Health Rounds: Benign mammography finding linked with heart disease

By Nancy Lapid

(Reuters) - Hello Health Rounds Readers! Today we report on studies that might lead to a closer look at mammography findings involving clogged arteries. We also feature a study that might lead to greater use of video visits by healthcare providers seeking to improve quality of life for patients near the end of life, and a review that takes a new look at the risks of treatment with a powerful blood cancer therapy.

Mammography finding in arteries could indicate heart disease

Calcium buildup in breast arteries detected by mammography usually is not a sign of cancer, but it might indicate a higher risk for heart disease, two research teams reported at the Menopause Society annual meeting in Chicago.

Following nearly 400 women for 18 years, one team found that atherosclerotic cardiovascular disease - clogged arteries limiting blood flow - was diagnosed in 23% of women with breast arterial calcifications, compared to 13.9% of those without.

"Prior research has already suggested this type of association," study leader Hannah Daley of Drexel University College of Medicine in Pennsylvania said in a statement. "Based on what we found, we believe the presence of breast arterial calcifications on a mammogram should be routinely reported."

Separately, researchers at Penn State College of Medicine in Pennsylvania reviewed data from nine previous studies involving nearly 47,000 women followed for nearly 12 years on average. They found that women with breast arterial calcification seen on mammography were at an increased risk of stroke, cardiovascular death, atherosclerotic cardiovascular disease and congestive heart failure.

"I think this study is important for primary care physicians, and also cardiologists, and really any clinician that looks at cardiovascular disease risk assessment," study leader Dr. Matthew Nudy said in a statement.

The information from these studies "reinforces that the risk factors for cardiovascular disease in women are different than for men," Dr. Stephanie Faubion, medical director for the Menopause Society, said in a statement.

Virtual palliative care visits prove helpful

Cancer patients who do not have access to in-person palliative care might benefit just as much from such care provided via video visits, according to a new study.

Palliative care focuses on providing relief from pain and other symptoms to improve the quality of life of patients with serious illnesses.

Across the United States, 1,250 patients recently diagnosed with advanced lung cancer were randomly assigned to receive early palliative care via video visits or in person, at least every four weeks.

Participants completed surveys at the start and then again every 12 weeks. Quality-of-life scores improved significantly in both groups and were equivalent at week 24, according to a study published in JAMA.

Satisfaction with care, anxiety and depression symptoms, use of approach-oriented or avoidant coping strategies, and perceptions of the primary goal of treatment and curability of their cancer were also similar between the groups.

Caregiver participation in palliative care visits was lower in the video group, but the groups did not differ in caregiver satisfaction with care, quality of life, mood symptoms or prognostic perceptions.

National guidelines in the United States recommend that palliative care be included in a patient's care from the time of diagnosis of advanced cancer, based on numerous clinical trials demonstrating its efficacy for improving quality of life, symptoms and other outcomes. But, the researchers noted, most patients and their families do not receive such care, in part because of the limited availability of specialty-trained clinicians.

"Many healthcare facilities now have the capacity to offer video visits," they wrote. "The present study adds critical evidence to support ongoing access to telehealth services, especially for vulnerable populations with serious illness."

No higher risk of second cancer found in CAR-T cell therapy

For blood cancer patients receiving CAR-T cell therapy, the risk of a second new malignancy is no higher than it would be after other standard treatments, according to a review of previous studies.

In CAR T cell therapy, a patient's own immune cells are altered so they will attack cancer cells. These T cells are extracted from the blood, genetically modified to fight the individual's cancer and then reinfused into the patient.

For the new study, researchers reviewed data on 5,517 participants in 18 clinical trials in the United States and other countries testing six CAR T-cell therapies: Bristol Myers Squibb's Abecma and Breyanzi, Johnson & Johnson's Carvykti, Novartis' Kymriah or Gilead Science's Tecartus or Yescarta.

After a median follow-up of 21.7 months, 5.8% of patients developed a second primary malignancy.

Among 1,253 participants in four studies that compared CAR T therapy with more traditional regimens, unrelated new cancers developed in 5% of CAR T recipients and in 4.9% of standard-of-care recipients, a difference that was not statistically significant, according to a report in Clinical Cancer Research.

Outcomes were similar regardless of cancer type or CAR T-cell product used.

Patients who had received at least three other treatments before CAR T had a significantly higher risk of second new cancers than patients who had received no more than two prior lines of therapy - possibly due to cumulative tissue damage caused by the multiple previous therapies, the researchers said.

CAR T cell therapy is the first in more than 20 years to show an overall survival benefit compared to the standard of care in the most common type of lymphoma seen in U.S. patients, study leader Dr. Kai Rejeski of Memorial Sloan Kettering Cancer Center in New York said in a statement.

The rate of second cancers was higher in studies with longer follow-up, perhaps reflecting the possibility that "more patients may be developing second primary malignancies because they are living long enough to do so," Rejeski said.

Overall, "these data do not suggest that there is an increased risk of second primary malignancies relative to other standard-of-care therapies," Rejeski said. "I worry that the warning labels may intimidate patients who receive this therapy, which may not be entirely founded."

In the United States and Europe, CAR T-cell labels must warn of a potential risk of a new, unrelated cancer arising after treatment, based on cases reported to the U.S Food and Drug Administration and the European Medicines Agency.

(Reporting by Nancy Lapid; editing by Will Dunham)