Wednesday, June 29, 2011

Survival Benefit With Mammography After 30 Years

By Charles Bankhead, Staff Writer, MedPage Today
Published: June 28, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
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Action Points  
§  Explain that almost 30 years after initial mammography, screened women continue to have a significantly lower breast cancer mortality risk compared with unscreened women.

§  Note that while the relative benefit has remained virtually unchanged, the absolute benefit has increased over time because the number of deaths prevented increases with longer follow-up time.
Almost 30 years after initial mammography, screened women continue to have a significantly lower breast cancer mortality risk compared with unscreened women, according to the latest results from a landmark Swedish study.
Women randomized to screening mammography were 30% less likely to die of breast cancer as compared with women who did not undergo breast imaging.
The relative benefit has remained virtually unchanged since Swedish investigators reported the first results (Lancet 1985;1(8433):829-832).
However, the absolute benefit has increased over time, as reported in an article published online in Radiology.
"Evaluation of the full impact of screening, in particular estimates of absolute benefit and number needed to screen, requires follow-up times exceeding 20 years because the observed number of breast cancer deaths prevented increases with increasing time of follow-up," Laszlo Tabar, MD, of Falun Central Hospital, and coauthors wrote in conclusion.
The Swedish Two-County Trial was the first study to demonstrate a reduction in breast cancer mortality from mammographic screening alone. A consistent benefit in favor of screening has persisted in periodic follow-up reports.
The subsequent reports after 15, 20, and 25 years of follow-up also showed a growing absolute benefit in terms of lives saved by screening mammography.
"Because breast screening prevents deaths in the medium to long term, rather than in the immediate future, long-term follow-up (at least 15 years) is required to estimate the absolute number of breast cancer deaths prevented," Tabar and coauthors wrote in their introduction.
The trial began in 1977, as women ages 40 to 74 living in two Swedish counties were organized into population clusters, and the clusters were randomly assigned to screening mammography or to usual care. When enrollment ended, the trial comprised 133,000 women, 77,000 randomized to screening mammography and 56,000 to usual care.
The screening phase of the trial lasted for about seven years.
Follow-up ended in 2005 in one of the two counties involved in the trial and in 2006 in the other county, resulting in total follow-up of 28 to 29 years.
Breast cancer cases and deaths were determined by a local endpoint committee and by overview committee consensus data.
By local adjudication, 1,426 breast tumors were detected in the mammography group, and 351 patients died of breast cancer. The authors reported that 498 (35%) tumors were symptomatic at diagnosis, accounting for 186 (53%) of breast cancer deaths in the group.
In the control group, 367 breast cancer deaths occurred among the 56,000 patients in the group.
The overview committee consensus analysis showed that 339 breast cancer deaths occurred in each arm of the trial. Both analyses showed a significant mortality reduction in women assigned to screening mammography.
The local endpoint committee found a 31% reduction in the relative risk of breast cancer mortality in screened patients (RR 0.69, P<0.0001). Overview committee consensus data showed a 27% reduction in breast cancer mortality risk (RR 0.73,P=0.002).
Reviewing the impact of screening on breast cancer mortality over time, Tabar and coauthors noted a 26% risk reduction by local adjudication after 10 years of follow-up, increasing to 30% after 15 years and remaining at 30% through 25 years of follow-up.
The overview committee consensus data showed a 20% reduction in breast cancer mortality risk after 10 years, increasing to 27% after 15 years and remaining at that level through the remainder of follow-up.
"At 29 years of follow-up, the number of women needed to undergo screening for seven years to prevent one breast cancer death was 414 according to local data and 519 according to consensus data," the authors wrote. "Most prevented breast cancer deaths would have occurred (in the absence of screening) after the first 10 years of follow-up."

Tabar and coauthors had no relevant disclosures.
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CONNECT EDUCATION WORKSHOPS

Like all of CancerCare’s services, our workshops are completely free of charge — no phone charges apply. However, pre-registration is required to secure your place on the call. To register for a workshop, please select from the list below and fill in your contact information.
If you have any questions, please email CancerCare’s Education Department atconnect@cancercare.org.

Upcoming Connect® Workshops

  1. JUN29
    Cancer and the Workplace
  2. JUN30
    Current Trends in Oral and Head and Neck Cancer
  3. JUL12
    Fear of Recurrence and Late Effects: Living with Uncertainty
  4. JUL26
    Living With Multiple Myeloma, Part II: Coping with the Stress of Caregiving When Your Loved One Has Multiple Myeloma
  5. AUG18
    Update on the Treatment of Liver Cancer
  6. AUG23
    Update on Lymphoma from the 2011 American Society of Clinical Oncology (ASCO) Annual Meeting
  7. AUG25
    Progress in the Treatment of Oral and Head and Neck Cancer
  8. SEP14
    Living With T-Cell Lymphoma, Part I: Update on Cutaneous T-Cell Lymphoma
  9. OCT12
    Living With T-Cell Lymphoma, Part II: Update on Peripheral T-Cell Lymphoma
  10. NOV16
    Living With T-Cell Lymphoma, Part III: Managing Treatment Side-Effects
  11. DEC16
    Update on Lymphoma from the 2011 American Society of Hematology (ASH) Annual Meeting

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Tuesday, June 28, 2011

Avoiding the “Spinach Effect”: Not Letting Cancer Define Me

June 28, 2011 by Editor
It’s an honor to host Tracy Seeley, author of My Ruby Slippers: the Road Back to Kansas on her book tour this week.
Avoiding the “Spinach Effect”: Not Letting Cancer Define Me
I used to think that mentioning my breast cancer at a social gathering was a bit like having spinach on my teeth.  I might have brilliant things to say about a movie I’d seen, or a funny story to tell about my garden.  But I feared that people would see only that shred of dangling spinach.  They couldn’t hear beyond the “cancer, cancer, cancer” ringing in their ears.  They couldn’t see me.
So I decided I wouldn’t talk about it.   After finishing treatment in September of 2002 (surgery, chemo and radiation), I wanted to be more than my cancer.  I’m a writer, a reader, a thinker, a teacher, a friend, a gardener, a lover of walks.  I like sewing and art and good food and cats.  I care deeply about the state of our beautiful, blue planet, and the lives of my daughters and friends.  So when anyone asked about my health, as they would, I’d say, “Thanks for asking, but I prefer not to talk about it.” And then I’d switch the subject.
But then I started writing My Ruby Slippers.  Writing a memoir might seem a funny thing to do for someone dedicated to privacy.  But I thought I could pull it off: write my own story without including the cancer part.   You might guess this didn’t quite work.  Cancer had reshaped my view of the world.  It had changed me.  So how could I leave it out?  After writing 100 pages of a cancer-free first draft, I knew I had to start again.
Writing My Ruby Slippers let me tell the story of my going back to Kansas, which was the story I wanted to tell.  That journey had led me to reconnect with and heal a difficult childhood and reconcile myself to the place I’d grown up.  But writing also helped me include my cancer story as only one aspect of my life, not the defining one.  It allowed me to frame my cancer on my own terms instead of the fearful terms that others might use.  I began to see my writing as a way of helping others see beyond the spinach on my teeth.
As I write in one section of My Ruby Slippers, cancer “whatever else it might be, is also a Rorschach test, a screen on which other project their own fears of mortality….If they would be afraid, I must be.  If they would feel the chill of shortening days, I must wear a sweater.”  But that’s not the way I see this disease or the way it feels to me.  It’s not a dark cloud or a dangling sword; and it’s “not the house I live in…it’s simply the road I walk.”
My cancer metastasized in 2006, and is now my chronic companion.  I mention that with some trepidation, because saying the words still feels like spinach in my teeth.  But I tell you this because even though the cancer road will not end for me until, well, it ends for good, that’s still not where I dwell.  For along that road lies a host of wonders, relationships, pleasures, and the full complexity of me.
______________________________________________________________________________________________________________
Tracy Seeley lives and writes in Oakland, California, with her husband, filmmaker Frederick Marx and three formerly feral cats.  An avid if amateurish organic gardener, she longs for a flock of backyard chickens.  In her free time, she’s an English Professor at the University of San Francisco.
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Monday, June 27, 2011

Nearly Half of Older Breast Cancer Patients Don't Get Recommended Radiation

PHOTO: Nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy despite guidelines that radiation after a mastectomy can save lives.
Nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy despite guidelines that radiation after a mastectomy can save lives. (Getty Images)
By LARA SALAHI (@LaraSalahiABC)
June 27, 2011

Nearly half of older women with advanced stage breast cancer who undergo a mastectomy don't receive radiation therapy, despite guidelines that say it can save lives, according to a report released Monday in the journal Cancer.
Researchers from MD Anderson Cancer Center in Houston looked at data for more than 38,000 women age 66 and older who underwent a mastectomy after a breast cancer diagnosis between 1999 and 2005. Nearly 8,000 of whom had an advanced form of the disease.
Although major guidelines released during the six-year period recommended radiation therapy after mastectomy for women with advanced forms of the disease, nearly half of the women whose records the researchers analyzed during that period did not receive the therapy.
Some women may have opted out of radiation therapy, said Dr. Benjamin Smith, assistant professor of radiation oncology at MD Anderson Cancer Center, and co-author of the study.
The women who were less likely to receive radiation were over age 80, suggesting that some of the women may have favored quality of life over duration of life.
But more likely, Smith said, the results suggest a disconnect between knowing what recommended guidelines state and following them.
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"Historically, radiation therapy was not thought to be helpful after mastectomy," said Smith. "So this bias against radiation after a mastectomy still probably exists to a certain extent."
Previous research found that women were more likely to receive radiation after a mastectomy if their surgeon recommended it. But, according to ABC News' chief health and medical editor Dr. Richard Besser, treatment, even beyond breast cancer treatment, is subjective for each patient.
"Difference in care doesn't mean that any one patient is getting suboptimal care," said Besser. But, he said, it is important for patients to understand what treatment is best for them. Besser suggested bringing someone along to an appointment to make sure the treatment options are understood.
Besser also suggested the following checklist of questions that may help patients make more-informed choices about their care:
What is my condition called?
What are my treatment choices, and what are the pros and cons of each one?
What treatment do you recommend for me and why?
Do you have written information about my condition that I can read? Can you recommend a good website or support group?
Can I follow up with you by phone if I have any additional questions?
Where can I go for another opinion?
While many patients may hesitate to ask their doctor to direct them somewhere else for a second opinion, many doctors are happy to do it, he said. And asking these types of questions could help patients understand what's best for them and to feel better informed about their medical care.
"I think more people are more apt to get a second quote for their car insurance than get extra quotes for medical care," said Besser. "Asking the right questions could mean the difference between right and better care.
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