In states where Medicaid was expanded under the Affordable Care Act (ACA), women are more likely to receive breast cancer diagnoses at an early stage, compared with women in other states, new research shows. Among women younger than 50, the average rate of diagnosis at advanced stages lowered from 23% to 21% between 2012-13 (before most states expanded Medicaid) and 2015-16 (after expansion), according to a Yale Cancer Center study published today in JAMA Surgery. In states where Medicaid wasn’t expanded, the average rate of advanced-stage diagnoses stayed constant at 26% during those years. “It’s a small percentage change [in expansion states] but it was statistically significant,” said Dr. Tristen Park, senior author of the study and a breast cancer surgeon at the Yale Cancer Center and Smilow Cancer Hospital, especially since the drop was evident over just a few years. “It’s quite exciting.
A new study—the largest of its kind—says that women who are diagnosed with the most common type of early-stage breast cancer most likely don’t need chemotherapy after they’ve had endocrine (hormone) therapy. The news could lay to rest some anguished conversations between doctors and patients. When a woman is diagnosed with breast cancer, all medical muscle goes toward eliminating the cancer and reducing the possibility of a recurrence. But for many women, chemotherapy can have disastrous results. This study says that if the additional treatment isn’t necessary—or has little measurable positive effect—many women can skip it.
A genetic test that helps doctors determine how best to treat breast cancer—and whether chemotherapy is likely to help—is significantly more likely to be administered to white women than blacks or Hispanics, a Yale study has found. The test, called Oncotype Dx (ODx), uses gene expression to gauge how early-stage breast cancer is affecting patients’ gene activity. It uses the information to determine how likely cancer recurrence would be, and physicians and their patients can use that knowledge to decide how to proceed with treatment. Yale researchers retrospectively analyzed a group of more than 8,000 Connecticut women who were diagnosed with hormone receptor positive breast cancer between 2011 and 2013, and found “significant racial and ethnic disparities in use of this new gene test,” said study leader Dr. Cary Gross, a member of Yale Cancer Center and professor of medicine and epidemiology at Yale School of Medicine. “It reinforces that, at the same time we are investing in developing new treatments and new testing strategies and we’re promoting them with great excitement, we really need to double-down our efforts to eliminate disparity,” Gross said.
Edith Baker of Plainville faced a devastating reality that patients with advanced cancer inevitably confront. She had stopped responding to conventional treatment. Radiation and chemotherapy could no longer contain her stage 4 bladder cancer. But there was a ray of hope. Baker’s oncologist at Saint Francis Hospital and Medical Center referred her to a clinical trial at UConn Health involving two immunotherapy drugs: the FDA-approved Keytruda (pembrolizumab) from Merck & Co., credited with successfully treating former President Jimmy Carter’s melanoma; and Epacadostat (IDO1 inhibitor), an experimental drug from Incyte Corp.
Connecticut has seen significant reductions in deaths from breast and colon cancer in the last three decades, but the state exceeds the national mortality rate for uterine cancer and three other cancers, as well as for mental health and substance use disorders. An analysis of data compiled by the Institute for Health Metrics and Evaluation at the University of Washington, published in JAMA, also shows wide disparities between Connecticut counties in death rates from certain cancers and other illnesses. Windham County had the highest mortality rates for seven of 10 cancers identified in the study as having the highest disease burden or responsiveness to screening and treatment, including pancreatic, uterine and lung cancer. Tolland County, meanwhile, had the lowest death rates for five cancers, including breast cancer, while Fairfield County was lowest for four. Similarly, deaths from chronic respiratory diseases in Windham County were nearly double the rate in Fairfield County – 63.13 per 100,000, compared to 34.15.
Thousands of metastatic breast cancer patients nationwide have given researchers access to their tumors and DNA in the hopes it will lead to breakthrough treatments and therapies for one of the most deadly forms of cancer. As the groundbreaking study enters its second year, more than 2,900 women and men have signed on to participate in the Metastatic Breast Cancer Project (MBCproject) since it launched Oct. 20, 2015. Spearheaded by the Broad Institute of the Massachusetts Institute of Technology and Harvard, the project aims to find possible new treatments for the disease by examining patient-submitted DNA and medical records. Thirty-eight patients from Connecticut have expressed interest in the project and 21 of them have taken the next step and signed consent forms granting researchers access to their medical files and DNA as of November, according to Corrie Painter, the cancer researcher directing the MBCproject.
Black women with breast cancer fare worse than other women when treated with early chemotherapy, according to new research from the Yale Cancer Center. Typically, black, Hispanic and Asian women are more likely to undergo neoadjuvant chemotherapy, or chemotherapy prior to surgery, than white women because they are more likely to develop advanced-stage breast cancer. But the new study found that black women are less likely to benefit from the treatment. The finding is significant because it proves further research is needed, and could impact how future research and treatment options are pursued for black women, said Brigid Killelea, the study’s first author and associate professor of surgery at Yale School of Medicine. “African American women didn’t respond as well to the chemotherapy when a pathologist looked at the tumors under a microscope after [subsequent] surgery,” she said.
When the American Cancer Society announced new guidelines for mammograms a week ago, the response on the organization’s Facebook page was swift. “For adoptees, this just adds 5 more years of potential unknowing,” wrote Angela from Connecticut. “Without a medical history, we are denied mammograms through insurance carriers.”
And then Dr. Henry Jacobs, a Hartford area longtime OB-GYN who, among other duties, serves as the Connecticut State Medical Society president, took to Facebook, too, and posted a message that summarized the general rage: “It is clear that rationing care is the new sales pitch and sacrificing women that could live out their lives is considered acceptable. I think it is UNCONSCIONABLE!!!!!!! We can afford athletes, entertainers, CEOs, hedge fund scammers that make upwards of a 100 million $$$$$ a year, but we can’t provide decent medical care to people???
Breast cancer patients who have additional tissue removed during a partial mastectomy are half as likely to need a second surgery, according to a Yale Cancer Center study released today. The study could have a major impact on thousands of patients, sparing them a second operation, according to researchers. “No one likes going back to the operating room, especially not the patients who face the emotional burden of another surgery,” said Dr. Anees Chagpar, the study’s lead author, associate professor of surgery at Yale School of Medicine and director of The Breast Center, Smilow Cancer Hospital at Yale-New Haven. Nearly 300,000 women nationwide are diagnosed with breast cancer each year. Most of them have early stages of the disease, and more than half of those undergo partial mastectomies to remove the cancer, Chagpar said.
Missed Wednesday’s chat on breast cancer? If you did, you can view the discussion with Dr. Kristen Zarfos by going to courant.com/beyondpink. Zarfos, the director of the Comprehensive Breast Health Program at The Hospital of Central Connecticut, division of the Hartford HealthCare Cancer Institute, answered questions on mammography, genetic testing and lifestyle risks, among others. This live chat was a collaboration of the Conn. Health I-Team (www.c-hit.org), which in October held a forum on breast cancer, and the Hartford Courant.