Transcript: Cancer | Apr 05, 2000

Maureen Taylor appears in a studio with yellow walls and a small TV set in the background, which reads “More to life.”

Maureen is in her late thirties, with wavy blond hair in a bob. She's wearing a blue blazer over a red shirt.

She says HELLO, I'M MAUREEN TAYLOR.
APRIL IS CANCER AWARENESS
MONTH, AND DOCTORS ARE MORE
HOPEFUL THAN EVER THAT THIS
KILLER DISEASE CAN BE BEATEN.
TODAY ON
MORE TO LIFE,
ONCOLOGIST Dr. ROBERT BUCKMAN
DISCUSSES NEW BREAKTHROUGHS
IN CANCER RESEARCH
AND TAKES YOUR CALLS.

(music plays)
The opening sequence shows a wooden table with a small lit candle.
Fast clips show different sets of hands performing activities on the table such as pulling petals from a daisy, drawing a big red heart, tuning a violin, flipping through the pages of a book, cooking, and pouring a glass of red wine.
In animation, the title appears inside the shape of a house: “More to life.”

Maureen reappears and says
WELCOME TO
MORE TO LIFE.
TODAY IS THE FINAL DAY OF
THE AMERICAN ASSOCIATION OF
CANCER RESEARCH CONFERENCE
IN SAN FRANCISCO.
ON THE AGENDA IS NEWS OF
IMPROVED CHEMOTHERAPY
TREATMENT, TECHNIQUES USED
TO STARVE TUMOURS, AND DRUGS
THAT MAY BE ABLE TO STOP
THE DEVELOPMENT OF CANCER.
HERE TO EXPLAIN WHY THERE IS
SUCH OPTIMISM AROUND CANCER
TREATMENT IS OUR FAVOURITE
ONCOLOGIST, Dr. ROB BUCKMAN.

Rob is in his late fifties, clean-shaven, with wavy shite hair. He’s wearing a gray coat over a gray sweater.

Maureen continues Dr. BUCKMAN IS THE AUTHOR OF
“What you really need to know about cancer.”

A picture of the book appears briefly.

Maureen continues HIS AUTOBIOGRAPHY
“Not dead yet” WILL BE WE RELEASED IN
PAPERBACK NEXT MONTH.

A picture of the autobiography appears briefly. The cover features a picture of Rob smiling in a library.

Maureen continues AND WE HAVE COPIES OF THAT
BOOK TO GIVE OUT TO THREE
LUCKY CALLERS.
WE ALSO HAVE SOME
COMPLEMENTARY TICKETS TO A
SPEECH THAT Dr. BUCKMAN IS
GIVING AT THE ONTARIO SCIENCE
CENTRE AS WELL.
SO LOTS OF GIVEAWAYS.
IF YOU HAVE QUESTIONS TODAY
ABOUT CANCER, FROM TREATMENT
TO PREVENTION TO
DIAGNOSES, GIVE US A CALL

A caption reads “416-484-2727. 1-888-411-1234.”
Then, it changes to “moretolife@tvo.org.”

Maureen continues
AND NICE TO SEE YOU
AGAIN, Dr. BUCKMAN.

Rob says LOVELY TO BE HERE, MAUREEN.

Maureen says WHY DO THERE SEEM TO BE SUCH
A FLURRY OF BREAKTHROUGHS
AROUND CANCER RECENTLY?

The caption changes to "Doctor Rob Buckman. Oncologist."

Rob says NOT RECENTLY.
I'M AFRAID IT'S EVERY WEEK.
I HAVE TO SAY, THIS IS, TO ME,
THE ATMOSPHERE IS STEADILY
AND PROGRESSIVELY IMPROVING.
AND THINGS HAVE BEEN ADDING
TO THE PILE OF KNOWLEDGE
FOR MANY YEARS NOW.
AND IN THE LAST, SAY, TWO,
THREE, FOUR, FIVE YEARS,
THAT RATE HAS INCREASED.
BUT UNFORTUNATELY, FROM THE
MEDIA POINT OF VIEW, YOU KNOW
THE AACR, THE AMERICAN
ASSOCIATION OF CANCER
RESEARCH, I THINK I'M
STILL A MEMBER, I THINK.
I'LL HAVE TO
CHECK UP ON THAT.

Maureen says IN GOOD STANDING?

Rob says EXACTLY.
THEY HAVE THEIR
MEETING EVERY YEAR.
AND PEOPLE ARE ALWAYS TRYING
TO SAY OH, ISN'T IT AMAZING?
AND VERY OFTEN, IT'S
MUCH LESS THAN AMAZING.
SO FOR EXAMPLE, IT IS POSSIBLE
THAT THIS CHEMOTHERAPY MAY BE
A TAD BETTER THAN THE OTHER,
BUT MY OWN FEELING IS IF YOU
LOOK BACK OVER THE LAST
15 YEARS, ADVANCES IN
CHEMOTHERAPY HAVE NOT BEEN, AS
IT WERE, REAL GETTING BETWEEN
YOUR FINGER AND
THUMB KIND OF ADVANCES.
ON THE OTHER HAND, THE KIND OF
STUFF THAT YOU'RE REFERRING TO,
STARVING TUMOURS, AGENTS LIKE
COMBRETASTATIN, AGENTS THAT
INTERFERE WITH A CANCER'S
ABILITY TO PROVIDE ITSELF WITH
ITS OWN BLOOD SUPPLY, SO
IT GIVES ITSELF A FUEL LINE.

Maureen says WHICH IT NEEDS IN
ORDER TO SPREAD.

Rob says EXACTLY RIGHT.
ANTI-ANGIOGENESIS AGENTS,
THESE KIND OF THINGS HAVE BEEN
COOKING STEADILY FOR MANY
YEARS, THESE KIND OF
BIOLOGICAL AGENTS HAVE BEEN
COOKING FOR MANY YEARS, AND WE
ARE NOW BEGINNING TO SEE THE
FIRST GLIMMER OF PAYBACK.
THIS IS, LET ME SAY THIS TO
THE VIEWERS, PLEASE DON'T
EXPECT THAT ANY OF THESE
AGENTS WILL BE, AS IT WERE,
ROUTINELY AVAILABLE
FOR SEVERAL YEARS.
SOME MAY BE QUICKER THAN
OTHERS, BUT IT IS QUITE
POSSIBLE THAT NOTHING DRAMATIC
IS GOING TO CHANGE IN
TREATMENT, EVEN AS A RESULT OF
WHAT WE'RE HEARING THIS YEAR,
FOR ANOTHER TWO
OR THREE YEARS.

Maureen says BECAUSE RIGHT NOW, IT WORKS
GREAT IF YOU'RE A MOUSE, BUT
HUMANS AREN'T MICE, RIGHT?

Rob says BINGO.
I'M AFRAID, VERY OFTEN, MOUSE
DOCTORS GET TO THE MEDIA AND
SAY, YES, IT'S A MAJOR
BREAKTHROUGH, WE HAD 12 MICE,
AND THEY'RE ALL STILL ALIVE,
WHEN I WOULD HAVE EXPECTED
ALL OF THEM TO HAVE DIED.
AND AS YOU JUST SAID, IF ALL
OUR CLINICS WERE FULL OF MICE,
LIFE WOULD BE
EASIER FOR EVERYONE.

Maureen says BUT THAT'S ANGIOGENESIS, AND
ANTI-ANGIOGENESIS AGENTS.
WHAT OTHER NEW RESEARCH
REALLY EXCITES YOU?

Rob says I THINK THERE ARE SEVERAL.
FOR A START, I WANT TO JUST
PUT ANTI-ANGIOGENESIS AGENTS
IN A SORT OF BAG,
AS IT WERE.
THAT WHOLE AREA
IS FASCINATING.
AND THAT AREA IS INTERFERING
WITH BIOLOGICAL SIGNALS.
VERY, VERY QUICKLY,
CHEMOTHERAPY IS DRUG THERAPY
OF GROWING CELLS.
AND IT IS LUCKY THAT IN
CERTAIN CANCERS, IF YOU GIVE
A HUGE BLAST OF CHEMOTHERAPY,
RELATIVITY SPEAKING, TO THE
CELLS, THE CANCER CELLS GET
HIT MUCH HARDER THAN THE
NORMAL BODY CELLS.
SO IN TESTICULAR CANCER, AND
IN SEVERAL OTHER CANCERS, AND
IN THE SETTING FOR ABOUT A
THIRD OF THE CASES OF BREAST
CANCER, YOU'RE DOING SOMETHING
BY KILLING GROWING CELLS.
BUT IT IS NOT SPECIFIC FOR
BREAST CANCER OR TESTICULAR
CANCER, WHATEVER.
IN THE LAST SAY 15 YEARS OR
SO THE RESEARCH DIRECTION HAS
BEEN TRY TO FIND OUT WHAT
SIGNALS SPECIFICALLY, IF I'M A
BREAST CANCER CELL, I SEND
OUT TO YOU IF YOU'RE ANOTHER
BREAST CANCER CELL, HEY, LET'S
DO SOMETHING, AND TOGETHER WE
SEND OUT SIGNALS TO THE REST
OF THE BODY SAYING, DON'T SEND
THE POLICE AROUND HERE, WE'RE
FINE, AND VARIOUS DEFENCE
MECHANISMS RELAX AND SO ON.
NOW THIS RESEARCH, LOOKING
INTO THE KIND OF SIGNALS THE
CANCER CELLS SEND TO EACH
OTHER, AND TO THE OUTSIDE
WORLD, THE BODY, THIS
IS BIOLOGICAL RESEARCH.
AND THIS HAS BEEN GOING ON
STEADILY AND PROGRESSIVELY FOR
MANY, MANY YEARS, AND NOW THAT
WHOLE AREA, WE'RE BEGINNING
TO SORT OF MATCH THE
KNOWLEDGE TO THE TREATMENT.
THE FIRST ONE WHICH EVERYONE
HAS HEARD OF IS HERCEPTIN,
WHICH IS A DRUG THAT
RECOGNIZES THE PRODUCT,
THE RECEPTOR, ACTUALLY, OF A
GENETIC THING CALLED HER2/NEU.
AND WHAT IT DOES, IF THE
CANCER HAPPENS TO BE USING
THIS SIGNALING SYSTEM,
HERCEPTIN COMES IN AND
INTERFERES WITH THE SIGNALING
SYSTEM, AND THE CANCER SUFFERS.

Maureen says SCRAMBLES THE RADIO
WAVES OR WHATEVER.

Rob says BRILLIANT, THAT'S EXACTLY
WHAT IT DOES, IS IT SCRAMBLES.
BUT YOU HAVE TO KNOW
WHAT WAVE LENGTH.
AND THAT'S WHAT THEY'VE BEEN
DOING FOR THE LAST 10 OR 15
YEARS, IS TO LEARN, WHERE
ARE THEY TRANSMITTING.

Maureen says THAT'S EXCITING.

Rob says THAT'S EXCITING.
ANTI-ANGIOGENESIS, HER2/NEU
HERCEPTIN IS ANOTHER,
COMBRETASTATIN IS ANOTHER,
AND THERE ARE MORE AND MORE
AND MORE GOING DOWN THE LINE.

Maureen says OKAY.
SOME STUFF TO TALK AROUND
CHEMOTHERAPY AS WELL,
AND WE WILL DO THAT.
BUT I'LL GIVE THE NUMBERS ONE
MORE TIME, AND WE'LL START TO
TAKE YOUR CALLS ON CANCER
FOR Dr. ROBERT BUCKMAN.
GIVE US A CALL

The phone numbers and email reappear briefly.

Maureen continues AND MARGARET IS
IN MISSISSAUGA.
HI, MARGARET.

The Caller says HI.

Maureen says HI.

The Caller says I WAS READING
THE STAR
TODAY, AND THERE'S AN ARTICLE.
IT'S ABOUT A DRUG, ST 1571.
HAVE YOU HEARD OF IT?

Rob says I HAVEN'T.
I'M TERRIBLY SORRY.
YOU'VE GOT ME THERE, MARGARET.
NUMBER ONE, I DIDN'T READ
THE
STAR
TODAY, AND NUMBER TWO,
I'M AFRAID I HAVEN'T HEARD
OF THAT PARTICULAR ONE.
DO YOU MIND TELLING ME WHAT IT
SAID, AND WE'LL SORT OF TRY
AND FEEL OUR WAY FROM THERE?

The Caller says SURE, IT'S A LEUKEMIA DRUG.
AND IT'S USED FOR TREATING CML,
CHRONIC MYELOGENOUS LEUKEMIA.

Rob says THAT'S RIGHT.

The Caller says YEAH.
NOW, IT'S SAYING, WE'RE HAVING
EXCELLENT RESULTS, AND IT'S
A Dr. BRIAN DRUKER, OREGON
HEALTH SCIENCES UNIVERSITY.

Maureen says AND IS THIS -- THERE WAS SO
MUCH IN ALL THE PAPERS TODAY.
THIS ISN'T THE ONE THAT'S
JUST BEEN APPROVED BY HEALTH
CANADA, IS IT?

The Caller says I DON'T THINK SO.

Maureen says ALL RIGHT.
WELL, MAYBE WE CAN SPEAK
IN GENERAL ABOUT LEUKEMIA.

Rob says LEUKEMIA IS VERY INTERESTING.
AND CML, THE ONE YOU'RE
TALKING ABOUT, MARGARET, IS A
VERY UNUSUAL CONDITION, IN
THAT IT MAY, AS IT WERE, SIT
THERE NOT DOING VERY MUCH FOR
QUITE A TIME, DURING WHICH
TIME YOU ONLY NEED RELATIVELY
SPEAKING GENTLE THERAPY,
SOMETIMES FOR SEVERAL YEARS,
AND THEN, ALMOST IN EVERY
CASE, AT THE END, IT
ACCELERATES AND GOES INTO
WHAT'S CALLED BLAST CRISIS.
AND FOR THE LAST 30 YEARS,
PEOPLE HAVE BEEN SAYING,
ARE THERE THINGS WE CAN
DO AT THIS STAGE THAT
STOP
THAT
HAPPENING?
CAN WE DO SOMETHING HERE, EVEN
IF IT'S NASTY, AND STOP,
YOU KNOW, LIKE BONE MARROW
TRANSPLANT, AND STOP
THAT HAPPENING.
AND THAT'S BEEN THE FOCUS.
AND ACTUALLY, THAT'S BEEN
MODERATELY SUCCESSFUL.
AND THERE ARE QUITE A FEW
AGENTS ALSO, SOME BIOLOGICAL
AGENTS, THAT WORK IN
CERTAIN KINDS OF LEUKEMIA.
LEUKEMIA, AS YOU GATHER,
IS NOT MY SUBJECT.
NUMBER ONE, I'M NOT UP TO
THE LATEST ADVANCES, AND
UNFORTUNATELY, I MISSED OUT
ON THE INFORMATION ON THIS
PARTICULAR DRUG AT ALL.
SORRY.

Maureen says LEUKEMIA IS ONE WE ASSOCIATE
WITH CHILDHOOD CANCER.

Rob says THERE ARE FOUR KINDS.
THERE'S CHILDHOOD LEUKEMIA IS
ACUTE LYMPHOBLASTIC LEUKEMIA
OF CHILDHOOD.
AND THAT IS A VERY,
VERY DIFFERENT DISEASE.
HIGHLY CURABLE.
YOU CAN PUT IT INTO REMISSION,
THAT MEANS, TEMPORARILY
SWITCH IT OFF, AS IT WERE,
IN LIKE 95 PERCENT OF CASES.
AND IT WOULD BE CURED IN THE
RANGE OF 50-60 PERCENT OF CASES.
THAT'S NOT BRILLIANT,
BUT IT'S PRETTY GOOD.
THAT'S ACUTE LYMPHOBLASTIC
LEUKEMIA OF CHILDHOOD.
THEN THERE'S ACUTE
MYELOID LEUKEMIA.
AS SOMEBODY ONCE SAID, IT'S
THE LOVE STORY LEUKEMIA,
YOU GET IT IN SORT OF EARLY
ADULTHOOD, TWENTIES, AND IT CAN
BE OBVIOUSLY LATER, AND ALSO,
ADVANCES IN THAT PARTICULAR
BONE MARROW TRANSPLANT CHANGED
THE OUTCOME OF THAT, AND THE
CURE RATE IS GETTING UP THERE.
IT VARIES DEPENDING ON
WHAT YOU ARE LOOKING AT.
BUT IF YOU HAPPEN TO HAVE A
RELATIVE WHO CAN GIVE YOU
BONE MARROW, IF THAT HAPPENS,
THEN THE CURE RATE IS
CERTAINLY IN THE RANGE
OF 40-50 PERCENT.
THOSE ARE THE ACUTE LEUKEMIAS,
LYMPHOBLASTIC, CHILDHOOD AND
MYELOID, ARE ONES IN WHICH
WHAT ARE CALLED BLAST CELLS,
WHICH ARE VERY, VERY IMMATURE
CELLS ARE RELEASED INTO THE
BLOOD, WHICH IS A SIGN OF HOW
FAST THE CANCER IS GROWING
IN THE BONE MARROW.
THE CHRONIC LEUKEMIAS, AND
THERE ARE TWO KINDS, CHRONIC
MYELOID, WHICH IS GENERALLY
SPEAKING OF AN OLDER AGE
GROUP, THE KIND YOU MENTIONED,
CML, AND CHRONIC LYMPHOBLASTIC
OR LYMPHOCYTIC LEUKEMIA,
WHICH IS REALLY SIMILAR TO A
SORT OF RATHER MATUREISH KIND
OF LYMPHOMA, AND AGAIN, CAN
BE SORT OF TEASED INTO
STAYING STABLE FOR QUITE
A LONG TIME.
THOSE ARE THE CHRONIC KINDS.
SO THERE ARE THE FOUR KINDS,
AND CML IS THE KIND IN WHICH
YOU ARE LIKELY THIS ORGAN HERE
IN YOUR BODY, THE SPLEEN, ON
YOUR LEFT SIDE,
IS LIKELY TO GROW.

Maureen says I SEE.
WELL, FOR IT NOT BEING YOUR
AREA, YOU SURE KNEW A LOT.

Rob says I KNOW A LOT FOR SOMEBODY
WHO DOESN'T KNOW MUCH, YES.

Maureen says MARGARET, THANK YOU VERY
MUCH FOR THE QUESTION.
CINDY IS IN UXBRIDGE.
HELLO, CINDY.

The Caller says HELLO.
HOW ARE YOU?

Maureen says FINE, THANKS.

The Caller says I HAVE A QUESTION
FOR THE DOCTOR.
I'VE HEARD ABOUT HOW BIRTH
CONTROL PILLS CAN CAUSE CANCER.
AND I HAVE SOME ENLARGED
VEINS IN MY LEG.
DO I HAVE TO CONSIDER ABOUT
THE EFFECT OF BIRTH CONTROL ON
MY BLOOD CLOT IN MY LEG?

Rob says ABSOLUTELY NOT.
ABSOLUTELY NOT.
THE DIRECT ANSWER TO YOUR
QUESTION IS ABSOLUTELY NOT.
BIRTH CONTROL PILLS,
PARTICULARLY WHEN THEY'VE GOT
THE HIGHER AMOUNTS OF ESTROGEN
IN IT, CAN INCREASE YOUR
BLOOD'S ABILITY TO CLOT.
AND IN THE OLD, OLD DAYS,
PROBABLY BEFORE YOU WERE BORN,
BUT WHEN I WAS A MEDICAL
STUDENT, THE BIRTH CONTROL
PILLS HAD LOTS OF ESTROGEN IN
IT, AND CLOTS IN THE VEINS IN
THE LEG WERE QUITE, NOT
QUITE COMMON, BUT COMMONISH.
ENLARGED VEINS ON THE OUTSIDE
OF YOUR LEGS, VARICOSE VEINS,
ARE NOT ACTUALLY A RISK
FACTOR FOR DEEP CLOTS.
THE CLOTS THAT WE WORRY ABOUT
ARE NOT THE ONES IN THE
SUPERFICIAL VEINS.
EVEN IF THAT HAPPENS,
THAT'S NOT A PROBLEM.
IT'S THE CLOT IN THE BIG VEIN
THAT RUNS DOWN THE MIDDLE OF
YOUR CALF.
AND IT IS CERTAINLY TRUE THAT
BIRTH CONTROL PILLS, EVEN AT
THE LOWER DOSES, DO INCREASE
YOUR CHANCE OF GETTING A CLOT.
SO IF YOUR CALF SWELLS, OR THE
CALF SUDDENLY BECOMES HOT,
PAINFUL AND TENDER, DO GO
TO A DOCTOR OR AN EMERGENCY
DEPARTMENT AND GET
SOMEBODY TO LOOK AT IT.
SO NUMBER ONE, THE ANSWER IS
YES BIRTH CONTROLS INCREASE
THE CHANCE OF CLOTTING.
NUMBER TWO, YOUR ENLARGED
VEINS ARE NOT A PROBLEM.
NUMBER THREE, CANCER,
COMPLETELY SEPARATE.
BREAST CANCER
RISK, FIRST OF ALL.
WE KNOW FOR A FACT IF YOU TAKE
THE BIRTH CONTROL PILL FOR
FIVE YEARS, THERE IS NO
INCREASED RISK OF BREAST CANCER.
THERE IS A SUGGESTION, AND THE
DATA ARE NOT VERY HARD YET,
THAT THERE IS A SLIGHTLY
INCREASED RISK BEYOND
TEN YEARS OF TAKING
BIRTH CONTROL PILLS.
AND IT'S A STANDARD PIECE
OF ADVICE THAT WHILE WE'RE
WORKING OUT THE DATA,
PROBABLY, IF YOU ARE TAKING
THE BIRTH CONTROL PILL, YOU
SHOULD STOP AFTER TEN YEARS
AND THINK OF ANOTHER
METHOD OF CONTRACEPTION.
SO THAT'S NUMBER ONE.
VERY SLIGHT, IF ANY,
INCREASE IN BREAST CANCER.
OVARIAN CANCER,
DECREASED RISK.
THIS IS PRETTY
HARD DATA NOW.
IT SEEMS IF YOU TAKE THE BIRTH
CONTROL PILL FOR SEVERAL
YEARS, YOUR CHANCE OF OVARIAN
CANCER, CANCER OF THE OVARY,
ACTUALLY GOES DOWN.
AND IN SOME RESPECTS, THAT
MAY BE EVEN MORE IMPORTANT.
BECAUSE OVARIAN CANCER IS
ACTUALLY QUITE A DIFFICULT
DISEASE TO DETECT AT AN
EARLY STAGE, YOU SEE?
BECAUSE IT'S INSIDE THE
PELVIS, IT CAN BEGIN TO COOK
LONG BEFORE YOU
NOTICE ANYTHING.
SO IN SOME RESPECTS, BREAST
CANCER IS EASIER TO DETECT
AT AN EARLY STAGE.
YOU HAVE A MAMMOGRAM, YOU
HAVE A CLINICAL EXAMINATION
EVERY YEAR.
SO OF THE TWO, ONE IS LESS
WORRIED ABOUT BREAST CANCER
THAN ONE IS ABOUT
OVARIAN CANCER.
BUT THIS IMPORTANT POINT
THAT THE BIRTH CONTROL PILL
DECREASES YOUR CHANCE OF
OVARIAN CANCER IS NOT GETTING
ENOUGH PUBLICITY.
WE'VE KNOWN IT FOR
SEVERAL YEARS NOW.

Maureen says WHAT ABOUT FERTILITY DRUGS,
AND THEIR RISK OF -- IS IT
OVARIAN CANCER?

Rob says I'M HONESTLY NOT
UP TO DATE ON THAT.
OBVIOUSLY, FERTILITY DRUGS
DO CHANGE THE PATTERNS
OF OVULATION.
AND I PROBABLY SHOULD KNOW
THE ANSWER TO YOUR QUESTION,
BUT I ACTUALLY DON'T.
SORRY ABOUT THAT.
I'M NOT DOING AT ALL
WELL TODAY, AM I?

Maureen says NO, YOU'RE DOING FINE.
CINDY, THANK YOU
FOR YOUR QUESTION.
AND SUZANNE IS IN OSHAWA.
HI, SUZANNE.

The Caller says HI.

Maureen says HI.


D says ABOUT A YEAR AGO, I HEARD THE
DOCTOR SPEAK ON
CITYLINE
HEALTH AND WELLNESS WEDNESDAY.
AND HE SAID FREQUENTLY PEOPLE
WITH FIBROMYALGIA ACTUALLY
HAVE A FORM OF CANCER.
AND I'VE BEEN RECENTLY
DIAGNOSED WITH FIBROMYALGIA.
AND MY UNDERSTAND WAS THAT
FREQUENTLY PEOPLE WHO HAVE
BEEN DIAGNOSED WITH
FIBROMYALGIA ARE
ACTUALLY MISDIAGNOSED.
SO I'D LIKE TO KNOW ABOUT
THE CONNECTION BETWEEN
FIBROMYALGIA AND CANCER.

Rob says SUZANNE, I'M REALLY WORRIED --
I'M SURE I DIDN'T SAY THAT.
I'M ABSOLUTELY SURE
I DIDN'T SAY THAT.

Maureen says THERE'S NO CONNECTION.

Rob says WHAT WE MAY HAVE BEEN TALKING
ABOUT THAT MAY HAVE CONFUSED
YOU, WE WERE TALKING ABOUT
FIBRO CYSTIC DISEASE OF
THE BREAST.
I CERTAINLY TALKED ABOUT THAT.
AND THERE ARE CERTAIN KINDS
OF ABNORMALITIES SEEN ON A
BIOPSY FOR CYSTS IN THE
BREAST WHICH ARE A RISK
FACTOR FOR BREAST CANCER.
THAT'S ATYPICAL DUCT
HYPOPLASIA, IF IT'S SEEN
AS A BIOPSY.
NOW, YOU MAY HAVE HEARD THE
WORD FIBRO AND MADE THAT LINK.
LET ME REASSURE YOU TOTALLY.
FIBROMYALGIA IS A WORD USED,
BASICALLY, IT'S A WORD USED
FOR WHAT WE USED TO CALL
SOFT TISSUE RHEUMATISM.
IT JUST BASICALLY
MEANS MUSCLE ACHE.
AND IT MEANS YOUR
MUSCLES ACHE.
USUALLY, THERE'S
NOTHING ELSE THAN THAT.
SOMETIMES YOU FEEL A
BIT TIRED AND SO ON.
IT IS, AS IT WERE, A
RAG BAG OF DIAGNOSES.
THE VAST NUMBER OF PEOPLE
HAVE NO, THANK GOODNESS,
NO SERIOUS DISEASE THAT
WE ARE ABLE TO DETECT.
LET ME SAY THIS VERY, VERY
CLEARLY, FOR THE VAST MAJORITY
OF PEOPLE WITH FIBROMYALGIA,
THE VAST, VAST NUMBER OF
PEOPLE WHO HAVE GOT ACHY
MUSCLES AROUND THEIR NECK, AND
IN THEIR THIGHS AND SHOULDERS,
LIKE THAT, ARE NEVER GOING TO
HAVE ANY SERIOUS CONDITION
ASSOCIATED WITH THAT WHATSOEVER.
SOME PEOPLE EVEN SAY A LOT
OF PEOPLE WITH FIBROMYALGIA
DON'T HAVE A SPECIFIC
DISEASE, BUT WHEN THINGS ARE
GOING WRONG WITH THEM, AND
THEY'RE UNDER GREAT STRESS,
AND THEY ARE EXHAUSTED AND
OVERPRESSED, THEY NOTICE THE
NORMAL ACHE OF MUSCLE.
YOU MUST KNOW, IF YOU HAVE A
TERRIBLE DAY AT THE OFFICE,
AND YOU'RE TENSE LIKE THAT,
WHEN YOU GET HOME, OH, OH,
LIKE THAT.
WELL, SOME PEOPLE SAY THAT
FIBROMYALGIA IS RELATED TO THAT.
AND THAT SORT OF THRESHOLD BY
WHICH YOU GO, THE THRESHOLD
BY WHICH YOU NOTICE MUSCLE
PAIN, GOES DOWN IN SOME
PEOPLE WITH FIBROMYALGIA.
BUT LET ME MAKE IT CLEAR,
FIBROMYALGIA, CANCER,
NO RELATION WHATSOEVER.
I'M SURE I NEVER
SAID THAT, SUZANNE.

Maureen says OKAY, GOOD.
YOU WERE TALKING ABOUT
DETECTING LUMPS AND WHATNOT.
WE'VE BEEN TALKING OFF THE TOP
ABOUT TREATMENTS ONCE CANCER
IS DETECTED.
BUT WHAT ABOUT IN THE AREA OF
DETECTION IN THE FIRST PLACE?
HOW ARE WE MOVING ALONG THERE?

Rob says ACTUALLY, A LOT OF IT
IS, AS IT WERE, LOGISTICS.
FOR EXAMPLE, THERE IS
A CANCER TEST THAT IS
INCREDIBLY SENSITIVE.
THE MOST SENSITIVE
CANCER TEST AVAILABLE.
IT'S CALLED THE PAP SMEAR.
IT'S NOT AMAZING.
YOU DON'T HAVE TO GO TO
WISCONSIN AND GET A GUY
TO DO A BLOOD TEST.
IT'S THE PAP TEST.
IF EVERY SINGLE WOMAN WHO HAD
EVER BEEN SEXUALLY ACTIVE HAD
A PAP TEST AS WE WOULD LIKE
THEM TO HAVE THEM, YOU KNOW,
PROBABLY EVERY THREE YEARS,
AND THEN IF YOU KEEP ON HAVING
NORMAL ONES, BY THE TIME YOU
GET TO 70, YOU CAN STOP HAVING
THEM THAT REGULARLY, MAYBE
EVERY FIVE YEARS OR SOMETHING
LIKE THAT, MAYBE LESS.
IF EVERY SINGLE WOMAN WHO HAD
EVER BEEN SEXUALLY ACTIVE HAD
A PAP TEST, THEN INVASIVE
CANCER OF THE CERVIX WOULD
PROBABLY DISAPPEAR.
I THINK IT'S ABOUT 3,000 CASES
IN WHICH CANCER DEVELOPS IN THE
CERVIX AND ACTUALLY INVADES.
WELL, IT CAN BE DETECTED BY THE
PAP TEST BEFORE IT INVADES.
AND IF WE REALLY GOT THAT
DONE, THEN BASICALLY, INVASIVE
CANCER OF THE CERVIX
WOULD DISAPPEAR.
THE PROBLEM IS THAT NOT ALL OF
THE PEOPLE WHO ARE AT HIGHEST
RISK, WHICH ARE GENERALLY
SPEAKING, THE PEOPLE WHO HAVE
THE LARGEST NUMBER OF SEXUAL
PARTNERS, AND BY, AS IT WERE,
RELATIONSHIP, IF YOU PICK A
WORD CAREFULLY, THAT HAPPENS
IN OFTEN LOWER SOCIO ECONOMIC
GROUPS, AND OFTEN IN
GEOGRAPHICALLY DISTANCE A
LONG WAY TO THE NEAREST TOWN
GROUPS, IF WE DID MANAGE
TO GET PAP TESTS DONE ON
EVERYBODY THAT NEEDED THEM AT
THE RIGHT TIME, THEN WE WOULD
HAVE AT LEAST 3,000 CASES
LESS OF CANCER OF THE CERVIX.
AND MANY HUNDREDS OF DEATHS
WOULD ACTUALLY BE PREVENTED.

Maureen says SO THAT'S A VERY GOOD
TEST FOR DETECTING CANCER.
WHAT ABOUT FOR
PROSTATE CANCER?
THERE'S BEEN SOME NEWS RECENTLY
ABOUT IMPROVING THE PSA.
THERE'S A LOT OF
FALSE POSITIVES.

Rob says THAT'S A PROBLEM.
THERE ARE TWO
PROBLEMS WITH THAT.
FIRSTLY, THE PSA, THE PROSTATE
SPECIFIC ANTIGEN IS A PROTEIN
MANUFACTURED BY
PROSTATE CELLS.
THEY SIT THERE MAKING IT.
IT ONLY, AS IT WERE, BECOMES
DETECTABLE IN THE BLOODSTREAM
IF THERE IS A BREAK IN THE
WRAPPING OF THE PROSTATE GLAND.
THE STUFF IS BEING MADE IN
HERE, POP THROUGH, GET INTO
THE BLOODSTREAM.
THAT HAPPENS IN CANCER OF THE
PROSTATE WHERE THE CANCER
CELLS, AS IT WERE, BREAK OPEN
THE CAPSULE, AND ALSO IN A
VARIETY OF OTHER CONDITIONS,
INCLUDING BENIGN INFLAMMATION
OF THE PROSTATE.
BENIGN PROSTATITIS.
SO FORTUNATELY OR
UNFORTUNATELY, BUT
UNFORTUNATELY, THE VAST
NUMBER OF PEOPLE WHO HAVE AN
ABNORMAL PSA FORTUNATELY DON'T
HAVE CANCER OF THE PROSTATE.
BUT WHEN YOU'RE WAITING
FOR A TEST, THEY'RE SCARED.
THEY'RE VERY, VERY SCARED.
WHAT PEOPLE HAVE BEEN DOING
PARTICULARLY OVER THE LAST TEN
YEARS OR SO IS TRYING TO
IMPROVE WHAT YOU ACTUALLY
MEASURE SO THAT YOU ONLY
MEASURE, AS IT WERE, THE PART
OF THE MOLECULE THAT IS MOST
LIKELY TO BE RELEASED WHEN
THERE IS CANCER
OF THE PROSTATE.
AND AGAIN, EARLY DATA
ARE KIND OF ENCOURAGING.
THE FIRST PROBLEM THEN IS GOOD
DETECTION, AND GET RID OF THE
FALSE POSITIVES IF YOU CAN.
THE SECOND POINT IS FOR EVERY
MAN, LET'S SAY IN HIS LATE
SIXTIES OR EARLY SEVENTIES,
WHO DEVELOPS CANCER OF THE
PROSTATE, IT'S A
VERY COMMON CANCER.
AND IN QUITE A LARGE NUMBER OF
THOSE CANCERS, IT ISN'T GOING
TO DO ANYTHING.
AND THEY ARE GOING TO DIE AT
THEIR NORMAL EXPECTED AGE,
FOR A MALE IN CANADA IS
78, I THINK, AT THE MOMENT.
THEY'RE GOING TO DIE OF
SOMETHING ELSE ENTIRELY.
AND THIS IS THE
REAL DIFFICULTY.
HOW CAN YOU DIAGNOSE THE
PROSTATE CANCER CASES THAT YOU
DO NEED TO DO SOMETHING
ABOUT, YOU NEED TO TAKE THE
OPERATION, TAKE THE PROSTATE
OUT PROBABLY WITH A RISK OF
SEXUAL IMPOTENCE.
HOW DO YOU DISTINGUISH THEM
FROM THE PROSTATE CANCERS
THAT ARE NEVER GOING
TO CREATE ANY PROBLEM?
NOW, THE AMERICAN ASSOCIATION
OF UROLOGISTS, AND CANADIAN,
HAVE SPENT A CONSIDERABLE
AMOUNT OF THINKING POWER
ON THIS, AND HAVE DRAWN
UP A SET OF GUIDELINES.
AND I WOULD SAY TO ANYBODY, IF
YOU'RE DOCTOR, YOUR UROLOGIST
says, HEY, YOU'VE GOT TO KIND
OF CANCER OF THE PROSTATE
THAT I'M NOT GOING TO WORRY
ABOUT, I'M GOING TO SEE YOU
AGAIN IN THREE MONTHS, OR IN
SIX MONTHS OR SOMETHING LIKE
THAT, AND IF IT HASN'T
CHANGED IN ANY WAY, WE'RE NOT
GOING TO WORRY ABOUT YOUR
PARTICULAR CANCER OF THE
PROSTATE, DON'T BE ALARMED.
YOUR DOCTOR MIGHT BE RIGHT.

Maureen says KNOWS WHAT HE'S DOING.

Rob says HE'S NOT FLANNELLING.

Maureen says THAT'S WHERE THAT IS.

Rob says THAT'S WHERE THE MONEY
IS GOING IN THE FUTURE.

Maureen says INTERESTING.
OKAY, MARIA IS NEXT.
SHE'S IN AJAX.
HI, MARIA.

Rob says HI, MARIA.

The Caller says HI.
I'M VERY WORRIED BECAUSE
BOTH MY GRANDMOTHERS HAD
BREAST CANCER, AND I WAS JUST
WONDERING WHAT MY ODDS ARE
OF GETTING IT MYSELF?

Rob says OKAY.
BRILLIANT QUESTION,
MARIA, THANK YOU.
I SPEAK TO EVERYONE IN AJAX,
I SPEAK TO EVERYONE AROUND THIS.
FIRST OF ALL, THERE IS AN
INCREASED FAMILY RISK IN
BREAST CANCER.
NUMBER TWO, THAT RISK HAS BEEN
OVERBLOWN A LITTLE BIT IN
THE PUBLIC'S EYE.
REALLY, YOUR RISK BEGINS TO
MOUNT WHEN YOU HAVE MORE THAN
ONE FIRST-DEGREE RELATIVE.
NOW, FIRST-DEGREE RELATIVE,
MARIA, IS YOUR MOTHER, YOUR
SISTER, OR YOUR DAUGHTER,
NOT YOUR GRANDMOTHER, OKAY?
SO TWO-SECOND DEGREE RELATIVES
DOESN'T REALLY -- ISN'T
REALLY A RISK FACTOR.
BREAST CANCER IS A
VERY COMMON CANCER.
I MEAN, THE RISK IS PROBABLY
IN THE RANGE OF 1 TO 11,
DEPENDS ON EXACTLY HOW
YOU ADD UP THE STATISTICS,
BUT IT'S AROUND THAT THING.
SOME PEOPLE SAY IF YOU LIVE
TO BE 90, THE TOTAL RISK IS
AROUND 1 TO 9 OR SO.
BUT IT'S IN THAT
KIND OF RANGE.
SO TWO GRANDPARENTS WITH
BREAST CANCER, AS YOU SAID,
MARIA, MIGHT WELL BE
JUST HAPPENSTANCE.
YOU'VE GOT PROBABLY QUITE A LOT
MORE THAN 10 SECOND-DEGREE
RELATIVES WHEN YOU
START TO ADD IT UP.
SO TWO OF THEM HAVING BREAST
CANCER IS PROBABLY NOT
A BIG DEAL.
SECONDLY, EVEN IF THERE WERE
A GENETIC LINK, THE GENETIC
LINKS ONLY ACCOUNT FOR ABOUT
ONE-TENTH OF ALL CASES OF
BREAST CANCER.
SO IF YOU TAKE A HUNDRED
PEOPLE WHO HAVE HAD BREAST
CANCER, ONLY ABOUT TEN OF
THOSE HUNDRED WOULD HAVE
THE GENETIC LINK ANYWAY.
IT'S NOT ONE OF THOSE THINGS
WHERE, YOU KNOW, ALL CASES
OF BREAST CANCER ARE
GENETICALLY LINKED.
IT'S ONLY AROUND 10 PERCENT.
NOW, AT THE PRESENT, I THINK
I'M CORRECT, MARIA, IF YOU
WENT TO THE WELL WOMAN CLINIC
ANYWHERE IN ONTARIO, THEY
WOULD SAY THAT RISK IS NOT
HIGH ENOUGH TO WARRANT
A BLOOD TEST.
WHICH OF COURSE SHOULD COME
AS A GREAT RELIEF TO YOU.
SO YOU STARTED YOUR QUESTION,
MARIA, BY SAYING YOU'RE
REALLY WORRIED.
I'LL SORT OF COMPLETE MY
ANSWER SAYING, PLEASE DON'T BE
REALLY WORRIED.
DON'T BE REALLY WORRIED.
IF YOUR MOTHER HAD HAD BREAST
CANCER AT AN EARLY AGE, AND
PARTICULARLY IF YOUR MOTHER
HAD HAD BILATERAL, WHICH MEANS
BOTH BREASTS, DIAGNOSED AT
EARLY AGE, THEN ONE'S CONCERN
BEGINS TO MOUNT.
AND IN THOSE CIRCUMSTANCES, WELL
WOMAN CLINIC MIGHT WELL SAY
THIS IS WORTH
HAVING A BLOOD TEST.
BUT AT THE PRESENT, THE
CURRENT RECOMMENDATIONS
WOULD SAY TWO SECOND-DEGREE
RELATIVES, GRANDMOTHERS,
PLEASE DON'T WORRY.
HAVE I MADE YOU
FEEL ANY BETTER?

Maureen says I HOPE SO.
THANKS, MARIA.
THANK YOU.
BACK TO DETECTION.
BASU SAYS, I WONDER HOW MANY
CANCERS GO UNDIAGNOSED,
OR ARE DIAGNOSED TOO LATE.
RECENT FINDINGS ON THE
POSSIBILITIES OF URINE ANALYSIS
FOR CANCER AND CALCIUM
DEPOSITS DETECTED FROM DENTAL
X-RAYS AS SCREENING
TOOLS ARE ENCOURAGING.
COULD YOU ENLIGHTEN US ON
THESE AND OTHER POTENTIAL
SCREENING TOOLS?

Rob says YES, I CAN.
THIS IS REAL SHARK
INFESTED WATER.
BECAUSE, IN ORDER -- I'M NOT
BEING NEGATIVE OR FACETIOUS
HERE, I'M REALLY NOT.
BUT IN ORDER TO BE A GOOD
SCREENING TEST, A TEST HAS GOT
TO HAVE INCREDIBLY
HIGH SENSITIVITY.
IT CAN'T MISS CANCERS.
YOU CAN'T USE A SCREENING TEST
ON THE ENTIRE POPULATION IF
YOU'RE GOING TO MISS HALF OF
THE CANCERS, OR THE CANCERS OF
THE X OR Y OR WHATEVER IT
IS YOU ARE LOOKING FOR
IN THAT POPULATION.
IT'S GOT TO BE REALLY,
REALLY SENSITIVE.
YOU'VE GOT TO PICK UP THE
VAST MAJORITY OF THE CANCERS.
SECONDLY, THE FALSE POSITIVE
RATE, IN OTHER WORDS WHAT'S
CALLED THE SPECIFICITY, HAS
GOT TO BE VERY, VERY HIGH.
IT'S NO GOOD ME SAYING, I'LL
DO A TEST ON MAUREEN AND ROB,
LET'S SAY, FOR CANCER
OF THE BLADDER.
AND WE'VE GOT --
THIS IS A BAD EXAMPLE.
CANCER OF THE SHOULDER JOINT,
THERE ISN'T SUCH A THING.

Maureen says OKAY, BUT SAY THERE WAS.

Rob says SAY THERE WAS.
AND, YOU KNOW, IN ORDER TO
FIND OUT WHETHER YOU'VE GOT IT
AFTER YOU'VE HAD THE TEST,
WE'D HAVE TO DO AN INCREDIBLY
COMPLEX OPERATION THAT COULD
LEAVE YOU WITH A USELESS ARM
THAT DOESN'T WORK VERY WELL.
WELL, SUPPOSE THAT TEST HAD
A 50 PERCENT SPECIFICITY.
AND YOU FOUND 10 CASES
IN YOUR POPULATION.
IT MEANS FIVE OF THOSE
OPERATIONS WERE FOR NOTHING.
SO THE CRITERIA BY WHICH
YOU, AS IT WERE, LOOK AT AND
EXAMINE, EVALUATE, THAT'S
THE WORD I'M LOOKING FOR,
A SCREENING TEST, IS
INCREDIBLY TOUGH.
AND THE PAP TEST
IS JUST SUCH A ONE.
IT'S SO GOOD.
THE WAY THEY STAIN THE CELLS
AND LOOK AT THEM, THAT THEIR
ABILITY TO SAY THIS IS A
PRECANCEROUS CHANGE IN THIS
PARTICULAR PATIENT, THIS IS
NOTHING, THIS IS A VIRUS,
DON'T WORRY ABOUT IT, BUT THIS
WOMAN, GET HER TO COME AND
HAVE ANOTHER PAP TEST IN THREE
MONTHS OR IN SIX MONTHS, OR
WHATEVER IT IS, THE
PAP TEST IS BRILLIANT.
EARLY URINE CYTOLOGY, URINE
CHEMICALS, THERE WERE MANY,
MANY CHEMICALS THAT WERE
MEASURED IN THE URINE,
A WHOLE BUNCH OF CHEMICALS I WAS
INVOLVED IN MEASURING AS PART OF
A PROJECT RUN BY A BOSS OF MINE
25 YEARS AGO CALLED SPERMIDINE,
SPERMIDINE AND PUTRESCINE.
THAT WASN'T THE NAME OF THE
BOSS, THAT WAS THE NAME OF
THE TEST THEY WERE
DOING IN THE URINE.
BUT URINE CYTOLOGY, URINE
PROTEINS, VARIETY OF AGENTS,
THESE ARE INTERESTING AND
IMPORTANT, BUT WE HAVE TO BE
VERY, VERY CIRCUMSPECT BEFORE
WE SAY THIS IS THE SCREENING
TEST THAT'S REALLY
GOING TO COUNT.
AND THE SAME IS TRUE OF
CHEMICAL DEPOSITS IN HAIR, IN
TEETH, ACTUALLY, IN BONE, TOO.
ALL OF THESE ARE VERY, IF YOU
PARDON THE USE OF THE WORD,
GROSS TESTS OF BODY FUNCTION.
AND WE HAVE TO BE VERY,
VERY CIRCUMSPECT.
EVEN SOMETHING RELATIVELY
SIMPLE LIKE LOOKING FOR BLOOD
IN THE STOOL, IN THE FECES AS
A TEST FOR EARLY BOWEL CANCER.
THAT WOULD SEEM
BLINDINGLY OBVIOUS.
BUT OF COURSE, HEMORRHOIDS
PUT BLOOD IN YOUR STOOL.
IF YOU HAVE BLEEDING GUMS FROM
GUM DISEASE, THAT PUTS BLOOD
IN YOUR STOOL.
IF YOU EAT RAW STEAK, THAT
PUTS BLOOD IN YOUR STOOL.
SO 20 YEARS AGO, WE THOUGHT,
HEY, FIND THE BLOOD IN THE
STOOL, WE'LL PICK
UP BOWEL CANCER.
20 YEARS LATER, WE'RE STILL
SAYING, WE'RE IMPROVING THE
TEST, WE'RE GETTING BETTER AND
BETTER, BUT IT'S STILL NOT AT
THE LEVEL YET, BUT IT'S CLOSE,
PROBABLY, WHERE WE CAN GO
EVERYONE SHOULD HAVE THIS.

Maureen says THAT STILL SOUNDS, I SUPPOSE,
LIKE WORTHY RESEARCH.
NOW, YOU JUST
MENTIONED RAW MEAT.
AND YOU WERE I WERE TALKING
BEFORE THE SHOW, ONCE AGAIN,
BARBECUING MEAT HAS TURNED
OUT TO BE A CARCINOGEN,
OR SOMETHING.
I IMAGINE IT'S NOT A HUGE
RISK, THOUGH, FOR BREAST
CANCER, COMPARED
TO OTHER RISKS.
AND IS THIS REALLY WHERE WE
OUGHT TO BE SPENDING OUR
MONEY, IF IT'S ONLY GOING
TO, YOU KNOW... IF THE CAUSAL
RELATIONSHIP IS NEVER GOING
TO BE REALLY DEFINITE?

Rob says OH, DEAR OH, DEAR.
YES, WHERE OUGHT WE TO
BE SPENDING OUR MONEY?
LET'S ANSWER ALL THOSE
QUESTIONS IN TURN, MAUREEN.
FIRSTLY, BASICALLY EVERYTHING
YOU SAID IS QUITE CORRECT.
WE DON'T KNOW UNTIL
DUPLICATING STUDIES ARE DONE
ON THE BARBECUE MEAT STORY.
I'M NOT CASTING ANY
ASPERSIONS ON THAT RESEARCH.
IT MIGHT BE THAT IN THIS
PARTICULAR CITY OR GROUP OF
PEOPLE AT THIS PARTICULAR
TIME, THE BARBECUE MEAT CAME
UP AS -- RIGHT,
VERY IMPORTANT.
BUT WE DON'T KNOW.
FOR EXAMPLE, YOU MIGHT HAVE
ONLY THREE OR FOUR FAMILIES,
LET'S SAY, IN WHOM BREAST
CANCER HAPPENS TO HAVE
A HIGH INCIDENCE.
AND THOSE FAMILIES MIGHT,
FOR NO PARTICULAR REASON,
BE MAJOR BARBECUE FANS.
NOW UNTIL YOU WHAT'S CALLED
STRATIFY OR CORRECT FOR
THE PRESENCE OF KNOWN RISK
FACTORS LIKE FAMILIES,
THAT WOULDN'T HELP.
I MEAN, FOR EXAMPLE, IF YOU
WERE DOING BARBECUE MEAT
AND LUNG CANCER, LET'S SAY.
YOU MIGHT HAVE SOMETHING.
OH, THERE WE GO.
THEN YOU WOULD NEED TO GO
BACK, JUST GIVING YOU AN
EXAMPLE, YOU'D NEED TO SAY, OF
THE PEOPLE WHO BARBECUE, ARE
THERE MORE SMOKERS AMONG THE
BARBECUERS THAN THERE ARE
AMONG THE NON-BARBECUERS.
AND IF IT'S LOTS MORE, PEOPLE
WHO LIKE TO SMOKE A CIGARETTE
OUTSIDE THE HOUSE AND LIKE TO
LIGHT A BARBECUE AT THE TIME,
SO SMOKING AND BARBECUING
TEND TO GO TOGETHER, I'M NOT
SAYING THEY DO, I'M JUST
SAYING IF THEY DO, THEN
OBVIOUSLY, YOUR DATA WOULD
LOOK LIKE BARBECUING MEAT
CAUSES LUNG CANCER,
BUT IT DOESN'T.
THIS IS THE IMPORTANT POINT.
YOU CAN'T MAKE ANYTHING
OF EARLY WHAT'S CALLED
EPIDEMIOLOGIC DATA
LINKING THE THINGS.
AND I DON'T KNOW HOW THESE
STUDIES WERE FUNDED, BUT THEY
MIGHT HAVE BEEN LOOKING AT A
WHOLE BUNCH OF THINGS WHICH
ARE REALLY WORTHY, AND
BARBECUE MEAT HAPPENED TO BE
SOMETHING THEY ASKED
AND IT CAME UP.

Maureen says OH, AND THE MEDIA WILL
PICK IT UP BECAUSE WE'RE
ALL CLEANING OFF
THE BARBECUE NOW.

Rob says RIGHT.
MY FAVOURITE ONE WAS MELANOMA,
WHICH CAME UP, THIS IS A STUDY
15-20 YEARS AGO, WHICH CAME UP
NEON LIGHTS IN THE KITCHEN.
I QUESTIONED THE PERSON IN
GREAT DETAIL ABOUT THAT.
HAVING A NEON LIGHT, YOU KNOW,
FLUORESCENT LIGHT IN THE
KITCHEN SEEMED TO BE A
RISK FACTOR FOR MELANOMA.
IT'S NEVER BEEN
SUBSTANTIATED SINCE.
BUT THE DATA --

Maureen says AND YOU DON'T WANT THAT TO
OVERSHADOW THE REAL MESSAGE,
WHICH IS STAY OUT OF THE SUN
AND DON'T GET SUNBURNED.

Rob says THIS WAS IN ENGLAND, WHERE
SUNBURN WASN'T SO MUCH
OF A PROBLEM.
BUT EVEN SO, SUN PROTECTION
IS, YOU'RE RIGHT.
ABSOLUTELY RIGHT.

Maureen says LET ME JUST MENTION THE
NUMBERS AND MY GUEST
ONE MORE TIME IS, OF COURSE,
Dr. ROBERT BUCKMAN.
HE IS THE AUTHOR OF HIS
AUTOBIOGRAPHY,
NOT DEAD YET,
AND WE HAVE COPIES
TO GIVE AWAY.
WE ALSO HAVE SOME
COMPLEMENTARY PASSES.
HE'S GIVING A TALK AT THE
ONTARIO SCIENCE CENTRE.
AND ALL THAT TO GIVE AWAY.
BUT YOU'VE GOT TO GET A QUESTION
TO AIR, THOUGH, TO QUALIFY.
AND e-mail YOUR QUESTION.

The phone numbers and email reappear briefly.

Maureen continues AND THE TOPIC, OF
COURSE, IS CANCER.
NELSON IS IN TORONTO.
HI, NELSON.

The Caller says HELLO.

Maureen says HI.

The Caller says HI.
I HAVE A QUESTION.
A FRIEND HAS BEEN RECENTLY
DIAGNOSED WITH INDOLENT
NON-HODGKINS LYMPHOMA.

Rob says YES, INDEED.

The Caller says AND I SUPPOSE YOU'LL GIVE
US A CAPSULE EXPLANATION.
AND ARE THERE TREATMENTS, WHAT
ARE THE SURVIVAL RATES, AND
NEW TREATMENTS OF
ANTI-ANGIOGENESIS AND LOW DOSE
CHEMO THAT THEY'VE BEEN
BALLYHOOING, HAVE THESE
ANY PROSPECT?

Rob says VERY IMPORTANT.
WITHOUT SOUNDING LIKE ONE OF
THOSE AWFUL AMERICAN AUTHORS
THAT KEEPS ON SAYING, READ MY
BOOK, THE SLOW GROWING, WHAT
ARE CALLED LOW GRADE, OR
INDOLENT LYMPHOMAS ARE
SOMETHING I DEAL WITH IN MY
BOOK,
WHAT YOU REALLY NEED
TO KNOW ABOUT CANCER.
AND I'M SORRY THERE'S A LITTLE
GLEAM IN MY EYE, IT'S NOT
I WANT TO SELL BOOKS.
THAT CHAPTER ABOUT THE
LYMPHOMAS WAS ONE OF THE MOST
DIFFICULT CHAPTERS TO
WRITE BECAUSE IT'S SUCH
A COMPLICATED AREA.
AND TO EXPLAIN THE LYMPHOMAS
TO PATIENTS IN A WAY THAT
DOESN'T EITHER PANIC THEM OR
CAUSE COMPLETE RELAXATION
OR OVERCONFIDENCE
WAS VERY DIFFICULT.
AND I SPENT A LOT OF
TIME ON THAT CHAPTER.
I'M VERY, VERY
PROUD OF IT, INDEED.
AND I TOOK IT AROUND TO A
LOT OF LYMPHOMA DOCTORS,
AND I REALLY, REALLY
FOCUSSED ON IT.
BUT LET'S TALK ABOUT IT.
LYMPHOMAS ARE CANCERS
OF THE LYMPH CELLS.
AND IT JUST HAPPENS THAT
HODGKIN’S DISEASE, WHICH IS
A SIMILAR KIND OF THING,
HAPPENS, BY COMPLETE
COINCIDENCE, TO LOOK DIFFERENT
UNDER THE MICROSCOPE, AND IT
HAPPENS TO RESPOND TO
DIFFERENT TREATMENTS, AND IT
JUST HAPPENS TO WORK
OUT RATHER DIFFERENTLY.
SO THERE'S THIS BUNCH OF
LYMPHOMAS, AND THIS THING
CALLED HODGKIN'S DISEASE.
BUT THEY ARE ALL CANCERS
OF THE LYMPH CELLS,
ROUGHLY SPEAKING.
THERE ARE THREE MAIN
GROUPS OF THE LYMPHOMAS.
THERE'S AGGRESSIVE ONES, OR
HIGH GRADE, WHICH CAN GO VERY
FAST, AND THEY CAN, AS IT
WERE, SPREAD QUICKLY THROUGH
THE SYSTEM, AND CAN, AND IF
UNTREATED, CAN GIVE YOU VERY
SERIOUS CONSEQUENCES AND
CAN KILL VERY QUICKLY,
IN A MATTER OF MONTHS, OR
SMALL NUMBER OF YEARS.
THE GOOD NEWS ABOUT THAT, THAT
SOUNDS LIKE TERRIBLE NEWS,
BUT THE GOOD NEWS IS THAT AT
LEAST HALF OF THOSE PATIENTS
ARE ACTUALLY CURABLE WITH
PRESENT CHEMOTHERAPY SYSTEMS,
INCLUDING HIGH DOSE
CHEMOTHERAPY AND BONE
MARROW TRANSPLANT.
AND THEN THERE'S A GROUP OF
WHAT ARE CALLED INTERMEDIATE
LYMPHOMAS THAT VARY.
SOME OF THEM TURN INTO HIGH
GRADE LYMPHOMAS LATER ON.
SOME DO BENEFIT FROM
MODERATELY AGGRESSIVE
TREATMENT, AND SO ON.
AND THEN THERE'S THE ONE, THE
GROUP THAT YOUR FRIEND HAS,
WHICH ARE NOT RARE.
I THINK OVER 50 PERCENT OF ALL
LYMPHOMAS ARE THE LOW GRADE
LYMPHOMAS, WHAT USED TO BE
CALLED WHEN I WAS A MEDICAL
STUDENT, FOLLICULAR LYMPHOMAS,
OR LOW GRADE LYMPHOMAS, AND
THEY'RE THE ONES THAT DEVELOP
VERY SLOWLY, AND THEY COME
AND GO, AND THEY COME AND
GO, AND THEY COME AND GO.
AND STUDIES HAVE SHOWN THAT
EVEN IN THE WORST, SORT OF THE
AVERAGE SCENARIOS, DOING THE
MINIMUM, THE AVERAGE SURVIVAL
IS IN THE RANGE OF SEVEN
TO TEN YEARS,
AVERAGE.
WITH A DISEASE THAT SORT OF
GOES LIKE THAT, AND TENDS TO
GROW SLOWLY, THAT MEANS THAT
50 PERCENT OF ANY GROUP OF
PATIENTS WILL BE ALIVE IN THE
RANGE OF SEVEN TO TEN YEARS,
AND OBVIOUSLY, THERE ARE MANY
WHO ARE ALIVE WAY BEYOND THAT.
PEOPLE HAVE ALWAYS WONDERED,
IF YOU TREAT THEM HARD EARLY,
WILL YOU STOP THE
DISEASE PROGRESSION?
SO FAR, THAT HAS NOT
PROVEN TO BE THE CASE.
THERE HAVE BEEN MANY STUDIES
OVER THE LAST 20 YEARS TRYING
TO TREAT LOW GRADE
LYMPHOMAS HARD EARLY.
AND SO FAR THOSE STUDIES, I
THINK I REFERENCE SOME OF THEM
IN THE BOOK, I'M TRYING TO
REMEMBER, HAVEN'T SHOWN
ANY BENEFIT.
NOW, AT THE MOMENT, THE
BIOLOGICS ARE NOT YET FULLY
EVALUATED IN THE LYMPHOMAS.
THEY ARE BEGINNING, AS I SAID,
TO SHOW PROMISE IN SOME OF
THE, AS IT WERE, NON-LYMPHOMA
TYPE CANCERS THERE ARE VERY
INTERESTING THINGS IN
THE BIOLOGICS LIKE IN
HERCEPTIN, BREAST AND SO ON.
ANTI-ANGIOGENESIS IN INDOLENT
LYMPHOMA, I'M NOT REALLY SURE
OF THE STATE THIS
MINUTE NOW TODAY.
SO IT'S VERY IMPORTANT, NUMBER
ONE, THAT YOU AND YOUR FRIEND
READ THAT CHAPTER IN MY BOOK.
YOU DON'T HAVE TO BUY A COPY,
GO TO THE LIBRARY AND READ
A COPY,
WHAT YOU REALLY
NEED TO KNOW ABOUT CANCER.
FRAME YOUR QUESTIONS, AND GO
TO THE DOCTOR LOOKING AFTER
YOUR FRIEND, MAYBE TOGETHER,
AND ASK, HOW AM I DOING?
WHAT KIND OF TREATMENT DO YOU
PLAN OVER THE NEXT FEW YEARS?
I'VE READ IN THE NEWSPAPERS
ABOUT LOW DOSE CHEMO PLUS
ANTI-ANGIOGENESIS AGENTS,
WHAT DO YOU RECOMMEND
IN THESE CIRCUMSTANCES?
AND LISTEN CAREFULLY.
WITH THE INDOLENT LYMPHOMAS,
ALTHOUGH IT SOUNDS LIKE, RUSH
IN AND GET TREATMENT, OH, IT'S
CANCER OF THE LYMPH SYSTEM,
RUSH IN AND GET TREATMENT,
WITH THE INDOLENT LYMPHOMAS,
THE LOW GRADE LYMPHOMAS, THE
ONE THING WE KNOW IS IT IS
POSSIBLE TO DO MORE HARM
THAN GOOD BY AGGRESSIVE
EARLY TREATMENT.
SO PLEASE DO REMEMBER THAT
ALMOST UNIQUELY AMONG THE
CANCERS, FOR LOW GRADE
LYMPHOMAS AND A FEW OTHERS,
CHRONIC LYMPHATIC LEUKEMIA,
AND A FEW OTHERS, BUT NOT
MANY, DON'T JUST DO SOMETHING,
STAND THERE, IS ACTUALLY A
GOOD POLICY, AND IT'S
A GENUINE POLICY.
DON'T JUST DO SOMETHING, STAND
THERE, MIGHT BE THE BEST POLICY.
SO TAKE YOUR FRIEND, AND TALK
TO THE DOCTOR LOOKING AFTER
THIS FRIEND, AND LISTEN
CAREFULLY TO WHAT THAT DOCTOR
HAS TO SAY.

Maureen says AND WHY WOULD THAT BE, THAT
YOU COULD DO MORE HARM THAN GOOD?

Rob says BECAUSE YOU CAN
FLATTEN THE BONE MARROW.
YOU CAN DO SERIOUS
PROBLEMS WITHOUT BENEFIT.
THAT'S THE POINT.
NOBODY WOULD MIND TAKING A
CHANCE -- I MEAN, IF I HAD
CANCER OF THE X OR Y, AND
SOMEBODY SAID, WE'VE GOT
10 PERCENT CHANCE OF DOING YOU
SERIOUS HARM WITH TREATMENT,
BUT THERE'S A CURE RATE OF 30
PERCENT OR 40 PERCENT, THEN,
YOU KNOW, I BEGIN
TO WEIGH IT UP.
IF YOU'VE GOT A 10 PERCENT
CHANCE OF DOING ME SERIOUS
HARM, BUT NO MEASURABLE
BENEFIT AT THE OTHER END,
THEN BY DEFINITION, YOU'RE
DOING MORE HARM THAN GOOD.

Maureen says YES, RIGHT, OKAY, GOT IT.
HEATHER IS IN BRAMPTON.
HELLO, HEATHER.

Rob says HI, HEATHER.

The Caller says HELLO.

Maureen says GO AHEAD.
HELLO?

The Caller says IT'S ABOUT FOUR QUESTIONS
ABOUT PANCREATIC CANCER.

Maureen says GO AHEAD.

The Caller says FIRST OF ALL, I'D LIKE TO
KNOW WHAT CAUSES PANCREATIC
CANCER, WHY IT'S IN OLDER
MEN, WHY MOSTLY IN MEN, AND
HAVE YOU NOTICED IT SPRINGING
UP IN YOUNGER MEN MORE
IN THE PAST FEW YEARS?

Rob says BRILLIANT QUESTIONS.
REALLY GOOD
QUESTIONS, THANK YOU.
AND HEATHER, THESE ARE NOT
EASY QUESTIONS TO ANSWER.
BASICALLY, MOST CANCERS GET
COMMONER AS YOU GET OLDER
BECAUSE PROBABLY THE NUMBER OF
STEPS THAT NEED TO GO WRONG
IN ORDER FOR A CANCER TO
FORM, THE OLDER YOU ARE, THE
MORE CHANCE THERE IS OF A
SERIES OF STEPS GOING WRONG.
PANCREATIC CANCER, LIKE MANY
OF THE AS IT WERE SOLID ORGAN
CANCERS, IS UNDOUBTEDLY
COMMONER AS ONE GETS OLDER.
THERE IS A, I THINK THERE IS A
SLIGHT PREPONDERANCE OF MALES
TO FEMALE, BUT THAT IS SMALL,
COMPARED TO THE SLIGHTLY
HIGHER PREPONDERANCE
OF SMOKERS COMPARED TO
NON-SMOKERS.
SO IT MAY WELL BE THAT GENDER
DIFFERENCES, AND I DON'T KNOW
THE ABSOLUTE FACTS, I
SHOULD, BUT I DON'T.
I BELIEVE THAT THE GENDER
DIFFERENCES ARE ACCOUNTED FOR
BY SMOKING PATTERNS.
CANCER OF THE PANCREAS IS
NOT CAUSED BY SMOKING, BUT
SMOKERS HAVE A HIGHER
TENDENCY TO GET IT.
PROBABLY THE NUMBER OF CASES
OF CANCER OF THE PANCREAS THAT
ARE AS IT WERE PRECIPITATED
BY SMOKING IS PROBABLY IN THE
RANGE OF 30 TO PROBABLY A BIT
MORE THAN THAT, 30-40 PERCENT
OF CANCER OF THE PANCREAS.
SO OVER HALF IS NOT ASSOCIATED
WITH SMOKING AT ALL.
BUT IT IS A DIFFICULT
DISEASE BECAUSE, NUMBER ONE,
IT'S DIFFICULT TO DETECT
IN THE EARLY STAGES.
THE PANCREAS IS RIGHT AT
THE BACK OF THE ABDOMEN.
AND THINGS COULD GROW EVEN
TO THE SIZE OF A TENNIS BALL
WITHOUT YOU ACTUALLY
NOTICING ANYTHING.
UNLESS IT HAPPENED TO BE RIGHT
AT THE HEAD OF THE PANCREAS,
IN WHICH CASE IT MIGHT BLOCK
THE BILE DUCT, AND YOU MIGHT
GO YELLOW, YOU MIGHT BECOME
JAUNDICED IN THE EARLY STAGE.
BUT IT'S DIFFICULT BECAUSE
IT'S VERY OFTEN NOT DETECTED
AT AN EARLY STAGE.
IT IS VERY, VERY, VERY
DIFFICULT TO TREAT.
SURGERY HAS A VERY LOW
RATE OF SUCCESS OF CURE RATE.
CHEMOTHERAPY DOES NOT HAVE
MUCH OF A RESPONSE, AND IT CAN
GROW RELATIVELY RAPIDLY
COMPARED TO OTHER CANCERS.
SO ONE MAY BE LOOKING AT A
SMALL NUMBER OF YEARS, OR A
LARGE NUMBER OF MONTHS,
RATHER THAN MANY YEARS.
SO IT'S A TOUGH DISEASE.
AND I GUESS I WOULD LIKE THE
MESSAGE TO GET ON THAT IT IS
A DANGER OF SMOKING.
IT'S NOT A BIG DANGER, YOU
KNOW, 30 PERCENT OF CASES OF
CANCER OF THE PANCREAS, AND
CANCER OF THE PANCREAS IS NOT
ALL THAT COMMON, BUT IT IS AN
ADDITIONAL DANGER OF SMOKING.
SO IT'S ANOTHER GOOD
REASON FOR NOT SMOKING.

Maureen says BUT WE DON'T REALLY
KNOW WHAT CAUSES IT.

Rob says NO, WE DON'T.

Maureen says IT'S NOT LIKE SMOKING AND
LUNG CANCER IN THAT RESPECT.

Rob says ABSOLUTELY NOT.
WHAT WE DO KNOW, I CAN ANSWER
THIS, WE KNOW THERE'S A WHOLE
BUNCH OF FACTORS IN THERE.
AND SMOKING IS ONE OF THE
FACTORS, BUT NOT A MAJOR ONE
LIKE IT IS IN LUNG CANCER.
AND THERE ARE A WHOLE BUNCH OF
OTHER FACTORS, SOME OF WHICH
MIGHT BE PURELY
ARBITRARY AND CHANCE.
I MEAN, FOR ALL WE KNOW,
I MIGHT HAVE THE KIND OF
GENETICS THAT MEAN THAT MY
PANCREAS IS PARTICULARLY
VULNERABLE TO THE KINDS OF
CHANGES THAT CAUSE CANCER, AND
I WOULD HAVE NO KNOWLEDGE
OF THIS AT THE MOMENT.

Maureen says RIGHT.
OKAY, THANKS VERY
MUCH FOR THE QUESTION.

Rob says DID WE MENTION, MAUREEN, I
DON'T KNOW IF WE DID, BUT MY
TALK ON MAY 2nd, IT'S GOING TO
HAVE A LITTLE BIT OF CANCER,
BUT IT'S MOSTLY LAUGHTER,
THE SECOND BEST MEDICINE.
AND YOU'RE GOING TO GIVE
THEM THE PHONE NUMBER,
WHICH IS 696-1000.
I'VE GOT TO REMEMBER THAT.
THEY WILL KILL ME IF
I DON'T MENTION IT.
WE'RE GIVING
MONEY TO CHARITY.
I'M NOT GETTING
ANY MONEY FOR THIS.
WE'RE GIVING MONEY TO A CHARITY
CALLED THE LEACOCK CLUB,
WHICH IS A FABULOUS CHARITY
WHICH GIVES START-UP GRANTS.
LIKE IF YOU'VE GOT A LOCAL,
SMALL COMMUNITY GROUP, AND YOU
JUST, YOU KNOW, LIKE A WHOLE
BUNCH OF KIDS WANT TO PLAY
BASEBALL, THEY START A
BASEBALL CLUB IN THAT AREA.

Maureen says OH, GOOD CAUSE.

Rob says GREAT CAUSE.
IT'S THE LEACOCK CLUB,
AND IT'S MAY 2nd.

Maureen says OKAY.
WE'LL GIVE THE NUMBER.

Rob says YOU'LL GIVE THE
NUMBER AT THE END.

Maureen says WE WILL.

Rob says AND YOU WILL MENTION
THAT IT'S 696-1000 AGAIN.

Maureen says I WILL DO THAT.
THANK YOU Dr. BUCKMAN.
HERE'S AN EMAIL.
THIS IS A CANCER I DON'T
THINK WE'VE DISCUSSED.
THERE SEEMS TO BE VARIOUS
OPINIONS WHEN ONE SHOULD HAVE
TESTS SUCH AS THE
COLONOSCOPY DONE?
I'VE ASKED MY DOCTOR, SHE SAYS
BECAUSE THERE'S NO PREVIOUS
HISTORY IN MY FAMILY, OTHER
THAN MY MUM, WHO FOUND ONE
POLYP, I CAN WAIT
UNTIL I'M 50.
I'M NOW 46.
I'M CURIOUS, SINCE I'VE
ALWAYS HAD A HISTORY OF
CONSTIPATION, WHICH SEEMS TO
BE UNDER CONTROL NOW, AND I
WONDER IF THIS PUTS ME AT A
RISK FACTOR FOR COLON CANCER.

Rob says YOUR DOCTOR IS RIGHT,
THANK YOU FOR THE EMAIL.
YOUR DOCTOR IS RIGHT.
IT IS CERTAINLY TRUE THAT IF
YOU TAKE CONSTIPATED PEOPLE,
COMPARED TO NON-CONSTIPATED
PEOPLE, THERE IS A SLIGHT
INCREASE IN BOWEL CANCER.
COLONOSCOPY IS NOT TO
BE UNDERTAKEN LIGHTLY.
IT'S A TEST IN WHICH YOU HAVE
TO WASH YOUR BOWEL OUT WITH
PURGATIVES FOR SEVERAL DAYS
BEFOREHAND, AND THEN THE LONG
TUBE IS PASSED PAINLESSLY,
ALTHOUGH WITH SOME DISCOMFORT,
THROUGH THE ANUS AND RIGHT
AROUND THE WHOLE COLON.
IT NEEDS TO BE DONE VERY
CAREFULLY, AND IT TAKES TIME.
IT'S NOT SOMETHING, IT'S NOT
LIKE A PAP TEST, YOU JUST GO
IN AND GET A PAP TEST DONE.
IT DEFINITELY SHOULD BE
DONE ON PEOPLE WHO HAVE A
HIGH FAMILY HISTORY
OF COLON CANCER.
YOUR MUM, HAVING ONE
POLYP, PROBABLY NOT.
AND PROBABLY, ALTHOUGH WE
DON'T KNOW THIS FOR CERTAIN,
PROBABLY COLONOSCOPY AT
THE AGE OF 50 MIGHT BE
A LITTLE BIT PREMATURE.
BUT CERTAINLY COLONOSCOPY
AT 46 IS PREMATURE.
IF YOU HAVE A FIRST-DEGREE
RELATIVE WITH BOWEL CANCER
DIAGNOSED BEFORE THE AGE OF
50, PROBABLY YOU SHOULD HAVE
YOUR FIRST COLONOSCOPY
AT THE AGE OF 50.
SINCE I HAVE A BROTHER WHO
IS ALIVE AND WELL, BUT HAD
EXACTLY THAT SITUATION JUST
AFTER THE AGE OF 50, I'M GOING
TO HAVE MY FIRST COLONOSCOPY,
I GUESS THIS YEAR.
OH, DEAR.
OH, WELL, OH, WELL.
YES, I'M 51, ACTUALLY.
I'M A BIT LATE.
I'LL JUST TELL THEM THE
FORMS WERE A BIT LATE.
BUT COLONOSCOPY IS AN
IMPORTANT, AS IT WERE,
TOOL OF EARLY DIAGNOSES.
AND THE EXACT ROLE OF IT THIS
MINUTE NOW, IN THIS YEAR
2000, HAS NOT
YET BEEN DEFINED.
WE DON'T KNOW TO WHOM WE
SHOULD RECOMMEND ROUTINE
COLONOSCOPIES STARTING
AT THE AGE OF 50.
I THINK WE WILL HAVE AN ANSWER
WITHIN THE NEXT TWO TO THREE
YEARS BECAUSE THIS
IS A HOT AREA.
RESEARCH IS
BEGINNING TO MATURE.
YOU AT 46, PLEASE RELAX,
LISTEN TO YOUR DOCTOR,
PROBABLY YOU SHOULD HAVE YOUR
FIRST COLONOSCOPY AT 50,
BUT ACTUALLY IF IT'S 52,
I WOULDN'T WORRY.
BUT PAY ATTENTION
TO THE CONSTIPATION.
NOT BECAUSE OF THE CANCER OF
THE BOWEL, BUT ALL THE OTHER
THINGS, LIKE HEMORRHOIDS LIKE
VARICOSE VEINS, LIKE PROBABLY
THE AFFECTS OF STRAINING AT
STOOL PROBABLY INCREASES
DIVERTICULITIS OF
THE BOWEL AND SO ON.
GO TO YOUR PHARMACIST AND
ASK THEM FOR WHAT ADVICE
THEY WOULD RECOMMEND.
YOU WANT A STOOL SOFTENER, AND
YOU WANT TO PUT IT, LIKE I
DO, NEXT TO THE COFFEE, FIRST
THING IN THE MORNING, SO I
HAVE MY COFFEE, AND I
HAVE MY STOOL SOFTENER.
THE ONLY SERIOUS SIDE EFFECT
IS IF YOU GO AND BUY YOUR
STOOL SOFTENER WITH YOUR
YOUNGER CHILDREN IN THE
PHARMACY, IF YOUR YOUNGER SON
IS LIKE MY SON, MATTHEW, HE
WILL STAND THERE AND IN A VERY
LOUD VOICE, SAY, DADDY, IS
THAT THE STUFF YOU'RE BUYING
TO MAKE YOUR POOS SOFTER?
EVERYBODY IN THE ENTIRE
PHARMACY TURNS AROUND AND
LOOKS AT YOU.
AND OF COURSE BECAUSE I'M
KEEN ON PUBLIC EDUCATION,
I HAD TO SAY, YES.
BUT
DO
PAY ATTENTION
TO CONSTIPATION FOR
CONSTIPATION SAKE.

Maureen says DO YOU THINK THERE IS
ANYTHING WE CAN DO TO PREVENT
COLON CANCER?
DO YOU BELIEVE IN INCREASING
THE FIBRE IN THE DIET TO SORT
OF MAKE THAT PROCESS...?

Rob says WE DON'T KNOW, BUT
PROBABLY YES.
AND PROBABLY THE BULKING
AGENTS, PLUS THE STOOL
SOFTENERS, YOU LOOK AT THE
FIBRE CONTENT OF THE STOOL
SOFTENER YOU'RE TAKING,
AND YOU'LL FIND IT'S GOOD.
PROBABLY INCREASING FIBRE
IN YOUR DIET DECREASES THE
TRANSIT TIME, AS IT WERE,
THE TIME THE STOOL SPENDS
IN YOUR BOWEL.
AND PROBABLY, IF YOU HAVE
THE POTENTIAL FOR MAKING
CARCINOGENS, CANCER-CAUSING
AGENTS, FROM DIGESTED MATERIAL
IN YOUR STOOL, IF YOU HAPPEN
TO HAVE THAT, AND WE THINK
THERE ARE CERTAIN BACTERIA,
JUST A PARTICULAR KIND OF
CLOSTRIDIUM, WHICH MIGHT
ACTUALLY INCREASE THAT
METABOLISM INTO CARCINOGENS,
IF YOU HAVE GOOD THROUGHPUT,
YOU MIGHT ACTUALLY DECREASE
THE CHANCE AND THE TIME
THE CLOSTRIDIA IS
IN YOUR SYSTEM.

Maureen says OKAY.

Rob says SO DO IT.

Maureen says ALL RIGHT.
DIANE IS IN MISSISSAUGA.
HI, DIANE.

The Caller says HI.
I HAVE A QUESTION ABOUT
THE THYROID GLAND.
I HAVE A SINGLE
NODULE ON MY THYROID.
AND I HAD THE TEST DONE A
COUPLE OF YEARS AGO WHERE I
HAD TO SWALLOW THE LIQUID,
AND THEN THEY DID A SCAN.
AND THAT SHOWED THAT IT
DIDN'T SEEM TO BE COLD.

Rob says GOOD.

The Caller says AND I HAD A BIOPSY DONE AFTER
THE FACT AS WELL BECAUSE THEY
WANTED TO BE SURE.

Rob says GOOD.

The Caller says THEN I WENT TO SEE, I BELIEVE
IT WAS AN ENDOCRINOLOGIST,
BUT HE SAID THERE IS A
POSSIBILITY AFTER THE BIOPSY
THAT IT COULD BE A FALSE
NEGATIVE BECAUSE OBVIOUSLY
THEY DON'T TAKE THE ENTIRE
NODE, JUST A SMALL PORTION
THROUGH THE BIOPSY.

Rob says CORRECT.

The Caller says BUT I DO HAVE ULTRA SOUNDS
EVERY YEAR TO MEASURE THE SIZE
OF THE NODULE.
SO JUST A QUESTION, SHOULD
I BE CONCERNED ABOUT
THYROID CANCER?

Rob says NO.
YOU'VE GOT A GREAT
DOCTOR THERE.
I'LL EXPLAIN SOME OF THAT
JUST TO THE GENERAL PUBLIC.
THE THYROID GLAND IS A GLAND
THAT PICKS UP IODINE FROM THE
BLOOD AND MAKES
THYROID HORMONE.
SOMETIMES, IT'S A BIT LIKE THE
BREAST, ACTUALLY, COMPARABLE
TO THE BREAST, IT'S
BASICALLY MADE OF CYSTS.
AND SOMETIMES YOU CAN GET
A NODULE IN THE THYROID.
WE WORRY ABOUT THOSE
NODULES IF THEY ARE COLD.
COLD, MEANING, WHEN YOU DRINK
RADIOACTIVE IODINE, THAT
RADIOACTIVE IODINE GOES TO
THE THYROID GLAND BUT ISN'T
TAKEN UP BY THAT
PARTICULAR NODULE.
THAT'S WHY IT
MEANS COLD.
THE REST OF THE GLAND IS NICE
AND WARM, TAKING UP THE
RADIOACTIVE IODINE, BUT THAT
PARTICULAR NODULE IS NOT.
WE KNOW THAT A SOLITARY COLD
NODULE DOES HAVE A CHANCE OF
IT BEING CANCER.
IN YOUR CASE, THANK GOODNESS,
THE NODULE WAS WARM, BUT THEY
DID THE NODULE ANYWAY.
AND THE BIOPSY, USUALLY IT'S
EITHER A FINE-NEEDLE ASPIRATION,
THEY SUCK STUFF OUT, OR THEY
MIGHT HAVE TAKEN A TRUE CUT,
AND IT DIDN'T SHOW ANYTHING.
AND THE MOST IMPORTANT THING
OF ALL IS NOT ONLY HAVE YOU
GOT TWO PASS MARKS ON YOUR
PAPER, BUT YOUR DOCTOR IS
DOING AN ULTRASOUND, WHICH IS
LIKE A LITTLE MICROPHONE JUST
TO SEE THE SIZE OF THE NODULE,
AND IS WATCHING IT YEAR BY YEAR.
RELAX.
THYROID CANCERS, NUMBER ONE
ARE RARE, NUMBER TWO, THEY
GROW VERY SLOWLY, NUMBER
THREE, THE CHANCE OF YOU
HAVING ANYTHING
LIKE THAT IS TIDDLY.
AND THE CHANCE OF ANYTHING
GOING UNDETECTED WITH YOUR
DOCTOR WATCHING OVER YOU IS ZERO
TO ALL INTENTS AND PURPOSES.
I'D BE MORE WORRIED
ABOUT FLYING.

Maureen says HAVE YOU EVER HEARD OF A
RELATIONSHIP BETWEEN, I THINK
IT'S THYROID CANCER, AND
TONSILS BEING ZAPPED WHEN YOU
WERE A KID?
YOU KNOW THE ADENOIDS?

Rob says THEY WERE FORMS OF
TREATMENTS, NOT WHEN YOU OR
I WERE A KID, I THINK IT WAS
LONG BEFORE THAT, WHERE THEY
USED TO ZAP ADENOIDS
AND TONSILS.
AND THAT'S QUITE CORRECT.
THAT IS A RARE, ULTRA RARE
CAUSE OF CANCER OF CERTAIN
AREAS, SARCOMA OF THE
SKIN, THYROID CANCER, TOO,
INADVERTENT EXPOSURE WHEN THEY
WERE USING X-RAY TREATMENTS
FOR FRIVOLOUS --

Maureen says I KNOW SOMEONE IT
HAPPENED TO, YEAH.

Rob says IT'S VERY, VERY RARE.
I SAW AS A MEDICAL STUDENT,
A PATIENT WHO'D HAD
RADIOTHERAPY FOR
RINGWORM OF THE SCALP.
AND THAT MUST HAVE
BEEN 1910 OR SOMETHING.
BUT EVENTUALLY, IT CAUSED
CANCER ON THE SKIN.

Maureen says OKAY, THANK YOU, DIANE,
FOR THE QUESTION.

Rob says THANKS, DIANE.

Maureen says ANNE IS IN TORONTO.
HELLO, ANNE.

The Caller says HI.
YES, MY DAD HAS HAD PROSTATE
CANCER, AND IT'S BEEN A REAL
ROLLER COASTER RIDE, I GUESS
FOR THE LAST THREE OR FOUR
YEARS, IT'S BEEN UP AND DOWN.
AND NOW THEY'RE SAYING IT'S
LEFT THE PROSTATE AND HAS NOW
GONE INTO THE BONE, HIS HIP,
AND UP INTO HIS SHOULDER.
HE'S NEVER HAD A SORE HIP.
HE'S NEVER HAD A SORE SHOULDER.
BUT THEY SAY IT'S INACTIVE.
HOW DO WE KNOW AS A FAMILY
HOW TO DEAL WITH THIS?
YOU KNOW, IT'S JUST BEEN
ONE THING AFTER THE OTHER.
THE ONE THING HE DID DO WAS
START TAKING ALL OF THESE
VITAMINS, AND ALL OF A SUDDEN
IT SORT OF LEFT THE PROSTATE.
HOW DOES THIS ALL --

Rob says I THINK I CAN HELP
PUT THAT TOGETHER.
BY THE WAY, AGAIN, I'M SORRY
TO BANG ON ABOUT MY BOOK, BUT
WHAT YOU NEED TO KNOW ABOUT
CANCER
IS WORTH A GLANCE.
ALSO, JOHN CLEESE AND I MADE
A VIDEO ON CANCER OF THE
PROSTATE, WHICH IS
ALSO WORTH A LOOK AT.
YOU CAN GET THEM AT MOST
PHARMACIES, THEY JUST LEND
THEM TO YOU.
BY THE WAY, I MEANT TO SAY TO
A PREVIOUS CALLER THERE'S A
GREAT VIDEO THAT JOHN CLEESE
AND I MADE ON CONSTIPATION.
DIFFERENT METHODS
OF APPROACHING.

Maureen says I BET THAT WOULD BE FUN.

Rob says IT'S VERY, VERY --
IT'S POPULAR.
THERE'S A 1-800
NUMBER FOR THEM, TOO.
NOW, CANCER OF THE PROSTATE,
WHAT YOU'VE SAID, ANNE,
IS REALLY IMPORTANT.
ROLLER COASTER.
AND THIS IS THE SWINE
OF THE THING IS THAT
VERY OFTEN, CANCERS, AND
CANCER OF THE PROSTATE IS
PARTICULARLY LIKE THAT.
OH, I'M FREE OF IT,
OH, IT'S COME BACK.
OH, I'M FREE OF THE
RECURRENCE, AND SO ON.
AND IT REALLY DOES
ROLLER COASTER.
IT'S A VERY GOOD DESCRIPTION.
AND SOME OF THE MOST DIFFICULT
THINGS TO BEAR ARE NOT THE
PHYSICAL SYMPTOMS, BUT
WHAT IS... HOW DO I REACT?
WHAT'S MY ATTITUDE?
HOW SHOULD I REACT?
HERE'S YOUR DAD.
AND THEY'VE DONE A BONE SCAN,
I ASSUME, AND THEY'VE SAID,
THERE'S A BIT OF THE CANCER
IN THE HIPBONE, AND IN THE
SHOULDER BONE, AND HERE'S YOUR
DAD, AS YOU'VE SAID, WITH
NO PAIN IN THE HIP
OR IN THE SHOULDER.
AND THAT'S QUITE COMMON, THAT
YOU CAN HAVE, NOWADAYS THE
DIAGNOSTIC TESTS ARE GOOD
ENOUGH SO YOU CAN SEE AN AREA
THAT IS DEVELOPING, BUT IT
DOESN'T CAUSE ANY SYMPTOMS,
WHICH IS GREAT IT DOESN'T
CAUSE ANY SYMPTOMS.
NO CONNECTION WITH THE
VITAMINS YOUR DAD HAS BEEN
TAKING WHATSOEVER.
FULL STOP AND END OF STORY.
IT DOESN'T MATTER IF HE HAD
FOUR BUCKETS OF VITAMINS A
DAY, OR IF HE NEVER LOOKED
A VITAMIN IN THE EYE,
DOESN'T MATTER.
NOTHING THAT HE ATE OR HAS
EATEN HAS ANY EFFECT ON THE
BIOLOGICAL BEHAVIOUR OF
PROSTATE CANCER CELLS.
IF THOSE ONES SPREAD TO HIS
BONE, IT'S BECAUSE THEY WERE
PROGRAMMED TO DO THAT 7 OR 8
YEARS AGO WHEN THEY FIRST
STARTED COOKING, DEVELOPING
INSIDE YOUR DAD'S PROSTATE.
AND THE MOST DIFFICULT THING
IS TO KNOW HOW TO REACT.
AND TO SOME EXTENT, THE MOST
SENSIBLE PIECE OF ADVICE I CAN
GIVE IS, YOU KNOW, TAKE THE
INFORMATION THAT YOU CAN,
ACCEPT THE UNCERTAINTY.
ACCEPT THAT YOU DON'T
KNOW HOW TO REACT TO IT.
ACCEPT YOU CAN'T HAVE YOUR
LIFE RULED TOTALLY BY
EXPECTATIONS AND SO ON.
AND GO THROUGH EACH DAY, YOU
KNOW, BEING GLAD FOR THE GOOD
THINGS OF THAT PARTICULAR DAY,
AND TEED OFF WITH THE THINGS
THAT ARE NOT SO GOOD THAT DAY.
IN OTHER WORDS, CERTAINLY,
PREPARE, AS I SAY TO ALL MY
PATIENTS, PREPARE FOR THE
WORST, AND HOPE FOR THE BEST.
AND THAT'S WHAT ONE DOES.
YOU SAY, THIS COULD
BE VERY SERIOUS.
I'M GOING TO MARK A LITTLE
AREA OF MY BRAIN, COULD BE
SERIOUS, I'M GOING TO IGNORE
THAT, AND I'M GOING TO SAY,
WHAT AM I GOING TO DO TODAY?

Maureen says RIGHT.
OKAY, ANNE, BEST OF LUCK.
I THOUGHT WE'D TAKE THE FINAL
MINUTE AND A HALF TO TALK
ABOUT WAITS FOR RADIATION IN
ONTARIO, ARE THEY GETTING ANY
BETTER, AND WHAT WOULD YOU
TELL A PATIENT WHO WAS GIVEN
THE OPTION OF
GOING TO BUFFALO?

Rob says I'M GOING TO SOUND A BIT
SKEPTICAL AND CYNICAL.
BUT THE WAITS FOR RADIATION
THERAPY ARE A PIECE OF
STATISTIC THAT SEEMS TO HAVE
EMOTIONAL AND POLITICAL CLOUT.
MEDICALLY SPEAKING, THE VAST
MAJORITY OF DELAYS DON'T
MATTER IN THE SLIGHTEST.
EIGHT YEARS AGO, WE'RE BACK TO
THAT STAGE HAVING A 12-WEEK
DELAY, AND I WAS TELEPHONED BY
A RADIO STATION IN BUFFALO.
AND THEY SAID, OH, WHAT DO YOU
THINK ABOUT THIS, ISN'T IT
DISGRACEFUL, YOU
BLOODY CANADIANS?
AND I SAID NO.
I SAID, FOR ALL OF MY PATIENTS
WITH CANCER OF THE BREAST, IF
THEY HAVE TO WAIT 8 TO 12
WEEKS, MEDICALLY SPEAKING,
NO PROBLEM.
WE DON'T KNOW OF ANY PROBLEM.

Maureen says OKAY.

Rob says THERE ARE LOTS OF CASES
IN WHICH THAT IS THE CASE.
NO PROBLEM.
I MEAN, I'D LIKE IT,
PSYCHOLOGICALLY, YOU'D LIKE IT
EARLIER, BUT I WOULD SIT WITH
MY DOCTOR AND SAY, DOCTOR,
DO I HAVE TO HAVE THIS
TREATMENT IMMEDIATELY?
IF SO GO TO BUFFALO.
IF NOT, DON'T WORRY.

Maureen says ALL RIGHT.
RAN OUT OF TIME.
COME AGAIN?

Rob says I CAN COME BACK IN 12 WEEKS
IF THAT'S ALL RIGHT WITH YOU,
MAUREEN.

Maureen says OKAY, 12 WEEKS.
Dr. ROBERT BUCKMAN IS AN
ONCOLOGIST AT SUNNYBROOK
HOSPITAL IN TORONTO.
ALSO THE AUTHOR OF
What you really need to know about cancer.
IT'S PUBLISHED BY KEY PORTER.
AND OF COURSE HIS
AUTOBIOGRAPHY
Not dead yet,
PUBLISHED BY DOUBLEDAY CANADA.
IF YOU'D LIKE MORE INFORMATION
ON CANCER, Dr. BUCKMAN
RECOMMENDS HIS
FAVOURITE WEBSITE
www.cancersource.com
FOR THE LATEST FINDINGS AND
ARTICLES BY LEADING SPECIALISTS,
INCLUDING Dr. BUCKMAN.
YOU CAN ALSO LOG ON TO THE
WEBSITE FOR THE CANADIAN
CANCER SOCIETY AT
www.cancer.ca
AND YOU'LL SEE A LINK THERE
TO BE A VOLUNTEER FOR THE
SOCIETY, WHICH IS A
GREAT THING TO DO.
ALSO, Dr. BUCKMAN, AS WE SAID,
WILL APPEAR AT THE ONTARIO
SCIENCE CENTRE ON MAY 2nd.
FOR TICKETS, CALL 416-696-1000.
AND THANKS FOR WATCHING
MORE TO LIFE TODAY.
I'M MAUREEN TAYLOR, HOPING
YOU'LL JOIN ME AGAIN MONDAY
THROUGH FRIDAY AT 1 O'CLOCK.

A slate appears with the caption “The advice given in the preceding program is of general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Watch: Cancer