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V.A. and Brest Cancer: Are their treatments up to snuff?

While we hear tell of improvements in breast cancer treatments, it seem the V.A. health care system has not caught up with the latest teast and treatments, or are just unwilling to pay for state of the art tests and treatments. The result is that the V.A. may be sending women with Breast Cancer to an early grave.
Women Vets and Breast Cancer Treatment

For women, the personal seems to always be political. Perhaps one of the most offensive realities is how women's health care can be driven more by politics and/or profit than by good science. We all know that politics has interfered w/ women's reproductive health care. We know that patriarchal control over politics and science has effected research and treatment of women's health issues.

But, what about cancer, breast cancer. How might politics and profit play into Breast Cancer treatment?

The following is a story in the making. It is not something that has happened; it is something that is happening. To me; and to many other women.

In March I agreed to have a mammogram as I was approaching 50. Now I had a baseline done at 40 and it seemed a little rough, so I expressed my concerns and the Roseburg V.A. facilitator assured me that the new machines were not bad and I could get a state of the art, no pain monogram in Roseburg.

Boy did I feel betrayed. This idiot tortured me for over an hour while she failed time after time to get a good image. Likely due to the fact that she was overcompressing, and each time she failed to get a viable image she just came back and clamped down harder. I was ready to b slap the woman. This was much worse than anything I remembered a decade ago. How could this be better; my breast was red and swollen when she was finished. Well the images were no good and the whole thing had to be repeated; this time in Portland at OHSU. What a difference!!!! No pain, little compression. Now I knew this woman who tortured me either did not know what she was doing or needed to be incarcerated to protect the general public. I complained to the Roseburg V.A.. The reply was that is the only imaging place in Roseburg. Hell man, tell these women the truth; I am sure they will not mind going to Portland to avoid useless tortured.

OHSU asked if there were any earlier images available for a bass line. I called Eugene were images were taken 10 years ago, only to find out they had been destroyed. Why did I have that "baseline" again?

After the new images were in; it was suggested that I have a core biopsy. It was done; the results came back. Invasive ductile carcinoma.

Now it was time to do research, so I thought. But, as it turns out, I should have done the research before the mammography. What? Research a condition before you know you have it? That is what you would have to do, it turns out, if you want to protect yourself from the medical establishment and their killer breast cancer tests and treatments.
What killer treatments? What do you mean?

Well, I found research, then more research, then more and more, indicating that trauma inducing mammography, biopsy, and surgery, chemo all may increase the rate of cancer growth. Now metastasis is the most dangerous feature of cancer. Yet, cancer treatment it seems can often induce metastases.
A few of many sources are:
"Excisional surgery for cancer cure: therapy at a cost, the Lancet Oncology, Coffey..... at  http://www.sciencedirect.com
"Does the act of surgery provoke activation of "latent" metastasis in early breast cancer?" at http:/www.pubmedcentral.nih.gov/ariclerender.fcgi?artid=468671
"Trauma-associated growth of suspected dormant micrometastasis", BMC Cancer, 2005;9/4 on line at  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1190165
"Treatment-induced growth factor causes cancer progression", Vanderbilt, at  http://www.brightsurf.com
"Wounding from biopsy and breast-cancer progression, Lancet, 2001 Mar 31;357(9261):1048
"Does surgery unfavorably perturb the natural history of early breast cancer..." Baum, Eur J Cancer2005, Mar:41 (4):508-15
"Wound-healing genes promote cancer progression, Lancet Oncol. 2004;5:138.

Now I was freaked! A cancer that I could have had for years, and could have grown slowly for many years more, may now kill me in a matter of a few years. Why was I not told of this risk? Why was nothing done to hedge against such a risk? The science on the risk was enough to justify warning and response. What the hell happened to "informed consent"? The lack of communication on the issue breached all trust; I would no longer consent to anything I have not checked out for myself.

Of course one might argue that it may be better not to know, that is that it could be that there no good reason to warn about what cannot be helped and will only cause anxiety. Core biopsy is the best way to distinguish cancer from benign tissue, and there is no known means to offset the rate of growth. "NO other way" is usually a logical fallacy; "No better way", is as I found highly suspect if not simply wrong,

It may be that a core biopsy is the best way to find cancer; but in many cases there are known means to offset the treatment induced stimulation of growth. In my case where 90% of my cancer cells test ER+ that is dependent upon estrogen for growth, something known within 3 days after the core biopsy. It seems logical that neoadjuvant (pre-surgery) hormone suppression starting right after the ER status is known to be + might be a good means to offset treatment/trauma induced growth. There are several ways this can be done including for premenopausal women like myself removal of the ovaries, radiation of the ovaries, or chemical suppression. "New opportunities in premenopausal breast cancer? goserelin (Zoladex) plus Aromatase inhibition" Jakesz, Breast Cancer Online, Cambridge Univ. Press 2006,

After that rough roseburg mammography and the core biopsy, I have repeatedly asked for immediate therapy in the form of tamoxifen, hormone suppression, oophorectomy, something to offset this risk of treatment induced growth. No help, just condensation and patronizing B.S. Yes, I am afraid, anyone but a fool would be; not just afraid of the cancer, but afraid of all the fools coming out of the woodwork to do harm in the name of health. It may be that some are helped, but others are harmed, they know this is true, but rather than spend the money on appropriate tests and treatment, for some reason, economic/political I suspect, the V.A. Drs. are holding by an out dated standard of care when it comes to premenopausal ER+ breast cancer treatment.

Also, being somewhat concerned about long term side effects including cervical cancer, of tamoxifen, I asked about surgical oophorectomy at the time of breast surgery or before, a treatment of choice in Italy.
"Ovarian oblation "Vs. goserelin with or without tamoxifen in pre-premenopausal patients with advanced breast cancer..."  http://annonc.oxfordjournals.org/cgi/content/abstract/5/4/337 also see. "Breast Cancer Growth and Surgical oophorectomy", Love and Neiderhuber, Ann Surg Oncol Vol.11 No 9 2004, 818-828
When I showed this study to the oncologist he pointed to the words "a trend did favour oophorectomy" emphasis the word "trend" and never looked to see that everyone in the study rec'd ovarian irradiation of some sort, surgical or goserelin, neither of which I am being offered. The idea that something should be done to offset surgical stimulation of growth was not in question but now assumed knowledge. Oophorectomy is "comparable in efficacy to ususal chemotherapy programs", what matters is tumor genetics in determination of appropriate therapy. certainly what we knew about my tumor thus far suggested further investigation into this line of thinking, that is in using hormone suppression as indicated by the ER+ status but not using chemo until testing proves effectiveness. Yet again, without further examination, my suggestion was refused. Oophorectomy would take two surgeons I was told, not practical. I asked about testing for chemo effectiveness, and was ignored, No 21 gene test, no neoadjuvant test, just the old fashioned if it is outside the breast you get radiation/chemo regardless. What happened to "do not harm"? Medical induced harm may have already been done and is currently being done, and they are determined to risk more, all with no hedge. Most people on wall street would not accept the odds without a hedge, why should breast cancer patients with their very lives in the balance?

In fact research supports this reasoning.
Baum and others have suggested that hormone suppression and COX2 inhibitors might, "in part suppress the activation of dormant metastases by the act of surgery. If this is the case, IQAs should be initiated at (or even before) surgery in order to optimize this effect. Furthermore, this benefit might be enhanced by the concomitant use of a COX2 inhibit."
"An exploration of relapse data by hazard rate as a means of developing biological insights into the natural history and treatment of breast cancer..." JCO 2005, v23 no 16S 612, at  http://meeting.jco.org/cgi/content/abstract/23/16_suppl/612
"...the next leap forward would depend on "stabilizing" these latent metastases...before letting a surgeon near a patient" (Baum, Breast Cancer Res, 2004 6/4: 160-161)
Vanderbuilt is experimenting w/ TGF-beta inhibitors.
others are experimenting w/ Bisphosphonates....

I asked about using Goserelin and an IA, and quoted the recent guidelines by the "American Society of Clinical Oncology and the National Comprehensive Cancer Network that "tamoxifen therapy (what I was being told I would be given sometime after surgery, perhaps after radiation and chemo (a delay in hormone suppression which research has shown could further harm my chances) should no longer be considered optimal therapy, and that all adjuvant treatment regimes should now include an A I, in combination with goserelin for premenopausal women. See.
"Breast Cancer Growth and Surgical oophorectomy", Love and Neiderhuber, Ann Surg Oncol Vol.11 No 9 2004, 818-828-
"Management of premenopausal women with early-stage breast cancer: is there a role for ovarian suppression?" Clinical Journal of Breast Cancer 2002; 3(4):260-267


I pointed to UK research concluding that, while, "no obvious survival benefit (quality of life, number of surgeries, treatment side effects... are not considered) to women with breast cancer...it does allow avoidance of surgery in some cases..." 14% in this small sample, and can allow for the testing effectiveness of systemic therapy.  http://www.springerlink.com/content/h2064j420p241v25/

His comment simply contradicted the study pointing to the small sample, ignoring the fact that the numbers were amazing. 14% of the women who underwent pre-breast surgery oophorectomy of some kind did not have to have breast surgery after 4 months of treatment. Now this was the most significant scientific discovery I could imagine. Take the ovaries first and in many cases then save the breast? Hmmm.

Again I was refused the up to date treatment and told I would get the best of care as was determined 25 years ago.

Which brings me to chemo and radiation which have proved only effective in a sub population of cancer patients, but continues to be applied to a larger population, potentially doing more harm than good. Sandra M Swain of the National Cancer Institute using Recurrence scores claims that patients w/ a low RS do not benefit from chemotherapy and ER+ tumors have a small benefit from chemotherapy."A step in the right direction:" Journal of Clinical Oncology Vol 24, no23, aug 10, 2006. Why do this harm again? Are there not test to narrow treatment down to the appropriate subgroup? There are ways. Yet none are being employed in my case, inspire of repeated request.

"Gene Expression and Benefit of Chemotherapy in Women with Node-Negative, Estrogen Receptor-Positive Breast Cancer" Journal of Clinical Oncology at " http://jco.ascopubs.org/cgi/content/abstract/JCO.2005.04.7985v1
"Genomic Test Improve Prediction of Breast Cancer Response to Chemotherapy, Hormonal Therapy" Univ. of Tx, MD Anderson Cancer Center, 12/14/06, at " http://www.mdanderson.org

Radiation not unlike other treatments is also only effective in the case of some tumors. "Predicting Recurrence by Beth W. Orenstein, Radiology Today Vol 8 No. 1 p20.

Despite the fact that hormone suppression is the best thing that we know can be done in my case, one has to wonder why two months after discovery, after biopsy may have increased the growth rate of my cancer, to months after status and type of cancer was known, no therapy has been administered. In fact not only have I been refused any type of hormone suppression in spite of my repeated requests, but they insist I must move forward with surgery, and accept that hormone suppression may be further delayed for radiation and chemo if there are any signs of metastasis or lymph positive status is discovered, and no plans of a test to ensure the chemo or radiation will even be effective.

Now some Drs. may claim these treatments are not approved. But, off label use of drugs and phase III experimental treatments are employed often, and insurance companies often do not have the choice not to cover such treatments. In fact, treatments can become standards of care prior to FDA approval.
The U.S. Congress passed a law in 1993 requiring Medicare ( http://www.medicare.gov/), the federally funded health care program for elderly and disabled people, to cover off-label drugs used in cancer treatment when the use is supported by:
a citation in at least one of the following authoritative drug reference books.
The American Society of Health-System Pharmacists' American Hospital Formulary Service (AHFS). There is a regularly updated online version.
U.S. Pharmacopeia Drug Information
two or more peer-reviewed articles published in respected medical journals.

The drug reference books are not available online to us layfolk, but I have provided the V.A. oncologists with an abundance of peer-reviewed articles published in respected medical journals. However, while Drs. can help a patient in seeking insurance coverage for treatment, the V.A. is my Dr. and insurance coverage. Are the Drs. told what treatments they can offer and what treatments they cannot based on economic factors overriding health concerns? What is going on with breast cancer care and the V.A.? I can remember when the V.A. did no women's medicine referring us to private Drs. Did they take us on only to provide us with substandard care?

M.C. Kean

homepage: homepage: http://www.patrickdodd.com
phone: phone: 541-956-1513


VA is Temple Of Death 14.May.2007 20:53

x

 http://www.cancersalves.com

do yourself and your loved ones a favor, and get as far away from the VA as possible

the above site is written by women, for women, specifically about breast cancer, but applicable to many other kinds of cancer

10 of the top 12 most prevalent bioterror agents manifest cutaneously as skin cancer/breast cancer

the VA knows all about this but is part of a vast depopulation program of the bush scum administration

many other doctors also know but use these illnesses as a means of milking money from the system, all the while cutting the victim up in as many pieces as possible before killing them....fyi and true as hell

do it now

b
alberto gonzalez bayer vatican anthrax
alberto gonzalez bayer vatican anthrax

Oriental Medicine as adjunct treatment 15.May.2007 06:35

acupuncturist

After you find yourself a better set of doctors, (and mortgage your home to do so, if you have one) please consider using Oriental Medicine, herbs and acupuncture as adjunct therapy to help western treatments be more effective. There are many qualified herbalists (generally trained in China where western and eastern medicine is taught at the same time and where oriental medicine doctors practice in hospitals) in Portland.

OHSU has acupuncturists who work in that hospital. ITM - The Institute For Traditional Medicine on Hawthorne has low income rates for people with critical illness, where you can pay only $150/mo and get free herbs and free acupuncture and massage if you qualify... The list goes on, and practitioners will generally tell you if they feel comfortable treating you in conjunction with your western therapy.

Oriental Herbs can boost immune function, as well as improving chemotherapy effectiveness DURING AND BEFORE TREATMENT, and are amazingly successful in protecting healthy tissue from harm DURING radiation and chemotherapy. Administered by a trained, experienced (10 years experience minimum), licensed herbal practitioner (make sure they have either been trained in California, or China, or can tell you how many clients they currently treat with cancer) of Oriental Medicine, Chinese Herbs can improve quality (and possibly quantity) of life greatly.

Update and in response 20.May.2007 19:29

MC Kean

acupuncturist. I am currently taking cats claw, Tumeric..., Thanks so much for the info I will check out OHSU acupuncture and ITM.

b, I cannot afford prvt. sector care at the level of care I can get at the Portland V.A. I could delay treatment to sign up for a trial, but I am not sure that is a good idea, and it seems you still have to pay for treatment, even in the trials. I would not contradict what you say about the Bush administration, and I have been personally told by one of his daddys old C.I.A. friends that, "there are too many people on this earth.. who do you think we will make sure dies". This was over 20 years ago in the heat of an argument. His wife rationalized racist theory over dinner; saying that you can tell what grade a student will get by their race. That night I realized I was dating the son of Nazis. It was over.

I could be a fool and could regret this; but I do trust the team that has come together at the V.A. I had to ask around, make requests, and be willing to reject a Dr. I did not feel good about, and had to be willing to read, listen, and argue, but I do trust the Drs. I now am working with, and the current plan of action enough to get through the surgery, including an oophorectomy and take an A.I. I do not however have faith in radiation and chemo. I do feel patient directed care is key. I did not get what I wanted, but there was a compromise. No matter how you slice it, treatment can stimulate growth and currently nothing is being done to directly address that issue. Neoadjuvant treatment has been used to shrink tumor size in order to allow for a lumpectomy rather than masectomy; why not as an attempt to offset or hedge against treatment/trama induced growth, and/or to increase chances of a clear surgical margin in patients (25%)who will refuse radiation and chemo.

Cancer for Profit 28.May.2007 10:29

Mary Birmingham smallrevolution@peoplepc.com

1. Mammography, core biopsy, surgery, anything that can produce trauma can increase the growth rate of cancer/metastasis.
2. There is sufficient (in phase III trials w/great success) scientific evidence to show that for ER+,PR+ (responsive to hormone suppression) breast cancer tumors neoadjuvant endocrine (hormone suppression/irradication) therapy can slow the growth rate, even shrink the tumors.
3. A significant number of women (25%)reject radiation and/or chemo. This is a group that given my kind of cancer are allowed neoadjuvant endocrine treatment in UK.
4. While it was a very small study, it looks like neoadjvant endocrine therapy does not compromise sentinel node status as does neo adjuvant chemo.
5. Neoadjuvant endocrine therapy is used to shrink tumors; but, American oncology has not accepted the use of no adjuvant endocrine treatment to offset the trauma stimulate growth of trauma induced by testing and treatment. In fact they do not tell patients about the treatment induced risks at all, violating informed consent. Endocrine treatment could be started within days of diagnosis. Many more women might opt for lumpectomy as this choice would not necessitate radiation and chemo. Even more may want to use it to offset treatment induced growth in the cancer.
6. Think of the money the big boys make when women who do not want to undergo radiation and chemo, opt for mastectomy; and then are encourage to undergo a procedure much more risky than neo adjuvant endocrine treatment w/lumpectomy, that is reconstruction, and esp. reconstruction w/implants.
7. While the "expert" profiteers try to convince us that implants are safe, they do not tell women that their chances of having to have surgery to deal w/an implant issue within 3 years is 40% and it just gets worse from there. You are not told that implants have never been subjected to objective scientific scrutiny. The FDA approval to allow the implants back on the market was on the basis of manufature produced bad research.
8. While off label use of drugs is considered ok, particularly for cancer patients.
While I have presented legitimate research after research to V.A. oncologist on both trauma/treatment induced growth and on neoadjuctive endocrine treatment.
While I have told them that I will not accept radiation or chemo.
While endocrine treatment might allow me to undergo a lumpectomy rather than a mastectomy, though this is not my primary goal which is to offset trauma induced growth.
while I have begged for three months while they set up "consults" w/everyone from the plastic surgeon to radiology; I have been refused neoadjuctive endocrine (or any other for that matter) treatment. I had a absurdly rough mammography that was too rough to get good images so had to be redone; I have had a core biopsy; both stirring up the cancer, but no treatment. To this date, no surgery is scheduled. I have requested oopherectomy which they will not do before the mastectomy for the same reasons they will not give me neoadjuvant hormone suppression--to protect the integrity of margins, that is to know if they want to try and try harder to talk me into radiation and/or chemo due to matastisis, that they may well be creating. OBGYN surgeons and breast surgeons are only at the V.A. one day a week and not on the same day. The V.A. is underfunded and overloaded. Thus, it seems difficult to get the two women's surgeons and the OR room all on the same day. So here I sit. All harm; and to date no good.


What do you think of this? If you are interested I can send you research links. With Michael Moores new film coming out; it may not be a bad time to think about not only the state of health care; but take a good critical look at what could be one of their their most profitable diagnosis, Breast cancer. But only if they can get us to do the implants; and exteed treatment/repeated surgeries,.... for years even decades. Neoadjuctive endocrine treatment which has to potential to reduce the number of surgeries required, reduce the number of masectomies required, thus reduce the number of implants they can peddle, and peddle they do; believe me, reduce the number of subsequent surgeries, and may even be able to reduce the number of women who undergo radiation and chemo. The expense of this treatment is much less. Profit potential, also much less. But, quality of life for the women; it has great potential.

Please this is important take the time to review the evidence; I will send you any links to the peer reviewed scientific research on any of the above details you would like.

Mary Birmingham
541-956-1513


All communication stops 01.Jun.2007 08:04

MC smallrevolution@peoplepc.com

Well I guess if you air the V.A.'s dirty laundry the stop talking to you. I now cannot get a facilitator nor a Dr. to return my phone calls. No appointment for surgery. No contact. I was invited to seek another Oncologist. I called S.F.V.A. they gave me a fax number and attn: to for the consult referal. I emailed and called Portland requesting the referal; no response. I called Roseburg to ask for the refural; no response.
Now I assume by now they are likely to know about the publishing; and may be reluctant to talk w/me w/o a lawyer. Why? I have no history of filing suits. I do have a history of screeming my head off at stupidity for profit and injustice.


Given my history.
Given the V.A. is the V.A.
Given the current U.S. regime is fascist
I am wondering if this is not intentional
seems unlikely; but in a world like to today
the question is not if I am paranoid but,
am I paranoid enough?


Modern day "Story of O": Breast reconstruction and genital mutilation 01.Jun.2007 11:17

MCKean smallrevolution@peoplepc.com

Well, well, well, it seems been counting determines health care alternatives. No real surprise there. It results in a sort of sick double standard in health care. A treatment can prove great benefit; but until all the risks are known; and it has been accepted as a "standard of care"; Drs. such as oncologists are reluctant to give it a try. On the other hand, if a treatment is highly profitable, all sorts of risks will be taken and reasonable standards of care thrown to the wind, as any suites will be offset by very high profits. This is the case w/implants. Yes, while I can not get neoadjuvant hormone suppression to restrict the growth of cancer; implants were not just offered, but promoted. I may have made a mistake given the snake oil job that was being done on me and the fact that it is very hard to have ones breast cut off; but by now they were a bit leery of my and my comment about, "informed consent". Thus, they had a woman sit in; who may well have been a lawyer. While the plastic surgeon insisted there was no link b/w the immune system problems (that it turns out over 400,000 women have reported) and silicone implants. The woman cautioned that the issue was still under research. He made a comment about, "that woman lost the suite". Now, I want to thank that woman, who I think was a lawyer, there not to protect my interests but that of the V.A.'s. Still, honesty and full disclosure is in both our interests; so I was glad she was there; having thrown up this big red flag to me that I did not know enough and needed to look further into this issue. It is hard to do all the research on all of the issues dealing w/breast cancer treatment, but it seems there is no stone that you can safely leave unturned. It turns out that the implants were put on the market w/o FDA approval. Subsequently the FDA took control, but allowed the implants to continue to be used w/o evidence of safety. After many complaints and law suites the FDA took the silicone implants off the market and requested the manufactures do research. They did research, bad research, research leading to whistle blowing and investigations. Yet the FDA allowed the silicone implants back on the market. I thought, ok lets go w/saline. Opps, no cannot do that either. Fact is no implant is safe. 40% of the women will have to go back in to deal w/a complication from an implant w/I three years. Though complications w/ saline are not as dangerous as complications w/silicone. Flap (using your own tissue from stomach or elsewhere) surgery is an alternative if you have enough fat; I do not.

Now during the interview w/the plastic surgeon I heard the most unsettling news that could have come from his mouth. He was talking about nipple reconstruction. I asked where he borrowed the tissue from, he simply said, "down there". I was on my way out the door by this time, and was not sure I heard right. Could "down there" mean the lybia? Now, I had studied the history of Genitalia mutilation in the U.S. as a response to ethnocentric ideas that women in other countries are abused more than in the U.S. While historically women have been mutilated as treatments for lesbianism, masturbation, promiscuity, "hysteria", ... the last case I knew about was in the 1950s. A man conspired w/his wife's Dr. to cut off the labia while she was undergoing surgery for something else. The husband had heard that this would make her multiclamatic. It made sex painful and she was unable to climax at all. Talk about the, "Story of O" syndrome. Is the U.S. really back to practicing genital mutilation; this time in the name of natural looking breasts? YES they are. Good goddess save us from the beast.

NOW I THINK "THE STORY OF O" IS MANDATORY PORNOGRAPHY FOR ALL YOUNG WOMEN TO READ.

Publishing this earned me a total lack of communication from the V.A. No surgery date has been set, Drs. nor facilitators return my calls.