Breaking Research News from sources other than Breastcancer.org
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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,"
DOI: 10.7326/M18-2147
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Fortunately for me my PCP looks at these kind of recommendations as being based on "herd mentality" and treats his patients as individuals. Had I not had my annual mammogram at age 77 who knows how long it would have taken that tumor near my chest wall to make itself evident in some nasty way? I would much rather have a biopsy with negative findings (been there, done that) than have no idea what is going on in my body that is treatable if known. My rant for the day!
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Beaverntx I think 75 is the cutoff age for the death panel.
Free fatty acids appear to rewire cells to promote obesity-related breast cancer
- Date:
- March 13, 2019
- Source:
- University of Illinois at Urbana-Champaign
- Summary:
- Free fatty acids in the blood are linked with higher rates of estrogen-receptor positive breast cancer in obese postmenopausal women, according to a new study.
- https://www.sciencedaily.com/releases/2019/03/1903...
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Yikes!
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Well since my cancer was diagnosed by clinical breast examination two years before I would have started getting mammograms, I'm glad that my gynecologist was not following that protocol.
How about extending the amount of time that insurance companies permit doctors to spend with their patients, so they can actually get both a breast exam and other beneficial health interventions?!?
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Salamandra, great idea. Used to be the case but with the increasing voice of the "bean counters" focus has changed from the patient to the bottom line!
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I have old-fashioned, standard medicare with a medigap policy. I have not had any problem seeing any docs whenever I want. Nor have I had any problem getting any testing. My docs don't rush me and take time to answer all my questions. However I do have friends who are on the Medicare HMO (Advantage) plans and have problems like everyone is describing.
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I get it that "over-diagnosis" has its problems but I have also noticed that no one who has been Dx'd with cancer ... even if it wasn't found by mammogram or practitioner exam... says "gee, it's too bad there's so much screening." I think that if you pole the public, they prefer to have more screening, not less. I am sure we have all noticed the "executive physicals" that some health care systems offer.... for a fee not covered by insurance. What are those? Extra screening! Is it strictly rational? Maybe not. Thing is, a certain percentage of us would rather be alive and vigilant than dead and rational. (And there's my rant for the day, too!)
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Off the shelf immunotherapy research being conducted. The future is full of hope. Let's all stick around for it.
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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.
Primary Source
Journal of Clinical Oncology
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Elucent Medical Receives FDA Clearance for Innovation for Breast Tumor Removal Procedures
EnVisio Surgical Navigation System and SmartClip Soft Tissue Marker provide alternative for painful and costly localization procedures
Elucent Medical announced that it has received U.S. Food and Drug Administration (FDA) 510(k) clearance for the clinical use of the company's EnVisio™ Surgical Navigation System. Elucent Medical's permanently implantable wireless SmartClip™ Soft Tissue Marker provides an alternative localization procedure. The SmartClip™ is used by surgeons with the company's EnVisio™ Navigation System to identify the location of the malignancy and to wirelessly navigate to it in real-time 3-D. The system can uniquely identify three different SmartClip™ Soft Tissue Markers – allowing physicians to effectively mark difficult lesions and navigate distances, depths, and directions... Elucent Medical is offering a ...solution that addresses a key challenge for breast surgeons: how to easily find the location of a malignant biopsy during surgery, especially in tissue that lacks anatomical landmarks.
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Lumpie- I heard a talk with a panel of MOs who said that they can't get authorization for the genetic testing for many patients especially if they are under 60 years old. The prices have come way down so maybe if the insurance refuses- patients could pay for it themselves.
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Nkb, my genetic testing was billed at about $4500 from the lab (independent of my hospital) and about $300 from my hospital for the counselor and the blood draw. I don't know how much it is other places, but it would be a stretch to cover that by myself.
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mountain Mia- that sounds like the prices for when I had the tests also- tho my insurance covered it- these MOs are saying that it is getting closer to $250-750 for the 11 or 13 tests that are the most important. Hope it is true.
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Effect of Radiotherapy After Breast-Conserving Surgery Depending on the Presence of TILs
- The purpose of this study was to analyze the association of tumor-infiltrating lymphocytes (TILs) with the effect of postoperative radiotherapy (RT) on ipsilateral breast tumor recurrence (IBTR) in a large randomized trial of 936 patients with stage I/II breast cancer. The authors found that high TIL values were associated with a reduced risk of IBTR (HR, 0.61; P=.033). The interaction between RT and TILs was not found to be statistically significant (P=.317).
- High TIL values within the primary tumor may be associated with a reduced risk for IBTR. The authors further conclude that patients with low TIL values may experience a greater benefit from RT with regard to reduced risk of IBTR.
DOI: 10.1200/JCO.18.02157 Journal of Clinical OncologyPublished online April 02, 2019.0 -
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.
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What genetic testing are you referring too, like BRACA and other mutations or something more specific?
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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.
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Thanks for clarifying. I was tested almost immediately at MDA since I was stage IV de novo at 41 with strong family history (mom and maternal aunt). Results were negative but the genetic counselor believed there’s something in a combination of genes not currently known. It was covered by my insurance since I was under 45, I only paid the $100 copay. Interesting stuff, thanks!
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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.sciencedirect.com/science/article/pii/S0304383519301983
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Organ Transplant Disability Bias Gets Second Look Under Trump
The Office for Civil Rights (OCR) in the U.S. Department of Health and Human Services (HHS) is reportedly considering written guidance warning health care providers that denying organ transplants based solely on disability violates the ADA.
{This would seem to raise some interesting questions about the possibility of transplant for oligo-metastatic disease.}
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as I recall, my genetic tests covered about 15 variables. Even with a strong family history (mom and both her sisters, who each had recurrences), the tests did not find any links. My insurer- Aetna- covered the tests. I think the hospital told me they will check results again in 5 years if new tests are available.
I find it unconscionable that some insurers won’t cover genetic testing and/or that the standard of care depends on where you live.
Lanne
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When I was diagnosed in 2012 I was tested for BRAC through Myriad which was negative. At the time, insurance didn't cover it so I paid $4000 for the testing. Took me forever to pay it off!! Well, now I've just gotten my mammogram results letter (all good!) and the letter says genetic testing is now strongly recommended for anyone having had BC. I called the breast center where I had my testing done because I wasn't sure if my original testing was all that was needed or if there was more. The counselor there said Myriad is now offering additional testing to anyone who only had BRAC done. It covers about 30 more genes that are looked at for other ties to BC and insurance should cover it. Apparently guidelines recommend the latest testing be done for all BC patients. So I've called my BS and they are supposed to be sending a referral to the breast center so I can go in for a blood draw to get the extra tests done.
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lala1, I am really impressed that you received a letter saying that testing is recommended. I would venture to say that most of us do not get such proactive notification. That is great that Myriad is offering additional testing. (I hope it is at a palatable-to-patient fee structure.) Sounds like most of us probably need to check in with our docs to be sure that we have had suitable testing. There is so much more to learn in the field of genetics. I venture to guess that this is something we each probably need to revisit with our providers every 5 years or so if we want to keep up with the latest findings. I sort of feel like that is something I can do for my family... to give them a heads up if there is a chance of increased risk. Right now, only about 10% of breast cancer can be associated with inherited risk.... which leaves so many of us wondering what the heck happened!
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Lumpie, what does Myriad test for? Is it similar to Oncotype? Thank you!
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lala1, the insurance should reimburse you the 4k!
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April1964: Oncotype and similar tests (like MammaPrint) test the genetics of a tumor. This is sometimes also referred to as "genomics." Myriad tests the genetics of your body/your person. You may also hear the term "germ line" in reference to genetics. That means things that are hereditary... which can be passed along within a genetically related family (parent to child). One of the best genetics references if you want to read more about genetics is the Genetics Home Reference. It is part of the NIH U.S. National Library of Medicine. Professionals use it, too! They used to have a really excellent glossary of terms which, lamentably, I can no longer find, but there is still lots of good descriptive/educational info. Here's the link:
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thank you so much Lumpie!!!!
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I initially had genetic testing for 6 variants which were all negative. Once my mom had BC for the second time, they did full panel on her and found VUS in CHEK2. They tested me for that same thing, but only that and found I had it too. I could not get full panel testing done "since I already had BMX, it would not alter my treatment". I had full panel testing done by COLOR Genomics for $250. It found the same VUS, but thankfully nothing more. It was very efficient and easy.
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