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Morning Briefing

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Monday, May 16 2016

Full Issue

The Origin Point Of Cancer Crucial To Understanding The Odds

While the cancer field is undergoing a revolution that could upend the way the disease is viewed, it's still helpful for doctors to know where in the body it started. And an oncologist realizes sometimes, when it comes to treatment, it's important for a doctor to use knowledge, wit and imagination to devise individualized therapies rather than going with the general course of action.

In the midst of a genetic revolution that promises to scramble everything we know about cancer and how to treat it, our experience of the disease today still begins with a single question: Where did it start? That, it turns out, remains a very useful question to ask. The practice of categorizing cancer according to its point of origin within a specific organ or system grew from decades of steady discoveries made by researchers staring at stained slides under a microscope. The shape of cancer cells, they found, would often give clues about a cancer鈥檚 behavior. Broken down and sorted by appearance 鈥 some cells might be flatter, some are shaped like rings, some look more like oats 鈥 cancers were treated differently, and treatment improved. Even as doctors move to the precision of genetic research, the knowledge gained by staring at cells continues to be crucial to treatment. (Bradley, 5/12)

The bone-marrow biopsy took about 20 minutes. It was 10 o鈥檆lock on an unusually chilly morning in New York in April, and Donna M., a self-possessed 78-year-old woman, had flown in from Chicago to see me in my office at Columbia University Medical Center. She had treated herself to orchestra seats for 鈥淭he Humans鈥 the night before, and was now waiting in the room as no one should be asked to wait: pants down, spine curled, knees lifted to her chest 鈥 a grown woman curled like a fetus. I snapped on sterile gloves while the nurse pulled out a bar cart containing a steel needle the length of an index finger. The rim of Donna鈥檚 pelvic bone was numbed with a pulse of anesthetic, and I drove the needle, as gently as I could, into the outer furl of bone. A corkscrew of pain spiraled through her body as the marrow was pulled, and then a few milliliters of red, bone-flecked sludge filled the syringe. It was slightly viscous, halfway between liquid and gel, like the crushed pulp of an overripe strawberry. (Mukherjee, 5/12)

Elsewhere, The Washington Post examines how few men realize how dangerous mutations to the聽BRCA gene could be for them聽鈥

Joe Scholten鈥檚 sister had already beaten breast cancer and was battling ovarian cancer when she tested positive for a genetic mutation linked to both. He responded by doing something unusual: He got tested, too. That鈥檚 how the District resident discovered that he also carried the defective BRCA gene. He quickly told his brothers, other relatives and, hardest of all, his daughter. 鈥淕etting tested was a no-brainer,鈥 he said, wondering what steps his sister would have taken if she鈥檇 learned early on about her own genetic risk. She was 54 when the ovarian cancer killed her. He realizes now that not knowing your medical pedigree is 鈥渃learly a danger.鈥 (McGinley, 5/15)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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