A project co-created by University of Colorado Cancer Center leader Jamie Studts, PhD, to boost lung cancer screening rates in Kentucky has proven so successful that Studts has received a grant from the Bristol Myers Squibb Foundation (BMSF) to create an enhanced version of the program that will roll out in two more states in the coming years.
When his mom fell off a ladder on New Year’s Eve a number of years ago, after deciding that was as good a night as any to clean the leaves from her gutters, one of the first things Ross Camidge, MD, PhD, did after she got home from the hospital was take her pulse.
New research from the University of Colorado (CU) Cancer Center highlights the need for additional data collection for women hoping to have successful pregnancies while undergoing treatment for lung cancer. Specifically, they focus on the diagnosis of advanced oncogene-driven non-small cell lung cancer (NSCLC) that disproportionately affects women of reproductive age.
A team of scientists and University of Colorado Cancer Center members are collaborating to understand pre-malignancy in lung cancer and decrease the risk of developing the disease, supported by a grant to promote such multi-investigator research.
Deaths from COVID-19 and drug overdoses grabbed a lot of the headlines in 2021, but recently released numbers from the Colorado Department of Public Health and Environment show that cancer was still a leading cause of death in the state, and the number-one cause of death for the 45–84 age range.
A new study from the University of Colorado Cancer Center explores which lung cancer patients are the best candidates for novel therapies that directly target a gene identified as driving certain cancers.
This year, lung cancer will account for an estimated 130,000 deaths in the United States – approximately 25% of all cancer deaths. Among those deaths, people who are Black will be disproportionately represented.
The American Cancer Society (ACS) released its annual cancer statistics last week, reporting that the risk of dying from cancer in the U.S. has fallen 32% over the past 28 years. Cancer deaths in the U.S. reached their peak in 1991, with 215 out of every 100,000 people dying from cancer, and have been falling ever since, largely due to a decline in the amount of people who smoke.
At her lowest point, after hearing there wasn’t much more that medicine or science could do for her, Connie Walters asked her best friend and ex-husband, Abel, to stay with her overnight. She wasn’t sure she would wake up and she didn’t want to die alone.
Lung cancer screening is recommended only for those who are at high risk for the disease — adults ages 50–80 who smoke at least 20 packs a year — but even among members of that high-risk group, screening rates remain low, ranging from 5% to 20% of those eligible for the screening CT scan.
There are two things most people believe about lung cancer, says Jamie Studts, PhD, co-leader of the Cancer Prevention & Control Program at the CU Cancer Center: Those who suffer from it most likely caused it by using tobacco, and the prognosis for surviving the disease is poor.
One of the reasons why cancer continues developing and growing is not just because cancer cells exist, but because they can recruit help from the body’s own blood vessels, stromal cells, and immune cells.
David Kooyman transferred his care to University of Colorado Cancer Center member and associate professor of thoracic oncology, Tejas Patil, MD, to be part of a clinical trial to help with his rare lung cancer gene fusion.
A new phase 3 randomized clinical trial overseen by CU Cancer Center member Chad Rusthoven, MD, and Vinai Gondi, MD, from Northwestern University, is testing whether a new treatment approach could result in improved outcomes for patients with small cell lung cancer (SCLC) that has spread to the brain.
Paul A. Bunn, Jr, distinguished professor, James Dudley Chair in Lung Cancer Research, Division of Medical Oncology, University of Colorado and a 2014 Giant of Cancer Care® in Lung Cancer, highlights encouraging data with fam-trastuzumab deruxtecan-nxki (Enhertu) in HER2-mutant non–small cell lung cancer (NSCLC).
Lung cancer is the deadliest cancer in the United States. In Colorado more than 2,500 people will be diagnosed with the disease and more than 1,400 will die of it in 2020. While advances in lung cancer treatment have gifted many patients with more time, the benefit of these treatments is limited by the racial and socioeconomic status of some patients in Colorado. A new study at the University of Colorado Cancer Center focuses on reducing disparities in lung cancer patients with diverse backgrounds.
University of Colorado radiation oncologist Chad Rusthoven, MD, was recently awarded the prestigious Dr. Charles A. Coltman Jr. research fellowship award from the Hope Foundation for Cancer Research. The award provides two years of salary support to engage early career investigators from Southwest Oncology Group (SWOG) affiliated institutions in clinical trial research.
The international First-line Radiosurgery for Small-Cell Lung Cancer (FIRE-SCLC) analysis led by University of Colorado Cancer Center researchers and published today in JAMA Oncology details clinical outcomes for 710 patients with brain metastases from small cell lung cancer treated with first-line stereotactic radiosurgery (SRS), without prior treatment with whole-brain radiation (WBRT) or prophylactic cranial irradiation (PCI).
March 5th: The first confirmed case of COVID-19 in Colorado is reported in a young man who had been on vacation to Italy before continuing his vacation amid the skiing and snowboarding crowds up in Vail.
March 10th: While I am in my lung cancer clinic, I get an email from Harry Ren, a doctor from the Shanghai Pulmonary Hospital who had worked with us previously. He had heard COVID-19 was in Colorado. Harry warns me to wear protective equipment, to keep myself and the team safe. Over 3,000 Chinese doctors and nurses have gotten sick from COVID-19.
March 11th: The World Health Organization officially labels COVID-19 a pandemic.
March 12th: We admit our first lung cancer patient with COVID-19 symptoms – a potential “patient zero” for us. Bert, short for Roberta, is a wonderful 77-year old retired publisher, who appeared to be responding to her treatment but then developed increasingly difficult breathing and low-grade fevers over a week.1 On her CT scan there are new infiltrates in both lungs. She had received immunotherapy together with her last chemotherapy which can cause inflammation in the lungs. We send blood tests for different infections, including COVID-19.
Bert is stabilized and kept under isolation conditions. Steroids, which can be used to treat inflammation in the lungs, but which could worsen some infections, are kept in reserve while the test results are awaited.
March 16th: All my work meetings have become virtual. From our respective rooms and offices, the clinical and research teams discuss ongoing clinical trial accruals; then new and difficult cases in our weekly Tumor Board.
March 17th: My clinic has changed dramatically. I see a fraction of the patients I would normally see in person; the rest are through telehealth appointments. Our scheduler jokes that tech support for older patients has now become an everyday part of her job.
March 19th: There is little traffic and I get rock star parking at the clinic. We still do not have the COVID-19 results back on Bert. It has been 7 days since she was admitted. Her other infectious tests are all negative.
I do my usual phone call with the thoracic oncology consortium that I direct – 14 University Hospitals and Cancer Centers across the USA and Canada. Patient accruals to clinical trials are down. Everything is becoming bottlenecked. Patients are scared. Staff are scared. However, the feeling on the call is that, as doctors, this is what we went to medical school for.
Because medical situations are the explosions we run toward rather than away from. In medicine, we are used to chaos. We are used to finding and protecting the possible, under a barrage of the uncontrollable, the impossible.
On the call among my colleagues, we all feel as if we are the shepherds of our own flocks. Patients with lung cancer are, in theory, no more susceptible to catch COVID-19 than anyone else, but if they do catch it, they will have a higher risk of dealing with the worst of the symptoms COVID-19 has to offer.
I finish off the day with a Remote Second Opinion from Israel.2 In Haifa, the patient and her children are now faced with not just the stress of her lung cancer growing, but a new kind of stressor. To determine the next best treatment would require a biopsy but going into the hospital to get this done could increase her risks of COVID-19 infection. To not get the biopsy would mean hunkering down with a progressing cancer or switching straight to chemotherapy in the absence of rational alternatives. The risks they are most worried about all relate to catching COVID-19. The risks from her progressing cancer appear clearer.
There are internet adverts for virus killing light-wands. Hydroxy-chloroquine, an anti-malarial and anti-inflammatory agent, is being thrown around as a possible ‘treatment’ for COVID-19 without any debate about the source or extent of the data available to support these claims. I revisit how patients with cancer can fall prey to promises of miraculous results from unproven treatments simply because they so desperately want the good news to be true.
March 21st: I get Bert’s COVID-19 test result back. She is negative. She finally starts steroids and her treatment can move on. It took 9 days to get her results back and we can only test people who are in-patients in the hospital. Any attempt to halt the spread of the virus by isolating known positive people using these tools is doomed to failure.3 Instead we have only one solution for the entire population: Keep distant, keep clean.
March 26th: Colorado as a state is ordered to stay at home. In the Cancer Center, we set in place jeopardy and double, triple and quadruple jeopardy plans. Who covers whose patients in the event one of our lung cancer doctors gets quarantined or sick. We even establish back-ups across other tumor-types in case whole teams are incapacitated.
March 31st: My thoughts on the similarities between how we are all dealing with COVID-19 worldwide and what patients with cancer have already been through from the moment they were diagnosed crystalize after a particular conversation in the clinic. The patient said to me, “Now you know what it’s like:”
This is what not knowing whether you will be well next month or on the verge of death feels like.
This is what not knowing if you will be financially ok or ruined because of matters beyond your control feels like.
This is what worrying that every minor symptom is the start of something far more deadly feels like.
This is what consuming every piece of news, hoping for a breakthrough, knowing that most of the breakthroughs you find are not real, but you still consume them because anything is better than nothing, feels like.
This is what watching others die and wondering if you will be next feels like.
But now we have to worry about COVID-19 as well.
That same day I see Bert again. She looks great and feels great. Her treatment, without the immunotherapy, is set to continue. Life goes on.
It didn’t take long for Jamie Studts, PhD, to notice a big difference between Kentucky, where he worked for 13 years in the Department of Behavioral Science at the University of Kentucky College of Medicine, and Colorado, where he was recently appointed Co-Leader of the CU Cancer Center Cancer Prevention & Control Program: “After my recruitment, I was on a visit to search for a house and I went to a bar with some family who live in the area. Outside there were 100 people and not one of them was smoking. There were maybe two or three people vaping, but nobody was smoking. That’s pretty different in Kentucky,” he says.
The use of PET-CT imaging gives doctors the best possible picture of non-small cell lung cancer (NSCLC), and this accurate imaging helps to match patients with the best treatments. Unfortunately, not every NSCLC patient gets the recommended PET-CT imaging. Now a University of Colorado Cancer Center study published in the Journal of the National Cancer Institute shows an important predictor of PET-CT use: African American patients were only about half as likely as non-Hispanic whites to receive this important imaging; Hispanics received this imaging about 70 percent as frequently as non-Hispanic whites.
Pooled analysis of three phase 1 and 2 clinical trials published online ahead of print in the journal Lancet Oncology show that the drug entrectinib is effective and well-tolerated against advanced ROS1 and NTRK fusion-positive non-small cell lung cancers (NSCLC). Results of the trials STARTRK-1 (NCT02097810), STARTRK-2 (NCT02568267), and ALKA, show 77 percent response rate to entrectinib in 53 patients with ROS1+ NSCLC, with a median progression-free survival of 19 months and a median duration of response of 24.6 months. In 54 patients with NTRK+ NSCLC, 57 percent responded to entrectinib, with a median progression-free survival of 11.2 months and a median duration of response of 10.4 months. Based on the early promise of these trials, in August 2019 the U.S. Food and Drug Administration granted entrectinib accelerated approval for the treatment of metastatic ROS1+ NSCLC and for advanced tumors across cancer types defined by NTRK fusion. The current journal articles update these findings that led to approval.
If Nancee Pronsati had been diagnosed with stage IV ALK-positive lung cancer a decade ago, her years of life expectancy would have been measured with fewer fingers than it takes to make a peace sign. But due to advances in genetically targeted therapies, many driven by research and testing at University of Colorado Cancer Center, Nancee is 3.5 years out from diagnosis and doing well. In honor of November’s Lung Cancer Awareness month, Nancee and her husband, Paul, are giving back to CU Cancer Center research programs that are developing the next generation of treatments against ALK-positive lung cancer.
“I was diagnosed when living in New York City and started treatment at Memorial Sloan Kettering,” Nancee says. “But my thoracic oncologist there knew I was from Denver and encouraged me to come home for treatment due to the incredible researchers and doctors here.”
In fact, CU Cancer Center has become an internationally recognized leader in the treatment of lung cancers driven by specific genetic alterations. The gene ALK is one of these alterations – when it becomes accidentally fused together with a partner called EML4, the resulting ALK-EML4 fusion gene makes the blueprint for a cancer-causing protein. CU researchers including D. Ross Camidge, MD, PhD, and Robert C. Doebele, MD, PhD have been at the forefront of testing drugs that silence the action of ALK, leading to FDA approvals for drugs like crizotinib, alectinib, brigatinib, and lorlatinib.
“I’m very active in a social media group for ALK-positive lung cancer patients, and everyone knows that Dr. Camidge is one of the only choices for a second opinion. It’s just accidental where I live. It’s been amazing to hear people from all over the country talking about the treatment here in Colorado,” Nancee says. (Many lung cancer patients access these second opinions without traveling, through CU Cancer Center’s Remote Second Opinion Program.)
One of the people Nancee and Paul met through their involvement with Denver’s ALK-positive community is Emily Daniels, also a patient of Dr. Camidge.
“Emily live near each other and walk together sometimes,” Nancee says.
During her treatments, Emily has worked with University of Colorado to set up a fund specifically supporting ALK-positive lung cancer research, along with the annual Links for Lungs golf tournament to raise for the fund (2019 sold out quick! Keep your eyes peeled for 2020). This November, Nancee and Paul decided to infuse another $100,000 into Emily’s fund for ALK-positive cancer research.
“Paul and I decided to donate to that part of the Lung Cancer Colorado Fund primarily because we liked the idea of all of the ALK-designated donations being consolidated as much as possible,” Nancee says.
“Seeing what Dr. Camidge and his team were able to do when Emily’s life was hanging in the balance – they were able to move with agility and creativity, and basically save her life – that’s a really compelling story,” Paul says. “The same thing could happen to Nancee. These targeted therapies don’t work forever, and when you see the team’s track record in figuring out what to do next, on the fly, to save that person’s life, that’s proof that our contribution is going to the right place.”
In addition to laboratory work, the fund supports the development of investigator-initiated clinical trials, a special class of clinical trial based on a researcher’s own findings or observations. Unlike trials sponsored by large pharmaceutical companies, investigator-initiated clinical trials tend to be nimble, moving promising treatment hypotheses quickly from pre-clinical testing directly into hospital settings where they can benefit patients.
“Dr. Camidge’s team is able to act quickly if they have an idea – combining existing drugs or testing some new theory – and that’s exciting for us. With a terminal disease, you want to move quickly, at the same time these other more measured approaches are being funded by drug companies,” Paul says.
In addition to skiing and craft breweries, Denver has become known for its community of researchers, doctors, and patients focused on the genetic alterations that drive lung cancer.
“These are people who are fighting for their lives every single day and they’re not just talking about it, they’re doing things. You feel a measure of pride in the community. The ferocity and passion, it’s cool,” Paul says.
It’s the ferocity and passion of people like Nancee and Paul Pronsati that will help to ensure that new treatments against the disease continue to come from Colorado.
Genetically targeted drugs and immunotherapies are transforming the way we treat many forms of lung cancer. However, a University of Colorado Cancer Center study published in the Journal of the National Cancer Institute shows that while the use of these drugs rose 27 percent from 2007 to 2015, new, high-cost lung cancer drugs are not used equally in all places, with all patients. Patients who lived in high-poverty areas were 4 percent less likely to be treated with high-cost lung cancer drugs. On the other hand, patients treated at National Cancer Institute-designated cancer centers were 10 percent more likely to be given these drugs than were patients treated in other settings.
“I have good news and bad news,” the ER doctor told me. I had been sent to the ER under the suspicion of a heart attack because of chest pains. “We took an x-ray of your chest. The good news is that your heart is fine. However, we found a large mass in your left lung. You probably have lung cancer. You should see someone about that.” Then he handed me a prescription for a very powerful pain killer. I did not see that as a good omen.
Within a few days I had the PET scan and the biopsy to confirm the diagnosis: non-small cell lung cancer. It had already metastasized to my spine and my ribs (the cause of my chest pains). I was Stage IV from the initial diagnosis.
My first meeting with the community oncologist was not real upbeat. I was warned to stay off the internet because I would only find the dismal survival statistics. The best they could offer was the standard of care chemotherapy, a doublet of a platinum-based chemo drug paired with another drug.
Of course I didn’t stay off the internet. I researched what were the “new and exciting” lung cancer treatments. I learned about gene mutations that could drive the growth of a cancer. Ones such as EGFR and ALK were responsible for some lung cancers. And for these there were already drugs available to treat, a class of drugs called inhibitors.
I also researched what cancer centers and what doctors were the experts in treating lung cancer and were doing research into new treatments. The University of Colorado Cancer Center was often on the top of the list. Additionally, I found that Dr. Ross Camidge was a leader in the research and practice around the overall treatment of lung cancer and specifically the treatment of mutation-driven cancers. And best of all, this was practically in my own backyard, a mere 60 miles from northern Colorado.
It was amazingly easy to get an appointment with Dr. Camidge. He educated me about the mutations that had been identified in NSCLC. And what drugs were available to treat which mutations. Another biopsy was scheduled and a molecular analysis to determine what actionable mutations, if any, I might have.
It was indeed my lucky day (if there is such a thing for someone with lung cancer) when he informed me that I was ALK positive. And there was an inhibitor to treat it. The drug crizotinib had been approved by the FDA just the previous last year. I started on it and my next scan showed great results. I was sent back to my local oncologist. Dr. Camidge said to return when my cancer comes back.
Inhibitors are truly wonder drugs. A few pills each day. And overall less-severe side effects than traditional chemotherapy. But they have a limitation. Almost invariably, resistance to the drug will develop. Minor mutations in the gene driving the cancer disable the drug’s therapeutic power. And the cancer comes back.
After about three years of life as normal, routine scans showed that my cancer was back. I had developed resistance to crizotinib. I returned to UCH and Dr. Camidge. He told me about a new ALK-inhibitor that was then in clinical trials. Brigatinib was successful in overcoming the resistance to crizotinib. He offered me the opportunity to enter the clinical trial.
I had several motivations to enroll in a clinical trial. Most importantly, it would provide access to a drug that potentially control my cancer. It’s also an important way that the practice of medicine can make scientific progress. I had run across many claims for cancer treatments that were based on limited, inaccurate, or anecdotal data. A clinical trial is the standard by how claims of efficacy are judged. The data is collected according to a very precisely defined protocol. The results are presented at professional conferences and published in established medical journals.
The clinical trial also allowed me to work more closely with the doctors, staff, and trial coordinators. I received wonderful support. Appointments were scheduled for me. The drugs were handed to me. I didn’t have to deal with insurance for anything related to the trial. I was responsible for only the standard of care items that I would have had regardless of my trial participation.
And then there’s the economic motivation to participate in a trial. You not only get access to the drug that could save your life, but in most cases the drug is provided by the drug manufacturer at no cost.
Brigatinib controlled my cancer for a year before I showed progression. Next up was the lorlatinib clinical trial. Lorlatinib is a third-generation ALK inhibitor and showed promise of working after brigatinib. I came off brigatinib, signed the paperwork, and a few weeks later started lorlatinib. Many more tests were involved. I had more scans and blood work. I spent a day at the hospital having my heart activity tracked via EKG after I took the dose of lorlatinib. And during each visit I took cognitive tests, computer-based activities to test my reaction time and short term memory.
Lorlatinib worked great for a while. But once again I showed progression, localized in a few lymph nodes. This time, there was no next-generation drug trial to jump to. Instead we opted to use targeted radiation to zap (technical term: ablate) the suspicious lymph nodes. I became familiar with the Radiation Oncology department on the first floor of the Anschutz Cancer Pavilion. A few months later after 10 radiation treatments, my scans were clear. My cancer was under control. I was fortunate to continue on with the clinical study protocol.
I’ve repeated this process two more times. As long as lorlatinib provides overall control of my cancer and the sites of progression are localized, I will continue. My last radiation treatment was January 2019 and my scans have been coming back clear – no sign (yet) of the cancer coming back.
This treatment of using radiotherapy to treat this pattern of progression in ALK patients was pioneered here at UCH.
Over these years, I’ve been fortunate that I had an “easy” cancer. I know that for many, their cancer is anything but easy. But I’ve been able to maintain my life as normal. I continued to work for several years after diagnosis before I took an early retirement offer.
I enjoy my retired life. My wife and I travel. I travel into the mountains often. And after a hiatus of about 50 years, I’ve started camping again. It’s been great to head off to the mountains with one of my son. And this last summer, my wife has started to join me on my camping trips.
Lung cancer is the number one cause of cancer related death in both men and women in the United States. In fact, according to the American Cancer Society, more people die of lung cancer than of colon, breast, and prostate cancers combined.
Despite advances in research, there are still misconceptions about the disease. I sat down with Dr. Ross Camidge, MD, PhD, Joyce Zeff Chair in Lung Cancer Research at University of Colorado Cancer Center to discuss the most common misconceptions he encounters:
University of Colorado Cancer Center member, Tejas Patil, MD, received the John Fisher Legacy Fellowship Award at the International Association for the Study of Lung Cancer (IASLC) World Conference held in Barcelona last month. Patil is the first physician worldwide to receive the prestigious $50,000 grant, which Patil will use to further his research in detecting lung cancer recurrence in early stages.
When it comes to using radiation against lung cancer, preliminary clinical studies were pretty clear: More is better. So why did alarge phase 3 clinical trialfind exactly the opposite – that stage III non-small cell lung cancer patients treated with higher doses of radiation actually hadshorteroverall survival than patients treated with lower-dose radiation?
Crizotinib and entrectinib are both active against ROS1+ non-small cell lung cancer. But which is best? The answer seems easy: Just compare the drugs’ clinical trial results. However, not all trials are created equal, and these differences in trial designs can lead to irrelevant comparisons – like comparing athletes’ running times without noting that one ran a kilometer while the other ran a mile. Now results from an innovative, “virtual” clinical trial presented at the American Society for Clinical Oncology (ASCO) Annual Meeting 2019 attempt to place crizotinib and entrectinib on an equal playing field. In this analysis, patients taking entrectinib were able to stay on treatment longer and had about almost 6 months longer progression-free survival than patients treated with crizotinib.
Brigatinib is a next-generation ALK inhibitor that earned FDA approval in 2017 as a second-line therapy after treatment with crizotinib for ALK-positive non-small cell lung cancer. Recently, clinical trial results published in theNew England Journal of Medicineand presented at the 2018 World Conference on Lung Cancer show itspromise as a first-line therapy. However, while brigatinib is commonly well-tolerated, in about 3% of cases, patients report experiencing shortness of breath within hours of starting treatment. With severe symptoms or if even mild symptoms occur after stopping and then restarting the drug, the manufacturer’s guidelines suggest permanently ceasing use. Nowa studyby researchers at Columbia University, University of California San Diego, and University of Colorado Cancer Center, published in theJournal of Thoracic Oncology,offers insight into the seriousness and duration of these symptoms, and suggests an alternative treatment strategy that could allow more patients to benefit from this drug.
The American Association for Cancer Research (AACR)announcedtoday that in partnership with the Lung Cancer Initiative at Johnson & Johnson, it will fund a major grant led by University of Colorado Cancer Center investigators to pinpoint the lung tissue characteristics that allow cancer cells to grow, potentially leading to new strategies to prevent and treat the disease.
Emily Daniels was 32 years-old and pregnant with her second child when she was diagnosed with lung cancer. One year later, Emily presented a check for more than $100,000 to theLung Cancer Colorado Fund(LCCF) bringing the fund over the $1 million mark.
At 32 years old and 33 weeks pregnant, Emily Daniels lived the kind of life that many of us strive to achieve. With a baby boy on the way, a loving husband, a healthy and happy 3-year-old daughter, family and friends close by, a good job, and an active social life, there was much to be grateful for. By all accounts, her day-to-day was perfectly normal and just the right amount of hectic.
According to the National Cancer Institute, patients diagnosed with non-small cell lung cancer (NSCLC) between the years 1995 and 2001 had 15 percent chance of being alive 5 years later. For patients with stage IV disease, describing cancer that has spread to distant sites beyond the original tumor, that statistic drops to 2 percent. Now a University of Colorado Cancer Center study published in the Journal of Thoracic Oncology tells a much more optimistic story. For stage IV NSCLC patients whose tumors test positive for rearrangements of the gene ALK (ALK+ NSCLC), treated at UCHealth University of Colorado Hospital between 2009 and 2017, median overall survival was 6.8 years. This means that in this population, instead of only 2 percent of patients being alive 5 years after diagnosis, 50 percent of patients were alive 6.8 years after diagnosis.
For many years, oncologists have known that cancers can secrete complex molecules into the blood and that levels of these molecules can be easily measured. These so-called ‘tumor markers’ are traditionally associated with a single dominant cancer type, for example Prostate Specific Antigen (PSA) linked to prostate cancer, Carcinoembryonic antigen (CEA) to colorectal cancer, CA125 to ovarian cancer, CA19.9 to pancreatic cancer and CA27.29 to breast cancer. However, the real challenge has been to determine a practical use for these markers. They don’t appear to be useful as a means of screening otherwise healthy people for evidence of underlying cancers.