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News from Annals of Internal Medicine Dec. 8, 2014

December 08, 2014

1. Breast density notification laws substantially increase costs yet save few lives

Laws requiring women to be notified of their breast density so that they may discuss supplemental screening options, including ultrasound, with their health care providers would substantially increase costs and save relatively few lives, according to an article published in Annals of Internal Medicine. More than 40 percent of women between the ages of 40 and 74 have dense breast tissue, which puts them at increased risk for breast cancer and affects how well a mammogram can detect abnormalities. As such, at least 19 states have enacted breast density notification laws so that women can make informed decisions about supplemental screening. With similar legislation being considered at a national level, researchers sought to determine the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Three validated simulation models predicted that supplemental ultrasound screening after a negative mammogram for women with dense breasts would result in limited health gains and substantially increased expenses. According to model estimates, supplemental screening for women with dense breasts and a negative mammogram would save 0.36 additional breast cancer deaths, gain 1.7 quality adjusted life years (QALYs), and result in 354 false-positive ultrasound biopsy recommendations per 1,000 women with dense breasts compared to biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained, but costs could be improved by restricting supplemental ultrasound screening to women with extremely dense breasts.

Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Sarah Keblin at sarah.keblin@med.uvm.edu or 802-656-3099.

2. Institute of Medicine 'Dying in America' report sparks discussion and debate

Four commentaries published in Annals of Internal Medicine discuss the recent report from the Institute of Medicine (IOM) titled "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life." Each commentary offers a different perspective on the topic of end-of-life care.
  • IOM Committee on Approaching Death co-chair, Philip A Pizzo, MD, discusses the importance of compassionate care that is respectful of patients' end-of-life preferences. He suggests that physicians, such as oncologists who care for seriously ill patients, should be open and honest with patients when discussing their treatment options and should remain fully present after palliative or hospice care has begun. Note: To interview Dr. Pizzo, please contact Ruthann Richter at richter1@stanford.edu or 650-725-8047.

  • Drs. Scott Halpern and Ezekiel Emanuel from the Department of Medical Ethics & Health Policy at the Perelman School of Medicine at the University of Pennsylvania recognize that sweeping overhauls in the delivery of end-of-life care are greatly needed. However, reimbursing physicians for engaging patients in advance care planning may not be the best approach. They explain some of the opportunities outside of physician incentives to improve the quality of end-of-life care. Note: To interview Dr. Halpern, please contact Emily Kane at emkane@exchange.upenn.edu or 215-898-0861. To interview Dr. Emanuel, please contact Beth Dunn at bethwalk@upenn.edu or 215-573-9384.

  • Debra L Ness, MS, from the National Partnership for Women and Families and Beverley H. Johnson, BSN, from the Institute for Patient- and Family-Centered Care, applaud the IOM for initiating a national conversation about end-of-life care. However, they argue that the report needs an authentic patient-and family-centered approach that focuses on working with rather than for patients and families. Note: To reach Debra Ness, please contact Cindy Romero at cromero@nationalpartnership.org or 202-986-2600.

  • Annals of Internal Medicine Deputy Editor, Jaya K. Rao, MD, MHS, praises the IOM report for suggesting that end-of-life care is a public health issue, a concept she championed while working for the Centers for Disease Control and Prevention (CDC) from 2000 to 2008. According to Dr. Rao, end-of-life care meets the criteria to be a public health priority. She hopes that members of the IOM Committee and health professionals will build on the report recommendations to educate and engage the public about this serious issue. Note: To interview Dr. Rao, please contact Angela Collom at acollom@acponline.org or 215-351-2653.

    American College of Physicians

    Related Breast Cancer Articles:

    Does MRI plus mammography improve detection of new breast cancer after breast conservation therapy?
    A new article published by JAMA Oncology compares outcomes for combined mammography and MRI or ultrasonography screenings for new breast cancers in women who have previously undergone breast conservation surgery and radiotherapy for breast cancer initially diagnosed at 50 or younger.
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    A Clinical Breast Cancer study demonstrates Videssa Breast can inform better next steps after abnormal mammogram results and potentially reduce biopsies up to 67 percent.
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    Breast cancer patients with dense breast tissue have almost a two-fold increased risk of developing disease in the contralateral breast, according to new research from The University of Texas MD Anderson Cancer.
    Some early breast cancer patients benefit more from breast conservation than from mastectomy
    Breast conserving therapy (BCT) is better than mastectomy for patients with some types of early breast cancer, according to results from the largest study to date, presented at ECC2017.
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    Low breast density worsens prognosis in breast cancer
    Even though dense breast tissue is a risk factor for breast cancer, very low mammographic breast density is associated with a worse prognosis in breast cancer patients.
    Is breast conserving therapy or mastectomy better for early breast cancer?
    Young women with early breast cancer face a difficult choice about whether to opt for a mastectomy or breast conserving therapy (BCT).
    Breast density and outcomes of supplemental breast cancer screening
    In a study appearing in the April 26 issue of JAMA, Elizabeth A.
    Full dose radiotherapy to whole breast may not be needed in early breast cancer
    Five years after breast-conserving surgery, radiotherapy focused around the tumor bed is as good at preventing recurrence as irradiating the whole breast, with fewer side effects, researchers from the UK have found in the large IMPORT LOW trial.

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