Double mastectomies found unnecessary in 70 percent of breast cancer patients

premature ovarian failureGiving up a physical part of one’s body is never an easy decision to make. This is especially true for women who suffer from breast cancer and get a mastectomy, or the removal of a breast. Still, a recent trend has been on the rise as women get double mastectomies, but according to a new study, as many as 70 percent of women who have a mastectomy do not need one, prompting researchers to worry about over-treatment and an increased chance of premature ovarian failure.

“People want absolute certainty,” breast surgeon Monica Morrow at the Memorial Sloan-Kettering Cancer Center said. “Unfortunately, even having a double mastectomy doesn’t provide certainty that breast cancer will not recur. So it’s a false sense of security.”

Morrow is a co-author of a paper that will be presented at the American Society of Clinical Oncology’s Quality Care Symposium in San Diego.

Another co-author, Sarah Hawley, of the University of Michigan, said double mastectomy “does not make sense” for about three-quarters of the women who are choosing the operation “because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast.”

The study examined 1,446 women that had been treated for breast cancer using traditional approaches, such as chemotherapy and DHEA fertility treatments and none had the cancer come back. Researchers found that, of the women who had a mastectomy, 20 percent had both breasts removed. That came out to a total of 7 percent of the women who had a double mastectomy performed.

Many women who have double mastectomies do so because they worry about the breast cancer recurring in the other breast. In fact, while 90 percent of women diagnosed with breast cancer worried about the possibility of cancer in the healthy breast, researchers say that cancer in one breast does not affect the chances of cancer in the other.

The more radical operation makes medical sense, Hawley says, for fewer than 10 percent of women with early breast cancer. Those include the 1.5 percent who have a genetic mutation called BRCA-1 or BRCA-2 and another 8 percent who have a strong family history, which means two or more immediate relatives who’ve had breast or ovarian cancer.

Regardless, researchers concluded women who do not fall into either of those situations, a double mastectomy as a preventative measure is likely overkill. The procedure also comes with a host of complications and leads to a more difficult recovery. Some women will also need to undergo radiation or chemotherapy, which will further delay their treatment and can result in a poor ovarian reserve.

“One of the biggest fears when you get a cancer diagnosis is, if I go through this treatment, can I be done, can I go on and live my life and not have to worry about it coming back?” Hawley says.

“I have seen young women who leave the office having signed up for lumpectomy,” Morrow says, “and they call back the next day and say, ‘Well, I was on the Internet or I was talking to my friends and they said I’m a young mother, don’t I want to do everything I can to be there for my child? I think I want a double mastectomy.’ “

New virtual reality simulator helps prepare doctors for brain cancer surgery

neurosurgery new jerseyA new virtual reality simulator is now providing neurosurgery trainees with the opportunity to practice brain cancer surgery techniques, according to a paper in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.

The neurosurgery New Jersey community is expected to change once the prototype system, called “NeuroTouch” gets on the mainstream market. NeuroTouch uses 3-D graphics and haptic technology to provide a realistic look and feel for practice in performing common tasks in brain cancer surgery.

With the a computer similar to those used to run popular video games, the software reproduces what a neurosurgeon sees through the operating microscope during surgery—including detailed, lifelike renderings of brain tissue, blood vessels, and tumors. The system also includes tool manipulators that give tactile feedback similar to what the surgeon would feel during surgery.

The NeuroTouch system was developed by a team of more than 50 experts from the National Research Council Canada, with input from surgeons at more than 20 Canadian teaching hospitals. The goal was to design a simulation system to provide neurosurgical trainees a realistic  learning program.

In one program task, the trainee must remove a brain tumor while leaving normal tissues intact, using two different suction devices. In this simulation, the system provides touch and visual cues to discriminate between healthy tissue and brain tumor.

In another task, the trainee is assigned to remove a vascularized tumor while controlling blood loss. The blood vessels and tissues are designed to look realistic and even have normal human heart pulsations. The vessels bleed when the surgeon applies a cutting tool and stop bleeding when he or she uses a cautery tool.

The two tasks were developed using 3D reconstructions of magnetic resonance imaging scan data from actual patients. With further development, the system may be used not only to practice basic procedures, but even to allow neurosurgeons to simulate and practice actual operations, based on the patient’s own MRI scan.

Medical simulators—similar to those used to train airline pilots—are increasingly viewed as a cost-effective complement to traditional surgical training for any aspiring neurosurgeon NJ. A commercially available simulator has proven effective in helping trainees perform minimally invasive gallbladder surgery more rapidly, with a lower risk of patient injury.

Breast Cancer: 6 Tips for Reducing Your Risk

Avoid Smoke: You don’t have to be a smoker in order to increase your risk for cancer. According to a 2005 study by the CEPA young women (before menopause) have an increased risk for breast cancer when exposed to second hand smoke. Be sure to help your loved ones around you quit smoking in addition to steering clear of smoky hangouts in bars and other public locations.

Get Moving: To cut your risk of breast cancer by 18% aim for at least 4 hours of cardiovascular exercise per week as recommended by the National Cancer Institute. Meeting this minimum helps with reducing the amount of estrogen in your blood stream which many cancerous tumor depend on.

Get Colorful: Studies show that eating at least 5 servings of fruits and vegetables per day can protect you against cancer development. Aim for a wide variety of colors such as green, red, orange, purple, and yellow. Keep in mind that the deeper the hue of the produce – the more cancer-fighting properties it has.

Skip Alcohol: Did you know that each alcoholic drink that a woman consumes each day increases her risk for breast cancer by 12%?

Loose Weight: Even being just a little bit overweight can have a big impact on your risk for developing breast cancer. Excess pounds increase the amount of insulin and estrogen in your body – both of which feed cancerous tumors.

Careful with Your Meat: Eating red meat, pork, fish, chicken, etc. cooked over a BBQ or at high temps can create chemicals called HCA which increases your risk for stomach, colorectal, pancreatic and breast cancer.

Prostate Cancer Treatment to Be Covered By Medicare

Medicare announced that they will pay for Provenge, a prostate cancer treatment drug which has demonstrated efficiency in improving health outcomes.

The Centers for Medicare and Medicaid Services (CMS) approved the drug stating “The evidence is adequate to conclude that [Provage] improves health outcomes for Medicare beneficiaries [with metastatic prostate cancer] and thus is reasonable and necessary for that indication.”

The Cost of 4 Extra Months

The prostate cancer treatment drug is an immunotherapy vaccine which was approved in April of 2010 by the FDA. It treats advanced prostate cancer by harnessing the immune system to attack cancerous cells. Clinical trials showed that, on average, patient’s lives were extended by 4 months with treatment. Provenge is given in 3 infusion doses, each 2 weeks apart. The total cost of treatment is approximately $93,000.

This announcement by CMS came as a bit of a surprise as Provenge has been controversial with regards to it’s cost. Many feel that the price of the treatment is not proportional to it’s demonstrated ability to extend lives only by a few short months. The CMS, however, is not supposed to take cost into consideration when making decisions about drug approval.

Increasing Access

This approval no doubt will greatly increase access to this prostate cancer treatment as more than 3/4 of men diagnosed with prostate cancer are at an eligible age for Medicare coverage. Furthermore, private insurances typically follow in suit with Medicare approvals.

Prostate cancer is the second most common cause of cancer death in men and there are currently 2 million men living in the US who have been diagnosed at some point in their lives. The average age at diagnosis is 72. As of now the only treatments for prostate cancer are surgery, radiation, chemotherapy, and hormone therapy.

UPDATE: Melanoma Treatment Drug Approved

The new melanoma treatment drug, Yervoy was, indeed, approved by the FDA on Friday as expected. Last week I blogged about the anticipated FDA decision to allow this drug to be available to the public. The FDA announcement came ahead of it’s Saturday deadline.

This new melanoma cancer treatment drug extends the life of patients by an average of 32 percent.

Dr. Gerald P. Linnette of Washington University and a participant in the Yervoy clinical trials said, “This is really the first time in the melanoma field that there is a drug that extended survival in a meaningful way.”

The Brisol-Meyers drug is expected to cost $120,000 for the complete treatment of 4 intervenous infusions administered over the course of 3 months.

The drug works by activating the immune system rather than attacking the cancerous cells themselves.

This is the fist melanoma cancer treatment drug to be approved in 13 years. The last drug, named interleukin-2, was approved in 1998 but is not very effective and rarely used.

“This is a very exciting time in the field of melanoma,” said Perry Robins, MD, President, The Skin Cancer Foundation. “As melanoma incidence continues to rise, we are hopeful that this new therapy will extend life and improve the quality of life for those patients with metastatic melanoma.”