Health care is the top domestic policy issue for Americans, but with so many different ideas to make the healthcare system more accessible and affordable, the issue is becoming increasingly complex. Because of its far-reaching impact, health care is often a politically charged topic and little change has yet been seen on a legislative level.

The U.S. Food and Drug Administration (FDA) first approved atezolizumab (Tecentriq^®) in 2016, but it received additional approvals when used in combination treatments for locally advanced or metastatic triple negative breast cancer (TNBC) and small cell lung cancer (SCLC) in March 2019.

A prediction test accurately identifies which women with estrogen receptor (ER)-positive, HER2-negative breast cancer will benefit from adjuvant chemotherapy, according to the results of a study published in Breast Cancer Research and Treatment. 
 

People with breast implants have a risk of developing breast implant-associated anaplastic large cell lymphoma (ALCL), the U.S. Food and Drug Administration (FDA) announced in April 2019. Typically the cancer is limited to the scar tissue and fluid near an implant, but some patients experience spread throughout the body. The risk increases with textured implants in particular.

On May 24, 2019, the U.S. Food and Drug Administration (FDA) approved alpelisib (Piqray®) in combination with fulvestrant for postmenopausal women, and men, with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test following progression on or after an endocrine-based regimen.

Unlike other types of breast cancer, a triple-negative diagnosis doesn’t have any of the common receptors found in other breast cancers, presenting potential treatment challenges to patients and providers. To assist patients with triple-negative breast cancer, the Centers for Disease Control and Prevention (CDC) created a new virtual program, allowing patients to consult and ask questions to a virtual coach in the comfort of their own homes.

After completing neoadjuvant chemotherapy for triple-negative invasive breast cancer, Madeline, age 32, had a bilateral mastectomy with reconstructive surgery. Final pathology showed residual disease in the breast and one lymph node, and her oncologist recommended adjuvant therapy with capecitabine (1,500 mg twice a day for 14 days, off for 7 days). Five weeks postoperatively, she started cycle 1. Eight days later, her husband called the cancer clinic reporting that over the past two days, his wife developed profound weakness, unremitting diarrhea despite using diphenoxylate and atropine as directed, and painful, red, swollen hands and feet. Her symptoms represented a drastic change from her usual routine and energy level.

On May 3, 2019, the U.S. Food and Drug Administration (FDA) approved ado-trastuzumab emtansine (Kakcyla®) for the adjuvant treatment of patients with HER2-positive early breast cancer (EBC) who have residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment.

On March 8, 2019, the U.S. Food and Drug Administration (FDA) granted accelerated approval to atezolizumab in combination with paclitaxel protein-bound for adult patients with unresectable locally advanced or metastatic triple-negative breast cancer whose tumors express PD-L1 (PD-L1 stained tumor-infiltrating immune cells [IC] of any intensity covering ≥ 1% of the tumor area), as determined by an FDA-approved test.

On February 28, 2019, the U.S. Food and Drug Administration (FDA) approved a trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta). The drug is a combination of trastuzumab, a HER2/neu receptor antagonist, and hyaluronidase, an endoglycosidase, for the treatment of HER2‑overexpressing breast cancer. 

Multigene testing for hereditary breast and ovarian cancer has increased the detection predisposition genes beyond BRCA1 and BRCA2, according to study findings presented at the San Antonio Breast Cancer Symposium on December 7, 2018. 

Sharon, age 40, was diagnosed with invasive ductal carcinoma. Pathologically, her tumor was grade I, estrogen- and progesterone-receptor positive, and HER2 negative. The mass measured 0.5 cm on ultrasound. Sharon has no family history of cancer and is devastated by the diagnosis. One of her close friends recently died from metastatic breast cancer, and she is certain will have the same fate. She tells Jennifer, an RN in the breast center, that she is going home to “get her affairs in order.”

Liquid biopsies—blood tests that detect circulating tumor cells—may help healthcare providers predict which women with hormone receptor-positive (HR+) breast cancer are at higher risk of recurrence, according to the results of a study published in JAMA Oncology.

October is Breast Cancer Awareness Month, and the Centers for Disease Control and Prevention (CDC) sent out a reminder to healthcare providers to share education and resources with their patients about breast cancer screening, detection, and prevention. CDC included a list for providers to highlight:

• Breast cancer risk factors
• Knowing what to do to lower those risks
• When to get regular breast cancer screenings

At a recent college alumni dinner, a friend and wine expert pulled me aside and asked, “Is it true that wine increases the risk of breast cancer?” She knew I worked in the cancer division at the Centers for Disease Control and Prevention (CDC), so it was a reasonable question. I’ve been at wine tastings she’s hosted, and I needed to be straight. 

“Yes,” I said, “the evidence is clear: drinking alcohol of any kind increases breast cancer risk.”

Researchers have discovered that breast myoepithelium cells actively work to keep breast cancer cells from spreading throughout the body. The findings were reported in the Journal of Cell Biology.

 Young women with high body fat have a decreased chance of developing breast cancer before menopause, according to a new study published in JAMA Oncology. The finding may help researchers better understand the role obesity plays in breast cancer risk.

Mrs. Johnson has just been told she's in remission from breast cancer. Which of the following isn't a surveillance recommendation?

A. Routine mammography screening every 12 months for locally recurrent tumors or new primary cancers  

B. Screening for cervical and colorectal cancer every six months for two years 

C. Gynecologic evaluation every 12 months for women on tamoxifen therapy who have an intact uterus 

D. Detailed history and physical examination every three to six months for three years  

On July 18, 2018, the U.S. Food and Drug Administration (FDA) expanded the indication for ribociclib (Kisqali) in combination with an aromatase inhibitor for pre/perimenopausal women with HR-positive, HER2-negative advanced or metastatic breast cancer, as initial endocrine-based therapy.

Mrs. Jones is a 66-year-old postmenopausal woman who developed left breast pain and a palpable mass. A mammogram and ultrasound showed a 4.6 cm mass with an enlarged axillary node. A core biopsy revealed invasive ductal carcinoma that is estrogen receptor positive, progesterone receptor positive, and HER2 negative. Positron-emission tomography and computed tomography scans revealed metastatic disease.

It’s been a long time coming, but the Childhood Cancer Survivorship, Treatment, Access and Research (STAR) Act was finally signed into law on June 6 by President Trump. The act focuses on advancing pediatric cancer research and treatments along with improving screening programs and supporting patients into survivorship. As with many issues in the U.S. capital, the issue had two sides: many healthcare professionals see it as a win to support childhood cancer survivors, but it raised concerns for others about potential coverage issues.

Which Breast Cancers Benefit from Treatment With Cyclin-Dependent Kinase 4/6 Inhibitor Treatment?

A. Newly diagnosed DCIS  

B. Metastatic, triple negative  

C. Premenopausal, neoadjavant  

D. ER+ metastatic

Although all cancers have a genetic basis, a subset result from an inherited (i.e., germline) mutation that puts a person at increased risk for certain cancers. Unfortunately, the signs of hereditary cancer are often overlooked or misunderstood. Here’s what oncology nurses need to know about BRCA mutations, one of the more common mutations you’ll see in practice.

Which of the following is gene that may play a role in tumor resistance to chemotherapy?

A. NRAS

B. APC

C. p53

D. VHL

An international survey of 86 genetic testing labs showed inconsistent protocols and standards for analyzing the BRCA1 or 2 cancer susceptibility genes and their variations. The results were reported in NPJ Genomic Medicine.

Test your oncology knowledge with ONS. Which of the following is a risk factor for developing breast cancer? 

1. Women who are gravida 3 para 2
2. Mild to moderate alcohol use
3. Absence of the BRCA1 or BRCA2 mutation
4. Going through menopause prior to age 55

Identifying genetically predisposed women with breast cancer who could benefit from risk assessment and genetic counseling is an important competency for oncology nurses. However, a recent study published in the Journal of Clinical Oncology (JCO) reported that fewer than 50% of newly diagnosed patients with breast cancer who should have been given formal genetic counseling actually received the appropriate genetic testing.

Lymphedema, the chronic swelling of a limb resulting from fluid accumulation, is a common sequela of surgery or radiation treatment for breast cancer. Nearly 90% of women who develop lymphedema do so within three years of treatment. Survivors commonly report physical and emotional distress, limitations to daily activities in fear of exacerbating lymphedema, and body image issues because of an abnormally enlarged limb.

On February 26, 2018, the U.S. Food and Drug Administration (FDA) approved abemaciclib (Verzenio™) in combination with an aromatase inhibitor as initial endocrine-based therapy for postmenopausal women with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 HER2-negative advanced or metastatic breast cancer.

On January 12, 2018, the U.S. Food and Drug Administration (FDA) granted regular approval to olaparib tablets, a poly (ADP-ribose) polymerase (PARP) inhibitor, for the treatment of patients with deleterious or suspected deleterious germline BRCA-mutated (gBRCAm), HER2-negative metastatic breast cancer who have been treated with chemotherapy either in the neoadjuvant, adjuvant, or metastatic setting.