Will 30% of Early Stage (1-IIIA) go on to metastasize??
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Hi ChiSandy:
Per my previous post, I think you are possibly over-inpreting the cross-over. The confidence intervals were wide in the lower range, and the authors do not attribute any such meaning to their results.
By my layperson's read of Albain (2010), there is nothing to suggest that these data were (or should be) viewed as indicating that adding chemotherapy is more detrimental than endocrine therapy alone in the Low risk group. This is particularly so when the authors characterize the treatments to be "equivalent" in the Low risk group and expressly stated that "the possibility of benefit cannot be completely ruled out."
Please read my complete post here:
https://community.breastcancer.org/forum/108/topics/812929?page=37#post_4784284
BarredOwl
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Lago - great post. Thanks.
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Komen is rated poorly as a charity, as much of the money stays at the top for administration of the charity.
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I've read that every hospital in the USA is able to keep its doors open because of it's oncology unit. Cancer treatment is a huge cash cow. Several treatments getting good success in other countries are not permitted in the US because they're not able to be patented, and Big Pharma (in bed with the FDA) prevents funding for studies in this country. It's possible that a cure for cancer is not desirable, as the cash cow would then dry up. Look at all the recent stories on the price of chemo.
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BarredOwl - I read it and appreciated it! Your posts are always very informative and clarifying!
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Thanks jojo9999!
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Kay...could you please supply your sources? Oncology units? Cash cows? Very hard to believe. Had physicians and researchers not believed that they were over treating patients with chemo, then genetic tests like the OncotypeDx and MammaPrint tests might never have been developed! You do realize that the money spent to develop these tests were far from inexpensive. However, they knew they wanted to spare as many people as possible from the risks of chemo and it was worth the investment in developing these tests.
Hang around here Kay and you will meet many people like me who were NOT recommended chemo and treatment has been minimal. I had complete faith in my oncologist's opinion. If you have sources to corroborate your opinion, I am very interested in seeing them.
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Kaymc, can you give an example of one of these treatments allowed elsewhere
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I am going to go out on a limb and say that obesity in America is EXTREMELY costly and probably is a great cottage industry within hospital walls. Strokes, heart attacks, uncontrolled blood pressure and diabetes are what probably keep hospitals in the black. I happen to know that the interventional cardiologist that did several procedures on the slender, DH earned a salary, last year, of over $3 million at a leading NY hospital. My oncologist, by comparison "only" earned a few hundred thousand dollars.
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I just did a quick search and the cost of cancer each year in US society comes to $88 billion. Obesity costs US society approximately $160 billion. Obesity costs 21% of health care costs.
Busom....there are some bad Pharma players, but suggesting their lobbies prevent bringing good treatments into the marketplace sounds like a conspiracy. Since the AIDS crisis began, the FDA has been very forthcoming in creating new ways to get into the marketplace what works and is SAFE. Read Eric Topol, MD's book The Creative Destruction of Medicine to understand how the digital revolution is helping evidence based medicine succeed.
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bosum, I just visited Florida and Pennsylvania and saw hospital billboards extolling their serviceS ( plural).
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voracious, I totally misread your post and thought you said your dear husband made 3 million... I was like well, no wonder she has so much time to read!
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Medical marijuana is legal here in IL, but your treating physician has to sign off on your application. My MO allows it only for her Stage IV patients and those on chemo with anorexia so bad they’re in danger of electrolyte imbalances or worse, cachexia. When I asked her why, she said that there is research that marijuana could have phytoestrogenic effects....and besides, she said “because you have asthma and shouldn’t be inhaling smoke of any kind.” Can’t argue with that. (My PCP is even more against it, given his stewardship of my lungs & vocal cords). There are the edibles, but you can’t control the dose and besides, none of my symptoms except perhaps anxiety might benefit from MMJ (and as soon as the anxiety abates, the paranoia starts, and then when the paranoia abates, the giggles start...and then I’m anxious about being seen acting silly, lather, rinse, repeat). I didn’t smoke so much weed in my wayward youth that I don’t remember that cycle!
We get “dueling cancer center” commercials here in Chicago, but that’s because we have so many topnotch centers & hospital systems that there is fierce competition among them. (20 years ago, it was hospital “birthing centers;” now the "dueling senior-residences/memory care commercials" are beginning as we boomers age, especially those of us caring for elderly parents)
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lisey...I wish!😘
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No Barred Owl, you're wrong. I read every word you write. I may not understand all of them but the more I read, the better my understanding
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Here is a chart of how much the average physician in each field makes:
Average U.S. Physician Salaries by Specialty
Allergy and Immunology $296,705 Anesthesiology $357,116 Cardiology $436,849 Colon and Rectal Surgery $343,277 Dermatology $400,898 Emergency Medicine $320,419 Endocrinology $217,610 Family Medicine $227,541 Gastroenterology $379,460 General Surgery $360,933 Hematology $376,660 Infectious Disease $205,570 Internal Medicine $223,175 Medical Genetics $158,597 Medicine/Pediatrics $205,610 Neonatology/Perinatology $290,853 Nephrology $306,302 Neurology $243,105 Neurosurgery $609,639 Nuclear Medicine $290,639 Obstetrics & Gynecology $315,295 Occupational Medicine $229,450 Oncology $341,701 Ophthalmology $343,144 Orthopaedic Surgery $535,668 Otolaryngology (ENT) $369,790 Pathology $302,610 Pediatric Cardiology $303,917 Pediatric Emergency Medicine $273,683 Pediatric Endocrinology $157,394 Pediatric Gastroenterology $196,708 Pediatric Hematology & Oncology $192,855 Pediatric Infectious Disease $163,658 Pediatric Nephrology $183,730 Pediatric Pulmonology $218,106 Pediatric Rheumatology $200,027 Pediatrics $206,961 Physical Medicine/Rehab $278,283 Plastic Surgery $407,709 Preventive Medicine $270,888 Psychiatry $227,478 Pulmonology $317,323 Radiation Oncology $418,228 Radiology $404,302 Rheumatology $244,765 Thoracic Surgery $471,137 Urology $381,029 Vascular Surgery $428,944
The income disparities are due to whether the docs are in surgical specialties (higher) or those that tend to be hospital-employed (lower). Cardiology, e.g., isn’t broken down into non-invasive, invasive, interventional, and cardiovascular surgeons. (Non-invasive cardiologists make about what internists do, and slightly more than family practitioners & general pediatricians; invasive ones, who do cardiac caths & implant pacemakers, make more; interventional ones, who do angioplasties, an order of magnitude more; and cardiothoracic surgeons either are very, very highly-paid or employed by their hospitals). Dermatology is an outlier because cosmetic procedures are a cash-cow. “Vascular surgeons” include both cardiac surgeons and those who rake it in doing hundreds of lucrative varicose-vein procedures. BUT the highest-paying specialties often have sky-high malpractice insurance premiums that can consume 30-50% of income. The figures also don’t take into account overhead for those not employed by hospitals: staff salaries, office space, equipment & supplies, continuing education (no longer provided free by drug companies).0 -
Sorry the cut-and-paste didn't work. Here's the link to the chart: http://www.theatlantic.com/health/archive/2015/01/...
And here is my explanatory paragraph in more legible form:
The income disparities are due to whether the docs are in surgical specialties (higher) or those that tend to be hospital-employed (lower). Cardiology, e.g., isn't broken down into non-invasive, invasive, interventional, and cardiovascular surgeons. (Non-invasive cardiologists make about what internists do, and slightly more than family practitioners & general pediatricians; invasive ones, who do cardiac caths & implant pacemakers, make more; interventional ones, who do angioplasties, an order of magnitude more; and cardiothoracic surgeons either are very, very highly-paid or employed by their hospitals). Dermatology is an outlier because cosmetic procedures are a cash-cow. "Vascular surgeons" include both cardiac surgeons and those who rake it in doing hundreds of lucrative varicose-vein procedures. BUT the highest-paying specialties often have sky-high malpractice insurance premiums that can consume 30-50% of income. The figures also don't take into account overhead for those docs not employed by hospitals: staff salaries, office space, equipment & supplies, continuing education (no longer provided free by drug companies).
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City's hospital specialists are raking in millions of dollars
They're operating in the green!
The highest-paid doctors in New York City are raking in millions of dollars each year, with some, even at struggling hospitals, getting six-figure bonuses, a Post review of hospital-based MDs has found.
The city's top earner was urologist and prostate-cancer specialist Dr. David Samadi, whose 2012 compensation came to $7.6 million. He was chief of robotics and minimally invasive surgery at Mount Sinai Hospital before moving to Lenox Hill Hospital last June.
Not far behind Samadi was his Mount Sinai colleague Dr. Andrew Hecht, head of spine surgery, whose compensation came to $6.9 million.
Both doctors were paid by Mount Sinai's Icahn School of Medicine.
"Whenever I see compensation data in health care, I'm stunned and nauseated," said Dr. John Santa, medical director of Consumer Reports Health. "I'm embarrassed for the profession."
Even the president of Mount Sinai Hospital, speaking at a conference last year, noted the "obscene levels" of pay for the hospital's interventional cardiologists, specialists who clear blocked arteries, according to a report in Bloomberg News.
The hospital's head of interventional cardiology, Dr. Samin Sharma, made $4.8 million in 2012.....
http://nypost.com/2014/04/13/citys-hospital-specia...
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Barred - You can count me as another avid reader of your extremely informative posts. I always learn from them.0
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Of course, that’s NYC. The less-lucrative specialties--such as pediatric endocrinology, rehab medicine, pathology, etc.--are completely hospital-employed and usually salaried. The hospital-based specialties in lucrative fields, that are cash cows for the hospitals, pay on a guaranteed-salary-plus-% of procedures basis--and the obscenely-paid ones are usually department heads. A disclaimer here: my husband is a cardiologist in private practice. He is still certified as “invasive,” since he did a lot of cardiac caths and angiograms (not to be confused with angioplasties), but because his knees and hips are beginning to give out he can no longer spend long hours in the cath lab. So he does a mixture of non-invasive cardiology (medical management, EKGs and ultrasound-echocardiography), and (mostly geriatric) primary care in a blue-collar neighborhood on the S. Side. He has office rent, a couple of nurses, a secretary, bookkeeper/office mgr. and a part-time receptionist to pay. We’re comfortable but nowhere nearly as well-situated as his colleagues with practices in wealthier neighborhoods and suburbs; and the interventional guy to whom he refers his angioplasties (and for whom he covers on vacation, in exchange for the ‘plasty doc covering for him when we’re away) makes in the very high six figures and lives in a huge house in a posh suburb. We live in a white-collar “family” neighborhood on the N.Side. When Bob had to take nearly a month off last year when he suffered first a botched colonoscopy, medical mismanagement of it, a hemicolectomy and then a strangulated hernia, our income dropped precipitously--no matter how much receipts go down, staff has a right to be paid without suffering a cut. He’s thinking of selling his practice to the hospital where he most often works--his gross income would be cut in half, but his overhead would disappear and he’d finally be working normal hours.
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chi...my son-in-law is a physician in private practice so I know the drill. Two nieces are hospital based physicians, one of whom is a pediatric oncologist....none are making insane salaries!
Wishing you and the DH the best....
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I was shocked to read the words "BarredOwl, you are wrong..." above. But it turned out that Luckynumber47 was only saying that she did indeed read what BarredOwl wrote! A more clear-thinking and helpful owl there never was, and we do appreciate her posts.
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SpecialK are you saying that the test is made on the tumour that was taken out 5 YEARS earlier??? What if it's not available? I can't remember what this was for, tried to keep my question in mind as I read the couple of pages until the end. Why can't they do the test at the time of original surgery?
Bosum, if you believe in conspiracy theories, then do you think kids are being made fat so doctors have their health care as they age? As someone said, diabetes, blood pressure, skeletal issues, etc are a huge part of the medical industry.
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barbe - yes, I am. It is fairly customary to keep those tissue samples for 10 years here in the US, but not sure about Canada. This test is done by one lab, like Oncotype and Mammaprint are, it is not being routinely done yet since it is a newer test and is not yet FDA approved. The test has only been available for a few years, and there is sporadic insurance payment for it, although I believe Medicare covers it, which can sometimes signal other insurers to cover it also. Because this test gives info at the five year point that seems to be when docs do it, but I asked the same question of my MO since they are using the original tumor. It may be that as this test gains acceptance, if it does, that it will be done at the time of diagnosis as it does potentially shed light via genetic assay on recurrence risk and effectiveness of anti-hormonal drugs. Knowing that some patients, like me, do not seem to gain as much benefit from anti-hormonals might change the way we are monitored after initial treatment.
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In addition, if a doctor is participating as an investigator in clinical trials with a pharma company - that is an additional large source of income. Sites are paid usually by each patient recruited and many doctors participate with multiple pharma companies. Back in the day this was quite common in drug trials. This has created career opportunities for nurses to specialize as coordinators in clinical drug trials both within pharma companies and at the investigator sites.
edited to add - we are bombarded here with cancer commercials from hospitals in the local area. Including insane number of drug commercials - that along with "junk" food.
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Recently, I had the BCI test. I am 6 1/2 years away from being diagnosed.
Just want to add DH is participating in a clinical trial for the last 10 years. Several years ago, the physician, who led the trial retired. Only 2 doctors agreed to continue the study. The DH has an orphan illness. We travel by plane twice a year for his extremely thorough exams. I pray for the day that the FDA approves the treatment so that we never have to travel again to receive care. I applaud all of his medical team for conducting the study, for without their dedication to the trial, the DH's quality of life would be even more diminished.
Since being diagnosed more than 20 years ago, we have looked far and wide for alternative "natural" alternatives. What I have learned from this journey is that when the body breaks down enzymes, it cannot distinguish from "natural" or "synthetic." Either can be dangerous.My preference would be for him to take whatever that is clinically proven to be safe and effective.
There is a special, warm place in my heart for all of those people who are courageous enough to participate in clinical trials.
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voraciousreader I totally agree about obesity. Seems doctors don't discuss your weight until you are at least 20lbs over. Then they don't discuss how to lose the weight, don't send you to a nutritionist or tell you how to exercise. That's part of the problem.
as you can see as far as specialists go oncologist don't make the most. You want to make money as a physician go into dermatology or plastic surgery. Also I believe that oncologists and OBGYN have the worst on-call schedules. I have 2 family members that are physicians (married to each other) One is a cardiologist (male) working at a hospital, the other (female) works at a pharmaceutical company. The one who works for the pharmaceutical company makes more money and isn't "on call".
"overweight kids are largely poor parenting" or just from poor families that can't afford good nutrition. Many of these families are eating more less expensive carbs or fast processed foods (because parent(s) work multiple jobs and don't have time to prepare) or are living in grocery store desserts.
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I really wish that more patients would participate in clinical trials as one of the things that is holding back the progress of finding a cure for cancer. Currently it's fewer than 10% across all cancers. There are a lot of participants for breast cancer trials, but relatively few for some of the cancers that occur less frequently.
I participated in 2 clinical trials from which we learned:
- Dose dense AC is more effective in preventing recurrence than metronomic dosing (constant smaller doses). We still don't know if 6 DD is more effective than 4 DD, but we should know this in the next couple of years.
- There is no difference in outcomes between weekly and every 2 weeks Taxol, with side effects being a trade off.
- Acetyl-L-Carnitine is not effective in preventing neuropathy with Taxol.
- I don't think they were able to determine genetically who would get neuropathy and who is unlikely to get it. This is unfortunate, as it would have been wonderful to be able to screen for this in advance of getting the drug.
I do not begrudge anyone being paid for being a clinical trials coordinator or principal investigator. It's additional workload, and they should be paid for it.I just won the high blood pressure lottery, so need to add that one to my list of things to pay attention to. A surprise for my doctor and also me, but thinking through a few odd things I have been experiencing, I have to admit that meds are a good idea. I am also going to lose about 8 more pounds in addition to the 7 or so that came off from all the cycling this summer. (I am one of the few patients that my internist did not have to tell to exercise more!!)Anyway, a week of Shit Happens, as not the only "surprise", most of which does not affect me directly. And no, I didn't win the Megabux Lottery either. - Claire0 -
"Acetyl-L-Carnitine is not effective in preventing neuropathy" actually in the study they found it made it worse…but there were taking mega-doses.
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Claire - I didn't mean anything negative about doctors who participate in clinical trials or the nurses who manage the studies. Actually this is a wonderful career path for any young person considering to be a nurse and likes detail work. They are highly sought after by research facilities, pharma and CROs. I would certainly pursue it if I were just starting college and like life sciences. I was a Clinical Data Manager for many years in Pharma and loved my job. (I was the CDM for allergy drug Allegra and built all the patient case report forms, diary, database dictionary and programmed all the data checks before access by statisticians.) These are excellent career paths for young people to consider.
sorry to get off topic....
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