More evidence is in this week that casts doubt on the value of mammograms. To recap: Canadian researchers followed nearly 90-thousand women since the 1980s. The women were randomly assigned to mammography or physical breast exam. Now 25 years later, the researchers say that roughly equal numbers of women in each group died of breast cancer — mammography, according to this study, is not affecting the death rate at all.
In addition, mammography comes with harms. More than 1 in 5 cancers found in the mammography group were not ones that pose a threat to women’s health, the researchers say. Doctors call this “overdiagnosis.” This is a problem because the treatments for cancer are aggressive — surgery, radiation therapy, chemotherapy — and can cause harms in and of themselves. “There is no question that there is an excess in the diagnosis of tumors that are not going to kill you,” Dr. Laura Esserman, head of the UC San Francisco breast care center, told me, “We all know this phenomenon exists, but this quantifies it.”
Those are the headlines. Thursday morning, KQED’s Forum got into more detail. I was particularly interested in two points the guests made. The first was about new approaches to screening and the second was about screening as distinguished from prevention. Continue reading
The issue of how often a woman should be screened for breast cancer has been a topic of hot debate for years. But of the many different issues that are closely examined, cost is rarely among them.
Even mentioning cost typically gets patients somewhat understandably up in arms — no one wants her life to be determined by mere dollars.
But what if those dollars are being spent poorly? The harms of mammograms are well-known — false positives and overtreatment among them. What if reconsidering what we’re doing and how we’re doing it could actually lead to more lives saved?
Into the fray comes an analysis from several researchers, including Dr. Laura Esserman, a breast cancer surgeon with UCSF. They calculated the costs for screening mammography in the U.S. under different scenarios. Continue reading
(Go Interactive Wellness/Flickr)
By Allison Aubrey, NPR
Exercise helps recovery after cancer treatment, but fatigue can make working out hard. Yoga can help reduce fatigue for breast cancer survivors, a study finds. It’s one of a growing number of efforts using randomized controlled trials to see if the ancient practice offers medical benefits.
Women who took a yoga class three hours a week for three months said they experienced 40 percent less fatigue compared to a group of breast cancer survivors who did not do yoga.
“Fatigue is a major and serious problem in survivors,” even years after treatments have ended, Janice Kiecolt-Glaser, a psychology professor at Ohio State University and lead author of the study, said.
The participants who did yoga also had lower levels of cytokines, which are markers of inflammation, in their blood, Kiecolt-Glaser says. Cytokine levels were reduced up to 20 percent six months after starting yoga. It’s not clear how this may affect their health, she says. Continue reading
Retailer J.C. Penney features a Girls Plus clothing department tailored to overweight girls. (Scott Olson/Getty Images)
Building on earlier research a major new study has found that girls are starting puberty at even younger ages. The most significant changes were seen in Caucasian girls and in girls who are overweight or obese. Still, girls who were not overweight were also entering puberty younger, the study found.
Researchers at three sites around the country — including the San Francisco Bay Area — followed 1,239 ethnically diverse girls from 2004 to 2011. They looked at breast development, a key marker for the start of puberty.
Girls who mature earlier are at risk for lower self-esteem and higher rates of depression.
Earlier studies had shown that African-American girls had reached this milestone at younger ages. “Now it looks like it’s happening earlier for Caucasian girls,” said Dr. Louise Greenspan, a pediatric endocrinologist with Kaiser San Francisco and one of the authors of the study. “Particularly, the overweight Caucasian girls are developing earlier than they have in the past.”
Researchers looked at a number of factors, but the “obesity epidemic appears to be a prime driver in the decrease in age at onset of breast development,” the authors wrote. Continue reading
By Patti Neighmond and Richard Knox, NPR
Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.
When Sally O’Neill’s doctor told her she had an early form of cancer in one of her breasts, she didn’t agonize about what she wanted to.
The 42-year-old mother of two young girls wanted a double mastectomy.
In many cases it doesn’t ever progress to invasive cancer, the type that can be life-threatening.
“I decided at that moment that I wanted them both taken off,” says O’Neill, who lives in a suburb of Boston. “There wasn’t a real lot of thought process to it. I always thought, ‘If this happens to me, this is what I’m going to do.’ Because I’m not taking any chances. I want the best possible outcome. I don’t want to do a wait-and-see.”
Today, 10 years later, O’Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a trend.
O’Neill had ductal carcinoma in situ, or DCIS. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years. Continue reading
(William West/AFP/Getty Images)
In a unanimous decision, the U.S. Supreme Court ruled Thursday morning that human genes are not patentable.
The case centered around Myriad Genetics, the holder of patents on two genes, BRCA1 and BRCA2. Some mutations of these genes are associated with an increased risk of breast and ovarian cancer. For women with a strong family history of these cancers, the only place they could be tested was Myriad Genetics, which sometimes charged more than $3,000 for the test.
Breast Cancer Action, an advocacy group based in San Francisco, was a plaintiff in the case, and executive director Karuna Jaggar sounded jubilant in a phone call Thursday morning.
“From our perspective, these patents never should have been granted in the first place,” Jaggar said. “There’s no question that DNA is a product of nature, and so it’s very affirming to see the court rule in our favor.”
BRCA1 and 2 mutations became international news when actress Angelina Jolie revealed that she’d had a preventive double mastectomy after testing showed that she had a specific mutation that put her at very high risk of developing breast cancer.
By Michelle Andrews for Kaiser Health News and NPR
Angelina Jolie’s decision to have a double mastectomy after genetic testing has prompted a discussion about which other tests should be covered. (Gage Skidmore/Flickr)
When it comes to inherited genetic mutations that increase the risk of breast cancer, BRCA1 and BRCA2 get nearly all the attention.
Inherited mutations in these genes cause from 5 to 10 percent of breast cancers as well as up to 15 percent of ovarian cancers, according to the National Cancer Institute.
There are other, rarer genetic mutations that also predispose women to breast cancer.
Other genes besides BRCA1 and BRCA2 may have mutations that predispose a woman to breast cancer.
Health insurers that cover BRCA-related testing and treatment without a hitch sometimes balk at providing coverage in these other instances. The predictive value of some of those variations isn’t always as strong or clear-cut.
When Angelie Jolie said earlier this month that she’d tested positive for a particularly harmful BRCA1 mutation and had a double mastectomy to substantially reduce her risk of getting breast cancer, she didn’t mention her insurance coverage. Continue reading
The first thing you need to know about the BRCA gene is that you have it.
Don’t panic. Everyone does. In fact, we all have two of them — the BRCA1 and 2 genes. They are normal genes that “have an important function in the cell. They are involved in repairing DNA damage,” explained Dr. Robert Nussbaum, a medical geneticist at UCSF. “When they’re functioning normally, they do a good job for us.”
We all have two copies of the BRCA genes. Men, too.
The problem is what happens when they don’t function normally. We’ll get to that in a minute. But first, in our call, Nussbaum gave me a helpful primer in basic genetics.
For starters, we all have two copies of each of the BRCA genes. Men, too. We get one copy from each parent. These genes are “like sentences,” Nussbaum said. ”They are made up of words.” When they’re spelled right, all is well.
But “you can have all kinds of misspellings,” Nussbaum said. “Red becomes reed. All kinds of things can happen that will alter the meaning of that sentence.” Continue reading
(Foreign and Commonwealth Office/Flickr)
Angelina Jolie lit up social media Tuesday morning with her announcement that she recently had a preventive double mastectomy. She took this route, she says, because she carries a specific BRCA1 mutation — putting her at an 87 percent risk of developing breast cancer and a 50 percent risk of ovarian cancer. You can read everything about her history in her New York Times piece, “My Medical Choice.”
But the key here is a specific BRCA1 mutation. There are many different mutations that can occur in the BRCA gene. Jolie is very careful to walk through all her personal decisions stemming from her unusually high risk, but emphasizes that “the risk is different in the case of each woman.”
About 10 percent of all breast cancers are due to those many BRCA mutations. Dr. Otis Brawley, chief medical officer with the American Cancer Society, explains in more detail what individual women should consider, in a response to Jolie’s piece:
This does not mean every woman needs a blood test to determine their genetic risk for breast and/or ovarian cancer. What it does mean is women should know their cancer family history and discuss it with their regular provider. If appropriate, they should be referred to and have the opportunity to discuss their risk and their options with a genetic specialist. Continue reading
I first saw the article Thursday night on Facebook, then stayed up until midnight reading it. In a helluva story, Peggy Orenstein addresses The Feel-Good War on Breast Cancer in this Sunday’s New York Times Magazine.
Orenstein is uniquely situated to write an article she hopes will “help change the national conversation.” She’s been treated for breast cancer twice in the last 15 years, including a mastectomy last fall, and the Times Magazine — for which she writes regularly — is one of the most powerful publications in the world.
Orenstein was first diagnosed with breast cancer in 1997 after her doctor sent her for a screening mammography. “I used to believe a mammogram saved my life,” she writes as the opening line of her piece. Today, she’s not so sure.
As she writes in the Times:
Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same Continue reading