Tag Archives: breast cancer

Trump Administration Censoring Women’s Health Info on Government Sites

Without much fanfare, valuable health information is being scrubbed from government websites.

Haven’t heard about this? That’s because it hasn’t gotten the press it should. While much media attention is spent on the Trump administration’s position on DACA or the latest trade agreement, the administration’s systematic withdrawal of health content – especially women’s health – from Health and Human Services run websites is a serious danger that can potentially harm patients.

In its THIRD report on censorship at the Office of Women’s Health, the Sunshine Foundation found that office’s breast cancer website and a page on reproductive health organization is now gone. If you try to go to either one, it redirects to a different page.

So, why is the administration doing such a thing? Good question. A spokesperson for HHS recently told ThinkProgress the following:

“The pages were removed on December 6, 2017 because content was not mobile-friendly and very rarely used. Before we update any of the information…we engage in a comprehensive audit and use analysis process that includes reviewing other federal consumer health websites to ensure we are not duplicating efforts or presenting redundant information.”

I find this information hard to believe considering breast cancer is the most common cancer among women. Also, this isn’t the first time the administration has launched a salvo against health information that it apparently finds objectionable for some reason.

Back in December, the administration informed officials at the Centers for Disease Control and Prevention – part of HHS – of a list of 7 prohibited words and phrases not to be used in documents for the agency’s budget request. And those words and phrases? “Vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

If this all sounds ridiculous, it’s more than that – it is deplorable, a word the administration is all too familiar with. But instead of getting angry, do something about this.

Contact HHS Secretary Alex and let him know you won’t stand for this kind of dangerous censorship. His email is Secretary@HHS.gov and phone number is 202-690-7000. And if you want to tell him via President Trump’s favorite medium, Twitter, Azar’s handle is @SecAzar.

First At-Home Genetic Test For Breast Cancer Risk Approved

The FDA has approved the first at-home genetic test for breast cancer risk. For the first time, the agency authorized 23andMe’s test for 3 BRCA1/BRCA2 breast cancer mutations, which are most common among Ashkenazi Jews.

After DNA analysis from a self-collected saliva sample, the results then detail whether a woman is at an increased risk of developing breast and ovarian cancer and whether a man is at an increased risk of developing breast or prostate cancer. It is important to note that the test only detects 3 out of the more than 1,000 known breast cancer mutations. Furthermore, only a small percentage of Americans carry one of these 3 mutations. Most breast cancer mutations that increase a person’s risk are not detected by this test.

Therefore, you are not completely out of harm’s way if you test negative for the 3 mutations. Due to the mentioned caveats, the agency indicated that patients should not solely rely on this test, nor should the test be used to determine a cancer treatment. Additionally, the FDA says that this test should not substitute for a doctor visit because it doesn’t account for every possible outcome.

What Could Be Bad About an At-Home Test for Breast Cancer Risk?

If you could take a test and have it determine whether you are at an elevated risk for developing breast cancer, who wouldn’t want to know such valuable information? And what if you could do it in the comfort of your home, without a prescription? That’s the crux behind 23andMe’s at-home genetic test, which the FDA just approved yesterday.

While at first glance the test seems like a real breakthrough and a new tool in the fight against cancer, the reality is that its impact will likely be more muted. And even worse, it could give some people a false sense of security and others a cause to worry for no good reason.

One of the test’s biggest appeals is that it is easy. Spit in a small tube, then send it back to 23andMe, which will examine the saliva for variants in 2 genes, BRCA1 and BRCA2. The presence of those variants is associated with a significantly higher risk of breast and ovarian cancer in women, and breast and prostate cancer in men, according to the company.

Before you go to 23andMe’s website to order a test, there are a few things you should know. The variants that are associated with the higher risk of cancers are most common in those of Ashkenazi Jewish descent. So if you are not an Ashkenazi Jew, there’s little reason for you to have the test done. Second, it only tests for 3 mutations that may cause cancer, even though there are far more, a point not lost on the FDA.

“The test only detects three out of more than 1,000 known BRCA mutations,” the agency said in a news release. This means a negative result does not rule out the possibility that an individual carries other BRCA mutations that increase cancer risk.”

A larger problem I see with this kind of test is that it eliminates the role of a physician to properly interpret the results and provide guidance for the patient. Many who have the test done and find they don’t have the mutations may get a false sense of security that they won’t get breast or ovarian cancer. On the other hand, those who find they do have the mutations may needlessly worry – having the mutation does not guarantee you will get cancer.

While the decision to have any genetic test is up to the individual, this new at-home variety brings with it a host of caveats. A test can tell you a lot of things, but not everything, which is why it’s best to meet with a doctor when it comes to any serious health issues.

Quick Hits: Penicillin Allergies and Surgical Infections, FDA Okays Drug for Metastasized Breast Cancer & More

Patients who were reported to be allergic to penicillin were 50% more likely to experience surgical site infections (SSI), according to a study by Massachusetts General Hospital. Researchers examined 8,385 patients who underwent 9004 different procedures from 2010 to 2014 including hip and knee reconstruction, hysterectomy, colon surgery, and coronary artery bypass. Out of those patients who underwent surgical procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. Posted October 9, 2017. Via Clinical Infectious Diseases.

The opioid addiction medicines buprenorphine and methadone can be given to patients that take tranquilizers such as benzodiazepines and other drugs that impact the central nervous system (CNS), according to an FDA review. Although the agency says that combining the use of drugs containing buprenorphine and methadone (e.g. Subutex, Bunavail, Suboxone and Diskets) with benzodiazepines such as Xanax (aloprazolam), Klonopin (clonazepam) and Ativan (lorazepam) or CNS depressants can increase serious side effects, the risk of opioid abuse outweighs these risks.

However, the FDA notes that patients should be made aware by their doctor of the increased risks –- including overdose and death — of combining opioid addiction drugs with CNS depressants, which also includes sleep drugs such as Ambien (zolpidem), muscle relaxants and antipsychotics, such as Abilify (aripiprazole) and Seroquel (quetiapine). Doctors should also work with patients to manage use of benzodiazepines and CNS depressants when starting opioid addiction therapy, and look at tapering use of those drugs as well. Posted Sept. 25, 2017. Via FDA.

The FDA has approved Verzenio, a new medication that will treat a common type of breast cancer after it spreads to other parts of the body. According to the FDA, “In the study, 19.7 percent of patients taking Verzenio experienced complete or partial shrinkage of their tumors for a median 8.6 months.” Patients should be cautious when using this new drug because it is associated with serious side effects including diarrhea, neutropenia, elevated liver blood tests and blood clots. The FDA also warns that pregnant women should avoid taking Verzenio because it may harm a developing fetus. Posted September 28, 2017. Via FDA.

Quick Hits: New Breast Cancer Drugs Have Fewer Side Effects, Antidepressant Use in Pregnancy and Autism & More

A new class of oral drugs for treating the most common type of breast cancer, known as cyclin-dependent kinase (CDK) inhibitors, appears to have fewer adverse events and side effects for most patients compared to other treatments. There are 2 CDK inhibitors currently on the market: Ibrance (palbociclib), approved in February 2015, and Kisqali (ribociclib), which was just approved in March. Both are used to treat hormone receptor-positive (HR+) metastatic breast cancer. A third CDK inhibitor, abemaciclib, is in late-stage development. Researchers examined all publicly available trials for the 3 drugs. The most common side effect was low white blood cells, a condition known as neutropenia that can lead to infection, though it was seen less in abemaciclib. However, neutropenia was usually temporary or resolved with a dose reduction. Other, more common side effects seen with the medications were diarrhea and fatigue. Less common side effects observed were nausea and alopecia (hair loss), though these were mild and treated through a dose reduction or a break from the drug. Posted July 14, 2017. Via The Oncologist.

Children exposed to antidepressants during pregnancy may have a slightly higher risk of developing autism than children of mothers with mental illness who didn’t receive the drugs. Researchers, however, stress that the absolute risk of autism was small, so the results should not be considered alarming. A team at the University of Bristol (UK) analyzed data from 254,610 individuals aged 4-17 of which 5,378 had autism. Of the 3,342 children exposed to antidepressants during pregnancy, 4.1% (136) had a diagnosis of autism compared with 2.9% (353) in 12,325 children not exposed to antidepressants whose mothers had a history of a psychiatric disorder. Researchers noted that overall, 95% of women who took antidepressants did not have a child with autism. An accompanying editorial noted that the results should not dissuade women with depression from using antidepressants in pregnancy since untreated depression can lead to “ substantial health consequences.” Posted July 19, 2017. Via The BMJ.

The FDA has approved a new hepatitis C (HCV) medication, Vosevi. The drug is actually a combination of two existing anti-viral treatments, sofosbuvir and velpatasvir (sold as Epclusa), and a new drug, voxilaprevir. Vosevi is for patients with HCV without liver disease (cirrhosis) or with a mild form of cirrhosis. Results from 2 late-stage trials demonstrated that 96-97% of patients who received Vosevi had no HCV detected in their blood 12 weeks after finishing treatment, an indication the infection has been cured. The most common side effects in patients taking Vosevi were headache, fatigue, diarrhea and nausea. Posted July 18, 2017. Via FDA.

 

Mammogram Pros and Cons (Yes, There Are Cons)

Mammogram Pros: They save lives. Mammograms are estimated to reduce cancer rates by 15%. Translated, that means that over a 10-year period if 2,000 women get screening mammograms, 1 will have her life saved.

Mammogram Cons: They cause significant harm. Over those same 10 years, of those 2,000 women 10 will undergo treatment for no reason — because of a cancer that never would have grown. Further, 200 of those 2,000 women will “experience important psychological distress including anxiety and uncertainty for years because of false positive findings,” according to a Cochrane review on breast cancer screening with mammography published in 2013.

These pros and cons apply to screening mammograms, which are those conducted on healthy women with no symptoms or history of breast cancer.

The overtreatment of breast cancers might be acceptable if the treatment was simple, low cost and reasonably pain-free. However, that is not how cancer care is today. Cancer treatment is a life-altering invasion of women’s bodies that can harm nearby organs, increase her risk for a secondary cancer and make it more difficult to treat an actual or secondary breast cancer.

A new research paper based on a national survey just published in JAMA shows just how skewed women’s perceptions of the benefits and harms of mammograms are.

When asked, more than 90% of women knew the 4 benefits of mammograms listed in a recent study. The benefits were (in no order) that mammograms can:

  • Save lives: 92% had heard this before and 66% called it “very Important”
  • Lead to earlier treatment: 96.2% had heard before and two-thirds called it “very Important”
  • Peace of mind: 92.2% had heard this before and 56.5% called it “very Important”
  • Find cancer early: 91.2 had heard this before and 65.9% called it “very Important”

Looking at the 7 questions about mammogram harms, I found a very different picture. Fewer women knew there were potential harms and the women ranked them lower.

  • Some breast cancers found by mammograms are treated with potentially risky surgeries or meds that would not have needed such treatment after all. 39.7% had heard of this before and 28.7% said it was “very Important”
  • Some breast cancers that are found by mammograms are so slow-growing that they would not have caused any health problems for women in their lifetime. 26.5% had heard of this and 21.5% called it “very Important”
  • Women who receive positive mammogram results, even if eventually it turns out they do not have cancer, may feel anxious and stressed. 77.6% had heard before and 23.5% found this “very Important”
  • Mammograms, like all x-rays, expose women to very small doses of radiation, which could increase risk for cancer. 67.4% had heard of this and 19.6% said it was “very Important”
  • Mammograms can find something that looks like cancer but eventually turns out not to be cancer. This is called a “false-positive” or “false alarm.” 75.4% had heard before and 23.4% called it “very Important”
  • Mammograms can lead to increased costs to women because of follow-up tests and procedures. 50.1% had heard this before and 18.8% said it was “very Important”
  • Mammograms can lead to increased costs to the health care system because of follow-up tests and procedures. 42.7% had heard before and 15.1% said it was “very Important”

Needing Few Slogans, More Science

The benefits of mammograms can by synthesized down to 2-3 word slogans like “Mammograms Save Lives” which is true, but it’s also true that “Mammograms have risks of harms.”

Face it, everyone knows someone who has had a breast cancer diagnosis. Between the education campaigns, the pink ribbons and the walks, the fear and loathing of breast cancers surround women and create an atmosphere of mammogram worship. “If I get a mammogram,” I think to myself, “then I won’t die of breast cancer.” Unfortunately, that’s not true. Some breast cancers are too aggressive and virulent to control or “beat,” no matter how early caught.

Somehow the message in America has changed from “Mammograms might help find cancer at a time when medicine can fight it,” to “If you get a mammogram every year you can prevent or avert breast cancer.” And that’s silly. At this point we don’t understand how and why breast cancer occurs so we can’t promise anyone that anything you do will let you avoid it.

It’s a challenge in a world of threats to maintain rationality instead of placing undue faith in a screening program that has plenty of flaws. It may be the best we’ve got, but after 30 years of “early detection saves lives,” don’t we deserve better? How about a screening program that can detect the difference between a cancer or pre-cancer that is a danger and those cancers that will never grow into a threat?

‘Cooling Cap’ May Lessen Hair Loss in Women Undergoing Chemo

For women undergoing chemotherapy, losing one’s hair is one of the treatment’s most devastating side effects. However, researchers have discovered a “cooling cap” that is placed on the scalp may help women with breast cancer lose less hair as a result of chemotherapy.

Researchers, led by those at the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, enrolled 182 women with either stage I or II breast cancer who planned to have at least 4 cycles of either taxane or anthracycline-based chemotherapy. The women were randomly chosen to receive the scalp cooling device or not cooling therapy.

The main purpose of the trial, appropriately named SCALP, was determine the safety and efficacy of the device in reducing hair loss (alopecia) in patients undergoing chemotherapy. Secondary endpoints were whether patients in the device arm needed a wig or scarf and overall quality of life.

Slight more than half of the participants in the cooling group didn’t need a wig or a scarf, while everyone in the control group did, the researchers reported in JAMA.

“With scalp cooling, we are lowering the temperature of the scalp, thereby constricting the blood vessels and reducing the flow of blood to the hair follicles, which will help reduce hair loss by limiting the amount of chemo drugs reaching the follicles,” lead study author Julie Nangia, MD, said in a statement.

View a video about the cooling cap and research on it from Dr. Nangia.