New official recommendation: Women should start every-other-year mammograms at age 40; some groups favor annual scans

Photo illustration from Medical News Today

By Carla K. Johnson
Associated Press

Regular mammograms to screen for breast cancer should start younger, at age 40, according to an influential U.S. task force. Women ages 40 to 74 should get screened every other year, the group said.

Previously, the task force had said women could choose to start breast cancer screening as young as 40, with a stronger recommendation that they get the exams every two years from age 50 through 74.

Tuesday's announcement by the U.S. Preventive Services Task Force makes official a draft recommendation announced last year. It was published in the Journal of the American Medical Association.

“It’s a win that they are now recognizing the benefits of screening women in their 40s,” said Dr. Therese Bevers of MD Anderson Cancer Center in Houston. She was not involved in the guidance.

Other medical groups, including the American College of Radiology and the American Cancer Society, suggest mammograms every year — instead of every other year — starting at age 40 or 45, which may cause confusion, Bevers said, but “now the starting age will align with what many other organizations are saying.”

Breast-cancer death rates have fallen as treatment continues to improve. But breast cancer is still the second most common cause of cancer death for U.S. women. About 240,000 cases are diagnosed annually and nearly 43,000 women die from breast cancer.

The nudge toward earlier screening is meant to address two vexing issues: the increasing incidence of breast cancer among women in their 40s — it’s risen 2% annually since 2015 — and the higher breast cancer death rate among Black women compared to white women, said task force vice chair Dr. John Wong of Tufts Medical Center in Boston.

“Sadly, we know all too well that Black women are 40% more likely to die from breast cancer than white women,” Wong said. Modeling studies predict that earlier screening may help all women, and have “even more benefit for women who are Black,” he said.

Here are more details on what’s changed, why it’s important and who should pay attention.

When should I get my first mammogram? Age 40 is when mammograms should start for women, transgender men and nonbinary people at average risk. They should have the X-ray exam every other year, according to the new guidance. Other groups recommend annual mammograms, starting at 40 or 45.

The advice does not apply to women who’ve had breast cancer or those at very high risk of breast cancer because of genetic markers. It also does not apply to women who had high-dose radiation therapy to the chest when they were young, or to women who’ve had a lesion on previous biopsies.

What about women 75 and older? It’s not clear whether older women should continue getting regular mammograms. Studies rarely include women 75 and older, so the task force is calling for more research.

Bevers suggests that older women talk with their doctors about the benefits of screening, as well as harms like false alarms and unnecessary biopsies.

What about women with dense breasts? Mammograms don’t work as well for women with dense breasts, but they should still get the exams.

The task force would like to see more evidence about additional tests such as ultrasounds or MRIs for women with dense breasts. It’s not yet clear whether those types of tests would help detect cancer at an earlier, more treatable stage, Wong said.

Does this affect insurance coverage? Congress already passed legislation requiring insurers to pay for mammograms for women 40 and older without copays or deductibles. In addition, the Affordable Care Act requires insurers to cover task-force recommendations with an “A” or “B” letter grade. The mammography recommendation has a “B” grade, meaning it has moderate net benefit.

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Bills to become law on vaping, pharmacy reform, vaccinations, drugs, at-home blood testing, coverage of cancer screening, more

Kentucky State Capitol (Photo via Wikipedia)

By Melissa Patrick
Kentucky Health News

In its 2024 session the Kentucky General Assembly has passed dozens of health-related bills that address a range of topics. With one day left in the session, here are some of them: 

Vaping: House Bill 11 limits legal sale of vaping products to those approved by the U.S. Food and Drug Administration. It also creates a database of retailers that sell the products and sets fines for retailers, manufacturers and wholesalers who violate the law.

HB 142 requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the state Department of Education. Changes in the Senate, accepted by the House, allow schools and their governing bodies to apply for grants related to nicotine usage and remove the mandate that schools suspend students with a third possession violation. 

Pharmacy reform: Senate Bill 188 changes laws governing commercial pharmacy benefit managers, with requirements aimed at saving the state's independent pharmacies from closing.  It provides for dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own.

The bill, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And a PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Reducing barriers to screening

Cancer detection: HB 52 will require health-insurance plans to cover all preventive cancer screenings and tests that are consistent with nationally recognized clinical practice guidelines without requiring patients to pay any cost-sharing requirements, including a deductible charge for the services.

The sponsor, Rep. Deanna Frazier Gordon, a Republican from Richmond, told Kentucky Health News in February that the cost for screenings is often a barrier for people who often don't get screened because they don't have symptoms.

HB 115 will eliminate co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Currently, screening mammograms are covered by insurance, but follow-up exams are often not. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not any more,"  Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

Vaccines and drugs  

Vaccinations: HB 274 will allow Kentucky pharmacists to order and administer vaccinations to children as young as 5. The state's routine vaccination rates for kindergarteners remain below pre-pandemic levels.

Pseudoephedrine: HB 386 will raise the annual purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their needs. The bill changes the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction, said sponsor Robert Duvall, R-Bowling Green.

Kratom: HB 293 will regulate kratom, a natural herbal supplement that is not currently regulated. It is often used for anxiety, pain, PTSD and opioid withdrawal. The bill defines kratom, prohibits sales to people under 21, puts it behind the counter and provides guidelines for manufacturing and labeling. It also says federal law supersedes state law on the matter. 

Blood thinners: HB 31 allows Medicaid patients in Kentucky who are on blood thinners to use at-home machines to test their blood. Patients on some blood thinners, like warfarin, now require a weekly trip to the doctor's office for blood work that looks at how fast their blood clots.

Amanda Crabtree, a registered nurse at University of Kentucky Chandler Hospital, told WKYT-TV that she hopes that other states will follow Kentucky's example in this legislation. Crabtree said she expects that Medicaid patients could receive their at-home machines as soon as this summer.

Health-care business issues

Provider liability: HB 159 will protect health-care providers from criminal liability when a medical error harms a patient unless the harm results from gross negligence or wanton, willful, malicious or intentional misconduct. 

This effort was led by the Kentucky Nurses Association, which said the bill "will prevent health-care professionals from being charged criminally for making a medical error; that makes it good for nurses and nursing, and puts Kentucky at the forefront of developing laws to protect health-care workers." 

Workplace violence: HB 194 extends to contract workers, such as travel nurses, the law that makes violence against health-care workers a third-degree assault. It also extends this protection, now limited to hospitals, to contract employees at health clinics, doctor offices, dental offices and long-term care facilities. 

Sepsis: HB 477 establishes diagnostic criteria for sepsis allow hospitals to preserve current rules used for reimbursement of sepsis care, which allow payment when it is detected early, instead of only allowing reimbursement after organ failure occurs. 

"We know that if sepsis is caught early, the likelihood of survival is great," Jim Musser, vice president for policy with the Kentucky Hospital Association, told Kentucky Health News in March. "But for every hour that we wait, the chance of mortality increases by 7 percent." In sepsis, "The body responds improperly to an infection," says the Mayo Clinic. "Sepsis may progress to septic shock . . . When the damage is severe, it can lead to death."

Other health bills that passed

Youth medical records: HB 174 allows parents have access to their child’s medical records until they turn 18. Right now, children 13 and older must sign a waiver for parents to have access to them. HB 174 also updates the state's Medical Orders for Scope of Treatment form, which defines a person's end-of-life wishes.

Veteran suicide prevention: HB 30 calls on the state Department of Veterans Affairs to create a suicide prevention program for service members, veterans and their families.

Stuttering: SB 111 eliminates some insurance coverage limits on speech therapy for stuttering. It was promoted by former UK basketball star Michael Kidd-Gilchrist, who has overcome stuttering.

Medicaid: SB 71 is designed to keep people from coming to Kentucky to establish residence so that they can sign up for drug treatment to be paid for by Medicaid. One challenge resulting from this practice, according to Rep. Shane Baker, R-Somerset, is that when they leave the program, they are often homeless. 

SB 280 will allow Level II trauma centers that partner with a  university to get the university-hospital rate for services delivered as part of that residency program.

The more health-related social needs factors a woman has, the less likely she is to get a mammogram; that matters in Kentucky

Centers for Disease Control and Prevention graphic

By Melissa Patrick
Kentucky Health News

A Centers for Disease Control and Prevention study says the more health-related social needs a woman has, the less likely she is to get a mammogram. 

The study defines health-related social needs, or HRSNs, as social conditions that adversely affect a person's health. Examples include feeling socially isolated, loss of work or reduced hours, dissatisfaction with life, the cost to access health care, a lack of transportation, and receiving food stamps. HRSNs are some of the social determinants of health. 

Using data from the CDC's 2022 Behavioral Risk Factor Surveillance System, a continuing national survey, the researchers found that mammogram use was almost 20% lower among women between the ages of 50 and 74 who had three or more HRSNs, compared to women who had no such needs.

The report did not provide state-level data, but health-related social needs are more prevalent in Kentucky than in most states.

In Kentucky, 59% of women aged 40-49 and and 72% of women aged 50-74 reported having had a mammogram within the previous two years, according to the 2022 BRFSS data. The rate for younger women 40-49 was the same as the national average, but the rate for those 50-74 was 4.6 percentage points less.

Among U.S. women aged 50 to 74 with no adverse HRSNs, 83 percent had a mammogram in the last two years, while that was true for only 66 percent of those with three or more adverse HRSNs.

“We have to address these health-related social needs to help women get the mammograms they need,” Dr. Debra Houry, chief medical officer at the CDC, said in a news release. “Identifying these challenges and coordinating efforts between health care, social services, community organizations, and public health to help address these needs could improve efforts to increase breast cancer screening and ultimately save these tragic losses to families.”

Breast cancer causes more than 40,000 deaths in U.S. women each year, according to the news release. 

Between 2016 and 2020, Kentucky's breast-cancer rate was 126.7 per 100,000 people and its breast cancer death rate was 21.6 per 100,000, according to the National Cancer Institute State Cancer Profiles. The national rate was 19.6.

The report adds that Black women and women of lower socioeconomic status are more likely to die from breast cancer. 

The U.S. Preventive Services Task Force currently recommends that women aged 50 to 74 get a screening mammogram every two years and that women ages 40 to 49 talk to their health-care providers about when to start and how often to get a mammogram.

Most health-insurance plans cover the full cost of screening mammograms, but follow-up diagnostic imaging is not always covered.

To address this, Kentucky lawmakers recently passed House Bill 115, which eliminates co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Gov. Andy Beshear signed HB 115 into law on April 5. It takes effect Jan. 1, 2025. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not anymore," Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

UK research reveals way to improve treatment for breast cancer

By Elizabeth Chapin
University of Kentucky

A recently study at UK's Markey Cancer Center uncovered a critical pathway involved in evasion of the immune system by breast-cancer cells, pointing the way to make chemotherapy for the disease more effective.

A study by UK Markey researcher Yadi Wu reveals a
potential pathway for breast-cancer drug development.
(Photo by Ben Corwin, UK Research Communications)

The study, led by Markey researcher Yadi Wu, addresses a crucial gap in the understanding of how breast cancer fosters immune evasion and offers a new potential target for cancer therapies.

The research suggests a chain reaction between three proteins helps breast-cancer cells evade the immune system. By disrupting this chain, researchers made the cells more susceptible to immunotherapy.

"The results suggest targeting this pathway in the development of cancer therapies," said Wu, an associate professor in the Department of Pharmacology and Nutritional Sciences. "This new knowledge could potentially lead to more effective breast cancer treatments for patients."

Cancer cells can avoid immune detection by manipulating genetic signals. One such way is through LSD1, a protein involved in regulating gene expression. High levels of LSD1 are found in many cancers and are linked to worse outcomes for patients. Studies show that blocking LSD1 can help immune cells fight cancer more effectively.

The lab study on breast-cancer cells revealed that CDK9, another protein involved in regulating gene expression, plays a crucial role in stabilizing LSD1 and therefore causing immune suppression. This stabilization is achieved through a process involving the third protein, RNF20.

When researchers disrupted this interplay by removing RNF20, breast cancer cells became sensitized to a type of immunotherapy treatment called anti-PD-1.

"This discovery is a significant step forward in our understanding of how cancer cells evade the immune system," said Wu. "Our findings highlight the potential importance of targeting the CDK9-RNF20-LSD1 pathway in the development of new cancer therapies, specifically immunotherapies."

The study was published the Proceedings of the National Academy of Sciences. 

Bill would make diagnostic breast examinations more affordable

Reps. Lisa Willner, left, and Kim Moser present HB 115 to the
House Health Services Committee. (Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

The General Assembly is advancing a bill to remove out-of-pocket charges for follow-up diagnostic breast examinations and supplemental breast examinations when they're medically necessary.

A scientific study has found that one in five women don't get recommended follow-up breast exams  because of cost.

The House Health Services Committee approved House Bill 115 Feb. 1, and the measure was posted for passage in the full House on Monday, Feb. 5. 

"This bill really is about early detection of breast cancer," said Rep. Kim Moser of Taylor Mill, the bill's primary sponsor and the committee chair. "It'll ensure that individuals at high risk for breast cancer have access to diagnostic mammograms or follow up imaging. This is obviously needed to rule out breast cancer or the need for further testing."

Rep. Lisa Willner, a Democrat from Louisville, presented the bill with Moser.  Willner filed a similar bill last year that did not get any traction.
 

"The good news is that overall, our overall cancer numbers are declining," Willner said. "But breast cancer is one of the areas that's actually on the rise in Kentucky, really emphasizing the importance of this bill." 

Indeed, Kentucky's breast-cancer rate showed a steady rise between 2005 and 2019, when it reached a high of 132 women with breast cancer per 100,000, according to the National Cancer Institute.

In 2020, the rate declined to 127 cases per 100,000 women, but that was a "temporary, anomalous year" because of the pandemic, according to NIC. The pandemic caused reduced cancer screenings and diagnosis, which resulted in a decline in the 2020 incidence rates for most cancer sites, the agency said.  

The American Cancer Society estimates that one in every eight women will be diagnosed with breast cancer in her lifetime.

In 2023, more than 4,030 Kentuckians will be diagnosed with breast cancer and more than 790 will die of the disease, according to a letter from philanthropist Susan G. Komen supporting Willner's 2023 bill. 

Dana Carter, regional manager for state policy and advocacy for Komen's breast-cancer foundation, explained to the committee members why the follow-up testing is needed and how it would remove financial barriers to medically necessary diagnostic and supplemental breast examinations. 

"Mammography is only the initial step in the early detection process and it is not able to diagnose cancer alone," she said. "Early detection of breast cancer is not possible without medically necessary follow up imaging or additional supplemental imaging which is required to rule out breast cancer or confirm the need for a biopsy." 

She said an estimated 12% of women screened with "modern digital mammography" will require follow-up diagnostic imaging.

Further, she noted that a Komen-commissioned study recently found that out-of-pocket costs for patients varied widely and are often high, adding to the stress and confusion for patients who need such tests.  

"For example, the average patient cost for a mammogram is around $250, and for a breast MRI over $1000," she said. 

Carter also pointed to a study published in the scientific journal Radiology that found "one in five patients would not go in for the recommended follow up because they had to pay a deductible." 

"Unfortunately, we received many calls and emails from individuals who are unable to pay the out-of-pocket costs for the recommended follow up breast imaging," she said.

"Without assistance, many simply will delay or forego these medically necessary tests. This can mean that patients will not seek care until the cancer is potentially spread, making it much more costly or in deadlier to treat." 

Carter added, "Breast cancer can be up to five times more expensive when it is spread beyond the breast to other parts of the body."

The state Department of Insurance estimates that the bill would increase the cost of health insurance a as much as 57 cents per member per month, or not at all. "This represents an increase of approximately 0.0% to 0.1% or approximately $0 to $2.5 million for all fully insured policies in Kentucky, excluding Medicaid and state employees, due to the increased costs for health plans," the department says. 

The agency "acknowledges that there is a potential for long-term savings due to increased affordability and accessibility to cancer diagnostic testing which could lead to earlier detection of cancer."

Lt. Gov. Coleman reflects on her preventive double mastectomy

Lt.Gov. Jacqueline Coleman (KL photo by Sarah Ladd)

By Sarah Ladd
Kentucky Lantern

Kentucky Lt. Gov. Jacqueline Coleman knew for a long time that one day she might learn cancer was at her door.

Her family history put her on heightened alert; her mother, aunt and cousin all had breast cancer. So she “wasn’t shocked” when, in September, a routine mammogram — her first — concerned her health-care provider.

She went for more tests, including magnetic resonance imaging and biopsy. After the biopsy she learned she needed surgery, either way. Her doctors were concerned about several areas in her breasts, and she was facing “biopsy and remove, biopsy and remove, times four.”

She knew immediately: “I don’t want to live like that.” Without the mastectomy, she faced “scans and screens and biopsies every six months for the rest of my life.”

“In a way, it was almost like I was waiting for this news,” she told the Kentucky Lantern during a sit-down interview in her Capitol office on Jan. 23. She would eventually undergo a double mastectomy on Dec. 18.

But as she wrapped up the last leg of a statewide re-election campaign with Gov. Andy Beshear, Coleman found herself in medical limbo. Screenings and tests defined her personal October and November, even as she debated her opponent on KET, traveled the state meeting voters and celebrating on election night.

“I’m going through the end of a campaign, which is … the most intense time, and I have all these questions,” she said. “And it was really hard to not know what was going to happen.”

The tests “just kind of get a little bit more invasive each time,” said Coleman, 41. “And of course, it takes time to … do the test, to have them read, to schedule the next one. It’s a frustrating process because you have more questions than answers, it seems, the entire time. But you’re also grateful that your doctors are being so thorough, and making sure to cover all the bases.”

In early December, Coleman was “relieved” to learn she could get a double mastectomy at Baptist Health in Lexington.

“I felt it would be irresponsible to have a three-year-old, and to not be as aggressive as I could be,” she said.

Coleman did not have cancer, but she didn’t know that until after her surgery, when her pathology results came back clean. “The one place that was a great concern came back benign, but had malignant potential,” she said. “And so I felt like I got ahead of it. And I feel like I made the right decision.”

At the mercy of disease

Coleman says she's “not the best person about going to the doctor,” but “I also know that being preventative gives you a chance.”

“When you’re reactive, you’re at the mercy of … It could be a disease,” she said.

Still, medical issues wait for no one.

“You’re fighting for your life, and you still have to pick the kids up, and you still have to go to the grocery, and you still have to go to work,” Coleman said. “The world doesn’t stop.”

If anything, she said, the whole experience left her with less patience for what she called “petty politics.”

“There are real problems in the world,” she said. “I think about the importance of women being empowered to protect their own health, to be trusted.”

 
Not alone 

After her surgery, Coleman got cards and letters from people all over the state telling her their stories about going through similar health challenges.

“It was a message of: ‘You’re not alone’,” she said. “But it was also a message of reassurance. And it was remarkable.”

Coleman said she finally feels like herself again, and is looking forward to getting back out in communities across Kentucky. And she plans to keep using her story to encourage others to seek preventive care — and to know there is a community of Kentuckians who relate to their journeys.

“I know how alone I felt when I got the news and when I tried to find my way and what was the right path for me,” she said. “And I don’t want other women to feel that way.”

Women from 40 to 49 should get mammograms every two years, and from 50 to 74, they should get the exam every year, according to the state Department for Public Health. To find out how to get a free or low-cost mammogram or cervical cancer screening, call 844-249-0708. Click here for more information.

Cancer is a leading cause of death in Kentucky, which has high rates of breast cancer. In 2021, Kentucky lost more than 10,000 people to cancer, according to the Centers for Disease Control and Prevention. Breast cancer is second only to lung cancer in its mortality nationwide, according to the American Cancer Society.

Lt. Gov. Coleman has twin mastectomy, citing exam, family history; says early detection and prevention made the difference

Lt. Gov. Jacqueline Coleman (January 2022 photo)

Kentucky Health News

UPDATE, Dec. 26: Coleman issued a statement saying in part, “My post-surgery reports came back clean! While I am grateful for my amazing health-care heroes, and the relief I feel for having answers, please hear me when I say, if I had put this off, skipped appointments, or not taken it seriously, it is likely the news I’d be sharing eventually wouldn’t be great. Early detection and prevention were the difference makers for me. And they are for you, too. Go schedule that appointment that’s been in the back of your mind.”

Lt. Gov. Jacqueline Coleman underwent a double mastectomy Monday, then issued a statement saying the surgery was prompted by an examination and her family history.

“Concerns were raised to me during a recent routine physical exam,” she said. “With a significant family history of cancer, I made the decision to have a double mastectomy. I am happy to report that a successful surgery was performed today, and I expect to make a full recovery.”

Coleman, 41, was re-elected in November and is considered a likely Democratic candidate to succeed Gov. Andy Beshear in 2027, when he would not be eligible for a third term. He and Coleman said her case was a good example of the need for regular screening exams and other preventive measures.

"Coleman’s office did not immediately clarify if she’d received a cancer diagnosis" or if the surgery was preventive, reports Tessa Duvall of the Lexington Herald-Leader, noting that "Such surgeries can reduce the risk of breast cancer by 90% or more," according to the American Cancer Society. "Certain genetic mutations — such as the BRCA1 or BRCA2 — carry with them a “greatly increased risk of breast cancer,” according to the Susan G. Komen Breast Cancer Foundation."

Coleman said, “As Kentucky’s highest elected teacher, it is only fitting that I leave you with a little homework: Schedule those preventive exams you’ve put off, hug your people a little tighter and be kind, because everyone is fighting a battle you may know nothing about.”

She also said, “I want to thank the health-care heroes for the compassionate care I continue to receive. I am more appreciative than I can articulate for your expertise and your kindness through this process. . . . I am eternally grateful for my loving and supportive family who makes that possible, a compassionate friend in Gov. Beshear and a top-notch staff.”

Breast-cancer patient unites community with the 'power of pink,' especially in October, which is Breast Cancer Awareness Month

Pink Sisters event at the Woodford County Courthouse (Photo by Catherine Anderson via UK)

By Elizabeth Chapin
University of Kentucky

Every October, the city of Versailles is adorned in pink. Light poles downtown don bright pink banners — each with the photo of someone diagnosed with breast cancer — patients, survivors and those who lost their lives to the disease.

Versailles resident Catherine Anderson and her daughter Peyton came up with the idea in 2021 and raised funds to get them installed with the support of local businesses and the community.

The banners do more than spread awareness. They recognize family members, friends and neighbors and serve as a reminder of how many lives are affected by the disease. For patients, they also serve as a reminder that they have a support system right in Versailles.

As a breast cancer survivor, Catherine knows the power of connection can make all the difference for someone going through treatment.

In 2018, Catherine detected a lump in her breast. Her doctor ordered a mammogram and she got the news soon after — breast cancer. For the busy mom and current college business officer at University of Kentucky’s Graduate School, the diagnosis was unexpected. She was just 36.

Peyton and Catherine Anderson (UK photo by Arden Barnes)

From the very first day of her cancer journey, Catherine and her significant other, Josh, made it a priority to keep life as normal as possible — especially for their daughter, Peyton who was then 12 years old.

“It was such an emotional time,” said Catherine. “At first I was uncertain about what the future would hold, but I remember telling Peyton, ‘I'm not going anywhere.’”

“I remember being so scared when I heard the awful news,” Peyton said. “On days when my parents would be gone for appointments, my grandparents and our friends would always make sure I got to where I needed to be so my parents and I didn’t have to worry.”

During Catherine’s first appointment at the UK Markey Cancer Center at Lexington Clinic, her oncologist, Rachel Harper, worked with a multidisciplinary team to develop a plan of care.

Catherine was diagnosed with stage 2 HR+/HER2+ breast cancer, also known as triple-positive breast cancer. “Triple positive breast cancer is driven by hormones and the HER2 protein,’’ Harper said. “While these features cause cancer to grow, they also offer more targets for treatment, so patients with this subtype can have good results with therapy.”

Her treatment regimen included five months of chemotherapy infusions followed by bilateral mastectomy and breast reconstruction surgery. She also took a targeted therapy called Herceptin for a year and remains on endocrine therapy.

Finding encouragement through connection

After her diagnosis, Catherine noticed how many people in her own community, including many other women under 40, were affected by the disease.

“Of course it was something I was more aware of,” Catherine said. “But now, looking back, I think other people going through the same thing just felt more comfortable sharing their story with me.”

One of the things that helped Catherine the most was connecting with other breast cancer patients and survivors. She formed a close friendship with another woman from Versailles who was diagnosed around the same time. The two would often get their chemotherapy infusions on the same day and talk for hours.

“If I didn't have her, I probably would have been lost,” she said. “It’s just not the same talking to people who haven't gone through this. The emotions you have when you find out you have cancer ... you feel like you have cooties. And nobody wants to come close to you.”

Catherine also found comfort in her care team, especially Harper.

“As my doctor, she was the one person I could truly believe when she told me everything was going to be OK, and that reassurance was so important,” Catherine said. “When I was done with treatment and visited her less, it felt like we were breaking up.”

Pink Sisters

Once she was cancer-free, Catherine was determined to give back to the community that had supported her so much.

“I think the positive side of that was she had such a sense of community surrounding her going through that fight, so we wanted to create that sense of community for others going through it,” said Peyton.

Catherine and Peyton created Pink Sisters, a nonprofit organization aimed at raising breast cancer awareness and providing resources to those affected. The name represents patients, survivors and the broader community of individuals affected by breast cancer.

“It's not just for the person fighting — and my daughter would attest to this — because it affects everybody,” Catherine said.

Pink Sisters is behind more than the pink banners installed in town each October. Since it became a 501(c)(3) in 2021, the group has raised funds to assist patient needs and become a resource to the community.

They also hold several local events where they share information about awareness and early detection, including self-examination — which saved Catherine’s life.

Most importantly, the group offers other patients and survivors the opportunity to connect through social events, a support group and online via their Facebook page.

“I was lucky to have a strong support group to help me through my breast cancer journey, but not everyone does,” Catherine said. “No one should go through it alone.”

Women should start getting mammograms at 40, experts say now

https://www.washingtonpost.com/wellness/2023/05/09/mammogram-age-40-breast-cancer-screening/

Breast Cancer Awareness Month reminds eligible women to get a screening mammogram; doctor says they're 'proven to save lives'

Image from Pngtree

By Melissa Patrick
Kentucky Health News

Because breast cancer often shows up without any symptoms, getting a mammogram is one of the most important things a woman can do to screen for it -- a message that's especially important to get out in October, which is Breast Cancer Awareness Month.

 "Screening mammography is the number one thing you can do for your breast health," said Dr. Richard D. Gibbs, a radiologist at the University of Kentucky's Markey Cancer Center, who is part of its breast-cancer team. He later added, "It's been proven to save lives." 

Gibbs said it's important to catch breast cancer early because it tends to lead to better prognosis and outcomes. Also, he said catching it early could result in "reduced or less" treatment. 

"Our goal would be to catch every cancer before it's about a half inch in size, or one centimeter in size," he said. "As it gets larger, you're more likely to have metastatic disease or where it spreads to the lymph nodes under the arm or throughout the body. . . . You'd rather catch it smaller before it has time to metastasize." 

The American Cancer Society estimates that nearly 4,000 women in Kentucky will be diagnosed with breast cancer this year and that 640 will die from it.  

Dr. Richard D. Gibbs

Gibbs, who is also a fellow with the American College of Radiology, said the cancer center follows recommendations of the college and The American Society of Breast Surgeons that women with average risk should get an annual screening mammogram starting at age 40 until about 75. Those with higher risk should start screening earlier. 

The cancer society's guidelines for women with average risk are a bit different. They say annual screening between 40 and 44 is optional; that women 45 to 54 should get mammograms every year; that women 55 and older can continue annual mammograms or switch to getting one every other year; and that screening should continue as long as a woman is in good health and expected to live at least 10 more years.

Some of the risk factors for breast cancer include being female (men can get it too), getting older, being obese, using alcohol heavily, having a family history of breast cancer, starting menstruation early or going through menopause late, having your first child after 30 or never giving birth, having radiation treatment to the chest or breast before 30, and having dense breast tissue. 

Gibbs encouraged women with dense breast tissue to seek out tomosynthesis or 3D mammography, which creates a three-dimensional picture of the breast and allows a health-care provider to see beyond the areas of density. In Kentucky, doctors are required to notify their patients if their mammograms show dense breast tissue and that while this tissue is not abnormal, it slightly increases the risk for developing breast cancer.  

He also cautioned that while family history increases a person's risk of getting breast cancer, 70% of women who get it do not have a family history, making it important for every woman who qualifies to be screened. 

Gibbs addressed some concerns women have about getting a mammogram. Cost, he said, should not be a concern because federal law requires health insurers to cover mammograms with no cost-sharing. In addition, the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program offers free and low-cost mammograms to women who are uninsured or underinsured. Click here to see if you qualify. 

Gibbs also stressed that mammograms use a very low dose of radiation, and that while some say it is uncomfortable, it does not hurt. He added that while some women are called back for further evaluation, most of them "do not end up with a biopsy and do not have cancer." (Screening mammography is not recommended for men, who have about one in 100 breast cancers.) 

Signs of breast cancer include any change in the size or the shape of the breast; pain in any area of the breast; nipple discharge other than breast milk, including blood; and a new lump or swelling in the breast or underarm, says the CDC. Men with breast cancer may notice redness or flaky skin in the breast, irritation or dimpling of breast skin, pulling in of the nipple, or pain in the nipple area.

A new way to detect breast cancer early is through a simple blood test called Galleri, which is designed to detect cancers by looking for signals of cancer on DNA that all cells shed into the bloodstream. Once cancer is detected, the test can then determine what part of the body it is most likely coming from. 

Dr. Whitney Jones

Dr. Whitney Jones, senior medical director of Grail, the manufacturer of Galleri, said the company is working on getting Food and Drug Administration approval for the test. "It's going to take us a little time," he said. 

He said the test has also not been approved by most insurance companies, but is available in all 50 states with a prescription from a provider. 

He encouraged anyone who would like to take the test to ask their physician if they offer it, and if they don't, to request it online from a telemedicine provider on galleri.com. The Galleri website says the list price for the test is $949. 

Jones stressed that the Galleri test is not a replacement for annual screening mammograms, but is meant to supplement it.

"This test is not a replacement for knowing your family history, doing self breast exams or for mammography as recommended by your provider," he said. "We really intend to backfill and help identify cancers in people either who had their cancer missed through screenings or for people who are not participating in current breast cancer screening right now. There's also a role for folks who've had breast cancer in the past and are more than three years out from successful treatment, we do pick up recurrence of disease as well." 

After receiving 600 public comments, health cabinet removes proposal to ban tattoos on scarred skin in updated regulation

By Melissa Patrick
Kentucky Health News

The state Cabinet for Health and Family Services has updated its requirements for tattoo studios in Kentucky, and they no longer prohibit tattoos on scarred skin, as first proposed.

WFPL photo

The cabinet said in a news release it had received more than 600 public comments on this proposal. In addition, WHAS-TV reported that almost 100 people from all over the state attended a public hearing about the issue May 28 in Frankfort.

"Based on comments received, we elected to remove the language relating to scar tissue," Dr. Jeff Howard, commissioner of the state health department, said in the release.

Opponents of the proposal have said there is no medical reason to ban such tattoos. Others have said such a ban is a violation of their civil rights, and there are already industry rules around this issue. Still others pointed out the many reasons people want to cover their scars, including cancer survivors who want to cover their mastectomy scars.

The state announced the original amendment to the regulation in April, which simply said "tattooing over scarred skin is prohibited." The proposal did not give any reason for adding this language; when asked about it, a cabinet spokesman said only that the proposal was made in an effort to update a regulation that hadn't been updated in 15 years.

In May, the health commissioner issued another release, saying the proposal to ban tattooing on scarred skin in the regulation "had some unintended consequences" and that the language regarding this issue would be addressed once the public comment period ended on May 31.

On Tuesday, July 16, the cabinet announced that the ban had been removed, citing a "a lack of available evidence to support this prohibition." It said the intent of the first revision was to prohibit the tattooing of freshly scarred skin, but "freshly" was left out.

Under the new rule, which next goes before the Administrative Regulation Review subcommittee, a person registering as a tattoo artist will have to complete training about blood-borne pathogens. The rules also outline a registration process for tattoo studios and increased fees to offset inspection cost.

The regulation also updates requirements for disinfecting and sterilizing equipment and adds a new rule to require a notarized statement of parental consent for a minor who is seeking a tattoo without a parent or legal guardian present.

Reporter writes about beating breast cancer, but perhaps most importantly, about first finding it: 'scheduling the mammogram'

One day each year, many newspapers go pink -- with pink ink or pink paper -- to increase awareness of breast cancer and support research to find a cure. This year, the Lexington Herald-Leader led its front page with a very personal a gripping story by staff writer Cheryl Truman about her breast cancer diagnosis, surgery and chemotherapy, and her struggle to get her life back and deal with troubling parts of the health-care system. The story is 1,928 words, and the most important may be at the end:

"Sometimes I will stop a moment and touch a flower, look for an extra few seconds at the farm view from my deck, brag about how the kids turned out. I am here to do that, and it has made all the difference," Truman writes. "Part of it is medicine, part luck. The first part was scheduling the mammogram."

Kentucky loses a health champion who advocated for health equity and community-based solutions; Dr. Gil Friedell was 91

Dr. Gilbert "Gil" Friedell

By Melissa Patrick
Kentucky Health News

Dr. Gilbert Friedell, who was a fierce advocate for health equity and finding community-based solutions to the many health issues that plague Kentucky, died Sept. 23 at the age of 91.

His mantra,"If the problems are in the community, the solutions are in the community," was a drumbeat message that will continue to guide the efforts of many who knew him.

"It is difficult to imagine a more selfless man of medicine," said veteran journalist Al Smith.

Friedell was described in his obituary as an "avid student," attending Harvard College in 1943 at the age of 16 and graduating from the University of Minnesota Medical School in 1950. He then went on to receive his medical training in pathology in Boston and served as a physician in the Navy reserves for two plus years.

He was a medical faculty member at Harvard, Boston University, the University of Massachusetts and the University of Kentucky, where he became the first director of the Lucille Parker Markey Cancer Center in 1983, with a focus on cancer prevention.

He stepped down as the director in 1990 to run Markey Cancer Control Program, where he worked to convey breast-cancer information to the public and health professionals through the Kentucky Cancer Program, the Kentucky Cancer Registry and a regional information service for Kentucky, Tennessee and Arkansas -- all organizations that he helped to create. He retired from this position in 1998.

Friedell was an unwavering advocate for increasing health care access to Kentucky's underserved citizens, especially those who lived in Eastern Kentucky. To that end, he co-founded Kentucky Homeplace, a lay health-worker program funded by the Kentucky General Assembly that facilitates access to health-care services in 30 Eastern Kentucky counties.

Since 1994, the program has served over 161,968 people who have received access to more than 4.9 million services valued at $324.4 million, according to Fran Feltner, director of UK's Center for Excellence in Rural Health, where the program is based.

"Gil was a true friend and mentor," Feltner said. "He truly understood the community."

Feltner recalled how they testified to lawmakers in Washington and Frankfort about the value of community health workers and helped pass the national Patient Navigator Bill, which recognizes the need for improving access to care.

"His legacy will never be forgotten and his love for the community will live in my heart and in our work as we continue the lessons learned," Feltner said.

Friedell's legacy will also continue in the work of the Friedell Committee on Health System Transformation, which he founded. He asked that it not bear his name, but the other members unanimously overruled him. The committees' mission is "to improve the health of Kentuckians by promoting an effective, values-based health system, advocating for community action, and measuring the system's performance."

"Gil indeed touched each of us deeply," said Carolyn Dennis, executive director of the committee. "His determination for a just healthcare system that respects the inherent right of every individual to receive the best care possible was contagious; everyone associated with the Friedell Committee carries that same passion and sorrow in his passing. . . . He will be sorely missed but his legacy will live on by all who knew and loved him."

Dennis described Friedell as a "consummate gentleman," partial to wearing a "jaunty bow tie and beret," who was "tireless in his quest to engage leaders in every geographic corner of the state to improve the health of their communities."

Friedell was the recipient of numerous awards, authored more than 200 articles in medical publications, served on many state and national public-health committees, and co-authored The Great Diabetes Epidemic: A Manifesto for Control and Prevention that published in 2014.

"The very vibrant Big Sandy Diabetes Coalition . . . is a testament to Gil, who was really its founder with his periodic trips here to encourage us and educate us about the diabetes epidemic," said Prestonsburg lawyer John Rosenberg. "He infected us with the belief that the solution to better health care was in the community, and that took hold. He was a wonderful man, in his quiet way, a great leader and a great spirit!"

Friedell's obituary said, "To those who knew him, Gil will be remembered for his wise personal and professional counsel, incisive questions, wit, infectious chuckle, poetic annual holiday letters and fondness for bow ties. Gil dedicated his life to transforming inequitable systems to make the world a better place."

Smith, a Friedell Committee member, said, "We remember him best when we do all we can for the good health of Kentucky."

Friedell is survived by Jan, his wife of 67 years, four of their five children, seven grandchildren, and one great-granddaughter. A memorial service will be held in Charleston, S.C. in the fall with details to follow. In lieu of flowers, donations may be made to the Gilbert H. Friedell Resident Scholar in Cancer Prevention and Control Fund, University of Kentucky, Markey Cancer Center, 800 Rose Street, Lexington KY 40536, to the attention of Elisha Maxson.

In a state thick with cancer, leaders of screening and research organizations targeted for cuts make cases for state money

Mammograms are a screening for breast cancer. (WTVQ image)

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposed budget for the next two fiscal years calls for cuts to five cancer research and prevention programs, including screenings for breast, colon, cervical, lung and ovarian cancer, and for research on lung cancer, all of which plague the state.

The programs are included in a list of 70 that Bevin proposed to eliminate to save the state $85 million, or less than 1 percent of the overall budget. He has said these cuts are necessary to help fund the state's ailing pension system.

Dr. Whitney Jones, a Louisville gastroenterologist and founder of the Kentucky Cancer Foundation, which provides funds for colon-cancer screening, said he recognizes the challenges of balancing a state budget, but hopes the state will reconsider eliminating the colon cancer screening and prevention program. He said of Bevin, "We hope this is just his first position."

Jones, who also founded the Colon Cancer Prevention Project in Louisville, called the state's improvement from 49th to 19th for colo-rectal screening in the past 15 years, "the best public health story" in Kentucky.

He added that this was only possible because the state offered screenings to uninsured and under-insured Kentuckians, expanded Medicaid to those who earn up to 138 percent of the federal poverty level, and has a unique, multi-partner screening program -- all of which he said makes Kentucky "the envy of most states in the nation."

But he also said there is still work to be done, because Kentucky still leads the nation in colon cancer and remains in the top 10 for colon-cancer deaths.

Doug Hogan, a spokesman for the state Cabinet for Health and Family Services, said the state's screening programs, including those for colon, breast and cervical cancer, are no longer needed because they are now covered by all insurance plans with no deductibles or co-payments.

Jones acknowledged that the program needs to be restructured because of the Medicaid expansion, but argues that it is still necessary for several reasons. He said Kentucky still has a large number of people without health insurance; the federal law that requires almost all Americans to have insurance or pay a tax penalty will be repealed at the end of the year; the coming work requirements and premiums in Medicaid will lead to some people going without coverage; and there will be a continuing need for education and outreach about cancer and screening.

"There has to be a better way to cut out the bad and support or maintain the good," Jones said. "And I would just suggest that the Kentucky Colon Cancer Screening Program is the baby, and not the bathwater."

Lung cancer research targeted in a state that has the most of it

Another program set to lose about $5 million is the Lung Cancer Research Grant Program, a collaboration between the University of Kentucky and University of Louisville that is funded by funds from states' 1998 settlement with cigarette manufacturers. UK's portion is $2.4 million, spokesman Jay Blanton said.

Dr. Mark Evers of UK's Markey Cancer Institute said this statewide initiative seeds a number of pilot projects and "spans the gamut" from new lung-cancer therapies and treatments to new clinical trials and prevention strategies, such as lung-cancer screening. He said such pilot programs are often used to help get larger grants from the National Institutes of Health and other sources.

Evers noted that the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative (the Kentucky LEADS Collaborative for short), now funded by a $7 million Bristol-Myers Squibb Foundation grant, is a great example of how a pilot project from this research grant program was able to get a larger grant to further its work.

"It really is a valuable mechanism for us to provide pilot funding for investigators to get the initial data so that they can carry that forward in larger extramural grants," Evers said.

He also noted that the research grant program is responsible for the Kentucky Clinical Trials Network, which he described as another joint venture with U of L that "pushes out" clinical trials for lung cancer, which have been conducted in about 90 percent of Kentucky's counties.

Asked if the program could survive without the state funding, Blanton, who sat in on the telephone interview with Evers, said, "We're just trying to get our arms around the numbers right now."

Asked why the program is important, Evers pointed to the state's high smoking rate, second in the nation, and its No. 1 rank in number of lung-cancer cases. "We've got a terrible problem with this in the state," Evers said.

When Kentucky researchers made a pitch to the National Cancer Institute, Evers said, "The first words out of their mouth were, 'What are you guys doing about your smoking problem?' So, it's really incumbent upon us to be able to have the resources to attack this by screening, prevention and treatment."

While Kentucky LEADS is on Bevin's list of programs that would get no state funding in the next two fiscal years, it has never received any, said Jamie Studts, a UK professor of behavioral science and the lead investigator for the collaborative. He said it had been slated to get $10,000 in each year of the current budget, but that Bevin had "red-lined" the allocation.

Studts said that the cut "doesn't directly affect us in terms of dollars, but indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Breast and cervical cancer: state squeezes local health departments

As for the screening programs for breast and cervical cancer, Hogan said that in addition to these screenings now being covered by insurance, they are also operated by federal funds, so elimination of any state funds would not impact them.

Allison Adams, president of the Kentucky Health Department Association, said that while it's true that the breast and cervical screening programs have not received any state dollars for several years and get some federal funds, most of their funding for these programs come from local tax dollars.

For example, she said that in the fiscal year that ended in June 2017, local health departments received about $607,000 in federal funding for breast and cervical cancer screening, and the rest came from $2.3 million in local dollars. The programs serve about 20,000 patients a year.

Adams said the real challenge for health departments to continue such programs, or any of the other initiatives that involves direct patient care, is that Bevin's budget has added $38.5 million to their annual pension liability. She said that will force the departments to provide programs that focus on overall health, safety and prevention and look for ways to spend $1 to affect 10 people, instead of $10 to affect one.

"Local health departments need to be working on the prevention piece, and less on the treatment and intervention," Adams said, but they "will have to do their own prioritization and determine which programs have the absolute most health benefit for all of Kentuckians. We really have to make some tough decisions of where we are going to spend our money that's going to have the greater impact over the health of Kentucky."

The Ovarian Cancer Screening Program is also slated to be cut. Linda Blackford of the Lexington Herald-Leader reports that this UK program offers free vaginal ultrasound screenings to women for ovarian cancer and has provided nearly 50,000 free screenings since its creation 30 years ago.

Blackford notes that the Pediatric Cancer Research Trust Fund, established in 2015 by Sen. Max Wise, R-Campbellsville, has been approved to receive $2.5 million in each year of the biennium to fund pediatric brain cancer research at UK and U of L. Bevin's budget calls for each of the universities to provide a minimum of $1.2 million a year for the program.

Bevin's budget boosts efforts against opioid abuse but would cut several health programs, including poison control center

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Gov. Matt Bevin's proposed budget would boost programs that fight substance-use disorders and the state's over-burdened social-services system, but calls for cuts to other health-related programs, including the state's only poison control center and one that trains doctors in rural parts of the state.

Bevin's proposal to the General Assembly calls for an additional $34 million to fight the opioid epidemic, with a focus on helping pregnant women addicted to drugs. It also includes $24 million to hire more social workers and give raises to those already employed.

Medicaid, which covers about one-third of the state's population, is the state's largest health expense. The governor's budget recommendation for Medicaid is around $11.5 billion in the first year and $11.8 billion in the second year, mostly from federal funds. The Kentucky Hospital Association told Kentucky Health News that it was pleased with the numbers.

"It looked like there was just a minimal reduction so we were pleased that the budget maintained the funding for Medicaid," said Nancy Galvagni, senior vice president of the association. "We understand from talking with people at the Cabinet [for Health and Family Services] that they consider it funded going forward."

Administration officials told reporters at a Jan. 17 budget briefing that the Medicaid budget had been included in the governor's across-the-board 6.25 percent cuts, but the cut was taken from the projected need of the Medicaid program, not current funding.

The governor also proposed that 70 state programs lose all of their funding, with a projected savings of $85 million a year. At least nine of them related to health. Some haven't received state funding in recent years, but others have depended on it.

One of those is Norton Kosair Children's Hospital Poison Control Center, which is the state's only poison control center, serving all 120 counties. It received $729,000 in each of the past two fiscal years from the state, Joe Sonka reports for Insider Louisville.

Maggie Roetker, a spokeswoman for Norton Healthcare, told Sonka that the funding amounts to 43 percent of the poison center's $1.7 million annual budget. She said the federal government provides $234,000 and Norton makes up the rest.

Sonka reports that according to the center's current service contract with the state, it fields about 70,000 callers a year; saves Kentuckians more than $10 million a year by keeping people out of emergency rooms; and saves Kentuckians $3 to $5 million per year by consulting with patients who are already hospitalized by a poison, which decreases the length of their stay.

Another program set to lose funding is Madisonville's Trover Clinic, for a program that allows medical students from the University of Louisville to complete the last two years of medical school in rural communities. The Kentucky Center for Economic Policy reports that this program is scheduled to receive $910,000 in the fiscal year that ends June 30.

Two other health-related programs on the governor's chopping block include the Lung Cancer Research Grants Program at U of L and the University of Kentucky, which is getting $5,176,100 in the current fiscal year and the Autism Training Center, now getting $119,300, according to KCEP.

The budget would "eliminate state funding for five cancer research or prevention programs, including . . . screening programs for colon, breast, cervical and ovarian cancer," Linda Blackford reports for the Lexington Herald-Leader. But it includes $2.5 million each year in new money for the Pediatric Cancer Research Trust Fund, for brain-cancer research at the two universities, which would have to each provide $1.2 million to match the state appropriation.

The fund was created in 2015 by Sen. Max Wise, R-Campbellsville, whose son Carter, now 10, had cancer when he was six months old. Wise said he and the universities asked for $9.8 million over two years. "It shouldn't be a competition, but unfortunately it is," Wise told Blackford. "We were not trying to play priorities or favorites."

The screening programs for breast and cervical cancer are operated with federal funds, so elimination of any state funds would not impact it, said Doug Hogan, spokesman for the Cabinet for Health and Family Services. Hogan said the colon-cancer screening program had not received state funds for several years.

"Health screenings for preventive services are covered by all insurance plans and there are no deductibles or co-pays," Hogan said. "That applies to various preventive screens including those for colon, breast and cervical cancers."

Jaimie Studts, professor of behavioral science at the UK College of Medicine, said the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative, also called the Kentucky LEADS Collaborative, has never received any state funding. He said it was slated to get $10,000 in each year of the current budget, but Bevin "red-lined" the allocation, saying the health secretary would need to determine how best to spend that money.

Including the program among the list of 70 to be cut "doesn't directly affect us in terms of dollars," Studts said. "But indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Some other health programs on the list hadn't received any funding from the state for the past several years: ARC of Kentucky, a group that supports people with intellectual and developmental disabilities, and Madison County Early Intervention Services. They were not scheduled to get any funding in the 2018 fiscal year, according to KCEP. It has published a list of programs proposed for elimination and the current appropriation for each.

Bevin says his cuts are necessary to fully fund the state's pension obligations, with his budget setting aside about $3.3 billion, or 15 percent of state spending, for that purpose.

Opponents of the governor's budget cuts are calling for raising new tax revenue through comprehensive tax reform, which the governor said could happen in 2018. However, his office said in his budget news release that "He is calling for genuine tax reform that will make Kentucky more competitive with its neighboring states -- not merely a bump in the sales tax or an increase in the cigarette tax."

Events scheduled in Ky. for Breast Cancer Awareness Month

October is Breast Cancer Awareness Month. The American Cancer Society's Making Strides Against Breast Cancer campaign is having events in Kentucky this month, including Sunday, Oct. 15 at Whitaker Bank Ballpark in Lexington; Sunday, Oct. 22 at Smothers Park in Owensboro; and Saturday, Oct. 28 at Waterfront Park in Louisville

The National Breast Cancer Foundation has a website where you can get a booklet with general information about cancer and specific information about breast cancer, including how to prevent it with healthy habits, and how to detect it early to prevent its spread and increase the chances of survival. Most women survive it with early detection and treatment.

"Breast cancer is the second most common kind of cancer in women. About one in eight women born today in the United States will get breast cancer at some point," says the breast-cancer website of the U.S. Department of Health and Human Services. It suggests some steps to raise awareness of breast cancer:

• Ask doctors and nurses to speak to women about the importance of getting screened for breast cancer.
• Encourage women between 40 and 50 to talk with their doctors about when to start getting mammograms.
• Organize an event to talk with women ages 50 to 74 about getting mammograms every two years.
• Host a breast cancer walk like those in Lexington, Owensboro and Louisville.

Radiology and breast-imaging doctors make a case for annual mammograms starting at age 40; other groups' advice varies

Centers for Disease Control and Prevention photo

Kentucky Health News

A recent study found that younger women of breast-screening age are more likely to develop aggressive breast cancers than older women, which reinforces the American College of Radiology and the Society of Breast Imaging's recommendation for annual mammograms starting at age 40.

“Aggressive cancers in women in their 40s must be identified early to be effectively treated. Letting these tumors grow even one extra year before screening greatly increases odds that the woman will die from breast cancer. Women 40 to 49 should be screened regularly,” Dr. Debra Monticciolo, chair of the American College of Radiology Breast Imaging Commission, said in a news release.

Other groups have somewhat different advice. The recommendations of the U.S. Preventive Services Task Force are that average-risk women who are 50 to 74 years old should have a screening mammogram every two years, and that average-risk women who are 40 to 49 should talk to their doctor about when to start and how often to get a screening mammogram.

The American Cancer Society recommends women with an average risk of breast cancer should begin having yearly mammograms at age 45, and can start having them every other year beginning at age 55. It adds that women should be able to start the screening as early as 40 if they want to.

The ACR, SBI, American Congress of Obstetricians and Gynecologists, National Comprehensive Cancer Network and others recommend that women start yearly mammograms at 40, says the radiology college's news release.

The college disputes the claim that mammogram results in overdiagnosis, citing a British Medical Journal study based on direct patient data that found overdiagnosis in about 2 percent of cases, which the college said fits with the American Cancer Society findings.

The college's news release says overdiagnosis is likely between 1 percent and 10 percent, largely due to condition called ductal carcinoma in situ, a noninvasive cancer that is often treated to avoid the potential development of an invasive cancer.

The college argues that concerns about "overdiagnosis, survival and screening versus treatment effectiveness" are "based on assumptions, many of which are unsupported, rather than direct patient data and should not affect breast cancer screening policy."

It also points to  two large studies that  found women who get regular mammograms cut their breast-cancer death risk in half, and that annual screenings have more live-saving benefit than biennial screenings for every age group.

Since the 1980s, when mammograms became widely done, the U.S. breast cancer death rate, which had been stable for decades, has dropped 38 percent as more cancers are found early, the release says.

The National Cancer Institute says about 12 percent of women in the United States today will develop breast cancer at some time in their lives, which means that if the current rate stays the same, a woman born today has about a one in eight chance of being diagnosed with breast cancer in their lifetime.

“Giving the second-leading cancer killer in women a head start through reduced or delayed screening can be lethal for these women. Starting screening at age 40 remains the best policy,” Dr. Wendy B. DeMartini,  president of the Society of Breast Imaging, said in the release.

The Lannin and Wang study was published in the June 8 New England Journal of Medicine.