A Bridge to Health Men s Health and Cancer

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1 A Bridge to Health Men s Health and Cancer Bertrand Tuan, M.D. Pacific Hematology-Oncology Associates California Pacific Medical Center San Francisco, CA

2 Causes of Cancer Death in California Asian Men

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4 Lung Cancer Though the incidence rate for lung cancer is falling in the non-asian populations, it has remained steady from in Asians Most likely related to the prevalence of smoking in Asian males and immigrants Provocative data regarding Chest CT screening

5 Survival of Patients with Stage I Lung Cancer Detected on CT Screening NEJM 10/26/06 32,000 patients screened with spiral CT Hx of smoking, second-hand smoke or occupational exposure 412 of 484 detected lung cancers were Stage I

6 Survival of Patients with Stage I Lung Cancer Detected on CT Screening Estimated 10-year survival was 88% The 8 patients with Stage I lung cancer who refused surgery all died within 5 years Historically the 5-year survival for patients with resected Stage I lung cancer is 70% Concerns over lead-time bias, clinically insignificant tumors, and risks associated with biopsies and surgery will be answered only when the results of national randomized studies become available

7 Diagnosis and Treatment of Lung Cancer Trend is for surgery followed by chemotherapy New advances in diagnosis include endoscopic ultrasound and endobronchial ultrasound for staging. Treatment frequently with video-assisted thoracoscopic surgery We must emphasize smoking cessation

8 Common Cancers in California Asian Men

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10 Liver Cancer A leading cancer in the Southeast Asian population Is quite prevalent in other Asian male populations We need to be vigilant about screening for hepatitis B and vaccinating those at risk for infection 1 in 10 Asians has chronic Hepatitis B. 1 out of 4 of them will die of liver cancer or liver failure

11 Liver Cancer Treatment Liver transplantation remains the only means of cure Limited to 15% of liver cancer patients Current UNOS criteria limit transplants to patients with 1 tumor<5cm or up to 3 tumors <3cm. Cure rates with OLT>80% UCSF trying to broaden criteria by downstaging larger tumors

12 Liver Cancer Down-staging treatments include radiofrequency ablation, hepatic artery chemoembolization, ethanol injection For patients not eligible for transplant treatment is palliative and can also include systemic chemotherapy UCSF also is active in living-donor transplants

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16 Nasopharyngeal Cancer Though rare in the United States, is present in epidemic levels in Asia and Asian immigrants EBV-associated malignancy? role of screening for serum antibodies in high-risk individuals such as family members Curable with radiation +/- chemotherapy

17 Colon Cancer A common cancer in Asian males Screening strategies include sequential fecal occult blood vs flexible sigmoidoscopies (may be performed by the nongastroenterologist) vs colonoscopies Screening for colorectal cancer (as opposed to prostate or lung) decreases mortality and is cost-effective at $10-25K per QALY

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19 Colon Cancer Treatments Surgery followed by chemotherapy is frequently curative In addition to chemo, newer, expensive, targeted therapies against the epidermal growth-factor receptor (vectibix, erbitux) or antiangiogenesis agents (avastin) will prolong the survival of patients with advanced disease

20 Prostate Cancer Screening Has not yet been proven to improve the survival of patients. Though 1 in 6 men will get prostate cancer in their lifetime only 3% of men die of prostate cancer. Medical organizations (ACP, ACS) recommend yearly digital rectal examinations and recommend yearly PSAs only after an informed discussion

21 Prostate Cancer Treatment Decisions should be guided by risk of progression of the cancer versus the medical condition of the patient and his life expectancy. Low risk tumors (non-palpable, gleason<6, PSA<10) may warrant observation in the older patient Definitive therapy (brachytherapy, XRT, surgery, +/- androgen deprivation) should be offered to the younger patient or the patient with high-risk disease