Download Articles January 22, 2013 – February 11, 2013 Breast Cancer

Articles
January 22, 2013 – February 11, 2013
Breast Cancer Recurrence Risk Higher With Certain Germ-Line DNA Alterations.
MedPage Today (1/19, Bankhead) reported, "The risk of breast cancer recurrence increased significantly
in patients who had specific germ-line DNA alterations, suggesting a potential new approach to
evaluation of recurrence risk," according to research published online in PLoS One. Investigators found
that "seven copy number aberrations (CNAs) significantly influenced the probability of recurrence-free
survival (RFS) (P<2.01 x=""></2.01>-5), and all seven had strong associations with the phenotype of
recurrent breast cancer by multivariate analysis." Meanwhile, "three additional CNAs influenced RFS in
patients with the luminal A molecular subtype of breast cancer."
Scientists Say "Quadruple Helix" DNA Could Help Fight Cancer.
BBC News (1/20, Amos) noted that the "famous 'molecule of life,' which carries our genetic code, is
more familiar to us as a double helix." However, Cambridge University scientists, in an article in the
journal Nature Chemistry, said that the "'quadruple helix' is also present in our cells, and in ways that
might possibly relate to cancer." They suggest that control of the four-stranded version of the Gquadruplex "could provide novel ways to fight the disease."
Utah-Based Hospital Attempts To Eliminate Waste Without Sacrificing Quality Of Care.
Salt Lake (UT) Tribune (1/28, Stewart, 107K) reports that "a trio of studies" by researchers at
Intermountain Healthcare have indicated that cheaper care may not always be for the best. John C.
Ruckdeschel, medical director of Intermountain's Oncology clinical program, began an initiative a
decade ago to excise tests and treatments "of questionable value to patients," and recently shared
results from the experiment at the American Society of Clinical Oncology's first Quality Care Symposium.
Among the findings, Intermountain "convinced radiologists to more promptly order" PET scans "on lung
cancer patients to determine if they're candidates for surgery." Ruckdeschel explained that PET scans
are more expensive, "but less error prone than the commonly used CT scan." The Intermountain team
also concluded that complex, expensive-to-treat diseases such as cancer are a large part of the problem.
Lumpectomy May Lead To Better Survival In Patients With Early-Stage Breast Cancer.
MedPage Today (1/28, Phend) reports, "In real-world practice, women with early-stage breast cancer
were more likely to survive if they had a lumpectomy rather than mastectomy," according to a study
published online in Cancer. Investigators found that "overall survival was 19% higher after breastconserving surgery and radiation than with mastectomy after adjustment for other factors." According
to the researchers, "These data provide confidence that breast-conserving therapy remains an effective
alternative to mastectomy for early stage disease regardless of age or hormone receptor status."
Task Force Guidelines Now Examined More Closely.
American Medical News (1/28, Moyer) notes that in November 2009, the US Preventive Services Task
Force issued a recommendation, saying "women younger than 50 didn't need routine mammography
screening." But within 24 hours, the guidance "caused such a controversy" that the American College of
Radiology "asked that the recommendation be rescinded"; and HHS Secretary Kathleen Sebelius issued a
statement to assure "physicians and patients that the task force...does not set federal policy." However,
task-force recommendations now "get a lot more scrutiny." For example, "37.7% of primary care
physicians said they would not change their prostate cancer screening practices following the task
force's October 2011 draft guidance that recommended against the PSA test," according to a study in
the "April 23, 2012, issue of Archives of Internal Medicine, now JAMA Internal Medicine."
Gene Expression Profiling May Spot BRCA Mutations.
MedPage Today (1/27, Walsh) reports, "Gene expression profiling may offer a simple way of identifying
women who are heterozygous carriers of the BRCA1 and BRCA2 mutations and therefore are at high risk
for developing breast or ovarian cancer," according to a study published online in Cancer Prevention
Research. Researchers found that "real-time PCR testing of lymphocytes from carriers of these
mutations identified 21 genes that showed significant differences in expression compared with controls
following irradiation (P<0.05)." The investigators reported that "further analysis revealed that a model
including 18 of the genes showed a sensitivity of 95% and specificity of 88% for identifying BRCA1 and
BRCA2 carriers."
Women Who Carry A BRCA Mutation May Enter Menopause Earlier.
Reuters (1/30, Pittman) reports that, according to a study published in Cancer, women who carry the
BRCA1 or BRCA2 gene mutation may enter menopause earlier than women who carry neither mutation.
The Time (1/29, Sifferlin, 3.38M) "Healthland" blog reports that "the study included 400 female
BRCA gene carriers in northern California and compared the timing of their menopause onset to 765
women without the gene mutation from the same region." Researchers "found that the BRCA carriers
were likely to enter menopause on average at age 50, compared to age 53 for the other women."
HealthDay (1/30, Dallas) reports, "Women who smoked more than 20 cigarettes daily who carried"
a BRCA "mutation went through menopause even earlier, with onset at age 46 on average."
Consumer Reports Releases Ratings On Cancer Screenings.
In its "Daily dose" blog, the Boston Globe (1/31, Kotz, 250K) reports that Consumer Reports "released a
report Wednesday rating" cancer "screening tests by effectiveness and found that many aren't worth
the time, money, or risk." Aside from largely agreeing "with the assessments of the US Preventive
Services Task Force," the "ratings also factored in the cost of the test, whether the cancer being
screened for was prevalent or rare, and whether the test has benefits beyond screening for a particular
cancer, according to Joel Keehn, senior editor at the magazine." The blog says that "colon cancer
screening, cervical cancer screening - such as the Pap smear - and breast cancer screening via
mammography were deemed to be the 'most effective tests available.'" Meanwhile, the screenings for
the following eight cancers received poor ratings from the magazine: bladder, lung, oral, ovarian,
pancreatic, prostate, skin, and testicular cancers.
Report Finds Oncology Doctors Struggling With EHR Features.
Healthcare IT News (1/31, 54K) says the research firm KLAS released a report, titled "Oncology 2012:
Pulling the Curtain Back," that found "as meaningful use and ACOs pick up steam, oncology providers
contend with regulatory pressures with or without help from their vendors." According to the report,
oncology information system vendors struggle with alerts as well as reporting. For example, providers
say Varian and Elekta's "canned reports are not robust enough to meet their needs, and the customized
reports are difficult to use. Epic's customized reports are not as user friendly as providers would like
them to be."
Randomized, Controlled Trial To Use Calorie Restriction As A Cancer Treatment.
Medscape (2/2, Mulcahy) reported that last month, "for the first time ever, a randomized controlled
trial that uses calorie restriction as a treatment for cancer - and measures a cancer-related outcome was approved by the institutional review board at Duke University in Durham, North Carolina, and is on
its way to the clinic." This "study will involve calorie restriction in men with prostate cancer - specifically,
cutting down on carbohydrates." Medscape added, "In what appears to be a manifestation of zeitgeist,
the approval at Duke comes when single-group studies of calorie restriction as a cancer treatment are
being planned (in breast cancer at Thomas Jefferson University in Philadelphia, Pennsylvania) or are
underway (in pancreatic and lung cancer at the University of Iowa in Ames)."
OIG Finds Medicare Overpaid For Breast Cancer Treatment.
Bloomberg News (2/1, Von Schaper) reported that HHS Office of Inspector General issued a series of
audits that showed Medicare "overpaid for Roche Holding AG (ROG)'s Herceptin [trastuzumab] breastcancer treatment by about $15 million" between 2008 and 2010. Specifically, "health-care providers
across the country charged Medicare for amounts of the drug they didn't administer to patients, running
afoul of billing guidelines." The overpayments came from jurisdictions in Florida, Iowa, Kansas, Missouri,
and Nebraska.
Activists Seek To Dispel Cancer "Myths."
Medscape (2/5, Chustecka), in an article that also discusses several cancer myths, reports, "The WHO is
funding a program to set up cancer registries in many developing countries, which will provide
information on the cancer burden and help governments plan their prevention and treatment
strategies." Meanwhile, "The American Society for Clinical Oncology announced plans to expand the
scope of its international programs and to double their funding 'to help address the growing global
cancer burden.' These programs involve providing oncology instruction for nonspecialists, offering
mentoring, and providing grants for research into cancer-control strategies in developing countries."
FDA Approves Generic Cancer Drug To Ease Shortage.
According to Reuters (2/5, Clarke), the drug was initially approved in 1995 as a treatment for ovarian
cancer; and it is now used to treat multiple myeloma and breast cancer as well as AIDS-related Kaposi's
sarcoma. Sun Pharma Global will be producing the generic version in 20-mg and 50-mg vials. Reuters
says the shortages of Doxil began in 2011, after Ben Venue, which is a Boehringer Ingelheim subsidiary,
ceased operations, citing quality control and manufacturing problems. Notably, in February 2012, the
FDA in an effort to help with the drug shortage, authorized the temporary, controlled importation of a
branded version of the drug, called Lipodox, which is also manufactured by Sun Pharma.
Meanwhile, HealthDay (2/5, Preidt) notes that during a speech at the "annual meeting of the American
Society for Clinical Oncology last June, Dr. Richard Schilsky, chair of ASCO's government relations
committee, told reporters that some shortages had eased, 'but there is still an unpredictable availability
of many drugs and we are never sure exactly when a generic drug is suddenly going to go out of
supply.'" Dr. Schilsky said such shortages cause a "tremendous amount of uncertainty - anxiety for our
patients and great difficulty in planning if you're a physician." In addition to Doxil, other drugs
experiencing intermittent shortages include "nitrogen mustard (used to fight blood cancers), paclitaxel
(important for breast cancer and other tumors), 5-FU (used in a variety of cancers), and methotrexate
(important to treat certain lymphomas)."
Study: Racial Disparities Still Evident In Cancer Death Rates.
The Los Angeles Times (2/6, Morin, 692K) "Booster Shots" blog reports that a study published in CA: A
Cancer Journal for Clinicians found that "cancer death rates among African American men declined
faster than those of white men in the last decade, even though overall survival rates for black men and
women remained the lowest of all racial groups for most types of cancer." The researchers said the
"racial gap was closing for lung and smoking-related cancers, as well as prostate cancer," but the
"disparity between black and white patients was widening for colorectal cancer and breast cancer.
"Between 2000 to 2009, the authors wrote "the cancer death rate among all American males declined
faster among blacks than among whites (by 2.4% per year for blacks vs 1.7% for whites)." The declines
among black and white women were 1.5% and 1.4%, respectively.
Biennial Mammograms May Be As Good As Annual Screening For Older Women.
HealthDay (2/6, Doheny) reports, "For older women ages 66 to 74, getting a mammogram every two
years appears as good as getting one every year, according to a new study" published in the Journal of
the National Cancer Institute. According to study author Dejana Braithwaite, "Your risk of having breast
cancer detected at a later stage is no greater if you screen every two years compared to every year."
Meanwhile, according to Braithwaite, "After 10 years of screening, almost half, or 48 percent, of the
women who were screened every year had at least one false-positive."