Wednesday, September 24, 2008

NCRCC Site Covers Politics and Breast Cancer

The National Breast Cancer Coalition's Web site is worth a look because of its coverage of breast cancer issues related to the presidential campaign. The non-partisan advocacy group was formed in 1991 to lobby "at the national, state and local levels for public policies that impact breast cancer research, diagnosis and treatment. Our grassroots advocacy effort has hundreds of member organizations and tens of thousands of individual members working toward increased federal funding for breast cancer research and collaborating with the scientific community to implement new models of research, improve access to high-quality health care and breast cancer clinical trials for all women, and expand the influence of breast cancer advocates in all aspects of the breast cancer decisionmaking process."

The organization's blog has some informative posts.  One compares Obama and McCain's health care plans and is worth poking into.  Obama's plan has been criticized as being more expensive, but that's because it covers more Americans, even those with existing conditions, such as cancer. As I have noted before, McCain does not cover those with existing conditions.  The site links to an excellent  Wall Street Journal article explaining the impact of the two candidates'  plans. One difference the newspaper notes:  Obama's plan would increase regulation.  McCain's would decrease it.  Interesting.

I have placed the group's pledge on the left column of my site.   Vote to let the candidates know that quality health care is a priority.   By signing, you also pledge to take the candidates' health care positions into consideration when voting.

While the economy is getting the attention this week, as well it should, health care cannot be ignored.   The financial health of the country, yes, is of prime importance.  The physical health, however, is equally important.

Saturday, September 13, 2008

Risk of Late Recurrence Lower for Hormone Negative

Here’s a good news/better new flash: women with early stage breast cancer remain at low risk of recurrence years after treatment. That’s good. Better is that women with hormone negative cancers face a much smaller risk of later recurrence than those with hormone positive. This, despite the fact that hormone negative is considered to be more lethal than positive.

The study, by researchers at the University of Texas M.D. Anderson Cancer Center, included 2,838 women with stage I, II, or III breast cancer between 1985 and 2001. Five years after beginning therapy—chemotherapy, radiation, tamoxifen or all three—those with hormone negative disease faced a seven percent chance of recurrence, while those with hormone positive had a 13 percent chance.

The really good news: 89 percent of all patients had no recurrences within 10 years; 80 percent had no recurrences after 15 years. Within five years, those with stage I cancer had a 7 percent risk of recurrence; stage II faced an 11 percent risk; and stage III faced a 13 percent risk.

The research was published online in the Journal of the National Cancer Institute on August 11, 2008. Because HER2 was not routinely measured at the time and Herceptin and aromotase inhibitors had not been introduced, they were not included in the data. Until 2000, tamoxifen was the only drug for follow-up breast cancer care, and it was limited to women with hormone positive disease.

Researchers say that, while the numbers are small, the fact that cancer can recur years after therapy points to a need for more follow-up care. An interesting conundrum, considering the fact that women with hormone negative cancer faced a lower rate of late recurrence than women with hormone positive disease. That is, women for whom there never has been a long-term drug treatment option did better than women with the drug.

The study does point to continued need for regular follow-up exams and mammograms. I would also emphasize the importance of focusing on a low-fat, healthy diet with plenty of exercise, which have been proven to lower the risk of recurrence of hormone negative breast cancer.

Thursday, September 11, 2008

Younger Women With Hormone Negative Benefit from Removing Second Breast

Having both breasts removed improves survival rates for young women with early stage hormone-negative breast cancer, according to a study presented at the 2008 Breast Cancer Symposium in Washington DC. And the reduction was significant—a 31 percent drop in mortality rates. Researchers at the University of Texas M.D. Anderson Cancer Center in Houston studied records of more than 80,000 breast cancer patients diagnosed from January 1998 through December 2003.

Women 18-49 with stage I-II breast cancer benefited from contralateral prophylactic mastectomy—or removing both the affected breast and the opposite—or contralateral—one. Older patients, those with stage III disease, or with hormone-receptor-positive breast cancer, saw no significant survival benefits from contralateral prophylactic mastectomy.

Presidential Politics and Health Care: Pay Attention

With presidential politics mired in lipstick on varied animals, it’s time to force a break from the silliness and look at how the candidates handle issues of actual importance, such as health care. Eerily enough, in her criticism of John McCain’s health care plans last April, Elizabeth Edwards called his proposals “painting lipstick on a pig.” (Perhaps it is time to put that phrase to rest, and leave the poor pigs to their mud.)

Edwards’ major complaint, cosmetics aside, is that McCain’s plan would not apply to either her or McCain—or me. It does not include any provisions to keep insurance companies from denying coverage for preexisting conditions. Elizabeth, John and I are all fine, with affordable health insurance and the resources to pay for care. Well, the other two have quite a few more resources than I do, but I still can afford the health care I need, which makes me fortunate indeed. Had I been diagnosed with breast cancer and not had insurance, though, I would have been in a truly scary place, at risk physically and financially. That happens to far too many Americans with serious illness and it is just plain wrong.

Paul Krugman, in the New York Times, agrees, and wrote at the time of Edward’s comments, “It's about time someone said that and, more generally, made the case that Mr. McCain's approach to health care is based on voodoo economics -- not the supply-side voodoo that claims that cutting taxes increases revenues (though Mr. McCain says that, too), but the equally foolish claim, refuted by all available evidence, that the magic of the marketplace can produce cheap health care for everyone.”

The McCain Web site says:  John McCain will reform health care making it easier for individuals and families to obtain insurance. An important part of his plan is to use competition to improve the quality of health insurance with greater variety to match people's needs, lower prices, and portability. Families should be able to purchase health insurance nationwide, across state lines.

Sounds good until you realize that there currently is plenty of competition in the insurance market and we still have 45.8 million uninsured American citizens —in a country with a population of 305 million.  That means 15 percent of Americans are uninsured. And 21 percent of those are under 17. So more of the same seems a weak argument. Competition in the market has only led to continued increases in insurance and health care costs. What’s more, portability applies only to those people whose employers offer them insurance in the first place, which happens less and less in this damaged economy.

Barack Obama proposes simply to cover all Americans. In May, he said, “If you already have health insurance, the only thing that will change for you under this plan is the amount of money you will spend on premiums. That will be less. If you are one of the 45 million Americans who don't have health insurance, you will have it after this plan becomes law. No one will be turned away because of a preexisting condition or illness.”

The Obama site defines Obama's Plan to Cover Uninsured Americans: Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress.

Obama’s plan is similar to one developed in Massachusetts  and instituted in 2006, which mandates coverage. Obama would subsidize costs for those at lower income levels through tax increases on those making more than $250,000.

Chris Hedges of Truthdig says neither candidate has it right, and that only a single-payer national health insurance system makes sense, citing a Harvard Medical School study that says this would save the country $350 billion a year. 

Still, we need to at least take baby steps, and proposing to shut down one of the country’s largest industries just isn’t going to happen overnight. Change will have to come incrementally, and Obama’s plan is a beginning. Canada went to a single-payer system in the 60s, so there is precedent for it happening. We need somebody with the courage and smarts to force that move. Obama’s 18-month focus on change is clearly the way to go, as evidenced by the fact that McCain is now using the same theme.

Whatever your politics, if you have a chance to visit with the candidates or their staffs, hold them accountable to health care change. More of the same is unthinkable. Make the candidates talk specifics on who they would cover and how. And make them stop talking about lipstick.