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Medicare Won’t Pay for Additional Breast Screening

Breast cancer is harder to find and has a higher incidence in women with dense breasts, but women older than 65 have found that Medicare will not cover supplemental screening in most cases. Mammography is the gold standard for detecting cancer in the breast, but the scan often can’t detect cancer in dense breasts. Dense breast tissue and tumors both appear white in a mammogram, so doctors often order a second imaging test, either an ultrasound or an MRI. But Medicare won’t pay for the second scan in most cases, leaving many women to foot the bill themselves. Advocates say for women with dense breasts, screening with only a mammogram is inadequate. “In women with the densest breasts, mammograms will miss about half of cancers present—half,” said JoAnn Pushkin, executive director of DenseBreast-info, in an article in the New York Times. “That’s a lot of cancers being left on the table, and an opportunity missed to find them at the earliest stage possible, when they’re most treatable.” Legislation proposed in Congress called the Find It Early Act would ensure that all health insurers, including Medicare, cover screening and diagnostic breast imaging, including mammograms, ultrasounds and MRIs. Nearly half of women 40 and older who get mammograms have dense breasts, according to the National Cancer Institute. Dense breast tissue itself is a risk factor for breast cancer, and women who have extremely dense breasts have twice the risk of getting breast cancer compared with women who have scattered dense tissue, according to a 2022 study published in the journal Breast.

A New Treatment for a Rare and Deadly Eye Cancer

Uveal melanoma is an eye cancer that strikes only 5 people per million, but the cancer spreads to other parts of the body in about half the people who get it. The median survival once the cancer has spread is less than seven months, according to a 2018 study in JAMA Ophthalmology. Researchers at the University of Pittsburgh Medical Center (UPMC) have developed a treatment that works on some patients with uveal melanoma and a tool that can predict which patients are most likely to benefit. The research, published April 16 in Nature Communications, is being validated in a small clinical trial. “We chose this because it was one of the only cancers that 10 years ago when we started, there was nothing approved for it,” said surgical oncologist Udai Kammula, who led the study and is director of the Solid Tumor Cell Therapy Program at UPMC Hillman Cancer Center, in an article in the Washington Post. Kammula and his team discovered that T cells, a key part of the immune system, were inside uveal melanoma tumors and turned on to be active, but they were prevented from multiplying and reaching the numbers required to kill the tumor. The researchers used a treatment called adoptive cell therapy, in which they removed T cells from the tumor and increased their numbers outside the body. After treating the patients with chemotherapy to kill off their immune system, they reinfused large numbers of the T cells, called tumor-infiltrating leukocytes (TILs) into the patients’ blood stream. They found that tumors shrink partially or completely in about 35% of patients receiving the treatment. Further research led the researchers to develop a tool that assigns a score to a uveal melanoma tumor indicating the likelihood that the tumor will respond to an infusion of TILs.

Drug Combination Offered in England for Children With Brain Cancer

The National Health Service in England will offer a new targeted therapy to children with brain tumors. The combination of Tafinlar (dabrafenib) and Mekinist (trametinib) has been approved for children 1 to 17 years of age with gliomas that have a BRAF V600E mutation. The combination treatment, which can be administered at home, targets proteins made by the mutated BRAF gene that are responsible for tumor growth. The therapy was found to stop the growth of tumors more than three times longer than standard chemotherapy in children with low-grade gliomas, while sparing them the harsh side effects of chemotherapy. “Though this will only affect a small population, it is of huge significance to them and their loved ones and represents real progress,” said pediatrician Michele Afif, the chief executive officer of the Brain Tumour Charity, in an article in the Guardian. “We hope that this will be the first of many new treatments that will ensure our community can live longer and better lives.” In the U.S., the Food and Drug Administration approved the Tafinlar-Mekinist combination in 2022 to treat cancers anywhere in the body that feature the BRAF V600E mutation, including pediatric glioma.