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Some Breast Cancers Are On The Rise…Others Will Become Less Common

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The reasons why are fascinating.

Breast cancer is already the most common form of cancer. We’ll see 234,000 new cases of the disease diagnosed this year alone — but according to new data presented at the American Association for Cancer Research’s 2015 Annual Meeting, that number is only set to rise substantially in the years ahead.

According to the research, breast cancer rates will increase by 50 percent by the year 2030, compared to stats analyzed from the year 2011 — a risk that’s especially potent in women over 70. Around 40 million women in the U.S., born between 1946 and 1964, will experience high absolute risks for postmenopausal breast cancer — or two to four percent risk over a decade-long span. Another 56 million women in their 20s and 30s will see a substantial risk of premenopausal cancer, around 0.4 percent to 1.5 percent over a 10-year span.

On the current trajectory, the total number of breast cancer cases will jump from 283,000 in 2011 to 441,000 in 2030. Although the number of diagnoses among women 50 to 69 should see a drop, the proportion of women seeing a breast cancer diagnosed between ages 70 and 84 will rise from 24 percent to 35 percent. This is mostly due to a jump in ER-positive, in-situ cancers, generally found by mammography, from 19 percent to 29 percent.

These numbers seem staggering, but, when you look at the reasons why, they make more sense:

1. Baby boomers are aging: There will be more women at an age where they experience a higher risk for breast cancer.

2. People are living longer. As women age, they’re more likely to develop breast cancer.

3. Estrogen positive breast cancer is on the rise.

Researchers delved into national data on breast cancer rates using projects run by the Census Bureau: NCI Surveillance, Epidemiology, and End Results Program. Then they used mathematical models to help forecast incidence of the disease, gleaning insights into the eventual burden of these cases and how we should approach prevention.

According to Richard Bleicher, MD, associate professor of surgical oncology and breast surgeon at the Fox Chase Cancer Center, these statistics are a reminder that we can’t get lax about testing and symptom checks. “It emphasizes the fact that screening is important,” he tells Yahoo Health. “There’s been a lot of controversy lately about mammography, the reliability, effectiveness and false positives — but mammography is still our front lines in detecting cancer.”

Bleicher also insists that it’s important for every woman to know the symptoms of cancer — whether she has family history and other risk factors, or not. “We hear different numbers, like one in eight women, or one in 11 women will develop cancer,” he says. “But it’s difficult to provide an exact estimate of cancer risk in the absence of a genetic mutation, which we know can lead to a 40 to 80 percent lifetime risk of developing breast cancer.”

It’s important to be aware of changes in your body. In addition to a lump in the breast, which most women know about, he says other reasons to see a doc include bloody discharge from the nipple, a lump in the armpit or changes to the contour of the skin.

However, no woman is immune to breast cancer, and all should be watchful. “It’s more common to get breast cancer in the absence of risk factors,” Bleicher says. “This is called sporadic cancer. Sometimes it’s due to various types of tissues having a high rate of cell turnover, or a hormone change, but the point is, even though you may do everything right — eat right, exercise, stay at a healthy weight — you may still get it.” Which is why you should know the signs, get regular screenings, and take active steps to reduce your risk.

On a positive note from the study, the researchers involved in the current study believe we’ll see fewer tough-to-treat cancers, like HER2-positive and triple-negative subtypes of breast cancer, as well as fewer estrogen receptor (ER)-negative tumors.

Why the drop in certain types? No one’s sure, but researchers are delving into clues. As an example, the trend in delaying motherhood and choosing to breastfeed may have something to do with a the reduction in the rates of these cancers, as early age at first birth and lack of breast-feeding are both risk factors for ER-negative tumors.

(Article Excerpt and Image from Yahoo! Health), article by:  Jenna Birch, April 20, 2015 – See more at: https://www.yahoo.com/health/u-s-breast-cancer-rates-will-increase-50-by-2030-116923364217.html?soc_src=mail&soc_trk=ma

Breast Cancer Treatments Expose A Huge Systematic Issue In American Health Care

The more breast cancer treatments a radiologist administers, the more reimbursements he or she typically receives. This is known, in healthcare, as fee-for-service medicine — and lots of experts don’t like it, largely because it creates an incentive to provide as much care as possible, regardless of whether patients get any healthier.

For ages, conventional treatment has been a five- to seven-week course of radiation after a lumpectomy. Women have to come see the doctor each day for breast cancer treatments, and doing that for over a month can be disruptive. But around 2008, researchers started publishing some great news: three weeks of higher-dose therapy could deliver equally good results for many patients. It has no worse side effects, and patients could spend less time and money on doctor’s visits.

“When we see patients who have breast cancer, their first concern is if it yields the same cure rate, which it does, and the second is whether it’s more toxic, and it’s not,” says Justin Bekelman, a radiation oncologist at the University of Pennsylvania whose practice focuses on treating prostate cancer. “Then it’s like, wow, if that’s true and the new breast cancer treatment is only three weeks, its a no-brainer.”

It seemed like a no-brainer to radiation oncologists too. In 2011, their trade group, the American Society for Radiation Oncology, found that the two options were “equally effective for in-breast tumor control and comparable in long-term side effects” for a huge percent of patients.

doctors don’t have incentives to stay up-to-date on new treatments

This makes it all the more surprising that, three years later, new research published today in the Journal of the American Medical Association shows that the vast majority of radiation oncologists aren’t using the new treatment.

The slow adoption of a faster and cheaper technology — one that delivers a better patient experience at a lower cost — isn’t just an issue with breast cancer treatments. It speaks to a lot of what’s screwed up in the larger American health care system. Doctors don’t have big incentives to stay up-to-date with new treatments. Sometimes, it’s actually financially ruinous for them to do so.

“This is the case where everyone could win, except for the radiation oncologists, who would be getting less money for fewer treatments,” says Zeke Emanuel, a bioethicist at University of Pennsylvania and co-author of the new study with Bekelman, the oncologist. “We have a persistence of no-value care, and that’s not good.”

Two-thirds of early-stage breast cancer patients get the wrong treatment

The new research looks at the insurance records of thousands of women treated for early-stage breast cancer between 2008 and 2013. It uses the billing claims that their providers submitted to see what type of treatment they got.

“We have a persistence of low-value care.”

It finds that use of the new treatment — known as hypofractionation whole breast irradiation — definitely increased from 2008 through 2013, as more research came out proving its efficacy. In 2008, when there was nearly as much research as there is today, 10.6 percent of women for whom the new treatment was endorsed ended up receiving it.

By 2013, that number had grown to 34.5 percent. That’s way more than 2008 — but also nowhere near a majority of patients getting a newer, faster, and equally good treatment as the older option. While the United States has made progress since 2008, for Emanuel, that one-third figure still raises the question: why, two years after national guidelines endorsed the new treatment, were most breast cancer patients not getting it?

Why don’t doctors pick the better treatment?

One cynical answer has to do with money: the more treatments a radiologist administers, the more reimbursements he or she typically receives. This is known, in healthcare, as fee-for-service medicine — and lots of experts don’t like it, largely because it creates an incentive to provide as much care as possible, regardless of whether patients get any healthier.

The billing records that Bekelman, Emanuel, and their co-authors examined show that insurance plans were billed more than $4,000 more for patients who received the older, longer course of treatment than those who had the newer, shorter chemotherapy sessions. Patients also had slightly higher (about $100) out-of-pocket costs for radiation-related expenses.

health care costs

“In terms of the financial pressures, right now we work in an environment that rewards higher intensity care and quantity rather than quality,” says Bekelman. “It’s not the whole story, but it’s part of it. Our health-care system certainly doesn’t incentivize and may even disincentivize high-value cancer care.”

And there’s also the role of old habits being hard to kill, and radiologists relying on the same treatment they’ve used for years now. Yes, it is a bit more expensive and inconvenient for patients, but there’s no evidence that it’s actively harming their health.

“If you don’t take into account convenience, costs to patients, and costs to society, you can tell yourself that it’s not the worse option,” says Emanuel.

This could be true not just on the part of oncologists but on the part of patients, too, who might assume that the longer, more expensive course of treatment has to be better. In most other things we shop for, like cars and vacations, bigger and more expensive generally means higher quality. Why wouldn’t health care be like that too?

“In cancer care, we’ve always thought that more is better,” Bekelman says. “The fact is more isn’t always better. Sometimes less is just right. But making that change in mindset can be difficult.”

Low-value care happens everywhere in the health care system

The financial incentives, the doctor preference, and patient attitudes — all of these add up to American women getting worse breast cancer care than women in other countries. In Canada, for example, more than 70 percent of eligible patients receive the new treatment. That’s double the rate here in the United States.

This isn’t an issue limited to breast cancer care. The American health care system is replete with examples of doctors providing care that doesn’t help people get better — care that wastes time, money, and energy on the part of patients and providers. Medicare, for example, spends an estimated $1.9 billion on care that study after study shows doesn’t make people healthier.

And by rewarding volume over value, the American health are system makes this type of unnecessary, unhelpful breast cancer treatments especially easy to provide. The incentives are all there to encourage doctors to provide more care, even if, like the older breast cancer treatment methods, it isn’t the best choice for the patient.

(Article Excerpt and Image from How we treat breast cancer exposes a huge systematic issue in American health care, December 10, 2014, www.news.yahoo.com).

Innovative New Therapy May Curb Need for a Mammogram in Orange County

A promising treatment for breast cancer may altogether scrap patients’ need for exposing themselves to the ill effects of radiation and chemotherapy, as well as the trauma of surgery. A team of researchers from Harvard University’s Wyss Institute of Biologically Inspired Engineering found a way to partially reverse the development of malignant cells in test mice and, subsequently, halt cancer. …

Why You Should Consider Visiting an Orange County Mammogram Facility

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Cancer is a frightening disease that typically strikes with little to no warning, and is best dealt with through prevention. In the case of breast cancer, NBC Los Angeles says that “while mammograms are not a cure for breast cancer, research has shown early and routine screenings are the best way for women to lower their risks of dying from breast cancer.” However, about 50 percent of all women who undergo regular mammograms don’t always follow through with their appointments.

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