Doctor warns of hidden facts, bad memory

Not really knowing your family medical history can cause you cancer woes, oncologist says 

Heredity and cancer are inexorably linked.

Even if you prefer denial.

Theodora Ross

Knowing your family history could save your life, according to a recent story by Theodora Ross, an oncologist at the University of Texas Southwestern Medical Center, in the Washington Post.

Hidden facts can be destructive, Ross indicates, pointing to one of her young patients who joked about her Irish heritage but discovered, through testing for breast cancer gene mutations, that she carried an Ashkenazi Jewish mutation that could spell trouble.

It was learned that her French Jewish family, apparently fearing anti-Semitism during World War II, had converted to Catholicism and made Ireland their home.

Ross, author of "A Cancer in the Family: Take Control of Your Genetic Inheritance," points out in her article that "many illnesses…are at least partly hereditary. One recent study found that 33 percent of cancer diagnoses can be explained by genes."

She also notes that "only one-third of Americans have ever tried to collect their family medical histories from relatives" and that part of the problem "is the fault of the medical profession…physicians [may] devote just three minutes to asking family-history questions during a patient's first visit."

Another difficulty is that many "relatives might never have revealed that they were sick, particularly if they struggled with a disease that carries a stigma." 

For example, she adds, "according to one study, 58 percent of psychiatrists said they wouldn't tell family and friends if they suffered from a mental illness."

Fear, ostracism and shame certainly can become obstacles to the truth.

Ross also cites patients who interpreted histories incorrectly, including one who "denied that he had a family history of cancer because, he said, nobody had died. Another suggested that her sister's breast cancer at age 38 was due to her divorce. One even told me her father had only 'a touch of melanoma.'"

In addition, language can be a barrier to understanding.

"It wasn't so long ago that tuberculosis was known as 'consumption' and epilepsy was 'falling sickness," Ross writes. "Strokes were 'apoplexy,' and 'bad blood' was code for syphilis."

Memory, too, can be faulty. Ross says that rather than factual it can be "a construction of what we think happened. Lung cancer may have, in fact, been colon cancer; ovarian cancer perhaps was cervical cancer."

Research into your family history, Ross indicates, is definitely worth the time invested. And The Centers for Disease Control and Prevention can be of assistance. So can the National Institutes of Health. 

Both have online guides that might help you get started.

To learn about the links between heredity and breast cancer, particularly BRCA1 and BRCA2 gene mutations, you also could check out "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

Aging increase causes spread of medical facilities

What's behind boom in cancer centers across U.S.? Answer: 'silver tsunami' and money

A cancer center building boom is spreading across the country, according to a story this week in the Washington Post by Brady Dennis.

The piece reports the American Cancer Society as saying "more than 1.6 million people in the United States will be diagnosed with cancer this year," and goes on to suggest "the number is certain to rise with the aging of the baby boom generation."

A steady population increase among the elderly means "a push to bring the latest specialized treatments and access to more clinical trials to patients who don't live near major academic research centers," the article states.

Voila! The national building boom.

Furthermore, the piece notes that because "medical advances are allowing more people to live longer with cancer and, in some case, to treat it as a chronic disease…there is fierce competition among hospitals searching for reliable revenue in a rapidly changing health-care landscape."

There remain many skeptics in the medical community, however, those who contend the label cancer center can easily be applied by virtually any facility and, therefore, "doesn't guarantee that each place will have doctors with deep expertise, a track record of good outcomes or credentials such as a National Cancer Institute designation as a top-notch center."

Dr. Peter Bach

Daniels' article quotes, for instance, Dr. Peter Bach, an oncologist and director of the Center for Health Policy and Outcomes at New York's famed Memorial Sloan Kettering Cancer Center.

Bach, whose wife, Ruth, died a few years back when her breast cancer recurred and metastasized, says his concern is that an average patient could have difficulty determining where to get "high-quality care when the market is flooded with places claiming to be cancer centers."

The Washington Post piece also says that "it remains unclear whether the proliferation of cancer centers…will lead to more tests, surgeries and mediations being billed to Medicare, private insurers and patients."

An outgrowth of the rise in the aging population, according to the story, is that well-known institutions — such as Sloan Kettering or Baltimore's Johns Hopkins — "are forming alliances with smaller hospitals in an effort to extend their brands, in some cases around the country and the globe."

The Post quotes Patrick Duke, managing director for a consulting group that advises hospitals about real estate projects, CBRE Healthcare, to the effect that the economics of cancer treatment "are good. That's a touchy subject for some people, but it's the reality…The procedures and the drugs are well reimbursed. It's a big business."

Is the boomer concept real?

Seven years ago, when I, Woody Weingarten, served on the Marin County Civil Grand Jury, I was repeatedly told our area was being inundated by a "silver tsunami." The truth of that became evident as I opened my eyes and saw who was driving on our highways, walking on our streets.

Clearly, the longer folks last, the greater chance there is for them to contract a life-threatening disease. My VitalityPress book, "Rollercoaster: How a man can survive his partner's breast cancer," whose aim is helping male caregivers, discusses the aging population, medical care in general and breast cancer care in particular, and high medical costs.

Guides can be useful, especially for underserved

Studies differ on whether trendy 'patient navigators' are truly beneficial in cancer cases 

Are navigators — those nurses or lay aides who guide cancer patients through the bureaucratic mazes that must be negotiated again and again in the medical system — really valuable?

Well, research findings are contradictory, according to a July 3, 2015 Washington Post article by Lenny Bernstein.

The Post piece cites, for example, a recent study conducted at the University of Alabama at Birmingham that looked at 6,743 cancer patients (aided by 42 lay navigators) covered by Medicare in five southeastern states. 

Researchers found, according to the Post, "that the number of hospitalizations, emergency room visits and admissions to intensive care declined more sharply among people assisted by navigators, as did costs."

Dr. Scott Ramsey

Systems are proliferating around the country in which such guides sometimes serve as patient helpers, sometimes patient advocates.

Navigators, in effect, have become trendy. 

But the Post also referred to an earlier study. That one, it said, showed only moderate benefits at best, and only after 90 days — except in cases involving what the lead researcher labeled "underserved patients who typically 'fell through the cracks' of the medical system."

In conjunction with those findings, the Post said "the debate over effectiveness and costs [centered on] the National Cancer Institute's $30.3 million, nine-site study of patient navigation. With smaller studies showing promise, the agency [had] hired and trained navigators to help 10,521 people with signs of breast, cervical, colorectal or prostate cancer…Most were minorities, had no insurance or were covered by government programs."

Navigators— sometimes nurses, sometimes not — purportedly added $275 per patient in costs.

But the Post also quoted a Seattle cancer center researcher, Dr. Scott Ramsey, who'd examined the cost-effectiveness question and who said navigators exist because "the cancer community has done a very poor job of helping patients through the system."

The fact "that navigation exists," he added, "is kind of an indictment of the cancer-care system." 

Looking at studies whose findings contradict each other is something I, Woody Weingarten, have done in "Rollercoaster: How a man can survive his partner's breast cancer," a book aimed at male caregivers. 

I believe it's worth checking out.

Warning: Be careful of fraudulent philanthropies

FTC says four cancer charities diverted $187 million of donors' money meant for patients

The Federal Trade Commission has called four cancer philanthropies a sham, claiming they bilked contributors of $187 million.

The charges were filed in a civil complaint.

No criminal charges were pending.

According to a recent article in the Washington Post, the charities' telemarketing and websites declared that the donations would pay for patients' pain meds, hospice services and other care. 

But, the FTC said, the bulk of the contributions actually benefitted the charities' three organizers, their friends and fundraisers — with less than 5 percent going to patients' needs.

A sidebar article by Ariana Eunjung Cha listed five reasons the government took so long to catch on. Among them:

• "The government is overwhelmed" by the sheer number of public charities — more than 1,050,000.

• The IRS has been "disincentivized from pursuing cases against charities."

Myra Miblowit of BCRF

• "The names of cancer charities, even legitimate ones, are confusingly similar to one another." The writer quotes Myra Biblowit, president of the respected Breast Cancer Research Foundation, as saying, "It is vitally important that donors utilize charity watchdog organizations to vet non-profits for transparency and efficiency."

"Rollercoaster: How a man can survive his partner's breast cancer," my new VitalityPress book that's aimed at male caregivers, includes a chapter, "Where Men Can Find Help," that lists organizations (including the BCRF), books and other resources I have vetted as being legitimate and useful.

The Post's main story — carrying the triple byline of Peter Whoriskey, Brady Dennis and Ariana Eunjung Cha — reported that "the scheme was a family effort," with each of the four charities run by either James Reynolds Sr.; his son, James Reynolds Jr.; or the father's ex-wife, Rose Perkins.

The money in question was raised between 2008 and 2012 by the Cancer Fund of America, Cancer Support Services, the Children's Cancer Fund of America and the Breast Cancer Society.

An agreement calls for the three family members to be banned from fundraising and charity management, and for the dissolution of the Children's Cancer Fund and the Breast Cancer Society.