Disease Management Update
Volume V, No. 25
October 16, 2008

Dear Healthcare Intelligence Network Client,

Breast cancer. Nearly 200,000 men and women were diagnosed with this disease in 2004, and it is among the top 10 causes of death for women in the United States. Midway through Breast Cancer Awareness month, this week's Disease Management Update focuses on breast cancer treatment — where there may be too much and where there is not enough.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Breast Cancer Remains Threat for Older Women
  2. Disease Management Q&A: Chronic Pain Management
  3. HealthSounds Podcast: Breast Cancer Survivors Navigation Kit
  4. "Over-Treating" Breast Cancer is Unnecessary
  5. Survey of the Month: Depression and DM in 2008
  6. Wellness and Health Promotion: Programs and Promotions Used by Health Plans and Employers

1. Breast Cancer Remains Threat for Older Women

Despite recent examples of young and middle-aged celebrities being diagnosed with breast cancer, more than half of breast cancers happen in women over age 65. That's why experts at the University of Michigan Comprehensive Cancer Center recommend women continue to receive yearly breast screenings through their 70s.

"Women don't seem to take the risk of breast cancer as they get older seriously. A lot of women seem to think of it as a middle-aged disease, and as they get older, they anticipate that if they were going to get breast cancer, they would have already had it. Therefore, they aren't as careful about getting screened," says Kathleen Diehl, M.D., assistant professor of surgery at the University of Michigan Medical School.

The risk of breast cancer increases with age, and does not drop off until after age 84. More than half of breast cancers are diagnosed in women age 65 or older, and as many as 45 percent are diagnosed after age 70. Older women who do not follow regular screening guidelines often are diagnosed at a later stage, when breast cancer is more difficult to treat.

Even women who have previously been treated for breast cancer frequently let their surveillance and screening fall by the wayside as they get older. But recent studies have shown that breast cancer survivors who continue to have annual mammograms after age 65 cut their risk of dying from the disease.

To learn more about this research, please visit:

2. Disease Management Q&A: Chronic Pain Management

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Danielle Butin, former manager of Health Information and Wellness at Oxford Health Plan.

Question: What kinds of programs and resources do you have available for patients dealing with chronic pain?

Response: (Danielle Butin) We have a chronic pain management program. There is so much information out there on pain management, from the use of analgesics to anesthesiology practices to pain reduction, but it is very hard for older adults to access and find courses that are specifically and solely geared towards self-management. Literally, how do you breathe? How do you reframe? I have yet to see studies that report on more than just reframing and improved health and perception and associated cost savings. We have developed a multi-week course in pain management taught by a complementary care practitioner with a background in the Alexander technique and other pain management techniques. She is a highly gifted lecturer who has written a book on living with chronic pain. Members attending this course learn how to get in and out of their beds and chairs, how to breathe and how to walk. They are given relaxation tapes and visual imagery tapes to listen to every night.

For more details on proactive care management, please visit:

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3. HealthSounds Podcast: Breast Cancer Survivors Navigation Kit

In this week's DM podcast, the winners of HIN's annual Healthcare Toolkits contest talk about the development and implementation of their toolkit "MyHealth, MyJourney," a post-diagnosis patient navigation kit developed by the Eden Communications Group, accented with artwork and writings by breast cancer survivors.

To listen to this complimentary HIN podcast, please visit:

4. "Over-Treating" Breast Cancer is Unnecessary

Recent research has shown that more women are choosing to have their healthy breast removed after being diagnosed with breast cancer. The number of double mastectomies from 1998 to 2003 more than doubled, according to one study. But this additional surgery has little impact on long-term survival or whether the cancer will recur, says Lisa Newman, M.D., M.P.H., director of the Breast Care Clinic at the U-M Comprehensive Cancer Center.

“Women are choosing to have more radical surgery than is necessary because of fear that their cancer will come back. Bilateral (double) mastectomy will decrease the possible need for future breast surgery, but it has little or no impact on the overall survival of a woman who has already been diagnosed with a single breast cancer,” Newman says.

For women who test positive for the BRCA1 or BRCA2 gene mutations, opting for a double mastectomy may make sense. The risk of developing breast cancer in the other breast is 30 percent. But women without the BRCA mutation do not face a higher risk of breast cancer in the unaffected breast.

“Women have the opportunity to choose the treatment that feels right for them. But over-treating breast cancer by removing a healthy breast is unnecessary,” Newman says.

To learn more about this research, please visit:

5. Survey of the Month: Depression and DM in 2008

Depression affects over 20 million Americans and billions of dollars are spent on treatment, medication and other therapies. Most cases of depression are still unrecognized or treated inappropriately, which leads to immeasurable costs in employee absenteeism, lost productivity and spiraling healthcare costs. Complete HIN's survey of the month on depression in DM programs in 2008 by October 31 and get a FREE executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Wellness and Health Promotion: Programs and Promotions Used by Health Plans and Employers

Employee health has become a primary concern of employers who are looking to shield themselves against rising healthcare costs and improve employees’ morale, attendance and productivity. What are other organizations doing about wellness? What do health plans offer? HIN asked health plans and employers about their use of health promotion programs. This executive summary specifies which programs are employed the most, along with common promotion strategies and challenges to successful programs.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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