The threat to US presidential candidate John McCain's life posed by his history of the skin cancer melanoma is detailed in Correspondence published in this week's edition of The Lancet, written by Dr John Alam*, Cambridge, MA, USA. Dr Alam is a registered Democrat who has made voluntary financial contributions to the maximum amounts allowable under US law to both the Obama campaign and the Democratic National Committee. The work in support of the Correspondence was conducted independently by Dr Alam and without financial support from any source.
The age and health status of 72-year-old Senator McCain has been a subject of much debate in the media. On the one hand, it is claimed that neither his age nor his health history are an issue and he is fit and ready to be president; on the other, it has been suggested that, should he be elected, tragedy could strike and he could die in office, which would leave Sarah Palin as president.
In the Correspondence, Dr Alam looks at McCain's battle with skin cancer some eight years ago. He had a high-risk skin tumour (cutaneous melanoma) removed in August 2000. Dr Alam says: "McCain's physicians provided a brief summary of his health status in May, 2008. Although the summary presents limited information on the lesion removed in August, 2000, (ulceration and histology status are not provided), sufficient information is given to use the 10-year prognostic model developed by Schuchter. McCain's melanoma fell into the higher-risk categories identified in that study: the tumour was 2.2mm thick, placing it into the second highest risk category (T3); McCain was older than 60 years at diagnosis; he is male; and his lesion was not on an extremity. As a result, using the prognostic model, his predicted 10-year-survival at the time of diagnosis was only 24%".
Initially, Dr Alam uses the model to predict the mortality risk to McCain as 12% per year for the next two years, and would remain so for several years thereafter. However, he acknowledges that one of the limitations of the model is that the patient experience that was utilized to develop the model was generally from the era prior to the use of sentinel lymph node (SLN) biopsy, which indicates whether the cancer had spread. Senator McCain did have SLN biopsy, which indicated his cancer had not spread. Dr Alam refers to two reports and says that this means McCain's prospects improve considerably, as SLN-negative patients have a mortality risk around half that of SLN-positive patients. Dr Alam concludes: "If we assume that this trend is maintained long-term, McCain's mortality risk due to melanoma is better but not eliminated, remaining at 6% per year."
Dr John Alam, Cambridge, MA, USA, T) +1 617-547-1061 E) jalam@comcast.net
Notes to editors: *Dr. Alam is currently an independent consultant to the biotechnology industry on matters relating to clinical trial design and analysis. Dr. Alam has 17 years' experience conducting clinical research within US biotechnology companies. From 1997 to 2008 he was at Vertex Pharmaceuticals Inc., where he most recently was Chief Medical Officer and Executive Vice President, Medicines Development. From 1991 to 1997, Dr. Alam held a variety of positions with Biogen, Inc., including Director of Medical Research and Program Executive for Avonex (interferon beta-1a).
Prior to joining the biotechnology industry, Dr. Alam was a research fellow at the Dana Farber Cancer Institute and had completed an internal medicine residency at The Brigham and Women's Hospital in Boston. He is a licensed physician in the Commonwealth of Massachusetts and is board-certified in internal medicine. Dr. Alam holds an M.D. with Distinction from Northwestern University Medical School and an S.B. in chemical engineering from the Massachusetts Institute of Technology.
Full correspondence: http://press.thelancet.com/mccainletterfinal%20.pdf
Journal
The Lancet