Cancer screening and conflicts of interest

Last week, several Times readers asked about the membership of the U.S. Preventive Services Task Force, the group that came out with the controversial finding that for most women, mammograms can wait until age 50. So we pointed to this site, where you'll see them all listed. By the way, all were appointed during the Bush administration, but they are not political appointees. So it's not fair to blame either the former or current president if you don't like their recommendations.

Now, for another side of the story, check out this article by Dr. Adriane Fugh-Berman, who my colleague Kris Hundley has quoted in her excellent stories about how the pharmaceutical industry exerts its influence with physicians to get them to prescribe their drugs. Fugh-Berman is an associate professor in the department of physiology and biophysics at Georgetown University Medical Center, and director of PharmedOut. Her co-writer Alicia M. Bell is the project manager and research assistant for PharmedOut.

The readers who wanted to know about the USPSTF membership theorized they had conflicts of interest that would cause them to recommend fewer mammograms.

Fugh-Berman and Bell point  to another kind of conflict, noting, for instance, that the manufacturers of breast imaging devices and breast biopsy products are faithful donors to groups like the American Cancer Society.

Of course, plenty of people with no such conflicts give to ACS and other cancer charities. But still, this seems worth noting in what is shaping up to be a continuing debate.

Charlotte Sutton, health and medicine editor

Let's talk about mammograms and Pap tests

This has been quite a week for women's health. First a prestigious medical panel tells us that for most women, mammograms can be put off until age 50, rather than 40, and can be repeated every-other-year, rather than the annual ritual many of us have been following.

Then another prestigious medical panel says Pap tests, which catch cervical cancer at its earliest stages, can be done every other year until age 30, and every three years after that.

We have a lot of questions about all this, and figure you do, too, and so we've invited Dr. Jennifer Gilby (pictured above), an ob/gyn at Bayfront Medical Center in St. Petersburg, to join us for a live chat here on the Personal Best blog, Monday at noon.

We'll field your questions about the screening tests, their advantages, their limitations, and how women can catch problems early -- and even better, help to prevent cancer from ever developing in the first place.

So, please join us Monday at noon. If you can't make it, please leave me your questions for Dr. Gilby in the comment area below, and check back later to see the transcript of the chat.

Charlotte Sutton, health and medicine editor

Quit smoking

It's expensive. It stinks. It's bad for your health. It's bad for your loved ones. It's even bad for pets exposed to passive smoke. Quit or make a plan to quit smoking today during the 34th annual Great American Smokeout. Free help is available through the American Cancer Society.

Irene Maher, Staff Health Writer

New mammogram findings: What's next?

There's been a huge uproar over this week's findings by a government task force that most women don't need to start getting mammograms until age 50.

We've known for a long time that breast cancer -- the No. 2 cancer killer of American women -- is far more common in women over 50, and that screening tests for younger women aren't as accurate, and could mean a lot more exposure to false positives, radiation and anxiety than is warranted by the actual help the test can provide.

St. Petersburg Times reporter Letitia Stein recently reported on the shortcomings of mammograms as a screening tool, including this stunning statistic: You have to screen 1,000 women to save one life.

But this isn't just a scientific issue -- it's also a hot-button political topic. In fact, as this Washington Post story explains, a different panel of medical experts made the same recommendation years ago, but the subsequent political outcry -- including a unanimous vote by the U.S. Senate -- quickly squashed it.

Many opponents of the new recommendations fear that they are based in a desire to save money, although the U.S. Preventive Services Task Force  staunchly denies that cost was a factor in its review of more than 40 scientific studies of mammography. But there's no doubt mammograms are expensive. Sure, we've seen ads for $65 mammograms, but the real cost is significantly higher -- hundreds of dollars. Here's one expert who puts it closer to $1,000, if you count everything, including depreciation on the machines.

So, not surprisingly, a lot of people are saying this is all an effort to help insurance companies save money by not having to cover so many mammograms. This afternoon, U.S. Health and Human Services Secretary Kathleen Sebelius stepped up to the microphone to assure us that nothing's changing in that regard.

“The task force has presented some new evidence for consideration but our policies remain unchanged,” she said. “Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

Members of Congress already are decrying the new recommendations, with some hinting that they're tantamount to healthcare rationing.

What do you think?

Is the U.S. spending too much money on mammograms at the expense of other health priorities? Is every life saved by mammography so invaluable that it's just wrong to worry about the cost? Are American women getting a false sense of security every time they get their annual mammogram?

Let's talk about it.

Charlotte Sutton, health and medicine editor.

AP Photo of Rep. Michele Bachmann, R-Minn., center, flanked by Rep. Cathy McMorris Rodgers, R-Wash., left, and Rep. Marsha Blackburn, R-Tenn., during a news conference on Capitol Hill in Washington, Wednesday, to discuss the new mammogram guidelines.

Breast cancer awareness: Is a mammogram worth it?

To screen or not to screen? This question has been much in the news as of late. With breast cancer, in particular, women hear a lot about the benefits of mammography, but not so much about the downsides.

As a health reporter, I explored the pros and cons of mammography in an article in today's St. Petersburg Times. As a women, I feel very conflicted.

I'm still a good decade away from my first recommended mammogram, but I'm no stranger to cancer. It's everywhere in my family.

Dad's had several large polyps removed from his colon. Mom's battled thyroid cancer. Both of my grandmothers had breast cancer. My aunt (my mother's sister) passed away a few years ago at age 56 from multiple myeloma, a rare and especially deadly cancer.

And I'm the dark-haired, Eastern European descendant known as an Ashkenazi Jew, from whom female cancers are particularly common.

During a recent doctor's visit, my gynecologist looked over my family history and asked if I wanted to be tested for the BRCA gene, which would indicate a higher likelihood of breast and ovarian cancer. I was there for something else, and brushed off the question. I wasn't ready to face the anxiety of waiting for test results, and in a worst case scenario, heart-wrenching decisions about removing my breasts and ovaries.

I am going to talk to my parents to learn a little more about the cancers on both sides of my family tree. But I know there aren't going to be clear-cut answers. All of my grandparents are dead, and two passed away when my parents were just children, so we'll never know if they would have developed cancer.

As the nation debate health care reform, I can see where it's a terrible waste of resources to be screening me for cancers that are unlikely. Those tests aren't without their own risks of complications. And there's nothing easy about this individual's decision to screen or not to screen.

Letitia Stein, Times health writer

Fertility after cancer: Moffitt Cancer Center holds out fertile hope

What price would you pay to survive a life-changing diagnosis like breast cancer? The loss of your breasts? The loss of your chance of having a child?

As cancer survivor rates improve, Moffitt Cancer Center is trying to help younger cancer patients hold onto their baby hopes. It is holding a free event on Monday, Oct. 26, to talk about cancer and fertility.

The event runs from 5:30 to 8:30 p.m. at the Vincent A. Stabile Research Building, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa. To R.S.V.P., call 1-888-MOFFITT.

The issues involved are thorny and emotionally charged. Life-saving treatments like chemotherapy can leave cancer survivors unable to reproduce. Fertility options for patients of child-bearing age include sperm banking and egg retrieval, but decisions often have to be made quickly.

Learn more about the issue and one woman's story in a recent article from the St. Petersburg Times.

Letitia Stein, Times health writer

Can green tea stop prostate cancer?

Men who have early signs of prostate cancer are needed for a study at Tampa's Moffitt Cancer Center that is investigating whether a compound in green tea can stop those early signs from progressing.

Participants in the one-year study, funded by the National Cancer Institute, will receive a capsule made from substances in green tea, called Polyphenon E, or a placebo. So if you're not a tea-drinker, no worries; you just have to swallow a pill.

To be eligible for this study, men must:
 
Be between 30 to 80 years old and have a biopsy-proven high-grade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) in the prostate diagnosed within the past six months
Have no history of prostate or other cancer (other than nonmelanoma skin cancer)
Have no history of kidney or liver disease
Be able to take the study drug and comply with scheduled monthly visits for one year
 
Participating research sites include:
Moffitt Cancer Center
James A. Haley Veterans’ Hospital
University of Florida
The University of Chicago
Thomas Jefferson University, Philadelphia
Louisiana State University, Shreveport
 
Principal investigator is Nagi Kumar, Ph.D., R.D., F.A.D.A.
 
For more information, call 1-888-MOFFITT and ask for information on the green tea study.

[Photo: Brand X Pictures]
 

Breast Cancer Awareness

October is National Breast Cancer Awareness month. Many doctors encourage women to start monthly breast self examination at age 20. BSE enables some young women to find cancer before they are old enough for annual mammograms, which the American Cancer Society says should begin at age 40.

Irene Maher, Staff Health Writer

UCH takes on breast care and high heels

'Tis is the month for breast cancer fundraisers. But here's one you don't see every day: Men in heels.

At the second annual Heroes 'N Heels fundraiser on Saturday, male employees from University Community Hospital and business executives will be donning stilettos to walk a mile in "her shoes."

The goal is to raise money for mammograms for women who can't afford them, a concern heard too often at UCH's Breast Center.

This year, organizers hope to raise $50,000. To learn more about the event, contact Nikki Powers at (813) 615-7663 or npowers@mail.uch.org.

-- Letitia Stein, Times health reporter

Bring on the pink ribbons ... and Botox?

Breast Cancer Awareness month starts today, and you know what that means -- the annual mix of vital information, worthy fundraisers, pink products .... and creative promotions. Here are a couple that I found in my email; let me know of more and I'll post them for all to see.

BJ’s Wholesale Club in Tampa is hosting a Pink Picnic on Friday featuring a local breast cancer survivor who will share her battle with the disease and answer questions at the event. There also will be an expert there from H. Lee Moffitt Cancer Center & Research Institute to talk about breast cancer screening, treatments and research.

Plus, you get a free lunch and coupons, and who doesn't like that? The picnic is Friday from 11:45 to 12:45 at BJ's, 7651 W Waters Ave., Tampa. While you're there, check out the pink ribbon products on sale to support cancer research. R.S.V.P. today to BJ’s Community Relations Specialist Laura Ferrario at lferrario@bjs.com. 
 
I already have a nominee for the most, er, creative breast cancer promotion: Tampa dermatologist Seth Forman, who says he'll donate one dollar for every unit of Botox sold at his office.

"Besides skin cancer, breast cancer is the most commonly diagnosed cancer among American women,” says Dr. Forman in a press release. “If I can do something to raise awareness and money for the cause, I’m happy to do it.”

I'm not quite getting the connection between skin cancer and Botox, but at any rate, his goal is to sell 5,000 units in October, and if he reaches it, he'll throw in another $5,000 cash.

What about you? What's the best/most interesting/most dubious Breast Cancer Awareness month promotion you've heard of? And feel free to give a shout out for friends who are participating in efforts to raise money for the cure, too.

Charlotte Sutton, health and medicine editor