(00:00:00) All right. Thank you Jim. It's six minutes past eleven o'clock. And this is midday for Saturday May 29th. 1993. I'm Paula Schroeder. Today. We're going to be talking about cancer with dr. Irving learner and oncologist in private practice in st. Paul. Of course there is of plethora of information out there about research and treatment for cancer. We sure are sure that you are going to have a number of questions as well and we will be taking your questions during this hour. But before I give out the phone number, I want to say welcome to Irv lunar. Thanks for coming in today. It's a pleasure to be here Paula. You know, there were we were just talking before we went on the air about all the information that comes out in newspapers and magazines about new Research into cancer. And there was just a study that came out from Dartmouth this past week that talks about prostate cancer saying that in older went men the wisest course of action may be no treatment at all rather than surgery and I'm just wondering as an oncologist. And if you're treating somebody with prostate cancer, do they often come in and say say I saw this newspaper article and you have to kind of Juggle your treatment with what the media is saying about particular kinds of cancer. Well, I think we have to be very mindful the media like like all the people in public life, and mostly we have to be aware of what's happening in the media. Yes, and be able to respond to it and in a situation that you're referring to to have some understanding what the study really said and what it meant so that we can be accurate about it, but we have to know what's happening in the media. Yes, the one to tell our listeners that we will be taking your calls, and if you have questions about that study or any others are some cancer that you may be dealing with yourself. You can give us a call here at 2276 thousand that's in the Twin Cities 2276 thousand outside the Metropolitan calling area. You can reach us toll-free at 1-800-321-8633. Two eight two eight well perhaps because we know that there is research going on. We have a sense that there is movement towards I hesitate to use the word cure for cancer because there are so many different kinds of cancer and what might work for one wouldn't work for another but do you have the sense that research is moving ahead at a fairly rapid Pace these days categorical? Yes, the the developments in medical research in the fight against cancer have been Monumental. The problem is it's the doubly Monumental problem and we're still pecking away at a huge Iceberg up trouble. It is the cancer situation, but in the course of my career the kinds of the accomplishments and triumphs that have occurred in oncology in the treatment against cancer have been mind-boggling those that remain to be done are still absolutely overwhelming when you say that the problem is Monumental do we here in the United States have a much? Bigger problem with cancer than other parts of the world. No, we had a somewhat different problem with cancer than other parts of the world. There are certain cancers that we have in larger quantity than other parts of the world and certain that we have less for example breast cancer is a bigger problem in all of the western world than it is in the eastern world. But stomach cancer is a smaller problem in the in the west than it is in the East and that's not necessarily being West and being East that there's differences in genetic traits because easterners who are born and raised in the west develop the Western incidence of breast cancer and a lower incidence of stomach cancer. Well that seems to suggest then that culture and of course diet then does indeed play a significant role in development of certain cancers. It certainly suggests that now to go the next step and figure out what it is about the diet that does that is an additional tricky thing to do and if you do figure out what does it then convincing the population do something different about it is another substantial step, but every one of those steps is possible and it's part of the reason that I'm very optimistic about this. It took ages and ages to figure out that cigarette smoking made lung cancer. It took additional agents to start convincing the population not to smoke. Both of those things have happened. The incidence of lung cancer is finally reducing and we have the right to look forward to a decline in the incidence of lung cancer deaths after the year 2000 course the the breast cancer the relationship between breast cancer and fat has been made in some studies and then there are other studies that say well now maybe the, you know, it really doesn't have anything to do with that. But do we have to have a definitive connection before you think that there will be a change in the way Society eats. Well that the that issue is point. Well taken the data is soft and so if there were no other considerations, I wouldn't think we'd have the right to tell our population to reduce their fat intake but having sex it's such a good thing to do with respect to your heart that go ahead and reduce the fat intake and have less heart disease and maybe you'll have less breast cancer. Yeah. Are we still looking at the numbers like 1 in 9 women? And having breast cancer, but that's the standard statistic in the u.s. If you don't have any additional risk factors women so often say that's why I had no history in my family. If you have no history in your family. Your lifetime risk is one and nine. If you have a history in your family your lifetime risk of somewhat higher. That's pretty risky. That's pretty risky. But it's a lifetime risk. It's not a threat to you right this minute. It's the same sort of problem that driving in your car has a substantial lifetime risk, and if you don't wear your seatbelt you increase the risk. So life is full of risks with breast cancer is is that definitely one cancer that is more treatable with early detection. Yes, I think the answer to that is as the generalization the early detection of breast cancer clearly increases the curability and the curability of breast cancer has increased over the last few years. The problem is it doesn't always work. Sometimes it's impossible to make an early diagnosis of breast cancer sometimes even when you do the behavioral characteristics of the breast cancer are such that it doesn't matter that much so it doesn't always work and that's that's a real deflation to people who've developed the expectation that as long as they do things, right? We will inevitably make an early diagnosis most of the time we will but not inevitably and that if we do make that inevitable early diagnosis, we will inevitably fix the cancer most of the time that's right, but not a hundred percent of the Well you hit on something there in some of the words that you use is that it doesn't always work. And that's one of the most frustrating things about dealing with cancer in four families of cancer patients as well is to say well, you know, we caught this early and yet mother is still having a terrible time with breast cancer at keeps progressing what's wrong with the doctor. We've created a set of expectations there's value in it because of the set of expectations the public awareness people are more inclined to take better care of themselves and to come in for early examinations. And that's all in the good side. But on the flip side of the coin it's a simple fact we can't always meet those expectations of this is a world of people and not machines and the rules don't hold hard and fast individual who does everything right may win. He has a better chance of winning, but he can still lose and we have to admit that to people as a matter of fact, I think one of our problems in public policy is that the expectations are too high right now, we've sold the Idea that if you only do this in this and this you will beat cancer. We're not that good yet and we have to admit it. Irving learner as our guest today. He's an oncologist in private practice in st. Paul and we're taking your questions about cancer research and treatment. The number in the Twin Cities is 2276 thousand and if you're calling from outside the metropolitan area, you can reach us at one eight hundred two, four two two eight two eight and we have a caller on the line now. Go ahead please (00:07:47) good morning. Good morning. I have a question concerning cancer and prophylaxis. I'm part of a national study just fortuitously they discovered on a routine physical 25 Mill at a known as in the colon and I'm now part of a nutritional study. They tell me that shortly. They'll be a publication on the effectiveness of Beta-carotene c and e and what their Studies have derived concerning the effect of free radicals and their amelioration wondered if you comment on it and secondly when this study ends if I wish to have full colonoscopy, it will be at my own expense which will be quite great. I think it would be a wise expense. I'm sure insurance companies are not going to approve such expensive diagnostic procedures routinely, but I'd like to live a little longer. So I'm going to pop or it myself. I wonder if you have some comments. (00:08:39) Well the comment on the prophylaxis with beta-carotene, for example, I think that raises a very interesting point. Can you define those terms for us, please? Prophylaxis prophylaxis is the prevention of something. Okay, and in beta-carotene is is a conjurer of vitamin A at the question is does an additional element amount of this beyond what we have in our average diet protect us from cancer that supposition has been around for a long time. But let me tell you what it takes. They'd approve a supposition like that. You have to take a carefully match group of people and give some of them beta-carotene and some of them Placebo. They can't know what they're taking and you have to give this over a long enough period of time and compare what happens these people recognizing that we believe that the production of a cancer takes 10 to 20 years. You can have Follies people for a very long time and ultimately determine whether the group that takes the thing in question in this case beta carotene makes a difference. I share with the listener. I'm a part of that same study and every morning every other morning I take a red capsule which is either beta-carotene or Placebo that study has been going on for almost 10 years now and they still can't make the distinction when we make the distinction we could were in the position of saying whether it's good public policy to take an additional dose of beta-carotene or not. If it is that will be terrific because it's a chief than safe thing to do and if it's not we have to be honest and say don't bother the second question. The reader asks about doing a colonoscopy if the Is that significantly high risk of colon cancer? I don't know this kind of policy has my personal belief is that that's good preventive medicine to inspect the entire colon periodically and to do colonoscopy and I think insurance companies or whatever structure we ultimately end up the with its paying for our medical care. I should cover that but whether his individual insurance company will agree with that's another issue that brings up even doing these studies like this. I'm wondering if there are certain people who are just predisposed to getting cancer that even if they go through Tess like this or studies like this and it's clear that yes, an additional amount of vitamin A will help certain people. It doesn't mean that it will help everyone right? Well, that's for sure the issue of whether you're predisposed. There are some ways of figuring that out that has there are some cancers that are familiar with one has a family history of breast cancer or colon cancer. We know that you're a additional risk and that involves a closer inspection. There are some rare family. Is in which all forms of cancer at an unusually high incidents and those families are subjected to the special study to try to determine what it is about those families that really makes cancer across the board and this of course raises the entire issue of oncogenes genetic disturbances, which predispose individuals to cancer. This is a whole new world that's currently exploding and the potential is absolutely astronomical the possibility of dealing with a well individual studying his genetic structure and drawing the conclusion that he is or is not at risk of certain Cancers and then perhaps going A Step Beyond that if he's at risk doing something to that genetic mechanism to protect him from it the possibilities. There are really really exciting is that we're a lot of the research is concentrated now. Yes, it is a lot of the research and a lot of the best minds are working in that area and I'm glad to see it something I don't deal with in my everyday life, but I think wonderful potential exists there. Well, certainly it seems that if you can get at the Cancer before it ever occurs, you've beaten the game rather than Trying to cure it. Once you've got it prevention is worth a lot. More than treatment 2276 thousand is the number to call in the Twin Cities for a if you have a question for dr. Irving learner about cancer one eight hundred two, four two two eight two eight and we have another caller on the line. Go ahead please (00:12:24) good morning. My mother is 93 years old has Alzheimer's and lat. Hello. Yes. (00:12:37) Oh, I'm sorry. We had a mixup on the Are you there? Yes. Okay. Go ahead. (00:12:43) Thank you. My mother is 93 years old and has Alzheimer's last week a small lump on the side of right in the corner of her right eye was biopsied and determined to be malignant basal cell carcinoma and physician describe the kind of treatment that would be necessary that would involve removing about two-thirds of the lower eyelid with considerable time needed to mend about six weeks with the eye closed and you may know what this procedure is. My concern is with a woman of this age. And in this condition are there other kinds of therapies, that would not be so intrusive and would not involve the kind of after care requirements that for a person with dementia would be Extremely difficult to maintain (00:13:44) possibly I wouldn't qualify as an expert on that and I would think that seeing a reconstructive surgeon or a dermatologist would be a proper course of events that basal cell carcinoma is not a very threatening lesion. It certainly doesn't threaten for life, but it can threaten for local problems that we want to take care of so that the quality of our life in our comfort is higher, but I wouldn't really address the question about alternative treatments. Doesn't this bring up the whole question. They'll print out particularly in this specific instance, but treating a 93 year old person for cancer. Especially with the health care reform that we're going to be going through it appears in the next couple of years. Is that going to be less likely to occur? Do you think yes, I think it is going to be less likely to occur and as public policy and let the state of the economy and looking for prudent and responsible medical care that that makes great sense unless of course, that's your 93 year old mother or your the 93 year old individual and unless of course not treating in pairs significantly quality of life. That's a good case in point. I don't think that ladies at risk of dying of that basal cell cancer, but if it went untreated I think that her remaining time might be seriously adversely affected Alzheimer's or not so that we still have to be Humane about this and make decisions that are appropriate to human beings and the conflict between individuals and their well-being in the society and its economic concerns. That's a very very tough call frankly. I don't think the docks are in a position to make that decision all by themselves and I think we as a society have to address that and be forthright. I did make some decisions that we can all live with together. Well having been in a family that has gone through this kind of process. I know that families in particular. Hang on to hope as long as it there's one last shred there at all. Even when the outcome is not good. It's not positive. So are we as a society going to have to change our attitudes about what's possible when it comes to treating cancer? Oh, I think definitely yes in part of this is the responsibility of the medical profession and of our public people's for example, the Cancer Society. We've sold the idea that we can do so much these days when in the truth is that we still have very substantial limitations. We have to change the expectations so that they're more legitimate. One of my colleagues has use the term selling know we have to become more skillful at selling know and making sure it's harder to sell. No than it is to provide. Yes. It takes more time and energy on the Physicians part more education, but it's a more legitimate and honest thing to do and we have to do more Of it as individual Physicians with our patients but also in terms of public policy of educating the public where the limitations are and what's appropriate and what's not so in an instance where you can say, well there's a 50/50 chance. How would you sell know in that instance or would you even try if there were 50/50 chance in my business? I'd sell yes because those are considered very good odds. We very frequently are in the position of dealing with much smaller odds than that. But even when the odds are only 20% that maybe 20% of something very good and the 80% were it fails you should be able to determine that promptly enough that an individual has the opportunity to try find out whether something is successful or not. If it is successful go for it if it's not successful back off and do something simpler Kinder more Humane and cheaper Let's go to another caller with a question for Irv learner. You're on the line. Go ahead please. (00:17:16) I just wanted to ask a question about the Went for a spin off something that happens from the treatment of breast cancer. And that is edema in the arm. And this is I see it in older women who had modified radical and and then perhaps radiation and then they live longer if they had in some chemotherapy to and then then they live longer of course, but edema in the arm is a really discouraging Situation and you don't hear it discussed at all when people talk about breast cancer. (00:18:05) Okay. So why does it occur in what can you do about it? Well, it's not the the collar is certainly correct. It's a definite complication of breast cancer treatment the primary treatment of breast cancer and has to do with the obstruction in the drainage of the arm at the level of the armpit as produced by the surgery in that area and or the surgery and radiation in that area and one statement that that's true though. I think is that with improved Surgical and radiation therapy techniques. It's a less common complication currently than it was some years ago, but it's a real bear when it occurs and it's a mechanical problem. You can't undo what you've done. So our ways of dealing with it are fairly limited. We use Arm elevation in some compression techniques and perhaps diuretics pretty much unsatisfactory. I'm glad to say that by and large that's a lesser problem 1993 and it used to be Let's go to another caller with a question for dr. Irving learner. You're on the air. (00:19:01) I would like to that ask. Dr. Lerner to speak on the breast cancer risks of women on estrogen replacement (00:19:07) therapy. Well, that's certainly a very timely issue and in a very controversial one my reading of the data about the connection between estrogen replacement therapy. I presume you mean the postmenopausal years, but the issue is not very much different in terms of taking the birth control pill taking estrogen the premenopausal years. Does it really increase the risk of breast cancer? There's no doubt that there is excellent scientific data that says it does increase the risk most of that data. However is provided at a Scandinavian literature and has to do with doses of estrogen in our lot higher than we're using in the u.s. Even so there is data that the doses that we use in the US are associated with a higher risk, but if you sort through this very carefully my reading is that the additional Risk by virtue of the doses that are usually being prescribed in the u.s. Now is very very modest that you probably are changing that risk from 1292 very little different than one and nine. And so I think by and large women should make their decision on estrogen replacement therapy not being over concerned about that. I would also point out that there is no Terrific data that says estrogen replacement and or the birth control pill reduces the risk of breast cancer. So one should understand that this is still an issue under some controversy. Well, no, no concrete answers in this field. That's Fisher's we have another caller on the line who has called either 2276 thousand or one eight hundred two, four two two eight two eight. Go ahead with your question, please (00:20:31) mine was on estrogen to I was wondering about cancer and estrogen because I've chosen not to take it and instead I exercise and I've always drank milk. So and I don't have any of the risk factors. Do you think under those circumstances? You would take extra Jenner? (00:20:49) Gee, I don't think I would take estrogen the weather used to take astronauts another issue certainly commend you for a for the exercise and the higher calcium intake and I wouldn't presume to know what your risk of osteoporosis is. That's a hard thing to quantify what the risk of osteoporosis is, one of the weaknesses of our systems that we don't have really good predictability. Body in terms of osteoporosis and when we finally see it, it's already happened. We wish we had done something different. There's no doubt that even in a woman who is very good about exercising and has a high calcium intake that the addition of estrogen adds a very substantial protection against osteoporosis and a modest protection against coronary disease. So just the fact that when exercises and takes the calcium intake doesn't mean she still ought to give serious consideration to taking replacement estrogen and the risk of estrogen making breast cancer as as I've defined before I think it's a relatively modest risk if it's real it all the certainly was the risk of estrogen making cancer of the uterus, which is irrelevant for those women have had a hysterectomy and not for the rest the addition of progesterone to the estrogen regimen almost certainly eliminates that possibility but makes it a more complex issue in a more expensive issue in terms of replacement treatment. There's no simple answer. Can you get those kinds of answers from a regular family practitioner or who's the best type of physician to go to alliances question? I think that by and large the answer to that is yes. These are such prevalent questions and there's so much literature about them that I think the answer is most of our family physicians are primary care providers are in a very good position to deal with him. I'll take another place that's good to deal with it Consumer Reports periodically puts out an article on this issue on this subject. That is very well taken in very well-reasoned. And every time they do I provide copies of those to my patients. So simply looking through back issues of consumer reports will provide you with some excellent up-to-date information on the controversy. All right. Thank you and we'll go to another caller with a question for Irv learner. Go ahead please (00:22:50) what part does stress play in cancer (00:22:54) very clearly cancer makes stress, but there's very little evidence that stress makes cancer. In fact, there is no compelling evidence that stress makes cancer for all. Talk that's been done about it. If you go through the data very very carefully, you'll find it very unpersuasive. But I can tell you for a fact that cancer makes stress in Spades indeed. And if you have cancer and that produces a lot of stress does that then make it worse? There's no compelling evidence that that's so and since literally everybody who has cancer has a lot of stress. It would be very hard to figure out. I'm unpersuaded. I mean there has been a lot of talk about the connection between stress and cancer. It's a very timely topical trendy kind of issue. But if you really sort through it carefully I find it very unimpressive that stress is it as a causal factor of any form of cancer? Just wondering though about attitude as one goes through treatment for cancer, if if you see that as a playing a big role. In fact, I think that I read one study that said people who were pretty irascible and angry and difficult to get along with actually did better in going. Treatment the presumption is and a lot of the argument is that the person with a positive attitude does better against this cancer? I believe that that's true insofar that the person with a positive attitude is more likely to enable us to use the various treatments that we have available and If those treatments are worth anything that patient will do better but the happy warrior Hubert Humphrey didn't lose his battle against cancer the bladder because he wasn't upbeat and positive he lost his battle because our treatments weren't good enough there is if you again try to look at the the actual data, it's very limited and the best study I've seen says that pessimist do better. I don't believe that but that's the best idea I've seen right? Okay Irv learner is our guest today. He is an oncologist in private practice in st. Paul and he's taking your questions about cancer research and treatment. The number in the Twin Cities is 2276 thousand if you're calling us from outside the metropolitan area, you can reach us at one eight hundred two, four two two eight two eight. It's 29 minutes before 12. Noon. And you are next. Go ahead please (00:25:08) I'd like to know if there is any method for early detection of pancreatic cancer. I'll hang up and listen to your reply. (00:25:16) That's a terrific question and I welcome it and the answer is no there is no early test for the detection of pancreatic cancer. And that puts the finger on one of our most important issues. That's a tough cancer in the reason that we have such a poor result against it at least in part is because we don't have a good early diagnostic technique and think for a minute what it would take to develop such a technique. This is a cancer that's tucked deep in the abdomen that doesn't tend to cause symptoms until it's fairly far Advanced. We're going to need to have some kind of a screening blood test or some other simple reliable inexpensive test that we can run that that we can count on. I'm afraid it's going to be a long time before we develop such a thing and that's certainly accounts in part for why we do is poorly against that cancer. Well, Is that the type of instance and where someone at one point complains of having pain or something? He's brought in for exploratory surgery and I've heard this several times. They opened him up and he was full of cancer after having absolutely no clue up to that point that there was anything wrong. How does that happen? That is how it happens cancers can sneak up they can be very Insidious and they can grow slowly and not cause a lot of trouble finally start to cause trouble and when we when we explore the patient either surgically or by some of our other tests find that it's no longer an operable lesion cancer pancreas is an excellent case in point and it speaks again to the fact that we have a long ways to go in terms of our diagnostic abilities. And also once we make the diagnosis and treating a cancer like cancer of the pancreas, it's a very difficult cancer to treat. Let's go to another caller with the question. Go ahead. You're on the (00:26:53) air. Thank you. Recently. I recently met marks the 15th. I had a blood test. There's a result of this on the eia of 3.6. I'm a nonsmoker my doctor then referred me for a CAT scan barium enema chest x-ray and colonoscopy all of the CAT scan in the chest x-ray and I became pregnant the CAT scan and the barium enema for our findings were normal and there is a pretty called a blip on the chest x-ray in the lower left lobe. I have no symptoms and I'm I'm just wondering what is this 3.6 mean does it mean that there is the cancer present and difficult to find but I guess that's (00:27:44) it. Okay. What CIA? Well, I don't know what the I is. I'm wondering if he doesn't mean cea would that be possible? (00:27:50) Dea, it's carcinoembryonic antigen (00:27:54) cea cea is a broad marker test a screening marker test. Well, I'd like to retract the word screening abroad marker test that can be very useful in following a documented cancer for example cancer of the colon or cancel the lung which trips the marker can be followed then are we doing? Well, are we doing poorly against it but it's not a very useful screening test and my personal opinion shouldn't be used as a screening test. It has never been demonstrated as having value as a screening test and certainly as public policy is not very useful 3.6 depending on the laboratory standards if they were the same as mine that would not be considered particularly elevated and I wouldn't pay very much attention to it a an elevation or a level of 3.6 would be certainly compatible with smoking a half a pack of cigarettes a day or some other for example minor abnormalities and liver function that will produce that so in my laboratory of CEO 3.6 would not be the cause of any particular concern. Again, I don't think it's a very good screening test and probably shouldn't be used that way. So he shouldn't worry at this point. I don't want to tell him that because I don't know what the laboratory dimensions are they are. But in my laboratory, I wouldn't be worried. All right, we have another question for dr. Lerner. Go ahead please (00:29:06) I received a most excellent care from your colleague. Dr. John wakefulness with my breast cancer seven years ago. I'm 47 years old now with under the good care and guidance and routine checks. I have remained disease-free. Would you please discuss your view of hormone replacement treatment for women survivors of breast cancer. (00:29:31) Well, firstly we thank you for the plug. I'm sure John will be happy happy to hear what you had to say. Your question is a very difficult one. Let me Define it for you. If a woman has had a breast cancer and is postmenopausal and is interested in hormone replacement therapy for the same reason all other women are to protect for a osteoporosis and coronary heart disease. Does she take a risk by taking estrogen therapy particularly after there's been a period of time. Laughs when she's not had activity for disease the current Trend in medical thinking is that we not take that risk. We don't think that the estrogen necessarily will incite a new cancer will inside a new cancer. But if there were any dormant cells from that original cancer might they light that up that's been our concern. But the truth of the matter is there's precious little scientific data that supports that concern and it's hard to find the data and my guess is that as we look into the next few years. We will become less concerted. They're not a lot of women out there who having a lot of symptoms of menopause menopause who would dearly love to be on estrogen and I think we're probably depriving them of a valuable treatment. My answer to this lady now is no I wouldn't take it yet but stick with us for a while and see if we don't change her mind based on some better research the best not to disturb those dormant cells. How long can those stay there dormant with breast cancer? Because each cancer has its own patterns breast cancer cells can show up as many as 20 and 30 years later. Which raises a very interesting issue what are they doing all that time? And there must be some kind of a relationship between the cancer in the person the person is winning all that time. Don't upset the apple cart. So the cancer gets the upper hand will go to another caller with a question for Irv learner. You're on the air. (00:31:12) Yes. Thank you. I'm 45 years old when I was around 10 years old. I had a major exposure to Airborne asbestos dust when I was a kid. I helped my father install some asbestos paneling and garage. It was we cut it on a table saw and it made clouds of dust. It took maybe a few weeks to do this. I remember breathing it in and getting it, you know all over us. It was just an awful thing. Anyway, we didn't know what we were doing a course in those days. I'm wondering is there anything that any test I should take is there any Can I forget about a one-time exposure or is that something serious that could still be in my lungs and how oh hang up and listen to your (00:31:55) answer? That's a good question. I'd like to address that in the first place. I don't think your particular risk is very high where asbestos has been risky in terms of producing later cancers, 20 30 40 years later has been in the continued exposure people who work with it over a very protracted period of time a single exposure even a nasty exposure. I don't think creates much of a risk at all. But I'll tell you what you should surely not do and that is smoked cigarettes because if you look at the data very carefully, especially exposure at alone in non-smokers definitely increases the risk of malignancy, but not very much asbestos exposure in cigarette smokers produces a Monumental increase in risk of cancer the to appear to act together very very strikingly in terms of producing cancer, but no, I don't think you've got any great risk there. Environmental causes are they particularly difficult to pinpoint? Yeah, they're very difficult to pinpoint. Asbestos is one that is known. There are a number of others like that tend to be relatively unusual. Radon May well be variable variable issue. It's a little hard to pin down the environmental issue. That's best known is cigarette smoke both to the smoker and to a lesser extent with secondhand smoke. It's 21 minutes before noon and you're listening to midday on Minnesota Public Radio Our Guest today is dr. Irving learner and we're talking about cancer 2276 thousand is the number to call in the Twin Cities. If you have a question for Irv, and you can reach us at one eight hundred two, four two 2828 if you're calling from outside the metro area and we do have another caller on the line. You are next. (00:33:30) Good morning. Dr. Lerner. Good morning. I have a question for you. My grandfather had prostate cancer later had develop prostate cancer late in life and had a vasectomy at a rather young age around middle age. Is there a connection between vasectomies and prostate cancer? Thank you. I'll hang up and listen (00:33:49) not so far as I'm aware. No, the vasectomy has been implicated as a possible source of later cancers in monkeys. I'm not aware of any data in human beings that it is. And in fact, I'll say hi to some evidence that might argue that it would be a small risk of small protection against cancer. They affecting these are done as prophylaxis individual with beige ectomy might be more sexually active. There's no question that being sexually active reduces the risk of prostate cancer. So I could argue it in the other direction. I didn't know that. Well, one of one of the battles between the Sexes for the that's going to be brought up in many. Let's go to another caller with a question for Irv learner. You're on the air. (00:34:30) Yes. Hi, I'm 44 and marriage and premenopausal and I found that I had a tumor in my left breast chose a bilateral mastectomy. It was a stage 1 grade 2 and I just finished six months of chemotherapy. EMF the tumor was 75% estrogen positive and I found the DNA test reported that it was an an employer fast-growing type of cancer. I'm struggling now with the decision to take tamoxifen and whether I can still have a family or if that's out of the question and what the risk is of not taking tamoxifen at this time. Thank you. (00:35:04) That lady must have gone to medical school. Well, I was going to say if having cancer turns you into a medical expert. She's a living example. I've need to tell you she's done her homework. That's very impressive and it's a very specific question. What what's the potential benefit of taking tamoxifen? What's the potential risk? She doesn't have any residual breast tissue since she elected to have bilateral mastectomy. So the tamoxifen wouldn't be protective in terms of a second breast cancer because she can't get a second breast cancer. So the only potential benefit would be in terms of protecting her from that primary breast cancer and I would think that based on the information she gave us that her risk is relatively small. It was not a very threatening cancer. It had mixed characteristics. We call them. The fact that was estrogen receptor-positive is very favorable the fact that it was stage one is very favorable, etc. Etc. Taking tamoxifen would be kind of frosting on the cake. I don't think it ought to be considered to be a very big decision. It might offer a little extra protection except for the issue of having a family taking these foxman would be a very small risk to her. Very very very small wrist towards an extraordinarily safe medicine. So except for the issue of having a family. I don't think it's a real hard call either way if she chooses to do it. There are reasons why that might be a good thing if she chooses not to do it. I don't think she needs to worry about it. Hmm. The the whole issue of treatment, we really haven't gotten into that too much and chemotherapy. She mentioned that she went through that there's radiation, of course and oftentimes a cancer patients will say they will say that they wonder if the treatment is worse than the disease because of the side effects of chemotherapy is their constant juggling with with the use of chemotherapy. And how much is too much and how much do you need to have in order for it to be effective you're addressing the issue we refer to as the cost benefit ratio, if you could tell in advance who was a responder to treatment if for example, you could do sensitivity testing the way we can with bacteria. This is not out of the realm of possibility and you could determine in advance that a patient was sensitive to the treatments that you're about to use then you go for it and you take the risk of the side effects because you know, you're going to get the kind of benefit that makes that worthwhile. Well 1993 were not there yet and by and large we find out whether patient responds. By giving the treatment and if they respond, there's no doubt that they get their money's worth and if they don't respond, there's no doubt they didn't so it seems to me that the proper way of dealing with this is to explain these things to a patient up front tell him what the chances are of responding what the chances are of being injured by the treatment itself. He makes he or she makes that decision it's her prerogative and then we go ahead and treat and if it works if we do get a response you go for it and you go as far as it'll carry you and if you don't get a response you quit doing it and at least consider the Alternatives one of which is not to treat at all. There are some who say it was the chemotherapy that killed him not the cancer. Is that possible sure. It's possible. They're potentially hazardous agents, but it shouldn't happen even even using aggressive chemotherapy the risk to the risk of dying should be exceedingly remote the risk of getting sick is pretty high. These are tough drugs to take and the the trend in more recent treatment is to use more treatment more aggressive drugs higher doses because we've seen higher response rates and an even more recently the concept of for example bone marrow transplantation. Well now transplantation isn't the treatment of such its kind of the Texas Rangers that bails you out of and gives you the opportunity to use super aggressive treatment, but super aggressive treatment is super unpleasant treatment and has a lot of other side effects associated with it. So these become very complicated decisions. Ultimately, we can't simply sit here and say we should do it or we shouldn't do it. What we should do is make sure our patients know what we're up to and have them decide what's right for them. Let's go to another question for dr. Lerner. You're on the (00:38:56) air. Yes, ma'am. Thank you. I'd like to inquire please about cancer funding I believe was a couple of years ago the Tribune carried a story about the relationship of funding for cancer research as opposed to AIDS research per patient. I wondered where this is at now, and if the funding is adequate where we're going with this, thank you. (00:39:17) An awful lot of money is being spent on cancer research and AIDS research. It's not an area in which I'm really an expert. You always need more money in both areas, but I believe that currently there is a reasonably equitable distribution of funding that's that's not an expert's comment on the matter and and I hope that everybody will continue to be motivated to continue to contribute to both areas and I hope the federal government will do the same but I do believe that there's a very balanced in these issues. It seems it seems very considerably that the squeaky wheel gets the oil and the people who complain get research allocated to them. The AIDS people have been very effective in doing this the cancer people have been very effective in doing this. There are other areas medical research where people haven't been as outspoken and I think are getting the shorter end but in these two areas, I think we're doing reasonably well. Okay, we have another question for Irv learner. Go ahead. You're on the air. (00:40:11) yes, I'm I'm calling regarding him 91 year old man that has been diagnosed with cancer the prostate and we wondered if it was beneficial for him to have had an orchiectomy or not or what he lived as well without one and if there is some place we could write for information on this. (00:40:32) It's a tough call. That's really not enough information to answer the question. This may be a 91 year old man who's in great shape and who still has a good expectation of life. It may be a cancer that we have a guest is a relatively innocent cancer. It may be a cancer that we have a guest is an aggressive cancer going to cause him a lot of trouble if it's the latter if it's a cancer that we have reason to believe is going to cause a lot of trouble the an orchiectomy at taking the testicles off believe or not as a relatively small operation with a very high success rate. So then in terms of cost benefit ratio, it's a very successful kind of procedure and I wouldn't hesitate to do it. But if you could make the prediction that it's a fairly innocent kind of cancer, there are reasons that one could sit on it for a while and not do it. Looks like some more investigation. What about a place to write for more information? I'm sorry. I didn't dress that the National Cancer Institute has a variety of Publications. I think their publication on cancer prostate is excellent, but I doubt if it's going to be discriminating enough to answer that particular question. So you need to talk to a doctor I think so. Yeah, let's go to another caller with questions for dr. Lerner. You're on the air. (00:41:35) Yes. I have a question about uterine cancer the diagnosis and the treatment and prognosis and why a to pap smears would not show that cancer was present in the uterus. Thank you (00:41:52) taking the last question first the past mirror is our best single screening. Test meets all the criteria of a great screening test, but what it screens for is cancer of the cervix, which is the mouth of the uterus and it's not very effective in screening for cancer the uterus itself, which is the body of the organ the rest of the organ also. Unfortunately, it's not very useful for screening for cancer of the ovary which Is a which is a more prevalent cancer and in a bigger killing cancer, so I'm not surprised at all the to pap smears missed it. I'd be a little surprised if pap smear picked it up. I think that's a relatively unlikely occurrence. If one can make an early diagnosis of cancer the uterus because you frequently can patients frequently present with with the vaginal bleeding and in evaluating for that one finds the cancer of the uterus. If you find a relatively early variant, it's very effectively treated by surgery in some instances by radiation therapy as opposed to surgery the the success rate is very is very high when you can pick up early ones by virtue of the behavioral characteristic the cancer. However, there are variants of cancer theaters which are by their own inherent nature aggressive and they don't allow us an early diagnosis. We pick them up too late for those those ordinary primary forms of treatment Numa cancer radiation therapy the brings up the whole issue of early detection by doctors and you were telling me before we went on the air that the failure to diagnose. Is one of the biggest well is the biggest cause for malpractice suits? It's kind of tough. I would think being in that position and not having a test that would allow you to make the diagnosis again. We've sold the population the concept that early diagnosis is the key and that's a good concept that I really do support it. But I think we've driven the point too hard. I think the public has the expectation if they're if they're responsible and they do the things we told them to do we will find their cancers. We ain't that good. We simply not good enough to do it the cancel uterus the camps of the pancreas that we've talked about already are excellent examples where we don't have the tools 1993 to do that patients have to do as well as they can and we have to do as well as we can and then we have to do better. Okay, Doctor Learners taking your question next. Hello, you're on the air. All right, we'll go to the will go to the next caller. Yes. Go ahead, (00:44:11) please. Okay, answer 12 years ago was one and twenty st. Louis county is one one in seven. Nationally. It's one in eight American Cancer Society. Everybody else has to catch it early and colleges that I've talked to say. They don't have the diagnostic tools catches The Phase 1 and two very important the kitchen Phase 1 and 2 and yet we don't have the tools to do it and what all the screening that the patient doesn't it's not an adequate in them. When is the National Cancer Institute and the American Medical Association going to get together and find diagnostic tools to catch it early. (00:44:50) It kind of follows up on the last response that you had for us. Yeah sure. Wish I knew the answer that question by dint of hard work and more research but don't underestimate the problem. We made that mistake in the 60s when we passed the cancer Bill during the Nixon Administration the concept the concept was that if we spend enough money we would fix the Problem in a given period of time it's too big a problem. We're not that good. We will fix it eventually, but I really don't know how long that will take. Okay. Let's go to another question for dr. Lerner. You're on the air. (00:45:18) Yes. I had colon cancer when I was 42 dick looks to in its I've been cancer-free for eight years seven years now. I'm at a high risk for osteoporosis. And so my oncologist says don't take oestrogen replacement because you had colon cancer. It's not advised in my gynecologist says take it. It's a good idea. So the possibilities exist for me to take tamoxifen. I like your views comparing to Max's when with estrogen for somebody who had a history of colon cancer. (00:45:59) What kind of come out on your own you're going to college aside on that one? I'm not afraid of your taking estrogen by virtue of your previous history of colon cancer. I presume the concern is that perhaps you have a higher risk of breast cancer and taking estrogen when increase that risk still further, but that gets to be kind of flimsy Connections in my mind. If somebody really knew that you were at risk for osteoporosis. I think it's perfectly legitimate that you take the estrogen. I'm not so sure how they know you're at such risk for osteoporosis. I find that a very difficult enough to crack taking tamoxifen is an alternative is a very complex question. We are currently trying to discern trying to figure out where they're taking tamoxifen is in a preventive way will prevent breast cancer. That's a very very big question if it turns out to be so maybe for the first time we could have a real impact on the making of breast cancer preventing breast cancer that be a wonderful wonderful thing to be able to do on the other hand. Could we afford to do it because then literally every adult women in the world ought to take tamoxifen and unless the price of tamoxifen comes down a long ways that's going to be very very hard. The fund is that the one that's from the yew tree. No, that's taxol. Okay. All right, and that's a treatment. That's another kind of treatment. Okay. We have a few minutes left in the program today and we're taking your questions about cancer Our Guest is dr. Irving learner who is an oncologist and you are next. Go ahead please. (00:47:20) Hello. Yes. You're on the air. Yes. Turn your radio down, please. Okay. Okay. Are we there? Alright wondering given the fact that many Studies have shown that pesticides and toxins are a factor in cancer why we're not pushing more to eliminate the pesticides and toxins and go to safer environmental cures and eliminate a lot of reasons for cancer. (00:47:52) Yes, I really don't know the answer to that the data is not that compelling in the first place and in the second place. I think there have been major efforts to cut back on those agents which have been shown to be carcinogenic but I don't pretend to be an expert there and I read it for not to handle that one. Do any of your colleagues get involved in that area that you're aware of the colleagues who are basically epidemiologist in environmental Physicians. The answer is yes, and they're working very hard on it but you'd be amazed how hard it is to come up with a solid data. That's something represents a risk to human beings. That's a very tough call. If you go back to my discussion about the beta-carotene the kind of studies you have to do to prove that something is carcinogenic for human beings and a real issue to human beings. It's a very difficult thing he had obviously we don't want the public to be exposed to something over a long time that makes a lot of cancers. So there's difficulty on both sides of the coin. Let's go to another caller with a question for Irv learner. You're on the air (00:48:45) afterburner. What do you think of the accuracy of the ca-125 in the detection of ovarian cancer or do you think it's beneficial? (00:48:54) The explain please. Oh, I'm sorry. The CI 125 is another marker test. We've already talked about the cea as a marker test. And now we're talking about the ca-125 is a marker test and it's a test that frequently not invariably will be elevated in the presence of a very in cancer. And if that's true, obviously the question is raised. Why don't we just do ca-125 in the population at large and see who's got ovarian cancer and who doesn't. Well there has never been a study demonstrated study completed that demonstrates the value and using the ca-125 in that screening fashion the accepted use of the ca-125 1993 is in following patients who've had ovarian cancer and helping keep track of them and can be very useful. They're not always not every patient with cancer the ovary trips the ca-125. So that's useful as a marker the decision to recommend something as a screening test. Nationwide is a very big decision witness the controversy that's come up about the PSA which is a similar marker about cancer the prostate before you Man, that is public policy because you're talking very big bucks and a society which is very stratfor Medical Care and which has some other exceedingly valid ways of spending those medical dollars. You better be sure that it really proves it's worth. It really does the job it supposed to do and to date the ca-125 has not met that test is a screening test in cancer of the ovary and there is no agency that I'm aware of that uses the ca-125 as an official recommendation for screening. The PSA is more difficult because the Cancer Society has taken the official position that the PSA should be used as a screening test for cancer the prostate and men over 50 and I can assure you that that has not met with universal Acceptance in the medical profession many Physicians feel that it has not demonstrated its value as a screening test in terms of saving lives. There is no doubt that it's an effective screening tests in terms of finding cancer the prostate but it doesn't help you answer the question. Have you found those cancers of the prostate which kill people in which enable you to make a diagnosis early that actually changes the way of the world. Those are very difficult questions. And again, we're strapped for funds and you're talking about doing something across the board to the population at large. You have to be very discriminating and making the answer. Well, we got about a minute and a half left in the program. So I'm going to forego any more phone calls. I think those of you who have been waiting so patiently and hopefully you can call the American Cancer Society or the National Cancer Institute to get more information about the questions that you may have. Let me ask you just one final question or many of us dread getting cancer is that dread Justified cancer has a bad rap cancer has so many connotations and I believe that the cancer had the cancer concept. The myth of cancer has been blown out of all expectation. You know when John Dean turned the Richard Nixon said there's a cancer in our midst. He didn't have to Define it but he didn't say there was hypertension are ministers kidney disease and it's he said there's cancer its cancer is a badass. Your cancer his however the number two killer in America. That's not take it out of context. Let's remember that we are probably in a position now to cure at least half the the major cancers that are presented to us the non skin cancers. So instead of being terrified about cancer, which I'm afraid is what we are. We need to be more realistic and more open about it. We need to do the things we know how to do 1993 and we sure as blazes need to find out a lot more things about the screening in the treatment of cancer, which I believe are on the brink of doing right now. I'm an optimist or I wouldn't be in this business, but I really do believe that the next few years are going to bring some major accomplishments and that optimistic note. We will close. Thank you. Dr. Irving learner for being with us today. My pleasure follow. Dr. Lerner is an oncologist and Private Practice in st. Paul. You've been listening to midday on Minnesota Public Radio. I'm Paula Schroeder.