Friday, December 15, 2017

OCMA Blog

Mission Dhulikhel, Nepal

Mission Dhulikhel, Nepal

November 11-22, 2015
This past November, under the umbrella of Arpan Global Charities CHOC and SJO doctors traveled to Nepal to exchange information and share their skills and time at the Kathmandu University Hospital in Dhulikhel, Nepal, an independent, non-profit  teaching hospital. Opened in 1996, the hospital, besides health services, also provides medical, dental and nursing schools, in collaboration with Kathmandu University.

The devastation from the 7.8 earthquake that killed 9,000 people and destroyed the area’s infrastructure in April 2015 was quite visible. The current fuel crisis was also evident causing the hospital to cook meals for patients and staff outdoors with wood.

Before the trip, some of the Dhulikhel surgeons requested needed supplies. SJO Interim Chief Medical Officer and orthopedic surgeon Paul Beck, MD, who made the trip along with his wife, internist Huong Thi  Duong, MD, cited arthroscopy shavers used to trim tissue in the knee as an example. “In the US we use these blades once but in Nepal they were reused and sterilized dozens of times and were quite dull.”  He has contacted a supplier in the US who will be donating new blades, although after the trip.

SJO NICU Medical Director and the founder of  Arpan Global Charities,  Sudeep Kurkreja, MD, and his wife, Song Kukreja, helped organize and participated in the trip. This Mission Dhulikel , Nepal was the 18th volunteer medical mission organized by Arpan Global Charities and was tremendously successful.  During this mission focus was more on teaching and education than service, although our team members examined and treated more than 300 patients and performed 65 surgical and dental procedures.  Every single day each team members gave 2-3 didactic lectures to their respective counterparts from Nepal as well as hands on demonstration of latest surgical procedures and skills. 

He continues, There is great need for exchange of knowledge and skills between the physicians and surgeons from US and Nepal.”  Dr. Ram Shrestha, the Vice Chancellor at Katmandu University Hospital in Dhulikhel, was very supportive of having an ongoing academic affiliation between Dhulikhel Hospital and SJH/CHOC.  We discussed at great length about developing exchange program between Kathmandu University Hospital in Dhulikhel and SJH/CHOC especially in the area of neonatology and pediatric surgery. SJH President and CEO Steve Moreau, who was part of this mission with his wife Anne, will be working with CHOC to facilitate this exchange.   

Also on the Nepal mission trip were anesthesiologist Jeffrey Sycamore, MD; dentist Vazrick Navasartian; pediatric infectious disease subspecialist Jasjit Singh, MD and her husband pediatric ENT Gurpreet Ahuja, MD; ophthalmologist David Yomtoob MD, and his wife Allison; pediatric nephrologist Dorit Ben-Ezer, MD and her daughter Maya; Hillary Nguyen, a SJO volunteer and Cal State Fullerton student; CHOC neonatal nurse Cindy Hecklau. All the volunteers paid for their own flight, meals, and accommodations at a lodge about a kilometer from the hospital.

This mission was not possible without contribution by each and every one of the volunteers and  our host team members at the Kathmandu University Hospital, Dhulikhel.

Anyone interested in upcoming mission trips with Arpan Global Charities can contact Dr. Kukreja at ArpanGlobal@gmail.com.

 


ASCO 2015 Update: Releasing the Potential of the Immune System

This article is brought to you by: John Link, MD of Breastlink

visit www.breastlink.com for more information

- The Annual Meeting of the American Society of Clinical Oncology (ASCO) provides an opportunity for thousands of oncologists and health care professionals to receive research updates and exchange ideas surrounding trends in cancer treatments.

More than 30,000 attend each year, making it one of the largest educational and scientific conferences dedicated to advancing cancer care. I recently joined my colleagues for the ASCO 2015 Annual Meeting, where a focus was on breakthroughs in immunotherapy.

What is Immunotherapy?

Immunotherapy refers to treatments that prompt the human body’s immune system to attack cancer cells. Cancer occurs when a genetic mutations occurs that causes a healthy cell to become cancerous. Can the immune system recognize these cancerous cells as harmful or are they too at home within the body?

Recently, we have determined that the immune system often does recognize cancerous cells. The immune system produces white blood cells called lymphocytes that target harmful substances, called antigens, within the body. In response to the development of some cancers, lymphocytes will gather around cancerous cells. However, they do not always infiltrate cancerous cells and cause them to die.

Some cancers produce certain proteins, such as programmed cell death 1 (PD1). These are similar to other naturally-occurring proteins that prevent the immune system from interrupting certain normal biological functions. For instance, these proteins prevent the body from rejecting a fetus during pregnancy. When a cancer cell produces PD1, it sends a message to lymphocytes to back off.

A relatively new class of drugs called PD1-inhibitors prevents cancer cells from disguising themselves as healthy cells. Several ASCO 2015 Annual Meeting presentations on PD1-inhibitors revealed that they were an effective treatment for several cancers.

  • Pembrolizumab – More than one-half of patients with advanced head and neck cancer experienced noticeable decrease in size of tumors following treatment with pembrolizumab.
  • Nivolumab – Tumors ceased growing in approximately one-half of patients with advanced liver cancer treated with nivolumab. Advanced lung cancer patients treated with nivolumab lived an average of three months longer than patients treated with docetaxel, a chemotherapy.

Immunotherapy in Breast Cancer Patients

Ongoing research is also investigating the use of PD1-inhibitors in breast cancer patients. In an early stage trial, 4 of 21 triple-negative breast cancer patients with the PD1 protein responded to a PD1-inhibitor currently under investigation. These results prompted the FDA to assign the drug, MPDL3280A, Breakthrough Therapy Designation, which is reserved for treatments that appear significantly more effective in clinical trials than existing treatments.

In an upcoming phase III trial sponsored by drug maker Hoffman-La Roche, researchers will investigate the use of MPDL3280A in combination with nab-paclitaxel, a type of chemotherapy, in patients with metastatic breast cancer. The phase III trial is currently recruiting patients. Eligible candidates include women with advanced triple-negative breast cancer with no prior chemotherapy or targeted systemic therapy for inoperable disease.

Breastlink will work with researchers as a clinical partner in ongoing MPDL3280A research. This means patients eligible to participate in the study can receive MPDL3280A at Breastlink locations in Orange County. At this time, Breastlink locations are the only sites in Orange County and Los Angeles County where patients can participate in this study. As part of our commitment to advancing innovative breast cancer therapies, Breastlink is excited to play a role in ongoing research and to offer patients an opportunity to participate.

One drug already approved by the FDA for breast cancer patients combines immunotherapy with conventional chemotherapy. Ado-trastuzumab emtansine ( T-DM1) uses an antibody called trastuzumab to target receptors present on cancerous cells in women with HER2-positive breast cancer. Once T-DM1 has bound to HER2 receptors, a chemotherapy agent called DM1 is delivered to the interior of cancerous cells, destroying them from the inside.

There are several benefits to immunotherapy over conventional chemotherapy and other targeted treatments. Researchers are continuing to produce evidence that immunotherapy improves clinical outcomes compared with conventional chemotherapy. Additionally, patients generally experience fewer side effects when treated. Immunotherapy also allows the immune system to develop a lasting memory of the antigen – in this instance, a type of cancer cell. If this specific type of cancer recurs, the immune system will continue to respond.

Developments such as those presented provide hope for a cure. The scientific and medical communities recognize new immunotherapy agents as huge breakthroughs. With these drugs, we can avoid treating more women with chemotherapy while improving their outcomes. At Breastlink, we are excited by these advancements and will eagerly track updates as they occur.


OC In+Care Newsletter - Issue 6


In this issue of the In+Care newsletter, we are going to discuss the Medi-Cal renewal process and some key things that may help your client(s) with their Medi-Cal redetermination packet. In Orange County, Medi-Cal is also called CalOptima.

What is Medi-Cal redetermination?

Medi-Cal recipients must have their eligibility assessed and verified every 12 months1. This process is to make sure clients are still eligible to receive Medi-Cal benefits. This process is different from Ryan White eligibility screening. If someone is receiving Ryan White services, they must continue to be screened for Ryan White eligibility every 6 months.

What will happen and what must be done?

Beginning in 2015, Medi-Cal will do a prescreening of recipients’ files to see if they are still eligible to receive services under Medi-Cal1. Clients may have received a Request for Tax Household Information (RFTHI) that must be completed for Medi-Cal to gain access to income information. If the information show that the individual is still eligible to receive Medi-Cal, their eligibility will automatically renew. Clients will receive a letter that states they are renewed for another year1. This means that they will not need to submit any information to continue being eligible for Medi-Cal.

However, if current or updated information is needed, a redetermination packet will be sent to the client asking for specific documents. Information needed is on a case-by-case basis1.

My client does not have a stable address, how can they complete the redetermination process?

Clients can call (800) 281-9799 or visit any Social Services Agency office (listed at the end of the newsletter) to complete the process.

My client received a redetermination packet, what are they supposed to do with it?

If the client receives a redetermination packet, provide all the required information before the due date indicated in the packet.

My client does not have a stable address or the address on file is wrong; what should they do?

Individuals can call (800) 281-9799 to see if they need to complete the redetermination process. If so, they can go to a Medi-Cal office (locations listed at the end of the newsletter) and find out what you need to do to get or keep coverage. If they need to update their address, they can call (800) 281-9799.

If my client has questions about the requested information who should they contact?

If there are questions, clients can contact their Medi-Cal worker or the contact person indicated in the redetermination packet.

Clients can also contact (800) 281-9799 for general Medi-Cal coverage questions.

When do clients have to return the completed redetermination packet?

The redetermination packet should have the due date when and all of the requested information must be provided. Make sure you do this as soon as possible before the due date.

What if clients do not submit their documents on time?

Medi-Cal benefits will be stopped. Clients will receive a Notice of Action that explains why their benefits have been stopped1.

The Notice of Action will also state that they have 90 days from the date of the Notice of Action, also called a “cure period”, to provide requested information2.

If the client provides the requested information within the 90 days after the notice, their benefits may be reinstated and there should be no break in Medi-Cal coverage. However, there may be delays in benefit claims if they are reinstated during the 90 day period.

If clients do not provide the information or the information submitted is not acceptable, their benefits will be stopped and they will have to reapply for Medi-Cal.

Can my client get ADAP for their medications if they are in the 90-day “cure” period?

No. Currently, ADAP guidelines states that clients cannot receive ADAP during the 90-day period. If clients receive a denial letter from Medi-Cal, they can apply to receive ADAP services with a Ryan White eligibility worker.

Can my client get Ryan White medical care if they are in the 90-day “cure” period?

No. Ryan White services are provided as payer of last resort. In order to receive Ryan White medical care a denial letter from Medi-Cal would be needed.

Should my client apply for Ryan White if they have Medi-Cal?

Yes. Ryan White covers services that are not covered by Medi-Cal (for example, food pantry, housing services, or legal services). Ryan White covers services that are partially covered by Medi-Cal (for example dental care). It is important to be screened for Ryan White eligibility to ensure they can access all the services they need and are eligible to receive.

Reminders:

  • Call (800) 281-9799 for Medi-Cal questions.
  • Clients should check and open your mail!
  • If clients change their address, they should let their Medi-Cal worker know.
  • If clients received a redetermination packet, they should provide the requested information as soon as possible to prevent a loss in coverage.
  • Clients can use https://www.mybenefitscalwin.org/ to help manage their Medi-Cal account online!

1 Department of Health Care Services. (2014, September 19). Medi-Cal Annual Redetermination Process for MAGI Beneficiaries (Reference ACWDL 14-18) Letter No. 14-32.

2 Department of Health Care Services. (2014, December 10). Medi-Cal Eligibility Division Information Letter No.: I14-60. Medi-Cal Renewal Process-The 90-Day Cure Period Job Aid.

 

Medi-Cal Locations
Hours of Operation: 7am-5pm, Monday-Friday

(800) 281-9799

Anaheim Regional Center
3320 E. La Palma Ave.
Anaheim, CA 92806


Garden Grove RegionalCenter
12912 Brookhurst St.
Garden Grove, CA 92840

Aliso Viejo RegionalCenter
115 Columbia
Aliso Viejo, CA 92656

Santa Ana Regional Center
1928 S. Grand Ave., BLDG. B
Santa Ana, CA 92705

 


Breastlink Celebrates 20 Years of Innovation in Breast Health Care

This article is brought to you by: Breastlink

visit www.breastlink.com for more information

This year marks 20 years Breastlink has helped patients with their breast health needs. As I reflect back upon our history I have never felt more strongly that our comprehensive, multidisciplinary approach to treat breast cancer best serves women.

I also believe, thanks to clinical research, we are on the cusp of discovering a real cure for many types of breast cancer in the next decade. Research has begun to reveal the genomic differences in cancer cells. This will lead to new, “targeted” agents that will significantly improve treatment options. Breastlink, through our work with the Cancer Research Collaboration, is involved in many of the promising clinical trials.

However, the reality persists that far too many women succumb to this truly horrible malady. Before we look to the future, I have outlined the history and progress of our practice.

History of Breastlink

In the 1970s, attitudes toward breast cancer treatment began to change for the better. Radical mastectomy had been the preferred method for treating breast cancer since the late 19th century. This procedure called for the complete removal of all breast tissue, the nipple, lymph nodes in the armpit, and muscles lining the chest wall beneath the breast.

During this time, women were rarely consulted about treatment. Some even awoke from sedation to find that the decision to remove their breasts had already been made for them.

The move toward a more individualized treatment approach was welcome. It became increasingly apparent that there were equally effective, more patient-friendly alternatives to radical mastectomy. As this occurred, more women refused the one-size-fits-all breast cancer treatment.

In 1979, the National Institutes of Health issued a statement declaring that surgery to treat breast cancer should preserve as much muscle tissue as possible. They also indicated radiation therapy could be administered as a primary treatment with limited surgery.

More importantly, the consensus statement recognized that a preoperative needle biopsy should be performed “before definitive therapeutic alternatives are discussed with the patient.”Physicians were finally beginning to realize that women should have a say in their treatment.

Inspired by the voices of women calling for a greater role in their treatment, as well as growing enthusiasm for the development of new and better ways to prevent, I helped to found one of the nation’s first comprehensive breast cancer treatment centers in 1985.

Helping to develop the breast cancer treatment center at the Long Beach Medical Center was an invaluable experience that would inform my decision-making when I set out to establish Breastlink.

Founded in 1995 as a single, outpatient facility in Long Beach, Breastlink has grown into a network of three outpatient breast cancer treatment centers. These centers offer women a multidisciplinary medical team and comprehensive services aimed at breast cancer screening, diagnosis, treatment and follow-up.

A Comprehensive Breast Cancer Care Model

Since breast cancer treatment paradigms began to shift in the 1970s, it has become apparent that a multidisciplinary approach to breast cancer offers women the most optimal care available.

A comprehensive breast cancer care model provides access to a coordinated team of multiple physicians practicing across different specialties. Using this model, a woman can have all of her breast cancer screening or treatment needs attended to by a single team working under the same roof.

As medicine has become increasingly specialized and new knowledge revealed how individual cancers behave differently, more and more types of physicians are included in breast cancer treatment. A breast cancer treatment team should include at least four or five different specialists, including:

Most physicians are inclined to practice what they know. For instance, a surgeon will most likely be inclined to believe that surgery is the best available treatment option. This is partly why radical mastectomy remained the standard of care for so long.

However, a multidisciplinary team working together can help physicians to look past professional biases. When we work together with each other and patients, the result is more appropriate treatment.

A comprehensive breast health care treatment model works most effectively when women are placed in a partnership with their physicians. The goal is to provide individualized care that is neither over-nor under-treated. Treatment should offer the best chance for survival with as few side effects as possible. Physicians can optimize treatment outcomes by offering a combination of education, compassion, communication and experience.

Providing comprehensive breast cancer treatment means treating the whole woman, not necessarily just the disease. Treatment must be compatible with women’s own beliefs and philosophies. Breastlink helps to accomplish this by providing numerous resources under one roof.

This includes physicians, nurses, researchers, medical assistants, psychotherapists and nutritionists. Each member of this treatment team, those seen and unseen, contribute to healing as defined by the woman being treated.

Looking Toward the Future of Targeted Therapies

Breast cancer is the result of gene mutations. Some mutations cause cells to achieve additional function, allowing them to grow out of control, or to become drug resistant and to spread to other parts of the body. Other mutations can cause cells to lose their function, which creates susceptibility to cancer.

Not all breast cancers are created equal. The underlying gene mutation that allowed cancer to begin growing will also dictate how that cancer behaves as it grows.

Growing knowledge of the relationship between gene mutations and breast cancers has led to the potential for evermore individualized treatments. For instance, in approximately 20 percent of cancers, a protein known as HER2 is present on the surface of cancerous cells. When this protein is present, cancers tend to grow especially quickly and aggressively.

To combat HER2-positive cancers, researchers and pharmaceutical makers have investigated drugs that specifically target this protein. Herceptin, introduced in the late 1980s, was one of the first of these targeted drugs to be developed. Herceptin can attach itself to HER2 proteins to slow cancer growth and promote chemotherapy response. We now have a number of anti-HER2 agents that target this type of breast cancer.

Herceptin is just one example of many targeted therapies, either on the market or being investigated. Targeted therapies are designed to attack a specific genetic mutation of the breast cancer.

It is important for women to learn about their individual cancer, as well as emerging treatment options and targeted therapies, to make an informed decision about treatment. Breastlink has been proud to participate in the research into these targeted therapies and to maintain up-to-date knowledge of ongoing research. This allows us to provide women the information they need to make a decision customized to their priorities and their disease.

Many gains have been made in our understanding of breast cancer over the past twenty years. Women have benefitted from advancements in prevention, screening and treatment. Research exploring new treatments and interventions show potential for continued improvement in breast health care.

A big part of what we do is clinical research. Over the next few years, we will expand our participation in research to help women have access to or receive therapies still under investigation.

Breastlink has worked with researchers for many years to improve access for patients to new drugs or therapies currently under investigation. Through a partnership with Cancer Research Collaboration, a non-profit organization, we are able to continue to offer our patients a robust opportunity to participate in the development of new agents and new tests.

This also provides researchers access to a team of clinical investigators with strong research backgrounds who can help to identify breast cancer patients that are qualified candidates for research projects. We believe partnerships such as these can improve process for delivery and approval of effective cancer therapies, and add to our collective knowledge of cancer. We strive for a future without breast cancer research moves us closer to this future.

I wish to thank my co-workers, colleagues, the community and, most of all, our patients for their support. Without you all Breastlink would not be possible. We look forward to working with you over the next 20 years and beyond to improve breast cancer care.

About Breastlink and Dr. John Link

John Link, MD is the founder of Breastlink and a leading medical oncologist dedicated to the care of women with breast cancer. To learn more about Dr. Link and Breastlink please visit Breastlink.com.


Eric G. Handler, M.D. Named the 2015 OCMA Physician of the Year

During the May 2015 OCMA General Membership Meeting, Eric G. Handler, M.D. was named the 2015 OCMA Physician of the Year.  The Orange County Register Coast Magazine put a spotlight on Dr. Handler’s achievement in their July issue.  Click here or on the link below and scroll through to page 135 to read more about Dr. Handler.

http://www.webpublished.com/gallery/view.asp?seq=280932&path=150624134129




USPSTF Recommendations Ignore Reality of Breast Cancer


This article is brought to you by: Breastlink

visit www.breastlink.com for more information

 

Annual mammogram screening beginning at age 40 saves lives. U.S. Preventive Services Task Force (USPSTF) recommends less frequent screening at a later age, not because screening will not save lives, but because it will not save sufficient numbers of lives when started before age 50. The recommendations are based on outdated, blemished data and do not evaluate cost-effectiveness or any other benefits of early detection. In fact, USPSTF states, “Screening mammography in women ages 40 to 49 years may reduce the risk of dying of breast cancer, but the number of deaths averted is much smaller than in older women and the number of false-positive tests and unnecessary biopsies are larger.”[1]

Women need to empower themselves with accurate information about screening to benefit from early detection.

The Reality of Breast Cancer in Younger Women

Women younger than 50 are diagnosed with and die from breast cancer. Research proves that mammogram screening can prevent breast cancer deaths in these women.

Nearly 65,000 women younger than 50 were diagnosed with breast cancer in 2013, according to the American Cancer Society. Nearly 5,000 women in this age group died from breast cancer.[2] Within its own recommendations, even USPSTF recognizes that mammogram screening contributed to a 15 percent decrease in breast cancer mortality among women aged 39 to 49.[3]

Decreasing mortality is not the only benefit from early detection with screening mammography – it is simply the most important benefit. There are many other potential benefits to identifying and treating cancer in its earliest stages:

·         Prevent chemotherapy

·         Prevent lymphedema

·         Limit surgery

·         Minimize radiation therapy

·         Decrease psychosocial impact

·         Maximize number of treatment options available

Mammogram is superior to clinical breast exam or self-exam at identifying small tumors. Tumors detected under 1cm in size, regardless of their biology, can almost always be treated without chemotherapy. About 20 to 30% of these tumors will have aggressive biology and if left to grow for one to two years, they would certainly require more aggressive treatment. USPSTF has failed to acknowledge the harms of chemotherapy needed for more advanced tumors.

Identifying tumors that have not spread to lymph nodes can minimize surgical and radiation treatments. Breast conservation and partial breast irradiation are options with early stage breast cancers. Surgical complications decrease when radiation can be avoided in the setting of mastectomy with reconstruction. Avoiding lymph node dissections also decreases the incidence of lymphedema. USPSTF has failed to acknowledge the burden of lymphedema when disease has spread to lymph nodes.

Aggressive treatments also represent a cost burden to individuals and to society. The total cost of treating all cancers exceeded $216 billion in 2009, according to the National Institutes of Health.[4] Breast cancer accounts for a significant portion of this. By detecting cancer at its earliest stages, the cost of cancer care can be greatly diminished. This cost burden inevitably has a direct psychosocial and economic impact to cancer patients, their families and society as a whole. The “harms” of a false-positive mammogram are almost trivial in comparison to the burden of advanced cancer care. USPSTF has failed to acknowledge the emotional and cost burden of delaying breast cancer diagnosis.

Due to significant advances in adjuvant therapies, death from breast cancer has improved even at advanced stages of diagnosis. However, USPSTF has failed to acknowledge 10 years’ worth of advancements in breast cancer treatment focused on minimizing surgery and radiation treatment when cancer is detected at early stage. These advancements have helped to decrease morbidity while improving quality of life for cancer survivors.  These benefits depend on early detection enabled by annual mammogram screening.    

It is irresponsible for USPSTF to describe harms of false-positives and anxiety of testing without discussing the benefits of avoiding aggressive treatment. Women should be empowered to make their own decisions about their health care. Failure to provide this information and limiting access to mammogram screening does not help to accomplish this. Furthermore, these “recommendations” made by USPSTF can be inappropriately used to limit insurance coverage for annual screening, prevent primary care providers and OB/GYNs from ordering screening, and discourage women from obtaining routine mammograms. By recommending annual screening beginning at age 40, women are encouraged to begin thinking about their breast cancer risk and breast health.

The Argument Against Mammogram Screening

USPSTF recommendations suggest women should begin screening at the age of 50 and continue screening every two years until the age of 74. This decision was made in 2009, reversing an earlier stance for annual screening beginning at age 40. A recent review of the 2009 decision upheld the reversal. These recommendations are based heavily on data provided by flawed research studies:

Canadian National Breast Screening Study

The Canadian National Breast Screening Study is one of the studies used to support current USPSTF recommendation.[5] Multiple independent researchers who reviewed this study noted multiple problems.[6]

·         Outdated mammogram technology from the 1970s.

·         Women included in the study were not appropriately placed in the screening and control groups.

·         Technicians performing exams did not receive special training in mammogram screening.

·         Radiologists interpreting mammograms were not trained specifically in breast imaging.

USPSTF recommendations also consider harms and risks like patient anxiety, false-positive results, recalls and overdiagnosis. These are important concerns to recognize, but are sometimes overstated. The Swedish Two-County Trial found that two lives are saved for every instance of overdiagnosis.[7] This trial also showed that recalls affected less than 1 in 20 women.

While it is necessary to talk about the harms and risks, physicians should discuss them with patients rather than denying them access to mammogram screening.

The Benefits of Mammogram Screening

The American Cancer Society, Society of Breast Imaging and American College of Radiology all recommend women receive mammogram screening once every year for as long as they are healthy. Numerous studies and data support this position.

National Cancer Institute SEER Data

While cancer treatments have improved, early detection enabled by mammogram has helped to reduce the mortality rate. Data collected by the National Cancer Institute over the last several decades supports this.

Mammogram Screening Rates

Breast Cancer Mortality Rates

1987: 22%

1990: 33%

2010: 67%

2010: 22%

Over a similar period of time, mammogram screening rates skyrocketed while breast cancer mortality rates decreased by one-third.[8][9]

University of Michigan Comprehensive Cancer Center

The ability of mammogram screen to aid early diagnosis is also evident in research published May 2014 in Cancer. Researchers compared data collected from 1977 to 1979 with data collected from 2007 to 2009. While incidences of early-stage breast cancer rose by one-half based on projected rates, incidences of late-stage breast cancer would have dropped 37 percent.[10]

Analysis of Mammogram Screening in Women Aged 40 to 49

Prior to its 2009 reversal, USPSTF recommended annual screening beginning at age 40. These recommendations relied on an analysis of eight randomized clinical trials, published 1997 in Journal of the National Cancer Institute.

Results from this analysis showed that women aged 40 to 49 benefitted from mammogram screening. Incidences of breast cancer and breast cancer deaths were lower among women aged 40 to 49 than for women aged 50 or older. A mortality reduction of 23 percent was noticed in this study when screening in women aged 40 to 49.[11]

More Deaths in Unscreened Women

A failure analysis published September 2013 in Cancer determined that most breast cancer deaths occur in women who do not receive routine screening. Unscreened women accounted for 71 percent of breast cancer deaths. Additionally, approximately one-half of these deaths were in women younger than 50.[12]

Breastlink Position

In summary, we agree with the USPSTF that screening mammography saves lives. We also agree with the American Cancer Society and many others that screening should begin at age 40 for average risk women and should occur annually while women are healthy. We believe this will maximize the benefit of early detection by not only saving lives, but also by reducing the need for more aggressive treatments.

Signed:

Dr. Nimmi Kapoor

Dr. John Link

Dr. John West

Dr. Lisa Curcio

Dr. Amy Bremner

Dr. Samantha Kubaska

Dr. June Chen

Dr. Wade Smith

Dr. Tchaiko Parris

Dr. Justin West

Dr. Mark Gaon

 



[1] U.S. Preventive Services Task Force. “Draft Recommendation Statement: Breast Cancer: Screening.” April 2015.

[2] American Cancer Society. “Breast Cancer Facts & Figures 2013-2014.” 2013.

[3] U.S. Preventive Services Task Force. “Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine. November 2009.

[4] National Heart, Lung, and Blood Institute. “NHLBI Fact Book, Fiscal Year 2012.” 2013.

[5] Miller et al. “Twenty-five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomized screening trial.” The BMJ. February 2014.

[6] Daniel B. Kopans. “Arguments Against Mammography Screening Continue to be Based on Faulty Science.” The Oncologist. February 2014.

[7] Tabár et al. “Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades.” Radiology. September 2011.

[8] National Center for Health Statistics. “Health, United States, 2013: With Special Feature on Prescription Drugs.” 2014.

[9] American Cancer Society. “Breast Cancer Facts & Figures 2013-2014.” 2013.

[10] Helvie et al. “Reduction in late-stage breast cancer incidence in the mammography era: Implications for overdiagnosis of invasive cancer.” Cancer. September 2014.

[11] Hendrick et al. “Benefit of Screening Mammography in Women Aged 40-49: A New Meta-Analysis of Randomized Controlled Trials.” Journal of the National Cancer Institute. January 1997.

[12] Webb et al. “A failure analysis of invasive breast cancer: Most deaths from disease occur in women not regularly screened.” Cancer. September 2014.


Do Breast Density Laws Improve Public Knowledge of Breast Density Issues?

 


This article is brought to you by: Breastlink

visit www.breastlink.com for more information



It is essential that women and their physicians understand how breast density affects breast cancer risk and screening. As of December 2014, 18 states had passed breast density laws to help improve public knowledge surrounding breast density by requiring radiologists to inform patients when mammography reveals dense breast tissue. Despite these developments, several recent surveys suggest that neither patients nor physicians fully understand the relationship between dense breast tissue, breast cancer risk, and breast cancer screening.

Patient Knowledge Regarding Breast Density

Public awareness campaigns to promote mammography screening have been effective and a significant reason breast cancer mortality has fallen over the past several years. In a survey conducted by the Working Mother Research Institute (WMRI), which we covered here, 70 percent of more than 2,500 respondents reported they had received a mammogram.

However, there seem to be gaps in public knowledge of the importance of breast cancer screening, particularly when it comes to breast density. Less than one-half of those surveyed for the WMRI report were aware that mammography is less accurate in women with dense breasts than those with fatty breasts. Only 13 percent were aware that dense breast tissue is a risk factor for developing breast cancer.

A recent international survey conducted by GE Healthcare, which included responses from 1,000 American women, returned similar results. Overall, 30 percent of respondents from 10 countries were not aware of the link between breast cancer and dense breast tissue. In the United States, less than 20 percent of women were aware of this link.

Physician Knowledge Regarding Breast Density

Physicians are partly to blame for the lack of widespread awareness around breast density. Primary care physicians have traditionally not received extensive training on breast density issues. These include dense breast tissue as a risk factor for breast cancer, the effect of dense breast tissue on mammogram sensitivity, and the use of supplemental screening in women with dense breast tissue.

To gauge how a breast density law in California has affected physician awareness, researchers from the University of California, Davis surveyed 77 primary care physicians. Results were published December 2014 in Journal of the American College of Radiology.

· About one-half were unaware that a breast density law had been passed.

· About two-thirds reported no change in patient concern regarding breast density.

· About one-fifth reported they had never had a patient bring up a breast density notification letter.

· Six percent reported they were “completely comfortable” answering questions regarding breast density.

· Three-fourths expressed interest in attending an educational presentation on breast density issues.

Researchers concluded that the California breast density law did not lead to a rise in familiarity of breast density issues among primary care physicians. “The results of this study suggest that 10 months after enactment of the California Breast Density Notification Law, the intent of the legislation has not been fully realized,” wrote lead author Kathleen A. Khong, M.D.

Breastlink is committed to sharing accurate, up-to-date facts regarding breast density with our patients and the physicians we work with. This includes information posted to our website and shared in our offices, continuing medical education courses, and educational community events. We believe that knowledgeable, well-informed patients and physicians working together leads to shared-decision making that results in the best possible outcomes.

To learn more about breast density, whether you are a patient of physician, please get in touch using our online ‘Contact Us’ form.


Up in the Cloud: Is It Safe to Store Protected Health Information on Remote Servers?

What exactly is the cloud? Cloud storage is a network of remote servers that allow for centralized data storage and online access to these resources. Your files are stored on a server connected to the Internet instead of being stored on your own computer’s hard drive. The cloud is convenient and cost-effective, providing a way to automatically back up your files and folders. 

Despite these benefits, recent publicity around hacks of public cloud storage websites has raised concerns about whether it is appropriate for medical practices and facilities to store health records and information in the cloud. 

Is cloud storage a safe way to store protected health information (PHI)? As with many new technologies, the safety level of the cloud, and whether it’s appropriate for use, depends on the vendor. There are several issues you will have to keep in mind:

  • Are the vendor’s security standards appropriate? You will have to research each vendor you choose. Make sure the company has a good reputation and solid security policies. 
  • How much data will you be storing? Ensure the vendor can handle the amount of data you would like to move to the cloud.
  • Ensure your data is encrypted when being uploaded to or downloaded from the cloud. This is also your responsibility. Make sure your browser or app requires an encrypted connection before you upload or download your data. 
  • Make sure your data is encrypted when stored in the cloud. Data protected by law, such as medical information or personal identifiers, should never be stored in the cloud unless the storage solution is encrypted. Only selected members of your organization should be able to decrypt the data, and your organization should create policies detailing under what circumstances information can be decrypted. 
  • Understand how access is shared in your cloud folder. Many cloud storage providers allow you to share access to your online folders. Be familiar with the details on how that sharing works. Awareness of who has access and how is critical to monitoring activity within your stored data.
  • Understand your options if the cloud provider is hacked or your data is lost. Virtually all cloud service providers require a user to sign an agreement that the user has very little, if any, remedy if a hack or a loss of data occurs. 

Cloud storage can be a valuable asset to medical practices and facilities, but make sure you have absolute confidence in the service provider’s ability to keep the data safe and secure. 

Contributed by The Doctors Company. For more patient safety articles and practice tips, visit www.thedoctors.com/patientsafety.


ATTN OCMA Members: Amendment to Bylaws for Review-2015

Dear OCMA Membership,

The Bylaws Committee of the Orange County Medical Association has reviewed and updated the organization's bylaws. The revisions have been approved by the Board of Directors and now need to be approved by the general membership. Therefore, for the next two months (April and May 2015) you may review the revised Bylaws by Clicking Here

 
Please submit any comments in writing via email to ocma@ocma.org or mail to 17322 Murphy Avenue, Irvine, CA 92614.



 


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