The mammogram debate may be have simmered since the uproar of a couple months ago. But confusion among women about when to start getting breast x-rays surges on.

In case you missed it, a federal panel of experts said in November that women should start getting mammograms at age 50, not 40. The U.S. Preventive Services Task Force said its goal was to reduce the harms of unnecessary treatment.

But critics -- doctors and patient advocates alike -- pounced on the recommendations and groups such as the American Cancer Society said women in their 40s should still get the screening tests. Maryland's own Sen. Barbara Mikulski even got a provision written into the health care bill on the issue.

So, what to do?

If you live in the Baltimore area, Anne Arundel Medical Center will host a free community forum on breast imaging Monday from 6:30 p.m. to 8:30 p.m. on the seventh floor of its Health Sciences Pavilion. Here are more details. During the forum, a breast surgeon, a radiologist and an oncologist, will offer their thoughts on the controversy.

The issue is far from settled. Screening has its downsides, argues a pair of pieces in the Journal of the American Medical Association. One, by Dr. Steven Woolf of Virginia Commonwealth University, notes the task force's recommendation wasn't calling for a ban of mammograms for women in their 40s, but rather advising doctors to discuss the matter with their patients to come to a decision on whether to screen. And ultimately, the decision rests with the patient, offers this doc. 

Chicago Tribune photo

Posted by Kelly Brewington at 7:14 AM | Permalink | Comments (0)
Categories: Cancer
        

There are lots of assumptions made about the U.S. health care system and how it differs from say, the British nationalized model. In America, everyone has unfettered access to top-notch drugs, while the Brits ration their care, goes the stereotypes. That leads many critics of U.S. health reform efforts to assume the American system is just fine the way it is.

But a new study by Johns Hopkins researchers finds the perceptions aren't so. The study compares the two systems' access to the most expensive cancer medications and asks: Which is more fair? And which cancer patients are better off?

The study, appearing in Milbank Quarterly, compared the costs of 11 pricey cancer drugs. In the UK, seven are free to all patients, with no out-of-pocket costs. Four aren't because they aren't considered worth the limited benefit. If patients want those drugs, they need to pay up.

Here at home, people with insurance have some coverage of all 11 drugs--but the range of out of pocket costs are enormous, depending on the carrier.

Both systems involve a kind of rationing, concludes the study. And here's something that will make reform foes gasp: The issue isn't whether rationing is good or bad, argues the reports' author, Ruth R. Faden, director of the Johns Hopkins Berman Institute for Bioethics. That's because no system can provide patients every medication or intervention to every patient all the time, she writes.

"The issue is what we should do about extraordinarily expensive treatments, some of which do very little to improve how well or how long people live," said Faden in a statement. At the same time, she adds, "there is no ethically defensible reason why some Americans have access to expensive cancer drugs and some do not."

Continue reading "Who gets expensive cancer drugs? And thoughts on rationing" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (2)
Categories: Cancer, Health care reform
        

New research puts a number on the cancer risk that the growing number of CT scans can pose patients -- the latest evidence that the scans may be overused.

The 70 million CT scans done in 2007 -- a jump from just 3 million in 1980 (!) -- could ultimately cause 29,000 new cancer cases, according to estimates from the study, which appears in the latest Archives of Internal Medicine. 

Doctors like the scans because they provide super-clear pictures inside the body. Their use has transformed medicine, allowing earlier diagnoses and treatment. But the research, the latest among several papers of late to raise doubts about whether CT scans make people healthier, suggests the imaging can do more harm than good. 

We've written before about not only the potential dangers of excessive imaging -- but how it contributes to skyrocketing health care costs. Those scans are pricey and can bring in big money to doctors practices, hospitals and imaging centers.

At a time when the nation is trying to rein in health care costs, could more prudent use of CT scans help?

Continue reading "CT scans, cancer risk and health care costs" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Cancer, Health care reform
        

Good news for men who enjoy a cup -- or more -- of coffee in the morning: avid coffee drinkers may lower their risk of developing prostate cancer, new research suggests.

Now, don't expect doctors to start prescribing morning lattes. The research is preliminary.

But in a federally-funded study of 50,000 men, those who drank the most coffee had a 60 percent less risk of aggressive prostate cancer than non-coffee drinkers, according to data presented at the American Association of Cancer Research conference taking place in Houston.

Well, why is that?

“Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer. It was plausible that there may be an association between coffee and prostate cancer,” said study author Kathryn M. Wilson, a postdoctoral fellow at the Channing Laboratory, Harvard Medical School in a statement.

Continue reading "Fight prostate cancer with a cup of joe" »

Posted by Kelly Brewington at 12:28 PM | Permalink | Comments (0)
Categories: Cancer
        

With the mammogram controversy showing no signs of simmering, HHS Secretary Kathleen Sebelius issued a statement yesterday afternoon in an attempt to distance the administration from the guidelines that have sparked so much debate.

If you haven't heard, a federal panel of medical experts said Monday that women should delay mammograms until age 50 and doctors shouldn't bother teaching women to do breast self exams. The U.S. Preventive Services Task Force said its goal was to reduce the harms of unnecessary treatment.

But critics are saying it's a glimpse of health care rationing soon to come under health reform. A group of Republican congresswomen said the guidelines are "a step back for women" and the beginning of rationing. The panel, critics fear, will influence policy and insurance companies won't cover the screens. Many of you expressed similar worries in my last blog post on this issue.

Sebelius tries to debunk this right away: The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government. ... Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.

Continue reading "More mammogram debate -- administration distances itself from guidelines" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Cancer
        

A government panel's new recommendation that women start mammograms at age 50, not 40, is has sparked angst, confusion, and even anger -- among health advocates and medical experts alike.

As we told you in a story today, the U.S. Preventive Services Task Force reversed existing recommendations that women get mammograms every one or two years starting at 40. Now, it says, start in your 50s, and do them every two years.

And remember how doctors have urged women to do breast self-exams? Well, skip those too. There's no evidence that teaching women to examine their breasts actually saves lives, the panel now says. 

So what's a woman in her 40s to think? That's the tenor of the emails I've been getting in response to this story. Women are confused. For years, doctors, patient advocates and every public service announcement with a pink ribbon on it has urged women to get annual mammograms and check their breasts for lumps. So, now what? Talk to your doctor, says the panel.

But many doctors are against the new recommendations, especially cancer specialists. CNN notes that the panel of 16 medical experts includes no oncologists.

There are no clear cut answers, even among doctors. One tells the WSJ health blog that there is no downside to breast self-exams, regardless of what the data show.

Another doc, who backs the guidelines, tells NPR that he tells is patients if they find lumps in their breasts to bring them to his attention. But then he says: The harm is twice as many women finding a lump, being anxious and having a surgical procedure to remove the lump or at least to put a needle into the lump. And if this doesn't result in any improvement in mortality, were not doing these women any favors.

Continue reading "Controversial mammogram guidelines confuse even the experts" »

Posted by Kelly Brewington at 12:00 PM | Permalink | Comments (12)
Categories: Cancer
        

Breast cancer patients often struggle with persistent pain long after their treatments are completed, according to new research published in the latest Journal of the American Medical Association.

Nearly half of patients surveyed said they had lingering pain two to three years after their cancer treatment, according to the study by Danish researchers. The pain can be severe to mild, and for some women it doesn't simply come and go -- it endures. Of the 13 percent of women who reported severe pain, 77 percent said they experienced it every day.

The study, which examined chronic pain in 3,754 women ages 18 to 70, found women younger than 40 were more likely to suffer from it. Of women who had breast-conserving surgery, the highest risk of pain was in young women 18 to 39 -- much higher than those in their 60s.

The pain was due to surgery and subsequent nerve damage, as well as chemotherapy and radiation treatments. Women felt pain in their breasts, but also under their arms and on the sides of their body.

The issue demands more attention, according to an accompanying editorial, from doctors from the Lee Moffitt Cancer Center in Tampa, Fla. ...

Continue reading "Chronic pain remains after breast cancer treatment" »

Posted by Kelly Brewington at 7:04 AM | Permalink | Comments (2)
Categories: Cancer
        

Last week, we discussed the American Cancer Society's guidelines on breast and prostate cancer and the notion that some cancer screenings may do more harm than good. It all comes from the idea that people can have certain cancers that may never hurt or kill them.

Some of you responded, well, how is that? We agree, it's a puzzling idea. Most of us have been taught that modern medicine exists to find our health problems and cure what ails us, fast and before it gets any worse. Shouldn't that be the same with cancer?

Well, a NYT story yesterday takes a look at how cancers detected early when they are very small can actually vanish and not cause a patient any harm in the future. Instead of growing worse, some of these cancers get smaller and cause the patient no problems.

Continue reading "An explanation of how cancers can disappear" »

Posted by Kelly Brewington at 12:20 PM | Permalink | Comments (2)
Categories: Cancer
        

We've had this conversation a lot here at Picture of Health when it comes to breast and prostate cancer: to screen or not to screen?

We've explored studies that expressed some doubts about the benefits of mammography, that some women overestimate the mortality reduction of breast cancer screening and that studies have shown that approximately 1 life is saved for every 1,000 mammograms given.

And we've discussed the debate over prostate cancer screening and whether the disease is being overdiagnosed, exposing men to potentially harmful treatment for cancers that may pose no harm to them in the long run. Another recent study showed that some men may not be getting the counseling from their doctors that they need to understand the risks.

So it didn't surprise us when an NYT story reported yesterday that the American Cancer Society is reconsidering its screening guidelines for breast and prostate cancer. And a new editorial in the Journal of the American Medical Association raises similar doubts, finding that such screenings are turning up more cancers that may never hurt people.

We wondered, though, is this really a shift in philosophy?

Continue reading "Concerns raised about the benefits of cancer screening ... again. " »

Posted by Kelly Brewington at 11:09 AM | Permalink | Comments (2)
Categories: Cancer
        

Recently, we brought you some news on prostate cancer screening and how the blood test that detects the disease may in fact be leading to overtreatment of the illness. Some researchers think the screening test does more harm than good, exposing men to unnecessary treatment of cancers that will never harm them and never kill them. Others said the research was bogus and that the test saves lives.

Well, a new study raises more questions about the popular test known as prostate-specific antigen screening, or PSA, and is sure to intensify the debate. Men are not getting adequate counseling from their doctors on the risks of such testing, a new study published today in the Journal of the American Medical Association .

In a survey of 3,010 men 40 and older in 2006 and 2007, about 30 percent had not discussed the screening with their doctors before they had the blood test. About 45 percent said they weren't asked by their doctor about their preference for the test and 48 percent could correctly answer questions about prostate cancer risk and the accuracy of screening.

"Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences," the reseachers write. "Indeed, most professional organizations recommend that the first step in screening should be a discussion between health care providers and patients about the risks and benefits of early detection and treatment so that patients can make informed decisions about whether to be screened."

Continue reading "More doubts about prostate cancer screening" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (12)
Categories: Cancer
        

A rising number of women are choosing to remove a healthy breast after being diagnosed with breast cancer -- even though there is little evidence that doing so improves survival, a new study found.

The research, which appears in Cancer, the journal of the American Cancer Society, examined data from 6,275 New York state women, who had prophylactic mastectomies -- removal of a non-cancerous breast as a preventive measure.

Researchers looked at women who had a healthy breast removed after the discovery of cancer in the other breast as well as woman without cancer who had both breasts removed, but had a strong family history of the disease or a gene making them more susceptible to it.

From 1995 to 2005, the number of women who had cancer in one breast and choose to have the other breast removed more than doubled. Those with no personal history of breast cancer who had both breasts removed also increased, but slightly.  

While the number of these kinds of mastectomies remains small, they're rising and such surgery comes with risks. Other studies reveal increases in overal mastectomies, raising concerns that some women are being treated too aggressively and whether doctors are doing the right thing for patients.

Continue reading "More women with breast cancer opt to remove healthy breast." »

Posted by Kelly Brewington at 7:08 AM | Permalink | Comments (2)
Categories: Cancer
        

My story today about overdiagnosis and overtreatment of prostate cancer reignites a controversial debate about whether men should be screened for the disease. 

In the two decades since a blood test became the prevailing screening tool for prostate cancer, more than 1 million men nationwide have been diagnosed with and treated for the disease—most of them unnecessarily, a new study finds 

The research, published in today's Journal of the National Cancer Institute, raises questions about whether the screening test -- known as prostate-specific antigen screening, or PSA -- does more harm than good. That may sound odd, since screening, on its face, seems beneficial. Catch cancer early and you'll live longer, right?

Well, not always. It's possible for people to have cancers that may never harm or kill them. When it comes to prostate cancer, many men are being diagnosed and referred to treatment that they don't need and that can actually cause harms such as incontinence and impotence, the study says.

Some urologists are pretty upset at the findings and think the study is misguided. They say it dismisses that PSA testing has helped doctors catch some cancers early and save lives.

With all the back and forth, men reading this are likely wondering: should I get a PSA test or not?

Well, that's a tough question to answer. The American Cancer Society and the U.S. Preventive Services Task Force don't recommend the screening but the American Urological Association does. The study's authors aren't advising for or against the PSA test, but they do stress that patients become informed and have conversations with their doctors about the risks of screening and possible treatment. Knowledge is power.

Posted by Kelly Brewington at 7:30 AM | Permalink | Comments (5)
Categories: Cancer
        

Hospitals have been sending me e-mails lately, telling me that "Prostate Cancer Awareness Month" is coming and touting free cancer screenings. We've all been told that early detection  saves lives.

A study published online late yesterday in the Journal of the National Cancer Institute suggests that these messages are getting through -- probably a bit too loud and a bit too clear. In fact, in the study of more than 10,000 Europeans, researchers found that 92 percent of women either overestimated the mortality reduction associated with breast cancer or didn't know what it was. They also found that 89 percent of men overestimated or didn't know the mortality reduction associated with prostate cancer screening.

The truth is that studies have shown that approximately 1 life is saved for every 1,000 mammograms given. The recommendation in the United States is to screen women with mammograms every year or two from the age of 40.

As for prostate-specific antigen (or PSA) screening, there is insufficient evidence that it saves lives and could instead lead to unnecessary treatment of cancers that might never develop into anything.

Continue reading "To screen or not to screen" »

Posted by Stephanie Desmon at 12:00 PM | Permalink | Comments (0)
Categories: Cancer
        

Studies have found many benefits to babies who are breastfed. But what about to their mothers? New research finds that women with a family history of breast cancer had a lower risk of developing the disease themselves if they breastfed.

The paper, published in the latest Archives of Internal Medicine, was based on questionnaires of 60,000 women who had given birth and took part in the long-running Nurses Health Study out of Harvard. Researchers followed them from 1997 to 2005 and found 608 cases of breast cancer from the group.

Women who had a mother or a sister with breast cancer and had breastfed were 59 percent less likely to develop breast cancer compared to women who had never breastfed. The study did not find a difference in risk for women without a family history of breast cancer.

Continue reading "Breastfeeding could lower cancer risk" »

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Cancer
        

Here's another interesting look at racial disparities in cancer. Researchers have wondered for years why black patients have worse survival from head and neck cancers than whites.

These cancers were once thought to be diseases of older men -- typically smokers and drinkers. But in recent years, experts have noticed a rise in younger men with such cancers and found that the sexually-transmitted human papillomavirus (HPV) is the cause.  Head and neck cancers can be devastating and disfiguring and researchers have been paying close attention to the HPV link for clues to better understand the cancers and the racial disparity. 

Here's the latest effort: A new study from University of Maryland researchers finds that, surprisingly, cancer patients who also tested positive for HPV had better prognosis than patients without the virus. Blacks had very low rates of HPV, and therefore, far worse survival than whites, according to the study, published in the journal Cancer Prevention Research. Researchers think this might explain why blacks have traditionally had worse outcomes with head and neck cancers. HPV could make all the difference. 

Continue reading "HPV may explain racial disparity in head and neck cancers" »

Posted by Kelly Brewington at 3:07 PM | Permalink | Comments (0)
Categories: Cancer
        

My story yesterday on the racial disparity in breast cancer deaths highlighted the debate over whether biology or environment is the cause of the problem. A recent study suggests that access to care alone can't explain the disparity, reopening a long-brewing discussion about whether genetics is the reason black women are more likely to die of the disease than white women.

Using genetics to explain racial disparities in health is a touchy topic. When I spoke to Dr. Otis Brawley at the American Cancer Society, he said he worried that the issue hearkens back to the old argument about blacks and genetic inferiority.

Yet, others insist genetic research is key to unlocking the mysteries of racial disparities and, most importantly, finding a cure. There's a great piece in CNN's Black in America 2 series, about  Dr. Lisa Newman, an African-American female surgeon, who travels to Ghana searching for genetic clues to why black women are twice as likely to get a rare and aggressive form of breast cancer known as triple negative.

Continue reading "Can genetics explain triple negative breast cancer?" »

Posted by Kelly Brewington at 12:10 PM | Permalink | Comments (8)
Categories: Cancer