Why Californians Are Living Longer With Most Types of Cancer
Many Breast Cancer Patients Can Skip Chemo, Study Finds
Therapy Made From Patient's Immune System Shows Promise For Advanced Breast Cancer
FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk
Should You Get a More Expensive, 3‑D Mammogram?
New Wrinkle in Mammography Debate: Many Detected Tumors May Not Pose Threat
Cooling Caps Shown to Limit Hair Loss in Breast Patients on Chemo
Some Insurers Require Genetic Counseling Before Breast Cancer Tests
With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study
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When he noticed rectal bleeding in 2010, he went to see his physician, who ordered a colonoscopy.[contextly_sidebar id=\"vc7B3eLIIv6aV3Hq5qcJq85a0z0PMqRC\"]\u003c/p>\n\u003cp>The diagnosis: colon cancer.\u003c/p>\n\u003cp>Kunitomi, now 74, underwent surgery, radiation and chemotherapy — and now he has been cancer-free for seven years. “The things that are said about early detection and living a healthy lifestyle are important,” said Kunitomi, a resident of Ventura County, Calif. “You are foolish if you don’t pay attention.”\u003c/p>\n\u003cp>Californians are living longer with most types of cancer, due to earlier detection and more effective treatments, according to\u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/13098\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a> from the University of California-Davis. But racial, ethnic and socioeconomic disparities persist, the report found.\u003c/p>\n\u003cp>The study, published this month, shows that 65 percent of people diagnosed with cancer between 2006 and 2010 survived five years or more from the time their disease was discovered, up from 58 percent for those diagnosed between 1990 and 1994. The researchers drew from data on 1.4 million California adults diagnosed with 27 different kinds of cancer. They found improved survival rates for patients with all but five types of cancer.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Non-Latino whites had the highest five-year survival rate for all cancers combined, followed by Latinos — though Pacific Islanders and Asians, like Kunitomi, had the highest rates for 13 of the cancers studied, including breast, colon, liver and lung. African-Americans had the worst overall prognosis.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444171\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_over-time1-1020x747.png\" alt=\"\" width=\"640\" height=\"469\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-1020x747.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-160x117.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-800x586.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-768x563.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-960x703.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-240x176.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-375x275.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-520x381.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>The California numbers echo a national trend of significant improvement in cancer survival, one also tempered by racial and ethnic disparities. A recent analysis in the journal Cancer, which relied on death rather than survival rates, found a \u003ca href=\"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21460\" target=\"_blank\" rel=\"noopener\">26 percent decline in cancer mortality\u003c/a> in the United States between 1991 and 2015 — translating to nearly 2.4 million cancer deaths avoided. The study showed mortality rates declined for all the major cancers, including breast, colorectal and prostate.\u003c/p>\n\u003cp>Dr. Otis Brawley, one of the authors of that report and chief medical and scientific officer of the American Cancer Society, attributed the improvement to better screening, detection and treatment — and a decline in smoking. He said cancer deaths likely would drop even further if there were more equal access to prevention, diagnosis and treatment.[contextly_sidebar id=\"fmc02MyXuNyOxUDOEz7MyAsTaZY5UAeN\"]\u003c/p>\n\u003cp>Perhaps unsurprisingly, the UC-Davis data show that poor Californians don’t live as long with cancer as those of greater means. About three-quarters of the patients at the highest socioeconomic level, with all cancers combined, survived five years or more. Just over half the patients at the lowest levels lived that long. Age was also a major factor: The younger patients were at the time of the diagnosis, the better their chance of survival.\u003c/p>\n\u003cp>Separate research from UC-Davis, published in 2015, showed the impact of health insurance status: Uninsured patients and those on Medi-Cal — California’s version of the federal Medicaid program for low-income people — had worse cancer care and outcomes than people with private insurance.\u003c/p>\n\u003cp>The research published this month showed the most critical factor in survival was finding the cancer early, which the report said underscores the importance of screening. One hundred percent of breast cancer patients survived at least five years if their disease was detected at stage 1. Only 28 percent of patients lived that long if their cancer was found when it was at stage 4, the most advanced stage. Most types of cancer show similarly stark disparities.\u003c/p>\n\u003cp>Stages, which depend in part on the size of the tumor and whether the cancer has spread, are a gauge of how serious the disease is.\u003c/p>\n\u003cp>“The earlier things are picked up, the more likely it is that treatment is successful,” said Dr. Kenneth Kizer, senior author of the study and director of the UC-Davis Institute for Population Health Improvement.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444172\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-1020x708.png\" alt=\"\" width=\"640\" height=\"444\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-1020x708.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-160x111.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-800x555.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-768x533.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-960x667.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-240x167.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-375x260.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-520x361.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>Cancer screening and treatment for African-Americans lag behind other racial and ethnic groups, said Dr. Nancy Lee, who is on the board of Black Women’s Health Imperative, a national organization that seeks to improve the health of black women. Long-standing and sometimes unrecognized bias in the health care system disadvantages black patients in a way that can compromise their medical outcomes, said Lee, who previously led the cancer division of the U.S. Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>White women in California are more likely to get breast cancer, the most common cancer among women, but black women are more likely to die from it, the UC-Davis report found.[contextly_sidebar id=\"VH6Y1JhelA7uLcj4KfqvO237ZI6LRYmK\"]\u003c/p>\n\u003cp>Bobby Smith’s wife, an African-American, died 13 years ago after her breast cancer moved into her lymph nodes and eventually metastasized to her brain. Smith said he doesn’t believe doctors gave her all the information she needed to make the best decisions about her treatment. “Health care professionals treat and serve people of color differently,” said Smith, who lives in Los Angeles.\u003c/p>\n\u003cp>The UC-Davis report used data from the \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\" rel=\"noopener\">California Cancer Registry,\u003c/a> a repository of data on cancer patients dating to 1988 that contains information on patient demographics, diagnosis, initial treatment and outcomes.\u003c/p>\n\u003cp>The rates reported in the study measure “relative” survival, which represents survival in the absence of other causes of death. The study showed patients with prostate, breast, melanoma and uterine cancers had among the highest survival rates: More than 80 percent of them lived at least five years after their diagnosis.\u003c/p>\n\u003cp>Survival did not improve for patients with some cancers, including bladder, cervical and testicular. And fewer than 20 percent of patients with cancers of the lung, liver, pancreas and esophagus lived past five years.\u003c/p>\n\u003cp>For breast cancer patients, five-year survival improved from 85 percent among those diagnosed between 1990 and 1994 to 90 percent among those diagnosed between 2006 and 2010.\u003c/p>\n\u003cp>The patterns were similar for lung cancer, the second most commonly diagnosed cancer in California and the leading cause of cancer deaths nationwide. The disease tends to be diagnosed late, and patients with stage 4 cancer had just a 4 percent survival rate after five years.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444173\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-1020x708.png\" alt=\"\" width=\"640\" height=\"444\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-1020x708.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-160x111.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-800x555.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-768x533.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-960x667.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-240x167.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-375x260.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-520x361.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>Kizer of UC-Davis said new treatments offer great promise for cancer patients, but how much money they have and who their insurers are may well determine whether or not they reap the benefits.\u003c/p>\n\u003cp>Cancer is hard enough for people with means and education, said Susan Lasker Hertz, 61, a Colorado nurse who was diagnosed with stage 2 breast cancer in 2009 and then developed leukemia three years later. Hertz, who is now in remission from both cancers, said her knowledge and experience helped her navigate the health care system and get treated quickly after her diagnosis. But it wasn’t easy.\u003c/p>\n\u003cp>“I am an educated, white, highly knowledgeable health care professional,” she said, “and it is still overwhelming.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>KHN's coverage in California is supported in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener\">Blue Shield of California Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Earlier detection and more effective treatments have helped drive a decline in cancer mortality rates, but racial, ethnic and socioeconomic disparities persist.","status":"publish","parent":0,"modified":1535738961,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":30,"wordCount":1183},"headData":{"title":"Why Californians Are Living Longer With Most Types of Cancer | KQED","description":"Earlier detection and more effective treatments have helped drive a decline in cancer mortality rates, but racial, ethnic and socioeconomic disparities persist.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Why Californians Are Living Longer With Most Types of Cancer","datePublished":"2018-08-30T21:00:22.000Z","dateModified":"2018-08-31T18:09:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444169 https://ww2.kqed.org/futureofyou/?p=444169","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/08/30/californians-living-longer-with-cancer-some-longer-than-others/","disqusTitle":"Why Californians Are Living Longer With Most Types of Cancer","source":"Health","nprByline":"Anna Gorman, KHN","path":"/futureofyou/444169/californians-living-longer-with-cancer-some-longer-than-others","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As he grew older, Dale Kunitomi paid closer attention to his health — and to his doctor’s advice. When he noticed rectal bleeding in 2010, he went to see his physician, who ordered a colonoscopy.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The diagnosis: colon cancer.\u003c/p>\n\u003cp>Kunitomi, now 74, underwent surgery, radiation and chemotherapy — and now he has been cancer-free for seven years. “The things that are said about early detection and living a healthy lifestyle are important,” said Kunitomi, a resident of Ventura County, Calif. “You are foolish if you don’t pay attention.”\u003c/p>\n\u003cp>Californians are living longer with most types of cancer, due to earlier detection and more effective treatments, according to\u003ca href=\"http://www.ucdmc.ucdavis.edu/publish/news/newsroom/13098\" target=\"_blank\" rel=\"noopener\"> new research\u003c/a> from the University of California-Davis. But racial, ethnic and socioeconomic disparities persist, the report found.\u003c/p>\n\u003cp>The study, published this month, shows that 65 percent of people diagnosed with cancer between 2006 and 2010 survived five years or more from the time their disease was discovered, up from 58 percent for those diagnosed between 1990 and 1994. The researchers drew from data on 1.4 million California adults diagnosed with 27 different kinds of cancer. They found improved survival rates for patients with all but five types of cancer.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Non-Latino whites had the highest five-year survival rate for all cancers combined, followed by Latinos — though Pacific Islanders and Asians, like Kunitomi, had the highest rates for 13 of the cancers studied, including breast, colon, liver and lung. African-Americans had the worst overall prognosis.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444171\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_over-time1-1020x747.png\" alt=\"\" width=\"640\" height=\"469\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-1020x747.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-160x117.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-800x586.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-768x563.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-960x703.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-240x176.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-375x275.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1-520x381.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_over-time1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>The California numbers echo a national trend of significant improvement in cancer survival, one also tempered by racial and ethnic disparities. A recent analysis in the journal Cancer, which relied on death rather than survival rates, found a \u003ca href=\"https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21460\" target=\"_blank\" rel=\"noopener\">26 percent decline in cancer mortality\u003c/a> in the United States between 1991 and 2015 — translating to nearly 2.4 million cancer deaths avoided. The study showed mortality rates declined for all the major cancers, including breast, colorectal and prostate.\u003c/p>\n\u003cp>Dr. Otis Brawley, one of the authors of that report and chief medical and scientific officer of the American Cancer Society, attributed the improvement to better screening, detection and treatment — and a decline in smoking. He said cancer deaths likely would drop even further if there were more equal access to prevention, diagnosis and treatment.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Perhaps unsurprisingly, the UC-Davis data show that poor Californians don’t live as long with cancer as those of greater means. About three-quarters of the patients at the highest socioeconomic level, with all cancers combined, survived five years or more. Just over half the patients at the lowest levels lived that long. Age was also a major factor: The younger patients were at the time of the diagnosis, the better their chance of survival.\u003c/p>\n\u003cp>Separate research from UC-Davis, published in 2015, showed the impact of health insurance status: Uninsured patients and those on Medi-Cal — California’s version of the federal Medicaid program for low-income people — had worse cancer care and outcomes than people with private insurance.\u003c/p>\n\u003cp>The research published this month showed the most critical factor in survival was finding the cancer early, which the report said underscores the importance of screening. One hundred percent of breast cancer patients survived at least five years if their disease was detected at stage 1. Only 28 percent of patients lived that long if their cancer was found when it was at stage 4, the most advanced stage. Most types of cancer show similarly stark disparities.\u003c/p>\n\u003cp>Stages, which depend in part on the size of the tumor and whether the cancer has spread, are a gauge of how serious the disease is.\u003c/p>\n\u003cp>“The earlier things are picked up, the more likely it is that treatment is successful,” said Dr. Kenneth Kizer, senior author of the study and director of the UC-Davis Institute for Population Health Improvement.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444172\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-1020x708.png\" alt=\"\" width=\"640\" height=\"444\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-1020x708.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-160x111.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-800x555.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-768x533.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-960x667.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-240x167.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-375x260.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1-520x361.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_breast-cancer1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>Cancer screening and treatment for African-Americans lag behind other racial and ethnic groups, said Dr. Nancy Lee, who is on the board of Black Women’s Health Imperative, a national organization that seeks to improve the health of black women. Long-standing and sometimes unrecognized bias in the health care system disadvantages black patients in a way that can compromise their medical outcomes, said Lee, who previously led the cancer division of the U.S. Centers for Disease Control and Prevention.\u003c/p>\n\u003cp>White women in California are more likely to get breast cancer, the most common cancer among women, but black women are more likely to die from it, the UC-Davis report found.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Bobby Smith’s wife, an African-American, died 13 years ago after her breast cancer moved into her lymph nodes and eventually metastasized to her brain. Smith said he doesn’t believe doctors gave her all the information she needed to make the best decisions about her treatment. “Health care professionals treat and serve people of color differently,” said Smith, who lives in Los Angeles.\u003c/p>\n\u003cp>The UC-Davis report used data from the \u003ca href=\"http://www.ccrcal.org/\" target=\"_blank\" rel=\"noopener\">California Cancer Registry,\u003c/a> a repository of data on cancer patients dating to 1988 that contains information on patient demographics, diagnosis, initial treatment and outcomes.\u003c/p>\n\u003cp>The rates reported in the study measure “relative” survival, which represents survival in the absence of other causes of death. The study showed patients with prostate, breast, melanoma and uterine cancers had among the highest survival rates: More than 80 percent of them lived at least five years after their diagnosis.\u003c/p>\n\u003cp>Survival did not improve for patients with some cancers, including bladder, cervical and testicular. And fewer than 20 percent of patients with cancers of the lung, liver, pancreas and esophagus lived past five years.\u003c/p>\n\u003cp>For breast cancer patients, five-year survival improved from 85 percent among those diagnosed between 1990 and 1994 to 90 percent among those diagnosed between 2006 and 2010.\u003c/p>\n\u003cp>The patterns were similar for lung cancer, the second most commonly diagnosed cancer in California and the leading cause of cancer deaths nationwide. The disease tends to be diagnosed late, and patients with stage 4 cancer had just a 4 percent survival rate after five years.\u003c/p>\n\u003cp>\u003cimg class=\"aligncenter size-large wp-image-444173\" src=\"https://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-1020x708.png\" alt=\"\" width=\"640\" height=\"444\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-1020x708.png 1020w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-160x111.png 160w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-800x555.png 800w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-768x533.png 768w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-960x667.png 960w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-240x167.png 240w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-375x260.png 375w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1-520x361.png 520w, https://ww2.kqed.org/app/uploads/sites/13/2018/08/cancer-survival_lung-cancer1.png 1024w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/p>\n\u003cp>Kizer of UC-Davis said new treatments offer great promise for cancer patients, but how much money they have and who their insurers are may well determine whether or not they reap the benefits.\u003c/p>\n\u003cp>Cancer is hard enough for people with means and education, said Susan Lasker Hertz, 61, a Colorado nurse who was diagnosed with stage 2 breast cancer in 2009 and then developed leukemia three years later. Hertz, who is now in remission from both cancers, said her knowledge and experience helped her navigate the health care system and get treated quickly after her diagnosis. But it wasn’t easy.\u003c/p>\n\u003cp>“I am an educated, white, highly knowledgeable health care professional,” she said, “and it is still overwhelming.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>KHN's coverage in California is supported in part by \u003ca href=\"http://www.blueshieldcafoundation.org/\" target=\"_blank\" rel=\"noopener\">Blue Shield of California Foundation.\u003c/a>\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444169/californians-living-longer-with-cancer-some-longer-than-others","authors":["byline_futureofyou_444169"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_264","futureofyou_1609","futureofyou_103","futureofyou_61","futureofyou_80"],"collections":["futureofyou_1093"],"featImg":"futureofyou_444175","label":"source_futureofyou_444169"},"futureofyou_442317":{"type":"posts","id":"futureofyou_442317","meta":{"index":"posts_1591205157","site":"futureofyou","id":"442317","score":null,"sort":[1528218044000]},"guestAuthors":[],"slug":"many-breast-cancer-patients-can-skip-chemo-study-finds","title":"Many Breast Cancer Patients Can Skip Chemo, Study Finds","publishDate":1528218044,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient’s risk.[contextly_sidebar id=\"BFMet48xKrp1h6NyWt3K8Xsz7gIOPSeq\"]\u003c/p>\n\u003cp>The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.\u003c/p>\n\u003cp>“The impact is tremendous,” said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don’t need treatment beyond surgery and hormone therapy, he said.\u003c/p>\n\u003cp>The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.\u003c/p>\n\u003cp>\u003cstrong>Moving Away From Chemo\u003c/strong>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.\u003c/p>\n\u003cp>For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.[contextly_sidebar id=\"sLig6uVQeZQDplnvMdLRkmGUnVlPvI7v\"]\u003c/p>\n\u003cp>The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.\u003c/p>\n\u003cp>The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forgo it.\u003c/p>\n\u003cp>The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.\u003c/p>\n\u003cp>\u003cstrong>What the Study Found\u003c/strong>\u003c/p>\n\u003cp>About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.\u003c/p>\n\u003cp>The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.[contextly_sidebar id=\"TPjTNdjmhxB5MX6ZoUQCtfkvBdzmJm43\"]\u003c/p>\n\u003cp>After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.\u003c/p>\n\u003cp>Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.\u003c/p>\n\u003cp>\u003cstrong>Will People Trust the Results?\u003c/strong>\u003c/p>\n\u003cp>All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.\u003c/p>\n\u003cp>Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think “if I don’t get chemotherapy I’m going to die, and if I get chemo I’m going to be cured,” but the results show there’s a sliding scale of benefit and sometimes none, he said.\u003c/p>\n\u003cp>Dr. Lisa Carey, a breast specialist at the University of North Carolina’s Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.[contextly_sidebar id=\"2pkXhBlSu04mLyMby8g8IUTSIxIwtjpB\"]\u003c/p>\n\u003cp>Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: “Risk to one person is not the same thing as risk to another. There are some people who say, ’I don’t care what you say, I’m never going to do chemo,’” and won’t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.\u003c/p>\n\u003cp>Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.\u003c/p>\n\u003cp>“I was a little relieved. I sort of viewed chemo as extra insurance,” she said. The treatments “weren’t pleasant,” she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, “but it was over fairly quickly and I’m really glad I had it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If doctors had recommended she skip chemo based on the gene test, “I would have accepted that,” she said. “I’m a firm believer in medical research.”\u003c/p>\n\n","blocks":[],"excerpt":"Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. ","status":"publish","parent":0,"modified":1528211669,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":904},"headData":{"title":"Many Breast Cancer Patients Can Skip Chemo, Study Finds | KQED","description":"Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Many Breast Cancer Patients Can Skip Chemo, Study Finds","datePublished":"2018-06-05T17:00:44.000Z","dateModified":"2018-06-05T15:14:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"442317 https://ww2.kqed.org/futureofyou/?p=442317","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/05/many-breast-cancer-patients-can-skip-chemo-study-finds/","disqusTitle":"Many Breast Cancer Patients Can Skip Chemo, Study Finds","source":"Health","nprByline":"Marilynn Marchione\u003cbr />Associated Press","path":"/futureofyou/442317/many-breast-cancer-patients-can-skip-chemo-study-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient’s risk.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.\u003c/p>\n\u003cp>“The impact is tremendous,” said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don’t need treatment beyond surgery and hormone therapy, he said.\u003c/p>\n\u003cp>The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.\u003c/p>\n\u003cp>\u003cstrong>Moving Away From Chemo\u003c/strong>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of gene-targeting therapies, hormone blockers and immune system treatments. When chemo is used now, it’s sometimes for shorter periods or lower doses than it once was.\u003c/p>\n\u003cp>For example, another study at the conference found that Merck’s immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The breast cancer study focused on cases where chemo’s value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.\u003c/p>\n\u003cp>The usual treatment is surgery followed by years of a hormone-blocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don’t need it, but evidence is thin on who can forgo it.\u003c/p>\n\u003cp>The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.\u003c/p>\n\u003cp>\u003cstrong>What the Study Found\u003c/strong>\u003c/p>\n\u003cp>About 17 percent of women had high-risk scores and were advised to have chemo. The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.\u003c/p>\n\u003cp>The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.\u003c/p>\n\u003cp>Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test.\u003c/p>\n\u003cp>\u003cstrong>Will People Trust the Results?\u003c/strong>\u003c/p>\n\u003cp>All women like those in the study should get gene testing to guide their care, said Dr. Richard Schilsky, chief medical officer of the oncology society. Oncotype DX costs around $4,000, which Medicare and many insurers cover. Similar tests including one called MammaPrint also are widely used.\u003c/p>\n\u003cp>Testing solved a big problem of figuring out who needs chemo, said Dr. Harold Burstein of the Dana-Farber Cancer Institute in Boston. Many women think “if I don’t get chemotherapy I’m going to die, and if I get chemo I’m going to be cured,” but the results show there’s a sliding scale of benefit and sometimes none, he said.\u003c/p>\n\u003cp>Dr. Lisa Carey, a breast specialist at the University of North Carolina’s Lineberger Comprehensive Cancer Center, said she would be very comfortable advising patients to skip chemo if they were like those in the study who did not benefit from it.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Dr. Jennifer Litton at MD Anderson Cancer Center in Houston, agreed, but said: “Risk to one person is not the same thing as risk to another. There are some people who say, ’I don’t care what you say, I’m never going to do chemo,’” and won’t even have the gene test, she said. Others want chemo for even the smallest chance of benefit.\u003c/p>\n\u003cp>Adine Usher, 78, who lives in Hartsdale, New York, joined the study 10 years ago at Montefiore and was randomly assigned to the group given chemo.\u003c/p>\n\u003cp>“I was a little relieved. I sort of viewed chemo as extra insurance,” she said. The treatments “weren’t pleasant,” she concedes. Her hair fell out, she developed an infection and was hospitalized for a low white blood count, “but it was over fairly quickly and I’m really glad I had it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>If doctors had recommended she skip chemo based on the gene test, “I would have accepted that,” she said. “I’m a firm believer in medical research.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/442317/many-breast-cancer-patients-can-skip-chemo-study-finds","authors":["byline_futureofyou_442317"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_73"],"tags":["futureofyou_264","futureofyou_1077","futureofyou_1189","futureofyou_61","futureofyou_215"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_365499","label":"source_futureofyou_442317"},"futureofyou_442273":{"type":"posts","id":"futureofyou_442273","meta":{"index":"posts_1591205157","site":"futureofyou","id":"442273","score":null,"sort":[1528131660000]},"guestAuthors":[],"slug":"therapy-made-from-patients-immune-system-shows-promise-for-advanced-breast-cancer","title":"Therapy Made From Patient's Immune System Shows Promise For Advanced Breast Cancer","publishDate":1528131660,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Doctors at the National Institutes of Health say they've apparently completely eradicated cancer from a patient who had untreatable, advanced breast cancer.[contextly_sidebar id=\"XBqZwaw0YLkXChOC5E9p7x7LlwjI87h0\"]\u003c/p>\n\u003cp>The case is raising hopes about a new way to harness the immune system to fight some of the most common cancers. The methods and the patient's experience are described Monday in a \u003ca href=\"https://www.nature.com/articles/s41591-018-0040-8\">paper\u003c/a> published in the journal \u003cem>Nature Medicine\u003c/em>.\u003c/p>\n\u003cp>\"We're looking for a treatment — an immunotherapy — that can be broadly used in patients with common cancers,\" says \u003ca href=\"https://ccr.cancer.gov/Surgery-Branch/steven-a-rosenberg\">Dr. Steven Rosenberg\u003c/a>, an oncologist and immunologist at the National Cancer Institute, who has been developing the approach.\u003c/p>\n\u003cp>Rosenberg's team painstakingly analyzes the DNA in a sample of each patient's cancer for mutations specific to their malignancies. Next, scientists sift through tumor tissue for immune system cells known as \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell\">T cells\u003c/a> that appear programmed to home in on those mutations.\u003c/p>\n\u003cp>But Rosenberg and others caution that the approach doesn't work for everyone. In fact, it failed for two other breast cancer patients. Many more patients will have to be treated — and followed for much longer — to fully evaluate the treatment's effectiveness, the scientists say.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Still, the treatment has helped seven of 45 patients with a variety of cancers, Rosenberg says. That's a response rate of about 15 percent, and included patients with advanced cases of colon cancer, liver cancer and cervical cancer.\u003c/p>\n\u003cp>\"Is it ready for prime time today? No,\" Rosenberg says.\"Can we do it in most patients today? No.\"\u003c/p>\n\u003cp>But the treatment continues to be improved. \"I think it's the most promising treatment now being explored for solving the problem of the treatment of metastatic, common cancers,\" he says.\u003c/p>\n\u003cp>The breast cancer patient helped by the treatment says it transformed her life.\u003c/p>\n\u003cp>\"It's amazing,\" says Judy Perkins, 52, a retired engineer who lives in Port St. Lucie, Fla.[contextly_sidebar id=\"LBQmSDLCPJe4N0too3CcLvpq1h2WnS7o\"]\u003c/p>\n\u003cp>When Perkins was first diagnosed and treated for breast cancer in 2003, she thought she'd beaten the disease. \"I thought I was done with it,\" she says.\u003c/p>\n\u003cp>But about a decade later, she felt a new lump. Doctors discovered the cancer had already spread throughout her chest. Her prognosis was grim.\u003c/p>\n\u003cp>\"I became a metastatic cancer patient,\" says Perkins. \"That was hard.\"\u003c/p>\n\u003cp>Perkins went through round after round of chemotherapy. She tried every experimental treatment she could find. But the cancer kept spreading. Some of her tumors grew to the size of tennis balls.\u003c/p>\n\u003cp>\"I had sort of essentially run out of arrows in my quiver,\" she says. \"While I would say I had some hope, I was also kind of like ready to quit, too.\"\u003c/p>\n\u003cp>Then she heard about the experimental treatment at the NIH. It was designed to fight some of the most common cancers, including breast cancer.\u003c/p>\n\u003cp>\"The excitement here is that we're attacking the very mutations that are unique to that cancer — in that patient's cancer and not in anybody else's cancer. So it's about as personalized a treatment as you can imagine,\" Rosenberg says.\u003c/p>\n\u003cp>His team identified and then grew billions of T cells for Perkins in the lab and then infused them back into her body. They also gave her two drugs to help the cells do their job.[contextly_sidebar id=\"7hRhhF6kMzZu5JjMty7K1k5yrQUh2pfA\"]\u003c/p>\n\u003cp>The treatment was grueling. Perkins says the hardest part was the side effects of a drug known as interleukin, which she received to help boost the effectiveness of the immune system cells. Interleukin causes severe flu-like symptoms, such as a high fever, intense malaise and uncontrollable shivering.\u003c/p>\n\u003cp>But the treatment apparently worked, Rosenberg reports. Perkins' tumors soon disappeared. And, more than two years later, she remains cancer-free.\u003c/p>\n\u003cp>\"All of her detectable disease has disappeared. It's remarkable,\" Rosenberg says.\u003c/p>\n\u003cp>Perkins is thrilled.\u003c/p>\n\u003cp>\"I'm one of the lucky ones,\" Perkins says. \"We got the right T cells in the right place at the right time. And they went in and ate up all my cancer. And I'm cured. It's freaking unreal.\"\u003c/p>\n\u003cp>In an \u003ca href=\"https://doi.org/10.1038/s41591-018-0065-z\">article\u003c/a> accompanying the new paper, \u003ca href=\"https://news.oicr.on.ca/2018/03/oicr-names-dr-laszlo-radvanyi-as-new-president-and-scientific-director/\">Laszlo Radvanyi\u003c/a>, president and scientific director of the Ontario Institute for Cancer Research, calls the results \"remarkable.\"\u003c/p>\n\u003cp>The approach and other recent advances suggest scientists may be \"at the cusp of a major revolution in finally realizing the elusive goal of being able to target the plethora of mutations in cancer through immunotherapy,\" Radvanyi writes.\u003c/p>\n\u003cp>Other cancer researchers agree.\u003c/p>\n\u003cp>\"When I saw this paper I thought: \"Whoa! I mean, it's very impressive,\" says \u003ca href=\"https://www.systemsbiology.org/bio/james-r-heath/\">James Heath\u003c/a>, president of the Institute for Systems Biology in Seattle.\u003c/p>\n\u003cp>\"One of the most exciting breakthroughs in biomedicine over the past decade has been activating the immune system against various cancers. But they have not been successful in breast cancer. Metastatic breast cancer is basically a death sentence,\" Heath says. \"And this shows that you can reverse it. It's a big deal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One key challenge will be to make the treatment easier, faster, and affordable, Rosenberg says. \"We're working literally around the clock to try to improve the treatment.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Therapy+Made+From+Patient%27s+Immune+System+Shows+Promise+For+Advanced+Breast+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"An experimental therapy seems to have eradicated cancer in a patient with metastatic breast cancer who had failed every other treatment. The goal is to reliably repeat that success in more people.","status":"publish","parent":0,"modified":1528135229,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":31,"wordCount":865},"headData":{"title":"Therapy Made From Patient's Immune System Shows Promise For Advanced Breast Cancer | KQED","description":"An experimental therapy seems to have eradicated cancer in a patient with metastatic breast cancer who had failed every other treatment. The goal is to reliably repeat that success in more people.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Therapy Made From Patient's Immune System Shows Promise For Advanced Breast Cancer","datePublished":"2018-06-04T17:01:00.000Z","dateModified":"2018-06-04T18:00:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"442273 https://ww2.kqed.org/futureofyou/?p=442273","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/06/04/therapy-made-from-patients-immune-system-shows-promise-for-advanced-breast-cancer/","disqusTitle":"Therapy Made From Patient's Immune System Shows Promise For Advanced Breast Cancer","source":"Health","nprByline":"Rob Stein, NPR","nprImageAgency":"Courtesy of Judy Perkins","nprStoryId":"615673436","nprApiLink":"http://api.npr.org/query?id=615673436&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/06/04/615673436/therapy-made-from-patients-immune-system-shows-promise-for-advanced-breast-cance?ft=nprml&f=615673436","nprRetrievedStory":"1","nprPubDate":"Mon, 04 Jun 2018 12:10:00 -0400","nprStoryDate":"Mon, 04 Jun 2018 11:02:00 -0400","nprLastModifiedDate":"Mon, 04 Jun 2018 12:10:02 -0400","path":"/futureofyou/442273/therapy-made-from-patients-immune-system-shows-promise-for-advanced-breast-cancer","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Doctors at the National Institutes of Health say they've apparently completely eradicated cancer from a patient who had untreatable, advanced breast cancer.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The case is raising hopes about a new way to harness the immune system to fight some of the most common cancers. The methods and the patient's experience are described Monday in a \u003ca href=\"https://www.nature.com/articles/s41591-018-0040-8\">paper\u003c/a> published in the journal \u003cem>Nature Medicine\u003c/em>.\u003c/p>\n\u003cp>\"We're looking for a treatment — an immunotherapy — that can be broadly used in patients with common cancers,\" says \u003ca href=\"https://ccr.cancer.gov/Surgery-Branch/steven-a-rosenberg\">Dr. Steven Rosenberg\u003c/a>, an oncologist and immunologist at the National Cancer Institute, who has been developing the approach.\u003c/p>\n\u003cp>Rosenberg's team painstakingly analyzes the DNA in a sample of each patient's cancer for mutations specific to their malignancies. Next, scientists sift through tumor tissue for immune system cells known as \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/t-cell\">T cells\u003c/a> that appear programmed to home in on those mutations.\u003c/p>\n\u003cp>But Rosenberg and others caution that the approach doesn't work for everyone. In fact, it failed for two other breast cancer patients. Many more patients will have to be treated — and followed for much longer — to fully evaluate the treatment's effectiveness, the scientists say.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Still, the treatment has helped seven of 45 patients with a variety of cancers, Rosenberg says. That's a response rate of about 15 percent, and included patients with advanced cases of colon cancer, liver cancer and cervical cancer.\u003c/p>\n\u003cp>\"Is it ready for prime time today? No,\" Rosenberg says.\"Can we do it in most patients today? No.\"\u003c/p>\n\u003cp>But the treatment continues to be improved. \"I think it's the most promising treatment now being explored for solving the problem of the treatment of metastatic, common cancers,\" he says.\u003c/p>\n\u003cp>The breast cancer patient helped by the treatment says it transformed her life.\u003c/p>\n\u003cp>\"It's amazing,\" says Judy Perkins, 52, a retired engineer who lives in Port St. Lucie, Fla.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>When Perkins was first diagnosed and treated for breast cancer in 2003, she thought she'd beaten the disease. \"I thought I was done with it,\" she says.\u003c/p>\n\u003cp>But about a decade later, she felt a new lump. Doctors discovered the cancer had already spread throughout her chest. Her prognosis was grim.\u003c/p>\n\u003cp>\"I became a metastatic cancer patient,\" says Perkins. \"That was hard.\"\u003c/p>\n\u003cp>Perkins went through round after round of chemotherapy. She tried every experimental treatment she could find. But the cancer kept spreading. Some of her tumors grew to the size of tennis balls.\u003c/p>\n\u003cp>\"I had sort of essentially run out of arrows in my quiver,\" she says. \"While I would say I had some hope, I was also kind of like ready to quit, too.\"\u003c/p>\n\u003cp>Then she heard about the experimental treatment at the NIH. It was designed to fight some of the most common cancers, including breast cancer.\u003c/p>\n\u003cp>\"The excitement here is that we're attacking the very mutations that are unique to that cancer — in that patient's cancer and not in anybody else's cancer. So it's about as personalized a treatment as you can imagine,\" Rosenberg says.\u003c/p>\n\u003cp>His team identified and then grew billions of T cells for Perkins in the lab and then infused them back into her body. They also gave her two drugs to help the cells do their job.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The treatment was grueling. Perkins says the hardest part was the side effects of a drug known as interleukin, which she received to help boost the effectiveness of the immune system cells. Interleukin causes severe flu-like symptoms, such as a high fever, intense malaise and uncontrollable shivering.\u003c/p>\n\u003cp>But the treatment apparently worked, Rosenberg reports. Perkins' tumors soon disappeared. And, more than two years later, she remains cancer-free.\u003c/p>\n\u003cp>\"All of her detectable disease has disappeared. It's remarkable,\" Rosenberg says.\u003c/p>\n\u003cp>Perkins is thrilled.\u003c/p>\n\u003cp>\"I'm one of the lucky ones,\" Perkins says. \"We got the right T cells in the right place at the right time. And they went in and ate up all my cancer. And I'm cured. It's freaking unreal.\"\u003c/p>\n\u003cp>In an \u003ca href=\"https://doi.org/10.1038/s41591-018-0065-z\">article\u003c/a> accompanying the new paper, \u003ca href=\"https://news.oicr.on.ca/2018/03/oicr-names-dr-laszlo-radvanyi-as-new-president-and-scientific-director/\">Laszlo Radvanyi\u003c/a>, president and scientific director of the Ontario Institute for Cancer Research, calls the results \"remarkable.\"\u003c/p>\n\u003cp>The approach and other recent advances suggest scientists may be \"at the cusp of a major revolution in finally realizing the elusive goal of being able to target the plethora of mutations in cancer through immunotherapy,\" Radvanyi writes.\u003c/p>\n\u003cp>Other cancer researchers agree.\u003c/p>\n\u003cp>\"When I saw this paper I thought: \"Whoa! I mean, it's very impressive,\" says \u003ca href=\"https://www.systemsbiology.org/bio/james-r-heath/\">James Heath\u003c/a>, president of the Institute for Systems Biology in Seattle.\u003c/p>\n\u003cp>\"One of the most exciting breakthroughs in biomedicine over the past decade has been activating the immune system against various cancers. But they have not been successful in breast cancer. Metastatic breast cancer is basically a death sentence,\" Heath says. \"And this shows that you can reverse it. It's a big deal.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>One key challenge will be to make the treatment easier, faster, and affordable, Rosenberg says. \"We're working literally around the clock to try to improve the treatment.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Therapy+Made+From+Patient%27s+Immune+System+Shows+Promise+For+Advanced+Breast+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/442273/therapy-made-from-patients-immune-system-shows-promise-for-advanced-breast-cancer","authors":["byline_futureofyou_442273"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1"],"tags":["futureofyou_264","futureofyou_1403","futureofyou_141","futureofyou_61","futureofyou_215"],"collections":["futureofyou_1093"],"featImg":"futureofyou_442274","label":"source_futureofyou_442273"},"futureofyou_440020":{"type":"posts","id":"futureofyou_440020","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440020","score":null,"sort":[1520362726000]},"guestAuthors":[],"slug":"fda-approves-first-direct-to-consumer-test-for-breast-cancer-risk","title":"FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk","publishDate":1520362726,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>[contextly_sidebar id=\"n8fyxUwdBRcgBMG96UbMv2Lu8p4ZNItq\"]But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.[contextly_sidebar id=\"ixqQWxrYKmKKTNT32BcHv1EguBJm96pF\"]\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n","blocks":[],"excerpt":"The test is a step forward in the availability of DTC genetic tests but it comes with caveats.","status":"publish","parent":0,"modified":1520993549,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":926},"headData":{"title":"FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk | KQED","description":"The test is a step forward in the availability of DTC genetic tests but it comes with caveats.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk","datePublished":"2018-03-06T18:58:46.000Z","dateModified":"2018-03-14T02:12:29.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440020 https://ww2.kqed.org/futureofyou/?p=440020","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/06/fda-approves-first-direct-to-consumer-test-for-breast-cancer-risk/","disqusTitle":"FDA Approves First Direct-to-Consumer Test for Breast Cancer Risk","source":"DIY Health","nprByline":"Sharon Begley\u003cbr />STAT","path":"/futureofyou/440020/fda-approves-first-direct-to-consumer-test-for-breast-cancer-risk","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Federal regulators approved the first direct-to-consumer test for the BRCA genes, which increase the risk of breast and ovarian cancer, the agency announced on Tuesday.\u003c/p>\n\u003cp>The test for the BRCA1 and BRCA2 genes, from \u003ca href=\"https://www.statnews.com/2017/04/07/genetic-analysis-need-to-know/\" target=\"_blank\" rel=\"noopener\">23andMe\u003c/a>, uses a saliva sample. But it assesses only three of the more than 1,000 known BRCA1/2 mutations, raising concerns that women who are told they do not have any of those variants will be lulled into believing that, as a result, they do not have an elevated risk for breast and ovarian cancer.\u003c/p>\n\u003cp>The three specific BRCA1/BRCA2 breast cancer \u003ca href=\"https://www.kqed.org/futureofyou/439059/why-even-siblings-can-get-different-ancestry-results-from-dna-tests\" target=\"_blank\" rel=\"noopener\">gene mutations \u003c/a>are most common in people with Ashkenazi (Eastern European) Jewish ancestry, accounting for more than 90 percent of their risk of heritable breast and ovarian cancer. But even in this population only 2 percent of women carry any of these three so-called “founder” mutations, the FDA said. Women with one of the mutations have a 45 percent to 85 percent chance of developing breast cancer by age 70, 23andMe said.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But these three variants are not the most common BRCA1/BRCA2 mutations in the general population: No more than 0.1 percent of women with non-Ashkenazi ancestry carry the mutations. “A negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk,” the FDA warned.\u003c/p>\n\u003cp>\u003cstrong>Test Limitations\u003c/strong>\u003cbr>\nThe 23andMe test “is a step forward in the availability of DTC genetic tests,” Donald St. Pierre, acting director of the FDA’s Office of In Vitro Diagnostics and Radiological Health, said in a statement. “But it has a lot of caveats.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The agency therefore warned that individuals and their physicians should not use the test results to make decisions about treatments, including prophylactic removal of the breasts or ovaries. That should be based on more extensive testing. Myriad Genetics, which developed the first BRCA1/2 tests, assesses DNA for thousands of variants; it has long \u003ca href=\"http://investor.myriad.com/releasedetail.cfm?releaseid=1021443\" target=\"_blank\" rel=\"noopener\">warned\u003c/a> that other tests, which came on the market after the Supreme Court threw out Myriad’s key BRCA patents, could mislead women.\u003c/p>\n\u003cp>In addition, most cases of breast cancer are not hereditary, from BRCA or other mutations, but “sporadic,” meaning they arise at random or from smoking, obesity, exposure to toxic chemicals, hormone use, and other environmental factors.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“At a minimum, 23andMe should be clear with people about what their test is and isn’t and present the information in a fair and balanced way that the average person can understand,” said Myriad spokesman Ron Rogers, who added that some customers might be uncomfortable about 23andMe’s \u003ca href=\"https://gizmodo.com/what-dna-testing-companies-terrifying-privacy-policies-1819158337\" target=\"_blank\" rel=\"noopener\">selling\u003c/a> of genetic information to third parties.\u003c/p>\n\u003cp>For women with Ashkenazi ancestry, the test “is not too bad as a screen,” said Robert Cook-Deegan of Arizona State University, a longtime scholar in the field of genomics ethics and law. “But for other groups with different founder mutations, and there are many, it won’t help much. There’s a big need for users to understand that nuance, which is not widely understood.”\u003c/p>\n\u003cp>\u003cstrong>Direct-to-Consumer Tests\u003c/strong>\u003cbr>\nThe FDA’s decision was based on data from 23andMe showing that its test can accurately identify the three genetic variants in saliva samples. The privately held company also submitted studies showing that consumers understood the report it will send to customers on what the results might mean, how to interpret them, and where to find additional information.\u003c/p>\n\u003cp>“Being the first and only direct-to-consumer genetics company to receive FDA authorization to test for cancer risk without a prescription is a major milestone for 23andMe and for the consumer,” Anne Wojcicki, 23andMe CEO and co-founder, said in a statement. “We believe it’s important for consumers to have direct and affordable access to this potentially life-saving information. … This authorization is incredibly valuable for those who might not be aware of their Ashkenazi Jewish descent.”\u003c/p>\n\u003cp>She, too, emphasized that “our test does not account for all genetic variants that can cause a higher risk of cancer, and people should continue with their recommended cancer screenings.” Myriad, for instance, has identified some 20,000 BRCA1/2 variants.\u003c/p>\n\u003cp>The decision follows one last year in which the FDA gave 23andMe the go-ahead to sell DNA tests assessing customers’ risk of 10 diseases, including Parkinson’s and late-onset Alzheimer’s. Those were the first FDA-approved direct-to-consumer tests for genetic risk of any disease or condition, which the agency said could help people make lifestyle decisions. At the time, the FDA also warned that genetic risk for complex diseases is not a sure thing: People whose 23andMe test does not find genetic variants that increase the risk of a disease can still develop it, and people whose DNA test shows no disease-causing variants might not.\u003c/p>\n\u003cp>The BRCA test will be part of 23andme’s $199 Health + Ancestry test. Existing customers can opt to receive BRCA information for no additional cost, and as with the other disease-risk tests they as well as new customers must specifically choose to receive the information.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“My libertarian streak says this, properly understood, is a good thing that increases access,” said Cook-Deegan, “although I do worry about proliferation of commercial purveyors as the sources of information and keeping the data.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440020/fda-approves-first-direct-to-consumer-test-for-breast-cancer-risk","authors":["byline_futureofyou_440020"],"programs":["futureofyou_54"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_15","futureofyou_264","futureofyou_38","futureofyou_1275","futureofyou_266","futureofyou_61"],"collections":["futureofyou_1093"],"featImg":"futureofyou_440021","label":"source_futureofyou_440020"},"futureofyou_438484":{"type":"posts","id":"futureofyou_438484","meta":{"index":"posts_1591205157","site":"futureofyou","id":"438484","score":null,"sort":[1516207930000]},"guestAuthors":[],"slug":"should-you-get-a-more-expensive-3-d-mammogram","title":"Should You Get a More Expensive, 3‑D Mammogram?","publishDate":1516207930,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I'd like to get a \"3-D\" mammogram instead of the standard test I'd had in the past.\u003c/p>\n\u003cp>\"It's more accurate,\" she said.\u003c/p>\n\u003cp>What do you say to that? \"No, thanks, I'd rather have the test that gets it wrong?\" Of course, I agreed.\u003c/p>\n\u003cp>A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional mammography, also called \u003ca href=\"http://www.breastcancer.org/symptoms/testing/types/dig_tomosynth\">digital breast tomosynthesis\u003c/a>, to the two-dimensional, or 2-D, screening women customarily receive.\u003c/p>\n\u003cp>What's not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who should pick up the extra cost involved?\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>According to the Food and Drug Administration, there were \u003ca href=\"https://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\">3,915 certified mammography imaging facilities\u003c/a> that offered digital breast tomosynthesis in January. That's a 30 percent increase over the previous January, when the total was 3,011.\u003c/p>\n\u003cp>Some facilities have switched over entirely to 3-D imaging, but many practices have both.\u003c/p>\n\u003cp>\"There's a lot of marketing pressure to offer these new machines,\" says \u003ca href=\"https://www.sph.emory.edu/faculty/profile/#!RASMIT3\">Robert Smith\u003c/a>, vice president of cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>Both types of tests use X-ray technology to create images of the breast. The 2-D digital mammograms that most women receive typically provide front and side images. For the 3-D test, the X-ray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine.\u003c/p>\n\u003cp>Studies have generally shown that the 3-D test is \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK343784/\">slightly better at detecting cancers\u003c/a> than the 2-D test, and women typically have to return less often to have additional images taken. But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal.\u003c/p>\n\u003cp>\"Cancers don't always progress and kill people,\" says Dr. Etta Pisano, chief science officer at the American College of Radiology's Center for Research and Innovation and a faculty member at Harvard Medical School. Pisano is leading a \u003ca href=\"https://www.cancer.gov/news-events/press-releases/2017/tmist-mammography-trial\">five-year clinical trial of 165,000 women\u003c/a> that will compare the two types of mammography to evaluate whether the new technology reduces the risk that women will develop life-threatening cancers.\u003c/p>\n\u003cp>\"If tomosynthesis is improving the likelihood of women to survive their breast cancers, they should have fewer cancers that are more likely to kill women over the 4.5 years of screening. Since tomosynthesis caught them early, they'll never grow up to be bad cancers,\" Pisano says.\u003c/p>\n\u003cp>Overdiagnosis is one of the potential downsides of this technology, says Dr. David Grossman, chair of the U.S. Preventive Services Task Force. The more sensitive test picks up more breast lesions for which the clinical significance is unclear, potentially resulting in women receiving more testing and treatment they don't need. Some \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK343784/\">research suggests\u003c/a> the biopsy rate is slightly higher with 3-D mammograms.\u003c/p>\n\u003cp>In addition, some of the mammography systems require both 2-D and 3-D X-rays, which can expose women to twice as much radiation. Other systems are able to generate a 2-D image from the 3-D version with software, eliminating the extra exposure. The 2-D image is important because clusters of calcifications, which may signal breast cancer, might be easier to see on the 2-D image, says Pisano.\u003c/p>\n\u003cp>Under the Affordable Care Act, most health plans are required to cover preventive services that are recommended by the task force without charging patients anything out-of-pocket. The task force \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1?ds=1&s=breast%20cancer%20screening\">recommends mammograms every other year for women ages 50 to 74\u003c/a>, but it says that there's not enough evidence to recommend 3-D mammograms at this time.\u003c/p>\n\u003cp>Insurance coverage of 3-D testing has improved in recent years, but it's not assured. The 3-D test typically \u003ca href=\"http://truvenhealth.com/Portals/0/Assets/studies/hologic/f_ceor-76167.pdf\">costs about $50 more\u003c/a> than a 2-D test, according to a 2015 study by Truven Health Analytics that was funded by Hologic, a manufacturer of 3-D mammography systems. Medicare also covers 3-D tests.\u003c/p>\n\u003cp>A growing number of states require commercial insurers to cover 3-D mammograms, including Arkansas, Texas, Connecticut, Maryland, Illinois and Pennsylvania.\u003c/p>\n\u003cp>My state of \u003ca href=\"http://www.dfs.ny.gov/insurance/circltr/2017/cl2017_s1_cl02_2016.htm\">New York also requires coverage\u003c/a>, without any out-of-pocket payments. Though I didn't have to pay it, the explanation of benefits form I got from my insurer says the 3-D portion of the test added $51 to the $157 cost of the mammogram.\u003c/p>\n\u003cp>\"Costs are high for new technologies,\" Pisano says. \"Maybe they are better, but we need to have evidence before we recommend it for the entire population.\"\u003c/p>\n\u003cp>So if you're offered a 3-D test, should you get it?\u003c/p>\n\u003cp>\"If the examination is available at no extra cost, the data we have now tells us it has some advantages,\" says Smith. On the other hand, \"any woman who's feeling stressed about the extra cost ... should feel comfortable getting a regular mammogram,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\">@mandrews110\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+You+Need+A+Mammogram%2C+Should+You+Get+One+In+%273-D%27%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"It's not yet clear if the three-dimensional approach is more effective at catching cancers that will kill.","status":"publish","parent":0,"modified":1516226226,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":917},"headData":{"title":"Should You Get a More Expensive, 3‑D Mammogram? | KQED","description":"It's not yet clear if the three-dimensional approach is more effective at catching cancers that will kill.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Should You Get a More Expensive, 3‑D Mammogram?","datePublished":"2018-01-17T16:52:10.000Z","dateModified":"2018-01-17T21:57:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"438484 https://ww2.kqed.org/futureofyou/?p=438484","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/01/17/should-you-get-a-more-expensive-3-d-mammogram/","disqusTitle":"Should You Get a More Expensive, 3‑D Mammogram?","nprByline":"Michelle Andrews\u003cbr />Kaiser Health News","nprImageAgency":"National Cancer Institute","nprStoryId":"578285604","nprApiLink":"http://api.npr.org/query?id=578285604&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/01/16/578285604/when-you-need-a-mammogram-should-you-get-one-in-3-d?ft=nprml&f=578285604","nprRetrievedStory":"1","nprPubDate":"Tue, 16 Jan 2018 10:52:00 -0500","nprStoryDate":"Tue, 16 Jan 2018 10:51:08 -0500","nprLastModifiedDate":"Tue, 16 Jan 2018 10:52:33 -0500","path":"/futureofyou/438484/should-you-get-a-more-expensive-3-d-mammogram","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When I went to the imaging center for my regular mammogram last year, the woman behind the desk asked me if I'd like to get a \"3-D\" mammogram instead of the standard test I'd had in the past.\u003c/p>\n\u003cp>\"It's more accurate,\" she said.\u003c/p>\n\u003cp>What do you say to that? \"No, thanks, I'd rather have the test that gets it wrong?\" Of course, I agreed.\u003c/p>\n\u003cp>A growing number of women are likely to face a similar choice in coming years as imaging centers across the country add three-dimensional mammography, also called \u003ca href=\"http://www.breastcancer.org/symptoms/testing/types/dig_tomosynth\">digital breast tomosynthesis\u003c/a>, to the two-dimensional, or 2-D, screening women customarily receive.\u003c/p>\n\u003cp>What's not yet clear is whether this newer, more expensive technology is better at catching cancers that are likely to kill. So should it be widely recommended? And who should pick up the extra cost involved?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>According to the Food and Drug Administration, there were \u003ca href=\"https://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm113858.htm\">3,915 certified mammography imaging facilities\u003c/a> that offered digital breast tomosynthesis in January. That's a 30 percent increase over the previous January, when the total was 3,011.\u003c/p>\n\u003cp>Some facilities have switched over entirely to 3-D imaging, but many practices have both.\u003c/p>\n\u003cp>\"There's a lot of marketing pressure to offer these new machines,\" says \u003ca href=\"https://www.sph.emory.edu/faculty/profile/#!RASMIT3\">Robert Smith\u003c/a>, vice president of cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>Both types of tests use X-ray technology to create images of the breast. The 2-D digital mammograms that most women receive typically provide front and side images. For the 3-D test, the X-ray arcs across the breast, creating multiple images of breast tissue. The experience is the same for women, though, because both scans involve compressing the breast between two plates extending from the machine.\u003c/p>\n\u003cp>Studies have generally shown that the 3-D test is \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK343784/\">slightly better at detecting cancers\u003c/a> than the 2-D test, and women typically have to return less often to have additional images taken. But the jury is still out on whether the newer technology is any better at identifying the advanced cancers that will become lethal.\u003c/p>\n\u003cp>\"Cancers don't always progress and kill people,\" says Dr. Etta Pisano, chief science officer at the American College of Radiology's Center for Research and Innovation and a faculty member at Harvard Medical School. Pisano is leading a \u003ca href=\"https://www.cancer.gov/news-events/press-releases/2017/tmist-mammography-trial\">five-year clinical trial of 165,000 women\u003c/a> that will compare the two types of mammography to evaluate whether the new technology reduces the risk that women will develop life-threatening cancers.\u003c/p>\n\u003cp>\"If tomosynthesis is improving the likelihood of women to survive their breast cancers, they should have fewer cancers that are more likely to kill women over the 4.5 years of screening. Since tomosynthesis caught them early, they'll never grow up to be bad cancers,\" Pisano says.\u003c/p>\n\u003cp>Overdiagnosis is one of the potential downsides of this technology, says Dr. David Grossman, chair of the U.S. Preventive Services Task Force. The more sensitive test picks up more breast lesions for which the clinical significance is unclear, potentially resulting in women receiving more testing and treatment they don't need. Some \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK343784/\">research suggests\u003c/a> the biopsy rate is slightly higher with 3-D mammograms.\u003c/p>\n\u003cp>In addition, some of the mammography systems require both 2-D and 3-D X-rays, which can expose women to twice as much radiation. Other systems are able to generate a 2-D image from the 3-D version with software, eliminating the extra exposure. The 2-D image is important because clusters of calcifications, which may signal breast cancer, might be easier to see on the 2-D image, says Pisano.\u003c/p>\n\u003cp>Under the Affordable Care Act, most health plans are required to cover preventive services that are recommended by the task force without charging patients anything out-of-pocket. The task force \u003ca href=\"https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1?ds=1&s=breast%20cancer%20screening\">recommends mammograms every other year for women ages 50 to 74\u003c/a>, but it says that there's not enough evidence to recommend 3-D mammograms at this time.\u003c/p>\n\u003cp>Insurance coverage of 3-D testing has improved in recent years, but it's not assured. The 3-D test typically \u003ca href=\"http://truvenhealth.com/Portals/0/Assets/studies/hologic/f_ceor-76167.pdf\">costs about $50 more\u003c/a> than a 2-D test, according to a 2015 study by Truven Health Analytics that was funded by Hologic, a manufacturer of 3-D mammography systems. Medicare also covers 3-D tests.\u003c/p>\n\u003cp>A growing number of states require commercial insurers to cover 3-D mammograms, including Arkansas, Texas, Connecticut, Maryland, Illinois and Pennsylvania.\u003c/p>\n\u003cp>My state of \u003ca href=\"http://www.dfs.ny.gov/insurance/circltr/2017/cl2017_s1_cl02_2016.htm\">New York also requires coverage\u003c/a>, without any out-of-pocket payments. Though I didn't have to pay it, the explanation of benefits form I got from my insurer says the 3-D portion of the test added $51 to the $157 cost of the mammogram.\u003c/p>\n\u003cp>\"Costs are high for new technologies,\" Pisano says. \"Maybe they are better, but we need to have evidence before we recommend it for the entire population.\"\u003c/p>\n\u003cp>So if you're offered a 3-D test, should you get it?\u003c/p>\n\u003cp>\"If the examination is available at no extra cost, the data we have now tells us it has some advantages,\" says Smith. On the other hand, \"any woman who's feeling stressed about the extra cost ... should feel comfortable getting a regular mammogram,\" he says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter \u003c/em>\u003ca href=\"https://twitter.com/mandrews110\">@mandrews110\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+You+Need+A+Mammogram%2C+Should+You+Get+One+In+%273-D%27%3F+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/438484/should-you-get-a-more-expensive-3-d-mammogram","authors":["byline_futureofyou_438484"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_353","futureofyou_264","futureofyou_80","futureofyou_1301"],"featImg":"futureofyou_438485","label":"futureofyou"},"futureofyou_408445":{"type":"posts","id":"futureofyou_408445","meta":{"index":"posts_1591205157","site":"futureofyou","id":"408445","score":null,"sort":[1497371415000]},"guestAuthors":[],"slug":"new-wrinkle-in-mammography-debate-many-detected-tumors-may-not-pose-threat","title":"New Wrinkle in Mammography Debate: Many Detected Tumors May Not Pose Threat","publishDate":1497371415,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Scientists say they may have solved a big medical mystery: why mammograms don't save more lives.\u003c/p>\n\u003cp>A study involving thousands of breast cancer cases, released last week, concludes that a significant proportion of tumors detected through \u003ca href=\"https://www.cancer.gov/types/breast/mammograms-fact-sheet\">mammography \u003c/a>are not small because they are found early.\u003c/p>\n\u003cp>Instead, the tumors are small because they are biologically prone to slow growth.\u003c/p>\n\u003cp>\"For over 100 years, we've known that small breast cancers have a much better prognosis than large breast cancers,\" says \u003ca href=\"http://yalecancercenter.org/patient/people/donald_lannin.profile\">Donald Lannin\u003c/a>, a professor of surgery at the Yale School of Medicine, who led the study. \"We always assumed that it was because we were catching the small cancers early and then that's why the cure rate was much better.\"\u003c/p>\n\u003cp>To test that assumption, Lannin and a colleague analyzed information about thousands of \u003ca href=\"https://www.cancer.gov/types/breast\">breast cancer\u003c/a> cases collected between 2001 and 2013 by the National Cancer Institute's \u003ca href=\"https://seer.cancer.gov/\">Surveillance, Epidemiology and End Results\u003c/a> database.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>They found that about 22 percent of tumors detected by mammography are the very slow growing kind. The study looked at factors such as whether a tumor is more or less likely to grow faster when exposed to hormones.\u003c/p>\n\u003cp>The results were published in a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsr1613680\">special report\u003c/a> in the \u003cem>New England Journal of Medicine.\u003c/em>\u003c/p>\n\u003cp>\"We thought almost all breast cancers were alike. You know, a breast cancer was breast cancer — it was bad,\" Lannin says.\u003c/p>\n\u003cp>Instead, he says that breast cancer varies \"tremendously,\" from some cancers that are extremely fast growing and aggressive to others that are extremely slow growing.\u003c/p>\n\u003cp>\"It takes 15 or 20 years for [these small tumors] to cause any problems. And you can kind of imagine that a lot of patients will die of something else over that 15 or 20 years,\" Lannin says.\u003c/p>\n\u003cp>That means a significant proportion of women who get screened for breast cancer with a mammogram go through biopsies, surgery, chemotherapy, radiation — and experience a lot stress — for tumors that may never pose a health threat.\u003c/p>\n\u003cp>It appears that \"screening disproportionately finds good cancers — cancers that may be better off not found,\" says \u003ca href=\"http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph\">H. Gilbert Welch\u003c/a>, a professor of medicine, community and family medicine at Dartmouth College. He was not involved in the new study.\u003c/p>\n\u003cp>\"I think that we all need to realize that we've probably oversold the idea that looking for cancer early is the best way to avoid it,\" Welch says. \"Mammography's a really close call. It's a choice. We've exaggerated its benefit and we've sort of understated its harms.\"\u003c/p>\n\u003cp>The American Cancer Society and other groups have recently \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\">pulled back\u003c/a> on their recommendations for how often women should get mammograms, and the society now says most women can wait until they are 45 to start getting screened annually.\u003c/p>\n\u003cp>But the \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/09/508928906/danish-study-raises-more-questions-about-mammograms-message\">long debate over mammography\u003c/a> is unlikely to end anytime soon. \u003ca href=\"http://www.sw.org/Dr-Debra-L-Monticciolo\">Debra Monticciolo\u003c/a>, a radiologist at Texas A&M Health Science Center and chairwoman of the American College of Radiology's Breast Imaging Commission, argues the new study is flawed.\u003c/p>\n\u003cp>\"We know that mammograms have led to finding tumors earlier and have decreased mortality overall and it's pretty significant,\" Monticciolo says.\u003c/p>\n\u003cp>\"What I'm concerned about is this will give patients or their physicians the idea that, well, if you have tumor with a 'favorable biology' that we just don't need to worry about it. And that's just not true,\" she says.\u003c/p>\n\u003cp>Others argue that the long-term solution is to come up with new tests that can tell the difference between breast tumors that are more likely to grow quickly and become life-threatening, and those that truly are nothing to worry about.\u003c/p>\n\u003cp>\"What we need to do is go from a mid-19th century definition of cancer that involved a biopsy to a 21st century definition of cancer that involves both [biological] and genomic testing,\" says \u003ca href=\"http://pressroom.cancer.org/OtisBrawley\">Otis Brawley\u003c/a>, chief medical officer at the American Cancer Association.\u003c/p>\n\u003cp>That kind of test would allow doctors to say, \" 'Mrs. Jones, you have a breast cancer that we should watch' or 'Mrs. Smith, you have a breast cancer that we should treat,' \" Brawley says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, Brawley recommends women continue to follow \u003ca href=\"https://www.cancer.org/latest-news/special-coverage/american-cancer-society-breast-cancer-screening-guidelines.html\">current guidelines\u003c/a> for getting mammmograms.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Some+Small+Tumors+In+Breasts+May+Not+Be+So+Bad+After+All&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Research indicates a significant number of the tumors detected through mammography are small because they are prone to slow growth. The findings suggest many are unlikely to become life-threatening.","status":"publish","parent":0,"modified":1497371447,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":23,"wordCount":716},"headData":{"title":"New Wrinkle in Mammography Debate: Many Detected Tumors May Not Pose Threat | KQED","description":"Research indicates a significant number of the tumors detected through mammography are small because they are prone to slow growth. The findings suggest many are unlikely to become life-threatening.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"New Wrinkle in Mammography Debate: Many Detected Tumors May Not Pose Threat","datePublished":"2017-06-13T16:30:15.000Z","dateModified":"2017-06-13T16:30:47.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"408445 https://ww2.kqed.org/futureofyou/?p=408445","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/06/13/new-wrinkle-in-mammography-debate-many-detected-tumors-may-not-pose-threat/","disqusTitle":"New Wrinkle in Mammography Debate: Many Detected Tumors May Not Pose Threat","nprImageCredit":"Lester Lefkowitz","nprByline":"Rob Stein\u003cbr />NPR Shots","nprImageAgency":"Getty Images","nprStoryId":"531786168","nprApiLink":"http://api.npr.org/query?id=531786168&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/06/07/531786168/some-small-tumors-in-breasts-may-not-be-so-bad-after-all?ft=nprml&f=531786168","nprRetrievedStory":"1","nprPubDate":"Wed, 07 Jun 2017 17:32:00 -0400","nprStoryDate":"Wed, 07 Jun 2017 17:01:00 -0400","nprLastModifiedDate":"Wed, 07 Jun 2017 18:01:18 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170607_atc_some_small_tumors_in_breasts_may_not_be_so_bad_after_all.mp3?orgId=1&topicId=1128&d=229&p=2&story=531786168&t=progseg&e=531882676&seg=17&ft=nprml&f=531786168","nprAudioM3u":"http://api.npr.org/m3u/1531945598-50fd1b.m3u?orgId=1&topicId=1128&d=229&p=2&story=531786168&t=progseg&e=531882676&seg=17&ft=nprml&f=531786168","path":"/futureofyou/408445/new-wrinkle-in-mammography-debate-many-detected-tumors-may-not-pose-threat","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/06/20170607_atc_some_small_tumors_in_breasts_may_not_be_so_bad_after_all.mp3?orgId=1&topicId=1128&d=229&p=2&story=531786168&t=progseg&e=531882676&seg=17&ft=nprml&f=531786168","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Scientists say they may have solved a big medical mystery: why mammograms don't save more lives.\u003c/p>\n\u003cp>A study involving thousands of breast cancer cases, released last week, concludes that a significant proportion of tumors detected through \u003ca href=\"https://www.cancer.gov/types/breast/mammograms-fact-sheet\">mammography \u003c/a>are not small because they are found early.\u003c/p>\n\u003cp>Instead, the tumors are small because they are biologically prone to slow growth.\u003c/p>\n\u003cp>\"For over 100 years, we've known that small breast cancers have a much better prognosis than large breast cancers,\" says \u003ca href=\"http://yalecancercenter.org/patient/people/donald_lannin.profile\">Donald Lannin\u003c/a>, a professor of surgery at the Yale School of Medicine, who led the study. \"We always assumed that it was because we were catching the small cancers early and then that's why the cure rate was much better.\"\u003c/p>\n\u003cp>To test that assumption, Lannin and a colleague analyzed information about thousands of \u003ca href=\"https://www.cancer.gov/types/breast\">breast cancer\u003c/a> cases collected between 2001 and 2013 by the National Cancer Institute's \u003ca href=\"https://seer.cancer.gov/\">Surveillance, Epidemiology and End Results\u003c/a> database.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>They found that about 22 percent of tumors detected by mammography are the very slow growing kind. The study looked at factors such as whether a tumor is more or less likely to grow faster when exposed to hormones.\u003c/p>\n\u003cp>The results were published in a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMsr1613680\">special report\u003c/a> in the \u003cem>New England Journal of Medicine.\u003c/em>\u003c/p>\n\u003cp>\"We thought almost all breast cancers were alike. You know, a breast cancer was breast cancer — it was bad,\" Lannin says.\u003c/p>\n\u003cp>Instead, he says that breast cancer varies \"tremendously,\" from some cancers that are extremely fast growing and aggressive to others that are extremely slow growing.\u003c/p>\n\u003cp>\"It takes 15 or 20 years for [these small tumors] to cause any problems. And you can kind of imagine that a lot of patients will die of something else over that 15 or 20 years,\" Lannin says.\u003c/p>\n\u003cp>That means a significant proportion of women who get screened for breast cancer with a mammogram go through biopsies, surgery, chemotherapy, radiation — and experience a lot stress — for tumors that may never pose a health threat.\u003c/p>\n\u003cp>It appears that \"screening disproportionately finds good cancers — cancers that may be better off not found,\" says \u003ca href=\"http://tdi.dartmouth.edu/faculty/h-gilbert-welch-md-mph\">H. Gilbert Welch\u003c/a>, a professor of medicine, community and family medicine at Dartmouth College. He was not involved in the new study.\u003c/p>\n\u003cp>\"I think that we all need to realize that we've probably oversold the idea that looking for cancer early is the best way to avoid it,\" Welch says. \"Mammography's a really close call. It's a choice. We've exaggerated its benefit and we've sort of understated its harms.\"\u003c/p>\n\u003cp>The American Cancer Society and other groups have recently \u003ca href=\"http://www.npr.org/sections/health-shots/2015/10/20/449920789/cancer-group-now-says-most-mammograms-can-wait-till-45\">pulled back\u003c/a> on their recommendations for how often women should get mammograms, and the society now says most women can wait until they are 45 to start getting screened annually.\u003c/p>\n\u003cp>But the \u003ca href=\"http://www.npr.org/sections/health-shots/2017/01/09/508928906/danish-study-raises-more-questions-about-mammograms-message\">long debate over mammography\u003c/a> is unlikely to end anytime soon. \u003ca href=\"http://www.sw.org/Dr-Debra-L-Monticciolo\">Debra Monticciolo\u003c/a>, a radiologist at Texas A&M Health Science Center and chairwoman of the American College of Radiology's Breast Imaging Commission, argues the new study is flawed.\u003c/p>\n\u003cp>\"We know that mammograms have led to finding tumors earlier and have decreased mortality overall and it's pretty significant,\" Monticciolo says.\u003c/p>\n\u003cp>\"What I'm concerned about is this will give patients or their physicians the idea that, well, if you have tumor with a 'favorable biology' that we just don't need to worry about it. And that's just not true,\" she says.\u003c/p>\n\u003cp>Others argue that the long-term solution is to come up with new tests that can tell the difference between breast tumors that are more likely to grow quickly and become life-threatening, and those that truly are nothing to worry about.\u003c/p>\n\u003cp>\"What we need to do is go from a mid-19th century definition of cancer that involved a biopsy to a 21st century definition of cancer that involves both [biological] and genomic testing,\" says \u003ca href=\"http://pressroom.cancer.org/OtisBrawley\">Otis Brawley\u003c/a>, chief medical officer at the American Cancer Association.\u003c/p>\n\u003cp>That kind of test would allow doctors to say, \" 'Mrs. Jones, you have a breast cancer that we should watch' or 'Mrs. Smith, you have a breast cancer that we should treat,' \" Brawley says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>In the meantime, Brawley recommends women continue to follow \u003ca href=\"https://www.cancer.org/latest-news/special-coverage/american-cancer-society-breast-cancer-screening-guidelines.html\">current guidelines\u003c/a> for getting mammmograms.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Some+Small+Tumors+In+Breasts+May+Not+Be+So+Bad+After+All&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/408445/new-wrinkle-in-mammography-debate-many-detected-tumors-may-not-pose-threat","authors":["byline_futureofyou_408445"],"categories":["futureofyou_1","futureofyou_1064"],"tags":["futureofyou_264","futureofyou_1275","futureofyou_120","futureofyou_1301"],"featImg":"futureofyou_408446","label":"futureofyou"},"futureofyou_338926":{"type":"posts","id":"futureofyou_338926","meta":{"index":"posts_1591205157","site":"futureofyou","id":"338926","score":null,"sort":[1487788153000]},"guestAuthors":[],"slug":"cooling-caps-shown-to-limit-hair-loss-in-breast-patients-on-chemo","title":"Cooling Caps Shown to Limit Hair Loss in Breast Patients on Chemo","publishDate":1487788153,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>It's no surprise that most women with breast cancer consider hair loss one of the most traumatic aspects of chemotherapy. That has led to a big market for cooling caps, which are purported to limit hair loss.\u003c/p>\n\u003cp>But cooling caps haven't been extensively studied in the U.S., and womens' experiences with the caps have been hit or miss. And just one cooling cap, the \u003ca href=\"http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm476216.htm\">DigniCap\u003c/a>, is approved by the Food and Drug Administration.\u003c/p>\n\u003cp>Two studies released recently show that at least half the women who used either the DigniCap or another scalp cooling system, the \u003ca href=\"http://paxmanscalpcooling.com/the-system\">Paxman\u003c/a>, lost less than 50 percent of their hair.\u003c/p>\n\u003cp>\"These findings appear to represent a major step forward in improving the quality of life of individuals with cancer,\" says Dr. Dawn Hershman, who studies the effects of cancer treatments at the Columbia University School of Medicine in New York. She wrote an \u003ca href=\"http://jamanetwork.com/journals/jama/article-abstract/2601483\">editorial\u003c/a> accompanying the studies in \u003cem>JAMA,\u003c/em> the journal of the American Medical Association.\u003c/p>\n\u003cp>But Hershman cautions that more study is needed to determine whether there is psychological benefit in using the caps to prevent hair loss.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>And the cost and who will pay for the treatment are also issues, she says. The average cost is $1,500 to $3,000, depending on the number of chemotherapy cycles.\u003c/p>\n\u003cp>In the DigniCap \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.21038\">study\u003c/a>, 67 of 106 women (66.3 percent) lost less than half their hair after four rounds of taxane chemotherapy. The women had either stage I or II breast cancer.\u003c/p>\n\u003cp>In contrast, all of the 16 women who did not use the cap lost all of their hair during chemotherapy.\u003c/p>\n\u003cp>The DigniCap system uses a double cap fitted to the scalp 30 minutes before an infusion, which keeps the scalp at 37 degrees Fahrenheit, plus or minus 2 degrees, during the session. The system was approved by the FDA in 2015 and is available at infusion centers in \u003ca href=\"https://dignicap.com/availability/\">17 states\u003c/a>.\u003c/p>\n\u003cp>The other \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.20939\">study\u003c/a> found similar results using the Paxman system. It was led by oncologist Julie Nangia of the Baylor College of Medicine in Houston.\u003c/p>\n\u003cp>Half of the 95 women (50.5 percent) using the Paxman system lost less than half their hair after four rounds of anthracycline and taxane chemotherapy, including five women who had no significant hair loss, as judged by independent observers from photographs.\u003c/p>\n\u003cp>Among the 47 who did not use the cooling system, all lost all of their hair.\u003c/p>\n\u003cp>The Paxman study was stopped earlier than planned, after four cycles of chemotherapy, because findings showed the cooling cap was highly effective at preventing hair loss. That cooling system is not yet available commercially in the U.S. and is under review at the FDA.\u003c/p>\n\u003cp>\"It's nice now to have two good studies focusing on the quality of life to make the cancer journey easier for women,\" Nangia tells NPR.\u003c/p>\n\u003cp>There were no serious side effects related to either cooler. A few people reported headaches, and some stopped using the device because they got too cold. Nangia says most patients described the device as \"reasonably comfortable.\"\u003c/p>\n\u003cp>The studies were funded and designed, in part, by their respective manufacturers, with varying levels of company input to the university investigators. In both cases, the researchers were free to publish results they deemed appropriate.\u003c/p>\n\u003cp>Researchers don't know exactly how the cooling caps work. One theory is that cooling constricts the blood vessels in the scalp, slowing the circulation and thereby reducing the amount of toxins to which hair follicles are exposed.\u003c/p>\n\u003cp>Or it may be that cold slows the growth of hair follicles, making them less susceptible to damage from chemotherapy, which targets rapidly dividing cells.\u003c/p>\n\u003cp>\u003ca href=\"http://pressroom.cancer.org/lenlichtenfeld\">Dr. Len Lichtenfeld\u003c/a>, deputy chief medical officer of the American Cancer Society, says it could be that \"by slowing down those cells whatever mechanism it may be — either starving their blood flow or slowing them down straightforwardly — the net effect is beneficial, causing hair not to fall out.\"\u003c/p>\n\u003cp>While chilling the scalp may seem to carry few risks, Lichtenfeld says there is a theoretical risk that inhibiting the effect of chemotherapy in the scalp could allow metastases to take hold there.\u003c/p>\n\u003cp>\"These techniques are relatively new,\" he says, and \"breast cancer is a disease that can take a long time before it comes back and if one is to be 100 percent certain then you need a long period of time to answer the question.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, cancer recurrence on the scalp has not been seen in the U.S. studies, but authors of both \u003cem>JAMA\u003c/em> papers say longer follow-up is needed to be sure that this is not a risk.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Cooling+Cap+May+Limit+Chemo+Hair+Loss+In+Women+With+Breast+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Cooling caps haven't been studied much in the U.S., and only one is approved by the FDA. Studies of two different caps show they can reduce hair loss by half in many women undergoing chemo.","status":"publish","parent":0,"modified":1487788185,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":786},"headData":{"title":"Cooling Caps Shown to Limit Hair Loss in Breast Patients on Chemo | KQED","description":"Cooling caps haven't been studied much in the U.S., and only one is approved by the FDA. Studies of two different caps show they can reduce hair loss by half in many women undergoing chemo.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Cooling Caps Shown to Limit Hair Loss in Breast Patients on Chemo","datePublished":"2017-02-22T18:29:13.000Z","dateModified":"2017-02-22T18:29:45.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"338926 https://ww2.kqed.org/futureofyou/?p=338926","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/02/22/cooling-caps-shown-to-limit-hair-loss-in-breast-patients-on-chemo/","disqusTitle":"Cooling Caps Shown to Limit Hair Loss in Breast Patients on Chemo","source":"KQED Future of You","nprByline":"Patti Neighmond\u003cbr />NPR Shots","nprImageAgency":"Courtesy of Baylor College of Medicine","nprStoryId":"515164003","nprApiLink":"http://api.npr.org/query?id=515164003&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2017/02/14/515164003/cooling-cap-may-limit-chemo-hair-loss-in-women-with-breast-cancer?ft=nprml&f=515164003","nprRetrievedStory":"1","nprPubDate":"Tue, 14 Feb 2017 22:21:00 -0500","nprStoryDate":"Tue, 14 Feb 2017 11:05:00 -0500","nprLastModifiedDate":"Wed, 15 Feb 2017 16:16:09 -0500","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/02/20170214_atc_cooling_cap_may_limit_chemo_hair_loss_in_women_with_breast_cancer.mp3?orgId=1&topicId=1128&d=234&p=2&story=515164003&t=progseg&e=515153847&seg=7&ft=nprml&f=515164003","nprAudioM3u":"http://api.npr.org/m3u/1515242394-5612bc.m3u?orgId=1&topicId=1128&d=234&p=2&story=515164003&t=progseg&e=515153847&seg=7&ft=nprml&f=515164003","path":"/futureofyou/338926/cooling-caps-shown-to-limit-hair-loss-in-breast-patients-on-chemo","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/atc/2017/02/20170214_atc_cooling_cap_may_limit_chemo_hair_loss_in_women_with_breast_cancer.mp3?orgId=1&topicId=1128&d=234&p=2&story=515164003&t=progseg&e=515153847&seg=7&ft=nprml&f=515164003","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It's no surprise that most women with breast cancer consider hair loss one of the most traumatic aspects of chemotherapy. That has led to a big market for cooling caps, which are purported to limit hair loss.\u003c/p>\n\u003cp>But cooling caps haven't been extensively studied in the U.S., and womens' experiences with the caps have been hit or miss. And just one cooling cap, the \u003ca href=\"http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm476216.htm\">DigniCap\u003c/a>, is approved by the Food and Drug Administration.\u003c/p>\n\u003cp>Two studies released recently show that at least half the women who used either the DigniCap or another scalp cooling system, the \u003ca href=\"http://paxmanscalpcooling.com/the-system\">Paxman\u003c/a>, lost less than 50 percent of their hair.\u003c/p>\n\u003cp>\"These findings appear to represent a major step forward in improving the quality of life of individuals with cancer,\" says Dr. Dawn Hershman, who studies the effects of cancer treatments at the Columbia University School of Medicine in New York. She wrote an \u003ca href=\"http://jamanetwork.com/journals/jama/article-abstract/2601483\">editorial\u003c/a> accompanying the studies in \u003cem>JAMA,\u003c/em> the journal of the American Medical Association.\u003c/p>\n\u003cp>But Hershman cautions that more study is needed to determine whether there is psychological benefit in using the caps to prevent hair loss.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And the cost and who will pay for the treatment are also issues, she says. The average cost is $1,500 to $3,000, depending on the number of chemotherapy cycles.\u003c/p>\n\u003cp>In the DigniCap \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.21038\">study\u003c/a>, 67 of 106 women (66.3 percent) lost less than half their hair after four rounds of taxane chemotherapy. The women had either stage I or II breast cancer.\u003c/p>\n\u003cp>In contrast, all of the 16 women who did not use the cap lost all of their hair during chemotherapy.\u003c/p>\n\u003cp>The DigniCap system uses a double cap fitted to the scalp 30 minutes before an infusion, which keeps the scalp at 37 degrees Fahrenheit, plus or minus 2 degrees, during the session. The system was approved by the FDA in 2015 and is available at infusion centers in \u003ca href=\"https://dignicap.com/availability/\">17 states\u003c/a>.\u003c/p>\n\u003cp>The other \u003ca href=\"http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.20939\">study\u003c/a> found similar results using the Paxman system. It was led by oncologist Julie Nangia of the Baylor College of Medicine in Houston.\u003c/p>\n\u003cp>Half of the 95 women (50.5 percent) using the Paxman system lost less than half their hair after four rounds of anthracycline and taxane chemotherapy, including five women who had no significant hair loss, as judged by independent observers from photographs.\u003c/p>\n\u003cp>Among the 47 who did not use the cooling system, all lost all of their hair.\u003c/p>\n\u003cp>The Paxman study was stopped earlier than planned, after four cycles of chemotherapy, because findings showed the cooling cap was highly effective at preventing hair loss. That cooling system is not yet available commercially in the U.S. and is under review at the FDA.\u003c/p>\n\u003cp>\"It's nice now to have two good studies focusing on the quality of life to make the cancer journey easier for women,\" Nangia tells NPR.\u003c/p>\n\u003cp>There were no serious side effects related to either cooler. A few people reported headaches, and some stopped using the device because they got too cold. Nangia says most patients described the device as \"reasonably comfortable.\"\u003c/p>\n\u003cp>The studies were funded and designed, in part, by their respective manufacturers, with varying levels of company input to the university investigators. In both cases, the researchers were free to publish results they deemed appropriate.\u003c/p>\n\u003cp>Researchers don't know exactly how the cooling caps work. One theory is that cooling constricts the blood vessels in the scalp, slowing the circulation and thereby reducing the amount of toxins to which hair follicles are exposed.\u003c/p>\n\u003cp>Or it may be that cold slows the growth of hair follicles, making them less susceptible to damage from chemotherapy, which targets rapidly dividing cells.\u003c/p>\n\u003cp>\u003ca href=\"http://pressroom.cancer.org/lenlichtenfeld\">Dr. Len Lichtenfeld\u003c/a>, deputy chief medical officer of the American Cancer Society, says it could be that \"by slowing down those cells whatever mechanism it may be — either starving their blood flow or slowing them down straightforwardly — the net effect is beneficial, causing hair not to fall out.\"\u003c/p>\n\u003cp>While chilling the scalp may seem to carry few risks, Lichtenfeld says there is a theoretical risk that inhibiting the effect of chemotherapy in the scalp could allow metastases to take hold there.\u003c/p>\n\u003cp>\"These techniques are relatively new,\" he says, and \"breast cancer is a disease that can take a long time before it comes back and if one is to be 100 percent certain then you need a long period of time to answer the question.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>So far, cancer recurrence on the scalp has not been seen in the U.S. studies, but authors of both \u003cem>JAMA\u003c/em> papers say longer follow-up is needed to be sure that this is not a risk.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Cooling+Cap+May+Limit+Chemo+Hair+Loss+In+Women+With+Breast+Cancer&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/338926/cooling-caps-shown-to-limit-hair-loss-in-breast-patients-on-chemo","authors":["byline_futureofyou_338926"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1"],"tags":["futureofyou_264","futureofyou_1189","futureofyou_1190"],"featImg":"futureofyou_338927","label":"source_futureofyou_338926"},"futureofyou_244518":{"type":"posts","id":"futureofyou_244518","meta":{"index":"posts_1591205157","site":"futureofyou","id":"244518","score":null,"sort":[1473787732000]},"guestAuthors":[],"slug":"some-insurers-require-genetic-counseling-before-breast-cancer-tests","title":"Some Insurers Require Genetic Counseling Before Breast Cancer Tests","publishDate":1473787732,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Health care providers and insurers agree that it’s in everyone’s best interest to refer women for genetic testing if their family history of breast or ovarian cancer puts them at higher risk. What they don’t agree on is what should happen before testing, specifically whether women need to be advised by a certified genetic counselor or someone with similar training before the test is ordered.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Too often the wrong tests were being ordered.'\u003c/aside>\n\u003cp>On the one hand, obstetrician-gynecologists say that counseling patients about hereditary cancers of the breast, ovaries, uterus and other reproductive organs is part of their normal routine, as is counseling pregnant patients about prenatal genetic testing. As licensed physicians, they are considered competent to provide this type of care.\u003c/p>\n\u003cp>“This is what we do,” said Dr. Mark DeFrancesco, the immediate past president of the American Congress of Obstetricians and Gynecologists, noting that most physicians have been taking family histories since medical school. “There are simple-to-understand criteria for who should be considered for genetic testing, and it usually has to do with whether you or someone in your family has had cancer.”\u003c/p>\n\u003cp>DeFrancesco recalled a patient whose mother, grandmother and maternal aunt all had breast cancer, but the insurer required she see a genetic counselor before testing would be approved. In such cases, “it will take a few extra weeks to get tested, and she might decide not to bother,” he said.\u003c/p>\n\u003cp>DeFrancesco said genetic counselors have an important role to play after testing has been done to help patients who test positive for a genetic mutation understand the results.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>In a statement released last December, the physicians group said it opposed such a restriction and warned that it limits patients’ access to care.\u003c/p>\n\u003cp>\u003cstrong>Insurers' View\u003c/strong>\u003c/p>\n\u003cp>Insurers sometimes take a different view, although their rules vary. Two national insurers, UnitedHealthcare and Cigna, require women to receive counseling by a certified genetic counselor or other professional trained in cancer genetics before they will approve coverage for tests that look for mutations in two genes, BRCA1 and BRCA2, that increase the risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>UnitedHealthcare began requiring genetic counseling for BRCA tests in January. The insurer allows physicians to do the counseling themselves if they attest they’re qualified to do so, said Dr. Lee Newcomer, senior vice president for oncology and genetics.\u003c/p>\n\u003cp>Cigna made counseling a requirement in 2013 for BRCA and colorectal hereditary cancers and a heart condition called Long-QT. In July, the company expanded the list to include all hereditary cancers. Cigna generally requires physicians to get additional training in cancer genetics in order to meet its counseling requirement, said Dr. Jeffrey Hankoff, Cigna’s medical officer for clinical performance and quality.\u003c/p>\n\u003cp>BRCA mutations increase a woman’s risk of developing breast cancer by age 70 by between 45 and 65 percent. They account for 5 to 10 percent of all breast cancers. BRCA mutations raise women’s risk of ovarian and other cancers as well. There are other known genetic mutations that also increase a woman’s risk for breast and ovarian cancers, but they are less commonly tested for.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent panel of medical experts, recommends that women with a family history of breast, ovarian, fallopian tube or peritoneal cancer be screened to determine if they’re at increased risk for BRCA mutations and referred for genetic counseling and testing, if indicated.\u003c/p>\n\u003cp>Under the health law, women with insurance aren’t responsible for paying anything out of pocket for the testing and counseling recommended by the task force if it’s performed by in-network providers.\u003c/p>\n\u003cp>The health law coverage requirement didn’t drive Cigna’s BRCA genetic counseling decision, said Hankoff.\u003c/p>\n\u003cp>“We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it,” Hankoff said. In addition, “Too often the wrong tests were being ordered.”\u003c/p>\n\u003cp>For example, a woman whose sister has been diagnosed with breast cancer and tested positive for a specific mutation doesn’t need a genetic test that looks for all hereditary breast cancer mutations, Hankoff said. She only needs to be tested for the specific mutation that her sister has.\u003c/p>\n\u003cp>Genetic counselors, meanwhile, try to walk a middle line in the debate. To become certified, people complete a master’s degree program that encompasses both classroom study and clinical training in genetics, ethics and the psychosocial aspects of helping families through diagnosis and the decision-making process, among other things. Certification by the American Board of Genetic Counseling is typically required in order to practice.\u003c/p>\n\u003cp>“There are a lot of complexities with genetic testing,” said Mary Freivogel, president-elect of the National Society of Genetic Counselors, who practices in the Denver area. “A lot of [OB-GYNs] don’t have the time or interest to do this well.”\u003c/p>\n\u003cp>With the number of genetic tests growing by leaps and bounds, meeting the demand for counseling can be a challenge, experts agree.\u003c/p>\n\u003cp>Physicians don’t necessarily get it right. For one thing, they often aren’t great at taking family histories, neglecting to gather information about the men in a family, for example, or factoring in close relatives who died at a young age, said Robert Smith, a cancer epidemiologist who is vice president for cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>“Not everybody has a set of family members that allow for the elevated risk to be obvious,” Smith said. “There’s a lot to be said for having a specialist do it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Health care providers and insurers don’t always agree on whether women need to be advised by a certified genetic counselor before the test is ordered.","status":"publish","parent":0,"modified":1475111594,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":991},"headData":{"title":"Some Insurers Require Genetic Counseling Before Breast Cancer Tests | KQED","description":"Health care providers and insurers don’t always agree on whether women need to be advised by a certified genetic counselor before the test is ordered.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Some Insurers Require Genetic Counseling Before Breast Cancer Tests","datePublished":"2016-09-13T17:28:52.000Z","dateModified":"2016-09-29T01:13:14.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"244518 http://ww2.kqed.org/futureofyou/?p=244518","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/09/13/some-insurers-require-genetic-counseling-before-breast-cancer-tests/","disqusTitle":"Some Insurers Require Genetic Counseling Before Breast Cancer Tests","nprByline":"Michelle Andrews\u003cbr />\u003ca href=\"http://khn.org/news/insurers-may-insist-on-counseling-before-genetic-tests-for-breast-cancer/\">Kaiser Health News\u003c/a>","path":"/futureofyou/244518/some-insurers-require-genetic-counseling-before-breast-cancer-tests","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health care providers and insurers agree that it’s in everyone’s best interest to refer women for genetic testing if their family history of breast or ovarian cancer puts them at higher risk. What they don’t agree on is what should happen before testing, specifically whether women need to be advised by a certified genetic counselor or someone with similar training before the test is ordered.\u003c/p>\n\u003caside class=\"pullquote alignright\">'Too often the wrong tests were being ordered.'\u003c/aside>\n\u003cp>On the one hand, obstetrician-gynecologists say that counseling patients about hereditary cancers of the breast, ovaries, uterus and other reproductive organs is part of their normal routine, as is counseling pregnant patients about prenatal genetic testing. As licensed physicians, they are considered competent to provide this type of care.\u003c/p>\n\u003cp>“This is what we do,” said Dr. Mark DeFrancesco, the immediate past president of the American Congress of Obstetricians and Gynecologists, noting that most physicians have been taking family histories since medical school. “There are simple-to-understand criteria for who should be considered for genetic testing, and it usually has to do with whether you or someone in your family has had cancer.”\u003c/p>\n\u003cp>DeFrancesco recalled a patient whose mother, grandmother and maternal aunt all had breast cancer, but the insurer required she see a genetic counselor before testing would be approved. In such cases, “it will take a few extra weeks to get tested, and she might decide not to bother,” he said.\u003c/p>\n\u003cp>DeFrancesco said genetic counselors have an important role to play after testing has been done to help patients who test positive for a genetic mutation understand the results.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>In a statement released last December, the physicians group said it opposed such a restriction and warned that it limits patients’ access to care.\u003c/p>\n\u003cp>\u003cstrong>Insurers' View\u003c/strong>\u003c/p>\n\u003cp>Insurers sometimes take a different view, although their rules vary. Two national insurers, UnitedHealthcare and Cigna, require women to receive counseling by a certified genetic counselor or other professional trained in cancer genetics before they will approve coverage for tests that look for mutations in two genes, BRCA1 and BRCA2, that increase the risk for breast, ovarian and other cancers.\u003c/p>\n\u003cp>UnitedHealthcare began requiring genetic counseling for BRCA tests in January. The insurer allows physicians to do the counseling themselves if they attest they’re qualified to do so, said Dr. Lee Newcomer, senior vice president for oncology and genetics.\u003c/p>\n\u003cp>Cigna made counseling a requirement in 2013 for BRCA and colorectal hereditary cancers and a heart condition called Long-QT. In July, the company expanded the list to include all hereditary cancers. Cigna generally requires physicians to get additional training in cancer genetics in order to meet its counseling requirement, said Dr. Jeffrey Hankoff, Cigna’s medical officer for clinical performance and quality.\u003c/p>\n\u003cp>BRCA mutations increase a woman’s risk of developing breast cancer by age 70 by between 45 and 65 percent. They account for 5 to 10 percent of all breast cancers. BRCA mutations raise women’s risk of ovarian and other cancers as well. There are other known genetic mutations that also increase a woman’s risk for breast and ovarian cancers, but they are less commonly tested for.\u003c/p>\n\u003cp>The U.S. Preventive Services Task Force, an independent panel of medical experts, recommends that women with a family history of breast, ovarian, fallopian tube or peritoneal cancer be screened to determine if they’re at increased risk for BRCA mutations and referred for genetic counseling and testing, if indicated.\u003c/p>\n\u003cp>Under the health law, women with insurance aren’t responsible for paying anything out of pocket for the testing and counseling recommended by the task force if it’s performed by in-network providers.\u003c/p>\n\u003cp>The health law coverage requirement didn’t drive Cigna’s BRCA genetic counseling decision, said Hankoff.\u003c/p>\n\u003cp>“We had concerns that people were having testing ordered that didn’t appear to need it and probably didn’t understand it,” Hankoff said. In addition, “Too often the wrong tests were being ordered.”\u003c/p>\n\u003cp>For example, a woman whose sister has been diagnosed with breast cancer and tested positive for a specific mutation doesn’t need a genetic test that looks for all hereditary breast cancer mutations, Hankoff said. She only needs to be tested for the specific mutation that her sister has.\u003c/p>\n\u003cp>Genetic counselors, meanwhile, try to walk a middle line in the debate. To become certified, people complete a master’s degree program that encompasses both classroom study and clinical training in genetics, ethics and the psychosocial aspects of helping families through diagnosis and the decision-making process, among other things. Certification by the American Board of Genetic Counseling is typically required in order to practice.\u003c/p>\n\u003cp>“There are a lot of complexities with genetic testing,” said Mary Freivogel, president-elect of the National Society of Genetic Counselors, who practices in the Denver area. “A lot of [OB-GYNs] don’t have the time or interest to do this well.”\u003c/p>\n\u003cp>With the number of genetic tests growing by leaps and bounds, meeting the demand for counseling can be a challenge, experts agree.\u003c/p>\n\u003cp>Physicians don’t necessarily get it right. For one thing, they often aren’t great at taking family histories, neglecting to gather information about the men in a family, for example, or factoring in close relatives who died at a young age, said Robert Smith, a cancer epidemiologist who is vice president for cancer screening at the American Cancer Society.\u003c/p>\n\u003cp>“Not everybody has a set of family members that allow for the elevated risk to be obvious,” Smith said. “There’s a lot to be said for having a specialist do it.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/244518/some-insurers-require-genetic-counseling-before-breast-cancer-tests","authors":["byline_futureofyou_244518"],"categories":["futureofyou_1062","futureofyou_1064"],"tags":["futureofyou_264","futureofyou_1046","futureofyou_120"],"featImg":"futureofyou_244544","label":"futureofyou"},"futureofyou_229777":{"type":"posts","id":"futureofyou_229777","meta":{"index":"posts_1591205157","site":"futureofyou","id":"229777","score":null,"sort":[1472080984000]},"guestAuthors":[],"slug":"with-gene-test-some-breast-cancer-patients-can-skip-chemo-study","title":"With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study","publishDate":1472080984,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Some early-stage, post-operative breast cancer patients meeting a certain genetic profile can avoid potentially dangerous and expensive chemotherapy with only a slightly lower survival rate, and without the cancer spreading, a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602253\">major study\u003c/a> published in The New England Journal of Medicine Wednesday has found.\u003c/p>\n\u003cp>The study said that 46 percent of subjects who were classified as high-risk by traditional clinical criteria but low-risk according to their genetics could skip chemo and expose themselves to just a slightly greater risk – 1.5 percent -- of the cancer \u003ca href=\"http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46283\" target=\"_blank\">metastasizing\u003c/a> after five years.\u003c/p>\n\u003cp>Those who received chemo had a 95.9 percent rate of success after five years, compared to 94.4 percent of those who did not get the treatment.\u003c/p>\n\u003cfigure id=\"attachment_230055\" class=\"wp-caption aligncenter\" style=\"max-width: 460px\">\u003cimg class=\"size-medium wp-image-230055\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg\" alt=\"A mammogram image.\" width=\"460\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg 460w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-400x521.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-768x1001.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-906x1180.jpg 906w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-1180x1538.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-960x1251.jpg 960w\" sizes=\"(max-width: 460px) 100vw, 460px\">\u003cfigcaption class=\"wp-caption-text\">A mammogram image. \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, the difference between opting for chemo or not is so small that \"You would have to treat 100 of those [patients] with chemotherapy for the benefit of one,\" said Dr. Laura van't Veer, one of the leaders of the breast oncology program at the University of California, San Francisco, who helped develop the test that the researchers used to determine the genetic risk level of recurrence for each patient.\u003c/p>\n\u003cp>That still may be enough of a difference for some patients and their doctors to choose chemo. In an \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMe1607947?query=featured_genetics\" target=\"_blank\">editorial\u003c/a> that accompanied the study in the NEJM, Dr. Clifford A. Hudis, chief executive officer of the American Society of Clinical Oncology, and Dr. Maura Dickler, a researcher who also treats breast cancer patients at Memorial Sloan Kettering Cancer Center in New York City, said the decision whether to undergo chemo or not won't be a slam dunk, even with the new information provided by the test.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It's such a low benefit that many breast cancer patients will decide not to take chemotherapy.'\u003ccite>Prof. Laura van't Veer, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\"(A) difference of 1.5 percentage points, if real, might mean more to one patient than to another,\" they wrote. \"Thus, the stated difference does not precisely exclude a benefit that clinicians and patients might find meaningful.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Dr. van't Veer said, nevertheless, many whose risk is low according to the test would opt out: \"It doesn't mean you should not acknowledge [the risk], but it's such a low benefit that many breast cancer patients will decide not to take chemotherapy.\"\u003c/p>\n\u003cp>Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, said that women at her clinic shown to be at low genetic risk through MammaPrint usually choose to forego chemo.\u003c/p>\n\u003cp>\"But there always [are] some patients for whom 1 percent benefit is enough — and you need to respect the wishes of each individual patient.\"\u003c/p>\n\u003cp>Side effects from chemotherapy can include hair loss, mouth sores, diarrhea, early menopause, dental issues and in rare cases leukemia and other diseases.\u003c/p>\n\u003cp>MammaPrint is priced at $4,200 and is covered by some insurance in the U.S.\u003c/p>\n\u003cp>\u003cstrong>European Study\u003c/strong>\u003c/p>\n\u003cp>The phase 3 study, called MINDACT, enrolled 6,693 breast cancer patients, recruited from 2007 to 2011 from 112 hospitals in nine European countries. Patients were between 18 and 70.\u003c/p>\n\u003cp>The point of the study was to compare a 70-gene risk-assessment test called \u003ca href=\"http://www.agendia.com/healthcare-professionals/breast-cancer/mammaprint/\" target=\"_blank\">MammaPrint\u003c/a> to a risk classification system that ignores genetics but takes into account clinical characteristics like a patient's age, tumor diameter, and whether the cancer has spread to the lymph nodes. The researchers wanted to know whether patients who were classified as high-risk according to the clinical criteria but low-risk according to MammaPrint had better or worse outcomes if they did not receive chemo.\u003c/p>\n\u003cp>Dr. van’t Veer and other researchers in the study are part of a company, \u003ca href=\"http://www.agendia.com/about/executive-management/\">Agendia\u003c/a>, that has sold MammaPrint commercially in the U.S. since 2008.\u003c/p>\n\u003cp>A total of 1,550 patients fell under a group with either high clinical and low genetic risk profiles or low clinical and high genetic risk profiles. Those patients were then randomized into either receiving chemo or not. After five years, those who had not received the treatment were 1.5 percent more likely to avoid seeing the cancer spread into distant areas than those who had received the treatment. [contextly_sidebar id=\"ZGXIiKTBs6PgwGIe3Te78GFDOl9QSCmS\"]\u003c/p>\n\u003cp>The study focused on women with stage 1, stage 2 and operable stage 3 breast cancer, with up to three affected lymph nodes.\u003c/p>\n\u003cp>About 246,660 patients will receive an invasive breast cancer diagnosis in 2016, according to the \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">American Cancer Society\u003c/a>. Of that group, van't Veer estimated that MammaPrint could flag 35,000 to 40,000 breast cancer patients as being in a position not to pursue chemotherapy and still experience a statistically small chance of recurrence.\u003c/p>\n\u003cp>Karuna Jaggar, the executive director of Breast Cancer Action, a breast cancer advocacy organization, thought the study was significant, and a win for what's known as precision medicine -- tailoring treatments according to the individual characteristics of patients.\u003c/p>\n\u003cp>\"We know that there are harms that come with any treatment, whether it's surgery, radiation or chemotherapy. And it's very important for patients to be able to weigh the risks and benefits when making their own treatment decisions.\"\u003c/p>\n\u003cp>Jaggar said the financial fallout from receiving chemotherapy can be significant. Besides the cost of treatment, which she said can reach well over $100,000, \"There's a lot of data that shows even several years after treatment, women who have undergone chemotherapy are more likely to be un- and underemployed.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine\" target=\"_blank\">NPR\u003c/a> contributed to this report.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Up to 46 percent of breast cancer patients who receive chemotherapy may find it no more effective than if they had skipped it altogether, and a genetic test can spare them the unnecessary treatment, a new study says.","status":"publish","parent":0,"modified":1472176697,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":969},"headData":{"title":"With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study | KQED","description":"Up to 46 percent of breast cancer patients who receive chemotherapy may find it no more effective than if they had skipped it altogether, and a genetic test can spare them the unnecessary treatment, a new study says.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study","datePublished":"2016-08-24T23:23:04.000Z","dateModified":"2016-08-26T01:58:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"229777 http://ww2.kqed.org/futureofyou/?p=229777","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/08/24/with-gene-test-some-breast-cancer-patients-can-skip-chemo-study/","disqusTitle":"With Gene Test, Some Breast Cancer Patients Can Skip Chemo: Study","source":"Future of You","path":"/futureofyou/229777/with-gene-test-some-breast-cancer-patients-can-skip-chemo-study","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Some early-stage, post-operative breast cancer patients meeting a certain genetic profile can avoid potentially dangerous and expensive chemotherapy with only a slightly lower survival rate, and without the cancer spreading, a \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMoa1602253\">major study\u003c/a> published in The New England Journal of Medicine Wednesday has found.\u003c/p>\n\u003cp>The study said that 46 percent of subjects who were classified as high-risk by traditional clinical criteria but low-risk according to their genetics could skip chemo and expose themselves to just a slightly greater risk – 1.5 percent -- of the cancer \u003ca href=\"http://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46283\" target=\"_blank\">metastasizing\u003c/a> after five years.\u003c/p>\n\u003cp>Those who received chemo had a 95.9 percent rate of success after five years, compared to 94.4 percent of those who did not get the treatment.\u003c/p>\n\u003cfigure id=\"attachment_230055\" class=\"wp-caption aligncenter\" style=\"max-width: 460px\">\u003cimg class=\"size-medium wp-image-230055\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg\" alt=\"A mammogram image.\" width=\"460\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-460x600.jpg 460w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-400x521.jpg 400w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-768x1001.jpg 768w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-906x1180.jpg 906w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-1180x1538.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/13/2016/08/iStock_000067189851_Large-1920x2502-960x1251.jpg 960w\" sizes=\"(max-width: 460px) 100vw, 460px\">\u003cfigcaption class=\"wp-caption-text\">A mammogram image. \u003ccite>(Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>In other words, the difference between opting for chemo or not is so small that \"You would have to treat 100 of those [patients] with chemotherapy for the benefit of one,\" said Dr. Laura van't Veer, one of the leaders of the breast oncology program at the University of California, San Francisco, who helped develop the test that the researchers used to determine the genetic risk level of recurrence for each patient.\u003c/p>\n\u003cp>That still may be enough of a difference for some patients and their doctors to choose chemo. In an \u003ca href=\"http://www.nejm.org/doi/full/10.1056/NEJMe1607947?query=featured_genetics\" target=\"_blank\">editorial\u003c/a> that accompanied the study in the NEJM, Dr. Clifford A. Hudis, chief executive officer of the American Society of Clinical Oncology, and Dr. Maura Dickler, a researcher who also treats breast cancer patients at Memorial Sloan Kettering Cancer Center in New York City, said the decision whether to undergo chemo or not won't be a slam dunk, even with the new information provided by the test.\u003c/p>\n\u003caside class=\"pullquote alignright\">'It's such a low benefit that many breast cancer patients will decide not to take chemotherapy.'\u003ccite>Prof. Laura van't Veer, UCSF\u003c/cite>\u003c/aside>\n\u003cp>\"(A) difference of 1.5 percentage points, if real, might mean more to one patient than to another,\" they wrote. \"Thus, the stated difference does not precisely exclude a benefit that clinicians and patients might find meaningful.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Dr. van't Veer said, nevertheless, many whose risk is low according to the test would opt out: \"It doesn't mean you should not acknowledge [the risk], but it's such a low benefit that many breast cancer patients will decide not to take chemotherapy.\"\u003c/p>\n\u003cp>Dr. Fatima Cardoso, the study's lead author and a breast cancer specialist at the Champalimaud Clinical Center in Lisbon, Portugal, said that women at her clinic shown to be at low genetic risk through MammaPrint usually choose to forego chemo.\u003c/p>\n\u003cp>\"But there always [are] some patients for whom 1 percent benefit is enough — and you need to respect the wishes of each individual patient.\"\u003c/p>\n\u003cp>Side effects from chemotherapy can include hair loss, mouth sores, diarrhea, early menopause, dental issues and in rare cases leukemia and other diseases.\u003c/p>\n\u003cp>MammaPrint is priced at $4,200 and is covered by some insurance in the U.S.\u003c/p>\n\u003cp>\u003cstrong>European Study\u003c/strong>\u003c/p>\n\u003cp>The phase 3 study, called MINDACT, enrolled 6,693 breast cancer patients, recruited from 2007 to 2011 from 112 hospitals in nine European countries. Patients were between 18 and 70.\u003c/p>\n\u003cp>The point of the study was to compare a 70-gene risk-assessment test called \u003ca href=\"http://www.agendia.com/healthcare-professionals/breast-cancer/mammaprint/\" target=\"_blank\">MammaPrint\u003c/a> to a risk classification system that ignores genetics but takes into account clinical characteristics like a patient's age, tumor diameter, and whether the cancer has spread to the lymph nodes. The researchers wanted to know whether patients who were classified as high-risk according to the clinical criteria but low-risk according to MammaPrint had better or worse outcomes if they did not receive chemo.\u003c/p>\n\u003cp>Dr. van’t Veer and other researchers in the study are part of a company, \u003ca href=\"http://www.agendia.com/about/executive-management/\">Agendia\u003c/a>, that has sold MammaPrint commercially in the U.S. since 2008.\u003c/p>\n\u003cp>A total of 1,550 patients fell under a group with either high clinical and low genetic risk profiles or low clinical and high genetic risk profiles. Those patients were then randomized into either receiving chemo or not. After five years, those who had not received the treatment were 1.5 percent more likely to avoid seeing the cancer spread into distant areas than those who had received the treatment. \u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The study focused on women with stage 1, stage 2 and operable stage 3 breast cancer, with up to three affected lymph nodes.\u003c/p>\n\u003cp>About 246,660 patients will receive an invasive breast cancer diagnosis in 2016, according to the \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics\" target=\"_blank\">American Cancer Society\u003c/a>. Of that group, van't Veer estimated that MammaPrint could flag 35,000 to 40,000 breast cancer patients as being in a position not to pursue chemotherapy and still experience a statistically small chance of recurrence.\u003c/p>\n\u003cp>Karuna Jaggar, the executive director of Breast Cancer Action, a breast cancer advocacy organization, thought the study was significant, and a win for what's known as precision medicine -- tailoring treatments according to the individual characteristics of patients.\u003c/p>\n\u003cp>\"We know that there are harms that come with any treatment, whether it's surgery, radiation or chemotherapy. And it's very important for patients to be able to weigh the risks and benefits when making their own treatment decisions.\"\u003c/p>\n\u003cp>Jaggar said the financial fallout from receiving chemotherapy can be significant. Besides the cost of treatment, which she said can reach well over $100,000, \"There's a lot of data that shows even several years after treatment, women who have undergone chemotherapy are more likely to be un- and underemployed.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://www.npr.org/sections/health-shots/2016/08/24/491213713/study-of-breast-cancer-treatment-reveals-paradox-of-precision-medicine\" target=\"_blank\">NPR\u003c/a> contributed to this report.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/229777/with-gene-test-some-breast-cancer-patients-can-skip-chemo-study","authors":["80"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_264","futureofyou_120","futureofyou_80","futureofyou_1025"],"featImg":"futureofyou_230022","label":"source_futureofyou_229777"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. For one hour a week, the show tries to lift the veil from the process of \"making media,\" especially news media, because it's through that lens that we see the world and the world sees us","airtime":"SUN 2pm-3pm, MON 12am-1am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/onTheMedia.png","officialWebsiteLink":"https://www.wnycstudios.org/shows/otm","meta":{"site":"news","source":"wnyc"},"link":"/radio/program/on-the-media","subscribe":{"apple":"https://itunes.apple.com/us/podcast/on-the-media/id73330715?mt=2","tuneIn":"https://tunein.com/radio/On-the-Media-p69/","rss":"http://feeds.wnyc.org/onthemedia"}},"our-body-politic":{"id":"our-body-politic","title":"Our Body Politic","info":"Presented by KQED, KCRW and KPCC, and created and hosted by award-winning journalist Farai Chideya, Our Body Politic is unapologetically centered on reporting on not just how women of color experience the major political events of today, but how they’re impacting those very issues.","airtime":"SAT 6pm-7pm, SUN 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Our-Body-Politic-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://our-body-politic.simplecast.com/","meta":{"site":"news","source":"kcrw"},"link":"/radio/program/our-body-politic","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/our-body-politic/id1533069868","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9feGFQaHMxcw","spotify":"https://open.spotify.com/show/4ApAiLT1kV153TttWAmqmc","rss":"https://feeds.simplecast.com/_xaPhs1s","tuneIn":"https://tunein.com/podcasts/News--Politics-Podcasts/Our-Body-Politic-p1369211/"}},"pbs-newshour":{"id":"pbs-newshour","title":"PBS NewsHour","info":"Analysis, background reports and updates from the PBS NewsHour putting today's news in context.","airtime":"MON-FRI 3pm-4pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/PBS-News-Hour-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.pbs.org/newshour/","meta":{"site":"news","source":"pbs"},"link":"/radio/program/pbs-newshour","subscribe":{"apple":"https://itunes.apple.com/us/podcast/pbs-newshour-full-show/id394432287?mt=2","tuneIn":"https://tunein.com/radio/PBS-NewsHour---Full-Show-p425698/","rss":"https://www.pbs.org/newshour/feeds/rss/podcasts/show"}},"perspectives":{"id":"perspectives","title":"Perspectives","tagline":"KQED's series of of daily listener commentaries since 1991","info":"KQED's series of of daily listener commentaries since 1991.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Perspectives-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/perspectives/","meta":{"site":"radio","source":"kqed","order":"15"},"link":"/perspectives","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/id73801135","npr":"https://www.npr.org/podcasts/432309616/perspectives","rss":"https://ww2.kqed.org/perspectives/category/perspectives/feed/","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvcGVyc3BlY3RpdmVzL2NhdGVnb3J5L3BlcnNwZWN0aXZlcy9mZWVkLw"}},"planet-money":{"id":"planet-money","title":"Planet Money","info":"The economy explained. 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