There’s always something going on in the world of lymphedema and lymphatic research! It can be a lot to keep up with, so here’s a digest of some of the latest headlines from the past week carefully curated to keep you in the lymphie loop.
“Breast Cancer Lymphedema Related to Multimodality Treatment”
The prevailing understanding of breast cancer-related lymphedema is that it’s caused by auxiliary node surgery alone, but a new study suggests that multimodality treatment — including surgery, radiation, and chemotherapy — is also associated with the risk of lymphedema.
“We must recognize that today, breast cancer is no longer a disease treated primarily through surgery, and many therapies impact the risk of this chronic condition,” said researcher Judy Boughey, MD, FACS, of the department of surgery at Mayo Clinic. “Risk factors appeared to be cumulative, affecting women in a step-like fashion.”
Dr. Boughey and her colleagues at Mayo Clinic reviewed the charts of 1,794 women with stage 0 to III breast cancer who were treated between 1990 and 2010 in Olmstead County, Minnesota, with a median follow-up time of ten years.
Among their findings, the team found that it was not so much the type of surgery (lumpectomy versus mastectomy) that influenced the risk of lymphedema, but the type of lymph node examination: conventional axillary lymph node dissection (ALND) led to 15.9% incidence of breast cancer-related lymphedema at ten years, compared with 5.3% for those who underwent sentinel lymph node examination. Radiation and chemotherapy contributed separately to the cumulative risk of lymphedema, particularly taxane chemotherapy.
“[Breast cancer-related lymphedema] is a multimodal insult to the axilla — the surgery has an impact, the radiation has an impact, and the chemotherapy has an impact,” said Dr. Boughey. “The highest rates of lymphedema were seen in patients who had trimodality therapy.”
The researchers used the data to asses incidence of breast cancer-related lymphedema and its risk factors over long-term follow-up, and presented their findings at the 2017 American Society of Breast Surgeons Annual Meeting.
“Breast cancer–related lymphedema risk is a consequence of multimodal treatment of patients undergoing therapy,” Dr. Boughey said. “This study can help identify patients who are at a higher risk for breast cancer–related lymphedema, and we can potentially individualize the surveillance of these patients to allow them to have earlier identification and earlier treatment.”
“Study of blood vessel growth may open new pathway to therapies”
A new Yale-led study found that a particular family of growth factors (FGFs) trigger the expression of a gene involved in many cancers; the gene sets off a specific chain of events that regulate the metabolism of cells lining the blood vessels. According to the article, this discovery is significant because it describes a previously unknown link between growth factors and cell metabolism, and pinpoints a pathway for potential therapies.
This carries implications for the treatment of cardiovascular diseases, cancers, and common eye diseases, so hopefully this will apply to lymphatic diseases, too!
“Scientists surprised to discover lymphatic ‘scavenger’ brain cells”
Researchers from the University of Queensland have discovered a new type of lymphatic cell in the brain.
“It is rare to discover a cell type in the brain that we didn’t know about previously, and particularly a cell type that we didn’t expect to be there,” said senior author Dr. Ben Hogan, an associate professor in the Institute for Molecular Bioscience at the University of Queensland.
It used to be believed that the brain didn’t have any lymphatic vessels, but this new discovery shows that it does in fact contain isolated lymphatic cells that help clean up cellular waste that leaks from the bloodstream.
The scientists made the discovery by studying tropical freshwater zebrafish, which share many of the same cell types and organs as humans. By studying the naturally transparent zebrafish under advanced light microscopes, they were able to find the cells and observe how they form and function in detail.
“Our focus now is to investigate how these cells function in humans and see if we can control them with existing drugs to promote brain health, and improve our understanding of neurological diseases such as stroke and dementia,” said Dr. Hogan.
“NIH to get a $2 billion funding boost as Congress rebuffs Trump”
Despite the President’s proposal to cut $1.2 billion from the medical research agency in the current fiscal year, the National Institutes of Health (NIH) will receive a $2 billion boost in funding thanks to a bipartisan spending deal reached last Sunday night (April 30th) in Congress.
According to STAT, this “sends a clear signal that lawmakers on both sides of the aisle prioritize funding for medical research and intend to honor the agreements laid out in the 21st Century Cures Act, a bipartisan bill that called for raising NIH funding and speeding approvals of new drugs and medical devices.”
This is great news for our lymphedema community because we rely on funded medical research to develop new and effective treatments, as well as to provide insight into our disease.
We need to talk about the American Health Care Act…
I generally try to avoid getting political here on the blog, but this is about access to health care, so please bear with me. Health care and insurance are complicated and nuanced issues, and we as people living with lymphedema know that better than anyone. Many of us have to fight just to get our compression garments and other treatments covered, and more still are in and out of hospitals fighting cellulitis infections and other complications.
We need to care about this.
On Thursday, May 4th, House Republicans approved their plan to replace the Affordable Care Act after failing to pass it twice before. The vote passed with a razor-thin margin of 217 to 213, and was remarkably done without a full Congressional Budget Office analysis of its full impact regarding cost, how many people would be covered, or what its influence on insurance rates would be.
The bill is now on its way to the Senate, where it will need a simple majority to pass. If it’s signed into law in its current form, the American Health Care Act will affect access to health care for millions of people in the United States.
The Affordable Care Act isn’t perfect, but this proposed plan sure isn’t, either. The AHCA would shrink Medicaid coverage, undercut some protections for people with pre-existing conditions, and eliminate billions of dollars in taxes that currently help pay for the Affordable Care Act. It will also change the rules and subsidies for people who buy their own insurance coverage. A lot of Americans have concerns, especially when it comes to coverage of pre-existing conditions (hello, lymphedema!).
According to a breakdown by NPR, under the American Health Care Act, states would be able to apply for a waiver that lets them opt out of most of the regulations and consumer protections that were included in the Affordable Care Act. These waivers would allow insurance companies in their states to eliminate required coverage (aka essential health benefits that were required under the Affordable Care Act, which include maternity leave, mental health services, and medically necessary prescription drugs); charge older people more than five times what they charge younger people for the same policy; and even charge more for or outright deny coverage to people who have pre-existing health conditions, such as cancer and — hello, again! — lymphedema.
Numerous prestigious medical groups have released statements opposing the American Health Care Act, including the American Academy of Pediatrics, the American Medical Association, the American Diabetes Association, the American College of Emergency Physicians, the National Organization of Rare Disorders, the American Lung Association, the American Hospital Association, the National Council on Aging, the American Congress of Obstetricians and Gynecologists, the American Psychological Association, the American Academy of Family Physicians… the list goes on and on.
The bill is moving across the Capitol to the Senate, but with only a two-vote Republican majority and likely no Democratic support, it would take only three GOP “no” votes to sink the bill in its current form. With internal disagreements among Republicans in the Senate as well as a wait for an updated CBO score, there’s hope yet that the new legislation won’t pass.
This is not about party affiliations: this is about access to health care for Americans. It should be a bipartisan issue but, unfortunately, it’s not.
So what can you as an American citizen do?
Contact your Senator!
Should you choose to contact your Senator to protest the American Health Care Act ahead of the Senate’s vote, here are some ways to do so.
Next, contact your Senators via email, telephone, or social media. If you call their office, IndivisibleGuide.com offers a great sample script you can use. Let them know how you feel, and if you are comfortable sharing your own experiences with health care, please do so!
You can also use a service like ResistBot, which will send a fax to your representatives completely free of charge. I did it over Facebook messenger, and it took all of five minutes before my faxes were sent to both my Senators.
(Psst… you can also use ResistBot to contact your reps about another important piece of legislation: the Lymphedema Treatment Act!)
Remember: there’s no pressure to craft the perfect message here, or to make it super complicated. Your reps just need to hear from you. That’s what living in a democracy is about, after all, and we lymphies know we are our own best advocates.
Stay informed and educated, lymphies!