Dr. Cynara Coomer

I am outraged with the recommendations from the U.S. Preventive Services Task Force. Not only does it send a mixed message to women about the benefits of a screening mammogram, it is also a dangerous practice to not screen women between the ages of 40-49 without an alternative test. Furthermore, early detection of breast cancer by mammograms has shown to have a significant decrease in the number of deaths. Although the numbers are more impressive for women over the age of 50, there is still a large impact for women in the 40-49 age group. For every 1,300 women screened between the ages of 50-59, one woman’s life is saved. For every 1,900 women screened between the ages of 40-49, one woman’s life is saved.  Is the difference in the ratio really worth denying women in their 40s a chance of survival?

Proponents of the task force’s recommendation argue that screening women in their 40s has led to a high number of false negatives, needless biopsies and unnecessary anxiety. However the impact of saving a woman’s life in my perspective outweighs these problems. Ultimately, we need to find more appropriate tests to screen women, but the mammogram is our best available modality at this time.

Because of the number of women under the age of 50 that I personally treat in my practice for breast cancer, I will not go against the American Cancer Society guidelines of starting mammograms at the age of 40. Depending on their risk factors, some women may need a baseline mammogram at the age of 35. The impact of these guidelines is not only about survival outcomes, it is also about the treatment options that are available when breast cancer is found early. When breast cancer is found at an early stage, there are more surgical options and it usually does not require the addition of chemotherapy. On the other hand, when cancer is found at a later stage, surgical options become more limited and treatment will most likely include radiation and chemotherapy. The prognosis is also worse when cancer is found at a later stage. So to think that costs will be lowered by decreasing the number of screening tests does not make sense when we risk diagnosing breast cancer at a later stage. In the end, the cost of treating advanced breast cancer is far more expensive.

I hope the task force reconsiders and reverses their recommendation so that women will continue to understand that mammograms starting at the age of 40 save lives.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

Dr. Cynara Coomer

The most common surgery for breast cancer these days is a lumpectomy, which is considered breast-conserving therapy. If patients choose to undergo this surgery, it has to be combined with radiation therapy, which can be administered in the form of external radiation, where the whole breast is radiated, or partial breast radiation called brachytherapy.

Another option for surgically treating breast cancer is by mastectomy. Mastectomies remove all the breast tissue, but nowadays, most women are candidates for immediate breast reconstruction done during the same operation.

When reconstruction is used, women can have either a skin-sparing, areola-sparing, or nipple-sparing mastectomy. This is where the skin and/or the areola and nipple are preserved, which improves the cosmetic outcome dramatically. The type of breast cancer that a woman has will determine which of these procedures is appropriate.

Reconstruction can be performed by using implants or tissue transplanted from other areas of the body. Most commonly, abdominal fat is used, which results in a tummy tuck.

Some patients may need to have chemotherapy prior to surgery. Although this is not proven to improve the survival outcomes, it increases the surgical options and may potentially decrease the risk of local recurrence in the breast.

There are so many more options for women these days for surgically treating breast cancer, and they should be discussed with a breast surgeon.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

1. What is the difference between colon cancer and rectal cancer?
Colon and rectal cancers are actually very similar — but the difference lies in what part of the large intestine the cancer affects. The colon and rectum make up a long, muscular tube that most people know as the large intestine. The first part of the large intestine is the colon and at the end of it is the rectum.

Cancers in the colon and rectum usually grow slowly and may start as benign polyps. These polyps are found during a colonoscopy, and early removal of polyps may prevent it from becoming cancer. Over 95 percent of colon and rectal cancers start in the cells that line the inside of the large intestine.

Cancer of the colon and/or rectum is the third leading cause of cancer in men and the fourth leading cause of cancer in women worldwide.

2. Who is at risk for colorectal cancer?
There are several risk factors for developing cancer of the colon and/or rectum including:

• Age — people aged 50 and over should be screened, with frequency depending on medical history;
• Medical history — a personal history of polyps or colorectal cancer increases your risk;
• Family history — a family history of colon cancer also raises your risk of developing the disease;
• Inherited syndromes — certain syndromes such as Familial Adenosis Polyposis (FAP) also increase your chances of developing colorectal cancer;
• Ethnicity — Studies have shown higher incidence of colorectal cancer in African-Americans and Ashkenazi Jews;
• Diet & lifestyle — diets high in red meat and overcooked foods, smoking, obesity, heavy alcohol consumption are all risk factors;
• Overall health — underlying conditions like type 2 diabetes can increase your chances of developing colon and/or rectal cancer.

3. What is the treatment and survival rate for rectal cancer?
Surgery is usually the most common treatment for stages I, II and III rectal cancer — although radiation and chemotherapy will often be given before surgery to try and shrink the tumor and kill off cancerous cells in affected tissue.

There are several types of surgery for rectal cancer. Stage IV rectal cancer is treated primarily with chemotherapy and palliative surgery, if necessary. Palliative surgery provides a treatment that will relieve a problem (such as a bowel obstruction) but does not lead to a cure.  In the case of obstruction, a colostomy surgery would be performed.

4. What does it mean to have a permanent colostomy bag?
Colostomy is a surgical procedure that brings a portion of the large intestine (colon) through the abdominal wall. Waste (stools) moving through the colon drain into a bag that is attached to the abdomen. It is done when the cancer is removed from the rectum or to bypass an obstruction caused by colon cancer. 
 
Contrary to people’s perception, having a colostomy bag is hygienic and can be very discreet because the bag can be well-hidden under clothing.
 
For some patients suffering from rectal cancer, colostomy surgery may be part of a curative treatment, while for others, it may be relief for an incurable situation. But either way — patients who are candidates for this procedure often see significant improvements in their quality of life.

5. What do you think about the trend of patients trying to treat themselves with herbal remedies?
I think that including alternative treatments with conventional medicine can be very beneficial to patients as long as it’s under the guidance of a medical doctor who supports this course of treatment and monitors a patient’s progress and overall health. I certainly don’t think that alternative treatments should replace conventional therapy and patients need to be careful because there are a lot of scams out there that may or may not be harmful, and can take a financial toll.

6. What are some of the reasons a person might seek alternative treatment?
One of the most effective uses of alternative medicine in cancer patients is to alleviate pain associated medical treatment. For example, acupuncture has been proven to help with pain and other negative side effects like nausea brought on by chemotherapy or surgery. Certain types of relaxation therapy can relieve anxiety associated with a course of conventional treatment. And there are some natural herbs that aid in calming nausea or vomiting — which are often side effects of chemotherapy.

So for patients who want to use alternative medicine to alleviate negative side effects of medical treatment or to enhance the healing effects of conventional therapy — physician-monitored alternative treatments can help. But again, there is no evidence to support alternative therapies being used in place of conventional medicine — whereas we have a wealth of evidence supporting the effects of chemotherapy, radiation and surgery in the treatment of cancer.

8. What advice do you have for people thinking of skipping out on medical treatment and trying alternative therapies for cancer?
Often when people are initially diagnosed with cancer, they often don’t feel sick (especially if the cancer is caught early) so a lot of times, the thought of going through medical treatment seems beyond the realm of comprehension.

There are no regulations for alternative treatments, and in most cases, no proof they work. If doctors give a medication and patients have severe negative side effects — that medication is studied and pulled from the market. But with a lot of these herbal remedies, there is no proof that these treatments work. Each patient is different and each situation is different. So what a patient really needs to consider when they talk to their doctor about their diagnosis, is how much they really want to risk.

It comes down to what your current treatment options are, and their effect on your quality — and ultimately quantity — of life.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

I recently read an article about a cancer patient who chose to use herbal remedies over a surgical procedure that could quite possibly have saved her life. Leslee Flasch was barely 50 years old when doctors told her she would need surgery for her rectal cancer that would leave her wearing a colostomy bag for the rest of her life. She had tried other conventional therapies, but refused surgery and turned to herbal supplements she had researched on the Internet. Her condition worsened and she eventually died.

This story is just the latest in what seems to be a growing trend of alternative treatments breaking into mainstream medicine — and in some cases, replacing it. In fact, a recent report even suggests that 60 percent of cancer patients try herbal remedies — and sometimes, the consequences are deadly.

Leslee Flasch’s story has prompted some questions about colorectal cancer and about the treatment of cancers with alternative therapies, so I sat down to answer some of them here. 

1. What is the difference between colon cancer and rectal cancer?
Colon and rectal cancers are actually very similar — but the difference lies in what part of the large intestine the cancer affects. The colon and rectum make up a long, muscular tube that most people know as the large intestine. The first part of the large intestine is the colon and at the end of it is the rectum.

Cancers in the colon and rectum usually grow slowly and may start as benign polyps. These polyps are found during a colonoscopy, and early removal of polyps may prevent it from becoming cancer. Over 95 percent of colon and rectal cancers start in the cells that line the inside of the large intestine.

Cancer of the colon and/or rectum is the third leading cause of cancer in men and the fourth leading cause of cancer in women worldwide.

 
2. Who is at risk for colorectal cancer?
There are several risk factors for developing cancer of the colon and/or rectum including:

• Age — people aged 50 and over should be screened, with frequency depending on medical history;
• Medical history — a personal history of polyps or colorectal cancer increases your risk;
• Family history — a family history of colon cancer also raises your risk of developing the disease;
• Inherited syndromes — certain syndromes such as Familial Adenosis Polyposis (FAP) also increase your chances of developing colorectal cancer;
• Ethnicity — Studies have shown higher incidence of colorectal cancer in African-Americans and Ashkenazi Jews;
• Diet & lifestyle — diets high in red meat and overcooked foods, smoking, obesity, heavy alcohol consumption are all risk factors;
• Overall health — underlying conditions like type 2 diabetes can increase your chances of developing colon and/or rectal cancer.

 
3. What is the treatment and survival rate for rectal cancer?
Surgery is usually the most common treatment for stages I, II and III rectal cancer — although radiation and chemotherapy will often be given before surgery to try and shrink the tumor and kill off cancerous cells in affected tissue.

There are several types of surgery for rectal cancer. Stage IV rectal cancer is treated primarily with chemotherapy and palliative surgery, if necessary. Palliative surgery provides a treatment that will relieve a problem (such as a bowel obstruction) but does not lead to a cure.  In the case of obstruction, a colostomy surgery would be performed.

4. What does it mean to have a permanent colostomy bag?
Colostomy is a surgical procedure that brings a portion of the large intestine (colon) through the abdominal wall. Waste (stools) moving through the colon drain into a bag that is attached to the abdomen. It is done when the cancer is removed from the rectum or to bypass an obstruction caused by colon cancer. 
 
Contrary to people’s perception, having a colostomy bag is hygienic and can be very discreet because the bag can be well-hidden under clothing.
 
For some patients suffering from rectal cancer, colostomy surgery may be part of a curative treatment, while for others, it may be relief for an incurable situation. But either way — patients who are candidates for this procedure often see significant improvements in their quality of life.

5. What would Leslee Flasch’s quality of life have been like if she had sought conventional treatment?
There’s still a lot we don’t know about this particular case. But I can say that If her cancer was caught in the in the early stages, the chances of her being cured would have been very good.  Colorectal cancer is almost always treatable if caught early.  She may not have required a colostomy if the cancer was treated in the very early stages when it was still small in size. 

Even in stage II and III, she could have been treated with surgery and chemotherapy and had an excellent prognosis. If she had agreed to a colostomy, she would have been able to return to her normal activities and lifestyle — and nobody would even be aware of the bag. 

In general, when treated at an early stage, most colorectal cancer patients survive at least 5 years. If the disease does not come back during this time, they are considered cured. Stages I, II, III are considered potentially curable.  Once the cancer spreads to other areas of the body (stage IV), the 5-year survival rate drops, and most cases are not curable.

6. What do you think about this trend of patients trying to treat themselves with herbal remedies?
I think that including alternative treatments with conventional medicine can be very beneficial to patients as long as it’s under the guidance of a medical doctor who supports this course of treatment and monitors a patient’s progress and overall health. I certainly don’t think that alternative treatments should replace conventional therapy and patients need to be careful because there are a lot of scams out there that may or may not be harmful, and can take a financial toll.

7. What are some of the reasons a person might seek alternative treatment?
One of the most effective uses of alternative medicine in cancer patients is to alleviate pain associated medical treatment. For example, acupuncture has been proven to help with pain and other negative side effects like nausea brought on by chemotherapy or surgery. Certain types of relaxation therapy can relieve anxiety associated with a course of conventional treatment. And there are some natural herbs that aid in calming nausea or vomiting — which are often side effects of chemotherapy.

So for patients who want to use alternative medicine to alleviate negative side effects of medical treatment or to enhance the healing effects of conventional therapy — physician-monitored alternative treatments can help. But again, there is no evidence to support alternative therapies being used in place of conventional medicine — whereas we have a wealth of evidence supporting the effects of chemotherapy, radiation and surgery in the treatment of cancer.

8. What advice do you have for people thinking of skipping out on medical treatment and trying alternative therapies for cancer?
Often when people are initially diagnosed with cancer, they often don’t feel sick (especially if the cancer is caught early) so a lot of times, the thought of going through medical treatment seems beyond the realm of comprehension.

There are no regulations for alternative treatments, and in most cases, no proof they work. If doctors give a medication and patients have severe negative side effects — that medication is studied and pulled from the market. But with a lot of these herbal remedies, there is no proof that these treatments work. Each patient is different and each situation is different. So what a patient really needs to consider when they talk to their doctor about their diagnosis, is how much they really want to risk.

It comes down to what your current treatment options are, and their effect on your quality — and ultimately quantity — of life.

Leslee Flasch is a perfect example of someone whose quality and quantity of life could have been extended by conventional therapy.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

The problem with trying to treat cancer has always been that the body does not accept cancer as something foreign. It is hard to target a tumor for destruction if you don’t recognize cancer as an invader. So traditional chemotherapies have been based on the idea that cancer is rapidly growing. Powerful drugs that destroy rapidly growing cells do well against cancer, unfortunately they also damage rapidly growing normal cells, especially the hair, stomach lining, and bone marrow – hence the usual side effects from Chemo, hair falling out, nausea, and anemia.

But the latest treatments are clever – they are based on genetic differences that lead to the production of certain abnormal proteins that promote cancer growth. They take into account that certain cancers, such as melanoma, are antigenic, meaning they have surface proteins that can be used to trigger our body’s immune system in ways that can shrink the cancer.

These treatments which are less toxic and more focused are generally better tolerated and cause less side effects. Once you convince the body that cancer is foreign, you can then provoke the immune system to fight it.

Three targeted therapies for cancer made very exciting news at the annual meeting of the American Society of Clinical Oncology this past week. First, with stomach cancer, a breakthrough treatment with the use of Herceptin, a very successful drug already in regular use for breast cancer. Herceptin targets an abnormal protein found in 1/4 of women with breast cancer and decreases recurrence in 50 percent.

This protein, (HER2) was now found in high amounts in 22 percent of patients with stomach cancer. There are 21,000 new cases a year of stomach cancer in the U.S. one million new cases worldwide. In a study out of Belgium, Herceptin used in stomach cancer patients with high amounts of this abnormal protein lived three months longer than those who weren’t treated. The risk of death decreased by 26 percent.

Second, in women with extensive breast cancer, another new option was found to be useful. PARP inhibitors are chemicals which keep cancer from repairing its damaged genes. Breast cancer patients who received this lived twice as long, an average of 9.2 months, even with extensive cancer. This treatment is exciting because it stops only the cancer from repairing itself, NOT normal tissue. It may be especially useful in patients where breast cancer is linked to specific genetic abnormalities such as BRCA gene.

Third, a cancer vaccine has been developed against lymphoma, using the body’s own immune cells to fight the cancer, was shown with a small group of patients to keep them in remission for 44 months compared to 31 months for those who didn’t receive it.

These are all preliminary studies, but they together show progress in using technology, genetics, and specific therapies to help patients based on their characteristics and not just bombing cancer with a one-size-fits-all, kill-the-cancer-before-you-kill-the-body approach.

In contrast, by using tailored treatments that take into account the specifics of a patient’s cancer, you may get a better result than the shotgun poisons of chemotherapy. The research here is early but promising.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The topic of anal cancer has gotten a lot of media attention lately because of Farrah Fawcett’s very public battle with the disease. And it’s raised a lot of important questions about advances in cancer treatment and the future for patients fighting the battle of their lives.

What is anal cancer and who is at risk for it?

Anal cancer is characterized by the growth of a tumor around the anus ― which is opening at the end of the intestinal tract — and it’s completely different from colon cancer. A large proportion of anal cancers have tested positive for human papillomavirus (HPV), which is a sexually transmitted disease, but this isn’t the only cause.

Other patient populations at a greater risk for developing anal cancer include patients with multiple sexual partners, those who participate in anal intercourse, smokers, people with immunosuppressive diseases, such as HIV, and people with chronic inflammatory bowel diseases.

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What is the treatment for anal or intestinal cancer?

If it’s caught early, the most common treatment for anal cancer is surgery. But in patients whose cancer affects the anal sphincter, having surgery to remove the tumor and cancerous cells can lead to fecal incontinence causing the need for a permanent colostomy. So often for these patients, radiation and chemotherapy may be the preferred course of treatment. For later stage anal cancers, doctors treat patients with a combination of radiation and chemotherapy.

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What is the cure rate for anal cancer?

Well ― like any cancer, early detection greatly increases the chance of survival. If it’s caught in the early stage, there is an 86 percent five year survival rate. If the cancer has spread to the lymph nodes, the survival rate decreases to 54 percent. Up to 10 percent of patients treated for anal cancer will develop cancer elsewhere in the body.

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What kind of advances are we making in cancer research?

We have made advances with regard to the surgical treatment of cancers by offering minimally invasive surgeries. In some cases, we’re able to provide surgical treatments with less negative side effects and shorter recovery time. Clinical studies have shown that other treatments like radiation and chemotherapy may be just as effective as surgery without many of the negative side effects.

With regard to medical treatments, there have certainly been advances in the kinds of treatments we’re using. New medical technologies are making it possible for doctors to individualize a patient’s treatment by studying the genetic makeup of their particular cancer — ultimately decreasing the chances of recurrence or spread of the cancer, and increasing a patient’s survival outcome.

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What are the major milestones/accomplishments we’ve seen in cancer research recently?

Well again, one of the major milestones is being able to identify the genetic makeup of cancers individual to each patient.

The other advancement is the research that’s been done in molecular-targeted therapies. These therapies target the development of cancers by inhibiting the growth of the disease at the cellular level — which we hope will be able to limit or potentially even stop the cancer from spreading.

Molecular-targeted therapy is a more specific treatment than chemotherapy, because chemo treatment kills off not only the bad cells — but also the healthy cells in the body. So with a therapy that is very specific in its attack of cancerous cells, the hope is that it should more be effective in stopping the development of the cancer.

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What are some tips for preventing cancer?

We’ve all heard it time and time again — good health comes from making healthy choices. So my first tip would be stop smoking! I’m sure I don’t have to tell you, cigarettes are full of cancer-causing agents and have been linked to the development of many cancers in the body.

Second, everything in moderation including alcohol! If you’re the kind of person who enjoys a nice cocktail, make sure you do it in moderation, which means 1 or 2 glasses — preferrably of red wine — or else,  just avoid alcohol all together.

Make healthy dietary choices. Try to maintain a diet rich in omega-3 fatty acids and fruits and vegetables. Both provide essential nutrients and antioxidants which help ward off disease. Limit the amount of read meat you consume, since high levels of it have been linked to certain cancers.

Recent studies have shown that vitamin D may play an important role protecting against the development of certain diseases. Because exposure to small amounts of sunlight causes the body to produce healthy amounts of vitamin D, people who live in cold environments or places with extended seasons of darkness may want to consider getting their vitamin D levels checked and taking supplements.

And finally — know your family history so you can better determine your risk for other cancers, because your screenings for certain cancers may start earlier than what is recommended to the general population, and preventive therapies may be an option for you.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

When I talk to cancer patients and survivors alike, I’m always inspired by their motivation, optimism and undeniable will to carry on the fight to beat their disease. Learning of a cancer diagnosis is a very hard thing for both the patient and the family.

But it’s especially hard when that patient is a child. These children face challenges on a level that most of us will never experience in our lifetime. And trying to explain to a child that they have cancer is a devastating task for both parents and health care providers.

Now imagine trying to explain a cancer diagnosis to an autistic child who now has to deal with the strict regimen of cancer therapy. His survival is completely dependent on the compassion and commitment of his parents, as well as the health care team that’s treating him.

Click here to read the report.

This is why I’m so outraged that a 9-year-old autistic boy has died from non-Hodgkins lymphoma. Jeremy Fraser lost his battle with cancer after his mother allegedly failed to provide him with the medications that he so desperately needed. Non-Hodgkins lymphoma is a very treatable cancer, but it requires adequate treatment that could range from months to a year. In fact, doctors had given Jeremy a 92 percent cure rate — assuming his mother would do her part in helping him complete treatment.

According to the reports that I have read, Jeremy was heading in the right direction, but was supposed to follow up at home with a very crucial phase in the treatment. But after his mother canceled a dozen chemotherapy appointments, and neglected to fill at least half of the prescriptions vital to the success of Jeremy’s treatment, he was returned to the hospital with only a 10 percent chance of survival — and in the end, it was too late.

I’m certainly mad at the lack of parenting skills that Jeremy’s mother has shown, but I don’t know if I should also be mad at the health care center that was treating him. Where was the follow up? Why not try to find out how this child is — especially if he has missed several appointments for chemotherapy treatment?

A child with cancer has died — not because if his disease — but because the negligence of the adults that should have been looking out for his well being. May God bless him and keep him safe.

CHICAGO — One look at Eileen Mulligan lying soberly on the exam table and Dr. John Marshall knew the time for the Big Talk had arrived.

He began gently. The chemotherapy is not helping. The cancer is advanced. There are no good options left to try. It would be good to look into hospice care.

“At first I was really shocked. But after, I thought it was a really good way of handling a situation like that,” said Mulligan, who now is making a “bucket list” – things to do before she dies. Top priority: getting her busy sons to come for a weekend at her Washington, D.C., home.

Many people do not get such straight talk from doctors, who often think they are doing patients a favor by keeping hope alive.

New research shows they are wrong.

When Suzanne Penney was diagnosed with leukemia after she battled breast cancer, she decided to undergo an injection of umbilical stem cells – and the procedure saved her life, KNSD-TV reported Thursday.

Penney, who lives in Carlsbad, Calif., contracted leukemia as a result of the aggressive chemotherapy she received for her breast cancer.

“When information about stem cells first came out I was against it,” Penney told KNSD-TV. “I always thought, ‘don’t mess with Mother Nature, and there’s going to be a bunch of cloned people walking around.’”

But, today, as Penney recovers in the hospital, doctors tell her that her leukemia is in remission.