Source: UC Irvine Health News, Making Breast Cancer Surgery More Precise; ucirvinehealth.org

One of the many problems facing breast cancer patients is weather their surgeon cut out all of the cancer in her breast during surgery. The goal in a lumpectomy is to completely remove the cancer while preserving as much normal breast tissue as possible. If a pathologist finds cancer cells on the edges of the tissue taken out, surgeons must assume the lumpectomy didn’t get the entire tumor. According to some statistics 30-60% of the time cancerous cells are found on the margins of the original cutting area, which require another surgery for the patient.

Sources: Nature Cell Biology, May 2013; Washington University School of Medicine, St. Louis

Breast Cancer Spread (metastasis) risk is higher in women with dense breast tissue.  Researchers at Washington University School of Medicine in St. Louis have discovered why breast cancer patients with dense breasts are more likely than others to develop aggressive tumors that spread. This greater density is caused by an excess of a structural protein called collagen.

Source:  Molecular Cell, May 2013; Western Schulich School of Medicine & Denistry (Ontario, Canada)

Breast Cancer isn’t all the same. There is a type of breast cancer called “triple negative” which has limited treatment options and the worst chance of survival. Triple negative breast cancer is generally diagnosed based upon the presence, or lack of, three “receptors” known to fuel most breast cancers: estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2 (HER2).

The most successful treatments for breast cancer target these receptors.  Unfortunately, none of these receptors are found in women with triple negative breast cancer. In other words, a triple negative breast cancer diagnosis means that the offending tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative, thus giving rise to the name “triple negative breast cancer.” While triple negative breast cancer is typically responsive to chemotherapy, triple negative tumors generally do not respond to receptor targeted treatments. Depending on the stage of its diagnosis, triple negative breast cancer can be particularly aggressive, and more likely to recur than other subtypes of breast cancer.

New research explains why some cancer cells don’t respond to chemotherapy, and identifies a mechanism to rectify that. The team at Western’s Schulich School of Medicine & Dentistry, led by Shawn Li, PhD, identified that a protein called “Numb” functions to promote the death of cancer cells by binding to and stabilizing a tumor suppressor protein called p53 -a master regulator of cell death. The scientists found when Numb is reduced or methylated by an enzyme called Set8, it will no longer protect p53. The research is published in the May 23rd issue of Molecular Cell. A related research paper on the role of chemotherapeutic agents on regulating protein methylation, also from the Li lab, will be published in the June 7th issue of Molecular Cell.

“If you don’t have Numb in a cell, then the p53 can be degraded very quickly, and these cells become resistant to chemotherapy,” explains Li, a professor of Biochemistry and Canada Research Chair in Cellular Proteomics and Functional Genomics. “So if we can prevent Numb from being methylated in cancer cells, then we will have the means to sensitize the cell to chemotherapy.”

Now that they’ve identified the Set8-Numb-p53 pathway, Li and his team are investigating various drugs to find a Set8 inhibitor which could be used as a novel breast cancer therapy alone, or in combination with other chemotherapy regiments.

For more information on Triple Negative Breast Cancer Click here for the TNBC Foundation^®  

The TNBC Foundation^® is devoted to finding targeted treatment for triple negative breast cancer. With your help, we will find a cure.

The Lewis Law Firm has a history of representing women who are diagnosed with breast cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.

It’s almost Memorial Day weekend, the kick-off to Summer and with Summer comes much needed warnings to enjoy, but be safe and aware of the cancer facts, in the sun!

The Lewis Law Firm has a history of representing patients diagnosed with cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with skin cancer contact the Lewis Law firm today for a FREE consultation.

Source: AARP Bulletin, May 2013 by Nissa Simon

Eyes may not be a window to the soul, as poets have claimed, but eyesight is certainly a window on the world. As boomers age, however, millions of them will struggle with some kind of eye disease. Over age 40, an estimated 25 million people have cataracts and more than 2.5 million have glaucoma; more than 2 million men and women over age 50 have age-related macular degeneration. Unfortunately, eye diseases often sneak up on us without warning. Here’s what experts say about these three common vision conditions – how they affect the eyes, who’s at risk and what treatments are available – along with developments that will help protect your eyes in the years ahead.

Cataracts

Cataracts are a price that many of us pay for growing older.

Light normally passes through the eye’s clear lens to the retina, the light-sensitive area at the back of the eye. Sometime after age 40, small clumps of protein can form in the lens and cause it to become cloudy – and the loss of vision cannot be corrected with glasses or contact lenses. This clouding is called a cataract.

Treatment: There is no cure for cataracts – surgery is the only effective treatment. “Most people consider surgery only when reduced vision interferes with activities like driving, work or hobbies,” says Richard Braunstein, M.D., of the north Shore-LIJ Health System in New York.

Before surgery the doctor will ask how you want to see out of that eye. You can choose a basic monofocal lens that will allow the eye to see clearly either close up or at a distance. You also can opt for a premium lens, such as one that corrects astigmatism, or a multifocal lens that can potentially restore a full range of vision without eyeglasses. Keep in mind that Medicare or private insurance won’t pay the generally hefty extra cost of these premium lenses.

During the operation the surgeon will make a small opening in the cornea (the front part of the eye), insert a tiny high-frequency ultrasound probe to break the cloudy lens into fine particles, vacuum them out and then implant a clear artificial lens. It’s often done in as little as 15 minutes. Painful? No, you’ll receive an anesthetic eye drop or injection as well as a sedative to relax you.

Looking ahead: A new procedure called laser-assisted cataract surgery uses a computer-guided laser to deliver pulses of energy to perform some of the steps that are now carried out with handheld instruments. Studies are now underway to evaluate both the safety and the advantages of this new technology. Private insurance or Medicare may not cover part of the cost. Ask your doctor.

Macular degeneration

The macula, a tiny area near the center of the light-sensitive retina, helps produce sharp close-up vision, enabling you to read fin print, recognize faces and sew on a button.

Progressive damage to the macula knocks out central vision, although side vision remains clear. After age 50, the condition is called age-related macular degeneration (AMD).

A combination of factors, including family history, smoking and sunlight, play a role in its development, says ophthalmologist Manju Subramanian, M.D., associate professor at the Boston University School of Medicine, but “we just don’t know why some people get it and some don’t.”

AMD has two forms; dry and wet. The dry form generally progresses slowly over a period of years. According to Subramanian, about 10 percent of dry AMD cases progress to wet, which happens when new blood vessels under the macula leak blood and fluid. Wet AMD is more aggressive and can cause severe vision loss in a matter of weeks or months.

Treatment: The gold standard of care for wet AMD, she says, uses antibodies to help prevent the growth of leaky blood vessels in the eye. The therapy can actually improve vision, the only method to do so.

There is no cure, but for someone with moderate or severe AMD – either dry or wet – supplements of high levels of antioxidant vitamins and minerals could slow its progression, according a study sponsored by the National Eye Institute. These supplements don’t benefit people with early AMD.

Looking ahead: A small clinical trial tested the safety – but not the efficacy – of transplanted human embryonic stem cells to treat people with problems affecting the macula. Four months after the procedure, the researchers found o safety concerns, no signs of rejection and no abnormal cell growth. Larger trials are in the offing for this groundbreaking development.

Glaucoma

Some researchers no longer think of glaucoma solely as an eye disease, but rather as a neurological disorder associated with nerve cells in the brain that degenerate and die, similar to what happens in Parkinson’s and Alzheimer’s diseases.

For many years, doctors believed that increased pressure within the eye brought about glaucoma’s damage, so the only goal was to lower pressure with surgery and medications.

“Yet some people with mildly elevated pressure may never develop glaucoma, and most people with glaucoma never had very high eye pressure,” says Jeffrey Goldberg, M.D., professor and director of research at Shiley Eye Center at the University of California, San Diego. “Although eye pressure is a risk factor for glaucoma and contributes to the damage, we don’t use pressure alone to make the diagnosis,” Goldberg says. “We also look for characteristic changes like loss of peripheral vision and damage to the optic nerve.”

Left untreated, glaucoma can cause blindness. Only about half the people who have the disease are aware of it. There are usually no early symptoms because glaucoma progresses slowly and affects peripheral vision first. “People tend not to notice that they’re losing their peripheral vision until much later in the disease, when it starts to creep in and affect their central vision,” Goldberg says. “Because we don’t have a proven way to undo the damage of glaucoma, we can only try to prevent further loss of sight.”

Treatment: Eyedrops to lower pressure are the most common early treatment. Surgery may be recommended to improve the flow of fluid out of the eye and control pressure.

Looking ahead: New research focuses on damage to retinal cells that connect the eye to the brain. Medications that slow down the death of these cells and protect healthy cells are in clinical trials. Some are injected into the eye, some are slow-release implants surgically place in the eye, and some are eyedrops.

Source: AARP Bulletin May 2013 by Nissa Simon

Here’s what we know: Research has linked high blood pressure with low levels of vitamin D. Older people have significantly higher rates of high blood pressure and lower levels of vitamin D. So do black adults in general. If you’re both older and black, take note.

Recent studies suggest that vitamin D supplements may help. In one three-month study of 50 black adults ages 43 to 60, blood pressure dropped the most in those taking the highest dose of vitamin D.

“The gains were modest, but significant,” says lead author John Forman, M.D.

Should you take a supplement? More study is needed. For now, experts advise a heart-healthy diet and exercise.

Source: AARP Bulletin/May 2013 by Bill Hogan

For nearly eight-years, New Jersey-based Par Pharmaceutical made millions of dollars by aggressively pushing Megace ES as a weight-gain drug for patients in nursing homes and other long-term care facilities. The problem is that the U.S. Food and Drug Administration had approved Megace ES only to treat weight loss associated with AIDS. IN fact, the FDA had twice instructed the company to do additional research and clinical trials if it wanted to market the drug for other uses.

Par, however, continued targeting doctors and nursing homes caring for non AIDS geriatric patients. The company rewarded top-performing sales reps with bonuses like Rolex watches and vacations to Mexico.

In March, facing a raft of criminal and civil lawsuits over it’s “off-label” marketing of Megace ES, the company pleaded guilty in federal court to misbranding its product and agreed to pay $45 million in penalties. Par Pharmaceutical had earned $11 million through its “end run” around the FDA, U.S. Attorney Paul Fishman said.

Although no allegations exist that anyone was harmed, the Justice Department says Par was aware of the potential side effects associated with the drug, including “an increases risk of deep-vein thrombosis, toxic reactions in elderly patients with impaired renal function, and mortality”.

Sources: David A. Hyman, MD, JD ; and Charles Silver, JD; CHEST 2013; 143(1):222–227

Take it with a grain of salt as it comes from a physician-lawyer and a lawyer, but strongly consider a well-researched article published in a peer reviewed medical journal which seeks to dispel the 5 Major myths that are consistently brought up by advocates for tort reform.

Myth 1: Malpractice Crises Are Caused by Spikes in Malpractice Litigation (ie, Sudden Rises in Payouts or Claim Frequency)

So-called “runaway” jury verdicts are rare and payment on them rarer still. Using data from State and Federal databases, including the National Practioner Databank, the authors determined that the frequency of medical malpractice claims and medical malpractice payments on malpractice claims were either stable or declining in the years preceding the “medical malpractice crisis” 1999 to 2000.  The vast majority of patients who have bad medical outcomes do not retain a lawyer and do not ever file a medical malpractice lawsuit.

Myth 2: The Tort System Delivers Jackpot Justice

Again, most medical malpractice cases are settled with less than 5% of medical malpractice cases going to trial.  And the doctors tend to win, at least 75% of the time.  The big verdicts get publicity because, well they are big verdicts.  But the fact is that big verdicts aren’t typically paid verdicts.  Appeals almost always follow and such cases, if not retried, are settled for substantially less money than the original reported verdict.  Settlements are almost always on the condition of non-disclosure agreements and therefore these do not get published with the detail and names that the original sensational news item will.

Myth 3: Physicians Are One Malpractice Verdict Away From Bankruptcy

Any verdict, blockbuster or otherwise, that exceeds the limits of a provider’s insurance coverage (typically $500,000 to $1 million) is very unlikely to be paid.  It certainly would be difficult if not impossible in some circumstances to collect a verdict directly from a doctor.  Out-of-pocket payments by physicians are extraordinarily rare.  In sum, physicians have effectively no personal exposure on malpractice claims (other than the obvious and unavoidable side effects of litigation, eg, the emotional and time-related costs of being deposed and the surcharges from their insurance company).

Myth 4: Physicians Move in Large Numbers to States That Adopt Damages Caps

The “we’re losing our doctors” cry has fallen on deaf ears.  Your doctors are still here, for the most part.  It is true that doctors are electing not to go into higher risk professions (obstetrics, surgery) and that this may be a response to medical malpractice claims but babies continue to be delivered at hospitals both with and without incident.  According to the authors’ extensive research, those patients who suffered grave and permanent injuries (including death)  received a mean payout of only $1.25 million and a median payout of about $1 million.  Not the kind of thing that causes doctors to leave en mas

Myth 5: Tort Reform Will Lower Health-care Spending Dramatically

The direct costs of medical malpractice claims (including the cost of malpractice awards and settlements and all costs associated with defending against such claims, including the administrative costs of medical malpractice insurers is relatively modest.  There is broad agreement that the direct costs of the malpractice system are on the order of 2% of health-care spending. Studies, commissioned by the Federal Government suggest that a cap on non-economic damages would reduce Medicare spending by a statistically insignificant 1.6%.

Damages caps do little to improve the malpractice system. Although they can dramatically reduce claims frequency, payouts per claim, and insurance premiums, they do not make health-care safer, reduce health-care spending, compensate those who are negligently injured, or make the liability system work better. The best reforms are patient safety initiatives that reduce the frequency and severity of medical mistakes.  Those tend to come  from medical malpractice lawsuits.

The Lewis Law Firm handles cases of medical malpractice in Philadelphia and New Jersey.  Call for FREE consultation today.  Have you or a loved one been the victim of medical maplractice?  Contact the Lewis Law Firm for a free consultation.

Sources: Current Litigation; US Food & Drug Administration

Breast Cancer can be detected early in many women who undergo routine mammography.  Unfortunately, simply having a mammogram isn’t always a guarantee that you or your doctor will receive your results.  The Lewis Law Firm urges all women who have a mammogram to follow up with their referring doctors.  Under Federal Law in the US, you are supposed to receive a letter from the center performing the mammography within 30 days advising you, in simple terms, of the results.  But does that mean you will?

Mammography is a business and like all businesses, mammography centers aren’t always successful.  We are aware of  no less than 3 mammography centers in Northern New Jersey which went bankrupt in 2009 and 2010 -literally closing their doors with patients still in radiology rooms.

Did you have a breast cancer screening mammogram scheduled and performed at any of the following New Jersey Mammography Centers?

Bergen Open MRI & Diagnostics, located at 1 W. Ridgewood Ave., Paramus, NJ;

Englewood Imaging Center, P.A., located at 177 N. Dean Street, Suite 102, Englewood, NJ; or

Imaging Center of Oradell, LLC, located at 680 Kindremack Road, Oradell, NJ.

Each of these facilities has gone through bankruptcy proceedings.  Their records (YOUR films and reports) may not have been sent to your referring doctor!  What does that mean for you?  It means that you may experience difficulty and or a significant delay in trying to obtain the results of your diagnostic studies.  This can have serious consquences to your health.  If you have breast cancer which is shown on any prior mammography then any delay in the diagnosis of your breast cancer can mean a missed opportunity for treatment and may eliminate or reduce the possibility of a cure.

Facilities performing breast mammography have reporting requirements which are established by Federal Law.  The failure to timely and properly interpret and report the results of a mammogram which reveals breast cancer is not only a violation of Federal Law, it is in our opinion, malpractice.

We are already aware of at least one patient who will likely not survive her breast cancer because these mammography centers did not send her mammogram results to the patient or to her doctors!  The delay in her diagnosis caused her breast cancer to progress from a lesser stage to a metastatic (spread) stage.

If you had a mammogram at any of the above mammography centers, or if you had a prior mammogram for which you never received a report, or if you believe that a mammogram was misread then contact the Lewis Law Firm.  The Lewis Law Firm has a history of representing women who are diagnosed with advanced breast cancer.  If you are in Philadelphia or New Jersey and you or a loved one have been diagnosed with breast cancer contact the Lewis Law firm today for a FREE consultation.