Oncology

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Wednesday, May 21, 1997

Number Of Skin Cancer Deaths Falling

JERUSALEM (May 21) - By the year 2000, one in 78 people will develop the potentially fatal kind of skin cancer, melanoma, and one in five will have a non-melanoma type of skin cancer. But the good news is that the number of deaths from skin cancer is declining due to earlier diagnosis.

According to Israel Cancer Association officials, 600 new cases of melanoma were discovered in Israel last year, compared to an average of 300 during each of the years between 1980 and 1985 and 400 each between 1990 and 1994. But due to increased awareness, nearly half are diagnosed during the early stages when survival is most likely, compared to only a little over a quarter in the early Eighties.

By far the most improvement has been in Tel Aviv, where for every late-stage diagnosis of melanoma, the cancer is caught early for eight people. In Jerusalem, there are the fewest number of melanoma cases due to the covered-up religious population of Jews and Arabs. But if they contract melanoma, their awareness of the need to go for early detection is less pronounced because of reduced exposure to the news media. Since CIS immigrants tend to have pale, sensitive skin and are not used to sunny weather, the ICA issues informational material in Russian.

At the earliest stages, when the tumor is small and before the cancer penetrates beyond the skin, 90 percent of all melanomas can be cured.

It used to appear in 30% more women than men, but the figures are beginning to balance out, with women now having 20% more. The ICA's explanation is that women are now more aware of the dangers of sun exposure and take more care to protect themselves with hats, long-sleeved, light clothing, sunscreens and sunglasses. Parents are urged to be especially care to protect children, as one or two serious sunburns at this age can cause melanoma in adulthood.

For the first time, the Health Ministry's Cancer Registry has released figures on the number of basal cell carcinoma cases. The most common of skin cancers, its incidence is growing, and some 7,500 new cases are diagnosed each year. Fortunately, it is not often fatal, but removing the tumor can cause serious esthetic harm and suffering.

Tuesday, May 20, 1997

Sheba Researchers Find Gene Linked to Breast,
Ovarian Cancers

TEL HASHOMER (May 20) - The first gene mutation causing ovarian and breast cancer to be discovered solely in Israel has been announced by researchers at Sheba Hospital at Tel Hashomer.

The new mutation was found to appear in Jewish women originating in Iran and Afghanistan. Women from these communities have been considered at low risk to develop these diseases, compared to the general population.

Epidemiological studies have shown that of 2,200 new cases of breast cancer and 360 of ovarian cancer in this country each year, three-quarters are in women of Ashkenazi origin and a quarter in women of Sephardi origin. But in families of Iranian and Afghani origin, where the diseases have struck several women, the mutation has been found in all the women examined so far.

Dr. Eitan Friedman, director of the onco-genetic unit at the Tel Hashomer hospital, said that now the mutation has been discovered, women of these origins who have had cases of breast or ovarian cancer in their families should come and be tested. Those found to bear the mutation should undergo periodic examinations by their doctors to detect the disease early, if it does appear.

Friedman said the hospital had developed a technique that allows the accurate diagnosis of the mutation without the use of radioactive materials. Some of the women found to have the mutation and who had finished giving birth had their ovaries removed as a preventive measure.

Since no more than 5 to 10 percent of all breast cancers are believed to be caused by genetic factors, women of Iranian and Afghani origin are still regarded as at significantly lower risk than Ashkenazi women to contract it. The spectrum of mutations among Israeli women is different than that of American Jewish women, he added.

Friedman said he has no idea if the mutation appears in non-Jewish women living in Afghanistan and Iran.

Friday, May 2, 1997

Animal Study Links Cell Phone 
Use With Cancer

JERUSALEM (May 2) -- Health Ministry officials urgently called health experts in Australia, Britain and the US yesterday for more details about what has been described as the first serious piece of lab research linking cancer with exposure to electromagnetic radiation from the use of cellular phones.

The study, conducted on 200 mice, was led by Dr. Michael Repacholi at the Royal Adelaide Hospital in South Australia, and published in Radiation Research, Vol. 147. The Australian authors claimed their article was turned down by the prestigious journal Science on the grounds that publication would cause panic, and by Nature because "it could not handle such important conclusions without the research being confirmed by further studies."

Dr. Avi Livnat, head of the ministry's medical device unit, who learned of the new study from The Jerusalem Post, stated that "the subject is important, thus we make efforts to update ourselves and study it in depth."

The amount of time Israelis spend conversing over cellular phones is known to be several times that of Americans, who use them mostly while driving. Nearly one out of four residents here has a cellular phone.

Livnat added that electromagnetic radiation has been suspected for many years of posing health risks, but despite the accumulation of much data, "there has been no proof, if levels are within international limits, that they cause health damage."

The text of the article, which last night had not yet reached Jerusalem, was requested by Livnat, who said that in the meantime the ministry will base its position on the US Food and Drug Administration, which recently "studied the matter carefully and reached the conclusion that there is as yet no proof of health dangers posed by cellular phone use. We will, of course, continue to study the matter and update the public on our findings."

Half of the mice were subjected to GSM-type pulsed microwaves at a power density roughly equal to a cellular phone handset transmitting for two half-hour periods a day. The electromagnetic radiation was equivalent to that emitted by a cellular phone, not the steady transmission of a cell-phone transmitting tower.

Over a period of 18 months, the exposed mice developed more than twice the rate of lymphoma (cancer of the lymphatic system) than those not exposed to the cellular phone radiation. The tumors began to appear after nine months.

The scientists noted that the lab animals were transgenic mice specially bred to be susceptible to cancers of the immune system, but these mice are commonly used in such studies as proxies, since cancer-causing effects are believed to be cumulative at the cell level.

The Australians said that while physiological reactions in mice are not identical to those in humans, "DNA is DNA, and the total exposure period is very much less than can be expected from human use [of cellular phones] over a lifetime."

Prof. John Goldsmith, a senior epidemiologist at the Ben-Gurion University medical school in Beersheba, called the study "very startling new evidence that must be carefully evaluated."

Although he did not advise the 1.3 million Israeli cellular phone owners to toss them out, the BGU expert on radiation epidemiology advised greater public awareness.

Raising the antenna while phoning is important, as is distancing the phone unit from the head, which can be done while using a remote speaking device in the car, he said. Public pressure in response to such studies will require cellular phone manufacturers to provide the public with better-shielded equipment, Goldsmith concluded.

Prof. Baruch Modan, a leading Tel Aviv University epidemiologist, said he had not yet seen the Australian study.

"Holding a cell phone while driving is more dangerous than ordinary use," he declared. "Certainly, it's not wise to exaggerate in cellular phone use. But it will take several years to get support from clinical findings for results on rodents."

Spokesmen for Pelephone, Cellcom and Motorola either declined to comment or said they would after reading the Australian study.

Sunday, April 6, 1997

Health: Israeli Women 
Waking Up to Breast Cancer

(March 30) This Thursday, hundreds of women (and some men) will march from Jerusalem's Liberty Bell Garden to Safra Square. The event is not a political protest, nor is it a union rally. They merely want the public in general, and women in particular, to be more aware of breast cancer and to know how to detect it early - and to call on the medical establishment to do more towards this end.

The Fight Against Breast Cancer Walk-a-thon will be sponsored by Hadassah-Israel with help from the Israel Cancer Organization and several other women's health groups, and held under the patronage of the Jerusalem Municipality's Council for the Advancement of Women.

At the end of the march, Riki Gal will entertain in a special "donated performance" with Nira Rabinovitz as master of ceremonies.

Breast cancer and how to reduce women's odds of succumbing to it have become a major issue in the US over the past decade. In the early 90s, a women's organization initiated a campaign, using a pink ribbon crossed under the neck as a symbol of the cause. Since then, pink enamel pins have served as a reminder, and Hadassah-Israel will be selling them at the march to increase awareness of the issue and to help cover march organizing expenses.

"This event won't be a fundraiser," says Hadassah-Israel national president - and powerhouse - Hinda Gross. "There will be entertainment, films, T-shirts and educational material. Many people have donated their services, and we can use all the help we can get," she says.

Israel is far behind the US when it comes to breast-cancer awareness, even though the risk is as high here (the lifetime risk is one in nine) as among American women or even higher (as 5% to 10% of breast cancers are inherited by the BRCA1 or BRCA2 gene, which is relatively common among Jewish women of Ashkenazi origin). Nevertheless, surveys have shown that an incredible 75% of all Israeli women over the age of 50 have never had a mammogram - the best way to detect breast cancer early.

"And, incredible as it seems, many women who have been struck by the disease refuse to tell anyone, even their first-degree female relatives whose risk for the cancer is heightened and lives could be saved by careful followup," Gross adds.

The Hadassah-Israel president, an energetic wife, mother and grandmother who immigrated from Philadelphia and helped found the communal settlement Neve Ilan outside Jerusalem, knows all about breast cancer. She has been struck by it four times in the last decade and is still fighting it. "I was diagnosed 10 years ago with stage-2 breast cancer on one side. A young surgeon at Hadassah-University Hospital on Mt. Scopus discovered it in a routine examination when I was there for gynecological surgery."

Her oncologists recommended a lumpectomy rather than a radical mastectomy, arguing that in her case, survival rates would be no lower with the minimal procedure. But then, seven years later, an entirely different cancer was discovered in the same breast (it had not metastasized from the initial tumor), and she decided to have a mastectomy, including the removal of lymph glands. Then cancer was discovered in the other breast too, and she had lost both of her breasts, wearing prostheses because she didn't want to undergo implant surgery.

More recently, she was found to have a tumor under one armpit, which she is being treated for with an installed catheter that sends chemotherapeutic doses into her body on a regular basis.

Nevertheless, although this treatment causes her to be "short-tempered, get sores in my mouth and bruise easily," she works hard at her job and hasn't let the latest incident faze her.

"The first time I was really scared. It got to a point where I wouldn't buy expensive clothing because I thought I wouldn't live long, so why waste the money," she recalls. "But I was lucky. I went to Hadassah's chief psycho-oncologist, Prof. Lea Beider, for support and my husband and children received much help."

Gross is keen on fighting the myths about breast cancer and surgery: that one's sex drive disappears forever, and that it's a death sentence.

"In fact, the vast majority of women whose breast cancer is discovered early will enjoy the same quality of life as before. One's quality of life even improves, because one learns to appreciate things that before one took for granted."

Gross spent years collecting and reading crates full of medical material on breast cancer. "I wanted to keep abreast of things," she says, using the word intentionally and with a big smile. But after a while she stopped. "I found that medical knowledge was changing, and that things that doctors swore were true yesterday were not true today."

She found that in many cases, patients consulted only surgeons rather than seeing both a surgeon and an oncologist. The synergistic collaboration of both specialists can benefit many patients, she says. Hadassah-Israel organized a breast-cancer awareness day at the Prime Minister's Office a while ago.

"People in the office warned us that many staffers were unlikely to want to hear about it and undergo an examination. And indeed, there were few present when Dr. Tamar Peretz of Hadassah's Sharett Institute began her talk. But soon, those who were there called their colleagues and they came pouring in."

Peretz conducted a study recently that found that haredi women were at high risk for developing breast cancer and for being diagnosed in the later stages, even though they tend to have many babies and to start a family early. Distributing informational material on mammograms, yearly clinical exams and monthly self-examination would best be carried out among this sector in the ritual baths, which they visit once a month. But trying to convince the rabbinical establishment and the haredi media (which won't even print the word "breast") was a difficult challenge.

"We finally succeeded in getting material distributed at the mikve in Telz Stone outside Jerusalem," says Gross, "and we hope it will lead to a campaign in other religious areas as well."

The breast-cancer rate among Arab women is much lower than among Israeli Jews, for various reasons (genetic, environmental and behavioral), but Hadassah-Israel has made efforts to bring them to breast clinics as well. Thanks to the national health insurance law and Health Ministry prodding, the four public health funds are finally being required to provide free mammograms once in two years to all women over the age of 50 (and those aged over 40 where there is a high risk). In addition, a permanent, organized campaign of invitations to a mammogram will be carried out by the insurers; if a woman doesn't respond to the first letter, she will get another one, and if she doesn't answer the second, she will be phoned, says ministry director-general Prof. Gaby Barabash.

"We want everyone to be better aware of the disease, the men too - for they all have mothers, wives, sisters, daughters," concludes Gross. "Men want their women to be healthy and they care." As for Hadassah-Israel, the next campaign the voluntary organization will launch is one to reduce smoking, especially in the workplace. And since smoking causes many types of cancers, and even has a link to breast cancer, there is nothing more natural for this health-oriented organization.