Recent articles in the Cleveland Plain Dealer and Canton Repository lament state budget cuts for county health clinics' child health programs. While budget cuts will be problematic for these programs and we all wonder why the state can't find funds for them elsewhere, the advocates for these programs wrongly place the blame on the state's recent decision to fund an additional $2.5 million for breast & cervical cancer screening for uninsured women.

Ohio has the 4th highest breast cancer mortality rate in the nation, meaning 46 other states do a better job of helping women survive breast cancer. Ohio's BCCP Screening Program currently serves less than 10% of eligible low income, uninsured women in the state.

Those in the women's health community have known for years that the $4 million per year Ohio receives from the Centers for Disease Control for its current program are frequently shared with other health programs. Staffers whose salaries are paid by BCCP Screening are often put to work on other public health programs, sending many uninsured women needing mammograms to a waiting list.

All health programs need adequate funding in Ohio and all should work to ensure the most service is provided for dollars budgeted. But targeting the Breast & Cervical Cancer Screening programs for blame in state budget cuts is unwarranted, unfair and counterproductive.

Ohio House & Senate Conference Committee leaders last week rejected a Senate passed amendment to the state budget that would create a Task Force to study reasons for disparities in cancer death rates among blacks in Ohio.

Though blacks are less likely to be diagnosed with cancer than other groups, their death rates are much higher. For example, Ohio black women are less likely to be diagnosed with breast cancer and are more likely to get annual screening, yet their mortality rate is 50% higher than caucasian women. Ohio's breast cancer death rate for black women is 9% higher than the national average for all black women. The Task Force would have studied Ohio cancer death rates to determine possible reasons for the disparity and ways to fix the problem, making a report to the Ohio General Assembly upon completion of its work.

Eliminating the language to create the Task Force is all the more incredible considering it would be made up of representatives from Ohio's leader cancer centers and ODH and it wouldn't have cost taxpayers a dime. All of those serving on the Task Force would donate their time.

One can only wonder why Committee Chairman Matthew Dolan felt it necessary to eliminate the Task Force language when it would only benefit the state.

From Science Daily:

Study: Chemo thwarted by cancer stem cells

PITTSBURGH, June 19 (UPI) -- U.S. cancer researchers have discovered cancer therapies often eliminate most of the disease but are thwarted by multiple-drug-resistant tumor cells.

University of Pittsburgh scientists said the resistant cells, called cancer stem cells, ultimately become the source of disease recurrence and eventual metastasis. But a team led by Assistant Professor Vera Donnenberg suggested effective chemotherapy must be able to target a small subset of cancer stem cells, which share the same protective mechanisms as normal lung stem cells.

The researchers identified a small, rare set of resting cancer stem cells in lung cancer samples that behave much like normal adult lung tissue stem cells. Both the cancer and normal stem cells were protected by multiple drug resistance transporters, even if the bulk of the tumor responded to chemotherapy.

"Because of the similarities between the way that normal stem cells and cancer stem cells protect themselves, cancer therapies have to be designed specifically to target cancer stem cells while sparing normal stem cells," Donnenberg said.

The research is available at www.regenerate-online.com/abstracts/1457.pdf

The study was presented last week in Toronto during a meeting of the Tissue Engineering and Regenerative Medicine International Society.

From the June 20 issue of the Journal of Clinical Oncology:

Purpose: Women with breast cancer do not consistently receive adjuvant treatments that have been shown to increase survival. Acquiring an understanding of the reasons for these lost opportunities may inform strategies for quality improvement.

Methods: Interviews were conducted with surgeons treating 119 women who did not receive guideline-recommended adjuvant therapy to ascertain reasons underlying treatment omission. Primary reason for underuse was categorized as not recommended, recommended but declined, or system failure (treatment recommended, not refused but did not ensue). Logistic regression identified patient characteristics, and surgeons' practice and referral patterns associated with underuse.

Results: Surgeons did not recommend adjuvant treatment for 41 (34%) of 119 women, most often because perceived risks exceeded benefits (37 of 119; 31%); unawareness of treatment benefits was rare (four of 119; 3%). Among the 78 (66%) of 119 for whom surgeons recommended treatment, 37 (31%) declined therapy; 41 (34%) system failures occurred. System failures occurred more commonly among minority than white women (73% v 54%; P < .01), and more commonly in women who were receiving Medicaid or were uninsured than those with Medicare or commercial insurance (54% v 19%; P < .01). Women treated by a surgeon who works closely with oncologists were less likely to experience a system failure (84% v 68%; P < .05).

Conclusion: One third of underuse episodes were attributable to surgeons' perceptions that treatment was not indicated, one third because women did not accept recommendations, and one third were the result of system failures. Reasons for underuse of adjuvant breast cancer treatments appear multifactorial and this heterogeneity suggests the need for simultaneous development of different strategies to improve care.

Link to Abstract:

http://jco.ascopubs.org/cgi/content/abstract/25/18/2516

The Commonwealth Fund issued its latest state scorecards for Health System Performance. Ohio's overall ranking was fairly good at 24 of 50 states. But once again, the state's ranking for breast cancer mortality per 100,000 placed it among the worst in the nation at 47, leaving only 3 other states with higher rates of mortality.

Ohio's consistent showing of good to moderate performance on most health care measures contrasted with its radically poor performance on breast cancer mortality indicates substantial and significant flaws in its breast cancer programs. How is it that Ohio can take care of the health care needs of every other population and disease group except for those with breast cancer? How does the state explain the continued decline in reducing breast cancer mortality and why are the programs designed to reduce mortality performing so poorly?

Given Ohio's persistent problems with waste, mismanagement and high overhead costs in its Breast & Cervical Cancer Screening Program, should the taxpayers give them more funding without demanding reforms? Ohioans deserve better and should demand it.

Read the Commonwealth Fund's Report at the link below:

http://www.commonwealthfund.org/usr_doc/StateScorecard_Ohio.pdf?section=5060