The evolving cancer drugs fund

‘The evolution of the cancer drug appraisal process: hosted by BMJ, this promotional campaign article by Roche includes ‘How will it work?’, ‘Implications for breast cancer’, and ‘consequences for HER2+ breast cancer – coming soon’.

‘…A new model was introduced on 29th July 2016, through which NICE will evaluate new cancer drugs as well as those already funded through the CDF. However, the anticipated reforms to the NICE evaluation process have not taken place. NICE will use the original methodology employed in 2009, which resulted in the rejection of many cancer drugs – the reason the CDF was introduced in the first place.’

http://hosted.bmj.com/how-will-it-work

Advertisements
Posted in Breast Cancer, Campaigns, cancer drugs, healthcare modernisation, patient safety | Tagged , , | Leave a comment

Breast screening, health checks and psychological tactics for GPs to encourage attendance, despite ineffectiveness and harms!

https://www.healthwatch-uk.org/images/Newsletters/Number_104.pdf

If you enjoy the series ‘Yes, Minister’ you will probably love Issue 104, 2016-17 of the HealthWatch charity’s Newsletter, especially pages 6-8.

Breast screening, health checks, nsaids, …what doesn’t work?

In his acceptance speech, HealthWatch Award Winner Peter Gotzsche asks, ‘Why is it controversial to tell the truth about healthcare?’

‘People ask me, why do you look for controversies? And I tell them, I don’t, they come to me. My work is something like that of a medical detective. People come to me if they feel something is wrong in healthcare. When I start looking into these issues, I usually dig very deep.

I find skeletons, and when I expose these skeletons, the people who buried them can get very angry.’

Peter     Peter Gøtzsche, physician, medical researcher and leader of the Nordic Cochrane Centre at Rigshospitalet in Copenhagen, Denmark.
The HealthWatch Award is presented annually to an individual who has made significant steps either in medical research or in improving the public’s understanding of health issues by clarifying complicated and often misunderstood medical matters for the general public.

……………………………………………………………………………………………………………….

And on page 4 of the same document: ‘Recent guidance from Public Health England arms general practitioners with psychological tactics to encourage patients to attend an NHS Health Check, despite evidence that shows such screening is ineffective’ – both articles alert the public to a side of healthcare which may well shock them.
There is much, much more at
Posted in Breast Cancer, breast screening, Campaigns, cancer, clinical trials, Compassion in healthcare, guidelines, harms, healthcare modernisation, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, patient safety, patient/doctor communication, Primary care, Public safety, Screening, Screening Mammography, speaking out, Uncategorized | Tagged , , , , | Leave a comment

A Valentine contribution for the Creative Writing Group

February 14

‘Thanks’, I say. ‘How sweet! – Cadbury’s Milk Tray’. The annual, unimaginative, unwanted treat.

You: ‘It’s nothing.’

True! But you think it will do… When we were 6 and fell in love, you promised a jewel in exchange for a playground kiss – and gave me your iced diamond biscuit.

But I reminisce…

‘Got to fly’. Happy Valentine’s – important meeting, mustn’t be late…’

Tumbled words

Words that creak

The obligatory peck on the cheek

I smile, and swallow a sigh

Poor Mr Plausible – betrayed by the anticipatory lustful glint in your eye

Go! Meet with your latest legs-up-to-armpits 20-something ‘secretary’. You’ll have sent her out to buy these – you always do.

No tears: I’ve known for years. What’s good for the gander will suit this goose. The red dress awaits, new undies too, bought for another man’s illicit pleasure.

I’m anticipating a day of exhausting leisure!

Posted in humour, Uncategorized | Tagged | Leave a comment

Breast cancer – intrabeam use recommended by NICE

After a 3 year delay, NICE has recommended controlled intrabeam radiotherapy use for breast cancer.

Apparently, “There are many advantages for the patient, including immediate delivery of the radiotherapy at the time of surgery and under the same anaesthesia.”

Arnie Purushotham, Cancer Research UK’s senior clinical adviser, welcomed NICE’s decision with the proviso: “Research has shown that, in some patients, there is a higher risk that the cancer may return compared to conventional radiotherapy. – We need to collect more data on all patients to monitor the outcomes of this treatment and ensure that patients are given the facts to make an informed choice on which type of radiotherapy they choose.”

NICE recommends controlled intrabeam use for breast cancer after three year delay. Jacquie Wise. BMJ 2017;356:j725

https://www.journalslibrary.nihr.ac.uk/hta/hta20730#/full-report

Posted in Breast Cancer, guidelines, informed consent, patient safety, personal autonomy, Uncategorized | Tagged , | Leave a comment

Breast Screening – Core Needle Biopsy of Breast Cancer Tumours Increases Distant Metastases in a Mouse Model.

Excerpt from authors’ conclusion:

Our experimental findings demonstrate for the first time that in the setting of malignant breast cancer, performance of a CNB is associated with a significantly increased incidence of pulmonary metastases. We also show that an additional impact of CNB includes creation of a distinctly immunosuppressive and pro-metastatic tumor microenvironment with elevated TGF-β/SOX-4associated EMT and significantly higher CTC levels. In this era of digital mammography when smaller breast cancers are being detected, presumably in a pre-metastatic state, biologic knowledge of the potential harms associated with the traditional work-up of breast cancer through the application of a CNB needs to be considered…’ Edward Gitau Mathenge, Cheryl Ann Dean, Derek Clements et al. Neoplasia, Vol 16, No 11, pp950-960.

Also

‘Circulating tumour cells increased immediately after the taking of biopsies from human squamous cell, prostate, breast and hepatocellular carcinomas. Although no increased risk of biopsy-induced distant metastasis has been reported for any type of tumour, this is inconclusive due to a lack of non-biopsied control groups in human studies. Reports of biopsy-induced metastasis in animal tumours indicate that the taking of transcutaneous biopsies from urogenital tumours may be associated with a risk of NTM. However, there is no evidence of a general increase in risk of distant metastases in any tumour type in people or animals. The overall risk therefore appears to be negligible when compared to the valuable information obtained from biopsies in veterinary practice.’ – ‘Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models’ – Klopfleisch R, Sperling C, Kershaw O, Gruber AD. Vet J. 2011 Nov, 190(2):e31-42

Posted in Breast Cancer, breast screening, citizen safety, harms, healthcare modernisation, informed consent, medicine's flaws, overdiagnosis, overtreatment, patient safety, patient/doctor communication, personal autonomy, Screening, Screening Mammography, Uncategorized | Tagged , , | Leave a comment

Breast screening – Wounding from biopsy and breast cancer progression

Surgical wounding associated with the extirpation of experimental primary cancers can trigger angiogenesis in previously dormant micrometastatic tumour deposits, which can result in the acceleration ofrelapse and death….’ ‘The uniform incapacity of randomised controlled studies of screening mammography to show early surgical advantage of screened populations aged 40–49 years might relate to this biology..

The lack of mammographic benefit…’ (in the Canandian study) …’can be explained by the extra 550 biopsies done in year 1 in the intervention group if 14 of these biopsies showed false-negative results and caused lymphangiogenesis and stage progression…’

‘…Our hypothesis is that stage progression associated with excessive biopsies in young women with abnormal mammograms offsets any long-term benefit for the screened populations. Michael Retsky, Romano Demicheli, William Hrushesky. The Lancet, Correspondence: Vol 357; 1048 (March 31, 2001).

Posted in Breast Cancer, breast screening, Campaigns, harms, healthcare modernisation, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, patient safety, Public safety, Screening Mammography, Uncategorized | Tagged , , | Leave a comment

Breast screening: overdiagnosis in Denmark

Yet more proof of overdiagnosis: a paper estimating overdiagnosis in Denmark, published in the Annals of Internal Medicine, concluded:

‘Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis.’

Breast Cancer Screening in Denmark: a Cohort Study of Tumor Size and Overdiagnosis. Karsten Juhl Jorgensen, Peter C Gotzsche, Mette Kalager, Per-Hendrik Zahl

http://annals.org/aim/article/2596394/breast-cancer-screening-denmark-cohort-study-tumor-size-overdiagnosis

An editorial by Otis Brawley, Chief Medical Officer for the American Cancer Society covers this important paper.

http://annals.org/aim/article/2597574/accepting-existence-breast-cancer-overdiagnosis

Posted in breast screening, Campaigns, citizen safety, Compassion in healthcare, harms, healthcare modernisation, information, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, personal autonomy, Public safety, Screening, Screening Mammography, Uncategorized | Tagged , | Leave a comment