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Breast Cancer Risk – Is it in your family?

The end of October may be drawing near, but it is still Breast Cancer Awareness month and coincidentally, some new research published in October, may help the cause.

We are never happy to report about the topic of this deadly disease; however, we are happy to report when new developments in cancer research carve pathways to truly understanding the causes and hopefully getting us on a stronger path to PREVENTION.

New studies published this week have divulged some new genetic causes of breast cancer.

The Facts

  • Normal lifetime risk of breast cancer is 12.5% for women in the US
  • 72 previously unknown gene mutations that lead to the development of breast cancer were discovered in these new studies
  • Over 550 Researchers from 300 institutions worldwide were involved
  • 65 of the newly identified genetic variants are common in female breast cancer patients
  • The final 7 of the 72 total mutations were found to prompt women to develop “estrogen-receptor-negative” breast cancer. This is the type of breast cancer that does not respond to hormone therapies (like tamoxifen).
  • Now, there are approximately 180 total known variants that are associated with breast cancer (if you add in the previous research to these new developments).
  • Blood samples from approximately 300,000 women were taken. About 50% of these women had breast cancer.
  • Researchers used the DNA from these blood samples to look for genetic mutations.
  • Researchers compared the DNA sequences in the women with breast cancer to those without, in order to detect subtle differences between them. They wanted to be sure these differences were not coincidental.
  • A gene is a very long strand of DNA. “DNA is made up of nucleic acids, and when a nucleic acid is incorrectly placed along the strand, this is referred to as a genetic mutation. A mutation is a misspelling such that the gene cannot code the proper protein. A gene that cannot code the proper protein leads to disease.” said Dr. Otis Brawley, chief medical officer of the American Cancer Society.
  • Maybe you have heard of the BRCA test? BRCA1 and BRCA2 are two well-known genes; when they contain mutations, it infers a high risk of breast cancer.
  • 55% to 65% of women who inherit a BRCA1 mutation and around 45% of women who inherit a BRCA2 mutation will develop breast cancer by age 70, according to the National Cancer Institute.
  • Unfortunately, what we know now about BRCA1 and BRCA2 explains very little about ALLL inherited breast cancers. Researchers wanted to discover the additional genetic mutations that can lead to breast cancer.
  • These mutations may not individually have as big as an effect as BRCA1 and BRCA2 defects, but there are many of them, so their “overall contribution is larger,” said professor Doug Easton of the University of Cambridge, who led the investigation.
  • A woman may have 2 or more of these common smaller risk gene mutations, so her risk for developing breast cancer increases due to their combined effects.

Why does it matter if the type of cancer is inherited or not?

  • If a patient’s cancer is due to an inherited genetic mutation, they may have an increased risk of OTHER cancers
  • Their treatment recommendations may differ based on this information.
  • A patient’s family members could be affected (with the same mutation).
  • Out of the 12.5% of women at risk for Breast Cancer in the US, 10% of breast cancers are hereditary.
  • Due to this research, this 10% estimate may potentially be low.

What does this all mean to us?

    • If a woman is found to have several of these smaller risk genetic mutations, she would benefit from earlier mammography screening.

THEREFORE

      • Breast cancer screening guidelines should be adopted. Right now, mammography guidelines are based on AGE alone as most insurance plans state that a woman is not able to have coverage for this screening until after age 35. If we adapt newer screening guidelines researchers feel that we will detect a higher number of breast cancers.
      • Experts can determine that someone with no cancer (often a cancer patient’s relative/family member) is at risk and the developments from these studies help those experts quantify that risk.
      • This is NOT just about Breast Cancer. The OncoArray which was the screening method used in research was designed to be used in many other cancer types, including prostate, ovary, colorectal and lung cancer.
      • This is NOT just about Cancer. Dr. Brawley shared that “this type of genome wide screening is being used to identify genes that are associated with increased risk of a number of diseases, including diabetes, Alzheimer’s disease, stroke and heart disease.”
      • The cost of the genetic screening is affordable. Obtaining blood or saliva for a genetic analysis is not costly.
      • Experts hope the developments which pointed to regions of the genome that regulate nearby genes, may soon serve as targets for new therapies or drugs to cure the disease.


What needs to change?

      • Currently, some women may not be covered by their insurance plans for breast cancer screenings if they are not the right age. This also applies to some men with BRCA mutations.
      • Healthcare providers need to be given the ability to use genetic information to customize their care by giving patients reasonable access to the necessary preventive screenings.

As supporters of all the research behind finding a cure or preventing ALL cancers, we at A4M are hopeful that more studies like this surface to prove the importance of genetic testing to our nation, our government and our medical community. We need to work together to accelerate the END of breast cancer along with all cancers! For more regarding Cancer Education, register NOW for our 25th Annual World Congress with afternoon sessions based on specific cancer treatments or please click here to learn about our Integrative Cancer Fellowship!

1Scutti, Susan. CNN.com. Breast Cancer Genetics Revealed. 72 new mutations discovered in global study. http://www.cnn.com/2017/10/23/health/72-new-breast-cancer-mutations-study/index.html. October 23, 2017. Accessed October 24, 2017.
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InternalMedReview – Inflammation Induced Chronic Fatiguing Illnesses

This is the state of the science regarding genomics and neuro-inflammation due to Lyme and Mold exposure. The premise is that the common presenting symptom of fatigue is caused by chronic inflammation, which can now be objectively measured and treated when due to a biotoxin exposure. This is breakthrough research and links inflammation, brain injury and underlying genomics. We are the only group in the world to publish these findings based on years of careful research. – Andrew Heyman, MD

We hear so much about genetics vs. genomics here at A4M/MMI, but the bottom line is that a huge leap was just made this month in our main mission. One of our leading faculty members, Andrew Heyman, MD who is also the Program Director of our Fellowship at George Washington University, just had his research published in The Internal Medicine Review’s October Issue.

Dr. Heyman along with another one of our expert faculty members, Dr. Richie Shoemaker, partnered in this research initiative and have worked tirelessly to gather this data. They are the only group in the world that has collected this amount of data in the chronic illness arena. As we continue to review the model of genomics, what is causing chronic disease – between genetics, DNA, RNA, etc. we have begun to become aware of an overlap with other conditions that we usually blame on lifestyle like obesity and diabetes, etc.

Is the presence of mold or moisture in our surroundings starting to shift our immune response?

Below we provide a summary on some exciting new insight into chronic diseases.

Inflammation Induced Chronic Fatiguing Illnesses: A steady march towards understanding mechanisms and identifying new biomarkers and therapies.

Ritchie C. Shoemaker1,4*, Andrew Heyman2, Annalaura Mancia3 and James C Ryan4
1Center for Research on Biotoxin-Associated Illnesses, Pocomoke, MD, USA
2Integrative Medicine, George Washington University, Washington DC, USA
3Department of Life Science and Biotechnology, University of Ferrara, Ferrara, Italy
4ProgeneDX, LLC, Deerfield Beach, FL USA

This breakthrough peer reviewed publication outlines the Chronic Inflammatory Response Syndrome (CIRS), an evidence-based model of assessment and treatment of Chronic Fatigue utilizing objective biomarkers, structural Brain MRI and transcriptomics, and moves medicine away from a ‘symptom only’ approach to managing the fatigued patient. CIRS is a neuroregulatory-inflammatory disease process found in genetically susceptible patients (20% of US population), initiated by exposure to a biotoxin(s) such as a water damaged building, Lyme disease, ciguatera, pfistera and many more. A final common pathway of immune dysfunction ensues, including abnormal findings such as Transforming Growth Factor Beta (TGFb), Vasoactive Intestinal Peptide (VIP), Melanocyte Stimulating Hormone (MSH), split products of complement activation, Matrix Metalloproteinase (MMP9) and others now available for use as clinical diagnostics. In cases of cognitive decline, new technology for brain MRI analysis, NeuroQuant, can pick up small changes in brain structures consistently shown in CIRS.

This work is based upon two randomized controlled trials applying a specific series of assessments and treatments designed to restore normal health status by:

1) eliminating the exposure
2) resolving immune dysfunction
3) repairing damage to the central nervous system

The CIRS protocol finally gives the practitioner a clinical roadmap for some of their most complex patients presenting with fatigue, especially those suffering from Lyme disease. This article offers clear, concise guidance on the diagnostic and therapeutic approach to define both an initial infectious process and a subsequent inflammatory illness and outlines how genomic testing can determine predisposition to chronic stages of Lyme after acute illness through use of Next Generation Sequencing to bring transcriptomics to the Lyme community.

The goal of this important scientific work is to help practitioners reduce uncertainty in their management of the CIRS patient and to ensure a rigorous, evidence based assessment and treatment process is applied utilizing both conventional and Integrative treatment strategies. It represents a new era in clinical medicine by applying a novel language of neuroimmune and genomic profiling, in order to guide health providers in their treatment of Lyme disease, mold exposure and other biotoxins.

Future research will focus on refining the treatment protocol, determining the role of transcriptomics in chronic inflammatory processes and exploring the relationship and overlap between CIRS and other common conditions such as cardiovascular disease, diabetes and obesity, chronic pain syndromes, concussion and brain injury, and neurodegenerative disorders.

On Friday, December 15, 2017 during our 25th Annual A4M World Congress, Dr. Heyman will be lecturing at our VIP breakfast symposium titled See the Forest through the Trees: Protocols for Lyme Disease, where he will cover what can reduce symptoms, of Lyme, strengthen the immune system, and potentially treat the entire illness.

If you are interested in furthering your coverage of the treatment of Lyme and other chronic illnesses, Dr. Heyman and Dr. Shoemaker have a two part online advance course that we offer.

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When can I finally retire? Doctors, where did all your money go?

Besides hearing that physicians and healthcare practitioners are always looking for the latest and greatest ways to treat their patients, one of the other things we constantly hear is the need for how to thrive in this crazy healthcare market.

Doctors no longer retire at the same age and with the same financial status that they used to. We hear from doctors that going to medical school no longer has the same luster it used to and that some actually discourage their own children from doing so. Why, if it is such a noble cause? Well, they tell us it is due to all of the financial burden/loans they can incur as well as the fact that they are not able to make up the difference after graduating like they used to with the new insurance reimbursement decreases and regulatory changes. Many argue it is not worth the liability.

A recent article was brought to our attention about an orthopedic surgeon, which hits very close to home as a lot of our members and attendees are also in the orthopedic field. This surgeon whose practice is in Tennessee had always planned to retire at 70 years old.1

In fact, a recent MDLinx survey shows that most physicians plan to retire between the ages of 65 and 70 but the majority do not have enough money saved up to maintain their lifestyle. According to this physician, most doctors choose 65-70 as retirement age because this is the age they begin to lose the steadiness in their hands or when their backs begin to get sore.

At 66, Dr. Deborah St. Clair says she is “barely hanging on” to her career and trying to save as many pennies as she can to retire. She does not believe she will be able to carry on past one more year and she fears that her “early” retirement based on her original date of 70 will end up costing her. She has only gotten to about half the savings she wishes she had achieved before having to retire from her practice.

It was a short 10 years ago that Dr. St. Clair’s practice was flourishing. She is now losing money and feels lucky to get 20 hours a week in the office. The small rural town where she lives has less than 17,000 residents which is not yielding as many patients as she was used to seeing. Unfortunately, although this rural location may differ from other doctors located elsewhere, what does add to the negative change is true for all healthcare practitioners: the changes in insurance and the regulatory issues.

The local hospital near Dr. St. Clair has had to dramatically increase its rates and has been forced to make patient stays shorter. The higher rates have caused patients with catastrophic coverage or high co-payments to have to avoid the hospital completely.

Physicians are said to have an average student debt load of $183,000, and certified financial planner Anthony Criscuolo at Palisades Hudson Financial Group explains that some physicians “get a much later start” than other professionals when trying to save for their retirement because “many of them are dealing with crippling debt when they’re fresh out of medical school.” As mentioned above, doctors are also getting squeezed by insurance reimbursement rates so they are not maintaining the incomes they expected to maintain as they approach their retirement age. “They’re really getting it at both ends,” Criscuolo explains.

Fidelity Investments studied 360 physicians and nearly half said that they can’t afford to contribute the maximum to their retirement plans at work. This article explains a lot more about reaching the right retirement savings goals as a physician, taking into account things like selling your practice and what a physician can do for financial security. All of this is very scary as we tend to think being a doctor is an amazing thing.

In an effort to keep potential doctors from getting discouraged or keeping our current doctors treating patients and doing their best, we have input some great time and energy into our new Practice Enhancement Training (PET) modules. PET was designed to help you as a healthcare practitioner “Optimize your Income” and “Exceeding your Patient’s Expectations”. PET’s goals are to help you BEFORE retirement.

If you are interested in how you can start enhancing you practice today, sign up for the next LIVE PET course in December at our 25th Annual World Congress!

1MDLinx Internal Medicine. Mindy Ligos. Managing Your Money. Real Stories from Real Doctors. Part 3-Where did all the money go? Prepping for retirement. https://www.mdlinx.com/internal-medicine/article/1152. September 2017. Accessed October 11, 2017.
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