Tag Archives: Breast Cancer

Young Women With Breast Cancer Are Increasingly Being Tested For BRCA Mutations

percent_cancer_riskUS News & World Report (2/11, Esposito) reports that research published online in JAMA Oncology indicates “testing for BRCA1 and BRCA2 gene mutations, which significantly increase a woman’s risk of getting breast cancer and ovarian cancer, is on the rise among women ages 40 and under who’ve been diagnosed with breast cancer.”

HealthDay (2/11, Norton) reports that investigators “found that of nearly 900 women who developed breast cancer at age 40 or younger, most had undergone BRCA testing within a year of their diagnosis.” The data indicated that “the percentage went up over time: By 2013, 95 percent had been tested.”

The Cancer Network (2/11, Levitan) reports that the researchers “noted that the high frequency of testing in this cohort likely reflects the fact that most women were insured, educated and treated at major cancer centers.”

Cancer Remains Costly Even After The Disease Has Been Treated

HealthDay (1/13, Dotinga) reports that research published in the Journal of the National Cancer Institute suggests that cancer “remains costly even after the disease has been treated.” Investigators found, for instance, that “non-elderly survivors of colon cancer had extra expenses of about $20,000 annually.” The “extra expenses included direct medical costs, as well as lost productivity.” Meanwhile, for breast cancer survivors “under 65, the economic burden totaled about $14,000, and for prostate cancer it was approximately $9,000.”

Long Distances To Treatment Centers May Be An Obstacle For Some Women Seeking Breast Reconstruction Following A Mastectomy

breast_cancer06142HealthDay (1/7, Dallas) reports that research indicates “long distances to treatment centers are a significant obstacle for some women seeking breast reconstruction after a mastectomy.” The study authors wrote, “While greater patient awareness and insurance coverage have contributed to greater breast reconstruction rates in the United States, geographic barriers to access this service remain, particularly to academic centers.” The research was published in Plastic and Reconstructive Surgery (abstract below).

Background: Inadequate access to breast reconstruction was a motivating factor underlying passage of the Women’s Health and Cancer Rights Act. It remains unclear whether all patients interested in breast reconstruction undergo this procedure. The aim of this study was to determine whether geographic disparities are present that limit the rate and method of postmastectomy reconstruction.

Methods: Travel distance in miles between the patient’s residence and the hospital reporting the case was used as a quantitative measure of geographic disparities. The American College of Surgeons National Cancer Database was queried for mastectomy with or without reconstruction performed from 1998 to 2011. Reconstructive procedures were categorized as implant or autologous techniques. Standard statistical tests including linear regression were performed.

Results: Patients who underwent breast reconstruction had to travel farther than those who had mastectomy alone (p < 0.01). A linear correlation was demonstrated between travel distance and reconstruction rates (p < 0.01). The mean distances traveled by patients who underwent reconstruction at community, comprehensive community, or academic programs were 10.3, 19.9, and 26.2 miles, respectively (p < 0.01). Reconstruction rates were significantly greater at academic programs. Patients traveled farther to undergo autologous compared with prosthetic reconstruction.

Conclusions: Although greater patient awareness and insurance coverage have contributed to increased breast reconstruction rates in the United States, the presence of geographic barriers suggests an unmet need. Academic programs have the greatest reconstruction rates, but are located farther from patients’ residences. Increasing the number of plastics surgeons, especially in community centers, would be one method of addressing this inequality.

High-Dose Radiation Therapy Compared with Conventional Radiation Therapy

HealthDay recently reported that research suggests that “high-dose radiation therapy over a short period of time treats early stage breast cancer as well as longer, conventional radiation therapy does.” Investigators found that “eight years after treatment, there were no significant differences in survival among hundreds of patients who received intense radiation therapy over four weeks or standard radiation therapy over six to seven weeks.” The findings were presented at the American Society for Radiation Oncology annual meeting.

Radiation therapy significantly reduces the risk of local cancer recurrence and improves the chances of survival, but many breast cancer patients don’t get standard radiation therapy because it takes a long time and has higher costs, the researchers said.

Intense radiation therapy shortens treatment by weeks and is far less expensive for patients, the study authors explained.

ACS breast cancer screening guidelines unlikely to impact insurance coverage

Kaiser Health News (10/24, Andrews) reported that “the American Cancer Society’s new breast cancer screening guidelines, recommend[ing] that women start screening later and get fewer mammograms…is unlikely to affect insurance coverage anytime soon.” These “guidelines on their own likely won’t change insurer and employer decisions regarding coverage of screening for breast cancer, experts agree.”

USA Today (10/26) editorial criticizes the new American Cancer Society (ACS) mammogram guidelines. USA Today writes that the panel responsible for the guidelines “opted for recommendations that invite devastating consequences for some women.”

In an “Opposing View” in USA Today (10/26), Ruth Etzioni, a biostatistician, and Kevin Oeffinger, a physician, both members of the ACS panel that wrote the guidelines, write, “The recommendation that by age 45 women should undergo regular screening is designed to limit the numbers adversely impacted while benefitting as many as possible.”

The New York Times (10/26, Subscription Publication) also editorializes on the new guidelines, saying they present “another wrinkle for women who are trying to make informed decisions about their health care.” The Times argues that “when there is still such a dizzying array of expert opinion, it would be wiser to require insurers to continue covering all women starting at 40.”

The Washington Post (10/24, Lerner), Barron H. Lerner, a professor in the division of medical ethics at New York University’s Langone Medical Center, wrote that “the ACS is to be applauded,” as “its new guidelines are based on the actual scientific value of early detection, not the organization’s needs and prior beliefs.”

Protesting for Metastatic Breast Cancer Research

It is estimated that 150,000-250,000, Women & Men in the U.S. are living with Metastatic Breast Cancer.  1430 people die every single day from MBC. 24% of these people are alive 5 years from Diagnosis. AND, only 7% of $15-BILLION dollars from 2000-2013, by the major government and non-profit funders in the US and the UK was spent on Metastatic focused Research. This is unacceptable, and change needs to happen.

I met an amazing woman, Beth Caldwell, who is one of the leaders of this MetUp Protest. Beth, is a young mother, metastatic breast cancer thriver, and passionate advocate. Beth, explains life as a MBC patient, the lack of funding & awareness it receives, and what we intend to do to change it. Tomorrow is one step of this process. You can see her video here: http://bit.ly/1N9a7KT and her Huffington Post article here: http://huff.to/1Ii99IL

METUP is a diverse, non-partisan group committed to direct action for a viable cure for breast cancer. We protest and demonstrate; we meet with government and health officials and researchers; we support research into metastatic disease; and we speak out against the sexualizing of breast cancer. We are convinced that the deaths of women and men from metastatic breast cancer are a paramount issue, and we pledge ourselves to oppose all who deny the reality of the 522,000 people who will die from metastatic breast cancer globally every year while waiting for a cure to be found.

Legislative Goals

    1. We want the SEER database modified to begin tracking when someone with early stage disease metastasizes, so that every woman and man with metastatic disease is counted.
    2. We want additional research funding for all cancer types. The National Institute of Health (NIH) now only funds about 8% of the grant applications it receives. We want that number increased to at least 25%.
    3. We want at least 30% of federal breast cancer research dollars to be spent on metastatic disease, with a focus on translational research.

Today, I will be joining over 220 Women & Men, to advocate that more funding for breast cancer gets allocated for Metastatic Research. This protest, AKA “DIE-IN” will take place on the West Lawn of Capital Hill, in Washington, D.C. We will make our voices heard, our bodies seen, and our passion for this change to happen. We will also be meeting with legislators to ask for their support.

I am honored to be here today, representing the many lives of women and men who have passed way too soon. And, to be that voice — advocating for change.

More to come soon!

“Mommy, are you going to die?”

picture2On May 28th, Thursday, it was the last day of school. I purposely scheduled my quarterly PET Scan, knowing how busy the day was going to be, with all the kids coming over to celebrate with their moms and friends. The anxiety and fear never leaves your mind, and the uncertainty overwhelms you. I tried my best to stay busy, but as the day and night progressed, I could feel my mind wonder. Conversations seemed to be less engaging for me, and all I wanted to do was call my oncologist to hear the results.

I had a big oncology conference the next morning in the city, and I was planning on driving that night after my parents arrived to relieve me. Than, the call came in, 9pm. There was an area, in my left adnexal, near my left ovary and fallopian tube that showed suspicious activity that needed to be further evaluated. All I could think of was, how in the world would I even have the time to find a gynecologic oncologist with my schedule so packed morning till night for the next 7 days. But, I had to do what women do best – put on my work hat, and place this to the back burner to focus on what the priority was at that moment. I had no choice. What I was able to do, and I realize how blessed I am, was the ability to access the top oncologists from all over the world. Professionally, I have the most amazing support network, and I asked every one I knew what this could be, and how to best proceed. The overall suggestion was to undergo surgery to remove this and get the pathology to determine if this was truly ovarian cancer as they suggested on the report, or the return of metastatic breast cancer.

When I arrived home from my trip, I had 3 names of the top gynecologic oncologists in my area. I scheduled my first appointment with a local doctor from Hinsdale Hospital. I went alone thinking I would hear the same suggestions from my connections. But, that was not the case. After my exam, and review of films, and tests, the doctor looked at me and said, “Ms. Jewett, I think you have metastatic breast cancer that has went to your ovary. We are going to need to perform a full hysterectomy. Now, keep in mind this could be benign, or it could also be a new primary, such as ovarian cancer. But, in my professional opinion, I think we are dealing with MBC.” As tears started to roll down my face, all I could think of was how much more could I possibly handle on my plate? Divorce? Cancer? Surgery?

The second opinion was the same recommendation. This doctor was the top gyn-onc from Northwestern. When I heard his thoughts on MBC, I cried and put my hand in his face and asked him to just stop talking. I could not hear anymore of his thoughts. Much less how he was going to take my uterus out through my vagina! I am 38 years old, cancer has taken my breasts, taken my ability to have any more children, and now it is going to take my remaining female parts next? When do I say enough is enough?

Cancer is an evil Bitch.

After that appointment, I had to meet with my attorney that is handling my divorce case. I remember sitting in the waiting room, thinking was this really my life? Not only did we have to discuss my financial concerns surrounding the divorce, but it was also time to consider a Will and Power of Attorney. And, I needed this information in place before my surgery date. I was sick to my stomach. All I wanted to do was to go home and hold my kids so tight and forget this was all happening.

My last appointment was with a female gyn-onc, on Thursday, who had a much more compassionate perspective and approach. She was able to confirm that this was not a mass, it was my ovary that was enlarged, and had some suspicious activity going on. She did agree that the best option would be a full hysterectomy. However, she understands that as a young woman, who is cycling every month, this would not be an easy journey. I asked if it was possible to leave my right ovary, at least until I was ready to let it go. She said she was open to that suggestion, but if I were to test positive for cancer, whether that was metastatic breast or ovarian, it would need to come out, no matter what. I like to think and believe there is hope. And, I like that she is a female doctor who has compassion, and understanding to do what is best for me in the midst of all the uncertainty and anxiety. I have come to realize that with a diagnosis like cancer, patients need to feel as if they have some form of control. It truly does help with the decision making.

When I arrived home from that appointment, my kids were very aware with what was going on. I had tried my best to keep them from all of this until I had a better idea what was going to happen. But, they had to know the reality, it was time. I sat them both down, alone. I explained to them that I had a PET scan, just as I always do every quarter, but this time something showed up that needed further evaluation.

My daughter, Kalli, immediately got upset and told me I was lying and she knows it was cancer. I told her we really did not know that, but I would need to have surgery to take out that “suspicious area” and some other parts to ensure we minimized my risk.

My son, Tyler, looked at me with tears in his eyes and said, “Mommy, are you going to die of cancer?” At this point, I could no longer hold back my emotions, and I simply told them both that I did not have that answer. What I could promise them was, I fought cancer twice now, and that I would do everything I could to fight it again. And this surgery was part of that process. I explained that we had some time until surgery, and that I wanted to take a vacation with them before, so we could enjoy the rest of their summer vacation before school started.

It has been the worst 3 weeks of my life. I have cried so much, felt the anxiety in my chest, and have feared what lies ahead. What I am so grateful for in the midst of this uncertainty is the overwhelming support, love, and compassion from all my friends and family, near and far, personally and professionally. I have gotten emails, calls, text messages, and cards, that fuel my strength to know we are not alone. There is an army with a lot of gear fighting this battle with us, and I will overcome this next chapter of my life.

So, for now I need time to process the reality. In the meantime, I am going to continue to focus on doing the work I love, embrace every moment of every day, and spend time with the people I love so much.

Life truly has a lot of challenges lately, but there is not a single moment that goes by that I do not count my blessings for the life I have been given.

From the bottom of my heart, THANK YOU for the support, and most of all, the love and compassion you have shown the kids and I.

Second Look Alters 20% of Breast Biopsy Conclusions

second-opinionMedscape Medical News recently published an article with the above title about a study from Roswell Park Cancer Institute showing that 20% of cases examined there resulted in a change from the prior diagnosis.

This comes on the heels of a recent JAMA study that has been widely discussed in the pathology and popular press about the discordance among practicing pathologists in primary breast diagnosis.

I think the bottom line here is that review of pathology slides can have a significant impact on patient care and you owe it to yourself to insure that a breast specialist or second opinion from an individual/institution with expertise reviews your slides.

The second opinion about a suspected breast cancer should be in the form of an “interinstitutional pathology consultation” (IPC) that includes a review by a specialized breast pathologist, the authors say.

“Specialized pathology is very important these days because there are so many advances in the field of pathology, and if you are not specialized, you will miss many of the new technologies and morphologies, new entities, etc, etc,” author Thaer Khoury, MD, from Roswell Park Cancer Institute, Buffalo, New York, told Medscape Medical News.

In his study, a second look at the pathologic samples from needle biopsies that were sent to Roswell Park by outside institutions resulted in a change in 20% of the cases that were examined.

“These results underscore the need for a second review of the original pathologic material by a pathologist who specializes in breast cancer prior to the implementation of breast cancer therapy,” he said.

The study was published online April 15 in the Breast Journal.

“At Roswell Park Cancer Institute, it is a routine practice to review the outside pathology slides and reports of all patients referred from different health institutions for further treatment,” Dr Khoury said.

“This type of review is a required part of our quality assurance policy, but it has never been formally evaluated in terms of the discordance rate and the subsequent clinical impact on patient care.”

Consequently, Dr Khoury and colleague Yousef Soofi, MD, sought to evaluate the impact of IPC for breast core needle biopsies received at their institution.

They retrospectively reviewed 502 breast core biopsy cases provided by referring institutions during a 1-year period (2012).

Surgical pathology follow-up was available for 25 (62.5%) cases with major discordance and for 13 (20.3%) cases with minor discordance.

The resulting interpretation changed management in 15 patients (3%); 25 patients (5%) had a potential of management change.

The most common reason for major discordance was in interpreting biomarkers, such as the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor type 2 (HER- 2).

Breast J. Published online April 15, 2015. Abstract