Cancer screening: Patients with a life expectancy of less than 10 years derive little benefit from screening for breast or colorectal cancer, a meta-analysis of randomized trials suggested. For every 1,000 women screened for breast cancer, almost 11 years would pass before one breast cancer death would be prevented. More than 10 years would pass before a single death from colorectal cancer would be prevented for every 1,000 persons screened, wrote Sei Lee, M.D., of the University of California San Francisco, and colleagues in BMJ online.

Increasing the number screened to 5,000 reduced the intervals to 3 and 5 years for prevention of one death by breast or colorectal cancer, respectively, they added.

Clinical guidelines target screening for breast and colorectal cancer to healthy older individuals with a substantial life expectancy, a position backed by the rationale that screening does not provide immediate benefits.

Early detection benefits: The benefits of cancer screening come from early detection of symptomatic cancers that would cause symptoms or death years later, according to the authors. As such, screening is associated with a “time lag to benefit.” When life expectancy is shorter than the time lag, patients are exposed to immediate risks of screening, which has little chance of providing a benefit.

However, the life expectancy required to benefit from screening for breast or colorectal cancer remains unclear. To examine the issue of time lag to benefit, Lee and colleagues performed a survival meta-analysis of major clinical trials of screening mammography and fecal occult blood testing (FOBT). They excluded studies that targeted younger populations. For screening mammography and FOBT, investigators calculated the number of years required to prevent a single cancer-related death with screening thresholds of 500 to 10,000 patients.

A review of multiple databases identified five mammography trials and four trials of FOBT suitable for meta-analysis. The mammography trials involved 13,811 to 61,004 patients, and follow-up ranged from 10 to 20 years.

Investigators limited their analysis to women ages 55 to 74. The primary outcome of all the trials was breast cancer mortality. The colorectal cancer screening trials included 30,964 to 150,251 patients, ages 45 to 80, and follow-up ranged from 8 to 19 years. Patients younger than 50 were excluded from analysis. The authors determined that 2.8 colorectal cancer deaths would be prevented after 5 years for every 10,000 patients screened by FOBT. With a screening threshold of 5,000 patients, the time-lag interval was 4.8 years to prevent a single death from colorectal cancer. The interval increased to 10.3 years per cancer prevented for a threshold of 1,000 patients. The mammography analyses showed that 5.1 breast cancer deaths were prevented over 5 years for every 10,000 women screened, one death in 3 years for a screening threshold of 5,000 women, and one death prevented every 10.7 years for every 1,000 women screened.

The frequency of serious harm has been estimated at three in 10,000 for breast cancer screening and one in 1,000 for colorectal cancer screening, the authors wrote. As a result, an absolute risk reduction of one in 1,000 would be reasonable as the threshold wherein potential benefit probably outweighs potential risk.

Cool program: The Navy Credentialing Opportunities On-Line (COOL) is a program that helps sailors find civilian information related to their enlisted or officer duties. Its web-based hub at www.cool.navy.mil catalogs and defines comprehensive information on occupational credentials - including certifications, licenses, apprenticeships, and growth opportunities - correlating with every Navy rating, job, designator, and collateral duty/out of rate assignment. It provides “how to” instructions for pursuing these credentials, links to credentialing organizations, and cross-references to programs that may help service members pay for credentialing fees, such as Montgomery GI Bill. It also has links to the United Services Military Apprenticeship Program (USMAP), Navy Tuition Assistance Program, and college information. Navy COOL has multiple benefits for sailors still serving and those about to separate. [Source: NAUS Weekly Update 11 Jan 2013]

Tricare Prime update: Tricare Prime, the military’s managed-care option, will end Oct. 1, 2013, for retirees, their family members and for military survivors who reside more than 40 miles from a military treatment facility or from a base closure site, Tricare Management Activity announced Wednesday. Most of these 171,400 beneficiaries will need to shift health coverage from Prime to Tricare Standard, the military’s fee-for service health insurance option. For beneficiaries who use more than preventive health care during the year, the shift will mean higher out-of-pocket costs. Defense officials expect the move to save the health care system up to $55 million a year. The rollback in number of Prime service areas will not impact active duty members or their families living far from a military base for tours as recruiters or in other remote assignments. Their health insurance through the separate Tricare Prime Remote program will not change. But grown children of members or of retirees who elected coverage under Tricare Young Adult insurance will, like retirees, lose access to managed care providers under Prime if they reside more than 40 miles from a base.

Tricare had considered ending Prime in remote service areas of the West Region on April 1, to coincide with changeover for that region’s Tricare support contactor. On that date, the TriWest Health care Alliance will give way to United Health care Services of Minnetonka, Minn.

Congressional committee staffs also had complained about a staggered start across regions to a major benefit change. So the Prime service area rollback will occur in the North, South and West regions simultaneously next fall. This will cause another set of challenges in remote areas of the West Region that an April 1 start there would have avoided. TriWest needed years to build its current network of providers far from military bases across the region. United Health will now be paid additional monies under a contract change order to build its own remote networks of providers. Those networks will only operate until October. How successful United Health can be in luring providers, or even beneficiaries, to new networks that will be dissolved quickly is anyone’s guess but the scheme has skeptics.

Tricare’s far more critical challenge, however, is to educate impacted beneficiaries that their Prime coverage will end and most of them will need to shift to Tricare Standard. An aggressive information campaign is planned with the first of three letters of explanation and warning to be sent to affected beneficiaries and families within 30 days, Lawhon said. Under Prime, beneficiaries get their care from a designated network of providers for a fixed annual enrollment fee, which for fiscal 2013 is set at $269.28 for individual coverage or $538.56 for family. Retirees and family members also are charged a co-pay of $12 per doctor visit. Under Tricare Standard, beneficiaries choose their own physicians and pay no annual enrollment fee. When in need of care, retirees must pay 25 percent of allowable charges themselves. They also pay an annual deductible of $150 for individual or $300 per family. Total out-of pocket costs; however, cannot exceed a $3000 per family catastrophic cap.

Some beneficiaries who see local Prime coverage end will be able to enroll in a remaining Prime network near base. To do so they would have to reside less than 100 miles from that exiting network and would have to waive the driving-distance standard that Tricare imposes for patient safety. That standard when enforced required that an assigned network provider be within a 30-minute drive of the beneficiary’s home. If displaced Prime beneficiaries meet the two requirements, then an existing network will make room for them regardless of number of beneficiaries enrolled, Lawhon said. But joining a new network also will mean new doctors. So most displaced Prime beneficiaries are expected to choose to use Tricare Standard instead to get care locally and, in many cases from the same physicians who treated them under Tricare Prime.

The push to end Prime in areas away from bases began in 2007 with design of a third generation of Tricare support contracts. But it took years to settle on winning contractors for the three regions due to various bid protests and award reversals. Health Net Federal Services has run North Region under the new contract since April 2011. Humana Military Health care Services has had the South Region under the new contract since April 2012. Along with TriWest, these contractors have continued to run remote Prime networks under temporary order while waiting final word from Tricare on imposing Prime area restrictions written into original contracts. The driver behind new restrictions on Prime is cost. Managed care is more cost efficient for the private sector but more expensive for the military to offer than traditional fee-for-service insurance. This is true in part because Congress won’t allow Prime fees to keep pace with health inflation. So more beneficiaries using Standard means less cost to Tricare. Of beneficiaries impacted by the Prime area rollback, more than half, almost 98,000, reside in South Region. Roughly 36,000 are West Region beneficiaries and more than 37,000 are in the North Region. [Source: Stars & Stripes | Tom Philpott | 10 Jan 2013]

VA Tinnitus Care update: The department of Veterans Affairs recently approved Sound Cure’s new device, the Serenade, to treat tinnitus, which plagues many people who have been exposed to explosions in war zones or have spent time working around large aircraft or with loud weapons. “We’re seeing lots of providers that are having very good success with patients,” said Jeff Carroll, director of clinical services and engineering at Sound Cure and one of the Serenade’s creators. The Serenade consists of a handheld device that produces sound waves through earphones to help mask tinnitus. It’s been on the market for a little over a year. Tinnitus has been the leading cause of military service-related disability since 2005, according to an analysis of Veterans Affairs statistics by the American Tinnitus Association.

Tinnitus primarily is caused by noise exposure, either cumulative or from a single extreme noise. Head and neck injury is also a cause, said Jennifer Born, director of public affairs for the Tinnitus Association. She said military members are disproportionately impacted by tinnitus compared to civilians because of the nature of their work.

About two-thirds, or more than 840,000, of all service members who seek disability care from the VA do so for tinnitus, she said. It costs the government about $1.28 billion annually to compensate them. Born said tinnitus causes sleep problems and sometimes makes it hard for people to go to work. She said it is often linked closely with post-traumatic stress disorder and depression. Existing treatments do not work for many people and have often proved to be more uncomfortable than the tinnitus itself, Born said. There is no known cure. Several years ago, the Tinnitus Association provided a grant to Sound Cure to come up with a new product to treat a wider range of people with more success. The Serenade was born.

Other treatments use sound waves to try to mask the tinnitus or ringing sensation. Often, the devices’ “white noise” sounds had to be played loudly to cover it up, said Carroll with Sound Cure. Many patients choose to suffer their tinnitus rather than deal with the devices’ loud noise, he said. The Serenade uses a softer level of a wider variety of sound waves, which the developers call S tones, to mask the tinnitus. The softer level makes it easier for patients to comply with the therapy.

Flags - The American Legion Post 70 has on hand American flags, all of the military service flags, POW/MIA flags, and S.C. State flags. Contact a member of Post 70 to purchase flags. The cost is $5.

American Legion Post 70 - Meeting at 6 p.m. on the third Tuesday of the month. For more information, contact Thomas Crisp at 940-2793.

American Legion Post 24 of Newberry has a meeting the second Tuesday of the month at 6:30 p.m. The American Legion Auxiliary Unit 24 meets the same day at 3 p.m. at Post 24.