In my day-to-day clinical herbal work, I find myself often as much a researcher as a practitioner. I am constantly reading and seeking out information and trying to join the dots what I’m learning to better understand the lived experience of my patience. I subscribe to several medical news feeds that keep me up to date with a lot of new thinking in cancer care. I try to learn something new every day.
These blog posts are intermittent and irregular according to what I am reading and thinking, and how it is shaping and informing and deepening my clinical practice.
As I find interesting articles that help me to help my patients, I post them here with a short commentary or discussion about their clinical utility. Some of it may be quite focused towards herbal medicine, some of it more about managing conventional cancer care, some of it will be about testing and interpreting results, some of it will be about the healing power of walking in the woods. The wide range of my clinical experience is reflected in the scope and breadth of the reports.
Pap smears to detect ovarian cancer
Overview
The online platform of the Journal of the American Medical Association has published a report suggesting that DNA from samples collected for Pap smears can be used to predict likelihood of high-grade, serous ovarian cancer up to nine years in advance.
The study was quite small, just 77 healthy women and 113 asymptomatic women who subsequently developed ovarian cancer, but it did show a strong correlation. The researchers created a diagnostic test known as the EVA (Early oVArian) cancer test, which has a sensitivity of 75% and specificity of 96%.
https://jamanetwork.com/channels/medical-news
December 27, 2023. doi:10.1001/jama.2023.25767
Medical News in Brief, December 27, 2023,, Test Using Routine Pap Smears Could Diagnose Ovarian Cancer Early, Emily Harris
Commentary
One of the clinical implications of this test may be that it can help guide decisions about elective oophorectomy. Women who have a strong family history of reproductive cancers, or of immediate relatives with BRCA 1 or 2 gene mutation, or who themselves test positive for BRCA 1 or 2 gene mutations that put them at higher risk of ovarian cancer, are often advised to remove the ovaries before any cancer shows up. This is not a decision to undertake lightly, at least in premenopausal women because there are consequences and side effects and other risk factors still to consider. It is possible that this new test could help to understand the risk profile a bit better and reassure patients about the choices they are making.
Working on the basis that information and knowledge is empowering, and that to make informed decisions about your own healthcare you need to understand the situation and implications, this is an exciting and innovative piece of research that should have great clinical application.
Risk of breast cancer from a drug used to treat Hodgkins lymphoma
Overview
Doxorubicin is a powerful chemotherapy drug routinely used as part of a chemo cocktail to treat Hodgkins lymphoma as well as several types of solid tumor. While the treatment is often quite successful, patients that survive the lymphoma may then go develop to breast cancer decades later. The authors of the study state that
“Women treated with doxorubicin for HL had a 40% higher risk for later breast cancer, and that risk was independent of age of treatment, receipt of chest radiation, and the use of gonadotoxic agents.
The risk for breast cancer with doxorubicin was dose-dependent, with each 100 mg/m2 dose increment increasing the risk by 18%. “
Journal of Clinical Oncology, February 15, 2024, Doxorubicin Exposure and Breast Cancer Risk in Survivors of Adolescent and Adult Hodgkin Lymphoma, Suzanne I.M. Neppelenbroek, MD et al https://doi.org/10.1200/JCO.23.01386
Commentary
The most interesting part of this study is that it took over 20 years for the elevated risk for breast cancer following treatment with doxorubicin to become apparent. After 30 years of follow-up, one in five survivors (20.8%) had developed breast cancer.
Given how many people have been given this drug over the decades since it was approved, this sounds like a crisis waiting to happen.
Doxorubicin is in a class of chemo drugs called the anthracyclines, and they have long been known to cause significant cardiac muscle damage a few years after use. When my patients take this class of chemo I recommend lots of cardiac tonics both during and for years after treatment. Hawthorn leaf, flower and berry are the most important – leaf and flower for supporting rate and rhythm, berry for strengthening the heart muscle, tissues and valves, rhodiola as an adaptogen with cardioprotective qualities, ginkgo for enhanced oxygenation, arjuna as a powerful cardiac tonic (structure and function), plus the supplements vitamin E, CoQ10, Acetyl-l-carnitine and taurine.
Of course I ask about past drugs history in all my patients, and follow up on known side effects, but now if they have taken doxorubicin I shall be sure to screen for breast cancer as well as heart disease.