Sunday, September 18, 2005

The Death of Mammography

Cancer has been with us since the dawn of mankind. At one time people thought cancer was a product of industrialization, but archaeological finds would reveal that the oldest specimen of cancer found in a human was discovered in the remains of a female skull sometime during the Bronze Age between 1900 and 1600 BC. Breast cancer has been documented since the 17th century BC, though back then it was treated with pretty barbaric means. The history of cancer, and breast cancer in particular, is varied, and can be found in "The Death of Mammography".
Can We Save The Mammogram?
The art and science of mammography are not infallible even under the most carefully controlled conditions, however a reduction in mortality from breast cancer has been exhaustively proven. The reason: early diagnosis. Even though the signs of early breast cancer can be very subtle, mammography is a woman's best bet for the survival of breast cancer.
In 2004, the American Cancer Society reports that 215,990 new breast cancer cases in women will be diagnosed, and 40,100 will die of it. Women are encouraged to get a mammogram every one-two years, after the age of 50. However, women have been misled, and are under the false impression that mammography is foolproof, and if the exam is done early enough and often enough, breast cancer can be detected, treated, and contained. In all cases, even under the most optimal circumstances, research has shown that as high as thirty percent of breast cancers are not visualized on mammography. It does not mean the radiologist is negligent. It means that mammography has become the most frequent modality in lawsuits claiming malpractice against radiologists.
In February 2004, in Florida, a jury found two radiologists liable of failing to diagnose a plaintiff's breast cancer. Though three radiologists compared and read three mammograms as normal, nine months later the woman found a lump, which turned out to be malignant. She sued; she had an aggressive attorney, an empathetic jury, and won.
The leading cause for medical malpractice claims is failure to diagnose breast cancer on a mammogram. Experts in the field say such lawsuits mainly stem from serious misconceptions about the ability of mammograms to detect cancers and from an assumption that the radiologists who read mammograms should be able to see things that may be discernible only in hindsight. Leonard Berlin, M.D., chairman of radiology at Rush-Presbyterian-St. Luke's Medical Center in Chicago says the public has a highly inflated view of the accuracy of mammography. Radiologists across the country are faced with the prospect of litigation and the high cost of malpractice insurance, and are now refusing to read mammograms. Radiology residents are passing over specializing in breast imaging, and over 700 mammography centers across the United States have closed their doors in the last few years.
The current medical liability crisis in this country is real and is not going to magically disappear any time soon. One of the original goals of this book was to present an unbiased account of decreasing access to health care services, specifically mammography. Sources from all the players involved, physicians, liability insurers, and plaintiff and defense attorneys, were contacted and questioned regarding various aspects of the issue. Surprisingly or not several malpractice plaintiff attorneys declined to give interviews. One in particular answered questions presented to him, then reneged. In fact, he gave an honest opinion regarding the crisis, which most plaintiff attorneys believe is non-existent, and stated that "if mammography dies it will not be because of the lawsuits arising out of the destruction of the lives of those women and their families that have been betrayed." The Association of Trial Lawyers of America (ATLA) was also contacted for interviews; no response was forthcoming. This is one reason it made it difficult to present an unbiased view. No one from the ranks of plaintiff trial lawyers attempted to back their assertion of protecting America's malpractice "victims."
However, a former trial attorney, currently a law professor, gave some insight, closely paralleling those of the ATLA, into the current malpractice liability issue. It appears a moot point in any case, because these lawyers are very powerful, are set apart from most industries, and pretty much a law unto themselves. That does not mean it cannot change, however.
The information is presented in the book how it was researched. By that is meant as efficient and unfettered as possible; sources were checked for reliability, and a representation of all players was invited to participate.
However, there is such a plethora of information about mammography and breast cancer and their various aspects, each topic could not possibly have been written about comprehensively in one book, and probably would require volumes. The intent was to present an overall view of the most important aspects of breast cancer and mammography, and their relationship to malpractice litigation and the decrease in access to mammography.
There is a breast cancer crisis in this country, and unless something is done about it, it will be too late to save mammography, the only screening test currently available for detecting breast cancer.

108 Comments:

Blogger Rene' Jackson, RN, BSN said...

Auntminnie.com




Sidestepping screening: What factors make women avoid annual mammography?
10/10/2005




Breast cancer has the highest incidence and mortality rates worldwide, and it is the second leading cause of cancer deaths for women in the U.S. While mammography is far from perfect, it remains the best screening tool available for the early diagnosis of breast cancer.



But studies show that about one in four women age 40 and older has not had a mammogram within the last two years. That figure is even worse for low-income women, with 40% admitting that they have never stepped within a few feet of the bucky. A recent study out of New Hampshire revealed that more than one-third of the women in that state who were eligible for mammography had never had the breast cancer screening test, or had not been tested in more than two years (Cancer, October 15, 2005, Vol. 104: 8, pp. 1726-1732).

This is despite the enthusiastic efforts by breast cancer screening advocacy groups to promote screening and boost awareness (American Cancer Society, May 9, 2005).

AuntMinnie.com took a closer look at some of the elements that may stop women, either intentionally or otherwise, from complying with annual screening recommendations. Of course, the issue is too complicated to attempt to summarize in a single shot. Still, breast imaging experts agree that certain broader obstacles continue to plague cancer screening programs, and continue to keep women out of screening facilities.

Personal experience

Chances are that every woman knows at least one person in her life who has been diagnosed with breast cancer, treated for breast cancer, or, worst of all, had a breast cancer scare. And if it happened to a friend (or even a friend of a friend), why couldn't the same fate befall her? As a result, many women subscribe to the "ignorance is bliss" school of thought. Getting an annual mammogram would then be akin to actively searching for a problem, pointed out Dr. Daniel Kopans, director of breast imaging at Massachusetts General Hospital in Boston. The possibility of breast cancer is scary enough; the process of getting a mammogram only adds to that anxiety, he said.

For a woman who has undergone screening, one bad experience -- in the form of a false-positive mammogram or a benign biopsy -- can make for a lifetime of aversion, according to Dr. Carol Kornmehl a radiation oncologist in Ridgewood, NJ, and the author of The Best News About Radiation Therapy.

On the other hand, personal experience can have the opposite effect. "Women who have a family member or close friend with breast cancer are more likely to learn and see firsthand the advantages of yearly mammography," said Dr. Nancy Elliott of the Montclair Breast Center in Montclair, NJ. But if their experience at the radiology facility is a negative one, all good influence may go out the window, she added.

Even if fear and anxiety don't directly factor into the equation, women may skip out on annual screening simply because they lack the time.

"Women sometimes forgo timely mammograms because of life events such as taking care of a sick relative or losing a spouse. Because women take care of the world, we forget to take care of ourselves," said Dr. Beth Deutch, founder and medical director of HerSpace: Breast Imaging Associates in West Long Branch, NJ.

Dr. Elizabeth Shaughnessy, Ph.D., an assistant professor in the division of surgical oncology at the University of Cincinnati agreed: "Family care issues may be a problem as women age. Women tend to be primary caretakers of their own parents and spouses. Often, they delay their own care because they are dealing with the care of others who may be sick or dying."

Referring physicians

Assuming that many women will find any excuse to avoid annual screening, whose responsibility is it to make sure that she still does it? Physician referral for screening has proved to be the strongest evidence of why women get screening regardless of age, according to Cheryl Kidd, director of education for the Susan G. Komen Breast Cancer Foundation in Dallas.

Still, the influence of a primary care physician (PCP) does have its limitations. Shaughnessy stressed that each generation faces medical management differently. For example, women born before the baby boomer era tend to follow their physician's recommendations before taking initiative in their own care. Unless the physician tells them to obtain a mammogram, they most likely won't. On the other hand, younger generations take a different view of self-care. They are more in tune with their bodies and are more apt to undergo screening tests.

Consistently educating referring physicians about mammography's strengths and weaknesses is the key. A large medical organization may support screening, but if an individual's doctor does not, his or her patient is not likely not avail herself of those services, Kopans said.

Public policy

Pink ribbons and fundraising walkathons aside, a mixed message is being delivered to women as to the details of screening. Government and professional organizations advocate mammographic screening for breast cancer, but differ on what age, and how often, a woman should screen. Consumer and breast cancer organizations also offer potentially conflicting information. Some hardliners believe that women have been misled about the benefits of screening in women ages 40-49, stating that there is no proof that mammography reduces breast cancer mortality in women younger than 50 (National Breast Cancer Coalition, May 23, 2004).

The Komen Foundation, the American Medical Association (AMA), the American Cancer Society (ACS), and the American College of Radiology (ACR) recommend yearly screening beginning at age 40. The U.S. Preventive Services Task Force (USPSTF) and the National Cancer Institute (NCI) recommend screening every one to two years beginning at age 40.

There are a number of reasons for the general lack of consistency in screening guidelines, and published research doesn't always clear up matters. To attempt to summarize the myriad breast cancer screening trials in a few words would be a disservice. Suffice it to say that results may vary depending on trial methodology, patient population, country of origin, and possibly even editorial policy of the journal that has opted to publish the study. Unfortunately, when the lay press gets hold of this information, it tends to present it in a sensationalized manner, and without much in-depth explanation as to the limitations that are inherent in scientific research.

So whose advice should a woman heed? That may very well depend on which breast cancer screening study is in vogue that particular week. "There are no data that, when properly analyzed, have ever shown that any of the parameters of screening change abruptly at any age," wrote Kopans in a recent commentary. "The age of 50 is completely meaningless and is arbitrary. Although many 'experts' understand this, opponents of screening have not found it necessary to alert women and their physicians to this fact" (The Death of Mammography by René Jackson and Alberto Righi, Caveat Press. Ashland, OR, 2005, p. 144).

Access

Mammography services currently face many challenges: it is the most frequently litigated radiology modality; not enough radiologists are choosing careers in breast imaging; and reimbursement rates are still dismally low. As a result, mammography centers are closing their doors, forcing women to travel longer distances for a screening mammogram, endure a longer wait time, or forgo the test altogether.

The average wait in New York is 40 days or more (versus two weeks in the later 1990s). In some parts of the country, such as Florida, there is a three-month wait for a screening mammogram. Since 1990, the percentage of mammography facilities open in the U.S. has dropped by almost 9%.

"Often, it is difficult to obtain an appointment, or there is a lengthy waiting period. Some women may just give up and then forget to make the appointment," Deutch said.

If changes aren't forthcoming in the reimbursement rates, access will become even more limited, according to Kidd. Low reimbursement serves as a disincentive to the development of breast cancer medical expertise and impedes patient access to quality care, she said.

A recent survey in Cancer found patients looking at wait times of one to two months, thanks in part to unfulfilled breast imaging positions (Cancer, August 1, 2005, Vol. 104:3, pp. 491-498).

Lead author Dr. Robert Smith from the American Cancer Society pointed out that "radiologists do not have a patriotic duty to read mammograms or to specialize in mammography ... (but) from a broad public health perspective, we have a collective duty to women at risk for breast cancer to acknowledge that we may be about to face a crisis and not wait for that crisis to occur before we seek solutions" (Reuters Health, August 26, 2005).

Cost

Cost has often been cited as a barrier to screening mammography. However, the ACS holds that lack of accurate knowledge of coverage rather than actual costs have deterred many women from screening.

Most insurance covers screening mammography, and most states have laws that mandate health insurers to reimburse some or all of the cost of a mammogram. Medicare also pays for a yearly screening. But women 65 years and older, and women earning less than $20,000 per year, are more likely to misunderstand their coverage, according to the ACS. This narrows down the pool of women obtaining yearly mammograms to women with higher incomes and better education regarding their insurance status.

Matters are even more dire for impoverished women without insurance, many of whom don't have access to healthcare or are contending with doctors who offer no advice on breast cancer screening, Kornmehl said. Their lack of compliance may also be fueled by a lack of understanding of the point of screening.

Some states have set up programs that would reduce or even eliminate health insurance co-payments in an effort to encourage women to comply with screening guidelines. But that loss of income will need to be offset by someone.

"Unfortunately, insurance companies and the federal government think mammography is too expensive, so women have to make a decision about what is important," Elliott said. "Is it the hairdresser, the massage, the restaurant, or the mammogram?"

By René Jackson
AuntMinnie.com contributing writer
October 10, 2005

René Jackson is a registered nurse and the co-author of the upcoming book The Death of Mammography, due November 19, 2005.

Related Reading

Many women fail to get regular mammograms, September 14, 2005

Radiologist shortage limits mammography access, August 26, 2005

Breast imaging expert accuses major journals of bias against mammo, July 20, 2005

Copyright © 2005 AuntMinnie.com

7:44 PM  
Blogger Rene' Jackson, RN, BSN said...

Spotlight

There's Already a "Cure" for Breast Cancer
Elizabeth Whelan, Medical Progress Today, 10-14-05

October is Breast Cancer Awareness Month. As has been the case for the last couple of decades, people festooned with pink ribbons will be walking, running, and racing for a cure that seems ephemeral, always just out of reach. But is it possible that a cure for breast cancer is already at hand - and that a prevailing societal resistance to good news (particularly advances by the reviled pharmaceutical industry) has kept the fact a well-guarded secret?

Dictionaries define the word cure as: "to make healthy again"; "recovery or relief from a disease"; "no sign of disease in the body and an adequate amount of time has passed so that the chances of recurrence of the disease are small"; or intervention such that "a person has about the same life expectancy as if they had never had cancer."

Assessing the current statistics on breast cancer survival, we may indeed be meeting the definition of cure:

Close to 100 percent of women who are diagnosed in the earliest stage of invasive breast cancer will survive ten or more years (presumably much longer, to be confirmed as new data comes in). With the new treatments and medication now available, only about 3-4 percent, perhaps fewer will suffer a recurrence of breast cancer in the affected breast or experience a new tumor in the other breast. That is about as close to a "cure" as one can get.

How We're Curing Breast Cancer

How did this encouraging state of affairs come about? There are three factors that have brought us closer to curing breast cancer:

1. Early detection of breast cancer through mammography. Women in the United States are increasingly undergoing screening for breast cancer after age forty or fifty. A larger percentage of breast tumors are being detected in the earliest stages - Stage 0, which is technically a pre-cancer such as "breast cancer in situ," or Stage 1, which is an invasive cancer at a single location, a size under 3/4 of an inch, that has not spread to the axillary lymph nodes or sites distant from the breast.

2. The treatment of Stage 1 breast cancer has been perfected to the point that it fits comfortably into the definition of "cure." With surgery (most often a lumpectomy) to remove the tumor and surrounding tissues, the chances of survival soar and the probability of recurrence plummets. With the addition of radiation therapy, survival rates increase further, and recurrence rates fall even more. And adding on a "radiation boost" following what is usually six weeks of radiation, the numbers look even better.

3. Adding yet another component to the treatment, hormonal therapy, brought the "cure" within reach. Since the early 1980s, women with early-stage breast cancer followed up their surgery and radiation with tamoxifen (Nolvadex), which lowered recurrence rates to less than 6-10 percent in a five-year period. Tamoxifen is associated with some negative side effects, though, including an increased risk of uterine cancer, hot flashes, and blood clots.

But a new category of drugs, aromatase inhibitors, has now replaced tamoxifen as the drug of choice for post-menopausal women after surgery and radiation - offering even more protection from recurrence and fewer side effects.

Aromatase inhibitors reduce the levels of estrogen in the body. These drugs include Arimidex (Anastrozole), Femara (Letrozole), and Aromasin (Exemestane). They inhibit 97-99 percent of a woman's estrogen production, thus cutting off the hormone that might feed the tumor or create new ones. (This class of drugs is approved for women with hormone-receptor-positive breast cancer, which represents most cases of breast cancer.)

The medical journal Lancet recently published an extensive article on aromatase inhibitors for breast cancer, reporting that using these new drugs after two years of tamoxifen resulted in yet another 40 percent reduction in breast cancer recurrence - as opposed to simply taking tamoxifen for another three years. These and similar data have now elevated the aromatase inhibitors to the position of "drug of choice" for post menopausal women either after two years of tamoxifen treatment, or simply for use right after surgery and radiation. As one physician said of aromatase inhibitors: they are "as revolutionary to the treatment of breast cancer as statins have been to cardiovascular disease or antibiotics to infections." We have the pharmaceutical industry (specifically, Pfizer, AstraZeneca, and Novartis) to thank for these new life-saving therapies.

Aromatase inhibitors are generally well-tolerated by women, but they do increase the risk of bone loss (osteoporosis), and women using them are advised to monitor their bone density levels and use calcium, vitamin D, and possibly osteoporosis drugs.

Adding Prevention to Treatment

We therefore have in hand treatments that reduce the risk of recurrence when diagnosed in Stage 1 to about 3-4 percent. Again, that, for all practical purposes, is a cure for breast cancer.

As if this good news about the cure being at hand were not enough, there is more: Aromatase inhibitors have the potential to prevent breast cancer from occurring in the first place, for healthy, high-risk women.

We know that this class of drugs, to use the words of the researchers, "profoundly" reduces the risk of recurrence in women who have already been diagnosed and treated for breast cancer. And we know that these drugs reduce the chance of cancer developing in the other breast by almost 80 percent.

As a result of these encouraging findings, American and Canadian scientists are now recruiting thousands of healthy postmenopausal women who are at high risk to participate in a study of what may be a super-drug that can prevent breast cancer. Indeed, the study's director, Dr. Paul Goss from Harvard, has stated that he hopes that this will show that the drug Aromasin cuts the breast-cancer rate by some 70 percent - making aromatase inhibitors a form of "chemo-prevention."

Still Focusing on the Bad News

The bottom line is that oncologists now have methods of upping the odds of surviving breast cancer - and in most cases, they are actually able to cure the disease. Indeed, progress in the field in the past decade has been nothing short of phenomenal. What is perplexing, then, is a) why so few people seem to know about these unprecedented breakthroughs, and b) why the media divert our attention from the strides made in treatment and prevention to bogus "cancer" risks such as pesticide residues in food, environmental contaminants like DDT, and everyday consumer products containing trace levels of chemicals (such as phthlates in cosmetics).

The Breast Cancer Research Foundation runs ads advocating efforts to "Erase Breast Cancer for Good" through "prevention and cures." But the foundation and other advocates have done little, if anything, to acknowledge that major progress has been made. Perhaps it is time for them to do just that: to let women and the men who love them know the good news is that the bad news is wrong.

Dr. Elizabeth M. Whelan is president of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).



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Medical Progress Today is published by the Center for Medical Progress at the Manhattan Institute for Policy Research.

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In this week's issue:


spotlight

There's Already a "Cure" for Breast Cancer
news

Studies Point to Drop in Heart Attacks
Lawmakers push plan to cut Medicaid costs
New Breakthroughs mean better outcomes
Cervical cancer prevented in 2-year study
commentary

The Constant Killer
Paying for Medicare: An Economic Look at the Program's Unfunded Liabilities
The Age of Medical Progress
High stakes in the Hague
Good News All Around
research

Early Experience With Pay-for-Performance



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9:22 PM  
Blogger Rene' Jackson, RN, BSN said...

Overdiagnosis and overtreatment of breast cancer: Estimates of overdiagnosis from two trials of mammographic screening for breast cancer
Stephen W Duffy1 , Olorunsola Agbaje1 , Laszlo Tabar2 , Bedrich Vitak3, Nils Bjurstam4, Lena Björneld5, Jonathan P Myles1 and Jane Warwick1
1Cancer Research UK Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Queen Mary College, University of London, London, UK
2Department of Mammography, Falun Central Hospital, Sweden
3Department of Radiology, University Hospital, Linköping, Sweden
4Department of Radiology, Center for Breast Imaging, University Hospital of North Norway, Tromsø, Norway
5Department of Radiology, Sahlgrenska University Hospital, Göteborg, Sweden

Breast Cancer Research 2005, 7:258-265 doi:10.1186/bcr1354

Published 10 November 2005

Abstract

Randomised controlled trials have shown that the policy of mammographic screening confers a substantial and significant reduction in breast cancer mortality. This has often been accompanied, however, by an increase in breast cancer incidence, particularly during the early years of a screening programme, which has led to concerns about overdiagnosis, that is to say, the diagnosis of disease that, if left undetected and therefore untreated, would not become symptomatic. We used incidence data from two randomised controlled trials of mammographic screening, the Swedish Two-county Trial and the Gothenburg Trial, to establish the timing and magnitude of any excess incidence of invasive disease and ductal carcinoma in situ (DCIS) in the study groups, to ascertain whether the excess incidence of DCIS reported early in a screening trial is balanced by a later deficit in invasive disease and provide explicit estimates of the rate of 'real' and non-progressive 'overdiagnosed' tumours from the study groups of the trials. We used a multistate model for overdiagnosis and used Markov Chain Monte Carlo methods to estimate the parameters. After taking into account the effect of lead time, we estimated that less than 5% of cases diagnosed at prevalence screen and less than 1% of cases diagnosed at incidence screens are being overdiagnosed. Overall, we estimate overdiagnosis to be around 1% of all cases diagnosed in screened populations. These estimates are, however, subject to considerable uncertainty. Our results suggest that overdiagnosis in mammography screening is a minor phenomenon, but further studies with very large numbers are required for more precise estimation.

12:48 PM  
Blogger Rene' Jackson, RN, BSN said...

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Radiologists in growing demand as locum tenens
11/15/2005




Driven by the national physician shortage in the U.S. and changing practice patterns among doctors, more hospitals, medical groups, and other providers are relying on the services of temporary -- or locum tenens -- physicians. Radiologists, in particular, are in demand as interim physicians in most parts of the U.S.

Each year Staff Care of Irving, TX, conducts a survey of the interim physician staffing market. The firm surveys both hospital and medical group administrators who use the services of locum tenens physicians and physicians working on a locum tenens basis. The survey also includes a review of the locum tenens staffing assignments conducted during the course of the previous calendar year.

The 2005 Review of Temporary Physician Staffing Trends (available at www.staffcare.com) indicates that approximately 34,000 physicians worked on a temporary basis in 2004, up from about 27,000 in 2001. The survey also indicates that spending on temporary physician services nationwide approached $3 billion in 2004 -- more than doubling over the last four years.

Radiologists are close to the top of the wish list for hospitals and others seeking temporary coverage. Based on the survey, the top eight medical specialties most in demand for temporary assignments include anesthesiologists/CRNAs, psychiatrists, radiologists, family practitioners, general internists, pediatricians, orthopedic surgeons, and general surgeons.

In 2004, Staff Care received requests for 30,114 days of radiology coverage from clients nationwide. Demand for temporary radiologists is widespread, though certain states generated more requests than others. The listing below shows the states generating the most requests for temporary radiologists.



Temporary Radiologist Days Requested - 2004


State Days Requested

New York 2,082

Florida 1,729

Texas 1,394

Georgia 1,301

Tennessee 1,156

South Carolina 1,096

Missouri 812

Ohio 775



In the past, locum tenens assignments for radiologists and other physicians were mostly located in midsized communities or smaller, rural areas. Recently, however, the physician shortage has become more pervasive, and even larger urban health systems are using locum tenens physicians to provide radiology coverage. Contrary to a lingering perception among some radiologists, locum tenens work is not confined to the country anymore.

Assignment lengths for locum tenens radiologists average about 10 days, while the length of individual assignments is generally based on the physician's availability. An increasing number of radiologists are using part of their vacation time to locum tenens work, traveling while enhancing their incomes. Typically, they are available for about 10 days and then must return to their full-time practices. However, many radiology assignments are open-ended as hospitals and medical groups seek permanent physicians while using locum tenens doctors to maintain patient care and revenue. Radiologists who are not in a full-time permanent practice can easily secure assignments longer than 10 days if they desire. In other cases, hospitals and medical groups require locum tenens radiologists for shorter assignments of one week or so to fill in for vacationing doctors.

Radiologists and other physicians working on a locum tenens basis are paid per diem. Daily rates for radiologists today range from about $1,200 to $1,600. Incomes for full-time locum tenens radiologists can be comparable to private practice radiologists. Premium pay is available to physicians working extra hours, and this can make the incomes of locum tenens radiologists even more competitive relative to traditional private radiology practice. In addition, many radiologists enjoy the freedom that working on a locum tenens basis offers and the relative absence of medical politics and other "hassle factors."

Radiologists who are able to read multiple modalities are generally more marketable as locum tenens radiologists than those who read only plain film. Many hospitals and medical groups require temporary MRI and mammography coverage, and are eager to place radiologists capable of reading these modalities.

Following the trend that has transformed nursing, a growing number of physicians are finding that temporary work is an interesting, relatively enjoyable alternative to traditional practice. Older doctors see it as an ideal form of semiretirement, while younger physicians can use temporary jobs as a way of finding the type of practice settings that suits them best.

The survey also included telephone interviews with 602 hospital and medical group administrators who use temporary physicians. Seventy-six percent of those surveyed indicated they use temporary physicians to maintain continuity of patient care, 44% indicated temporary physicians prevent loss of revenue, 44% indicated that these physicians are immediately available, and 27% indicated that such assignments prevent "burnout" among permanent medical staff.

In the past, temporary physicians were mostly used to fill in for sick or vacationing physicians. In an era of physician shortages, administrators use temporary physicians in a number of creative ways to maintain patient care and shore up revenues. The workforce in other healthcare professions has becoming increasingly mobile in recent years, and the same is now true for radiologists and other physicians.

By Christin Canon
AuntMinnie.com contributing writer
November 15, 2005

Christin Canon is vice president of Staff Care, a national locum tenens staffing firm based in Irving, TX. She can be reached at ccannon@staffcare.com.

Related Reading

Rads are still in demand, recruiting survey shows, June 7, 2005

Radiology's class war? SalaryScan reveals red state/blue state divide, May 31, 2005

Radiologists are hot, but no longer red-hot, July 26, 2004

Heartland imaging pays for U.S. radiologists, May 11, 2004

Survey says rads are working harder for less, April 15, 2004

Copyright © 2005 AuntMinnie.com

12:49 PM  
Blogger RJackson said...

Breast cancer discovery is year's 'biggest news'
By Liz Szabo, USA TODAY
One of the most exciting developments in cancer this year, experts say, was the news that certain patients with early-stage breast cancer can cut their risk of relapse in half by taking the drug Herceptin.
"Hands down, Herceptin is the biggest news of the year," says Linda Vahdat, head of the breast cancer program at Weill Medical College of Cornell University.

Herceptin works by turning off growth signals in tumors that make lots of the HER-2 protein. About 25% to 30% of the more than 211,000 breast cancer patients diagnosed each year have this type of tumor. Among these patients, combining Herceptin with chemotherapy also reduced the risk of death by one-third, according to research presented in May at the American Society of Clinical Oncology.

After three years, 94.3% of women who took the Herceptin combination were alive compared with 91.7% of those who got chemo alone, according to an article in The New England Journal of Medicine. Reducing the risk of death that much in only three years is extraordinary, Vahdat says. It usually takes five to 10 years to see any difference in survival. "To see a magnitude of benefit so early on is tremendous," she says.

Medical advances have helped women with breast cancer live an average of 15 years after diagnosis, according to an analysis published in May in Lancet.

Patients who took Herceptin had a higher risk of heart failure. Herceptin has been used since 1998 to treat advanced cancers.
http://www.usatoday.com/news/health/2005-12-27-breast-cancer_x.htm

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3:09 PM  
Blogger Rene' Jackson, RN, BSN said...

Permanent seed implants reduce radiotherapy burden in breast cancer
1/5/2006
By: Shalmali Pal




Permanent breast seed implants were successfully used as the sole adjuvant radiation technique for early-stage breast cancer, according to Canadian researchers. They reported the first use of the technique, in a series of patients, in the January issue of the International Journal of Radiation Oncology, Biology, Physics.

Current breast radiation methods are time-consuming -- three to seven weeks' worth of treatment -- and also carry significant side effects, such as acute skin reactions. Permanent breast seed implants would be implanted just once, and would deliver a therapeutic radiation dose to the tumor site, with the radiation levels declining to harmless levels over time.

"Therefore, simpler effective treatment delivered over a shorter period of time is required to improve the care of these women," wrote Dr. Jean-Philippe Pignol, Ph.D., and colleagues from Sunnybrook and Women's College Health Sciences Centre at the University of Toronto. "We have developed a permanent breast 103-Pd seed implant (PBSI) technique administered under neuroleptanalgesia in a single one-hour session" (IJROBP, January 2006, Vol. 64:1, pp. 176-181).

For this study 16 women over the age of 40 were enrolled. All were diagnosed with an infiltrating ductal carcinoma of less than 3 cm with surgical margins of 2 mm or more. The treatment plan included breast ultrasound to localize and measure the size of the surgical bed, as well as measure the distance to the skin surface.

CT simulation helped determine clinical target volume (CTV) and planned target volume (PTV). A dose of 90 Gy was the minimal peripheral dose to cover PTV. A 17-gauge fiducial brachytherapy needle was used for seed implantation. This device facilitates accurate seed placement, according to the authors.

A CT scan was done two months after the procedure to evaluate end-of-treatment dose distributions. Patients recorded their pain levels before and after the procedure, and answered a satisfaction questionnaire.

According to the results, the average CTV was 8.0 cc and the average PTV was 31.7 cc. The latter "is much smaller compared to PTV volumes in other partial breast irradiation series," the authors stated.

On average, 70 seeds were used per patient, with a seed strength ranging from 1.59 U to 2.59 U. The V100 (relative volume receiving 100% of the prescribed dose) significantly improved over time, coming in at 74% for the first eight patients and climbing to 87% for the remainder. The authors stated that this demonstrated an operator learning curve phenomenon. In addition, the V100 and the V200 (relative volume receiving 200% of the prescribed dose) increased between CT scans, indicating that the seeds came closer together with time.

So far, none of the patients have evidence of their cancer returning, and the researchers report that acute skin irritation is six times less frequent when compared to external beam radiation.

In terms of pain, 56% of the patients reported pain during the procedure. One week later, 37% claimed minimal pain while 31.5% experienced moderate to significant pain. Asymptomatic hardening of the implantation site occurred in 62.5% of the women, although complete healing occurred at two months.

The authors acknowledged that pain may be a limiting factor with PBSI, but pointed out that 57% of the patients reported being very satisfied with the procedure. Also, women with larger seromas (where seeds could float freely inside the cavity) and larger tumor size (exceeding the template grid) may not be eligible for PBSI.

However, "this technique represents an ultimate step in reducing radiation treatment burden (and) in reducing dose delivered to the skin," the authors wrote. Another major advantage is that patients are discharged the same day as the procedure, returning to a relatively normal life.

By Shalmali Pal
AuntMinnie.com staff writer
January 5, 2006

Related Reading

Distance from radiation therapy facility affects breast cancer treatment, November 29, 2005

Breast MR helps refine partial-breast irradiation, October 19, 2005

Gamma detector proves less invasive, more accurate for seed migration, June 15, 2005

8:25 PM  
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12:50 PM  
Blogger Rene' Jackson, RN, BSN said...

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Auto breast US handily spots lesions in early study
1/13/2006
By: Shalmali Pal




Automated breast ultrasound (ABUS) has proved to be as effective as handheld ultrasound (HHUS) for identifying lesions, according to a pilot study out of the Elizabeth Wende Breast Clinic in Rochester, NY. The technique has potential as a screening adjunct to mammography, according to the lead author.

"The pilot study was performed on diagnostic patients to examine its ability to visualize known areas of interest and its equivalence to handheld ultrasound," explained Dr. Stamatia Destounis in an e-mail to AuntMinnie.com. "Handheld ultrasound, performed by the radiologist, will continue to be the diagnostic tool."

Destounis, a clinical associate professor at the University of Rochester, presented the results of her group's research at the 2005 RSNA in Chicago. For this study, images of known regions of interest were collected by five radiologists using traditional ultrasound. Both benign and malignant lesions were included, and were indicated with a skin marker during HHUS. Hard-copy mammograms and HHUS images were compared with soft-copy ABUS images.

For ABUS, the images were acquired in three views with the patient in a supine position. The ABUS system (SomoVu, U-Systems, San Jose, CA) had a scanning frequency of 10 MHz and a 15-mm field-of-view. The scanning depth was 5 cm.

"The unit has automated settings/scanning parameters, which are useful," Destounis said, explaining an advantage of ABUS over operator-dependent HHUS. Also, "ABUS can be performed by a trained technologist (rather than a radiologist). The ABUS can provide additional information to the radiologist.... This can save time as the radiologist will interpret the ABUS scan, but not perform it themselves."

According to the results, in 40 patients ABUS identified 41 lesions, including cysts, fibroadenomas, and lesions that were highly suspicious for cancer. All the cancers (15/15) were found with ABUS on at least one view. Core biopsy proved 13 of the 15. The mean size of these lesions was 14 mm and 54% were nonpalpable.

Many of these patients (93%) had heterogeneously dense breasts, which makes ABUS particularly useful in women with dense breasts, Destounis said.

The concordance between mammography and HHUS versus mammography and ABUS came in at 91%. Based on ABUS results, two cases were downgraded from BI-RADS 3 to 2, while one case was upgraded from BI-RADS 3 to 4. However, none of these cases were cancer.

Destounis said the next phase of research will be a larger clinical trial to test ABUS' performance as a screening tool in conjunction with mammography.

The exact role of ultrasound in breast cancer screening is still under review by the radiology community. As of December 2005, the American College of Radiology Imaging Network (ACRIN 6666) protocol was closer to achieving its patient enrollment goal (2,706 of 2,808). This multicenter trial will assess whole-breast ultrasound for screening in a high-risk population.

In a recent study, Dr. Christiane Kuhl and colleagues out of Bonn, Germany, stated that the combination of ultrasound with mammography seemed insufficient for early diagnosis of breast cancer in high-risk women (Journal of Clinical Oncology, November 20, 2005, Vol. 23:33, pp. 8469-8476).

Previously, Dr. Wendie Berg, Ph.D., and co-investigators found that diagnostic ultrasound was more sensitive in mammography in dense breasts, although there was the risk of overestimating tumor extent with ultrasound (Radiology, December 2004, Vol. 233:3, pp. 830-849).

Still, the promise of ABUS may lie in digging up previously unseen cancers. "We see it as an additional tool in patients (in which) mammography's performance is lacking (in dense-breasted women)," Destounis said.

By Shalmali Pal
AuntMinnie.com staff writer
January 13, 2006

Related Reading

Lesion size, diameter, and location affect breast US interpretation, November 28, 2005

3D imaging creates paradox for ultrasound vendors, November 9, 2005

US-guided optical breast imaging separates benign from malignant tumors, October 13, 2005

Copyright © 2006 AuntMinnie.com

9:08 PM  
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6:23 PM  
Blogger Rene' Jackson, RN, BSN said...

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Radiologists maintain dominance in breast biopsy procedures
1/10/2006
By: Shalmali Pal




Breast biopsy rates grew quite dramatically during the latter part of the 20th century, and radiologists performed the majority of those procedures, according to a new Medicare database analysis. But as has been the case of late, radiologists did have to contend with some competition in this arena.

"I think anybody who does breast imaging is well aware that there is a conflict -- at many institutions, many departments, many practice groups -- between radiologists and surgeons over who should be doing breast biopsies," said Dr. David Levin during a presentation at the 2005 RSNA meeting in Chicago. "The goal of this particular study was to determine which specialties perform the most breast biopsy and to examine recent trends in the practice patterns of these procedures."

Levin's group at Thomas Jefferson University in Philadelphia used data from the U.S. Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary Master Files for the years 1999-2003. The database provided exam volume and provider specialty for each of the Current Procedural Terminology (CPT) codes assigned to breast biopsy.

"We studied the four surgical codes for breast biopsy of any type," Levin explained. "We did not count the supervision and interpretation codes because that would lead to duplication of procedure numbers. We used specialty codes to classify providers as radiologists, surgeons (breast, general), and then all other physicians."

The following are the main CPT codes for breast biopsy used for this study:

19100 -- Biopsy of the breast (percutaneous, needle, core) without imaging guidance
19101 -- Biopsy of the breast (open, surgical) without imaging guidance
19102 -- Biopsy of the breast (percutaneous, needle, core) with imaging guidance
19103 -- Biopsy of the breast (percutaneous, automated, vacuum-assisted) with imaging guidance
Levin said that his group did not include the CPT code for surgical excision of lesions as that was outside the scope of this biopsy-specific study.

The authors first extracted the total utilization rate of breast biopsy per 1,000 Medicare fee-for-service beneficiaries. In 1999, the utilization rate was 265 per 1,000. In 2003, the figure jumped by 35%. They also determined that 83% of all breast biopsies were done with imaging.

Based on physician specialty, 62% of all breast biopsies were performed by radiologists, while surgeons did 33% of the procedures. Other physicians handled 5%.

"Radiologists clearly dominated," Levin said. "If we look just at the two codes that used imaging, radiologists do 72% of all breast biopsy that utilize imaging for guidance. Surgeons do only 24%. Other physicians do about 4%."

Finally, the group extracted overall trends in breast biopsy. Levin pointed out that in 1999 radiologists did perform more biopsies, but not much more than surgeons. However, by 2003, "there (was) a very healthy upswing in the number of procedures performed by radiologists. The surgical trend line remained relatively flat," he said. From 1999 to 2003, the total volume increase in breast biopsy procedures was 50%, with an 84% increase among radiologists versus 25% among surgeons.

"The conclusions of our study are that within the Medicare population -- and I don't really see why this should be any different in the commercial population -- the rate at which breast biopsy is being performed is increasing," Levin said. "Secondly, most breast biopsies are being done with imaging guidance. Third, radiologists perform the majority of breast biopsies."

In response to a question from an RSNA attendee, Levin said his group could not calculate how many surgical biopsies were preceded by wire localization. That kind of information was not available in this CMS database, Levin explained, and would have required access to individual patient records.

Another audience member suggested that all of radiology could learn a lesson from breast imagers by making more of an effort to reach out to patients and possibly prevent other specialists from horning in on their territory.

"It's easy to grouse about self-referral," he commented. "One of the unique features of mammographers is that they tend to interact with patients as real, live human beings. I think the numbers make a case that we can be real clinicians and we can compete in the arena of self-referral."

By Shalmali Pal
AuntMinnie.com staff writer
January 10, 2006

Related Reading

Radiologists retain MRI turf, for now, December 1, 2005

Radiologists nab share of Medicare bone scan market, September 12, 2005

Interventional rads still lead in peripheral arterial interventions -- for now, January 26, 2005

Copyright © 2006 AuntMinnie.com

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9:24 PM  
Blogger Rene' Jackson, RN, BSN said...

Doctors for Medical Liability Reform (DMLR) Applauds President Bush's Support for Vital Medical Liability Reform Legislation

Group Calls on the U.S. Senate to Vote

WASHINGTON, Feb. 1 /PRNewswire/ -- In last night's State of the Union speech, President Bush called on Congress to address the growing medical liability crisis by passing vitally needed reform legislation. "And because lawsuits are driving many good doctors out of practice - leaving women in nearly 1,500 American counties without a single OB-GYN - I ask the Congress to pass medical liability reform this year."

Stuart L. Weinstein, M.D., Chair of DMLR, praised President Bush for his continued strong support of medical liability reform and called on the U.S. Senate to act without delay.

"I urge the U.S. Senate to heed the President's call and pass medical liability reform now," said Dr. Weinstein. "The situation is critical and patients cannot afford to wait any longer. Medical lawsuit abuse is forcing good doctors to move out of state, retire early or cut back on many risky, life-saving treatments, leaving patients to wonder whether they'll be able to find the care they need when they need it most. Meanwhile, younger doctors are shunning high-risk specialties at a time when an aging population is placing even greater demands on our health care system."

DMLR is reaching out to patients, concerned citizens and physicians across the country to educate them on medical lawsuit abuse and the patient access to care crisis. The response has been overwhelming.

"The public understands that personal injury lawyers have created a system that does not protect patients," said Dr. Weinstein. "And they want their lawmakers in Washington to put it to an end."

The U.S. House of Representatives passed medical liability reform legislation 12 times since 1995 - three of those times were in 2005. This important issue has repeatedly stalled in the U.S. Senate, where it has been held up by a mere handful of votes. The Senate of the 109th Congress has not yet addressed medical liability reform.

Doctors for Medical Liability Reform (DMLR) is a national coalition of 230,000 practicing medical specialists committed to protecting patients' access to healthcare by supporting federal legislation that will reform our nation's broken medical liability system. DMLR has launched a major national grassroots effort called Protect Patients Now that includes physicians, patients and concerned citizens across the country.


Source: Doctors for Medical Liability Reform

CONTACT: Eileen Doherty, +1-202-725-6126, for Doctors for Medical Liability Reform


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Profile: Rene Jackson, RN - 3

1:18 PM  
Blogger Rene' Jackson, RN, BSN said...

Winning the war?
BY ELVA K. ÖSTERREICH NEWS EDITOR
February 5, 2006

Mammography is more than just modern hype, according to Dr. Michael Linver, co-director of the Breast Imaging Center of X-Ray Associates of New Mexico.

"We do know that mammography does work for early breast cancer detection," Linver said during a Tuesday presentation at Gerald Champion Regional Medical Center.

"Mammography has provided us with our most effective weapon yet in our war against breast cancer."

There are many studies indicating mammography makes a difference, Linver said. New guidelines suggest mammography screenings begin at age 40 and occur yearly after that, he said.

"I still think there is a role for breast self-examination," Linver added. "Mammography must be done in concert with a good breast physical exam regularly by a physician, and monthly self-examination by the woman herself. By following this complete three-pronged attack, we can find up to 95 percent of breast cancers in their early, more curable stages."

Mammography is effective, available, reproducible and affordable, Linver said.

"The death rate continues to fall and we're finding smaller cancers," he said. "If every woman had a mammogram today we would find 500,000 cancers."

Linver talked about avoiding more invasive tests by doing thorough mammographies.

"It's a daunting task," he said. "You have to be very careful not to be distracted by the obvious."

Some mammography problems include dense tissue where its impossible to distinguish cancer from the other tissue in the breast, and the fact that some cancers simply don't show on a mammography.

Linver said he uses other, new tools to supplement the mammography at his business.

"I could not be a breast imager without ultrasound," he said. "But it is only a supplement."

Ultrasound is a "real" art form, Linver said. There is a lot more inconsistency from one operator to the next. He uses ultrasound to help determine the nature and placement of possible cancers he sees on the mammograms.

"The truth is, a bad mammogram is worse than no mammogram at all because it can give the woman a false sense of security because of faulty technique or interpretation," Linver said.

Soon there will be a digital mammography revolution, Linver said. In the next five years, digital processes will simplify the steps operators have to go through, and make imaging easier and more accessible.

But Linver said while digital technology is costly, the cost for current technology has gone down.

In 1986 the average cost of a mammogram in New Mexico was $150. Now it averages $90 statewide.

"No other test in all of medicine has dropped its costs so greatly over this time," Linver said.

Also, Linver said, state and federal governments are helping out. In 1990 the New Mexico passed a law mandating all insurance companies and HMOs cover screening mammograms on all women enrolled under their policies.

"If your insurance company is not offering you mammography and you are at least 35 years old, you should insist on it," Linver said. "If your insurance refuses, they are in violation of state law and can have their state license to sell insurance revoked."

Nevertheless, not everyone has insurance, he admitted.

"There are many women who have to put food on the table before they pay for a mammogram," Linver said.

Some information in this story is from a paper by Dr. Linver, "Mammography: Winning the war on breast cancer."

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7:07 PM  
Blogger Rene' Jackson, RN, BSN said...

Posted on Sun, Feb. 05, 2006
Medical EdgeMammogram remains vital in detecting breast cancerDear Mayo Clinic: I’m 50 years old and confused about the usefulness of mammography. Is it worth the trouble to get one? – Green Bay, Wis.
Answer: Yes, most definitely! And here’s why:
Breast cancer is the most common cancer in women in the United States – with an estimated 216,000 new cases of Stage I-IV (invasiveness) diagnosed in 2004. Of these cases, about 40,100 women will die from the disease. Breast cancer is the second leading cause of cancer deaths in women, just after lung cancer.
Although the role of mammography has been questioned in recent years, deeper analyses and survival trends reveal that mammography is a valuable early-detection tool that can reduce mortality from breast cancer. As a result, mammography remains the cornerstone of breast cancer detection.
Women need to take all steps to detect breast cancer early, when it’s most curable. General recommendations include:
•Clinical breast exams done by an experienced physician every one to three years, depending upon age. Up to 10 percent of breast cancers can be detected manually – yet not show up on the mammogram.
•Monthly self-exams.
•Screening mammograms.
Experts, however, don’t agree on the exact frequency with which women should get mammograms. The American Cancer Society recommends a yearly mammogram beginning at age 40, while the National Cancer Institute recommends that women 40 and older have a mammogram every one to two years. Conflicting recommendations can confuse patients. Turn to your doctor for guidance.
Your doctor will advise you about how often to get screening mammograms based on your age and family history. For example, women whose mothers, sisters, aunts or grandmothers have had breast cancer are at an increased risk for inheriting mutated (changed) genes linked to the hereditary form of the disease. If genetic tests reveal mutations, a woman should begin getting screening mammograms at age 25, or 10 years earlier than the age at which the youngest member of the family developed breast cancer.
In general, doctors recommend that women at increased risk of breast cancer because of mutated genes get a mammogram each year. Unfortunately, studies show that screening mammograms in this at-risk population detect early signs of abnormal breast tissue in only 33 percent of cases. Because of this, doctors sometimes advise patients to have a breast magnetic resonance imaging, known as an MRI, study. While breast MRI detects 90 percent to 100 percent of cancers, it’s expensive and has not been endorsed as a routine screening tool.
As you can see, studies are needed to clarify the optimal role that each technology can play. A positive fact is that indeed new technologies are under development. And even though mammogram screening has some weaknesses, there are many more strengths including early detection and helping to improve survival due to breast cancer.
– Edith Perez, M.D., Hematology/Oncology, Mayo

7:12 PM  
Blogger Rene' Jackson, RN, BSN said...

Protect Patients Now

Last week in his State of the Union Address, President Bush urged the Congress to pass medical liability reform legislation. Protect Patients Now is urging all its supporters to write their Senators to tell them to bring this important vote to the floor without delay.

Please visit our website at www.ProtectPatientsNow.org, where you will find an easy to use interactive tool which has all the information you need to contact your Senator. We have provided you with sample letters which can be used as is, or modified. You can also use our interactive tool to draft your own letter which will automatically be sent to your Senator.

Medical liability reform has already been passed by the House of Representatives. It’s time the U.S. Senate takes a stand and brings this vital issue to a vote. There’s too much at stake to do nothing.

So please take a moment to contact your Senator and tell him to protect patients and support medical liability reform now. Thank you for your help.

7:13 PM  
Blogger Rene' Jackson, RN, BSN said...

CancerConsultants.com


Benefits of Screening Mammography Documented

Two recently published studies have documented the benefits of screening mammography. In one study, published in BMC Cancer on January 30, 2006, researchers from Italy reported that breast cancers detected within a mammography screening program had more favorable characteristics and better outcomes than breast cancers detected outside of the screening program.[1] The second study from Sweden, published in Cancer Epidemiology Biomarkers and Prevention in January 2006 reported that breast cancer screening programs reduced breast cancer deaths by 40%-45%.[2]

Breast cancer is diagnosed in approximately 250,000 women annually in the United States alone. Since the disease is highly curable when it is found and treated early, it is recommended that women 40 years of age or older undergo screening mammography every 1-2 years. However, there has been controversy over whether or not routine screening mammography improves survival over non-screened populations.

To evaluate the effect of a population-wide mammography screening program, researchers in Italy conducted a study in the province of Modena. Modena introduced a mammography screening program in 1995. The program offered free mammographic screening every two years to women between the ages of 50 and 69 years. Roughly 80,210 women in the population were eligible for the screening program.

To determine whether the program was detecting breast cancers at an earlier stage than they would have been detected otherwise, the researchers compared breast cancers detected among screened women to breast cancers detected among unscreened women. Between 1996 and 2000, 65% of eligible women participated in the screening program. During these years, 587 new breast cancers were diagnosed among screened women and 471 breast cancers were diagnosed among unscreened women. Cancers in the screened population had more favorable characteristics and were associated with better survival:

Screen-detected cancers were smaller, more likely to be low grade, and more likely to be node negative.
Five-year overall survival among the women with invasive breast cancer was 94% among the screened women and 84% among the unscreened women.
Five-year survival without cancer recurrence or the development of a new cancer was 89% among the screened women and 75% among the unscreened women.
The researchers conclude that breast cancers diagnosed through the mammography screening program tend to be diagnosed at an early stage and tend to have a favorable prognosis.

The Swedish study included approximately 45% of all Swedish women. They evaluated outcomes of over 500,000 women who were treated in a prescreening era and over 500,000 treated in a post-screening period of time. The follow-up in this study was 20-44 years. They observed over 6,000 breast cancer deaths. Attendance in screening was 75%. Recall rates were 4-5% for the first round of screening and 3% for later years. They reported a detection rate of 5 per 1,000 women screened in the first round and 4 per 1,000 in subsequent screenings. After correcting for self-selection bias, researchers concluded that there was a 43% reduction in breast cancer mortality associated with screening. They estimated that the number screenings needed to save one life was 472.

Comments: This is further evidence that organized screening programs can prevent deaths from breast cancer.

Related News:

Breast Cancer Detected by Screening Associated with Improved Survival (8/29/2005)

Danish Researchers have Concluded That Screening Mammography Decreases Deaths from Breast Cancer (2/4/2005)

Breast Cancers Detected By Mammography Have Lower Recurrence Rate (2/3/2005)

Screen-Detected Breast Cancers Treated with Less Toxic Therapy (1/13/2005)

Better and More Frequent Breast Cancer Screening Needed for Women Aged 40-49 Years (10/18/2004)

Norwegians Define False-Positive Recall Risk in Mammography Screening (9/23/2004)

Elderly Women Often Inappropriately Screened for Breast and Cervical Cancer (5/6/2004)

Scandinavian Researchers Report Significant Over-diagnosis of Invasive Breast Cancer Due to Screening Mammography (4/26/2004)

Annual Mammography Screening Not Effective For Women with BRCA Mutations (4/30/2004)

References



--------------------------------------------------------------------------------
[1] Cortesi L, Chiuri VE, Ruscelli S et al. Prognosis of Screen-Detected Breast Cancers: Results of a Population Based Study. BMC Cancer. 2006;6:17.
[2] The Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening mammography: 1. Further confirmation of extended data. Cancer Epidemiology Biomarkers and Prevention. 2006;15:45-51.



© 1998-2006 CancerConsultants.com All Rights Reserved.

These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. All readers should verify all information and data before administering any drug, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein.
© 1998-2006 CancerConsultants.com All Rights Reserved.

These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. All readers should verify all information and data before administering any drug, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein.

7:15 PM  
Blogger Rene' Jackson, RN, BSN said...

Report: Lawsuits limit cancer tests
Too many Florida women go without mammograms as legal fears affect medical providers, a task force says.
By CARRIE JOHNSON, Times Staff Writer
Published December 18, 2004

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TALLAHASSEE - Experts and doctors agree that not enough Florida women are getting mammograms, but the cause of the shortfall has provoked a sharp debate.

Now, a task force appointed by the Legislature and the governor is blaming lawsuits for discouraging radiologists from offering mammograms, which could reduce the availability of the test.

The task force, comprised largely of radiologists and insurance representatives, recommends the Legislature consider increased legal immunity for mammography specialists, including a $150,000 cap on punitive damages for malpractice claims.

"If action is not taken now," the report states, "more cancers will go undetected, delays in treatment will increase and more unnecessary deaths will occur."

But critics say the task force's findings are based on inconclusive evidence. They say there is a greater need to address more critical factors preventing women from getting mammograms, particularly low income and lack of insurance.

"The malpractice changes would take away a victim's rights for no reason," said Betsey Herd, a malpractice lawyer with the Tampa law firm of Wagner, Vaughan & McLaughlin. "It would give these patients less protection than any other patients on the books."

The task force sprang from a controversial proposal during the spring legislative session to grant radiologists who read mammograms immunity from patients' lawsuits.

The bill drew criticism from many, including the Florida Academy of Trial Lawyers. It was eventually scaled back to a study of the availability of mammograms in Florida.

Dr. Ada Patricia Romilly, a task force member and administrative leader for breast imaging for the H. Lee Moffitt Cancer Center in Tampa, said fewer radiology residents want to study mammograms because of the potential legal risks.

More than 13,350 women in Florida will be diagnosed with breast cancer this year, and 2,480 women will die from the disease. Mammograms correctly find cancers 83 to 95 percent of the time, but as much as 17 percent of tumors are missed during at least one exam.

A 2002 Physicians Insurers Association of America breast cancer study examined malpractice claims involving 25 companies. It found radiologists accounted for 33 percent of all claims and the most common allegation against radiologists was "mammogram misread."

There are four breast-imaging fellowship programs with six available seats in Florida, according to the task force's study. All are vacant.

The task force also cited a recent survey of 211 radiology residents that showed 63 percent of students wouldn't accept a fellowship in breast imaging.

"Why would you get into a field where you have all these trepidations?" Romilly said. "Why would they jeopardize their lives and their careers if it's not absolutely necessary?"

To lure more radiologists into the field, the task force is recommending that the Legislature grant radiologists the same protection given to emergency room doctors, including a different burden of proof in medical liability cases.

But Herd, who was also a member of the task force, said it's unfair to compare radiologists to emergency room doctors, who have to make split-second decisions to save a patient's life.

"A mammogram is scheduled," Herd said. "A radiology technician can ask questions, take a medical history. That's a relationship an ER doctor doesn't get the benefit of having."

Also, because there is a lack of accurate medical liability insurance and claims data, the task force had to base its findings mostly on national studies and anecdotal evidence, Herd said. She said she plans to urge legislators to focus on the task force's other findings, especially the difficulty low income and uninsured women have in obtaining mammograms.

The study showed about 69 percent of women who are privately insured get annual mammograms, while only 42 percent of uninsured women and 4 percent of non-HMO Medicaid patients get the test.

"If the Legislature is going to run off and give special interests this kind of protection without any data, with only a perception, then what is going to happen to the victims?" Herd said. "Something has to be done to help them."

Carrie Johnson can be reached at 727 892-2273 or cjohnson@sptimes.com

© Copyright, St. Petersburg Times. All rights reserved

7:30 PM  
Blogger Rene' Jackson, RN, BSN said...

In the Spotlight

Policy Forum: The State of the Union Health Care Proposals
We Need a Cure for Lawsuit Abuse

James R. Copland
Medical Progress Today
February 9, 2006

The Bible tells us that wise King Solomon resolved a dispute over a baby’s true parentage by proposing to split the infant in two. Our modern-day infants are endangered as well: as President Bush rightly noted in his State of the Union address, thousands of counties in the U.S. lack a single obstetrician. And like the imposter mother in the Biblical story, the well-financed plaintiffs’ bar would rather see the baby killed than lose a grip on its counterfeit claims.

Perhaps nowhere in the wild world of torts do we see legal excess so injurious to public well-being as in Trial Lawyers, Inc.’s profitable suits over infant birth defects. Such suits are the mother lode of medical malpractice claims, bringing in verdicts that exceed $100 million, and in the process, greatly enriching kings of tort like former vice presidential candidate John Edwards, who scored much of his wealth convincing sympathetic juries to make doctors pay for babies born defective.

It’s sad but true that some babies are born with defects. It’s also true, though, that the vast majority of birth defects are either genetic or stem from the pre-natal environment in the mother’s womb. While doctor error in delivery can harm newborns, the percentage of birth defects linked to obstetrician error is low indeed.

Lay jurors have little ability to distinguish between the rare cases in which physician mistakes cause infant birth defects and the vast majority of cases in which babies’ problems are simply bad luck. Naturally sympathetic, jurors tend to err on the side of affixing blame, even when there is none.

The result is unsurprising. When any activity is taxed, we tend to get less of it. So OB-GYNs have dropped their high-insurance obstetric practices, retired, or moved to areas less hospitable to lawsuit abuse. The areas left behind – those 1500 counties alluded to by the president – have far worse health care for mothers and babies as a result. And the areas affected aren’t only in remote rural locations; in recent years, South Philadelphia, a hotbed for lawsuits, has witnessed the closing of all its maternity wards.

The other natural consequence of the tort tax on obstetricians is that the health care providers change their behavior in an effort to lower their costs. The plethora of multimillion-dollar verdicts linking cerebral palsy to alleged birth asphyxiation in delivery encouraged doctors to perform more caesarean sections – procedures that are more expensive and often riskier for mothers’ health. Over thirty years, the incidence of C-sections quadrupled; the incidence of cerebral palsy didn’t budge an inch.

In continuing to highlight how lawsuit abuse harms American health care – and specifically in pointing out how litigation drives crucial medical caregivers out of the market, to everyone’s detriment – the President deserves much credit. But what about his proposed solution?

The centerpiece of President Bush’s medical malpractice reform is a $250,000 cap on noneconomic damages. Such caps exist in many states, most notably California, where over the damage cap’s 27 years on the books medical malpractice insurance premiums have risen at less than one-third the national rate.

By eliminating sky-high verdicts, such damage caps keep the pressure off critical specialists treating high-risk patients, e.g., neurosurgeons, orthopedic surgeons, and obstetricians. Also, by restoring a sense of predictability to the med-mal lawsuit lottery, damage caps reduce defensive medicine and lower health care costs: studies have shown that $250,000 caps reduce health costs by 5 to 9 percent.

So the President’s pet reform could have real impact, and it isn’t inherently “unfair” as its critics like to suggest: regulatory agencies regularly put prices on intangible harms, including human lives, and most states have substituted strict workers’ compensation injury schedules for traditional workplace injury tort regimes. Still, it’s important to note that there are genuine federalist objections to establishing a national solution for medical malpractice lawsuit abuse. If California has good laws limiting medical malpractice suits, and Pennsylvania has an overly permissive regime, doctors will tend to move out of Pennsylvania and into California, all else being equal. So states have every incentive to get their laws right (even if legislatures held captive by the trial bar, in the short run, won’t do so). Medical malpractice liability is thus very different from that over drugs and medical devices, where suits in outlier plaintiff-friendly “magic jurisdictions” can affect all Americans’ health, owing to the national commercial markets for such products.

So while the President’s bill is probably salutary on its face, it could set an unsettling precedent in overturning states’ historic province over medical malpractice tort law. In different hands, the effects could be deadly: witness the current “Democratic alternative” to the President’s reform, which sets damage caps at $878,000 and attempts to exert federal price controls on state insurance policies.

I’m not sure whether these federalist objections are sufficient to override the real good that President Bush’s medical malpractice reform would do, but they are enough to give me pause. And there is simply no way that the United States Senate will approve the President’s bill. Therefore, in addressing medical malpractice, I hope that the President is genuinely committed to finding solutions that rely on alternative approaches, such as the bipartisan Fair and Reliable Medical Justice Act, which would offer states grants to develop special “health courts,” such as those advocated by Common Good’s Philip Howard.

America’s system of litigation harms our health care in myriad ways; not only in the area of medical malpractice, but also by retarding medical innovation through mass tort suits over drugs and medical devices. There’s simply no silver bullet solution. The President is offering needed leadership on this issue. Here’s to hoping that in promoting change he tackles the issue with enough flexibility to maximize opportunities for real reform.



--------------------------------------------------------------------------------


Jim Copland is the director of the Manhattan Institute’s Center for Legal Policy.

6:07 PM  
Blogger Rene' Jackson, RN, BSN said...

MR mammography: Screening tool or diagnostic adjunct?
2/9/2006




Introduction

Breast cancer is the most common type of cancer among U.S. women regardless of race, age, or ethnicity. The types of various breast cancers are illustrated in table 1 as summarized by the American Cancer Society (2004). Mammography combined with breast self-exam is the most important tool available to women for early detection of breast cancer. Frequently, however, mammography and the breast self-exam are not utilized, and lesions may go undetected for months or even years.

Sadly, it is estimated that 211,240 women will be diagnosed with breast cancer this year according to the National Cancer Institute (2005). Of those it is estimated that 40,410 will die. Several risk factors are important considerations when evaluating patients with possible breast cancer. These risk factors include:

A first-degree relative with breast cancer (mother, daughter, sister), especially if the cancer developed before menopause or was bilateral
Early menarche and/or late menopause
Nulliparity
Previous personal history of breast cancer
Prior radiation exposure
BRCA1 or BRCA2 (autosomal dominant breast cancer susceptibility gene)
A prior biopsy of atypical ductal hyperplasia or lobular carcinoma in situ is also a risk factor for breast cancer. If the patient feels a palpable mass on self-examination, this should also raise concern for breast carcinoma.

Case study

The role of MR mammography, combined with computer-aided detection (DynaCAD, Invivo, Pewaukee, WI), was illustrated by a case seen recently at Waukesha Memorial Hospital in Waukesha, WI ("Radiography and pathology reports," April 7, 2005, Waukesha Memorial Hospital and Oconomowoc Memorial Hospital, Waukesha, WI).

The patient was a 42-year-old woman who experienced right breast trauma, then subsequently noticed a palpable mass in the upper outer aspect of that breast. The injury occurred in February 2005, and there was no history of breast carcinoma. One month later a bilateral mammogram was performed, and the technologist reported a 5-mm moveable palpable abnormality. Mammography showed multiple benign-appearing masses in the right breast, as well as what appeared to be a lymph node in the left breast measuring approximately 5 mm. CAD was used to additionally assess the full-field digital mammograms.

Bilateral breast ultrasound was also performed during this visit, and demonstrated multiple well-defined anechoic and hypoechoic lesions, which showed through-transmission and no posterior acoustic shadowing. Although through-transmission typically indicates fluid, specifically cysts, some of these lesions were indeterminate. In the left breast, the 5-mm lesion was hypoechoic and had characteristics of a benign intramammary lymph node.

These findings were assigned BI-RADS Category 0: Needs additional imaging evaluation. Table 2 contains additional BI-RADS categories developed by the American College of Radiology for standardization of MR mammography reporting. The results were discussed with the patient and an MRI was recommended.

MR is known for its sensitivity for neoplastic disease and is a powerful diagnostic tool when evaluating patients with metastatic disease and unknown primary cancer. MR mammography can be a valuable adjunct to conventional imaging when x-ray mammography, ultrasound, or physical exam is indeterminate (American Journal of Roentgenology, December 2002, Vol. 17:6, pp. 1493-1501).

To better assess these lesions, which were not impressive on either mammography or ultrasound, an MRI was performed the following week. The MR scan protocol appears in table 3. The patient's previous mammograms and ultrasound examinations were available for comparison.

MR imaging revealed the two lesions, as well as two smaller enhancing masses thought to be intramammary lymph nodes. The left lateral breast had a 3-mm area of enhancement that had benign characteristics.

Time-intensity curves were performed with CAD on the right breast lesions at the 10 o'clock position, 3 cm and 4 cm from the nipple (figure 1 and figure 2, respectively, below). Dr. Christiane Kuhl and colleagues described three basic time-intensity curve types as summarized in table 4. A graphic illustration of the various curves is presented in figure 3 (Radiology, April 1999, Vol. 211:1, pp. 101-110).


Figure 1: Type III curve (below) corresponding to the right breast lesion at the 10 o'clock position, 3 cm from the nipple (above). All images courtesy of Dr. Kathleen Klaas and Bernadette Kaufman.





Figure 2: Similar type III curve (below) corresponding to the right breast lesion at the 10 o'clock position, 4 cm from the nipple (above).


Figure 1 demonstrates a type III curve corresponding to the right breast lesion at the 10 o'clock position, 3 cm from the nipple. In observing the parametric map and subtraction image, the enhancement pattern is suspicious for malignancy. A rapid uptake of contrast is immediately followed by rapid washout. Figure 2 shows similar tissue kinetics for the lesion 4 cm from the nipple.

A cyst aspiration/core biopsy was scheduled for the following day; however, no fluid could be aspirated and an ultrasound-guided core biopsy was performed on the lesions at the 10 o'clock position of the right breast, 3 cm and 4 cm from the nipple. Both specimens were positive for grade III invasive ductal carcinoma. Of the five cores from the specimen at the 10 o'clock position, 3 cm from the nipple, all five samples were positive. Likewise, all six cores from the specimen 4 cm from the nipple were also positive.

The patient underwent a lumpectomy with sentinel node biopsy. The pathology again showed extensive mitoses consistent with grade III invasive ductal carcinoma. Figure 4 (below) shows a representative microscopic section of the mass 4 cm from the nipple at a magnification factor of 100x. Figure 5 is the same area magnified 400x. Figure 6 shows a representative microscopic section from the other mass, which was 3 cm from the nipple magnified 100x. Figure 7 is magnified 400x. The tumors were estrogen receptor- and progesterone receptor-negative. Two sentinel nodes were negative.


Figure 4: Above, IDC right breast, 10 o'clock, 4 cm from the nipple magnified 100x.
Figure 5: Below, IDC right breast, 10 o'clock, 4 cm from the nipple magnified 400x.


Clearly the MR mammography was able to give the clinician a better picture of the tissue kinetics of the suspicious lesions. In the tiered approach to breast imaging that took place here, the physical exam was able to draw attention to the lesions. Conventional mammography and ultrasound were able to confirm the presence of an abnormality, but were unable to characterize it. Yet MR was able to detect changes in tissue kinetics that went unnoticed in other modalities. It is for this reason that MR mammography needs to be part of every breast center's imaging arsenal. Only pathology could confirm cancer.


Figure 6: Above, IDC right breast, 10 o'clock, 3 cm from the nipple magnified 100x.
Figure 7: Below, IDC right breast, 10 o'clock, 3 cm from the nipple magnified 400x.


Discussion

With known sensitivity and the apparent increase in specificity afforded by MR CAD, it would stand to reason that MRI is the best screening tool available, but for many reasons this is untrue. In the example cited above, the patient went through normal channels to get to a diagnosis, and eventually had a biopsy confirming cancer. If MR were the screening tool, it would have been detected even earlier, but in cases of women of normal risk this might not be the case.

An enhancing benign lesion could be biopsied and proved negative after performing one of the most expensive and inaccessible diagnostic imaging examinations in the industry. Dr. Elizabeth Morris stated that in high-risk populations, MR screening mammography resulted in 15% to 25% of patients requiring biopsy; however, only 40% of those were positive. In a normal risk population, many women could potentially be put through the physical and emotional torture of unnecessary biopsy if MR were indeed a screening tool (Applied Radiology, May 2005, Vol. 34:5, pp. 4-9).

It could be said that a false positive is better than a false negative, but the reality of a false positive can have devastating physical and emotional ramifications on certain patient populations, especially younger patients (Annals of Internal Medicine, September 3, 2002, Vol. 175:5, pt.1, pp. 347-360).

The thought of having breast cancer is a horrifying experience for most patients. The grieving and loss associated with the fear of losing a body part, for instance through mastectomy, deeply affects many women. After initial diagnosis, there is a waiting period for subsequent diagnostic studies and every moment that passes exacerbates anxiety in patients diagnosed with breast cancer. When biopsy fails to confirm the diagnosis, some patients are relieved while others live in fear of cancer. The various aspects of emotional response to false-negative results are numerous and complex.

MR mammography is among the most expensive diagnostic tests available. It would entail a prime time 45-minute scheduling slot in the MRI suite, the presence of a technologist and a radiologist, injections of MR contrast, and postprocessing of images.

If this study were ordered on a daily basis for the screening of women of normal risk, it could impede accessibility of the study to women of higher risk, such as those described in the American College of Radiology's Practice Guidelines for the Performance of Magnetic Resonance Imaging (MRI) of the Breast (2005).

Patients with lobular cancer, a family history of breast cancer, a palpable mass, or BRCA1 or BRCA2 genetic mutation are among the groups of women at highest risk. These women can benefit from the increased sensitivity of MRI and the potential value added by MR CAD and MR-guided intervention.

Unfortunately, the insurance companies are the driving force in the way physicians practice medicine. According to the 2004 Tennessee Blue Cross/Blue Shield Reimbursement Guidelines, screening with MR mammography is not a reimbursable procedure. This compounds the problem of high cost and lack of availability, leaving conventional mammography as the gold standard for breast cancer screening.

The U.S. Food and Drug Administration has currently approved only conventional x-ray mammography for breast cancer screening (2005). The roles of other modalities are secondary and reserved for cases that require problem-solving. The sensitivity of mammography is high compared to ultrasound and clinical exam, but low compared to MRI; ultrasound's specificity is higher than MRI, but lower than mammography. So it seems there is no perfect imaging method to both detect and characterize lesion of the breast in women of normal risk who present for screening (Journal of the American Medical Association, September 15, 2004, Vol. 292:11, pp. 1317-1325).

As illustrated in the case study, MRI can play a very important role in the diagnosis and treatment of breast disease. The patient in the example study benefited from a number of advantages MRI has over other modalities. MRI's ability to display images in various planes, subtract images from each other, and display contrast enhancement patterns in both color maps and time-intensity curves helped the radiologist identify and characterize lesions, which were indeterminate by other imaging modalities yet positive for cancer on pathology.

These tools can be particularly helpful for diagnosis and staging, and for follow-up care as well. After a patient has undergone chemotherapy, surgery, radiation therapy, or any combination of the three, MRI can paint a clearer picture of the disease before, during, and after therapy.

The role of MRI for detecting breast cancer is particularly important for women who have a confirmed diagnosis, as it can help stage the disease and potentially spare tissue by defining tumor borders better than other modalities. It can also play an important role in therapy planning as MR-guided wire localizations have become more common. In these situations MR and pathology have confirmed malignancy, and MR is then used to place wires to delineate tumor borders. MR mammography is also useful in evaluating the success of neoadjuvant therapy (AJR, June 2005, Vol. 184:6, pp. 1774-1781).

Some patients wish to try chemotherapy prior to excision of a lesion in hopes of sparing breast tissue. Chemotherapy prior to surgery can decrease tumor size, limiting the amount of tissue excised from the breast, and can result in a better cosmetic outcome.

Conclusion

Current literature supports the theory that while MRI of the breast may lack specificity, the addition of CAD to the MR mammography protocol can decrease interpretation time and add confidence to the diagnosis. Additionally, the availability of open breast coils brings the opportunity to perform MR-guided interventions. If a lesion is found and characterized on MR, a biopsy can be performed immediately to confirm it. The diagnostic imaging community may never find the elusive one-stop-shopping method for breast imaging and diagnosis, but for the time being, MR mammography has taken the lead, primarily for high-risk patients.

By Dr. Kathleen K. Klaas and Bernadette M. Kaufman
AuntMinnie.com contributing writers
February 9, 2006

Dr. Kathleen Klaas is director of breast imaging at Waukesha Memorial Hospital in Waukesha, WI. Bernadette Kaufman is product manager of breast MRI at Invivo of Orlando, FL.

Related Reading

Adding MRS to MRI ups specificity for finding breast lesions, December 16, 2005

Breast MRS proves sensitive to all cancers but not in normal breast tissue, November 27, 2005

PEM turns in solid results for detecting breast malignancies, November 10, 2005

Siemens, Invivo partner on CAD for MRI, November 4, 2005

Copyright © 2006 AuntMinnie.com

6:38 PM  
Blogger Rene' Jackson, RN, BSN said...

Cancer News Article




Further Evidence of Mammography Benefit
A large study from Sweden suggests that mammographic screening for breast cancer reduces the risk of death from breast cancer by 40%-45%. These results were published in the journal Cancer Epidemiology Biomarkers & Prevention.

Breast cancer is diagnosed in approximately 250,000 women each year in the U.S. alone. Since the disease is highly curable when it is found and treated early, it is recommended that women 40 years of age or older undergo screening mammography every 1-2 years.

To evaluate the effect of screening mammography on breast cancer mortality, researchers conducted a study among women living in nine counties in Sweden. The study participants represented roughly 45% of the total female population of Sweden. Though a previous report by these researchers demonstrated that mammographic screening reduced breast cancer mortality, the current study differed in that it involved a larger number of women and a longer period of follow-up.

To estimate the benefit from screening mammography, researchers compared mortality rates during two time periods—the period prior to the introduction of screening and the period after the introduction of screening. Information was available for 542,187 women during the prescreening period and for 566,423 women during the screening period.

Roughly 75% of women participated in the screening program. During 22 to 44 years of follow-up, there were a total of 6,231 deaths due to breast cancer; 4,778 of these occurred among women who had been initially diagnosed with breast cancer during the study period.

Compared with the prescreening period, breast cancer mortality rates were 45% lower after introduction of the screening program. After accounting for factors that may bias study results, there was still a 43% reduction in breast cancer mortality in the screening period. These findings indicate that an estimated 472 women would need to be screened in order to save one life.

The researchers conclude that these results provide further evidence that screening mammography reduces the risk of death from breast cancer.

Reference: The Swedish Organised Service Screening Evaluation Group. Reduction in Breast Cancer Mortality from Organized Service Screening with Mammography: 1. Further Confirmation with Extended Data. Cancer Epidemiology Biomarkers & Prevention. 2006;15:45-51.

Related News:

Screen-Detected Breast Cancers Have More Favorable Characteristics (1/30/06)

Additional Evidence that Mammograms Save Lives (10/27/05)

© 1998-2006 CancerConsultants.com All Rights Reserved.


These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. All readers should verify all information and data before administering any drug, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein.

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9:15 PM  
Blogger Rene' Jackson, RN, BSN said...

'Low Awareness of Shortcomings of Mammograms, Strong Desire for Blood Testing' Shown by New Power3 Medical-Driven Survey on Early Detection of Breast Cancer
3/21/2006 8:28:00 AM EST
A new Internet-based survey focusing on breast cancer awareness and detection technology has shown a strong desire for blood-based early-detection testing and a low awareness of the limitations of mammography.

The survey asked three questions:

-- "Were you aware that 1 in 8 women in the U.S. have - or will develop - breast cancer in their lifetimes?" 47.3% of the more than 250 respondents said they were "very aware" of this fact, with an additional 40.6% saying they were "somewhat aware." Only 12% said they "were not aware at all";

-- "Were you aware that mammograms show indications of breast cancer only after the cancer has existed for 6-10 years?" 8.9% said they were "very aware," 13.8% said they were "somewhat aware," and 77.3% said they were "not aware at all";

-- If you could take a blood test for early and accurate detection of breast cancer, how likely would you be to choose this method rather than a mammogram?" 94.8% said "very likely," 3.9% answered "very likely," and 1.3% responded, "not likely at all."

The survey was conducted by and on www.woodlandsonline.com, a 10-year-old portal that lets residents of The Woodlands in suburban Houston quickly and easily find and share information. The survey was suggested by Power3 Medical Products, Inc., a leading proteomics company focused on developing and commercializing early detection diagnostic tests for cancer and neurodegenerative diseases.

The breast cancer awareness and detection survey has been moved and is continuing on the Power3 Web site (www.power3medical.com/default.aspx). Power3 also plans to continue to conduct the survey through affiliated hospital research centers.

'Mammography Not Final Solution in Saving Lives'

"For years, mammography was thought to be the final solution to saving lives, but still many women with breast cancer initially detected by mammograms ultimately die of the disease, said Dr. Alan Hollingsworth, a nationally-known breast cancer specialist at Mercy Woman's Center in Oklahoma City, and a member of Power3's Scientific Advisory Board.

"Mammograms show only tumors that have existed for years and which have grown to an average of 1 centimeter," said Dr. Hollingsworth. "MRIs detect more than twice as many tumors as mammography, in that they can recognize smaller growths of only 5 millimeters, which is actually one-eighth the volume of a 1 centimeter tumor. However, MRIs cost many times more than mammography, and thus do not present a practical fiscal answer as a general screening test for women.

Dr. Hollingsworth said that studies have shown mammography to be about 55% to 70% sensitive to the recognition of these 1 centimeter breast cancers, while MRI is about 90% to 95% sensitive.

As the principal investigator of a clinical validation study by Power3 at Mercy Woman's Center, Dr. Hollingsworth said that early indications showed blood serum testing had an 80-90% sensitivity and also may provide the potential to detect breast cancers that mammography misses.

Dr. Hollingsworth also said that a screening blood test could function independently of breast density, which is the primary reason cancer is often missed with mammography.

"If the blood test indicates cancer, even with a negative X-ray, the patient could go on to screening ultrasound or MRI," he said. "The healthcare industry cannot come close to accommodating the entire adult female population with these expensive screening modalities, so we desperately need a blood test to efficiently utilize the technology that we have in place, closing the gap left by mammography alone."

"Power3 is optimistic about the cutting-edge technology in our blood serum biomarkers and the more sensitive breast cancer detection test developed in collaboration with Dr. Hollingsworth," said Dr. Ira L. Goldknopf, Ph.D., Power3's chief scientific officer, who will present findings of the validation study to the OncoProteomics World Congress in San Francisco next month.

About Power3 Medical Products

Power3 Medical Products, Inc. (PWRM.PK, www.Power3Medical.com), is a leading proteomics company engaged in the discovery of protein footprints, pathways, and mechanisms of diseases. Power3's patent-pending technologies are being used to develop screening and diagnostic tests for the early detection and treatment of disease, and its identified protein biomarkers, drug targets, and diagnostic tests are targeted toward markets with critical unmet needs in areas such as breast cancer and neurodegenerative disease. Power3 operates a state-of-the-art proteomics laboratory in The Woodlands (Houston), Texas.

This press release contains forward-looking statements within the meaning of section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. With the exception of historical information contained herein, the matters discussed in this press release involve risk and uncertainties. Actual results could differ materially from those expressed in any forward-looking statement.

CONTACT:
Power3 Medical Products, Inc. Steven B. Rash, 281-466-1600 srash@power3medical.com or The Kaminer Group David A. Kaminer, 914-684-1934 dkaminer@kamgrp.com

7:41 PM  
Blogger earnest said...

Here's a useful resources on early detection breast cancer worth a look: http://breast-cancer1.com/

8:22 PM  
Blogger Rene' Jackson, RN, BSN said...

Cancer News Article




Screening Mammography and Risk of Over-Diagnosis
According to a study conducted in Sweden, roughly 10% of the breast cancers identified by screening mammography among women between the ages of 55 and 69 would never have come to medical attention without screening. These results were published in the British Medical Journal.

Breast cancer is diagnosed in approximately 250,000 women each year in the U.S. alone. Since the disease is highly curable when it is found and treated early, it is recommended that women 40 years of age or older undergo screening mammography every 1-2 years.

A potential risk of screening for any type of cancer is that screening will detect a cancer that would never otherwise have come to medical attention. This is referred to as “over-diagnosis.” As a result of over-diagnosis, some individuals receive cancer diagnoses and treatments that they might otherwise have avoided.

As an example of over-diagnosis, consider an individual who has cancer, but who will die of another cause before the cancer causes noticeable health problems. Screen-detection of this cancer would lead to unnecessary cancer treatment. This sort of situation is generally not possible to predict in advance, but understanding how frequently it occurs can help women make more informed decisions.

To estimate the rate of over-diagnosis in a screening mammography program, researchers in Sweden compared the number of breast cancer diagnoses among women who participated in a screening program to the number of breast cancer diagnoses among women who did not participate in the screening program. Women were randomly assigned to one group or the other, and were followed for 15 years after the end of the screening trial. The current study focuses primarily on women who were between the ages of 55 and 69 at the start of the screening trial.

Over the entire period of the study, women who had been randomly assigned to the screening group were diagnosed with 10% more breast cancers than women who had been randomly assigned to receive no screening.

The researches conclude that among women between the ages of 55 and 69, roughly 10% of the breast cancers identified through screening mammography would never have come to medical attention without screening. This is the rate of over-diagnosis from screening mammography in this population.

The researchers note, however, that there is still evidence that screening mammography saves lives. Findings from the current study do not undermine this benefit of mammography. Rather, information about the risk of over-diagnosis can help women and their physicians more completely understand the risks and benefits of screening.

Reference: Zackrisson S, Andersson I, Janzon L et al. Rate of Over-Diagnosis of Breast Cancer 15 Years After End of Malmö Mammographic Screening Trial: Follow-Up Study. British Journal of Cancer. 2006;332:689-692

Related News: Further Evidence of Mammography Benefit (2/9/06)

© 1998-2006 CancerConsultants.com All Rights Reserved.


These materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. All readers should verify all information and data before administering any drug, therapy or treatment discussed herein. Neither the editors nor the publisher accepts any responsibility for the accuracy of the information or consequences from the use or misuse of the information contained herein.

9:09 PM  
Anonymous Anonymous said...

Rene, about your reference to the BMJ article about overdiagnosis from Malmo trial. Have you read the rapid responses to this article? Because the authors of the article got their math wrong and underestimated the results considerably - the second response explains it very clearly. Other responses outline additional factors that increases the number even higher.
As far as whether benefits of mammograms outweight the risk - it is really different for different women. For some women a small chance that their life will be saved is well worth a greater chance to become a cancer patient; for others it is not. It is time that women were given the truth and allowed to make their own decisions.

1:22 PM  
Blogger Rene' Jackson, RN, BSN said...

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How the legal system stacks the deck against mammography
4/3/2006
By: René Jackson




A survey of radiologists published in Radiology last year produced a shocking statistic: half of the doctors responding said they had been a defendant in a medical malpractice lawsuit.

Does this mean that half of our nation's radiologists are negligent? Not likely. Instead, the survey has a deeper meaning -- that the U.S. legal system is out of control and threatens to strangle sectors of healthcare that are critical to maintaining the welfare of our population.

One such sector is mammography. The U.S. is experiencing a medical liability crisis, which is fast getting away from radiologists, and mammography is headed toward being one of its casualties. Because of the threat of malpractice litigation, high liability insurance costs, and low reimbursement, radiologists are refusing to read mammograms, and radiology residents show no interest in specializing in breast imaging. This is occurring as demand for their services is rising due to an aging population.

This article outlines how the legal system has stacked the deck against mammography, creating a perfect storm of wily plaintiffs' attorneys, juries with unrealistic expectations, and mammography providers caught in the middle.

Mammography isn't perfect

Sickness and disease are in the cards for many of us, and death is inevitable. At times, though, our mortality can be hastened by the negligent actions of a physician, say by leaving a surgical instrument inside a patient, or cutting off the wrong limb. In such cases, no doubt exists in anyone's mind that the physician must be held accountable -- a legitimate medical malpractice case.

However, the norm in the U.S. is for lawyers to bait unsuspecting potential clients who may have suffered a health setback into becoming plaintiffs against anyone in the medical establishment who they believe could be responsible for their misfortune. What lawyers don't say, though, is that medicine is not an exact science. Instead, lawyers and the media have raised the public's expectation of medicine so high that physicians and healthcare practitioners are held to a perfect standard of care they cannot possibly attain.

Along with ob/gyns and surgeons, radiologists are fast becoming the most popular targets for medical malpractice suits, with failure to diagnose breast cancer on mammography becoming an increasingly common accusation. How can that be, especially when mammography performed under the best conditions can have up to a 30% miss rate?

The answer is because malpractice litigation is an extremely lucrative undertaking, and breast cancer is a very emotional issue. Add together the wrenching picture of a young woman in her prime diagnosed with a fast-growing breast cancer, a lawyer who convinces her that the cancer should have been caught on a mammogram, a smooth-talking expert witness for the plaintiff, and a sympathetic jury, and you have a million-dollar verdict.

Though breast cancer has been around for thousands of years, mammography is fairly young. Through the years, breast imaging has matured from a simple clinical assessment into an all-inclusive evaluation. But mammography is still fallible -- miss rates are documented up to 30%.

But in court cases, the jury is not always told this fact. Or if it is, it is downplayed by the plaintiff's attorney. Breast cancer is not an easy disease to explain or diagnose, and reading a mammogram comes with its own innate difficulties. Breast cancer is not just one disease, but many, and the reasons for contracting it are varied.

For example, in a court case, a lay jury does not know that younger women have denser breasts in which cancer can grow faster, though their cancer risk is lower. As women age, their risk increases, their breasts are less dense, and the cancer tends to grow slower. As with anything else in medicine, though, this is not set in concrete. There are exceptions to rules. For instance, an older woman can have dense breasts with fast-growing breast cancer.

What else is a jury expected to understand? Microcalcifications, asymmetry, axillary tail of Spence, hindsight bias, lead-time bias, interval cancers, and dot size. Besides that, jurors have to listen to opposing expert witnesses telling them what the standard of care should be for that particular case.

In essence, we have a lay jury deciding whether a physician is guilty of medical malpractice -- if his or her actions have fallen below the standard of care -- all the while being expected to understand what it took the physician years to learn. In addition, you can have the same case tried in two different localities and have opposite verdicts. Lawyers thrive on this type of lawsuit.

A deterrent to negligence?

But are these lawsuits deterring legitimate negligence? Not nearly. After the case is tried, even if the verdict is for the plaintiff, there is no remediation for the "negligent" physician -- just an exchange of money. There is no understanding of why something happened.

Mammography does not cure or prevent breast cancer. Though it is the only tool we currently have available for detecting breast cancer at its earliest and most treatable stages, it has limitations. Why? Because it can't take into account the woman's history and the characteristics of her breast cancer, or the radiologist's experience and perception, image interpretation, and other factors.

Radiologists themselves will disagree on the interpretation of the same screening or diagnostic mammogram. Dr. Mark Klein of Washington, DC, says that it is documented that up to 67% of mammographically detected breast cancers missed on initial interpretation are visible in retrospect. However, this does not point to incompetence; it is a limitation of the technology.

So where do we go from here? Several tests for diagnosing breast cancer look promising. For example, MRI is currently being studied. However, it is not considered a screening test, but is used in conjunction with computer-aided detection (CAD). It also does not always distinguish correctly the difference between benign and cancerous conditions. PET can identify invasive ductal carcinoma, but can miss invasive lobular carcinoma. It also does not identify noninvasive tumors well.

It's a money thing. And, as in many arenas, education is the key. The public has to be informed, as well as educated. But unless we are personally involved as a plaintiff or a physician defendant, being human we don't usually care. Educating the public won't be an easy task.

Plaintiff trial lawyers vigorously defend the current legal status quo in the guise of protecting those who are "victims" of medical malpractice. It's pervasive. Go to www.classaction.com. You will see lawsuits involving the drugs Accutane, Bextra, Paxil, Vioxx, and Zyprexa, as well as Guidant and Medtronic defibrillators; the Logitech mouse; nursing homes; air, soil, and ground water contamination; body parts; and defective products. Nothing is sacred to plaintiff trial lawyers.

Tort reform is part of the answer, but trial attorneys have a powerful lobby against it, because the stakes are so high. In his recent State of the Union address, President Bush said doctors and nurses must be put back in charge of American medicine, instead of those in charge now -- bureaucrats, HMOs, and lawyers. He urged Congress to pass medical liability reform because a major cause of the high cost of healthcare is the threat of medical malpractice litigation to physicians. He's right, no matter what trial lawyers try to bamboozle the public into believing.

It's not just up to Congress, though. Every citizen has a duty to be a part of constructive political change. That is not always the case, though, because Americans tend to overlook serious matters unless an issue emerges up close and personal.

Many women are currently under the false impression that mammography is foolproof and that if the exam is done early enough and often enough, breast cancer can be detected, treated, and contained. This is misleading. However, change is inevitable, and technology is such that someday there will be a substitute for mammography.

Radiologists may disagree when, where, or how this will happen, but most agree that right now mammography is still the only tool available to diagnose breast cancer early enough to be treated, and we need to save it from extinction. To do this, the public must be educated as to not only the limitations of mammography, but that medicine is not a perfect science.

By René Jackson
AuntMinnie.com contributing writer
April 3, 2006

René Jackson is a registered nurse and the co-author of The Death of Mammography with Dr. Alberto Righi.

The opinions expressed in guest editorials are those of the author, and do not necessarily reflect the views of AuntMinnie.com.

Related Reading

Book review: The Death of Mammography, January 24, 2006

Sidestepping screening: What factors make women avoid annual mammography? October 10, 2005

Copyright © 2006 AuntMinnie.com

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advise? I get so much lately it's driving me insane so any support is very much appreciated.

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