Do Breast Cancer Patients Skip Follow-Up?

Over 20% stopped seeing cancer docs 5 years after diagnosis

Follow-up guidelines vary widely among national organizations for patients with early-stage breast cancer treated with curative intent. The study sought to evaluate the patterns and predictors of provider follow-up care within the first 5 years after diagnosis.

Twenty-one percent of patients with early-stage breast cancer discontinued seeing any oncology provider over the 5 years after diagnosis. Coordination of follow-up care between oncology specialists may reduce discontinuation rates and increase clinical efficiency.

https://www.medpagetoday.com/hematologyoncology/breastcancer/79043?xid=nl_mpt_DHE_2019-04-08&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-04-08&utm_term=NL_Daily_DHE_Active

https://ascopubs.org/doi/abs/10.1200/JOP.18.00229

DOI: 10.1200/JOP.18.00229 Journal of Oncology Practice 15, no. 1 (January 1 2019) e1-e9.

ACP Wrangles Diverging Breast Ca Screening Guidelines

Guidance for average-risk women draws rebuke

Women ages 50 to 74 at average risk for breast cancer should undergo screening mammography every other year, according to the latest guidance from the American College of Physicians (ACP), recommendations that were met with immediate pushback from the radiology community.

Additional guidance statements emphasized women at average risk for breast cancer should not be screened. For example, average-risk women ages 40 to 49 should discuss the potential risks and benefits of undergoing mammography with their physicians, with the understanding that the potential harms outweigh the benefits in most women of this age.

Women ages 75 or older, or those with a life expectancy of 10 years or less, should discontinue breast cancer screening.

Finally, they said, among average-risk women of all ages, clinical breast examination (CBE) should not be used to screen for breast cancer. Instead, the 5 to 10 minutes this exam takes should be "devoted to healthcare interventions of greater proven net benefit."

The ACP considers women with dense breast tissue on mammography and no other risk factors to be at average risk.

In a joint statement, the American College of Radiology and Society of Breast Imaging warned that ACP's new recommendations could "result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year,"

https://www.medpagetoday.com/hematologyoncology/breastcancer/79085?xid=nl_mpt_DHE_2019-04-09&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-04-09&utm_term=NL_Daily_DHE_Active

https://annals.org/aim/fullarticle/2730520/screening-breast-cancer-average-risk-women-guidance-statement-from-american

DOI: 10.7326/M18-2147

Genetic Testing Lags in Breast, Ovarian Ca

Contributors include physician, patient, financial factors

Rates of genetic testing for breast or ovarian cancer remained well below levels associated with current clinical guidelines, according to a large retrospective analysis.

Medical records showed that a fourth of patients with breast cancer and about a third of those with ovarian cancer had genetic test results. Testing rates varied by factors unrelated to genetic risk, such as race and insurance status. Among the patients tested, 8-15% had at least one pathogenic variant that warranted a change in care... testing rates <100% for women younger than age 45 with breast cancer are "suboptimal" and that "a 30% genetic testing rate for patients with ovarian cancer is inadequate." [Patients] may not understand that a positive result may impact their own future cancer screening or ovarian cancer treatment options. 24.1% of the patients with breast cancer and 30.9% of the patients with ovarian cancer had undergone genetic testing. Only 2% of patients with breast cancer were tested for all 11 genes designated by current clinical guidelines as susceptibility genes.

https://www.medpagetoday.com/genetics/genetictesting/79173?xid=nl_mpt_DHE_2019-04-12&eun=g1278169d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%202019-04-12&utm_term=NL_Daily_DHE_Active

Primary Source

Journal of Clinical Oncology

Source Reference: Kurian AW, et al "Genetic testing and results in a population-based cohort of breast cancer patients and ovarian cancer patients" J Clin Oncol 2019; DOI: 10.1200/JCO.18.01854.

My insurer would not pay for genetic testing either. We found a lab that would do it for around $400 "cash" paid by me/the patient without doing the insurer's paperwork. Some labs offer "patient assistance programs" for those who either do not have insurance or whose insurance will not cover the testing. It is worthwhile to ask. Sometimes these programs depend on your household income. You will still have to have an order from your physician and you they may want you to agree ahead of time that you will pay a fixed price and that they will not file insurance paperwork. It is interesting that they seem to be discussing this testing as "standard of care" but that insurers are not paying for it. Unfortunately, it seems like it often takes a while before the insurers catch up to actually paying for standard of care.

illimae, Basically, yes. There are a lot of labs that offer testing. And your physician will recommend the testing that seems most appropriate. Some labs offer a breast cancer specific panel that screens for risk for hereditary breast cancer risk only. A lab may also offer a multi-cancer panel that screens for elevated risk for multiple types of cancer. BRCA genes would almost certainly be included in either of those but it's always wise to double check. Of course, our knowledge of genetics and causality continues to evolve, so these tests may change over time as researchers learn more. As that knowledge evolves, you may be able to get updated results or you may need to be retested. Keeping in mind that this is just one lab/just one example, if you want to read up on the tests available by looking at a lab's website, here are a couple of links to a lab I know some practitioners to use:

Breast cancer panel {interestingly, this indicates that it is for ER+, HER2− early-stage breast cancer patients only}

https://myriad.com/products-services/breast-cancer/endopredict/

Multiple hereditary cancers:

https://myriad.com/products-services/hereditary-cancers/myrisk-hereditary-cancer/

Some of the web pages have videos. It can actually be quite educational if you are interested in genetics.

On the TRAIL of a Solution to Trastuzumab Resistance in HER2+ Breast Cancer

A genomic and proteomic analysis of HER2-positive breast cancer cell lines that are resistant to trastuzumab found a deregulation of the cell death pathway known as TRAIL (tumor necrosis factor–related apoptosis-inducing ligand). The finding presents the possibility of targeting this pathway as a way to lessen the impact of trastuzumab resistance in HER2-positive breast cancer.

https://www.cancernetwork.com/her2-positive-breast-cancer/trail-solution-trastuzumab-resistance-her2-breast-cancer

https://www.sciencedirect.com/science/article/pii/S0304383519301983

https://doi.org/10.1016/j.canlet.2019.03.042