Payment Rates May Affect Breast Cancer Treatment

Use of a costly breast cancer therapy called intensity-modulated radiation therapy is strongly influenced by what Medicare will pay for the treatment and where radiation oncologists practice, according to a new study. Researchers analyzed Medicare data for 26,163 women with localized breast cancer who had surgery and radiation therapy between 2001 and 2005. During that time, Medicare billing for the treatment, called IMRT, increased more than 10-fold (from 0.9 percent to 11.2 percent of patients).

The average cost for radiation treatment within the first year after breast cancer diagnosis was $7,179 without IMRT and $15,230 with it. Billing for IMRT was five times higher in regions of the country where the treatment was covered by local Medicare carriers than it was in areas where it was not covered, the researchers said. They also found that billing for IMRT was more common among patients treated in freestanding radiation treatment centers (7.6 percent) than among those treated in hospital-based outpatient clinics (5.4 percent).

The findings "suggest that with respect to breast radiation therapy, much of the variation in cost can be directly attributed to inconsistent treatment definitions and reimbursement rates authorized by Medicare and its intermediaries," concluded Dr. Benjamin D. Smith, of the M.D. Anderson Cancer Center in Houston, and his colleagues. The study is published in the April 29 online edition of in the Journal of the National Cancer Institute.

Tissue Analysis May Help Predict Breast Cancer Outcome

An analysis of breast tissue may help doctors better predict outcomes for women with breast cancer, a new study reports. Researchers analyzed what they describe as "highways" of connective tissue in breast cancer tumors, and found that the way collagen fibers the main component of connective tissue are arranged may aid in a patient's diagnosis and help determine treatment. Collagen not only surrounds most body organs and helps provide structure for the body, it also tells cells how to behave, the study authors noted. Normally, a close-up of collagen resembles a jumbled path or a plate of cooked spaghetti.

In the new study, the researchers analyzed tumor cells from 200 patients with invasive breast cancer. The investigators found signs that the collagen began to act differently as the tumors progressed. "We think the cancer cells start to pull on the collagen and straighten it out, forming a track or highway on which the cells can migrate," study senior author Patricia Keely, an associate professor of cell and regenerative biology at the University of Wisconsin-Madison School of Medicine and Public Health, said in a university news release. As the highways became more developed, the prognoses for patients worsened, the study found.

"We have identified a novel collagen-signature system that may become a very useful addition to the tools clinicians use to determine a breast cancer patient's prognosis," Keely explained. The research is published in the March issue of the American Journal of Pathology. Commenting on the study, Dr. Priscilla A. Furth, a professor of oncology and medicine at Georgetown University's Lombardi Comprehensive Cancer Center, described it as an example of "valid basic research." However, "before any new prognostic test can go into practice it must be extensively validated. This publication is a first step that might trigger additional research to examine the utility of this type of analysis in different settings and by different groups," said Furth, who was not involved with the study.

Drop in Breast Cancer Among White Women May Have Stalled

Many American women abandoned hormone replacement therapy after a 2002 study found the treatment was tied to higher breast cancer risk. A sharp drop in breast cancer incidence among whites was observed soon after. However, a new study suggests that the 2002-2003 decline in breast cancer incidence among white women did not continue through 2007. The data suggests that the drop in breast cancers linked to women abandoning hormone replacement therapy (HRT) has now bottomed out.

Breast cancer rates among U.S. white women fell by about 7 percent between 2002 and 2003 after the release in 2002 of findings from the Women's Health Initiative study that linked HRT with an increased risk of breast cancer. To examine whether that trend has continued, American Cancer Society and U.S. National Cancer Institute (NCI) researchers reviewed breast cancer data collected from 2000 to 2007 by NCI Surveillance, Epidemiology and End Results (SEER) registries across the country.

The analysis revealed that the sharp decline in breast cancer rates among white women that occurred between 2002 and 2003 did not continue between 2003 and 2007. Instead, breast cancer rates among white women remained relatively stable from 2003 to 2007. "Postmenopausal hormone replacement therapy certainly had accounted for an increase in the incidence of developing a breast cancer. The use of postmenopausal HRT had sharply declined after multiple reports proved this relationship," noted one expert, Dr. Sharon M. Rosenbaum-Smith, a breast cancer specialist and surgeon at the Comprehensive Breast Center at St. Luke's-Roosevelt Medical Center in New York City.

Breast Cancer Treatment May Lead to Hip Fracture

Middle-aged breast cancer survivors face an increased risk for hip fractures, a condition normally uncommon in women younger than 70, a new study has found. Researchers at Northwestern University in Chicago say that this may be because early menopause caused by breast cancer treatment and the effects of breast cancer drugs could weaken the bones by the time women reach middle age. The finding came from a study of six women who had survived breast cancer and, in their early 50s, were being treated for hip fractures.

Most of the women did not have osteoporosis, but they did have lower-than-normal bone mineral density (osteopenia). This suggests that rapid changes in bone architecture caused by chemotherapy, early menopause and adjuvant breast cancer therapy may not be detected on a bone mineral density test, said Dr. Beatrice Edwards, an associate professor of medicine and orthopedic surgery and director of the bone health and osteoporosis program Northwestern University's Feinberg School of Medicine, who led the research.

The women had been diagnosed with early-stage breast cancer, and their treatments had included lumpectomy, radiation therapy and chemotherapy with cytoxan and adriamycin for one to four years before they broke a hip. All of the women were perimenopausal at the time of the fracture. In four of the women, their breast cancer had grown in response to estrogen, and their cancer therapy had included aromatase inhibitors to prevent their bodies from making estrogen. Recent research has linked aromatase inhibitors with possible bone loss in women.

Breast Cancer Outcome: Your Doctor Matters

How doctors choose to treat their breast cancer patients and whether those treatment choices follow established recommendations may play a larger role in whether a cancer returns than experts have believed. In a new analysis looking at 994 women with ductal carcinoma in situ, the most common type of noninvasive breast cancer, researchers found treatment variations from surgeon to surgeon are significant, and may account for up to 30 percent of recurrences.

"Treatment variation is a troubling but well-known phenomenon in health care," said study author Andrew W. Dick, a researcher at RAND Corp. in Pittsburgh. The report is published online Jan. 3 and in the Jan. 19 print issue of the Journal of the National Cancer Institute. "The reason it is surprising in this case is that the variation is quite large, and related to factors that are very important in health outcomes," Dick said.

Those factors include having "negative margins" meaning that cancer cells are more than 2 millimeters away from the removed tissue's edge and getting radiation therapy after breast-conserving surgery. The variation by surgeon in treatments accounted for 15 percent to 35 percent of cancer occurring in the opposite breast in the next five years and 13 percent to 30 percent of recurrences over 10 years, the investigators found.

Weight-Lifting After Breast Cancer Won't Cause Lymphedema

Contrary to conventional wisdom, lifting weights doesn't cause breast cancer survivors to develop the painful, arm-swelling condition known as lymphedema, new research suggests. There's a hint that weight-lifting might even help prevent lymphedema, but more research is needed to say that for sure, the researchers said. Breast cancer-related lymphedema is caused by an accumulation of lymph fluid after surgical removal of the lymph nodes and/or radiation. It is a serious condition that may cause arm swelling, awkwardness and discomfort.

"Lymphedema is something women really fear after breast cancer, and the guidance has been not to lift anything heavier even than a purse," said Kathryn H. Schmitz, lead author of the study to be presented Wednesday at the San Antonio Breast Cancer Symposium. " to tell women to not use that affected arm without giving them a prescription for a personal valet is an absurdist principle," she added. A previous study done by the same team of researchers found that exercise actually stabilized symptoms among women who already had lymphedema.

"We really wanted to put the last stamp on this to say, 'Hey, it is not only safe but may actually be good for their arms," said Schmitz, who is an associate professor of family medicine and community health at the University of Pennsylvania School of Medicine and a member of the Abramson Cancer Center in Philadelphia. "It's almost like a paradigm shift," said Lee Jones, scientific director of the Duke Cancer Institute's Center for Cancer Survivorship in Durham, N.C. "Low-volume resistance training does not exacerbate lymphedema."

Recent Stress May Reduce Cancer Therapy Effectiveness

Physical or mental stress one or two days before cancer treatment may reduce the effectiveness of the therapy, researchers have found. In a series of experiments using breast cancer cell cultures, a research team at Ohio State University found that mental and physical stress including rigorous exercise activates a stress-related protein that can trigger a chain reaction that enables cancer cells to survive cancer treatments. Specifically, the investigators discovered that the presence of the heat shock factor-1 (HSF-1) protein could impair the process that kills cancer cells even after their DNA was damaged by radiation or chemotherapy, according to the report published in the Sept. 21 online edition of the journal Molecular Cancer Research.

It may be possible to develop drugs that suppress HSF-1 and use these drugs as a supplement to cancer therapy, the study authors suggested in a university news release. In the meantime, patients should try to avoid physical and mental stress in the days before cancer treatment, they recommended. "One of the known inducers of (HSF-1) is exercise. I am not against exercise, but the timing is critical. It looks like any intense or prolonged physical activity a couple of days before the start of cancer therapy is highly risky, and has potential to reduce the benefits of treatment," lead author Govindasamy Ilangovan, an associate professor of internal medicine, said in the news release.

Absent Father Might Mean Earlier Puberty for Higher-Income Girls

Girls growing up in higher-income homes without a biological father are likely to reach puberty earlier than others, new research finds. "In higher-income families, father absence predicted earlier puberty, but it did not in lower-income, father-absent," said study leader Julianna Deardorff. "Girls in upper-income households without a father were at least twice as likely to experience early onset of puberty, as demonstrated by breast development," she said. The researchers defined higher income as $50,000 or more a year.

Early maturation in girls is linked with emotional and substance use problems and earlier sexual activity. These girls also face a higher risk for breast cancer and other reproductive cancers later in life. Previous research has linked absent-father households and earlier puberty, but this study adds more information, said Deardorff, an assistant professor of public health at the University of California, Berkeley. "We were looking at very early signs," such as breast development and the growth of pubic hair, she said. Other researchers have focused on the start of menstruation without looking at factors such as income and ethnicity, according to background information in the study.

Girls are reaching puberty earlier in the United States, where the average age of menstruation is about 12 years, Deardorff said. Recent research has found some girls starting to develop breasts as early as age 7 or 8. For their study, published Sept. 17 in the Journal of Adolescent Health, Deardorff and her colleagues followed 444 girls, aged 6 to 8 at the start, and their mothers. They gathered extensive data on factors such as weight, height, stage of breast and pubic hair development, father's presence and income. Eighty percent of the girls said their fathers did not live with them.

Radiation Exposure Raises Likelihood of Second Cancer

Radiation exposure increases the risk that cancer survivors will go on to develop another malignancy, finds a new study. It was known that radiation exposure can cause cancer but it wasn't known whether it increases a person's risk of developing more than one. In order to find out, American and Japanese researchers analyzed data from more than 10,000 survivors of the atomic bomb attacks on Hiroshima and Nagasaki who developed primary cancers. "We found that radiation exposure increased the risks of first and second cancers to a similar degree," study first author Dr. Christopher Li, a breast cancer epidemiologist and a member of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center in Seattle, said in a center news release.

"People exposed to radiation who developed cancer also had a high risk of developing a second cancer, and the risk was similar for both solid tumors and leukemias in both men and women," Li said. The link between radiation exposure and second cancers was especially strong for radiation-sensitive cancers such as leukemia and tumors of the lung, colon, breast, thyroid and bladder. The study appears in the Sept. 15 issue of the journal Cancer Research. "Our findings suggest that cancer survivors with a history of radiation exposure should continue to be carefully monitored for second cancers," Li said. He also thanked his Japanese colleagues for their collaboration. "Through innumerable publications, [they] have transformed the tragedy of the atomic bombings to fundamental scientific advancements that have impacted radiation protection standards and policies worldwide," Li said.

U.S. Meets Initial Breast-feeding Goal, Falls Short on Others

Seventy-five percent of U.S. newborns delivered in 2007 started life breast-feeding a figure that meets federal goals but that rate plummeted to 43 percent at six months and 22 percent at one year, a federal government study released Monday shows. Half of the states had breast-feeding initiation rates above 75 percent, which is the National Healthy People's 2010 goal. That program also calls for 50 percent of infants to continue breast-feeding for six months and 25 percent for one year, said the U.S. Centers for Disease Control and Prevention's 2010 Breast-feeding Report Card. "Meeting the national breast-feeding initiation goal is a great accomplishment in women's and children's health, but we have more work ahead," Dr. William Dietz.

"We need to direct even more effort toward making sure mothers have the support they need in hospitals, workplaces and communities to continue breast-feeding beyond the first few days of life so they can make it to those six- and 12-month marks," he said. The report shows that breast-feeding initiation rates ranged from 52.5 percent in Mississippi to nearly 90 percent in Utah. Breast-feeding rates at six months ranged from about 20 percent in Louisiana to more than 62 percent in Oregon, while rates at one year ranged from 8 percent in Mississippi to nearly 40 percent in Oregon.

U.S. hospitals had an average score of 65 out of 100 possible points on a CDC survey that measures infant nutrition and care, according to the report card. The scores ranged from 50 in Mississippi to 81 in New Hampshire. Less than 4 percent of U.S. births occur at facilities designated as Baby-Friendly, a program sponsored by the World Health Organization and UNICEF. The program outlines 10 steps that support the initiation of breast-feeding and identifies hospitals that meet internationally recognized standards for maternity and breast-feeding support. "High initiation rates tell us that a lot of moms plan to breast-feed, but these rates do not indicate that a birth facility is doing what it need to support them in their effort," Carol MacGowan, public health advisor for the CDC division, said in the news release.

Cosmetic Surgery Not a Help for Body Dysmorphic Disorder

One in five people with a condition known as body dysmorphic disorder (BDD) undergo cosmetic procedures, but only 2 percent of them experience a reduction in the severity of their condition after their treatment, researchers say. "BDD is a psychiatric disorder characterized by preoccupation with an imagined or slight defect in appearance, which causes clinically significant distress or functional impairment. A majority of these individuals believe they have an actual deformity that can be corrected by `cosmetic treatments to fix these perceived defects rather than seeking psychiatric interventions," study co-author Dr. Katharine A. Phillips, director of the body image program at Rhode Island Hospital, said in a hospital news release.

Phillips and her colleagues looked at 200 people with BDD and found that 31 percent sought and 21 percent underwent surgical or minimally invasive cosmetic treatment. Among those who actually had a cosmetic procedure, most continued to have BDD symptoms afterwards, and in some cases they developed new preoccupations with their appearance, the researchers noted. The investigators also surveyed 265 cosmetic surgeonsand found that 178 (65 percent) reported treating patients with BDD. But among those cases, only 1 percent of the treatments resulted in symptom improvement for patients with BDD, the study authors reported.

"These findings, coupled with reports of lawsuits and occasionally violence perpetrated by persons with BDD towards physicians, have led some to believe that BDD is a contraindication for cosmetic treatment," Phillips said. The most common surgical procedures sought by BDD patients are rhinoplasty (nose jobs) and breast enlargements, while the most common minimally invasive treatments are collagen injections and skin treatments known as microdermabrasion, the study authors noted. The researchers also found that three-quarters of procedures requested by BDD patients involved facial features and that more than one-third of patients received multiple procedures.