Local, state and national news of interest to the physician community

October 18, 2023

Written by Ryan Gabriel, MD

Member of the Richmond Academy of Medicine

Radiology Associates of Richmond 

Director of Breast Imaging, Henrico Doctors' Hospital

Leaves are changing and cooler weather is in the air, which means only one thing - Breast Cancer Awareness Month. As healthcare providers, it's important to remember the impacts of breast cancer in the community. Breast cancer affects 1 in 8 women in the U.S. In 2023, an estimated 297,790 women will be diagnosed with breast cancer and 43,700 women will die of the disease.

Screening mammography has been the only test in randomized clinical trials to reduce breast cancer deaths. While there are multiple recommended guidelines, the American College of Radiology recommends screening beginning at age 40 and continuing annually for average risk women. This regimen has been demonstrated to reduce deaths by about 40%.

As a clinician, you have seen reports or have heard the term - dense breasts. Approximately 50% of women in the U.S. have dense breasts which means the glandular (milk producing) tissue comprises 50% or more of the total breast tissue. Breast density can only be determined by breast imaging and not by physical exam or breast size. Labeling a patient as having dense breasts is an important distinction for a few reasons: 



1. Women with dense breasts have a greater risk of developing cancer than those without dense breasts.
2. Dense tissue can obscure cancers.
3. Patients with dense breasts must be informed in writing by law.

So, what do you do if your patient has dense breasts? Start a (brief) conversation!

1. Inform patients that their risk may be higher and cancers may be hidden.
2. Present options for supplemental screening. There are 3 tests that can be used for supplemental screening (choose one): Abbreviated MRI, Contrast Enhanced Mammography (CEM) or Ultrasound. Each exam has pros and cons but Abbreviated MRI and CEM have a greater sensitivity and cancer detection rate than ultrasound.
3. Gauge interest. Each patient falls on a spectrum of willingness to engage in supplemental screening. Find out where your patient lies. It's important to respect patients' wishes and guide them to an informed decision. If you are ever stuck, phone your favorite breast radiologist. 

Finally, a few questions (and the answers) about breast cancer screening that our patients ask.

1. Do I have to have a mammogram? I don't like all the radiation. While it's true that mammograms use radiation, the dose is very low. The average dose of a screening mammogram to a patient is equivalent to living on Earth for 7 weeks. 
2. Can I skip the mammogram and go straight to ultrasound? No. Ultrasound compliments the mammogram but has never been proven in randomized trials to reduce deaths. Non-invasive cancers and smaller invasive cancers are difficult or impossible to see at ultrasound and can be missed.
3. I’m experiencing breast pain, does that mean I have something serious like breast cancer? No. Breast pain is incredibly common and is not typically associated with breast cancer. Unilateral or bilateral, cyclical, diffuse breast pain can be managed without imaging and usually resolves without intervention. In most instances, a mammogram and ultrasound do not demonstrate a cause for the patient's pain. Caffeine intake is NOT associated with breast pain. Additional supplements such as Evening Oil of Primrose, Vitamin E, and Vitamin B6 may lessen the severity of symptoms. 

While breast imaging can cause anxiety, Screening Mammography Saves Lives. Enjoy the changing weather and phone a friend if you have any questions. 

IN RELATED NEWS... Breast cancer rates are on the rise, but the number of survivors is increasing as well: The Hill.

Thank You,

RAM Members!

A special thanks to all of our RAM physicians who attended the MSV Annual Meeting at The Norfolk Hilton the Main this past weekend on behalf of the Academy, on behalf of their specialty societies, or as an MSV designated delegate. Our delegates decided on important changes and additions to MSV's policies.

Delegates discussed many resolutions including protecting physicians from health plan credit card fees, the sanctity of the physician-patient relationship, mental health support, and many more. 

A special congratulations to Dr. Alice Coombs, who was installed as MSV's next president! RAM is proud to have you lead the state and we're excited to see what challenges you take on over the next year! Special thanks to Dr. Harry Gewanter for his excellent leadership this past year.

We'd like to thank Drs. Sidney Jones, Bruce Silverman, and Mark Townsend for their service on Reference Committees and to Drs. Deborah Barron, Susan Caley, and Sam Bartle for their service on the Tellers, Credentials and Rules Committees.

A special congratulations to RAM member and past president, Dr. John O'Bannon, for receiving MSV's Clarence A. Holland, MD Award. This award recognizes an MSV physician member with high personal integrity who has demonstrated outstanding leadership in the field of political advocacy. 

Dr. Coombs' inaugural address

RAM Delegates reviewing Reference Committee Reports

Dr. O'Bannon receiving the Clarence A. Holland, MD

Award from MSV

CLICK HERE for more images from our annual meeting!

Dr. Lloyd Alterman has had enough of Big Pharma ads on television. In a recent opinion piece published by Medscape, he asks a very good question: "Why not spend these advertising dollars on programs to make drugs taken by the millions of Americans with common conditions (eg, hypertension, diabetes, heart failure) more affordable?" Questioning whether the ads even offer educational benefit to patients, Alterman discusses conflicts that can arise between patient and physician over such commercials. Read more of his compelling argument here.

A tentative agreement was announced last Friday by the coalition of unions representing Kaiser Permanente health care workers, removing (for now) the specter of further strikes following last week's three-day long walkout, the largest in the history of American health care, per Fox Business and AP.

"The new contract aims to address staffing shortages with raises that will amount to 21% in wage increases over the next four years, to help retain current workers," NPR says. This as Gov. Gavin Newsom (D) signed a bill in Kaiser's home state of California raising minimum wage for California health care workers to $25: The Hill.

Nearly $130 billion: That's the value of total benefits nonprofit hospitals delivered to their communities in 2020, according to analysis from the American Hospital Association.

That figure, the latest one for which AHA and Ernst & Young (EY) LLP had comprehensive data available, was $20 billion more than the previous year, Chief Healthcare Executive reports. It's also 15.5 percent of their total expenses that year.

It also included "$57 billion in financial assistance during the pandemic, making up almost 7% of non-profit hospitals' total expenses that year." RevCycleIntelligence reports.

The newest data was released in response to a report (covered in last week's Leg.Up) by Senator Bernie Sanders (I-VT) slamming nonprofit hospitals for not providing enough "charity care," and amidst questions by federal lawmakers about whether nonprofit hospitals are meeting their obligations as tax-exempt organizations.

Electronic polls opened October 13 to vote for RAM's 2024 Board of Trustees.

The RAM Board of Trustees serves staggered two-year terms. Each year, approximately one-half of our board completes their term in office. At the close of 2023, six Trustees' terms expire.

Please click here to learn more about each candidate. Online voting will close on November 14th at 6:00 p.m.

"Flu cases are low nationwide, the Centers for Disease Control and Prevention reported Friday, but there are early signs that the virus is beginning to spread," CNN reports. Most of the flu cases reported so far this season are influenza type A, specifically the H1N1 strain.

A pair of studies has provided useful data and insights into RSV vaccines. One estimates that widespread use of Pfizer's maternal RSV shot Abrysvo could slash annual hospitalizations in half, saving up to $691.8 million in direct medical costs (Fierce Pharma). Another determined that adult RSV vaccine Arexvy sustains its efficacy over two seasons, Reuters and MedPageToday report.

Unfortunately, there is growing vaccine hesitancy among pregnant women, NBC News reports. And just as the COVID vaccine rollout has had its hiccups, so too goes the RSV vaccine rollout. High demand but low supply of RSV antibody shot Beyfortus has left pediatricians frustrated, says CBS News. See also: CBS News.

And finally, hopefully not a harbinger of things to come this season: CDC says children and adolescents faced an unusually high influenza severity last respiratory virus season (2022-23), CIDRAP reports.

For the latest news on the third "leg" of the "tripledemic" trio, see the COVID Communiqué below!

IN RELATED NEWS... Why are viral infections so common in colder weather? A scientific "breakthrough" now provides an answer: CNN.

"HCA Healthcare's Johnston-Willis Hospital is the first in the nation to provide a new treatment for patients with brain metastases from lung cancer.

"The clinical trial is investigating the potential benefit of combining noninvasive focused ultrasound with systemic immunotherapy, according to an Oct. 12 system news release. The treatment opens the blood-brain barrier, which defends the brain against harmful substances, to help critical medications reach the critical lesions in the brain.

"Two patients have begun the six-treatment cycles.

"'The potential success of this trial could be groundbreaking in the management of metastatic brain tumors not only for lung cancer, but also for breast cancer and melanoma,' principal investigator [and RAM member] K. Singh Sahni, MD, neurosurgeon and medical director of the Neuroscience and Gamma Knife Center at Johnston-Willis Hospital, said in the release.

"The trial is expected to conclude in August," Becker's Hospital Review concludes.

Rheumatologists: Several headlines of interest floated across the wire this past week. Among them:

• More than 20% of the American adult population had some form of arthritis during 2019-2021; nearly 50% among those age 65 and older: MedPageToday.
• FDA warns of arthritis and pain meds tainted with undisclosed ingredients that can cause serious side effects: New York Post.
• Methotrexate was found to improve hand osteoarthritis symptoms: Medical Xpress.
• The genetic origins of Reynaud's phenomenon have been discovered; they may lead to new treatments: NBC News; Nature.
• Saline lavage, a common shoulder procedure meant to loosen up calcified tendons, was found to be without benefit: MedPageToday.

The American Society of Hematology (ASH) has weighed in on the American Board of Internal Medicine's (ABIM's) Maintenance of Certification (MOC) process with a letter expressing concerns and outlining actions that should be taken to improve the system, including avoiding high-stakes assessments, reducing the number of Longitudinal Knowledge Assessment questions physicians receive, and eliminating redundancy between the MOC requirement to have a current license and the requirement to report continued medical education to ABIM. Click here for more. The online petition to eliminate the MOC requirement, reported here previously, now has nearly 21,000 signatures.

Wondering about the newest research in the field of oncology? Here's the absolute latest news on a variety of cancers, prevention, and treatments:

• Regular use of chemical hair relaxers by Black women increased their risk of uterine cancer by 50%: NIH; FDA plans to ban them and other hair-straightening products: CNN; The New York Times.
• A promising cancer drug may both slow tumor growth and restore the body's immune response against cancer: The University of Texas at Austin.
• Another promising prostate cancer treatment can reverse the cancer's resistance to therapy in late diagnoses: The Guardian.
• OvaPrint blood test could detect ovarian cancer earlier: Fox News; AACR Journals.
• Faster, more precise diagnoses of brain tumors are being performed on the operating table by an AI tool: The New York Times; Nature.
• Non-melanoma skin cancers (NMSC) are killing more people globally than melanoma: Reuters.
• New lung cancer cases are higher in younger women than men: MedPageToday; The New York Times.
• FDA approves "expanded use of Merck's blockbuster immunotherapy Keytruda in early-stage patients with non-small cell lung cancer who can get their tumors removed surgically": Reuters; MedPageToday.
• Also approved: Encorafenib (Braftovi) with binimetinib (Mektovi), for treating metastatic non-small cell lung cancer patients whose tumors harbor a BRAF V600E mutation: MedPageToday.
• Aggressive surgery to remove as much tumor as possible in metastatic colorectal cancer did not adversely affect patients' quality of life: JNCCN.
• And finally: FDA approves HistoSonics' histotripsy device, for noninvasive treatment of liver tumors.

RAM Events & News

Retired Physicians: Come On Out!

Are you a retired physician interested in staying up to date on topics of interest to the medical community and getting to know other retired physicians? Look no further than our Lunch on Tuesday educational program series that is held three times a year. Join us for lunch and an engaging and enriching experience!

We are pleased to announce Dr. Arturo Saavedra, Dean of VCU School of Medicine and VCU Health executive VP for medical affairs, as speaker for our upcoming October Lunch on Tuesday program, held Tuesday, October 24 from 12:30 p.m. to 1:30 p.m. at The Westwood Club (6200 West Club Lane).

Negotiating in the Board Room

Join us Wednesday, October 25 for our last Women in Focus meeting of the year.

Spend an evening getting to know other women physicians, dinner at Buckhead's Chop House, and hear from RAM board member and new MSV President Dr. Alice Coombs on Negotiating in the Board Room.

Join us on Tuesday, November 14 at the Country Club of Virginia for our next General Membership Meeting with Dr. Karen Rheuban, director of UVA's Center for Telehealth, who will discuss the transformation of public policies that support the delivery of virtual care and touch on the potential of digital innovations on the future of healthcare. Cocktails at 5:30 p.m., dinner at 6:15 p.m. and the presentation at 7:00 p.m.

Medi¢: The Business of Medicine

What makes it into your hospital employment contract can determine whether you achieve your personal and professional goals. Here's what you need to know. 

Other Medical Business News:

• Rising Healthcare Costs: Medicare Part B premiums will rise by 6% next year (The Hill) as the average employer health insurance family plan this year costs $24,000 (WSJ).
• Following years of losses, drug retailer Rite Aid has filed for bankruptcy in the face of crushing lawsuits related to the opioid epidemic: WSJ; NYT; Reuters.
• Walgreens' $1 billion cost-cutting plan includes closure of 60 clinics: Fierce Healthcare. What's up with all these pharmacy closures? CNN Business and CBS News explain, while AP reports on "pharmacy desert" fears.
• Pfizer agrees to pay $50 million to settle claims by drug wholesalers that they overpaid for EpiPen allergy treatment devices as a result of anticompetitive tactics by the drugmaker: Reuters.
• Novo Nordisk warns against a surge of fake Wegovy/Ozempic versions for sale online: Reuters.
• Grocery delivery company Instacart is expanding its number of partnerships with hospitals and health systems: Becker's Hospital Review.
• Elf Bar disposable e-cigarettes were banned from importation by the FDA but are still widely available. How? They merely changed their name: AP.

• COVID vaccine rollout update: Many community health centers are still waiting to receive doses amidst delays: NBC News.
• Seven million Americans now have received updated COVID vaccines: Reuters.
• Novavax vaccine now available in U.S. pharmacies: Reuters.
• U.S. COVID markers continue a downward trend: CIDRAP.
• A new long COVID theory proposed by scientists: Viral remnants in the gut interfere with the body's serotonin levels; Prozac and tryptophan to be tested as possible treatments: Penn Medicine; The New York Times; Stat.
• Paxlovid seems to lower the risk of long COVID but isn't prescribed often: NBC News. The lifesaving antiviral may become even less utilized next year as its prices are anticipated to rise: CNN.
• Three vaccine doses can lead to a 69% reduction in the risk for long COVID: Antimicrobial Stewardship & Healthcare Epidemiology.
• An intranasal COVID vaccine is showing promise in studies: MedPageToday.
• Childrens' immune systems tend to neutralize SARS-CoV-2 as soon as it reaches the nose, as opposed to adults' systems not reacting until it reaches the blood stream: USA Today; Cell.
• AI tool is predicting new COVID mutations to develop preemptory antibodies: Axios.
• Higher rates of comorbidities and care access disparities in the Black community are causing repeated COVID infections to have an outsized impact on health: NBC News.

Quick Bites

Brief Useful & Intriguing Health News of Note:

Global Perspective

• WHO releases updated guidance on adolescent health and well-being.

National News

• FDA announces it will move forward with proposed menthol cigarette ban: CNN.
• Will California's ban on red food dye no. 3 put pressure on the FDA to enact a national ban? The New York Times and NPR investigate.
• FDA warns of dangers of unsupervised use of compounded ketamine for treatment of psychiatric disorders: The New York Times.
• Digital Health Advisory Committee created by FDA to explore the complex scientific and technical issues related to digital health technologies, such as AI and machine learning.

Drug, Tech & Vax News

• Reuters has more first-hand reports of suicidal thoughts associated with weight loss drug Wegovy.
• Mounjaro study: Obese and overweight people lost at least a quarter of their body weight, or about 60 pounds on average, when combined with intensive diet and exercise: AP.
• Nasal spray opioid antidote Opvee is now being shipped to first responders and pharmacies: USA Today.
• Gabapentin proved no better than a placebo as a painkiller after major surgery: MedPageToday.
• Narcolepsy drug solriamfetol (Sunosi) significantly improved attention deficit-hyperactivity disorder (ADHD) symptoms: Journal of Clinical Psychiatry.
• Investigational add-on drug evenamide significantly improved symptoms in patients with treatment-resistant schizophrenia: Newron Pharmaceuticals.
• Eli Lilly's mirikizumab, treatment for moderately to severely active Crohn's disease, helps over half of patients in a study: Reuters.
• Cheap drug amitriptyline can improve symptoms of irritable bowel syndrome: Reuters.
• A novel conditioning agent could help preserve fertility in patients undergoing gene therapy for sickle cell disease and other genetic blood disorders: Nature.
• A monkey has been kept alive for two years with a pig kidney in the latest animal organ donor research announcement: USA Today; Nature.
• Parkinson's disease can be tracked better by wearable devices than human observation: The New York Times.

FDA Approvals

• Oral etrasimod (Velsipity), for treating moderately to severely active ulcerative colitis (UC) in adults: Pfizer.
• Expanded indication of the WaveWriter Alpha Spinal Cord Stimulator Systems for the treatment of painful diabetic peripheral neuropathy: Boston Scientific.
• TriLEAP, a low-profile plating system used to cover forefoot, midfoot, and hindfoot elective and trauma procedures: Johnson & Johnson.

Medical Miscellany

• CDC recommends longer vaccine needle lengths for some: health.
• Chronic kidney disease was the strongest risk factor for sudden cardiac arrest among Hispanic and Latino adults in the first study to evaluate this population in the U.S. for risk factors of this major cause of death: Stat.
• Six percent (1.3 million) of all injuries treated in emergency departments in 2020 were assaults: Axios.
• Patients in intensive care units (ICUs) needed fewer blood transfusions if smaller test tubes were used to obtain blood samples from them: Reuters; JAMA.
• Increased thrombosis, mortality when fresh frozen plasma is used in transfusions: MedPageToday.
• New genetic clues have been discovered that may explain how centenarians live so long: CBS News.
• Brain death guidance updated for first time in a decade: Becker's Hospital Review.

Pathogen Report

• Raw milk consumption leaves 14 sick with campylobacteriosis in Utah: KSL.com; CIDRAP.
• More Measles in the Midwest: New cases reported in Wisconsin, Illinois: CIDRAP; USA Today.

FUN FACT OF THE WEEK

It's common knowledge that the Spanish Flu Pandemic of 1918 was highly unusual in its tendency to cut down healthy young adults in the prime of their lives. Well, that was the belief until very recently; a new study has unearthed secrets from the bones of Spanish flu victims, including the revelation that many had signs of chronic diseases and nutritional deficiencies. Much like COVID, it appears the Spanish flu had a way of capitalizing on those with pre-existing conditions, even if they didn't realize they had them. Read more here.

Thanks for reading The Leg.Up!



I strive each week to bring you an informative and (occasionally) entertaining recap of news in the world of medicine and how it affects you. Please be sure to send me any feedback and news tips:

[email protected].

Click here for past editions of The Leg.Up.

Scott C. Matthew

RAM Director of Communications

Richmond Academy of Medicine

www.ramdocs.org

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