers could find an antibody that would inhibit the growth of the her2/neu gene? that was slamon's challenge. and the result, after a decade of work, is herceptin -- the first biological therapy that attacks cancer at its genetic roots. dr. slamon: what the antibody is able to do, is attach to this protein, and actually block or change that signaling, so that the signals that tell the cell to grow don't work. traditionally what we treat cancer with are nonspecific toxins -- nonspecific therapies like chemotherapy, or radiation therapy, which kills bad cells and good cells,
hoping to kill more bad than good when we use them. if we can identify what's broken in a cell that's making a malignant cell from a normal cell, it has always been hoped that we could target that. in clinical trials involving 940 women with advanced breast cancer, herceptin produced dramatic results. for some patients, tumors disappeared. in others, herceptin stopped progression of the disease. when combined with chemotherapy, patients had a 50% better response rate than patients using chemotherapy alone. but as impressive as these results are, herceptin is not a cure for breast cancer. of the 180,000 cases of breast cancer diagnosed each year, just 60,000 involve the her2/neu gene. dr. slamon: and it's not effective even for all of those patients. so, we're working on two problems in parallel.
number one -- those patients who have the alteration who should respond -- why aren't they responding? what can we do to make them respond? number two -- those patients who don't have the alteration, what alterations do their tumor cells have that we might be able to target? before herceptin or any other drug is approved for use by the food and drug administration, it must be rigorously tested... not only in the laboratory, but with patients. research conducted by doing clinical trials that involve patients with cancer have made extraordinary contributions to our treatment of cancer. fifty years ago, virtually all children with cancer died. now, 75 or 80%... basically are cured of their cancer, live more than five to ten years, and usually live a normal life span. that's all due to the fact that virtually every child with cancer is enrolled in a clinical trial. dr. ganz: i remember some young men, that when i first trained,
with testicular cancer -- a rare cancer, but very aggressive. and they would routinely be dying on our wards with advanced tumors. and, again, being so close in age to them, it was a very tragic situation. and all of a sudden, a new drug came on the scene. it was called cisplatinum, and it had actually been tested in some experimental trials where they took all sorts of patients with advanced cancer, and, lo and behold, a few of them with advanced testicular cancer responded. and then, before we knew it, it was incorporated into a standard treatment regimen. and, all of a sudden, we were curing this disease. some critics denounce clinical trials on the basis of their cost, the potential risk to participants, and the conflict of interest that may exist between drug companies and researchers. still, many scientists believe that such trials are essential. dr. glaspy: clinical trials are the gold standard
for changing disease rates or outcomes with disease. these things are usually heralded by one thing that works, and causes a lot of attention, but has side effects, or isn't fully perfect. and i think that vanguard has been that the story with tamoxifen and breast cancer prevention. that was very important. it was the first time we've ever given patients a pill that lowered their cancer risk. in this case, it was breast cancer, and it lowered risk by 50%. the breast cancer prevention trial -- the first of its kind in the united states -- was designed to see whether the drug tamoxifen prevents breast cancer in women who are at high risk of developing the disease. the 13,000 women who participated in the study were randomly assigned to receive tamoxifen or a placebo. tamoxifen is a hormone. it acts as an estrogen in some tissue,
and an anti-estrogen in another. it's an anti-estrogen in the breast. it blocks the binding of estrogen to estrogen receptors in the breast, therefore, it reduces the proliferation of cells in the breast, so it reduces the likelihood of cell turnover, and the likelihood of cancer either progressing, or actually developing. but if it is an estrogen in other tissues... it could cause endometrial cancer. debbie, here's a heartbeat that is low. it needs to be taken care of. keep an eye on her, because she's short of breath. dr. bernstein: the risk of dying from endometrial cancer, or even developing endometrial cancer, is far lower ever... than the risk of getting either a second breast cancer, or developing breast cancer. so we then want to weigh the risks and the benefits. tamoxifen did increase the women's chances of three rare but life-threatening health problems... one of which was endometrial cancer. but the incidence of this occuring was quite small.
dr. ganz: there's still critics... who are concerned about the drug, and... they can certainly raise their questions. but i think there's no question that we looked at the safety and efficacy of tamoxifen, and found that in fact, it did reduce the risk of breast cancer. women may take that information now, and decide that they want to be treated, or they may say, "gee, you know... it's still uncertain, and i don't want to do that." the challenges of treatment, the uncertainties of the disease, are difficult for any cancer patient to endure. ms. coscarelli: cancer, because it's a life threatening illness, comes with it a whole host of psychological issues that are presented or existential issues that come up as a result of a cancer diagnosis. and i think that because of that, and because of the nature of it, and the nature of the difficult treatment that patients have to undergo in order to survive their cancer, that there are many concerns
and problems that have to be dealt with. so, how does one react to that? well, people react to that in a variety of ways, and no two people are exactly alike. ann: vulnerability was the only choice i had. i didn't have a choice to be tough. but then, for other people, a certain amount of denial and going, "well, this is going to work." there are different human beings, and there are different paths through this. some cancer patients have found that it helps to talk with others who are battling the disease. pam: the support group has been wonderful. not only the information, but the sharing of the fears... ms. coscarelli: groups can be helpful at almost any phase. and, in fact, we have groups for different phases of the cancer. we try to keep people who are newly diagnosed together. we have groups for people who are -- after the cancer diagnosis, no longer on treatment --
who are dealing with kind of the reentry back into the world of work and living, and still dealing with the changes that have come about in them. i shared it with everybody, and i had a lot of support from friends, and with the groups. it's been great. we also have groups for patients who recur. and that is the reality of cancer... that, for a certain percentage of patients, their disease will recur. cindy: i was very reluctant to go to any kind of a support group because i was one of the tough ones. but the thing that i liked, aside from all the jokes, was that if i did get to that scary place where i might cry, or i might demonstrate my vulnerability, somebody who's sitting next to me totally understood and wasn't going to say, "oh, you're going to be fine." if i hear that one more time, that's one time too many. "uh, yeah, thank you, that's great, but right now, i don't feel like that, and i want someone who understands i don't need to hear that." ann: i all of a sudden i started going for very long walks,
and spending a lot of time trying to run away from this whole horrible, horrible thing. you tell yourself you're supposed to be tough. you're supposed to tough this out. you're supposed to handle it well, whatever that possibly means. and it was quite clear to me that was not in the cards. as you say, for me, at least... and this is personal -- different people -- that's one of the things that a group does... is that it tells you that "normal" covers a wide spectrum. and for me, at least, "normal" meant being incredibly vulnerable, and reaching out to a group, reaching out to my husband, and it changed my life in so many ways. cindy: one of my favorite things someone says is... "well, if that happened to me, i would just die." i go, "you know... you don't get to die." you have to wake up every morning and go, "okay, today i have, doctor appointment, radiation, blah, blah, blah." and you don't get to hide from it. you can take walks all day long, but it's still there when you come home.
ms. coscarelli: it's not just the disease that you're treating. you're treating a whole person. and that's the orientation that we've taken... how do we treat that whole person, because in reality, the disease is a small part of it. it's the repercussions of the disease that someone has to live with, and those repercussions are on the family, on the individual and their psychological status. dr. ganz: cancer is a family disease. there's no way you can exclude the family from this, and it's a rare patient who won't tell anyone about their diagnosis. occasionally it happens, but, most of the time, everyone -- the co-workers, the extended family, everyone knows about what's going on, because people do feel more comfortable about being open. but it also serves another important point, in that you need all the help you can get. our treatments are so complex. if somebody's living in a large city, and they want to go to a specialized medical center such as ours, they may have to travel twenty or thirty miles. well, you can't go back and forth
"am i being overly concerned about this?", or... "should i be worrying about that?" ms. coscarelli: and you can't forget the interaction between people because you're a worker, you're a parent, you're a mother, you're a sister, you're a friend. and so, in all of those things, those relationships become affected as people react to the diagnosis, and also as they attempt to interact with you and share in that experience. even young children feel the threat of cancer. pam: and it took for my youngest several years before she was ready to tell me how frightened she was that she was going to lose a mother... when she was... seven. it was very frightening, and she did come up with that several years later. so she really could remember that fear...? oh, absolutely. but was probably too afraid to express it at the time. ( sighing ) to me. i don't know if she did to other people.
i know it was very nice -- she went to a very large public school, and she found teachers that had been her own teacher, her friends, teachers of her older sister's that she didn't even know. and she would be telling them about my blood count, and working everything out, and i was very appreciative for that. spread the roots, so they fan out, instead of spiralling around in a ball. ann: my daughter keeps saying, "why do you have to know... and think about this all the time? why can't they put it all in one little package so that it can go away?" well, it doesn't go away... and there are bad things about that. and the fear is always -- it's part of my life now. but there have been... partly through the work that i've done with the group, there have been such good things. i think we all went through a process of winnowing our lives.
i think this is something that everybody did that i saw. we all started taking a look at our lives and going, "all right. what's important?" that is not de. it's a bud. ( laughing ) this is a dead-head. ms. coscarelli: so you don't know exactly what the factors are... but, there may be an important role that support group plays in terms of the education that's provided, the ability to share one's feelings, and how one goes about living one's life. and you all heard that those women in there were very invested in life. they were invested in living, and they were invested in taking this cancer experience, which is extraordinarily difficult, and they wanted to turn it into something good. and they did. and you have to believe somewhat in the power of that, and how that can be healing for the soul, and healing for the body. cindy: i've put a lot of energy
into being a counselor for the american cancer society, because i think i understand... that combination of shock and dismay, and confusion that somebody has when they're first diagnosed. and i learned, if nothing else... how to listen and be there. ann: i think one of the things that happened with me, is that cancer became rephrased into something that was normal. "okay, you are alive, you have cancer, you have normal feelings. you are a normal human being, and you are... you continue." cindy: something very cool my oncologist said to me, was, "if you can take the energy that your body has put into building these tumors, and have it for yourself again, aren't you going to feel great?" and her words eventually came true... but it took a lot longer than i really ever thought it would.
"the human condition"" is a 26-part series about health and wellness. for more information on this program, and accompanying materials, call: or, visit us online at: