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.
The racial disparity between white and black cancer patients in accessing timely treatments has virtually disappeared in states where Medicaid expanded under the Affordable Care Act (ACA), according to a new study. Yale Cancer Center researchers analyzed more than 30,000 health records and found that, prior to Medicaid expansion, black adults with advanced or metastatic cancer were 4.8 percentage points less likely than white adults to begin treatments within 30 days of being diagnosed. But in states where Medicaid was expanded, in 2014 or later, the percentage of black patients getting timely treatment rose from 43.5 percent to 49.6 percent. There also was a small improvement in expansion states among white patients receiving timely treatment – from 48.3 percent to 50.3 percent – bringing the post-expansion difference between the two racial groups to less than one percentage point. “Our results suggest that Medicaid expansion led to improved health equity,” said study author Amy Davidoff, a senior research scientist at Yale School of Public Health and in Yale Cancer Center’s Cancer Outcomes, Public Policy, and Effectiveness Research Center (COPPER).
The state Medical Examining Board Tuesday placed a Yale Cancer Center doctor’s license on probation for five years, saying his excessive abuse of alcohol affects his ability to practice as a physician. The board accepted a consent order that said Dr. Harris E. Foster Jr. abused alcohol to excess at various times between 2012 and May of this year. Last week, the cancer center’s website listed Foster as a professor of urology at the Yale School of Medicine and as the director of female urology and neuro-urology at the center in New Haven. After a reporter inquired about his status, the cancer center’s website on Tuesday only listed him as a urology professor. Mark D’Antonio, a spokesman for Yale New Haven Hospital, said Tuesday that Foster is still affiliated with the cancer center, but he cannot comment further because Yale does not comment on personnel matters.
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.
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.
The U.S. Supreme Court’s decision today to invalidate a Utah company’s long-held patents on genetic testing for breast and ovarian cancer is expected to result in the test being more accessible to women, at a lower cost, experts say. The court’s 9-0 decision comes four years after the American Civil Liberties Union on behalf of 20 named plaintiffs, including Ellen Matloff, director, Cancer Genetic Counseling at the Yale Cancer Center, filed a lawsuit charging that the patents held by Myriad Genetics of Utah on the DNA of two genes, known as BRCA1 and BRCA2, is unconstitutional and should be ruled invalid. The lawsuit also challenged Myriad’s right to set prices on their exclusive testing that critics said “locked out” some women from affording the life-saving test, which costs about $3,450. “I am thrilled with the decision. I think it’s been inhumane for one company to make the call on how much these important tests will cost,’’ said Marya DiPerna, of Naugatuck, whose own BRACAnalysis genetic test was negative a year ago. The patent “made it unavailable to those whose insurance won’t pay for it and who cannot personally otherwise afford it,’’ added DiPerna, who applauded the decision. “I was lucky that my husband’s insurance covered the cost because my sister, a deployed Marine’s wife, had breast cancer. She had to fight for her test while she was sick and at first, she was denied,’’ added DiPerna. Her sister could not afford to pay for the test while she was in treatment and raising her children alone as a military mom.