I thought I had seen it all until I saw the “sexy” Sesame Street costumes that are new this year for Halloween. You too can be amazingly slut-tastic as Elmo, Big Bird or Cookie Monster while you troll the street for candy. More of a Pixar fan? How about sexy Nemo from Finding Nemo fame?
More of a baseball fan in this season of Giants glory? How about a Yankee babe inviting you to take one for the team? Talk about a stand-up double.
Has anyone noticed the irony that all of these characters were male before their costumes were paired with thigh-high tights?
I guess it’s only fitting that everyone seems to look like the St. Pauli Girl in October given that it is not only Halloween, but also National Breast Cancer Awareness Month. While I had been planning to write something about National Breast Cancer Awareness Month for the last several weeks, it kept slipping my mind until the, ahem, “evidence” was too difficult to ignore. Big Bird with cleavage? Don’t those airbags interfere with flight? But seriously folks…
There is a great deal of coverage of National Breast Cancer Awareness Month and that is wonderful to see. Breast cancer is, as many know, one of the scariest diseases that women face and it affects more than 200,000 people per year, killing 40,000 of them. 1 in 8 women will be diagnosed with breast cancer in their lifetime. Because of the incredible efforts of scientists, clinicians and activists, there have been dramatic improvements in breast cancer treatment leading to significantly increasing rates of survival. Organizations like “Save the Tatas” provide society with the dual virtue of promoting consumer awareness of these issues and giving us tacit permission to use the word “tatas” with impunity. Gotta love it.
Most people who consider themselves educated about health issues think they know the risks associated with breast cancer. Genetics, alcohol, hormone therapy…these have all received a fair amount of news coverage. These same women tend to be highly aware of the importance of getting regular mammograms. However, what the vast majority of women do NOT know, and what the medical profession has poorly communicated, is that mammograms miss 20-30% of cancers that are present at the time of screening and that the primary reason for these false negative results is that tumors are harder to detect in women with dense breasts.
According to the National Cancer Institute, breasts contain both dense tissue (i.e., glandular tissue and connective tissue, together known as fibroglandular tissue) and fatty tissue. Fatty tissue appears dark on a mammogram, whereas dense tissue and tumors appear as white areas. Because fibroglandular tissue and tumors have similar density, tumors can be harder to detect in women with denser breasts.
It is worth noting that 50% of women under the age of 50 and 30% of women over the age of 50 have dense breast tissue and are thus subject to poor mammography results (and are also at much higher risk of breast cancer). It is young women, those same gals that are packing their assets into Sexy Elmo’s sleek red fur suit, who are most likely to have cancers missed by mammograms unable to see the troubled tissue. This is the reason that we hear so many stories about women who are diagnosed with late stage breast cancer despite having had regular mammograms that showed nothing amiss. It is not that there was nothing to see, it is that the tool we have relied upon isn’t up to the task in women whose breast density is greater than average. As a woman ages, her breasts usually become more fatty, and false-negative results on mammograms become less likely. Look everyone—I finally found an upside to aging boobs! What do I win?
Breast density is a relatively objective thing, by the way. Radiologist reports from mammograms can provide a woman with a clear status on this issue. The problem is that clinicians have historically dismissed this issue and few women have been informed that their dense breasts might be rendering their annual mammograms relatively useless. Furthermore, high breast density in and of itself is a major risk factor for breast cancer and very few women are aware that this risk is even more serious than a family history of breast cancer.
The hilariously named but highly informative website AreYouDense.com estimates that less than 10% of women have been talked to by their doctors about these issues. Even fewer are sent for an alternative screening modality, such as MRI, which is known to find about 95% of breast cancers. There is a reluctance to use MRI for screening because of its high cost: approximately $1000-$2500 per screening vs. $100-$200 for mammogram. Fortunately, there appear to be some changes coming both in the imperative to inform women about the issues of dense breast risk and in the opportunity for effective low-cost screening alternatives.
In 2009, Connecticut Governor M. Jodi Rell, a breast cancer survivor, presided over the adoption of a new law in her State that requires patients to be informed about their level of breast density and requires patients with high breast density to be specifically informed by their provider that mammography has poor sensitivity for dense breasts and that they therefore may benefit from FDA cleared alternate secondary tests. This is a huge leap forward in patient empowerment and several other states, including California and New York, are actively considering similar laws. It is a damn shame that we have to pass laws to get clinicians to do the right thing, but at least it’s a start.
The best thing that could happen is that every State would adopt laws requiring that any woman with dense breasts be informed and be provided coverage for a proven secondary screening modality. Overcoming insurer resistance to covering secondary screenings is a major challenge given the more than 1.5 million women likely to be eligible for them each year. In a healthcare system where everyone is trying to figure out how to make ends meet, the extra $1.5-$3 billion that could accrue from these screens is a daunting figure. But there is good news here as well.
My venture firm, Psilos Group, has invested in a Northridge, CA company called Gamma-Medica (GMI), which offers a product called LumaGEM. LumaGEM is a Molecular Breast Imaging (MBI) product offering a newer FDA-cleared and commercially available breast cancer diagnostic technology that has been evaluated in thousands of patients at the Mayo Clinic and other leading U.S. medical research facilities. MBI delivers the same sensitivity (meaning equally few false negatives) and higher specificity (meaning measurably fewer false positives) than MRI for detecting cancer in dense breasts, meaning that it delivers a correct result the vast majority of the time and at least as often as MRI (the current gold standard). High specificity is important because fewer cancers are missed. Mayo Clinic researchers have shown that MBI can detect three times as many cancers in women who have dense breast patterns on their mammograms. MBI’s increased specificity is important because it means that fewer women will be told they may have breast cancer and be sent for breast biopsies as a result. Many clinicians estimate that as many as 90% of breast biopsies are negative and thus they are grossly overused due to the propensity of current tests to yield false positives. That means a lot of extra cost and a lot of extra patient fear while they wait to find out what is likely good news. Notably, the cost of an MBI scan on the LumaGEM system runs between $300-$500 depending on where you get it. For more information about MBI, click here.
The punchline is that LumaGEM’s MBI imaging modality delivers equal or better results as compared to MRI but does so at about one third the cost. With an estimated 1.5 million secondary MRI scans expected in 2010, the full implementation of the MBI alternative would yield a savings of $2.25 to $5.25 billion, not including the cost reduction in capital expenditure, downstream healthcare costs from early detection, reducing unnecessary treatments and the greater physiological suffering of patients and their families.
The reason Psilos invested in GMI is because our investment strategy is to support products and services that measurably improve quality of care while materially reducing the cost of care. It is hard to find a better example of a product that walks that talk better than LumaGEM. Just by using this test as an alternative to MRI the healthcare system can save literally billions of dollars. Perhaps even more relevant, consider the following: five-year survival rates for women with breast cancer are greater than 98% when the cancer is diagnosed early and the disease is localized to one area. Survival is only 1 in 4 by contrast when the cancer has already spread to distant sites in the body by the time the disease is diagnosed. Late diagnosis triples the treatment cost to over $50,000 per patient as well. Yet only 60% of breast cancers are found and diagnosed in the earliest stages despite knowledge of how to improve these odds. The cost of the missed cancers is staggering across a broad demographic including 40% of all women in the United States. Improving early detection in women at higher risk for developing breast cancer would immediately impact the over $209 Billion per year in medical costs and lost productivity due to breast cancer. In our world, GMI offers an opportunity to do well by doing good, and for Psilos that’s the right way to play the game.
So, for the love of God, if you are a woman, peel back those Big Bird feathers, ask your doctor if you have dense breasts and find out how you can be sure you are getting the most from your annual screening process. If you are a man with female loved ones, the next time one says, “hey pal, eyes up here,” use that split second of eye contact to let her know that she should talk to her doctor about this issue. Armed with knowledge and equipped with technology, it is possible to make a serious difference in the early detection of breast cancer. In this World Series season, don’t let cancer steal second base!