Category Archives: Breast Cancer

Nipple aspirator

Nipple aspirate test is no substitute for mammogram – FDA

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Consumer Update from the US Food and Drug Administration

ucm378297Many women admit that getting a mammogram is no fun, and may wish there was an easier, more comfortable way to screen for breast cancer in its earliest and most treatable stages.

Some companies today are promoting a test in which a breast pump is used to collect fluid from a woman’s nipple to screen for abnormal and potentially cancerous cells. This test—called a nipple aspirate—is being marketed as the latest and greatest tool in early breast cancer screening, one that is easier, more comfortable and less painful than the mammogram.

However, there is no clinical evidence to support these claims, says David L. Lerner, M.D., a medical officer at the Food and Drug Administration (FDA) and a specialist in breast imaging.

“FDA’s concern is that the nipple aspirate test is being touted as a stand-alone tool to screen for and diagnose breast cancer as an alternative to mammography,” Lerner explains. “Our fear is that women will forgo a mammogram and have this test instead.” This could result in serious health consequences if breast cancer goes undetected, he notes.

FDA is unaware of any valid scientific data to show that nipple aspirate tests, when used on their own, are an effective screening tool for any medical condition, including the detection of breast cancer or other breast disease, Lerner says. Researchers are still studying whether these tests may one day be used, in conjunction with other medical devices, to screen for disease.

In February 2013 FDA issued a warning letter to Atossa Genetics, Inc. that, among other things, informed the company that their test was misbranded in that its labeling was false or misleading. The agency asked the firm to take prompt action to correct the violations addressed in the warning letter. In October 2013, Atossa initiated a voluntary recall to remove the ForeCYTE Breast Health Test from the market.

Unsubstantiated Claims

In addition to stating that the test can help women 18 years and older determine their risk level for breast cancer, Atossa claimed that its test was “literally a Pap smear for breast cancer.” According to FDA medical officer Michael Cummings, M.D., who reviews obstetrical and gynecological devices for the agency, this claim is unsubstantiated.

“The cervical Pap smear has a known clinical benefit supported by extensive clinical studies over many years,” Cummings says. “Its scientific ability to screen for cervical cancer is unquestioned.” The nipple aspiration test has no such evidence supporting it, he attests.

In addition, Lerner explains that if a Pap smear shows abnormal cells of the cervix, there are follow-up procedures that can be done to try to identify the location of those cells, after which a biopsy of the area is possible. With a breast nipple aspirate, if there are abnormal cells, the test does not target where those cells are coming from, so a biopsy may not be possible. Moreover, while the risk of abnormal cervical cells progressing to cancer is known, the risk of abnormal breast cells progressing to cancer is not.

Lerner says the test may produce results that are falsely positive or falsely negative. “False positives are possible because cells can be damaged in the aspiration process and look abnormal,” he notes. “We are even more concerned about false negatives,” he adds. Companies acknowledge that over 90% of their fluid samples may contain either very scant cells or no cells at all. Yet the companies call such results “diagnostically useful” and even conclude that a patient is healthy based on a cell-free sample, he says. “The test may be missing cancers and giving women dangerous false assurance,” Lerner says.

Mammography Still the Best

The mammogram can be uncomfortable for the woman being screened because it compresses the breast to flatten out the breast tissue and increase the clarity of the X-ray image. Still, FDA is not alone in believing that mammography is the most effective method for screening for breast cancer. Other organizations agree, including the American Cancer Society, the American College of Radiology (the professional society of physicians who specialize in medical imaging) and the National Cancer Institute, a division of the National Institutes of Health.

The National Cancer Institute states that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 70. The National Comprehensive Cancer Network (NCCN) 2013 guidelines state that the clinical utility of nipple aspiration is still being evaluated and that it should not be used as a breast cancer screening technique.

FDA recommends that women who have received a nipple aspirate test as a form of breast cancer screening should also have a mammogram according to screening guidelines or as recommended by their doctor, and should talk to their health care professional about whether additional tests are needed.

“The bottom line is that women should not rely solely on these nipple aspirate tests for the screening or diagnosis of breast cancer, “Lerner says. “Mammography is still the gold standard.”

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Dec. 12, 2013

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Women’s health – week 8: Breast cancer screening

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From the Office of Research on Women’s Health

Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Breast cancer is a malignant tumor that starts in cells of the breast. The disease occurs almost entirely in women, but some men develop breast cancer.

Because cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or the lymphatic system, breast cancer can spread to almost any other part of the body and be life threatening.

You can help with early detection by knowing your risk factors, including genetic ones, getting regular exams, and having mammograms of your breasts. It is also important to keep in mind that most women who have known risk factors do not get breast cancer.

Also, most women with breast cancer do not have a family history of the disease. If you think you may be at risk, you should discuss your concern with your health care provider. Your health care provider may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Scientists are still studying the exact causes of breast cancer. Research has shown that women with certain risk factors are more likely than others to develop breast cancer. These factors are:

  • Age: Risk increases with aging.
  • Personal history: Risk increases with previous history of breast cancers. A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: Risk is higher if a woman’s mother, sister, or daughter has had breast cancer. Risk is also higher if her father or brother or other relative (in either her mother’s or father’s family) has had breast cancer.
  • Genetics: Risk increases if there are changes in certain genes, including BRCA1, BRCA2, and others.
  • Childbearing: Risk may increase if a woman never had children or had her first child at an older age. Risk may also increase if a woman had her first period at an earlier age or menopause after 55 years.
  • Menopause: Risk may increase for women who take menopausal hormone therapy withestrogen plus progestin after menopause.
  • Obesity/weight: Risk increases with being overweight or obese after menopause.
  • Race/ethnicity: Risk increases based on a woman’s race/ethnicity. Breast cancer is diagnosed more often in white women than in Latina, Asian, or African American women.
  • Previous treatment with radiation: Risk increases for women who had radiation therapy to the chest (including the breasts) before age 30.
  • Breast density: Risk may increase for older women whose mammograms show more dense tissue than fatty tissue.
  • Physical fitness: Risk increases when a woman is physically inactive throughout her life.
  • Alcohol consumption: Risk increases with increased alcohol consumption. Studies suggest that the more alcohol a woman drinks, the greater her risk.
Diagram showing the breast and mammary glands.

Diagram showing the breast and mammary glands.

Common symptoms of breast cancer include:

  • A lump or thickening in or near the breast or in the underarm area.
  • Nipple tenderness.
  • A change in the size or shape of the breast.
  • A nipple turned inward into the breast.
  • Scaly, red, or swollen skin of the breast, areola, or nipple. Ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge.

Early breast cancer commonly does not cause pain. Still, you should consult with your health care provider about breast pain or any other symptom that concerns you. Most breast changes are not cancer, but it is important to check out any symptoms as early as possible.

Treatment

Surgery, radiation therapy, hormone therapy, chemotherapy, and biological therapy are all options for treating breast cancer. Be sure to consult with your health care provider before pursuing any option.

for more information: www.cancer.gov
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Women’s Health – Week 7: Breast cancer an overview

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From the Office of Research on Women’s Health

Cancer is a term used for diseases in which abnormal cells divide without control and can invade other tissues. Breast cancer is a malignant tumor that starts in cells of the breast. The disease occurs almost entirely in women, but some men develop breast cancer.

Because cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or the lymphatic system, breast cancer can spread to almost any other part of the body and be life threatening.

Diagram showing the breast and mammary glands.

Diagram showing the breast and mammary glands.

You can help with early detection by knowing your risk factors, including genetic ones, getting regular exams, and having mammograms of your breasts. It is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease.

If you think you may be at risk, you should discuss your concern with your health care provider. Your health care provider may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Scientists are still studying the exact causes of breast cancer. Research has shown that women with certain risk factors are more likely than others to develop breast cancer. These factors are:

  • Age: Risk increases with aging.
  • Personal history: Risk increases with previous history of breast cancers. A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
  • Family history: Risk is higher if a woman’s mother, sister, or daughter has had breast cancer. Risk is also higher if her father or brother or other relative (in either her mother’s or father’s family) has had breast cancer.
  • Genetics: Risk increases if there are changes in certain genes, including BRCA1, BRCA2, and others.
  • Childbearing: Risk may increase if a woman never had children or had her first child at an older age. Risk may also increase if a woman had her first period at an earlier age or menopause after 55 years.
  • Menopause: Risk may increase for women who take menopausal hormone therapy withestrogen plus progestin after menopause.
  • Obesity/weight: Risk increases with being overweight or obese after menopause.
  • Race/ethnicity: Risk increases based on a woman’s race/ethnicity. Breast cancer is diagnosed more often in white women than in Latina, Asian, or African American women.
  • Previous treatment with radiation: Risk increases for women who had radiation therapy to the chest (including the breasts) before age 30.
  • Breast density: Risk may increase for older women whose mammograms show more dense tissue than fatty tissue.
  • Physical fitness: Risk increases when a woman is physically inactive throughout her life.
  • Alcohol consumption: Risk increases with increased alcohol consumption. Studies suggest that the more alcohol a woman drinks, the greater her risk.

Common symptoms of breast cancer include:

  • A lump or thickening in or near the breast or in the underarm area.
  • Nipple tenderness.
  • A change in the size or shape of the breast.
  • A nipple turned inward into the breast.
  • Scaly, red, or swollen skin of the breast, areola, or nipple. Ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge.

Early breast cancer commonly does not cause pain. Still, you should consult with your health care provider about breast pain or any other symptom that concerns you. Most breast changes are not cancer, but it is important to check out any symptoms as early as possible.

Treatment

Surgery, radiation therapy, hormone therapy, chemotherapy, and biological therapy are all options for treating breast cancer. Be sure to consult with your health care provider before pursuing any option.

for more information: www.cancer.gov
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8 Ways Young Women Benefit From Obamacare – Cosmopolitan

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By Phil Galewitz
KHN Staff Writer

This KHN story was produced in partnership with 

number 8You’ve heard people arguing about Obamacare (officially known as The Affordable Care Act or ACA) for months … but you may have tuned it all out, because it’s all so confusing and you don’t even know how — or if — it affects you.

But starting in 2014, the law will require people who can afford insurance to carry it or risk paying a fine, so now’s the time to pay attention.

And the fact is, you may discover that there are lots of benefits you’ll be able to take advantage of. Here’s a quick list of what’s great about the ACA, especially for young women:

  • You can stay on your parents’ health policy until you turn 26. Previously, most insurers did not allow young adults beyond age 21 to stay on their parents’ policies. More than 3 million young adults have gained coverage since this provision went into effect in 2010. Your parents will be charged the same rates as when you were younger. You can be covered by their policy even if you’re married, but the coverage won’t extend to your spouse.
  • You’re entitled to free preventive care, including birth control. Since 2012, nearly 30 million women have benefitted from free preventive services including checkups, screenings for diabetes and HIV, contraceptives and family planning counseling. The law requires plans to cover all FDA-approved birth control methods without co-pays. This includes pills, injectables, implants, intrauterine devices (IUDs), and sterilization procedures. Plans must cover all brand name contraceptives without generic equivalents, or where the generic equivalent is medically inappropriate. Certain religious employers are exempt from the birth control requirement.
  • You may be eligible for government discounts on insurance. Starting Oct. 1, new online health insurance exchanges will go live in every state, selling coverage that will take effect Jan. 1, 2014. The exchanges will allow you to compare prices and benefits to find an insurance plan you can afford that fits your needs; if you still feel you can’t afford it, you can find out whether you’re entitled to a federal tax credit based on your income. The lower your income, the higher the tax credit. You can get the discount at the time you enroll. Find information on your state exchange here.
  • You’ll have maternity coverage, no matter what. You may not know this but only about 12 percent of health plans sold on the individual market currently include coverage for maternity, according to Judy Waxman of the National Women’s Law Center. But starting next year, all individual health plans will have to include 10 essential health benefits including maternity care, as well as hospitalization, prescription drugs, mental health services and preventive services.
  • You can’t be charged more than a guy. In most states, insurers are currently allowed to charge women more than men for individual coverage. According to the National Women’s Law Center, in 30 percent of cases, nonsmoking women were charged more than men who smoked. Such gender rating will be outlawed starting next year.
  • You can’t be rejected for having a “pre-existing condition.” Today, insurers can deny you health insurance if you have a chronic condition such as asthma or diabetes (in which case you’re considered a health risk); if they do accept you regardless of these conditions, they can still charge you more for coverage. But starting next year it will be illegal for them to penalize you this way; health premiums may vary based on three factors only: age, where you live, and whether you’re a smoker.
  • If you are an individual who makes under $16,000 a year, you may be eligible for Medicaid. Medicaid is the state-federal health insurance program for the poor, and it’s being expanded by the law to those whose annual income is under the federal poverty level. However, because the Supreme Court ruled that the expansion is optional for states, only about half of them are participating. Check out this infographic to see if yours is one of them.
  • If you’re a breastfeeding mom, you can pump at work more comfortably. Since 2011, the law has required employers to provide a “reasonable break time” and a private place (not a bathroom) for you to pump breast milk during the workday. The law also requires health plans to cover the costs of breastfeeding equipment and breastfeeding counseling without a copay.

One final note: not everyone will see immediate coverage changes; many of you who get your insurance through your job are in “grandfathered” plans, which are exempt from some of the rules. Ask your company’s health benefits administrator if this is the case for you.

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Baby boomers can take steps to live long and healthy lives – CDC

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Aging and Health in America, 2013

Longer life spans and aging baby boomers will combine to double the population of older Americans during the next 25 years to about 72 million.

Heart disease, cancer, stroke, chronic lower respiratory diseases, Alzheimer’s disease and diabetes continue to be the leading cause of death among older adults.

State of Aging and Health in America 2013 Adobe PDF file [PDF - 3 MB] provides a snapshot of our nation’s progress in promoting prevention, improving the health and well-being of older adults, and reducing behaviors that contribute to premature death and disability.

The report looks at 15 key health indicators that address health status (physically unhealthy days, frequent mental distress, oral health and disability); health behaviors (physical inactivity, nutrition, obesity and smoking); preventive care and screening (flu and pneumonia vaccine, breast and colorectal cancer screening); and fall injuries for Americans aged 65 years or older.

As the baby boomer population ages, it is important to take steps to ensure older adults live long and healthy lives.

Get Screened

A man and woman huggingLess than half of men and women aged 65 years or older are up-to-date on preventive services including flu vaccine, pneumonia vaccine, colorectal cancer screening, and mammography for women.

Mammography is the best available method to detect breast cancer in its earliest, most treatable stage before it is big enough to feel or cause symptoms. Women aged 50-74 should get mammograms every two years.

Colorectal cancer screening tests can find precancerous polyps so that they can be removed before they turn into cancer.

They can also detect colorectal cancer early, when treatment works best. Older adults should be screened for colorectal cancer by having a fecal occult blood test (FOBT) during the past year, a flexible sigmoidoscopy within 5 years and FOBT within 3 years, or a colonoscopy within 10 years.

Get Vaccinated

Flu and pneumonia is the seventh leading cause of death among adults 65 years or older, despite the availability of effective vaccines. Older adults should get the flu vaccine every year and get the pneumonia vaccine at least once.

Be Physically Active

Women riding bicyclesRegular physical activity is one of the most important things older adults can do for their health. Physical activity can prevent many of the health problems that may come with age, including the risk of falls.

How Much Activity Do Older Adults Need?

2 hours and 30 minutes (150 minutes) of moderate-intensity aerobic activity (i.e., brisk walking) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups.

OR

1 hour and 15 minutes (75 minutes) of vigorous-intensity aerobic activity (i.e., jogging or running) every week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups.

OR

An equivalent mix of moderate- and vigorous-intensity aerobic activity and muscle strengthening activities on 2 or more days a week that work all major muscle groups.

Eat Fruits and Vegetables Daily

Diets rich in fruits and vegetables may reduce the risk of some cancers and chronic diseases, such as diabetes and cardiovascular disease. Fruits and vegetables provide essential vitamins and minerals, fiber, and other substances that are important for good health.

Adults aged 65 years or older should eat 5 or more fruits and vegetables daily.

Quit Smoking

Tobacco use remains the single largest preventable cause of disease, disability, and death in the United States. For help quitting, visit www.smokefree.govExternal Web Site Icon or call 1-800-Quit-Now.

Take Medication for High Blood Pressure

High blood pressure is a major risk factor for cardiovascular disease, the leading cause of illness and death among older adults. Of the almost 67 million Americans with high blood pressure, more than half do not have it under control.

Health care providers, such as doctors, nurses, and pharmacists, can track their patients’ blood pressure, prescribe once-a-day medications, and give clear instructions on how to take blood pressure medications.

Patients should take the initiative to monitor their blood pressure between medical visits, take medications as prescribed, tell their doctor about any side effects, and make lifestyle changes, such as eating a low-sodium diet, exercising, and stopping smoking.

 More Information

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5 things to know about breast implants

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A Consumer Update for the FDA

breast implantShould I get breast implants? Are there alternatives? Will they need to be replaced?

And if you decide to get implants, there are even more questions. Saline or silicone?  What style? How much monitoring is needed?

Researching breast implants can be overwhelming and confusing. The Food and Drug Administration (FDA) has online tools available to help women sort through the information and provides questions to consider before making the decision.

Know the Basics

FDA has approved implants for increasing breast size in women, for reconstruction after breast cancer surgery or trauma, and to correct developmental defects. Implants are also approved to correct or improve the result of a previous surgery.

A number of studies have reported that a majority of breast augmentation and reconstruction patients are satisfied with the results of their surgery.

FDA has approved two types of breast implants for sale in the U.S.: saline (salt water solution)-filled and silicone gel-filled. Both have a silicone outer shell and vary in size, shell thickness and shape.

Know the Risks

Silicone implants sold in the U.S. are made with medical-grade silicone.  These implants undergo extensive testing to establish reasonable assurance of safety and effectiveness. Nonetheless, there are risks associated with all breast implants, including:

  • additional surgeries
  • capsular contracture—scar tissue that squeezes the implant
  • breast pain
  • rupture (tears or holes in the shell) with deflation of saline-filled implants
  • silent (without symptoms) rupture of silicone gel-filled implants

FDA experts suggest five things women should know about breast implants.

1. Breast implants are not lifetime devices.

The longer a woman has them, the greater the chances that she will develop complications, some of which will require more surgery.  The patient can also request additional surgeries to modify the aesthetic outcome, such as size or shape.

“The life of these devices varies according to the individual,” says Gretchen Burns, a nurse consultant at FDA’s Center for Devices and Radiological Health (CDRH).  “All women with implants will face additional surgeries—no one can tell them when.” While a few women have kept their original implants for 20-30 years, “that is not the common experience.”

2. Research products.

Review the patient labeling. FDA advises that women look at the Summary of Safety and Effectiveness Data (SSED) for each implant to learn about their characteristics and the fillers used. SSEDs have been produced for all approved saline and silicone gel-filled breast implants. These summaries provide information on the indications for use, risks, warnings, precautions, and studies associated with FDA approval of the device. Look at the frequency of serious complications found in the SSED. The most serious are “those that lead to further surgeries, such as ruptures or capsular contracture,” says Tajanay Ki, a biomedical engineer in CDRH.

FDA advises health care providers to give women the full labeling—all of the patient information from the manufacturer—for an implant. Ask your surgeon for the most recent version of the labeling. You should have at least 1-2 weeks to review the information before making a decision, but with some reconstruction or revision surgery cases, it may be advisable to perform surgery sooner.

3. Communicate with the surgeon.

Surgeons must evaluate the shape, size, surface texture and placement of the implant and the incision site for each woman. Ask the surgeon questions about his or her professional experience, the surgical procedure, and the ways the implant might affect an individual’s life.

Also, tell the surgeon about previous surgeries and your body’s response—for example, whether surgeries resulted in excessive scar tissue—and discuss your expectations. This helps the surgeon make operative decisions that achieve the desired appearance (i.e., incision location and size, implant size and placement).  Many women undergo reoperation to change implant size.  To achieve optimal results after the first procedure, careful planning and reasonable expectations are necessary.

4. Learn about long-term risks. 

Some women with breast implants have experienced connective tissue diseases, lactation difficulties or reproductive problems. However, current evidence does not support an association between breast implants and these conditions. FDA has identified a possible association between breast implants and the development of anaplastic large cell lymphoma (ALCL), a rare type of non-Hodgkin’s lymphoma. Women who have breast implants may have a very small but increased risk of developing ALCL in the fluid or scar tissue surrounding the implant. Like other lymphomas, ALCL is a cancer of the immune system and not of breast tissue.

5. Monitoring is crucial. 

FDA recommends that women with breast implants:

  • promptly report any unusual signs or symptoms to their health care providers, and
  • report any serious side effects to MedWatch, FDA’s safety information and adverse event reporting program.

Furthermore, women with silicone implants should get MRI screenings to detect silent ruptures three years after their surgery and every two years after that.  Insurance may not cover these screenings.

Burns recommends that women with breast implants continue to perform self-examinations and get mammograms to look for early signs of cancer. “Just because you have implants doesn’t mean you can ignore other breast health recommendations,” she says.

FDA’s Online Resources

FDA has a breast implants web page (www.fda.gov/breastimplants) with resources that include:

  • Links to patient information and data for each product.
  • Information about risks and complications
  • Questions to ask health care professionals regarding breast implant surgery
  • Contact information for manufacturers of FDA-approved breast implants and related professional organizations

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

February 20, 2013

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Cancer rehab begins to bridge a gap for patients

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By Rachel Gotbaum

This story was produced in collaboration with NPR

It was her own experience with debilitating side effects after cancer treatment that led Dr. Julie Silver to realize there is a huge gap in care that keeps cancer patients from getting rehabilitation services.

Silver was 38 in 2003 when she was diagnosed with breast cancer. Even though she is a physician, she was shocked at the toll chemotherapy and radiation took on her body. Silver was dealing with extreme fatigue, weakness and pain.

“I was really, really sick, sicker than I ever imagined,” says Silver, who is an assistant professor at Harvard Medical School. “I did some exercise testing and I tested out as a woman in my 60s. So I had aged three decades in a matter of months through cancer treatment.”

Silver went to her oncology team for help. They told her to go home and heal. “The conversation should have been, ‘We’re going send you to cancer rehab to help you get stronger,’” she says. But that’s not what happened, and after Silver came to realize that her experience was typical, she set out to change the system for other patients.

In 2009 she started a program designed to offer cancer survivors rehabilitation therapy after treatment. It’s called STAR and is now offered in almost all 50 states. The program is growing, as is research showing that many of the quality-of-life problems cancer survivors have are physical and can be helped with rehab.

But even with the awareness of its benefits growing, there is still a disconnect for patients.

“Patients are getting stuck, and they don’t know where to go,” says Dr. Rebecca Lansky, a rehabilitation specialist at the University of Massachusetts Medical Center. She says the focus on cancer care is on treatment and that cancer patients suffering from major side effects often fall through the cracks. She recalls one patient who struggled with the side effects of tongue cancer treatment.

“He had radiation to the whole jaw and neck so he couldn’t open up his mouth for six months,” Lansky said. “He had a feeding tube, and he kept going to his oncologist saying, ‘How can I get better? What I can do? He finally got referred to me and we are now opening up his jaw six months after he has been unable to move.”

Dr. Rebecca Lansky examines a patient (Photo by Rachel Gotbaum/For KHN)

Dr. Rebecca Lansky examines a patient (Photo by Rachel Gotbaum/For KHN)

A 2008 study of breast cancer patients in the Journal of Clinical Oncology found that 90 percent of the patients needed rehab but only about one third were getting the therapy.

“I’ve seen cases where someone has had a lot of pain, and they’ve done scans and it’s not a malignancy and maybe they have done exploratory surgery to see what is happening and not really finding much except a lot of scar tissue,” says physical therapist Jennifer Goyette, a STAR trained therapist who works with cancer patients in Worcester, Massachusetts. “I am able to get them a lot of relief and a lot of times patients don’t need to have further intervention. They don’t want to be on the narcotics for the pain management. They would rather come here.”

One of Goyette’s clients is 56-year-old cancer survivor Deborah Leonard. For two years after her treatment for early stage breast cancer, Leonard had swelling, pain and a large mass in her breast –which was not cancer.

“Clearly I didn’t have that before the surgery, because the tumor was so small and this was much bigger, and it just kept getting bigger,” says Leonard. “By nighttime my breast was extremely swollen and very painful.”

At first doctors thought Leonard might have an infection and gave her antibiotics. When that didn’t work they did another surgery to remove scar tissue. But the problem returned. Her doctors were suggesting a third surgery when Leonard finally found Goyette.

After three sessions with Goyette doing what is called lymphatic drainage, Leonard felt much better. Goyette uses manual pressure to clear Leonard’s lymphatic system, allowing the build up of fluid causing Leonard’s pain and swelling to subside.

“I had a 6-inch mass that is now down to half its size,” says Leonard.

“I’m sleeping at night, I have energy again. More people need to know about this because you don’t have to be a martyr and grin and bear it. This works.”

The issues are different for every type of cancer – head and neck cancer patients may need swallowing and speech therapy; blood cancer patients may need therapy similar to cardiac rehab to rebuild their strength and stamina; and patients treated for colon cancer can get help from physical therapists with back pain and abdominal swelling.

Most insurers do cover rehab for cancer patients, but sometimes patients must battle to get more than the standard 9 to 12 sessions covered. Another barrier to care is that too few oncologists and cancer surgeons refer their patients to rehab.

The Commission on Cancer, the arm of the American College of Surgeons that accredits cancer programs in U.S. hospitals, recently announced new requirements aimed at improving care for survivors of cancer including better access to rehabilitation therapy.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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U.S. cancer deaths continue long-term decline

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By Bill Robinson
NCI Cancer Bulletin

According to the latest national data, overall death rates from cancer declined from 2000 through 2009 in the United States, maintaining a trend seen since the early 1990s.

SR-inside

Mortality fell for most cancer types, including the four most common types of cancer in the United States (lungcolon and rectumbreast, and prostate), although the trend varied by cancer type and across racial and ethnic groups.

The complete “Annual Report to the Nation on the Status of Cancer, 1975–2009″ appeared January 7 in the Journal of the National Cancer Institute.

The report also includes a special section on cancers associated with the human papillomavirus (HPV) that shows that, from 2008 through 2010, incidence rates rose for HPV-associated oropharyngealanal, and vulvar cancers.

HPV vaccination rates in 2010 remained low among the target population of adolescent girls in the United States.

As in past years, NCI, the American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR) collaborated on the annual report.

Cancer incidence data came from NCI’s Surveillance, Epidemiology, and End Results (SEER) database and the CDC, with analyses of pooled data by NAACCR. Mortality data came from the CDC’s National Center for Health Statistics.

Incidence Rates Vary, Death Rates Continue to Drop

Among men, the overall rate of cancer incidence fell by an average of 0.6 percent annually from 2000 through 2009. Cancer incidence rates were stable among women during the same time period and rose by 0.6 percent per year among children. (See the table.)

“The continuing drop in cancer mortality over the past two decades is reason to cheer . . . The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections.”

The declines in cancer mortality averaged 1.8 percent per year for men, 1.4 percent per year for women, and 1.8 percent for children (ages 0 to 14 years) from 2000 through 2009.

During the same period, death rates among men fell for 10 of the 17 most common cancers and rose for three types of cancer. Death rates among women fell for 15 of the 18 most common cancers and also rose for three types of cancer.

“The continuing drop in cancer mortality over the past two decades is reason to cheer,” said ACS Chief Executive Officer Dr. John R. Seffrin in a statement. “The challenge we now face is how to continue those gains in the face of new obstacles, like obesity and HPV infections. We must face these hurdles head on, without distraction, and without delay, by expanding access to proven strategies to prevent and control cancer.”

HPV Vaccination Rates Low

The special section on HPV-related cancers showed that from 2000 through 2009, incidence rates for HPV-associated oropharyngeal cancer increased among white men and women, as did rates for anal cancer among white and black men and women. Incidence rates for cancer of the vulva also increased among white and black women.

However, cervical cancer rates declined among all women except American Indian/Alaska Natives. In addition, cervical cancer incidence rates were higher among women living in lower-income areas.

The annual report also showed that, in 2010, fewer than half (48.7 percent) of girls ages 13 through 17 had received at least one dose of the HPV vaccine, and only 32 percent had received all three recommended doses, a rate that fell well short of the Department of Health and Human Services’ Healthy People 2020 target of 80 percent.

The rate is also much lower than vaccination rates reported in Canada (50 to 85 percent) and the United Kingdom and Australia (both higher than 70 percent).

Vaccination series completion rates were generally lower among certain populations, including girls living in the South, those living below the poverty level, and Hispanics.

“The influence that certain viral infections can have on cancer rates is significant and continued attention to the effect[s] of HPV infection, in particular, on cervical cancer rates is critical,” said NCI Director Dr. Harold Varmus in a statement. “It is important, however, to note that the investments we have made in HPV research can only have the tremendous payoff of which they are capable if vaccination rates … increase.”

Cancer Incidence and Mortality Rates, 2000–2009

Men Women
Incidence Increase

  • kidney
  • pancreas
  • liver
  • thyroid
  • melanoma
  • myeloma

Decrease

  • prostate
  • lung
  • colorectal
  • stomach
  • larynx
Increase

  • thyroid
  • melanoma
  • kidney
  • pancreas
  • leukemia
  • liver
  • corpus and uterus

Decrease

  • lung
  • colorectal
  • bladder
  • cervix
  • oral cavity and pharynx
  • ovary
  • stomach
Mortality Increase

  • melanoma
  • liver
  • pancreas

Decrease

  • lung
  • prostate
  • colon and rectum
  • non-Hodgkin lymphoma
  • kidney
  • stomach
  • myeloma
  • oral cavity and pharynx
  • larynx
  • leukemia
Increase

  • pancreas
  • liver
  • corpus and uterus

Decrease

  • lung
  • breast
  • colon and rectum
  • leukemia
  • non-Hodgkin lymphoma
  • brain and other nervous system
  • myeloma
  • kidney
  • stomach
  • cervix
  • bladder
  • esophagus
  • oral cavity and pharynx
  • ovary
  • gallbladder

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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Lung Cancer

A glimpse into future of cancer screening

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Lung Cancer

X-ray showing lung cancer – Photo/NCI

By Elia Ben-Ari
NCI Cancer Bulletin

Ask experts to predict the future of cancer screening, and you’ll get a range of answers.

But all would agree that we need better ways to detect cancers early in the course of disease, and these new tools should improve on the benefits of screening while limiting the harms.

“There have been some improvements in triaging patients with new molecular approaches, but with the possible exception of spiral CT screening for lung cancer, we haven’t had any major breakthroughs in early detection” for more than two decades, noted Dr. David Sidransky, director of head and neck cancer research at the Johns Hopkins University School of Medicine.

The dearth of such advances is not for lack of trying. Developing new screening approaches and rigorously establishing their validity is challenging, however, and there are many potential stumbling blocks along the way.

“The bar for ‘proof’ that a particular screening strategy is clinically effective is very high,” noted Dr. Mark Greene, chief of the Clinical Genetics Branch in NCI’s Division of Cancer Epidemiology and Genetics (DCEG). “A screening test must be shown to reduce the death rate from the disease for which screening is being done.”

Much of the search for new screening tests focuses on biomarkers—proteins, DNA, RNA, or other molecules that can signal the presence of cancer and be detected noninvasively in blood, urine, or other readily obtained patient samples or tissues.

Researchers are also developing new imaging methods that could be used for early detection, either alone or in concert with biomarkers.

Whatever the approach, “screening is moving away from detecting an advanced consequence of cancer, which is the formation of a mass [or tumor], toward detecting the very earliest changes in the cancer process,” said Dr. Larry Norton, deputy physician-in-chief for breast cancer programs at Memorial Sloan-Kettering Cancer Center.

Dr. Norton chairs the external consulting team for the Early Detection Research Network (EDRN), an initiative of NCI’s Division of Cancer Prevention that supports efforts to discover and validate new cancer biomarkers and technologies.

“Molecular detection of cancer is possible only through evidence-based strategies and implementation,” commented Dr. Sudhir Srivastava, who directs the EDRN. “It takes a village to meet the challenges of early-detection research.”

The Post-PSA Era

Microscopic view of prostate cancer

Prostate Cancer

In the case of some cancers, researchers are developing new screening tests because the value of existing tests for those cancers has been called into question, perhaps most notably in the case of prostate specific antigen (PSA) testing for prostate cancer.

“The idea that one biomarker such as PSA is going to be useful for all settings has evolved. We now believe that we’ll need panels of biomarkers,” said Dr. Mark Rubin, a professor of pathology at Weill Cornell Medical College.

To identify those biomarkers, researchers are using methods such as microarrays and whole-genome sequencing, which rapidly yield a wealth of information, to profile changes that occur in cancer.

Using such an approach, Dr. Rubin, Dr. Arul Chinnaiyan of the University of Michigan, and their colleagues discovered the fusion gene TMPRSS2-ERG, which is found in about half of all prostate cancers.

“That fusion gene is seen only in cancer, and, in particular, only in prostate cancer,” said Dr. Rubin, whose team has developed a test to assess the levels of this fusion gene in urine samples. “Our approach now is to try to explain the other 50 percent of prostate cancers with other cancer-specific molecular events” that could eventually form a screening test based on a panel of genetic markers.

For example, Dr. Rubin co-led a recent study that identified a gene called SPOP that is mutated in about 10 percent of prostate cancers.

“We can add that gene mutation to the gene fusion to improve on the test,” he explained. “This is the sort of approach we think will be useful for prostate cancer, as well as other cancers in the future.”

Applying Lessons Learned

To avoid unnecessary biopsies or treatment of prostate and other screen-detected cancers, researchers are trying to find biomarkers that better identify which cancers are likely to progress, noted Dr. Joshua LaBaer, director of the Center for Personalized Diagnostics at the Biodesign Institute at Arizona State University and co-chair of EDRN’s steering committee.

“What we’ve learned from PSA is that if we’re going to come up with new screening tools, we also have to develop tools that give us a better idea of disease prognosis.”

Whereas some cancers detected by screening will progress and metastasize, others may never cause illness during a person’s lifetime.

“What we’ve learned from PSA is that if we’re going to come up with new screening tools, we also have to develop tools that give us a better idea of disease prognosis,” said Dr. James Brooks, a professor of urology at Stanford University.

Dr. Brooks and Dr. Sanjiv Gambhir, chair of the department of radiology at Stanford, lead a project to deploy new technologies that could form the basis for the next generation of prostate cancer screening tests.

To pave the way for tests that rely on panels of blood-based diagnostic or prognostic protein biomarkers, they are starting to test the performance of a magneto-nanosensor chip technology developed at Stanford.

The sensor, which detects proteins tagged with magnetic particles, can measure the levels of up to 64 different proteins simultaneously, in very small sample volumes.

The Stanford team also hopes to adapt an imaging technology being studied in Dr. Gambhir’s lab to improve the accuracy of prostate cancer detection by transrectal ultrasound.

The method uses gas “microbubbles” that are encased in a lipid shell to which specific antibodies are attached as a contrast material for ultrasound imaging.

The antibodies target a receptor for vascular endothelial growth factor, which is a protein found in newly formed tumor blood vessels. The patented antibody-labeled microbubbles are awaiting Food and Drug Administration approval for human testing.

The Stanford team’s long-term goal is to combine their blood-based biomarker and imaging methods to improve early detection and prognostic assessment of prostate cancer and eventually other cancers.

Combining molecular biomarkers and imaging for cancer screening “is a very powerful approach,” commented Dr. Sidransky. “We used to believe in the power of a marker to do everything,” he added. “We now know that’s not true.”

A Sense of Urgency

Researchers have long sought an effective screening strategy for ovarian cancer, and numerous candidate biomarkers for the disease have fallen short of expectations.

“Ovarian cancer is the paradigm for why we need early detection,” said Dr. Michael Birrer, a professor of medicine at Harvard Medical School. The disease can be cured by surgery if discovered early. But “75 percent of tumors are detected at the advanced stage, and those patients are hard to cure,” said Dr. Birrer.

Dr. Birrer and Dr. Steven Skates, an associate professor of medicine at Harvard, are leading a two-pronged effort to discover new biomarker candidates that may ultimately lead to a blood test for the early detection of ovarian cancer.

We used to believe in the power of a marker to do everything. We now know that’s not true.—Dr. David Sidransky

The first strategy will use extensive proteomic profiling of fluids from benign and malignant tissues, such as ovarian cysts, “to find candidate biomarkers that are systematically different between the two,” Dr. Skates explained.

The second strategy involves genomic analyses to identify genes that are expressed differently in ovarian cancer tissue samples than they are in normal tissues that may give rise to ovarian cancer, and then bioinformatic analyses to look for genes whose protein products are also likely to be secreted into the bloodstream.

Using either the proteomic or genomic approach, or a combination of both, the researchers hope to come up with a short list of candidate biomarkers for further testing and refinement.

“We may be lucky to find that some of those candidates are actually early-detection biomarkers that can be measured in blood,” Dr. Skates said.

Those biomarkers could form the basis of a blood test to screen postmenopausal women, and other women at increased risk of ovarian cancer, at regular intervals.

For women who test positive on the blood test, a follow-up test, such as transvaginal ultrasound or newer imaging methods, might be used as part of an overall screening approach in the future, Drs. Birrer and Skates suggested.

Gazing into the Crystal Ball

3d Chromosome with DNA visible insideNo one can predict with certainty which types of tests will be most effective for screening for particular cancers. However, “if you want to prognosticate the future of cancer screening, my guess is that nucleotide [RNA or DNA]-based tests are going to be the most promising, at least in the short term,” Dr. Brooks said. “The power of nucleic acids is that you can amplify them to an extraordinary degree, which you can’t do with proteins,” Dr. LaBaer added.

Future DNA-based screening tests might detect methylation or other epigenetic modifications of DNA that occur specifically in cancer. “For example, we published a paper last year showing widespread and reproducible changes in DNA methylation in prostate cancer,” Dr. Brooks said.

And future screening tests may detect biomarkers in patient samples other than blood or urine. “One area where I think you’re going to see a change is in…tumors that affect the gastrointestinal tract” or other parts of the digestive system, Dr. LaBaer predicted. “You can look in stool for aberrant nucleic acids [from cells shed by tumors].” Researchers are also investigating sputum-based tests to detect lung cancer early.

“A possibility for the future is that we may stop thinking about cancers in terms of organ sites and may think more in terms of disrupted pathways or molecular variants of cancer,” Dr. LaBaer continued. In that case, “the biomarker people are going to have to work closely with the imaging people to very quickly turn a biomarker discovery into identifying where the tumor is.”

“We’re rapidly changing our concept of what cancer is,” noted Dr. Norton. “You can’t separate screening from understanding biology, from therapy, from prevention. The biggest challenge is weaving it all together [into] the big picture.”

Furthermore, he added, “we may find out that early detection is not helpful in certain situations, and that’s also important. We may not want to screen for certain cancers if we find out that prevention may be a better place to put our resources.”

“Mortality rates for some cancers have remained constant for the past 40 years, and in some of these cancers, new therapies have extended life for a few years but are not increasing the cure rates,” Dr. Skates noted. “Improved early detection for these cancers could shift that number so that more people are cured…. The payoff could be so big.”

The NCI Cancer Bulletin is an award-winning biweekly online newsletter designed to provide useful, timely information about cancer research to the cancer community. The newsletter is published approximately 24 times per year by the National Cancer Institute (NCI), with day-to-day operational oversight conducted by federal and contract staff in the NCI Office of Communications and Education. The material is entirely in the public domain and can be repurposed or reproduced without permission. Citation of the source is appreciated.

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Doctor inspects mammogram. Photo by Bill Branson/NCI

With routine mammograms, some breast cancers may be overtreated – article and video

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Doctor inspects mammogram. Photo by Bill Branson/NCI

By Richard Knox, NPR News
This story comes from KHN partner NPR‘s Shots blog.

The endless debate over routine mammograms is getting another kick from an analysis that sharply questions whether the test really does what it’s supposed to.

Dr. H. Gilbert Welch, coauthor of the analysis of mammography’s impact, which was just published in the New England Journal of Medicine, tell Shots that the aim was to “get down to a very basic question.”

Welch explains his study in this video:

That is, do annual mammograms among women over 40 discover early-stage breast cancers that can be treated so that they never become deadlier late-stage tumors?

Welch, of Dartmouth Medical School, and coauthor Dr. Archie Bleyer of the Oregon Health and Science University, analyzed 30 years of data on breast cancer incidence.

Over the last three decades, diagnoses of early-stage breast cancers soared, largely due to routine mammogram screening. But the incidence of late-stage cancers declined only slightly. That leads some to question whether mammograms are really doing what they’re supposed to — catching early cancers before they progress.

“And what we see is a dramatic increase — a doubling — in the amount of early-stage cancer,” Welch says. “But we don’t see a corresponding decrease in the amount of late-stage cancer.”

They say this means mammography isn’t catching many advanced breast cancers — even though it’s very good at catching early tumors.

Too good, perhaps. The duo says many of the early tumors revealed by mammography don’t need to be treated at all. Doctors call that “over-diagnosis.”

Welch says more than a million women have been over-diagnosed with breast cancer over the past 30 years. And the problem continues.

“Seventy thousand women a year are over-diagnosed and treated unnecessarily for breast cancer,” Welch says.

This all may come as a shock to many women — and their doctors. No other diagnostic test has been more aggressively promoted than mammography — or, lately, been so controversial, with the possible exception of PSA tests for prostate cancer.

“Whenever I see a paper like this, I say, ‘Oh, boy, here we go again!’” says Dr.Carol Lee, a breast imaging specialist at Memorial Sloan-Kettering Cancer Center in New York City.

Lee is on the communications committee of the American College of Radiology, whose members often do mammograms. The group, in a statement, says the new analysis “is simply wrong.”

The ACR statement’s main criticism is that Welch and Bleyer don’t account for what the radiologists say was a steady increase in the incidence of invasive breast cancer. They say that can explain why mammography didn’t lower the incidence of advanced breast cancer more.

Welch rejects that claim. “Why was breast cancer incidence so stable in the late ’70s, only to shoot up in the 1980s – the very time mammography was introduced?” he writes in an email. “Why didn’t incidence rise dramatically in women under 40 — those not exposed to screening?”

Welch is no newcomer to debates over the benefits and harms of diagnostic screening tests. In fact, he’s a well-known iconoclast, who last year published the popular book Overdiagnosed: Making People Sick in the Pursuit of Health.

Earlier this year, LocalHealthGuide ran an article about Welch’s book “Overdiagnosed: Making People Sick in the Pursuit of Health,” with he wrote with Dartmouth researchers and physicians Lisa Schwartz and Steven Woloshin.The book argues that the medical establishment’s embrace of early diagnosis and treatment as the key to keeping people healthy actually does the opposite. To read the article go here.

“He has a preexisting bias, just as those of us in the breast imaging community have a preexisting bias,” Lee says. “The truth probably lies somewhere in between.”

Still, Lee finds it hard to believe that 70,000 women a year are diagnosed with breast cancer that would not have progressed. And she says the debate isn’t very helpful to most women.

“What my friends in Connecticut want to know is, ‘Should I have a screening mammogram?’ And … this kind of study sometimes raises more questions than it answers,” Lee says.

San Francisco breast surgeon Laura Esserman agrees that women are tortured by these endless debates. But she sees a way out of the dilemma.

“Our concept of cancer has got to change,” she tells Shots. “We now recognize that there isn’t just one pathway — it’s not cancer, yes or no.” And doctors know now that cancer doesn’t always lead to death.

Esserman thinks mammography screening should be done more selectively. Women at lower risk of breast cancer — because they don’t have close relatives who’ve had it or have a genetic predisposition for it — may not need to be screened so often.

Second, she says women and their doctors have to get out of the mind-set that any breast cancer should be treated maximally. For instance, doctors now routinely deploy surgery, hormones and radiation to treat a condition called ductal carcinoma in situ, or DCIS.

“We can watch a lot of those things and most of them turn out to be just fine,” she says.

But this is a long way from how either mammography or breast cancer treatment is practiced right now.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Breast Cancer stamp thumb

Tips for breast cancer prevention, screening, treatment and survivorship from the Hutch

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1996 Breast Cancer Awareness U.S. Postage StampTo mark National Breast Cancer Awareness Month  Seattle’s Fred Hutchinson Cancer Research Center and its clinical care partner, the Seattle Cancer Care Alliance have published a “baker’s dozen” of top beast health tips gleaned from four previously published tip sheets.

TOP TIPS FOR BREAST CANCER PREVENTION from Anne McTiernan, M.D., Ph.D., a member of the Center’s Public Health Sciences Division and author of “Breast Fitness” (St. Martin’s Press):

1) For all women: Follow a healthy lifestyle, including keeping your weight in normal range (body mass index under 25), being physically active (at least 30 minutes a day of moderate-intensity exercise), minimizing alcohol intake (one drink a day or less), and don’t smoke.

Overweight, inactivity and alcohol all increase risk for breast cancer, and smoking increases risk in some women.

 2) For young women: Breast-feed your babies for as long as possible.  Women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer.

3) For postmenopausal women: Avoid hormone replacement therapy.

Menopausal hormone therapy increases risk for breast cancer.

If you must take hormones to manage menopausal symptoms, avoid those that contain progesterone and limit their use to less than three years.

“Bioidentical” hormones and hormonal creams and gels are no safer than prescription hormones and should also be avoided.

4) For high-risk women: Consider taking an estrogen-blocking drug.

Women with a family history of breast cancer or who have had breast biopsies or are over 60 should talk to their doctor about the pros and cons of estrogen-blocking drugs such as tamoxifen, raloxifene, and aromatase inhibitors.

TOP TIPS FOR BREAST CANCER SCREENING AND EARLY DETECTION from Constance Lehman, M.D., Ph.D., director of Radiology at Seattle Cancer Care Alliance:

5) If you are over 40, get a mammogram. Early detection of breast cancer offers the best chance for a cure. SCCA supports the American Cancer Society’s recommendation that women begin annual mammography screening at age 40.

6)  Know your risk. Tell your doctor if you have family members who have had breast cancer, especially a mother or sister, and if they had breast cancer before reaching menopause because your own risk of cancer may be higher than average.

Some women at high risk may be recommended for annual MRI in addition to a screening mammogram.

 7) Don’t put off screening because of discomfort or fear of the results: A mammogram should never be painful.

To reduce discomfort, try to schedule the exam after your monthly period, when breast tissue is less sensitive.

You may benefit by taking an over-the-counter anti-inflammatory such as ibuprofen or acetaminophen before your mammogram. Above all, tell the mammography technologist about any discomfort you may be experiencing.

Most abnormalities found after a mammogram are not cancer.

However, in some cases you may be called back for more tests, such as additional mammography or ultrasound screening, to confirm that the area on the screening mammogram is normal.

TOP TIPS FOR BREAST CANCER PATIENTS DURING TREATMENT from Julie Gralow, M.D., director of Breast Medical Oncology at Seattle Cancer Care Alliance and co-author of “Breast Fitness” (St. Martin’s Press):

8) Choose your doctor wisely. Breast cancer specialists who work at dedicated cancer centers offer specific expertise as well as access to the latest treatments that are part of clinical studies.

Such centers can provide other specialty services, usually under one roof, such as physical therapy, nutrition and social work.

9) Get specifics on your diagnosis and treatment. To maximize your time with your providers, bring your questions with you in writing to your appointments.

Ask for copies of your test results and keep a notebook of all these results. Keep a list of questions that arise between visits so you don’t forget, and take notes of the answers.

Above all, make informed decisions; learn as much as you can about your diagnosis and treatment.

10) Get good nutrition and bone up on bone health. Cancer treatment may influence taste and smell, and it may alter your digestion. Foods that you normally enjoy may not taste good during treatment while, paradoxically, foods that normally don’t appeal to you might taste better.

You may have more energy and less nausea if you eat smaller amounts of foods more frequently rather than eating three big meals per day.

Eat more vegetables, fruits, whole grains, nuts, seeds and legumes such as black beans and lentils.

Choose a rainbow of colorful whole foods (like deep greens of spinach, deep blues of blueberries, white for onions, and so on) to ensure that you get a variety of anti-cancer nutrients.

Alcohol is usually not preferred or recommended during treatmentKeeping your bones healthy throughout your life is important; however, if you’re a woman who’s been diagnosed with breast cancer, bone health is especially important.

Research shows that some breast cancer treatments can lead to bone loss. Plus, women are about twice as likely as men to develop osteoporosis after age 50.

Talk to your health care team about specific recommendations for keeping bones healthy, taking calcium and vitamin D, and appropriate weight-bearing exercises to help keep bones strong.

TOP TIPS FOR BREAST CANCER SURVIVORS from Karen Syrjala, Ph.D., director of Biobehavioral Sciences in the Hutchinson Center’s Clinical Research Division and co-director of the Hutchinson Center Survivorship Program

11) Get a summary of your treatments. Have a list of what surgery, radiation and chemotherapy doses you received so that you can communicate these to your primary care providers. This will help you plan for the next tip on the list.

12) Make a plan for monitoring the long-term effects of your cancer treatment. Talk to your doctor about the potential long-term effects of your cancer treatment and what to watch out for. For example, some cancer treatments can increase the risk of cardiovascular problems or second cancers; others can impact your bones.

13) Learn how to manage the fear of cancer coming back. First, find out your risk of recurrence from your health care provider. Second, remember that risk is an estimate based on averages and does not always apply to you as an individual. Third, consider counseling or other assistance to help you face your fears and move forward.

To learn more read the full tip sheets:

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An electronic screen showing the NEWS

Today’s health headlines – August 9th

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By Stephanie Stapleton

Today’s early morning highlights from the major news organizations, including news about campaign trail sparring over women’s health issues, a political ad that has drawn criticism and a Romney aide’s response.

Los Angeles Times: Survey: 61% Of Employers Expect Cost Increase From Healthcare Law

More than 60% of employers in a new survey anticipate some increase in their health benefit costs due to the federal Affordable Care Act. The survey of 1,203 employers by the Mercer consulting firm found that 20% of those businesses expect an increase of 5% or more (Terhune, 8/8).

Los Angeles Times: Obama: Romney ‘More Suited To The 1950s’ On Women’s Health

Obama’s remarks at a community college in Denver were tailored to woo women voters, a critical part of his base, and included a full-throated appeal based on policy and personality. Obama spoke of his single mother who raised him and died of cancer in her 50s, as well as his wife and daughters. He was introduced by Sandra Fluke, the former Georgetown law student who last spring found herself at the center of the debate over birth control coverage and religious freedom. Fluke was called a “slut” by Rush Limbaugh when she spoke out in favor of a new mandate requiring health insurance companies to cover contraception. Limbaugh later apologized (Hennessey, 8/8).

The Washington Post: Romney Spokeswoman Praises His Efforts On Health-Care Reform As Governor:

Portrait of Willard "Mitt" Romney

Mitt Romney drew new fire from his conservative allies on a familiar topic Wednesday — health-care reform — as his spokeswoman offered unusual praise for his efforts on the issue as Massachusetts governor. In an interview with Fox News Channel on Wednesday, Andrea Saul invoked Massachusetts’s expansion of health coverage as a defense to a harsh new ad funded by a super PAC supporting President Obama (Helderman and Blake, 8/8). (Photo by Jessica Rinaldi

Komen Breast Cancer Charity’s Top Leaders Step Down: Los Angeles Times

The changes came six months after a public uproar when Komen’s decided to stop funding breast health services operated by Planned Parenthood. Though Brinker and others in the national leadership said that the decision to halt funding had nothing to do with abortion politics, critics and some local Komen affiliates cried foul, and the charity reversed its decision within days (Brown and Khan, 8/9).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Gilda's Club Seattle Logo

You’ve been treated for cancer — now what?

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Treatment Summaries and Surviorship Care Planning

What do you do when you’ve finished treatment?

How do you coordinate your ongoing care with your Primary Care doc?

How do you keep track of your medical records and get the right information to the right people about what you’ve been through?

Now we have some answers.

  • Debra Loacker, RN, will provide an overview of the valuable information provided in cancer treatment summary and the survivorship care plan. You will learn where to obtain a copy of your own treatment summary, and how your doctor can use it.
  • Patricia Read-Williams, MD, will share her perspective as a Primary Care Provider on the importance of these documents in the care provided to cancer survivors.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org


Gilda’s Club Seattle

Gilda’s Club is a non-profit group that provides meeting places where men, women and children living with cancer and their families and friends join with others to build emotional, social and educational support as a supplement to medical care.

The club’s services are free and include support and networking groups, lectures, workshops and social events in a nonresidential, homelike setting.

The club is named in honor of Gilda Susan Radner was an American comedienne and actress, best known for her years as a cast member of Saturday Night Live.

Radner, who died at 42 of ovarian cancer, helped raise the public’s awareness of the disease and the need for improved detection and treatment.

Lectures are held on Thursday evenings at Gilda’s Club, 1400 Broadway, Seattle.

Please RSVP to attend.

Refreshments served 6:45-7:00 pm

Lecture begins 7:00-8:30 pm

All lectures are open to the public. There is no cost to attend our lectures.

Please RSVP 24+ hours in advance to attend and pre-register for Noogieland childcare a minimum of 72 hours in advance.

When:

6/21/12 , 6:45-8:30 p.m.

Where:

Gilda’s Club Seattle • 1400 Broadway, Seattle, WA 98122

Phone: 206.709.1400 • info@gildasclubseattle.org • www.gildasclubseattle.org

 

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Swedish to open new Women’s Cancer Center

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Seattle’s Swedish Medical Center will open a new cancer center that will provide services tailored specifically for women — next Tuesday, June 5th.

The 23,600-square-foot True Family Women’s Cancer Center will occupy the fifth and sixth floor of the medical center’s Arnold Pavilion at 1221 Madison on Swedish’s First Hill campus.

The goal is to bring the Swedish physicians specializing in treating cancer in women into a single location to better coordinate care and to provide women cancer patients with a place where they can find all the services they need under one roof, said Dr. Patricia Dawson, the medical director of the new center and a breast surgeon with the Swedish Cancer Institute.

Although women and men have many of the same kinds of cancer, these cancers often have a different course in women and respond differently to treatment, said Dr. Dawson.

Women with cancer also often seek the kind of community and support services the new center hopes to offer, she said.

In addition to exam rooms, imaging services and procedure rooms, the new center will have support-group meeting rooms, counseling services and an educational resource center.

The facility’s decor and layout was designed to be both practical and “calming and restful” with the aim of enhancing both the quality of care and the quality of the patients’ experience, Dr. Dawson said.

The new center brings together a variety of clinicians and services that in the past have been scattered across the Swedish Medical Center’s main campuses.

Alexis Vanden Bos, a patient of Dr. Dawson who has been treated for two breast cancers, remembers having to shuttle between campuses during her treatments, often carrying her radiology films under her arm.

Alexis Vanden Bos

“It wasn’t bad, but how much easier this will be,” Vanden Bos said. “Now, I’ll be able to talk to both my surgeon and my oncologist in one place. I’ll love having all my people together.”

Construction of the $11 million facility was funded entirely from philanthropic gifts. The families of Patricia True, Doug and Janet True, and Bill and Ruth True began the fund-raising effort with $2 million donation.

Other major contributors include Eve and Chap Alvord, Robin Knepper, the Norcliffe Foundation, Bruce and Jeannie Nordstrom, Seattle Radiology, and Sellen Construction.

Additional support came from more that 2,500 individual donors.

The center’s staff will include oncologists, surgeons, onsite radiologists, psychological and genetic counselors, physical therapists, social workers and patient education specialists.

The center will provide resources for women with most cancers, including bladder, brain, breast, cervical, colorectal, esophageal, head and neck, leukemia, liver, lung, lymphoma, multiple myeloma, ovarian, pancreatic, renal/kidney, skin, thyroid and uterine.

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surgeons performing surgery in operating room

Higher cost of cancer care in the U.S. may be ‘worth it’ — study

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By Sarah Barr

Higher U.S. spending for cancer care pays off in almost two years of additional life for American cancer patients on average compared to their European counterparts — a value that offsets the higher costs –according to a study in the April issue of the journal Health Affairs.

While previous studies have suggested U.S. cancer patients have better survival prospects than their European counterparts, the researchers wanted to examine whether those prospects justify higher U.S. costs.

To do so, they translated the longer lives of U.S. patients into dollar amounts using a conservative estimate of the value of a human life year — in the context of the tradeoffs people are willing to make to reduce their risk of death — and compared those amounts to U.S. spending on cancer care.  The method does not take into account quality of life or individuals’ earnings.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it,’” the researchers wrote in the study. They cautioned the findings do not prove that all treatments are cost-effective or a that a causal link exists between spending on cancer care and survival gains.

“We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed ‘worth it.”

The study found that the longer lives of U.S. patients were worth an average value of $61,000 per individual, or $598 billion total, in constant dollars, for those diagnosed between 1983 and 1999 — more than the additional amount the U.S. spent on treatment compared to other countries.

Michael Eber, a senior analyst at Precision Health Economics, a health care consulting company, and a co-author of the study, said that the findings point to the need for further research into what drives the survival differences between U.S. and European patients.

“It calls for a closer look at the value of individual treatments and interventions,” he said.

For the study, the researchers looked at the survival outcomes for U.S. patients compared with those from 10 European countries and found that for most cancer types, U.S. patients lived longer.

Specifically, from 1995 to 1999, U.S. patients lived an average of 11.1 years after diagnosis, while European patients lived 9.3 years.

The researchers used those numbers as a baseline and based their findings on how survival gains improved in each country over time.

They also found that from 1983 through 1999, U.S. spending increased from $47,000 to $70,000 per cancer case, while in the 10 European countries, spending on cancer care increased from $38,000 to $44,000 per case.

The additional U.S. spending during that time period on the kinds of cancer the researchers examined totaled $158 billion.

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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