Category Archives: Uncategorized

Fast Facts: Should you get screened for Lung Cancer?

Uncategorized, ,

For our in-depth article on lung cancer screening, click here.

By Tiffanie L. Hammond, Amrita Ford, MA, and Anna E. Mazzucco, Ph.D.
January 2014

Lung cancer is the second most commonly diagnosed cancer in both men and women in the U.S., but it is the #1 cancer killer. In 2013, approximately 228,000 men and women were diagnosed with lung cancer and close to 160,000 men and women died from it.  One of the reasons lung cancer is so deadly is that symptoms usually appear during the later stages, when treatment is least effective. General symptoms include:

  • a persistent cough that may worsen over time, including coughing up blood
  • breathing trouble, such as shortness of breath
  • chest pain
  • raspy or hoarse voice
  • frequent lung infections, such as pneumonia
  • extreme and constant fatigue
  • unintentional weight loss

If you experience any of these symptoms, call your doctor.

The purpose of screening for cancer is to diagnose it before symptoms appear, when it can be treated more effectively.  In July 2013, the U.S. Preventative Task Force (USPTF) released a draft recommendation for screening those at highest risk for lung cancer using low-dose computerized tomography scans (low-dose CT), which was finalized in December.  CT scans provide very detailed pictures of your lungs, much more detailed than x-rays. Researchers found that using low-dose CT scans could reduce lung cancer deaths by 20%.  People who should be screened include:

  • Current smokers between 55 and 79 years-old who have a smoking history of “30 pack-years” (20 cigarettes a day for 30 years, 40 cigarettes a day for 15 years, and so on)
  • Former smokers (who quit in the last 15 years) who are between 55 and 79 years-old and had a “30 pack-year history of smoking.

 

To calculate your pack years, visit http://smokingpackyears.com/.

This draft recommendation was finalized at the end of 2013. Already insurance companies are covering the cost of the screening, as long as the person meets the screening criteria.

As with any screening, there are risks as well as benefits. Some of the risks include radiation exposure and a high rate of false positive test results—test results indicating that a person has something worrisome in their lung that turns out to be nothing serious. Some experts call this “over-diagnosis.” In the largest study done so far, about 1 in 4 people had a false positive finding if they had three years of annual screening.  A false positive finding can lead to invasive procedures, such as needle biopsies, which can puncture the lung and cause it to collapse.  Although very serious complications are rare (less than one in 1,000), they can occur.  Even low-dose CT scans of the lungs expose patients to much more radiation than a chest x-ray. There is almost no short-term risk from this radiation, but having many x-rays or several CT scans can increase a person’s risk of cancer. A 2012 law increased funding for lung cancer research to promote better detection and treatments in the future.   Research is also being done to find ways to reduce the number of false-positives and unnecessary follow-up procedures.

For more detailed information about lung cancer risk factors, symptoms, detection, and CT screening, including the risks of radiation and over-diagnosis, see this article.

Comments of the Cancer Prevention and Treatment Fund on FDA draft guidance to industry on Acrylamide in foods

Testimony & Briefings, Uncategorized, , ,
January 14, 2014

The Cancer Prevention and Treatment Fund strongly supports the Food and Drug Administration in its efforts to advise industry on reduction of acrylamide in food products.  The Grocery Manufacturers Association estimates that acrylamide is present in approximately 40% of the total caloric intake in a typical American diet.1 Given this near-ubiquity, and the fact that the chemical reaction which produces acrylamide also produces commercially desirable color, taste and texture characteristics, reduction of acrylamide represents a challenge.  However, the evidence of possible human harm necessitates its treatment as a significant public health issue. While this report represents an important step in FDA regulation of acrylamide and suggests many possible acrylamide reduction methods, we are concerned that this guidance is not specific enough in providing clear and concrete recommendations that can be implemented.  Although FDA guidance does not have the force of law or regulation, the addition of terms such as “when feasible” implies that the FDA is not serious in its efforts to persuade companies to substantially reduce acrylamide.  FDA monitoring of acrylamide in 2002 indicated wide variation even among products from the same food category –as much as 5 or 10 fold differences in several categories.  This is clear evidence that significant acrylamide reduction can be accomplished without losing desirable product qualities. Thus, although there is clearly much room for improvement, this report contains few immediately implementable guidelines for industry. Since 2002, it has been known that acrylamide is created in food products as the result of a reaction between carbohydrates and the amino acid asparagine at high temperatures during browning (i.e., the Maillard reaction).2  In addition to its known neurotoxic properties, both animal toxicology and human epidemiological studies suggest that acrylamide may be cancer-promoting, which has led to its carcinogen classifications by EPA, NTP and IARC.3,4,5,6 Higher dietary acrylamide consumption has been associated with increased risk of endometrial, ovarian, pancreatic, renal and possibly breast cancer.7,8,9,10.  Acrylamide is already regulated in drinking water and was classified by EPA as “likely to be a carcinogen to humans” and was classified by the National Toxicology Program as “reasonably anticipated to be a human carcinogen,” both more than a decade ago.  The European Food Safety Authority has been overseeing acrylamide monitoring within the European Union since 2007, and the European Commission has set recommended indicative values for acrylamide in food products, providing a quantitative framework for both assessment of reduction efforts and investigative action.  This is a very important health issue and we strongly urge the FDA to intensify its efforts and assert leadership of both the national and international efforts to regulate acrylamide and ensure public safety. Our areas of specific concern are the following:

  • While encouraging manufacturers to conduct their own testing, FDA should update and expand its own monitoring efforts.  Monitoring of acrylamide in food products over time is needed for any reduction efforts to be assessed and successfully implemented.  The current FDA monitoring strategy tested only several hundred foods in four geographic regions annually between 2002 and 2006, and the last publicly available information is from 2006.11  Given the wide range of acrylamide levels even within a single food category, more extensive and up-to-date monitoring is needed to adequately evaluate acrylamide levels and the success of reduction methods.
  • While this report encourages manufacturers to monitor acrylamide levels, it does not give any specific values which should prompt corrective efforts.  Without such guideposts, monitoring alone is unlikely to result in significant reductions.  Recommended target values or action levels, together with active monitoring, will allow FDA and manufacturers to directly access efficacy of reduction efforts and trigger investigation when needed.  The European Commission has set indicative values for acrylamide in food products, including separate values for products intended for infants and young children, and these values are intended to be gradually reduced.12  Indeed, these indicative values have been broadened to include more specific categories and some have already been lowered since their release in 2011, and the European Food Safety Authority is currently conducting a risk assessment at the request of the European Commission to determine if current recommendations are sufficiently protective.  Such a system provides a quantitative framework for reduction efforts and allows increased surveillance of items of special health importance.  Values at least as low as the 2013 European Commission indicative values should be adopted, with the shared intent of gradual lowering of these values as reduction efforts improve.
  • Without accurate and affordable detection techniques, manufacturers are unlikely to measure acrylamide in their products, especially when participation is voluntary.  This guidance encourages manufacturers to be aware of acrylamide levels in their food products.  This is a crucial step towards evaluating reduction efforts.  However, this vital imperative is followed by a discussion of both the technical limitations and expense associated with current methods of acrylamide detection.  While FDA has committed to improving these techniques, they remain costly and fraught with technical limitations, making widespread voluntary use, especially by small manufacturers, unlikely.  FDA should continue to investigate means to improve acrylamide detection and make specific recommendations to industry regarding best possible techniques in order to facilitate participation in monitoring.  As an example, the European Commission has recently set measurement uncertainty (MU) values and tasked the European Committee for Standardisation (CEN) with analytical standardization of LC-MS and GC-MS for acrylamide detection.  Such efforts, in addition to adoption of standard references, will increase consistency and improve confidence in acrylamide detection efforts.
  • In this guidance, the FDA specifically states that it does not intend to recommend one method over another.  This is unfortunate because it leaves both guesswork and legwork to industry.  FDA states that “this guidance is intended to suggest a range of possible approaches to acrylamide reduction and not to identify specific recommended approaches.”  The role of federal agencies should include evaluating reduction approaches to determine which are more efficacious and feasible than others, and providing that potentially useful information to industry, even if only to help identify and encourage prioritization of those approaches first, in addition to continuing research in this area.  Clear communication of superior and cost-effective approaches to acrylamide reduction may result in higher industry participation and more successful reduction efforts.
  • FDA monitoring since 2002 has shown that many foods contain higher levels of acrylamide than the level considered safe by the EPA for drinking water.  Some of the highest acrylamide levels are found in potato and cereal products which are common in the American diet.  These surveys also show that a healthy diet which includes whole grains can have significant acrylamide levels, potentially even higher than a diet which includes less healthful choices such as potato chips and French fries.  The FDA has maintained its message to consumers that a balanced, healthy diet is a way to manage concern over acrylamide consumption, when the evidence shows that this advice is not accurate. 
  • The effects of acrylamide reduction on overall product nutrition should be considered in the context of all health risks and benefits.  For example, lower temperature frying reduces acrylamide, but also requires longer cooking time, resulting in higher fat content in fried foods.  While we commend thorough consideration of all possible health implications of acrylamide reduction methods, FDA should also consider which outcomes can be more easily mitigated by other dietary or lifestyle interventions in order to fully assess risks and benefits.

Lastly, as acrylamide accumulates in food as a result of the handling and cooking process, rather than in the raw food itself, and is a serious human health concern, it could be viewed as source of food adulteration and regulated as such under Section 402(a) of the Federal Food, Drug and Cosmetic Act with action levels.  We ask that FDA consider these improvements to this draft guidance, and use its full authority to ensure that the public is sufficiently protected.

The Cancer Prevention and Treatment Fund

 For additional information, contact Anna Mazzucco at am@center4research.org or (202) 223-4000.

Statement of Dr. Diana Zuckerman before the FDA Advisory Committee Regarding Dapagliflozin (Farxiga)

Testimony & Briefings, Uncategorized
By Diana Zuckerman, Ph.D.
December 12, 2013

Thank you for the opportunity to speak today.  I’m Dr. Diana Zuckerman. I’m president of the Cancer Prevention and Treatment Fund.

Our center is dedicated to improving the health and safety of adults and children, and we do that by conducting and scrutinizing research and explaining the findings to health professionals, patients, and the general public.   Our non-profit center does not accept funding from pharmaceutical companies, so I have no conflicts of interest.

Today I am speaking from my perspective as someone trained in epidemiology at YaleMedicalSchool. I also was on the faculty at Yale and at Vassar and conducted research at Harvard, and was a fellow at the Center for Bioethics at the University of Pennsylvania.  I’ve also discussed the data with an expert on our staff who previously worked at NCI, Dr. Anna Mazzucco.  I’m putting together all of those perspectives, as well as having worked for the U.S. Department of Health and Human Services, as a consultant to the Institute of Medicine., and as someone with several close family members with diabetes, one of whom died from the disease..

My concern about this drug is that there are just too many unanswered questions – and those unanswered questions are frightening ones.  That was true when the FDA rejected this application for approval 2 years ago, and it is still true today.

Question #1: How well does it work?

The results indicate that DAPA is NOT effective for patients with moderate to severe renal impairment.  As the FDA has noted, 20-40% of diabetes patients have compromised renal function.

DAPA is better than placebo but does not provide a significant improvement over currently available drugs.  Specifically, glipizide was superior in the short-term and comparable to DAPA at week 52.

So, in the context of these limited benefits what are the risks?

FDA stated that the animal studies conducted could not rule out the possibility that dapagliflozin contributes to bladder cancer.   We completely agree.  Experiments done using cell lines and tumor models which are not implanted in the bladder cannot answer questions about the risks to humans.  Because in humans, changes in the bladder microenvironment or urine flow may be most relevant to carcinogenesis.  FDA has already suggested use of an appropriate animal model which could address these concerns, specifically a “a (BBN) chemically-induced rodent bladder cancer model (4-hydroxybutyl(butyl)nitrosamine).

Why didn’t the company do the right kind of animal study?  That’s an important question to keep in mind.  But, until the correct type of animal studies are done, DAPA must be considered a possible cause of bladder cancer.  Since other effective diabetes drugs are already on the market, and those drugs are more effective for more patients, bladder cancer is an unacceptable risk.

But bladder cancer isn’t the only concern.  What about breast cancer?  The FDA consultant gave several reasons why DAPA is unlikely to have caused the breast cancers that were observed.

These reasons included:

  • short treatment time prior to onset,
  • the decline in incidence risk ratio over time, and
  • the fact that the breast cancers were estrogen receptor positive.

 

Let’s start with the short treatment time before onset.  We all know that cancer usually takes years to develop.  So, it would be easy to assume – or perhaps hope – that the increase in cancer happened by chance.  But wishful thinking isn’t enough.  We need to know.

When the percentage of women taking hormone replacement therapy for menopause dropped dramatically, the rate of new cancers in the U.S. went down for the first time ever.  Experts in the field agree that this unexpected quick effect was because of the drop in use of hormone therapy.  So, we know from that experience that even a slow growing cancer can be stimulated by a drug.

We challenge the other 2 assumptions as well.  Hormone receptor status is irrelevant because the potential mechanism for this drug to cause breast cancer is unknown.  It is entirely possible that dapagliflozin could act in multiple biological pathways, including hormone receptor signaling, or in a biological pathway that is common to breast cancers regardless of hormone receptor status.

Similarly, long-term biological responses to dapagliflozin and potential feedback mechanisms in breast tissue are also unknown.  Thus, the decline in incidence risk ratio over time doesn’t mean the drug is safe — because the body could respond differently to dapagliflozin over time.

Diabetes and the prior use of hypoglycemic medications were also listed as reasons to doubt potential breast cancer risk, but these factors are common among all patient groups in these trials.

In summary, these arguments cannot rule out the possibility that dapagliflozin causes breast cancer.  The only way to answer this question is with appropriately designed animal models of mammary tumors, or human patients.

Other Safety Issues:

Renal impairment/failure adverse events were associated with dapagliflozin treatment in data based on 13 short-term studies (3.2% in dapagliflozin-treated patients vs. 1.8% with placebo) and the 9-short-term plus long-term studies (6.7% vs. 4.2%) studies.  As many diabetes patients already have compromised renal function, this risk represents a significant health hazard primarily for the patients most likely to receive this drug.

At two different doses, the DAPA patients had elevated LDL levels, while placebo patients did not.  This increase raises concerns that any potential cardiovascular benefits – which are questionable — cannot justify the additional risks.

Lack of Diversity in the Studies

In the entire clinical program, less than 4% of the patient s were African American.  And yet 13% of African Americans have type II diabetes.  They should have been tested if the intent was to approve the drug for all Americans, not just white Americans.

But, given the risks, it would be difficult to justify recruiting African Americans or whites for more research at this time.

When I speak at FDA advisory committee meetings it is always as a scientist, but today I also want to speak on behalf of patients.  My Dad developed diabetes at the age of 90, probably because he took lupron for prostate cancer.   In retrospect, that was probably not a good treatment decision, since prostate cancer is rarely fatal.   It would certainly be ironic if a diabetes patient developed bladder cancer, which is often fatal, or breast cancer, which can be fatal, as a result of taking a diabetes medication that is no more effective, and often less effective, than other diabetes treatments on the market.

It’s hard to imagine a well- informed patient choosing DAPA, but unfortunately, patients are rarely well-informed.   I assume that the physicians on this panel would clearly and carefully inform their patients of the risks of this drug, but in the real world, many doctors won’t be well-informed because the company that makes DAPA is telling doctors very clearly that DAPA is safe and does NOT cause cancer, when the truth is we don’t know, but it might.

We can’t solve this with a black box warning on a label, because many doctors and patients don’t read the labels.  We can’t ethically rely on post-market studies, because it would not be ethical to prescribe this medication with all these unanswered questions.

I sympathize with the companies’ repeated efforts to get this drug approved, but I wonder why they didn’t do the animal study that the FDA recommended.   And I would not want anyone I care about to take a drug with such serious potential risks when so many alternatives are on the market that do not cause cancer.

Have colon cancer? Skip the hot dogs, deli, and burgers

Colon Cancer, Colon Cancer, Diet, Habits, & Other Behaviors, Uncategorized
Caitlin Kennedy, Ph.D.

New research shows that eating red meat and processed meat increases the risk of colon cancer or of dying from colon cancer. The 2013 Cancer Prevention study by the American Cancer Society has been studying the impact of diet on cancer by following 184,000 patients for 18 years.13

Among the men and women diagnosed with colon cancer, those who ate more than 4 servings per week of red or processed meat before and after they were diagnosed with colon cancer were significantly more likely to die from colon cancer than those who ate fewer than 4 servings per week. Processed meats include deli foods such as hot dogs, sausage, bacon, and bologna, ham and other lunch meats, and bacon. Those who ate more than 4 servings per week had a 79% higher risk of dying from colon cancer compared to those who ate these foods less often. Those who had a family history of colon cancer and ate these foods frequently were especially likely to die from colon cancer.

Remember that “portion” sizes are smaller than what many people typically eat in a meal. For example, 2 hot dogs are considered 2 portions, and one double quarter pound hamburger is considered 3 portions. A large steak could be counted as 3 portions or even more.

Previous research has found connections between eating red meat frequently and an increased likelihood of being diagnosed with colon cancer and other health problems. However, this study is the first to show an increased risk of death from colon cancer.

Bottom line

These very popular foods are more harmful than any of us would like to think. The best way to prevent a variety of health problems, including colon cancer, is to limit red and processed meats in your diet. While the chicken or turkey you make in your oven is fine, the processed chicken and turkey sold at the deli counter or packaged in the supermarket are processed foods. Unfortunately, grilled foods including grilled chicken have also been associated with colon cancer.14 Fish and beans are other healthier sources of protein. If you have a family history of colon cancer, you should be especially careful to eat red and processed meats less frequently. Keep in mind that the American Cancer Society study found an increased chance of dying from colon cancer for men and women who ate these foods either before or after they were diagnosed with colon cancer.

The good news is that it’s never too late to start eating healthy and cutting back on your red and processed meat consumption! Even if someone is already diagnosed with colon cancer, eating less red meat and less processed meat can increase the chances of cancer survival.

Surgery after Lumpectomy: Is it Possible to get All the Cancer out on the First Try?

Breast Cancer, Uncategorized
Amrita Ford, MA, Cancer Prevention and Treatment Fund

Lumpectomy, or partial mastectomy, is the most common surgery for invasive breast cancer.[1]   It is performed in 60-75% of new breast cancer cases each year and has been in use for 30 years. Also called breast-conserving surgery, lumpectomy removes the cancerous tumor while preserving as much of the breast as possible.[2]  In an attempt to preserve the size of the breast, however, a doctor may accidentally leave behind a small amount of cancer. That’s why almost one in every four lumpectomies is followed by additional surgery, according to a February 2012 study published in the Journal of the American Medical Association.[1]

These repeat surgeries (also known as re-excisions) include women with ductal carcinoma in situ (DCIS), an early noninvasive form of breast cancer that if left untreated can develop into invasive breast cancer.

Experts believe that some women are having additional operations they may not need and others are missing out on surgery that could help prevent a recurrence of breast cancer.

During a lumpectomy, surgeons remove the cancer, along with some surrounding normal breast tissue. They then send the surgically removed tumor and surrounding rim of healthy tissue to a pathology lab. A pathologist will examine the tumor and breast tissue under a microscope, and if no cancer cells are found near the edges of the healthy tissue, it is called a clear margin.[2]

However, surgeons differ widely in their interpretation of the pathology results and disagree on how big of a margin there should be between the cancer and the healthy tissue. This results in re-operation rates for individual surgeons that range from 0 to 70%.[1] Some surgeons consider a lumpectomy successful as long as there is a clear margin between the cancer and normal tissue. Other surgeons prefer a wider margin, sometimes up to 5-10 millimeters, and if there is less, they will operate again. Differences in surgical training or a surgeon’s confidence in removing tumors may explain why surgeons treat margin sizes so differently and why there is a lack of standardization. Rates of repeat surgery also vary from one hospital to another, ranging from 1.7% to 20.9%. That means the number of surgeries a patient will undergo depends in part on her surgeon and the hospital where she receives treatment. The variation between hospitals may be explained by differences in the operating technique of surgeons, or the way in which different pathology teams analyze tissue specimens.

In the study, almost half of the repeat surgeries were done in women with clear but less than 1 millimeter margins, indicating that the surgeries may not have been necessary.[1]
Additional surgeries can be emotionally and physically taxing for patients, as well as an added financial burden. Many women who have repeat surgery subsequently undergo total mastectomy (removal of the entire breast), so the decision to operate again is a significant one. For patients who had a clear margin between tumor cells and healthy tissue, the factors that influenced the decision to operate again were the particular hospital, an unknown cancer diagnosis prior to initial surgery (versus a preoperative diagnosis like invasive ductal carcinoma, for example), and tumor size (very small and very large tumors were more likely to be re-operated).

On the other hand, 14% of patients in the study without clear margins did not undergo an additional surgery, despite being at an increased risk for breast cancer recurrence later on.1 Patients who had evidence of cancer left behind were more likely to be operated on again if their final diagnosis (based on the pathology report after the first surgery) was lobular cancer or if cancer cells were found in their blood or lymphatic vessels. Also, patients who had a lumpectomy based on an unknown cancer diagnosis were more likely to have additional surgery. Other factors may have played a role in the decision not to operate again, such as specific pathological features of the tumor, clinical characteristics of the breast cancer, and the patient’s wishes, but this study did not look at those factors.

The study suggests that whether breast cancer patients undergo repeat surgery following a lumpectomy depends not only on their clinical condition but also on their surgeon and where they receive treatment. While it suggests some patients are having too many surgeries, having a high rate of repeat surgery is not necessarily a bad thing and could mean a surgeon is especially diligent about removing all cancer cells. Similarly, a low re-operation rate could mean the surgeon usually performs lumpectomies correctly the first time, but it could also mean that he or she performs more mastectomies over lumpectomies initially or fails to provide additional surgery when it is needed. [3]

What Other Studies are Saying

The purpose of additional surgery following a lumpectomy is to reduce the chances of breast cancer recurrence or death from breast cancer. However, the long-term benefits of additional surgery are unclear. Some studies have shown that very small margins (less than 2 millimeters) between the cancerous area and healthy breast tissue lead to an increased risk of recurrence, so a second surgery would be a good idea. [4,5,6] A meta-analysis, which is a combined analysis of several different studies, concluded that wide margins of at least 10 millimeters are important for patients with ductal carcinoma in situ (DCIS) to lower the risk of recurrence.[7] However, other studies have found that larger margins (2 millimeters or greater) don’t reduce recurrence and are, therefore, usually unnecessary. [8,9] Even larger margins (5-10 millimeters) have not been conclusively linked to a reduction in breast cancer recurrence, especially if the patient undergoes radiation or other therapies following surgery to further decrease the chance of recurrence.

Meanwhile, other methods to reduce the number of repeat surgeries are being investigated. Physicians at the University of Michigan Comprehensive Cancer Center were able to reduce the number of repeat surgeries by having an on-site pathologist present in the operating room during lumpectomy surgeries. [10] The pathologist would examine the tumor and surrounding tissue immediately after their removal and give the results back to the waiting surgeon, who could at that point continue with additional surgery if necessary. Having an on-site pathologist reduced the percentage of patients requiring additional surgery from 25% to 11%. The on-site pathology lab, however, required a different approach for analyzing tumor and tissue samples called frozen section analysis. Frozen section allows samples to be analyzed in a short amount of time and involves freezing the specimen, cutting it, and staining it so it can be viewed under a microscope. The study found that frozen section analysis was just as accurate as traditional methods; however another study found it was slightly less accurate for analyzing the margins of patients with DCIS. [11] Although the approach increases surgical time for a lumpectomy and requires an investment from the medical center, both time and money will be saved in the long run if women are operated on fewer times.

The Bottom Line

There is no clear evidence whether a second surgery is a good thing for patients because it means the surgeon is being cautious, or a bad thing because women are undergoing two surgeries instead of one. Maybe surgeons could simply ask patients what they would prefer: Would they rather have more of their breast tissue, a bigger “lump,” removed during the first lumpectomy surgery in order to reduce the chance of a second operation, or would they prefer taking out as little breast tissue as possible (preserving the breast’s appearance more), knowing that if the margins aren’t clear, the surgeon will have to perform a second surgery? Judging from the available research, it seems likely that a woman will be more satisfied with the outcome of her lumpectomy if she has a say in whether to remove more or less breast tissue at the initial surgery.

References:

  1. McCahill LE, Single RM, Aiello Bowles EJ, et al. Variability in reexcision following breast conservation surgery. JAMA. 2012;307(5):467-475.
  2. Breast Lump Removal. http://www.nlm.nih.gov/medlineplus/ency/article/002918.htm. Accessed February 13, 2012.
  3. Morrow M, Katz SJ. The challenge of developing quality measures for breast cancer surgery. JAMA. 2012;307(5):509-510.
  4. Dillon MF, McDermott EW, O’Doherty A, Quinn CM, Hill AD, O’Higgins N. Factors affecting successful breast conservation for ductal carcinoma in situ. Ann Surg Oncol. 2007;14(5):1618-1628.
  5. Kunos C, Latson L, Overmoyer B, et al. Breast conservation surgery achieving >or=2mm tumor-free margins results in decreased local-regional recurrence rates. Breast J. 2006;12(1):28-36.
  6. Chan KC, Knox WF, Sinha G, et al. Extent of excision margin width required in breast conserving surgery for ductal carcinoma in situ. Cancer. 2001;91(1):9-16.
  7. Wang S-Y, et al. Network meta-analysis of margin threshold for women with ductal carcinoma in situ. J Natl Cancer Inst. 2012;507-516.
  8. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383-393.
  9. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer. 2010;46(18):3219-3232.
  10. Sabel MS, et al. Development of an intraoperative pathology consultation service at a free-standing ambulatory surgical center: clinical and economic impact for patients undergoing breast cancer surgery. Am J Surg. 2011.
  11. Cendán JC, Coco D, Copeland EM 3rd. Accuracy of intraoperative frozen-section analysis of breast cancer lumpectomy-bed margins. J Am Coll Surg. 2005;201(2):194-198.

2012 Foremother Awards & Health Policy Hero Luncheon

Uncategorized

banner-cancer-prevention-fund

Cordially Invites You to Our

2012 Foremothers Awards and
Health Policy Hero Luncheon

Friday, May 11, 2012 at Noon
The Cosmos Club of Washington, D.C.
2121 Massachusetts Avenue, NW

Join us on May 11th, the Friday before Mother’s Day, at the elegant Cosmos Club of Washington, D.C. as we honor our 2012 Foremothers and Health Policy Hero.   The Foremother Awards are for lifetime achievement for Washington area women whose lives have touched adults and children across the country.Description: https://mail.google.com/mail/images/cleardot.gif

Katharine Weymouth, publisher of The Washington Post, will emcee.

  • Joan Claybrookis a nationally respected consumer advocate whose work has saved lives and improved public policies that affect all of us. She was president of Public Citizen from 1982 until 2009, fighting for safer cars, food, and medicines as well as campaign finance reform.
  • Dr. Beatrix Hamburgwas the first African-American to graduate from Vassar and the first African-American woman to graduate from Yale Medical School. She has dedicated her life to improving the lives of our nation’s children, as past president of the William T. Grant Foundation and as a faculty member and leader at the nation’s top medical schools.
  • Alice Rivlinwas the founding director of the Congressional Budget Office from 1975-1983, and the first woman Director of the White House Office of Management and Budget. She served as Vice Chair of the Federal Reserve Board, and has also been credited with saving the District of Columbia from financial disaster as chair of the DC Financial Management Assistance Authority from 1998-2001.

Linda Birnbaum, Director of NIH’s National Institute of Environmental Health Sciences (NIEHS) and the National Toxicology Program, will be honored as our 2012 Health Policy Hero for her outstanding research on the health effects of environmental pollutants and chemicals. Thanks to her leadership, NIEHS is carrying out groundbreaking research, prevention, and intervention efforts that are making our homes and communities safer across the country.

Take advantage of this great opportunity to meet these four inspiring women, previous Foremother honorees, and many of D.C.’s other movers and shakers.  Help us honor the newest inductees into this special society for remarkable women.  Lunch is from noon to 1:30, preceded by a champagne reception for honorees and patron guests.

Donations must be made by April 15 to guarantee a seat.

Prices below are valid through April 15.

Regular lunch tickets are available for a donation of $90 per ticket.  A table for 10 is $850.

Patron Tickets ($150 per ticket) include a champagne reception with the current and former honorees just before lunch, priority seating, listing in the program, and free valet parking.

Corporate sponsorships are also available, from $1,000-$10,000.

The National Research Center for Women & Families is the leading national organization dedicated to improving the health and safety of all adults and children. Our goal is to prevent diseases and help families get the most effective medical treatments, regardless of the disease or illness.  Our Cancer Prevention and Treatment Fund focuses on reducing cancer risks in our homes and communities, educating adults and children about harmful cancer-causing exposures, and helping patients, with their doctors, make the best choices for their medical care.

 

Proceeds from the luncheon will support our Cancer Prevention and Treatment Fund, which has been designated as one of America’s best charities by the Independent Charities of America.

 

 

Please contact Emily Moore at em@center4research.org

or (202) 223-4000.

Payment: Please donate online here.

(Write “Foremothers Luncheon” in the comments box and be sure to provide contact information) or mail a check made payable to “Cancer Prevention and Treatment Fund” to 1001 Connecticut Ave, Suite 1100, Washington, DC 20036.

Get BPA Out of Our Food!

Uncategorized
Cancer Prevention and Treatment Fund

Every time you drink a can of soda or eat pizza made from canned tomato sauce, you are consuming bisphenol  A (BPA) – a synthetic estrogen! This is because BPA leaks from the lining of the can and into your food and beverages. By March 31 – just days away – the federal Food and Drug Administration will decide whether or not to continue allowing food packaging with BPA in it. Make your voice heard! Act now before the FDA decides.  Email the FDA today and tell them you want BPA out of your canned drinks and other food packaging!

Here is a sample letter, but feel free to make any changes!

Send your email to margaret.hamburg@fda.hhs.gov

Dear Commissioner Hamburg,

Please ban the use of bisphenol A (BPA) in all food and beverage containers.

BPA is a synthetic form of estrogen, and research shows that BPA could increase the risk of breast cancer, prostate cancer, diabetes or miscarriages. It may interfere with chemotherapy if consumed by breast cancer patients.  Even though the level is low in each food package, it adds up!  Studies have shown that BPA is in breast milk, saliva, urine, amniotic fluid and cord blood.

We are grateful that the FDA has finally banned BPA in baby bottles and sippy cups, but that is not enough to protect our children. As Commissioner, your decision about BPA will affect the health of adults and children across the country, for decades to come.  Please ban BPA from food containers.

Thank you.

[YOUR NAME]