Transforming Cancer Care eNewsletter: Issue 1
American women may be collectively shaking their heads as they weigh somewhat conflicting recent mammography guidelines. In a report early this year, the United States Preventative Task Force (USPTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, recommended that women of average risk – ages 50 to 74 – receive a screening mammogram once every two years. USPTF went on to suggest that younger women (those in their 40s) talk with their physician regarding their individual need for a mammogram.
But last fall the American Cancer Society (ACS) updated its guidelines to recommend that women ages 40 to 44 be given the choice whether or not to begin having annual breast cancer screening mammograms. The ACS also recommended that women age 45 to 54 get annual mammograms; and those ages 55 and older switch to mammograms every two years, or elect to continue yearly screening as long as she is in good health and expected to live 10 more years or longer.
Adding to the confusion, a U.S. Congressional bill (H.R.3339 - Protecting Access to Lifesaving Screenings Act (PALS Act) introduced last July, and included in the recently enacted Consolidated Appropriations Act, mandates continued Medicare coverage for mammography screening for at least two more years
Continuing Recommendations for Annual Mammograms Starting at 40
A number of health care professionals say the confusion around disparate screening recommendations may have a chilling effect on breast cancer detection because some women may now believe they do not need early preventive care.
Northwell Health’s Dr. Karen Kostroff and Dr. Nina Vincoff continue to urge women to begin annual mammograms at age 40, saying the benefits of earlier mammograms outweigh the potential inconvenience of returning for additional screenings because of potential false-positive results.
“Research clearly shows that mammography screening saves lives and is critical in the early detection of breast cancer,” says Dr. Kostroff. “Being able to detect cancer in its earliest stages greatly reduces the amount of treatment required and frequently will decrease the mortality rate. For many women, this means less invasive surgery, without having to undergo chemotherapy and radiation.”
Mammogram risks for younger women have been overstated; Dr. Vincoff emphasizes, and often based on previous imaging technologies. Today’s advanced digital breast tomosynthesis greatly reduces the need for follow-up screening.
“Conclusions used in the development of these newest screening guidelines were made before 3-D mammography was commonly used,” Dr. Vincoff said. “Studies comparing 3-D to 2-D mammography have shown that 3-D mammography increases the detection of invasive breast cancer by up to 40% while simultaneously reducing the need for extra views after screening mammography by up to 40%.
Both physicians encourage women to conduct monthly breast self-examinations, starting in the late teens. They also recommend women who are at greater risk of breast cancer (such as those who carry a breast cancer gene mutation or who have a significant family history of breast cancer) confer with their health care providers about additional screening options.
With new research and guidelines being published regularly, perspectives, such as those offered by Dr. Kostroff and Dr. Vincoff, can help provide guidance to referring physicians. To speak with Dr. Kostroff or Dr. Vincoff about breast cancer screening guidelines, contact them through the Northwell Health Cancer Institute at 855-858-8550.
Karen Kostroff, MD, FACS, is Chief of Breast Surgery, North Shore University Hospital and Long Island Jewish Medical Center, Co-Director of the Northwell Health Cancer Institute Breast Cancer Center of Excellence, a member of Northwell Health Physician Partners and a Clinical Assistant Professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Nina Vincoff, MD, is Chief of Breast Imaging Division, and a member of Northwell Health Cancer Institute and Northwell Health Physician Partners
At the recent annual meeting of the American College of Surgeons in Chicago, Dr. Gary Deutsch presented findings from a study he led showing that surgical removal of melanoma tumors that have spread to the abdomen can extend survival rates.
The study, which tracked outcomes of 1,600 patients who were treated between 1969 and 2014, indicated that patients who underwent surgery to remove metastatic melanoma that had spread to the liver and other abdominal organs lived more than twice as long as those who only received drug treatment. This type of surgery was previously thought to be useless because stage 4 melanoma of the abdomen was considered incurable.
Combining Surgery with Immune-Based Drug Treatments
With new immune-based drugs available to fight advanced melanomas, the study has offered insight into whether or not the surgical removal of part of a cancerous organ could make a difference in patient survival rates.
“We have been trying to gauge the role of surgical resection for metastatic melanoma since the development of (immune-based drugs),” said Dr. Deutsch. “The new findings suggest that they might. Today, metastatic melanoma is discovered earlier in a number of patients likely because of better imaging techniques, so surgeons may be able to intervene before it becomes futile.”
All of the patients in the study had potentially operable melanoma that had spread to the abdomen. Those who received complete, curative surgery had an average survival rate of more than two years. Dr. Deutsch believes that surgery “can really make a difference in the patients with GI tract metastases.”
Dr. Deutsch’s findings are considered preliminary and will be published in a peer-reviewed journal later in 2016. For more information about Dr. Deutsch’s research, contact him through the Division of Surgical Oncology at (516) 487-9454.
At the 57th annual meeting of the American Society for Radiation Oncology (ASTRO), findings conducted by the Radiation Therapy Oncology Group (RTOG) were presented showing that breast cancer type 1 susceptibility gene (BRCA1) protein expression is an important predictive biomarker of survival in patients with glioblastoma multiforme (GBM) tumors. The study's findings were presented by Dr. Maria Vasilakopoulou who carried out the research in the laboratory of Dr. David Rimm under the supervision of the principal investigator, Dr. Jonathan Knisely.
The study investigated, with tissue microarrays generated from tumor specimens of patients enrolled in RTOG prospective clinical trials of treatments for GBM, the quantitative expression and prognostic significance in relation to survival of four molecular biomarkers, including the BRCA1 protein, which is well-known from its linkage to hereditary breast and ovarian cancers. Only BRCA1 showed a statistical significance with survival rates. In patients with tumors with low levels of the BRCA1 protein, the survival rate was about four times longer than for those with tumors that produced more of the protein.
Predictive Biomarker May Lead to Advances in GBM Tumor Treatments
Because this protein is necessary for helping the body repair mistakes in DNA, the findings may indicate that tumors that are not efficient in repairing DNA mistakes could be more susceptible to some anti-cancer drugs and radiation therapy. This is the first time that a study has shown this gene to be a predictive biomarker of survival in patients with this aggressive, malignant brain tumor.
“These results suggest that BRCA1 testing could play a future role in the development of more individualized treatment options for patients whose tumor genetic profile shows low BRCA1 protein expression,” says Dr. Knisely. “For patients with high levels of the protein, agents that down-regulate BRCA1 may be beneficial in sensitizing them so that they can respond better to cytotoxic therapies.”
The next steps with this promising research will be to conduct a validation study to further evaluate the correlation between BRCA1 expression and survival. “A number of additional steps are needed before any clinical trials of targeting DNA repair mechanisms in GBM are undertaken, but the approach of targeting DNA damage repair has very recently shown extremely promising responses in selected patients with chemotherapy resistant prostate cancer.”
Incident Learning and Building a Culture of Safety
In an educational ASTRO session entitled “Incident learning and building a culture of safety”, co-chaired by Dr. Ajay Kapur and Dr. Jing Zeng, recent developments in incident learning at the national level were presented. The launch of RO-ILS: Radiation Oncology Incident Learning SystemTM marks a major step taken by ASTRO in response to the national need for enhanced safety in radiation medicine. The focus of this session was to educate practitioners on the links between safety culture and adverse events, as well as barriers and enablers to incident reporting and learning.
In addition, a panel was held to discuss user experience following the initial year of use of the RO-ILS system in clinical practice. Dr. Kapur highlighted the complexities of radiation medicine, and that error mitigation is best served by a systems-engineering approach combined with a safety culture. He also stressed that systems-sensitive safety cultures drive the rate of reporting up, creating additional opportunities for learning and mitigating risk.
With advances in cancer detection and treatment happening at an increasingly rapid rate, information, such as the topics presented at ASTRO, are a benefit to referring physicians, as well as to their patients. For more information about Dr. Knisely’s research on GBM tumors or Dr. Kapur’s presentation on radiation safety, contact them through the Department of Radiation Medicine at (855) 927-6622.
Maria Vasilakopoulou, MD., Ph.D., is a Medical Oncologist and clinical researcher at the Pitié-Salpêtrière Hospital, in Paris, France.
David Rimm, MD, Ph.D., is a Professor of Pathology and Medical Oncology at Yale University.
Jonathan Knisely, MD, is Chief of the Division of Radiosurgery and Stereotactic Program in the Department of Radiation Medicine at Northwell Health Cancer Institute, a member of Northwell Health Cancer Institute and Northwell Health Physician Partners and Associate Professor at Zucker School of Medicine.
Ajay Kapur Ph.D., DABR, is Director of Medical Physics Research and Education and Associate Director of Medical Physics at Northwell Health.
Dr. Jing Zeng is an Assistant Professor of Radiation Oncology, University of Washington School of Medicine and Radiation Oncologist at University of Washington Medical Center.
Lenox Hill Hospital recently launched their new Division of Gynecologic Oncology. Led by Dr. Jeannine Villella, the program specializes in providing comprehensive gynecologic cancer care for women of all ages.
Through the program, Dr. Villella offers both minimally-invasive robotic and radical surgical procedures, as well as chemotherapy. She is also focused on state-of-the-art research in ovarian cancer immunotherapy. She has active clinical trials in ovarian cancer vaccine therapy, which is at the forefront of innovative cancer research.
Dr. Villella’s office is located at 635 Madison Avenue in New York City and features a spa-like setting. Her all-woman practice offers concierge-level care, which includes the prompt return of patient calls and detailed consultations provided in a calm, nurturing environment. The office strives to give patients appointments within 24 to 48 hours and maintains constant contact to ensure seamless care from start to finish.
“Women with cancer, care where they’re seen,” says Dr. Villella. “They want to feel cared for and comfortable in a serene environment without long wait times. I believe we’ve accomplished this and more through the program. Patients are given a very high level of attention to help ease their fears and discomfort during this difficult time in their life; while getting the finest level of care.”
Because of Dr. Villella’s reputation as a renowned expert in gynecologic oncology and the quality of care that she and her team provides, the program is drawing patients from New York State and beyond for cancer treatments.
Complementary Supportive Care, Outreach and Research
Other services available through the Division of Gynecologic Oncology include holistic treatments such as acupuncture, nutritional counseling to deal with the effects of chemotherapy and a survivorship program. Outreach efforts will also be a primary focus as the program grows and will include cancer prevention classes, wellness lectures and cooking demonstrations.
The Gynecologic Oncology program will also include a research laboratory, currently in the final stages of construction, which will be used for clinical trials and translational research in immunotherapy to procure tissue for future research conducted worldwide. Findings from this innovative research, as well as the specialized care and treatment offered through the Division of Gynecologic Oncology, will benefit you as a referring physician, as well as your patients.
For more information about the Division of Gynecologic Oncology at Lenox Hill Hospital, call (212) 434-3770.
Jeannine Villella, D.O., FACOG, FACS, is Chief of Gynecologic Oncology at Northwell Health Cancer Institute at Lenox Hill Hospital, a member of Northwell Health Cancer Institute and Northwell Health Physician Partners and Associate Professor at Zucker School of Medicine.
Northwell Health Cancer Institute and Cold Spring Harbor Laboratory (CSHL) recently launched a translational research fellowship training program in medical oncology. The three-year program is open to candidates who have an MD or MD/Ph.D. with the following qualifications:
- Completed ACGME accredited residency in internal medicine
- Strong academic record with advanced training or experience with translational research
- Demonstrated conviction and extraordinary interest in translational medicine with a focus in a specific area of oncology
A Unique Fellowship Opportunity
As part of the strategic affiliation between Northwell Heath and CSHL, this highly unique, research fellowship training program offers both translational and clinical training. At Northwell Health Cancer Institute, the fellow will receive one year of formative clinical and clinical research training, attend didactic lectures and multidisciplinary tumor boards, and serve on internal committees. This is followed by two or more years of postdoctoral research training, working in the lab of an investigator on several projects in translational cancer medicine. As part of the program, the fellow will by mentored by national-recognized faculty of both Northwell Health and CSHL. Upon completion of the program, the fellow will be board eligible in medical oncology and prepared for a career in translational cancer investigation, as well as clinical cancer medicine.
“This fellowship training program is truly unique,” says Dr. Thomas Bradley. “”The selected fellow will have the opportunity to train at one of the world’s leading cancer research organizations as well as one of the largest cancer programs in the NY metro area. In addition, he or she will gain the unique perspective of both a researcher and a clinician, ultimately leading to new scientific discovery and leading-edge diagnostic and treatment options.“
Initiatives to Advance Cancer Care
In April 2015, Northwell Health and CSHL entered into a groundbreaking affiliation to accelerate cancer research, diagnosis and treatment. The affiliation brings together research scientists, clinical translational researchers and cancer clinicians to advance cancer diagnostics and therapeutics. In addition to the new joint fellowship program, the affiliation recently received Institutional Review Board approval for a phase one trial of a new HER2 breast cancer drug. A phase one clinical trial unit and a cancer-specific bio bank are in development and disease-specific retreats have been initiated to help strengthen relationships and set agreement on disease-specific research.
Currently Accepting Candidates
Northwell Health Cancer Institute is currently seeking qualified candidates for the translational research fellowship to start in July 2016. Applications are also being accepted for those candidates interested in a July 2017 start date. Individuals who would like to apply should contact Kerry Wallace, manager, educational initiatives at [email protected].
Thomas Bradley, MD, is Director of the Fellowship Program in the Don Monti Division of Medical Oncology/Hematology, member of Northwell Health Cancer Institute and Northwell Health Physician Partners and Associate Professor at Zucker School of Medicine