Breaking Research News from sources other than Breastcancer.org
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Interesting article about hospital pricing. It is all smoke and mirrors. Hospitals price things with magic words and insurance companies adjust the prices with different magic words. And poof! there is the amount you still owe.
Comparing prices on healthcare for individual services also is an interesting idea. It assumes that we buy our healthcare one illness or surgery at a time -- or perhaps it assumes we SHOULD buy it that way. Which is ridiculous, because we are whole people and should have our health considered as a whole bodily and mental being, and not as bits and pieces to be returned to the factory for a tune-up, one at a time.
Another assumption is that people actually CAN comparison shop, or that it is a good idea to shop on price. I have 2 hospitals in my town that provide cancer care. One is in the top 20 on the country for cancer care, and the other is not even on the list. Which one should I go to? Should I make that decision based on the cost of care or on the expertise?
And what about the people who have no cancer center close to them? Or hospital that is qualified to do knee replacement? What competition is there for their business? They will go to whatever hospital they can manage in their lives, even if it's a 90 minute drive each way. Rural American lives this way.
In the meantime, today I got a letter from the insurance company saying my base rate is going up another 12.6% for next year. Year after year I have double digit increases in rate. And still, ridiculously, every day I am grateful I have health insurance, that somehow the republicans have not managed to pry out of my hands yet. Because this year's care for me will likely exceed $150,000. And I hit my out-of-pocket maximum for the year months ago.
Sorry for the rant. I know that's not really the point of this thread. Just call me skeptical that new rules or executive order will actually improve healthcare in the US.
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Senate Committee OKs Act to End Surprise Billing
Core focus of the "Lower Health Care Costs Act" is price transparency
A bipartisan bill focused on eliminating surprise medical bills and lowering patients' out-of-pocket costs passed out of the Senate Health, Education, Labor and Pensions Committee in a 20-3 vote on Wednesday.
A core focus of the "Lower Health Care Costs Act" is price transparency, said Committee Chairman Lamar Alexander (R-Tenn.).
....he, along with ranking committee member Patty Murray (D-Wash.), agreed that the best solution is to pay out-0f-network doctors in hospitals the median contract rate that in-network doctors are paid for those same services in a particular geographic area -- a strategy dubbed "the benchmark solution."
While Alexander noted that the benchmark solution was deemed the most effective approach to lowering healthcare costs by the Congressional Budget Office, he said he was open to continue working on the bill to see if it could be improved.
Alexander outlined other measures included in the current bill:
- Mandating that healthcare facilities offer a summary of services after discharge, and requiring that hospitals send all medical bills within 45 days
- Directing doctors and insurers to give patients price quotes on their expected out-of-pocket costs for care
- Helping to bring biosimilars to market faster by leveraging a "transparent, modernized and searchable" patent database
- Keeping the FDA drug patent database system up to date in order to accelerate generic product development
- Banning the abuse of "citizen petitions" which can "unnecessarily delay drug approvals"
- Closing a loophole that enables drug companies to retain exclusivity and prevent less expensive drugs from coming to market by making insignificant tweaks to old drugs
The bill would also increase prescription drug competition by eliminating "gag clauses" in insurance contracts, and by banning pharmacy benefit managers from charging more for a drug than they paid for it,it would target several public health challenges, such as supporting state and local efforts to raise vaccination rates, efforts to prevent and curb obesity, and expanding healthcare technology to better serve rural communities, as well as enforce mental health parity laws.
The bill would also expand mandatory funding for community health centers and four additional programs "to ensure that 27 million Americans who rely on these centers for primary care and other healthcare can continue to access centers close to home,"
...amendment to the bill ...also wrapped in two other measures; one that would raise the minimum age for purchasing any tobacco product to 21 from 18, and another that would ban anti-competitive practices in generic drug development such as sample-blocking.
An amendment to require insurance companies to post information regarding network adequacy, based on the insurers last interaction with a provider, was also approved by the committee, along with the FAIR Drug Pricing Act, an amendment that calls for transparency from pharmaceutical companies that plan to raise prices of their products.
Alexander said he aims to hold a floor vote on the bill before the end of July.
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MountainMia: yes. There are so many problems.... outrageous out of pockets, even with "good" insurance...access to facilities, especially for those in rural areas....the fact that, for many of us, our health insurance is wrapped up with our jobs, so if we lose our jobs, we lose our insurance. Not to mention that, if lifetime limits come back, many of us are proverbial toast. Lots of issues that need to be addressed.
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Banned Antibacterial Tied to Osteoporosis—
Associations strongest in postmenopausal women
The antibacterial chemical triclosan was tied to deleterious bone changes in women, according to researchers in China.
In an analysis of over 1,800 adult women, high exposure to triclosan was associated with a nearly 2.5-fold increased chance of developing intertrochanteric osteoporosis...
An endocrine-disrupting chemical (EDC), triclosan is a chemical with antibacterial properties that was commonly used in household items such as soap, mouthwash, and hand sanitizers. Along with a slew of similar chemicals, the FDA banned triclosan from being used in over-the-counter soaps in 2016 and hand sanitizers in April 2019. Despite the current ban, the chemical may still be found in other daily products not regulated by the FDA, such as clothing (athletic wear) and contaminated water.
the authors reported that women who fell into the highest tertile of triclosan exposure also had significantly lower bone mineral densities (BMDs) compared with women in the lowest exposure group...
When the analysis was restricted only to premenopausal women, there were no associations between any degree of triclosan exposure with BMD in any area of the body.
Primary Source
The Journal of Clinical Endocrinology & Metabolism
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SHARE Report Back from ASCO on Metastatic Breast Cancer
Webinar
Dr. Linda Vahdat, medical oncologist at Memorial Sloan Kettering Cancer Center and Chief of Medical Oncology and Clinical Director of Cancer Services at Norwalk Hospital, will summarize research presented at ASCO 2019 focusing on metastatic breast cancer. Dr. Vahdat will also discuss her current research in triple negative metastatic breast cancer.
{This webinar was presented 6/25/2019. If you register, the recording opens up.}
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This website has a calendar of events that you may be interested in. It includes webinars! https://thestormriders.org/ Some conferences do live streaming.
I’ve put some webinars on my calendar and will be attending the breast cancer conference in Seattle in September. Lots of interesting stuff!
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Scientists discover 'switch' that helps breast cancer spread around the body
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Researchers Turn On PTEN Tumor-Suppressor Protein in Cancer Cells
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Rate of Memory Change Before and After Cancer Diagnosis
Question Are factors associated with carcinogenesis associated with a slower decline in memory function before and after cancer diagnosis in middle-aged and older US adults?
Findings In this population-based cohort study of 14 583 individuals, those with an incident cancer had modestly higher memory function and slower memory decline both before and after their diagnosis than similarly aged individuals who remained cancer free for a mean 11.5-year follow-up.
Conclusions and Relevance In this study, older individuals who developed cancer had better memory and slower memory decline than did similarly aged individuals who remained cancer free. These findings support the possibility of a common pathologic process working in opposite directions in cancer and Alzheimer disease.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2736177
JAMA Netw Open. 2019;2(6):e196160. doi:10.1001/jamanetworkopen.2019.6160
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Hematologic Safety Analysis of Palbociclib With Letrozole in Postmenopausal Women With ER+/HER2− Advanced Breast Cancer
- The Oncologist This analysis of clinical trial data evaluated the hematologic adverse effects of palbociclib associated with the use of letrozole in patients with ER+/HER2− advanced breast cancer. The incidence of grade 3 neutropenia was 55.6%, and 95.3% of patients experienced some neutropenia, which was managed by dose modification. The progression-free survival was similar among those experiencing grade ≥3 neutropenia requiring dose modification and those without grade ≥3 neutropenia.The use of palbociclib with letrozole for women with ER+/HER2− advanced breast cancer is associated with a high incidence of neutropenia, which can be managed by dose modification. This change in dose does not appear to impact efficacy.https://www.practiceupdate.com/C/85638/56?elsca1=emc_enews_topic-alerthttp://theoncologist.alphamedpress.org/content/early/2019/06/06/theoncologist.2019-0019doi:10.1634/theoncologist.2019-0019 Additional commentary on this study: https://www.practiceupdate.com/C/85638/56?elsca1=emc_enews_topic-alert
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Cancer-related financial burden among patients with metastatic breast cancer.
Presented at ASCO Saturday, September 29, 2018
Background: Recent data suggest that the adverse financial impact of cancer is an underappreciated source of potential harm to patients, also known as "financial toxicity". Little is known about the financial impact of cancer in patients with widespread, incurable disease, despite the relatively high cost of their care. We conducted a national survey of patients with metastatic breast cancer to address this gap.
Conclusions: Metastatic breast cancer patients reported an unprecedented level of cancer-related financial harm and significant worry about the financial legacy left behind in the wake of their illness. Health insurance expansion is a necessary, but insufficient strategy to address this financial burden; additional interventions to prevent and mitigate cancer-related financial harm are urgently needed.
https://meetinglibrary.asco.org/record/166359/abstract
Citation: J Clin Oncol 36, 2018 (suppl 30; abstr 32)
There is a related article/discussion on this presentation/article here:
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Interesting video montage of newspaper articles regarding breast cancer over the last 100+ years.
"This is a story spanning over a century of headlines for breast cancer and promises for a cure."
https://www.facebook.com/watch/?v=891998281148250
{You may need to be a group member to view the video.... not sure....}
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I like the video of the bullies.
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Appreciate the palbo/ Letrozole article Lumpie
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New Study Shows a Decline in the Incidence of Recurrent Metastatic Breast Cancer Over Time but no Improvement in Survival
New York, NY (February 1, 2019) A retrospective analysis – reported in the journal Breast Cancer Research and Treatment, by Judith Malmgren, PhD, and co-authors – studied 8292 women with stage I-III invasive breast cancer, 964 of whom (11.6%) were later diagnosed with recurrent metastatic breast cancer (rMBC). The authors found a significant decline in rMBC over time, but no increase in distant disease survival. Distant disease survival after an rMBC diagnosis decreased over time, from 23% in the years between 1990 and 1998, to 21% between 1999 and 2004, and to 13% between 2005 and 2011.
https://4fq5um2tr9f1r1ne5s8uo915-wpengine.netdna-ssl.com/wp-content/uploads/press-release-Feb-1-2019.pdfhttps://link.springer.com/article/10.1007/s10549-018-05090-y
DOI https://doi.org/10.1007/s10549-018-05090-y
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MRI vs Mammography for Breast Cancer Screening in Women With Familial Risk
- The Lancet Oncology This multicenter, randomized trial compared the benefit of MRI versus mammography for breast cancer screening among patients with a familial risk of breast cancer who were BRCA1/2 or TP53 wildtype. MRI screening detected more breast cancers and detected breast cancer at an earlier stage than mammography. Higher breast density was associated with poorer tumor stage and lower specificity in both screening groups.MRI screening appears to detect breast cancer at an earlier stage compared with mammography, and this could potentially improve outcomes. However, MRI may be associated with more false positives, particularly in women with a high breast density.
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New Study Shows a Decline in the Incidence of Recurrent Metastatic Breast Cancer Over Time but no Improvement in Survival
Would I be interpreting this plausibly to say that the current regimes for preventing progression (hormone blockers, etc) are doing a good job preventing some women who would otherwise have progressed from progressing, but that possibly they are the ones who would not have died from metastasis anyway, and would have brought up the survival stats, and now are not? That is... interesting and disturbing in a way.
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Mixed Results for Profiling in Predicting Late Recurrence in ER+ Breast Cancer
Tools may, however, help select patients for extended treatment
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Dueling Views on Genetic Testing in Breast Cancer
Journal correspondence makes cases for, against expanded germline testing
A call for universal genetic testing in women with newly diagnosed breast cancer stirred up strong views on both sides of the issue, which played out in correspondence to a leading oncology journal.
Late last week, JCO published three letters about the study, two from oncologists who disagreed with Beitsch and colleagues and one from a group of cancer specialists who supported the recommendation for universal testing. Additionally, JCO published a response from Beitsch and coauthors.
The disparate views reflected the complexities of interpreting, explaining, and acting on test results.
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Hi Salamandra: Yes, I think that you interpretation is pretty much correct. They seem to be saying that treatments are pretty good at keeping cancer from coming back (recurrence or metastasis) but that overall survival has not gotten better. I read at least a fair amount of the article and I am trying to recall discussion of causality.... Maybe some of the healthier patients never progressed. I have read elsewhere that therapies for MBC patients are improving quality of life but not extending it (although I can't give you a citation for that off the top of my head). This state of affairs leaves many parties frustrated and puzzled.... not to mention disappointed.
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Almost Half of Breast Cancer Mutations Missed by Test Criteria
Similar rate of variants in women included, excluded by NCCN guidelines
Women who did not meet guideline criteria for genetic testing in breast cancer had a prevalence of potentially pathogenic mutations similar to that of women who met current testing criteria, data from a multicenter prospective registry showed. The results showed that 9.39% of women who met National Comprehensive Cancer Network (NCCN) testing criteria had pathogenic or likely pathogenic (P/LP) aberrations in their breast tumors. Women who did not qualify for testing by NCCN criteria had a prevalence of 7.9%, which did not differ significantly from the NCCN-qualified group...
https://www.medpagetoday.com/hematologyoncology/breastcancer/78190
https://ascopubs.org/doi/full/10.1200/JCO.18.01631
DOI: 10.1200/JCO.18.01631 Journal of Clinical Oncology 37, no. 6 (February 20 2019) 453-460.
{This relates to the post regarding "dueling views" above.}
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Analytics, AI begin to show results in oncology
Research using data, analytics and artificial intelligence in oncology is in the early stages, but studies presented at a recent conference show there is real-world progress to report, writes Dr. Nathan Levitan of IBM Watson Health. AI can help physicians manage large amounts of data and facilitate shared decision-making with patients, as well as process clinical trial eligibility criteria and match patients to trials, Levitan writes.
Note: author is Nathan Levitan, M.D. the chief medical officer for IBM Watson Health Oncology and Genomics.
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Frequency of Pathogenic Germline Variants in CDH1, BRCA2, CHEK2, PALB2, BRCA1, and TP53 in Sporadic Lobular Breast Cancer
Christos Petridis, Iteeka Arora, Vandna Shah, Charlotte L. Moss, Anca Mera, Angela Clifford, Cheryl Gillett, Sarah E. Pinder, Ian Tomlinson, Rebecca Roylance, Michael A. Simpson and Elinor J. SawyerDOI: 10.1158/1055-9965.EPI-18-1102 Published July 2019
Abstract
Background: Invasive lobular breast cancer (ILC) accounts for approximately 15% of invasive breast carcinomas and is commonly associated with lobular carcinoma in situ (LCIS). Both have been shown to have higher familial risks than the more common ductal cancers. However, there are little data on the prevalence of the known high and moderate penetrance breast cancer predisposition genes in ILC. The aim of this study was to assess the frequency of germline variants in CDH1, BRCA2, BRCA1, CHEK2, PALB2, and TP53 in sporadic ILC and LCIS diagnosed in women ages ≤60 years.
Methods: Access Array technology (Fluidigm) was used to amplify all exons of CDH1, BRCA2, BRCA1, TP53, CHEK2, and PALB2 using a custom-made targeted sequencing panel in 1,434 cases of ILC and 368 cases of pure LCIS together with 1,611 controls.
Results: Case–control analysis revealed an excess of pathogenic variants in BRCA2, CHEK2, PALB2, and CDH1 in women with ILC. CHEK2 was the only gene that showed an association with pure LCIS [OR = 9.90; 95% confidence interval (CI), 3.42–28.66, P = 1.4 × 10−5] with a larger effect size seen in LCIS compared with ILC (OR = 4.31; 95% CI, 1.61–11.58, P = 1.7 × 10−3).
Conclusions: Eleven percent of patients with ILC ages ≤40 years carried germline variants in known breast cancer susceptibility genes.
Impact: Women with ILC ages ≤40 years should be offered genetic screening using a panel of genes that includes BRCA2, CHEK2, PALB2, and CDH1.
Footnotes
- Note: Supplementary data for this article are available at Cancer Epidemiology, Biomarkers & Prevention Online (http://cebp.aacrjournals.org/).
- Cancer Epidemiol Biomarkers Prev 2019;28:1162–8
- Received October 9, 2018.
- Revision received December 7, 2018.
- Accepted April 3, 2019.
- Published first July 1, 2019.
- ©2019 American Association for Cancer Research.
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Lumpie of course my brain went somewhere else when I read “AI.” 😉
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New name for breast-cancer syndrome could help to save lives
People of all sexes can have risk genes that are often assumed to affect only women. Renaming the syndrome should aid cancer prevention and treatment
Patients do "not realiz{e} that people of all sexes (including transgender people) can have mutations in BRCA1 and BRCA2 genes. These genes do encode the proteins associated with susceptibility to breast cancer. But they are also associated with an increased risk of prostate and pancreatic cancer, among others.
"Because this is not widely understood, testing is not being done for the right people at the right time. Those who identify as men are especially less likely to be tested. And people who are tested can have difficulty understanding the full meaning of their results...
"...hereditary breast and ovarian cancer syndrome, or HBOC. This term is not only misleading, it is also cumbersome and hard to remember. Fortunately, there is a simple solution: rename the syndrome.
"I propose that HBOC be renamed King syndrome. ...it would recognize the seminal contributions of pioneering cancer geneticist Mary-Claire King, the discoverer of BRCA1.
Article by Colin C. Pritchard
https://www.nature.com/articles/d41586-019-02015-7
Nature 571, 27-29 (2019)
doi: 10.1038/d41586-019-02015-7
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Ingerp: Oh, that's funny! Yes, our minds automatically go to a different AI...except those, perhaps who work in IT. Then, if they have BC, they must constantly pause and change gears!
Happy Independence Day to all!
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Facebook seeks to limit circulation of debunked medical claims
07/02/19
Facebook on Tuesday announced it is seeking to limit the circulation of debunked medical claims after multiple reports found that bogus cancer cures are rampant on the platform.
"In order to help people get accurate health information and the support they need, it's imperative that we minimize health content that is sensational or misleading," the blog post reads.
The tweaks come on the heels of two reports from The Washington Post and The Wall Street Journal detailing how users can get sucked into rabbit holes of medical misinformation when they're seeking more information about cancer diagnoses.
The Post identified groups dedicated solely to sharing "natural" cures for cancer, which have been shown to be ineffective when pursued without modern medicine.
The Journal's investigation found multiple figures without medical licenses selling bunk cancer "treatments" such as baking soda injections and juice regimens.
At a hearing last week, lawmakers dug into a Facebook representative over the continual presence of anti-vaccine content, saying it amounts to a public health hazard and the company is not taking action quickly enough.
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Study Probes How to Tell Elderly Patients Not to Bother With Cancer Screening
07/02/2019
...current clinical guidelines recommend against screening many older adults, such as those with less than 10 years' life expectancy. For doctors, talking to a patient about the idea that they've "aged out" of cancer screening can be a challenging conversation.Studies have found that cancer screening in adults with limited life expectancy can present unnecessary risks and lead to unnecessary treatments. That's because the tests may detect slow-growing tumors that aren't likely to affect an older person's lifespan.Patients and clinicians ... agreed that patients should play an active role in making the decision to stop screening. Clinicians tended to worry that patients might perceive the recommendation to stop screening in a negative light and that it would make patients angry. However, patients mostly responded that if they trusted their clinician, they would not think negatively of them for initiating the conversation. -
Why It's Still 1989 for Primary Care
Time and financial pressures keep PCPs from keeping up
- by Milton Packer, MD
- July 03, 2019
{This article provides remarkable insight on the "nuts-and-bolts" challenges associated with providing good quality primary care in today's healthcare - and payment - environment.}
Without doubt, U.S. patients with many chronic illnesses are not receiving good quality medical care to reduce suffering and prolong life.
What happens if a physician tries to make a difference and spends a bit of extra time? Their schedule runs late. When a survey subsequently asks if their appointment started on time, patients say no. And thus, the physician's patient satisfaction scores suffer.
To get real medical attention these days, you need to have an illness that requires or is amenable to a procedure for which the physician is paid. The result: when compared with other countries, we have the most expensive healthcare in the world, but we have worse outcomes.
..finding someone to blame does not fix the problem.
Our healthcare delivery system for chronic illness is horribly ill, even for those with full access to healthcare. Financialization has hollowed out its core mission and has made it meaningless. Increasing access to a failing medical infrastructure may sound good, but it does not address our core issues.
Healthcare for patients with chronic illnesses in the U.S. is on life support. The medical community seems helpless to fix this problem -- presumably because the solution is political, not medical.
The most important crisis facing U.S. medicine is not access to healthcare. It is access to 21st century healthcare.
{Author provides disclosures.}
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