Antioxidants and cancer

Sue Rochman, a fantastic science journalist who contributes regularly to Cancer Today, covers a surprising contradiction in the current issue: Taking supplements containing antioxidants, substances touted to keep cancer at bay, may actually fuel its recurrence or onset. And the link is even stronger for breast cancer.

https://www.cancertodaymag.org/Pages/Summer2020/Cancer-Treatments-and-Antioxidant-Supplements-Can-Be-a-Bad-Mix-.aspx?

Antioxidants including vitamins C, A and E, carotenoids, and coenzyme Q10 are all available through food. The problem occurs when these “immune-system boosters and free-radical fighters” are packaged in the form of supplements containing uncertain amounts of antioxidants that can actually heighten cancer risk.

The takeaway message is often the same. Eat for health rather than rely on slick marketing of synthetic alternatives. Educate yourself rather than bank on the hype.

A different space for survivorship

Cancer Today‘s recent newsletter featured a wonderful editorial published in Oncology Practice, one of the journals sponsored by the American Society of Clinical Oncology. The piece addresses the insufficiency of addressing cancer survivors as either dying of cancer or cured of cancer. Instead, the authors suggest, many, many people diagnosed with cancer are experiencing it as a long-term chronic condition, a journey marked by moments of remission and moments of recurrence (accompanied by further treatment and remission). This third space isn’t about living cancer-free or suffering until the final breath, but rather about living in a body that just happens to experience cancer now and again and addressing those episodes when they occur.

Authors Spoozak, Wulff-Burchfield, and Brooks write that

Our language around cancer care requires a frameshift to elevate those who will        never ring a victory bell or feel at home in the language of survivorship, who are not beating cancer but rather living with it. . . . [Recognizing this broadening view on cancer care] necessitates making space for the growing number of patients who are learning to live full and meaningful lives with a body full of cancer cells and to allow their experiences to transform the way we treat, study, and talk about cancer care.

So well said, and so necessary. Cancer is complex, and our language has to reflect that complexity.

The full opinion piece can be found here: https://ascopubs.org/doi/pdf/10.1200/OP.20.00183

 

Welcome to the kingdom of the sick

Salon.com just published an article that I wrote about facing the coronavirus while teaching a course at UAB called Writing and Medicine. Take a look!

https://www.salon.com/2020/05/02/welcome-to-the-kingdom-of-the-sick/

The title comes from Susan Sontag’s examination of metaphors in the way society talks about health and illness, saying that all of us at one time or another hold citizenship in “the kingdom of the well” and “the kingdom of the sick.” In an effort to distance ourselves from the realm of the sick, we construct metaphors that aim to explain why others–not us–are diagnosed with the most complex and least understood of diseases . . . like COVID-19.

The long path to vaccine production

One of the staples of my course called Writing and Medicine, offered to students pursuing degrees in fields as diverse as public health, professional writing, neuroscience, genetics, and education, is a visit by the current director of my university’s IRB (Institutional Review Board). The IRB office is where proposals for research studies involving human subjects are examined and approved (or rejected) from an ethical standpoint.

At the point in the semester during which we read Rebecca Skloot’s book The Immortal Life of Henrietta Lacks, our class discusses the importance of considering the ethical dimension of human subject research. In 1950s Baltimore, Henrietta Lacks was treated for cervical cancer following a biopsy that confirmed she had the disease. The cells scraped from her cervix for the biopsy turned out to be phenomenal in their ability to replicate exponentially. As a result, those cells–named HeLa cells–became one of the most used cell lines in research labs around the globe. And beyond, as it turns out, since the cells were sent into outer space as well.

All of this taking and using of Henrietta’s cells happened behind the scenes (at first) as one researcher after another spread news of the promise of HeLa as well as the cells themselves. And when use of the cells continued decade after decade, even today, no one much cared any more where they’d come from or whether the woman who contributed them unknowingly to science had participated in their distribution and the many discoveries made as a result.

As much as we tire of repeating the same routine day after day while sheltering at home, there’s a reason why a vaccine for the Coronavirus can’t be trotted out too soon. Researchers have to be aware of the risks to human subjects who are testing the effectiveness of the vaccine and the potential risks to those of us who choose to be vaccinated once the product goes to market.

Read on for an article in National Geographic about why it takes so darn long to make a vaccine available.

https://www.msn.com/en-us/health/medical/why-a-coronavirus-vaccine-could-take-way-longer-than-a-year/ar-BB12qM5X?li=BBnbfcL

By the way, if you’ve not read Skloot’s book, you should. It’s a real page-turner.

 

Disparate Perspectives, Unifying Messages

Two articles addressing breast cancer were published today in the popular media:  Angelina Jolie’s essay in Time magazine (where she now serves as a contributing writer) and Shabnam Mahmood’s article on BBC.com. The two report from disparate perspectives, but both convey a similar message.

Jolie’s essay discusses the many positive advancements in breast cancer research and increased efforts to provide access to detection and treatment. She then acknowledges that “while [the] stories” she presents of new findings and survival rates “should give us hope, we still have a long way to go.” She catalogues a plethora of other ills facing women–not just the physical manifestation of breast cancer, but also factors like women’s rates of depression brought on by a host of cultural and institutional realities. Among them, according to the World Health Organization, are “discrimination, overwork, poverty, malnutrition, low social status and unremitting responsibility for the care of others.”

While I am often skeptical of insights offered by individuals who enjoy extreme privilege and access to the best care the world has to offer, I was in total agreement with Jolie’s point that as human beings, we must remember that “it should not take someone getting sick to realize that caring for them and not harming them is necessary.” Simply put, too many women, both those living in our own backyards (like Edwina and women like her who face cancer while struggling to survive in homeless communities) and those across the globe, suffer in unimaginable ways physically and mentally every single day. It doesn’t take a cancer diagnosis to ruin their lives, or for them to experience unrelenting fear.

They are already in peril.

Jolie encourages readers to “[h]elp young women know their value. Help keep women you know safe. And before a woman is in the hospital, dying, and that reality is written on a diagnosis sheet, look into her eyes and consider the life she is living and how it might be with less stress.” Women are survivors in so many ways, and these ways should be acknowledged and responded to consistently and conscientiously whether or not a woman adds breast cancer to her identity.

https://time.com/5709290/angelina-jolie-cancer-research-prevention/

Mahmood’s report “Treating Breast Cancer When You Can’t Say ‘Breast'” offers a similar sentiment, when the author notes both the toll of breast cancer in Pakistan and the broader cultural landscape that cannot be ignored when addressing that toll.

The author begins by saying that “Pakistan has the highest rate of breast cancer in Asia. Early detection is essential to treatment but medical experts fear many women are not coming forward due to a culture of modesty.”

https://www.bbc.com/news/world-asia-50103088

Because breasts, and cancer associated with the breasts, are tied with Pakistani women’s sexuality, discourse regarding the disease–and related symptoms, health education efforts and programs–is restricted.

It’s not just men who are avoiding the subject, either. Women fear discovering they have breast cancer—or risking screening that might reveal a positive diagnosis–because detection, at any stage, can have devastating effects apart from the health consequences. Women with breast cancer are frequently perceived as unmarriageable, and their plight considered an inappropriate subject for conversation.

As a 26-year breast cancer survivor, I was encouraged when I came across these two publications on the same day in October. While there’s plenty of pink in the article about breast cancer in Pakistani–the Pink Ribbon Foundation is in full swing in the country, lighting up national attractions like cotton candy on a stick (an effort that I doubt does much to change perceptions of the marriageability of a breast cancer survivor or the expectation that she must marry to be worthy)–neither story waxes over the complexities of talking about breast cancer in context.

It’s not about the disease. It’s about the individual lives the disease touches–how and who we are before and while breast cancer comes knocking.

Hmmm, pink hummus?

You’d think that I’d be desensitized to the pinkwashing that occurs each October. Forces like Breast Cancer Action encourage folks to “think before you pink,” to find out just what a corporation is doing to  propel breast cancer research or improve access to screening before buying a pink-ified product. Too often, corporate contributions to the cause are 1) minuscule, 2) contradictory to the company’s unhealthy practices that might be fueling cancer incidence at the same time it decries the horrors of the disease, and/or 3) targeted in a way that fails to represent the widest disparities in survival (e.g., catering to a youthful, financially- secure, low-risk population of women).   

As I strolled down the deli aisle of my local Publix yesterday, I came across a sea of pink that could not be ignored. Boar’s Head has gone full-out pink in its packaging of hummus during the past couple of years with more and more flavors emerging pinkfully–traditional, Kalamata olive, everything bagel, sweet chili garlic, artichoke and spinach, the list goes on. To be fair, I haven’t taken the time to research Boar’s Head’s contributions to the breast cancer cause. But somehow, “pink” and “hummus” just don’t seem to go together.

Good news, and bad, about young people and cancer

Lately, I’ve come across a number of news stories celebrating the decline of several types of cancer across particular segments of the U.S. population. Unfortunately, some less encouraging news was released today: https://www.livescience.com/64668-obesity-cancer-young-adults.html

Turns out that Millennials are currently more susceptible to certain kinds of cancer, largely due to their packing on the pounds. Cancers including pancreatic, kidney, and colorectal are increasing among young people. Since these cancers are traditionally associated with older folks, diagnosis of younger bodies is unexpected–making careful “surveillance” of symptoms rare as well, thus upping the possibility of diagnoses at later stages.

Perhaps it’s just the population of students who take my classes, but the majority seem committed to a healthy diet and overall lifestyle. Students often spring into class right after a visit to the gym, and more often than not, their snacking fare during class (which happens to coincide with lunchtime in one case) consisting of veggies and hummus or a lean turkey sandwich. That said, I have observed that those young people in my classes who appear to follow a less health-focused regimen are often on the other end of the spectrum: leaning towards obese rather than a tad out of shape.

One thing that does disturb me about the report that the rise of certain cancers among Millennials is being attributed to rising rates of obesity is the blame and shame that coincides with the assumption.  Obesity is certainly a negative trend. An increase in certain cancers among the young is not good news. But I’m not sure we are equipped to address potential solutions in a productive way. Telling Millennials to eat less and work out more arguably misses the mark–there are much larger issues driving obesity (pre-packaged foods full of caloric preservatives and enticing devices for delaying physical movement) that certainly must be addressed. I hope we get our approach to the “problem” right this time around.

A significant loss in the cancer community

On Christmas Eve, the cancer community lost a remarkable physician, researcher and caring human being, Dr. Jimmie Holland: https://www.nytimes.com/2018/01/04/obituaries/jimmie-holland-who-cared-for-the-cancer-patients-mind-dies-at-89.html?emc=edit_th_20180107&nl=todaysheadlines&nlid=44005038

I met Jimmie (and her husband, James) a few years ago through my participation in the American Association for Cancer Research Scientist-Survivor Program. She was a kind and compassionate woman who was one of the first to notice in the 1970s that oncologists and cancer researchers were striving to understand the characteristics of the disease itself but not the emotional strain that a cancer diagnosis brings.  These days, the notion that patients would be treated without considering their psychological condition–namely, their fears, anxieties and sense of extreme loss–is unfathomable. We have people like Jimmie to thank for the shift.

When I was diagnosed with breast cancer for the first time in 1993, I truly couldn’t believe the emotional rollercoaster that I found myself riding. While all mortal beings know, theoretically, that our time on this earth will come to an end, the thought comes barreling home when diagnosed with a potentially fatal disease. Especially at 29.

Those emotions still dwell in my gut, and they arise whenever I find myself reeling back into a cancer state of mind.

Extreme loneliness, the sense that I, alone, had been thrown into a horrifying experience.

Fear of the new reality, physically and psychologically, as I began an arduous treatment regimen.

Uncertainty about the future–what kind of life lay ahead, and if briefer than anticipated, how I might find peace and fulfillment in the time remaining.

Jimmie Holland understood those feelings and devoted her career to giving them voice. She was in all ways an advocate for patients and a beacon of honesty for physicians who needed to hear that treating cancer requires acknowledging the human component.

 

 

Science needs your cells

Tonight, the film adaptation of Rebecca Skloot’s book The Immortal Life of Henrietta Lacks debuts on HBO. The book is one of my favorites. The story of Henrietta Lacks (and her descendants) alongside the evolving discovery of the seemingly infinite replication of HeLa cells taken from Henrietta’s malignant tumor is brilliantly told by Skloot. And, the work effectively reveals the complexity of ethical decision-making when individual bodies are involved in the process of furthering scientific knowledge. My class in Writing and Medicine just finished reading the book, and  the students had much to say about the benefits and drawbacks of using discarded bio-specimens for research without patients’  full knowledge or permission.

Of course, in the story of Henrietta Lacks, issues of class and race influence how readers might interpret the use of one woman’s cells in millions of research studies around the world since the 1950s. In a story published in The New York Times this week, though, Holly Fernandez Lynch and Steven Joffe caution society against privileging individual autonomy over scientific progress. Simply put, human tissue–which is often disposed of following surgical procedures, anyway–is needed by researchers who seek to better understand how all of our bodies work and how to address those diseases that hinder us.  https://www.nytimes.com/2017/04/21/opinion/henrietta-lacks-why-science-needs-your-cells.html?emc=edit_th_20170421&nl=todaysheadlines&nlid=44005038&_r=0

I don’t know that there is an easy answer to the central dilemma explored in Skloot’s book. From an admittedly (selfish) academic perspective, that complexity is what most fascinates me about science and medicine.

No, Cosmo, No!

Cosmopolitan magazine screwed up big time. The publication sent out a tweet on Monday touting cancer as a route to weight loss.

Here’s a response from The Washington Post, a rant that I’d far rather draw attention to than the misguided message in Cosmo: https://www.washingtonpost.com/news/morning-mix/wp/2017/04/12/dear-cosmopolitan-magazine-cancer-is-not-a-diet-plan/?utm_term=.c4b2155779e2

As someone who’s experienced breast cancer twice in the last 24 years, I guarantee that enduring a grueling treatment regimen and looking one’s best don’t go hand in hand.