When the lights power on in the operating room at Bridgeport Hospital, more than a half of the acute care team of surgeons peering from behind the masks are women. That’s unusual, given that only 28 percent of all surgeons in Connecticut are female, according to the latest figures from the American Medical Association (AMA). Flexible work schedules and hiring more surgeons to ease the on-call burden has helped to lure more women to the trauma surgical team, said Bridgeport Hospital’s chief medical officer, Dr. Michael Ivy, a trauma surgeon. Hospitals statewide have launched initiatives to help boost the ranks of women surgeons. There’s been progress, but gaps persist.
Declines in several key cancer-screening procedures among the elderly can be linked to shifts in screening guidelines issued by major public health organizations, according to recently released findings by Yale researchers. James Yu, associate professor of therapeutic radiology at the Yale School of Medicine, and Sean Maroongroge, a third-year medical student, gleaned data from Medicare billing records from 2000 to 2012, analyzing more than 230 million screenings for prostate, breast, and colorectal cancers. Yu, a member of the Yale COPPER Center (Cancer Outcomes, Public Policy, and Effectiveness Research Center), and Maroongroge, also tracked evidence-based screening guidelines issued by five prominent organizations: the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists (ACOG), the American College of Gastroenterology (ACG), and the American Urological Association (AUA). They found that the rates for mammography, which is the primary means of screening for breast cancer, declined 7.4 percent overall during the period studied; prostate screening rates rose 16 percent during the first seven years studied then declined to 7 percent less than the 2000 rate by 2012. Colorectal cancer screening rates also dropped overall.
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.
Medicare-funded breast cancer screenings jumped 44 percent from $666 million to $962 million from 2001 to 2009, yet those added costs did not improve early detection rates among the 65 and older Medicare population, according to a Yale School of Medicine study published recently in the Journal of the National Cancer Institute. The increase was due mostly to the use of costlier digital mammography ($115 per screening) compared to film mammography ($73 per screening), along with newer and expensive screening and adjunct technologies, including breast ultrasound, magnetic resonance imaging (MRI) and biopsy. The study is the second from Yale since January 2013 to conclude that increased Medicare spending for breast cancer screening does not necessarily translate into better outcomes. The latest study has spurred debate about the cost and value of mammography in Medicare beneficiaries, particularly women 75 and older. Some physicians recommend continued screening, while others argue that it is unnecessary and only fuels anxiety among older women.
Thanks to the CT-N Connecticut Network, C-HIT’s women’s health forum — “Beyond Pink: New Frontiers In Screening, Treating & Preventing Cancer” — is available on demand. C-HIT’s Oct. 21 forum featured a panel discussion by leading breast cancer experts: Dr. Anees Chagpar, the head of the Breast Center – Smilow Cancer Hospital at Yale-New Haven, Dr. Kristen Zarfos, a surgeon at the Hospital of Central Connecticut, and Dr. Regina Hooley, a Yale radiologist. They were joined by U.S. Rep. Rosa DeLauro. To view the video, click here.
Connecticut’s share of funding from the National Cancer Institute has dropped 19 percent since 2010 – a steeper decline than many other states, an analysis of National Institutes of Health (NIH) data show. Federal cancer institute funding to Connecticut fell to $33.4 million in 2014 – down from $41.1 million in 2010. The biggest grantee, Yale University, is receiving $7 million less from the National Cancer Institute (NCI), one of the NIH’s most prominent centers. Overall, NIH research grants to Connecticut fell to $461.3 million – down from $484.4 million in 2010, NIH reports show. Most of that decline was in research awards to Yale, which dropped $25 million.
Dr. Erin Hofstatter, a young research scientist and breast cancer specialist at Yale’s Smilow Cancer Hospital, often prescribes tamoxifen, raloxifene and similar drugs to her patients. The drugs “reduce your risk (of cancer recurring) by half … but they come with baggage,” she tells her patients, “hot flashes, night sweats, leg cramps, small risk of uterine cancer, small risk of blood clots, small risk of stroke, you have to get your liver tested.”
Hofstatter’s unease with standard treatments for breast cancer has spurred her to seek alternative, safer ways to treat breast cancer. To this end, she has begun a study of black cohosh, in the pill form of an herb from the buttercup family, used for thousands of years by Native Americans to treat menopausal symptoms.
“There’s data to suggest that [black cohosh] is protective,” she said, “both in breast cancer survivors and potentially preventive in women who’ve never had breast cancer, based on a few large observational trials.”
Just as practices like acupuncture and meditation – once considered, at best, nontraditional are now widely used to help patients cope with the side-effects of cancer treatments and other illnesses, natural products – foods (blueberries, walnuts, soy), herbs like black cohosh and plant-based anti-oxidants like capsaicin (which makes hot peppers hot) have become accepted subjects for research. But far from simply embracing these practices or foods, scientists now apply rigorous scientific methods to what are considered non-traditional medications to determine just how effective – or ineffective — they are. A similar scientific focus is being directed at exercise, diet, and meditation.
US Rep. Rosa DeLauro and leading breast cancer experts from The Breast Center-Smilow Cancer Hospital at Yale-New Haven and the Hospital of Central Connecticut will be the featured panelists at a unique community forum organized by the Connecticut Health I-Team (www.c-hit.org), a non-profit news service that provides in-depth coverage of health care issues. The forum – “Beyond The Pink Ribbon: New Frontiers In Screening, Treating and Preventing Cancer” – will focus on the latest inroads and challenges in breast cancer detection and treatment. The event is open to the public, and early registration (at www.c-hit.org) is encouraged. Proceeds from ticket sales will benefit The Breast Center – Smilow Hospital and C-HIT’s ongoing health journalism. Speakers include: Dr. Anees Chagpar, director of The Breast Center – Smilow Cancer Hospital at Yale-New Haven, who led the effort for Yale to become the first NCI designated Comprehensive Cancer Center in the Northeast to have a nationally accredited breast center; Dr. Regina Hooley, a radiologist and researcher at the Yale Cancer Center who specializes in ultrasound screening, mammography and breast density; and Dr. Kristen Zarfos, a renowned surgeon and women’s health specialist at the Hospital of Central Connecticut who led a successful grassroots campaign to ban “drive-through” mastectomies in Connecticut.