Are toxic treatments a thing of the past?

Many early-stage breast cancer patients may now skip chemo, new study's docs indicate

Lots of women with early-stage forms of breast cancer don't need chemotherapy.

At least that's the bottom line of a major international study, according to a recent report by Denise Grady in The New York Times.

Dr. Ingrid A. Mayer

Grady quotes Dr. Ingrid A. Mayer of Vanderbilt University Medical Center, an author of the study, as saying, "We can spare thousands and thousands of women from getting toxic treatment that really wouldn't benefit them. This is very powerful. It really changes the standard of care."

Instead of chemo, the study found, some women could "take only a drug that blocks the hormone estrogen or stops the body from making it."

That drug, tamoxifen, and related medicines "have become an essential part of treatment for most women," Grady's article says, "because they lower the risks of recurrence, new breast tumors and death from the disease."

The findings, which refer to that alternative endocrine therapy, apparently apply to about 60,000 women a year in the United States, according to Dr. Joseph A. Sparano of Montefiore Medical Center in New York, the study's leader.

The Times quotes Sparano as saying that "now we can spare chemotherapy in about 70 percent of patients who would be potential candidates for it based on clinical features."

But, the story adds, both Mayer and Sparano say women 50 and younger "might benefit from chemo even if gene-test results suggest otherwise. It is not clear why. But these women require especially careful consultation, they said."

The study, called TAILORx, was published in The New England Journal of Medicine and presented at a Chicago meeting of the American Society of Clinical Oncology. It was started in 2006 and was paid for by the U.S. and Canadian governments and philanthropic groups.

After 2016, Genomic Health, the company that makes the gene test Oncotype DX Breast Cancer Assy, the one most used in the United States, helped pay for it.

The test, available since 2004, costs about $3,000, and insurance usually covers it.

Some 260,000 new cases of breast cancer are expected in women in the United States this year, and 41,000 deaths. Globally, according to the Times, "the most recent figures are from 2012, when there were 1.7 million new cases and more than half-a-million deaths."

Chemo, long feared because of nausea and hair loss, puts patients at risk for infection and leukemia later in life. But endocrine therapy also has side effects. According to Grady, they include "hot flashes and other symptoms of menopause, weight gain and pain in joints and muscles."

Tamoxifen can increase the risk of cancer of the uterus, the story notes.

Despite the discomforts and risks, women with breast cancer have been getting chemo since 2000, when the National Cancer Institute recommended it even for those whose disease had not spread to lymph nodes "based on studies showing it could prevent the cancer from recurring elsewhere in the body and becoming incurable."

Sparano contends, however, that although "recurrences were being prevented, and lives prolonged…we were probably overtreating a lot of these women."

Mayer admitted that "we couldn't figure out who we really needed to treat."

More details on studies about the disease, treatments and risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Java industry fighting California jurist's decision

Professor-doctor rebukes judge's final ruling that coffee labels warn about cancer risks

After countless delays (that have taken eight years), it's a done deal at last. Almost.

At least a Los Angeles Superior Court judge's final ruling about the need for warning labels on coffee has become a fait accompli, though not everyone's sanguine about his decision. 

The decision, as might be expected, is being appealed by coffee producers.

Dr. Aaron E. Carroll

And in a recent article in The New York Times under the rubric The New Health Care, Dr. Aaron E. Carroll claims the ruling — which harkens back to statewide ballot Proposition 65 enacted in 1986 and concerns a suit filed against about 90 coffee companies by a nonprofit, Council for Education and Research on Toxics — isn't backed by evidence and could do more harm than good.

The judge's decision is based on the fact that coffee contains acrylamide, which the International Agency for Research on Cancer has warned is a "probable human carcinogen." 

But Carroll, a pediatrics prof at the Indiana University School of Medicine who blogs on health research and policy, maintains the agency "has backpedaled in recent years, [essentially reversing itself when] in 2016 it declared that 'drinking coffee was not classifiable as to its carcinogenicity to humans.'"

Superior Court Judge Elihu Berle finalized his ruling in early May after having tentatively made the same decision in March.

The coffee industry has argued all along that the acrylamide is present in coffee but at harmless levels.

What's next? 

The nonprofit, according to an Associated Press story, now must "seek a permanent injunction that would either lead to ominous warning labels" or a commitment by the industry to reduce the chemical from their product, as the potato chip industry did years ago when it, too, was sued by the same group.

Carroll, who's also been outspoken that there's little evidence to support the notion that artificial sweeteners pose a health risk, asserts that acrylamide "is found in about 40 percent of the calories consumed by people in the United States," and notes that the Food and Drug Administration "reports that there is no viable commercial process for making coffee without producing at least some acrylamide."

The writer, who's opposed to most warning labels, points out that "meta analyses have shown that coffee is associated with lower risks of liver cancer, and no increased risk of prostate cancer or breast cancer," and that "when we look at cancer over all, it appears that coffee — if anything — is associated with a lower risk of cancer."

Carroll has authored a new book, "The Bad Food Bible: How and Why to Eat Sinfully," which contends that butter, salt, diet soda and alcohol have undeserved bad reputations.

Prop 65 had mandated "that businesses with more than 10 employees warn consumers if their products contain one of many chemicals that the state has ruled as carcinogenic" — a category acrylamide falls into. 

More details on which carcinogens appear in which products can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Quirk in cancer drug coverage causing disparity

Advocacy groups seek U.S. law killing price disparity that keeps women from pill form of chemo

Cost may be steering some breast cancer patients away from the preferred pill form of chemotherapy.

Many aren't getting those treatments, which can be taken in the privacy and convenience of the the patient's home as opposed to the intravenous drugs given in hospitals and oncologists' offices, because those pills costs thousands of dollars a month versus the infusion drugs that can require a comparatively small co-pay.

Because of the expense difference, caused by a quirk in how Medicare and private insurance plans cover cancer drugs, patient advocacy organizations are fighting for passage of a Cancer Drug Coverage Parity Act, which is languishing in Congress like so many other consumer-friendly ideas.

Terry Wilcox, co-founder and exec director of one of the advocacy groups, Patients Rising, wrote a recent op-ed piece for The Hill — a Washington, D.C., political newspaper and website — that pushes the idea of eliminating the pricing disparity.

Forty-three states have passed laws mandating parity so far, but that doesn't apply to federally mandated plans such as Medicare (or, for that matter, many employer-sponsored plans).

At the moment, oral therapies are classified on the national level as a "pharmacy benefit," burdening patients with the much higher co-payments (in contrast to the "medical benefit" designation for the intravenous treatments). 

The proposed change would make the pills more accessible.

And drop their cost from about $10,000 per treatment to as little as one-fifth that price.

Because of the "cost burden," Wilcox writes, "some patients forego their treatment altogether."

His article cites a new study in the journal Oncology that finds nearly half of cancer patients abandoning chemo therapies when their out-of-pocket expenses go above $2,000.

Wilcox's article notes that, worst of all, "roughly one-third of new chemotherapies only exist in pill form, meaning patients treated with the newest and best therapies have no other option."

Anita DeVine

According to Anita DeVine, co-chair of a Detroit group, Cancer Thrivers Network for Jewish Women, "the extremely high cost of oral chemotherapy is wiping people out [and because] it is so costly, people are not filling their prescriptions and not getting therapy."

Furthermore, she says, "it is predicted that in the next three to five years, up to 50 percent of chemotherapy will be oral."

Partially because of new treatments, including immunotherapies, death rates for cancer have fallen 26 percent since 1991 — resulting, Wilcox maintains, in 2.4 million lives saved.

The Parity Act bill has been introduced bye Rep. Leonard Lance, a New Jersey Republican, and Rep. Brian Higgins, a New York Democrat.

The cost of drugs is further discussed in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book that I, Woody Weingarten, aimed at caregivers.

Plans to cut health care costs may be backfiring

Study shows delays in breast cancer testing, treatment due to high deductibles could kill

Delay might be deadly.

Especially when it comes to women getting tested for breast cancer.

Many, however, nevertheless delay their testing and treatment when faced with high deductibles, according to a story by Reed Abelson this week in The New York Times.

High deductible plans, his story, says, "have become commonplace, a deterrent used by [insurance] companies to lower health care costs by discouraging unnecessary tests or treatments."

But those plans inherently carry great risks, Abelson writes, despite their having become much more popular "since the Great Recession 10 years ago [when] people increasingly deferred medical care, putting off elective surgeries and doctors' visits," action that did result in national health care spending slowing.

However, a recent study of women with insurance plans that carried deductibles of at least $1,000, the writer notes, "underscores the danger to consumers required to shoulder a greater share of those costs."

The study also professes that "women who had just learned they had breast cancer were more likely to delay." 

About half of all covered U.S. workers "are now enrolled in plans with a deductible of at least $1,000, and many must pay several thousand dollars in medical bills before their plans even start to cover their care," Abelson contends.

Moreover, a survey of employer benefits by the Kaiser Family Foundations shows "about 11 percent of covered workers have a deductible of at least $3,000" and, the Times story maintains, employers are "more frequently giving their workers no other option."

A review of medical claims, Abelson's article charges, "exposed a pattern: Women confronting such immediate expenses put off getting diagnostic imaging and biopsies, postponing treatment."

Dr. J. Frank Wharam

The piece also quotes Dr. J. Frank Wharam, Harvard researcher and one of the study's authors, to the effect that those women "delayed beginning chemotherapy by an average of seven months."

The bottom line: "Slight delays added up to long delays," Wharam notes in the Journal of Clinical Oncology.

Survival rates are, naturally, higher for patients with some cancers if they're treated early.

In that regard, the Times piece goes on to report that "high-deductible plans pose a problem, say researchers who have studied them, because patients do not always distinguish between the care they should get and what they can do without."

The story also quotes Dr. Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center as it makes a key point: While high-deductible plans are meant to encourage people to think twice about whether a test or treatment is necessary and if it can be done at a lower price, "it's also frankly to impede their use of these services."

Although the plans apparently are succeeding in reducing the use of care, he asks: "The question is, at what cost?"

More insight into how the medical industry deals with the cost of care can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregivers.

Writer of book on MysteryDates® needs advice

'Rollercoaster' author seeks your help in picking title of his new volume on relationships

Woody Weingarten

I, Woody Weingarten, need your assistance.

I'm comfortably near the end of the third draft of my new book but am unsure what to call it. So I'd like you to help me pick one of the two working titles.

Please let me know which you prefer and, if you feel particularly energetic, why. 

And if you have any additional suggestions, just send along them to: 
voodee@sbcglobal.net or www.vitalitypress.com/

Here are my finalists at the moment.

Sizzle!

How MysteryDates® can 

recharge your relationship

Hundreds of tips on what you 

can do and see, where to go

— locally, nationally, globally

                  or

MysteryDates®

How to keep a sizzle

in your relationship 

Hundreds of tips on what you 

can do and see, where to go

— locally, nationally, globally

This second book, by the way, is in no way related to my first except that it, too, includes anecdotal material from my three-decade-plus marriage to Nancy Fox, the heroine of "Rollercoaster: How a man can survive his partner's breast cancer," which I aimed specifically at male caregivers.

Thanks for your support.

Can chemical in Roundup cause cancer?

California ruling that might lead to warning labels on weed killer is challenged in federal court

Agricultural groups are trying to overturn a California ruling that might require warning labels on a popular weed killer.

According to a recent Associated Press story, a coalition of a dozen national and Midwestern groups is seeking an injunction that would keep the state from enforcing a ban that could include a cautionary phrase about Roundup potentially causing cancer.  

The lawsuit, filed in federal court in Sacramento, claims the warning would be "false" and "misleading" and alleges that the state's decision "violates constitutional due process and free speech rights and should be superseded by federal regulations."

Roundup's main ingredient, glyphosate, has been widely used since 1974. The AP story notes that it kills unwanted weeds while leaving crops and other plants alive — and is not restricted by the U.S. Environmental Protection Agency.

However, the story also reports that International Agency for Research on Cancer, based in Lyon, France, has classified glyphosate as "a probable human carcinogen," an action that prompted the California Office of Environmental Health Hazard Assessment to add it last summer to a list of chemicals known to cause cancer.

That listing, the AP indicates, "could eventually lead to a requirement for warning labels on the product."

Among the plaintiffs is the St. Louis-based Monsanto Co., which makes Roundup and, the suit says, has invested "'hundreds of millions of dollars" in the herbicide and its related glyphosate-tolerant seeds.

Gordon Stoner

Sam Delson

The story quotes Gordon Stoner, past president of the National Association of Wheat Growers, as saying a cancer warning "would result in higher food costs, crushing blows to state and agricultural economies and lost revenue up and down the entire supply chain."

But Sam Delson, COEHHA spokesman, said the agency "is confident its rules are legal."

Details about various disease risks can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

'Ask Amy' writer promotes 'ring therapy'

Syndicated columnist offers advice for cancer patients on dealing with anxious supporters

Amy Dickinson

"Grief circles" can be a useful tool for cancer patients to cope with their disease.

According to a recent syndicated "Ask Amy" column by Amy Dickinson, the circles — otherwise known as "ring therapy" — conceptualize "the important idea that, when dealing with tough to tragic times, it is important for the person at the center of the circle [the patient]…to preserve her strength by only dealing with the person most intimately involved in her care — this might be a spouse, family member, or friend."

Other relationships, she wrote, "arrange outward in concentric rings. This is called the 'kvetching order.'"

Dickinson's column, which was in response to an elongated cry for help by a breast cancer patient who signed her plea "Not Dead in California," said that "ring therapy is mainly…to give you permission to react the way you want to during a time when you need to preserve your strength."

The patient is "not supposed to be worrying about how to be gentle and polite," she adds.

Dickinson also notes that the patient "can say anything (complain, cry, howl at the room) to those in outer rings, but those in outer rings should limit their own needs, fears, and statements and focus only on being helpful. No unsolicited advice, no raging at the injustice of it all, no demands for comfort or constant updates."

The letter-writer had explained that a close friend was "having trouble coming to terms with my diagnosis, as well as my not taking her up on her offers of help (yet)," and noted that the friend had "called a few nights ago sobbing and looking to me to help her feel better [about my long-term prospects and diagnosis], "which isn't as good as it could be, but…also not as bad as it could be."

She went on to say that she'd "rather not be calming down my friends when inside I'm losing my mind with the slow paced of health care and juggling my appointments and treatments" and, in this particular case, "cannot be the person making [the friend] feel better about my illness."

The columnist advised the letter-writer to tell members of her support group that she understands "that this is hard for you, but I can't help you through this. I've got too much on my plate" — and to encourage such friends, when they are upset, "to contact someone else in an outer ring."

Details of how I, Woody Weingarten, dealt with my wife, Nancy Fox, when she was being treated for the disease can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I aimed at male caregivers.

It — and the Marin Man to Man website about a weekly support group I've been running since that time — includes anecdotal material about how she hadn't wanted to worry about my reactions to what was going on with her.

Acrylamide chemical in java may be perilous

Judge rules Starbucks, 90 other companies may have to display coffee warning in California

Because of a judge's decision, Starbucks and about 90 other roasters, grocery stores and retail shops may soon have to display a cancer warning on coffee sold in California.

According to yesterday's Associated Press story by Brian Melley, the Los Angeles judge ruled in favor of a nonprofit, the Council for Education and Research on Toxics, that had sued the companies in 2010 for failing to comply with state law by not providing a "clear and reasonable warning" of a known carcinogen.

Superior Court Judge Elihu Berle's decision — to the effect that the companies hadn't shown the threat from the chemical was insignificant — was issued as a proposed ruling, which means he could change his mind (although, reportedly, that's unlikely).

Berle, the AP piece said, gave the defense several weeks "to file objections to the proposed ruling before he makes it final."

After that ruling, a decision on monetary damages could be forthcoming.

The suit has centered on a chemical, acrylamide, that was produced in the roasting process.

Berle wrote that, while the "defendants failed to satisfy their burden of proving…that consumption of coffee confers a benefit to human health," the plaintiff had "offered evidence that consumption of coffee increases the risk of harm to the fetus, to infants, to children and to adults."

He also said that the "defendants' medical and epidemiology experts testified that they had no opinion on causation."

The AP story noted that the coffee industry has maintained that "the chemical was present at harmless levels and should be exempt from the law because it results naturally from the cooking process necessary to make the beans flavorful."

The article also indicated that attorney Raphael Metzger, who brought the lawsuit, said "he wants the industry to remove the chemical from its process [but] coffee companies have said that's not feasible and would make their product taste bad."

Metzger's group had earlier brought a similar case that resulted in potato-chip makers agreeing in 2008 "to pay $3 million and remove acrylamide from their products rather than post startling warnings that can be found throughout California and are largely ignored," the story added.

Many coffee companies, according to the AP, "have already posted warnings that specifically say acrylamide is found in coffee and is among chemicals that cause cancer. However, many of those warnings are posted in places not easily visible, such as below the counter where cream and sugar are available."

William Murray

William Murray, president and CEO of the National Coffee Association, has claimed in an emailed statement that "coffee has been shown, over and over again, to be a healthy beverage. This lawsuit…has confused consumers, and does nothing to improve public health."

Nearly half the defendants in the coffee case have already settled — and agreed to post warnings. Among the latest was 7-Eleven.

Details on everyday products that may cause cancer can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.