An Argument for Ultrasound
In the fall 2015 issue of CURE in the FirstLine section, there is an article titled “Dense Breasts Alone May Not Warrant Follow-up Imaging After Screening Mammogram.” This article states that additional screening after a mammogram for women with dense breast tissue who are at low risk for breast cancer may be unnecessary. The reality is that all women with dense breast tissue are high-risk.
I consider myself a perfect example of this. I am a very healthy, non-smoking, low-weight, low-BMI 56-year-old woman who eats a healthy diet, exercises regularly and has no family history of cancer. I also have annual doctor’s exams and mammograms and have always been told that I have dense breast tissue. Ten months ago, I was diagnosed with breast cancer after receiving a “normal” diagnosis following a mammogram. It was an ultrasound performed after the mammogram that showed the cancerous tumor.
In the past 10 months, I have had surgery, radiation and 10 months of chemotherapy, with four more to go. I am very fortunate that my prognosis is quite good; however, without the ultrasound, my story could have had quite a different ending.
Deerfield, New Hampshire
Editor-in-Chief Debu Tripathy responds: There are four categories of breast density, the highest termed “extremely dense.” It is true that this group, representing 5 to 10 percent of all women, faces a higher risk of breast cancer. Also, these cancers are harder to detect with mammograms, so additional imaging with ultrasound is appropriate. The next most dense category is termed “heterogeneously dense” and accounts for about 40 percent of women. Whether or not women in this group are at elevated risk for breast cancer or more misses with mammograms is still being debated, but most experts agree that these patients do not need additional imaging besides mammograms. The bottom line is that we need more accurate early-detection tests.
Support Chemotherapy Parity Laws
A letter in the fall issue addressed the distinction between insurance coverage for chemotherapy and for cancer drugs that are taken orally [explaining that these oral drugs are covered under prescription plans, sometimes with high copays for patients]. Over the past several years, 39 states have passed “chemotherapy parity” legislation which requires insurers to reimburse oral cancer drugs at the same rate at which they reimburse for chemotherapy. I worked with Chris Peace, my representative to the Virginia House of Delegates, in 2012 to get chemotherapy parity legislation enacted in the Commonwealth of Virginia. Not surprisingly, insurance companies fought it, but the logic and fairness of the legislation, combined with the strong support of cancer organizations, were more powerful.
Congress has considered national chemotherapy parity legislation and should be urged by your readers to pass it. In addition, there needs to be transparency in how the cost of these drugs is determined to ensure that costs are reasonable, and drug companies should be prohibited from actions designed to extend patent protection beyond its stated period, since this keeps prices up. Competition among drug makers is the best way of making sure that cancer patients are not subjected to unreasonable and unrealistic costs, especially since targeted oral therapies are the new direction of cancer treatments.
Providence Forge , Virginia
Choose Your Own Path
I wanted to say thanks to Merle Sprinzen Tessier for the great article, “Mustering Courage.” I had a very similar experience.
In 2013, at age 43, I was diagnosed with stage 2a estrogen-positive breast cancer. I had a small tumor in my right breast, and margins were good. I had chosen mastectomy (bilateral), as I wanted to avoid radiation. Upon finding that the cancer had spread to one sentinel node, my physicians recommended chemotherapy. After much research on my own, I asked for a referral to a conservative oncologist and requested an Oncotype DX test, which can help predict disease aggressiveness and the likelihood of benefit from chemotherapy after surgery in women with early-stage, estrogen receptor-positive breast cancer. The oncologist still recommended chemotherapy, but I was determined to decide my own treatment path after receiving my Oncotype score. The oncologist agreed and ordered the test. My score was 17, which was at the upper end of the low-risk group. Due to my score, I met the criteria to join a clinical trial, and I was randomized into the group without chemotherapy. I, like Merle, wanted to avoid chemotherapy at all costs due to the numerous side effects — those known and not known, short-term and long-term.
My physicians and mother, a retired nurse, thought I was crazy and putting myself at risk. I, however, felt it was the chemotherapy that would put me at risk, in return for very little benefit.
Congratulations to Merle for being cancer-free for six years! I hope to follow in her footsteps, and I thank her for encouraging patients to have the courage to determine their own treatment paths.
Park Hills, Missouri
IMPRESSED BY CURE
I just want to thank you for the great articles in CURE. I am a certified cancer exercise trainer, and train several cancer patients and survivors. When I read CURE, most of the time I learn something new or read something that I need to pay attention to in my clients.
I have to add that I am always impressed with the art work on the magazine covers and in the online newsletter. I don’t know who your artist is, but he or she is doing a fantastic job.
Managing Editor Beth Incollingo responds: Creative Director Ray Pelesko designs CURE covers, and Andrew Roth, managing editor of curetoday.com, chooses images for the newsletter. We agree that they’re doing a terrific job!