Breast Cancer

Breast Cancer Patients Forego Post-Surgery Treatment Due to Mistrust, Study Suggests

Breast Cancer | Johns Hopkins Medicine

Home > News > News Releases > 2017 > Breast Cancer Patients Forego Post-Surgery Treatment Due to Mistrust, Study Suggests

November 1, 2017

Other factors, including prognosis, influenced noncompliance; building trust in medical institutions key

Nearly one-third of women with breast cancer went against their doctor’s advice and chose not to begin or complete the recommended adjuvant anti-cancer therapy to kill residual tumor cells following surgery, according to a study led by a Johns Hopkins Bloomberg School of Public Health researcher.

A survey that included 2,754 breast cancer patients in Florida and Pennsylvania during a two-year period found that this “treatment discordance” – not following a doctor’s recommended treatment plan in its entirety – was more ly among patients who reported a general distrust of medical institutions and insurers. The patients’ trust or distrust of their own doctors did not seem to be a factor.

Small studies in the past have found that some patients refuse their doctors’ advice and choose not to undergo or complete adjuvant therapy after breast cancer surgery.

The new study, published in Cancer Epidemiology, Biomarkers & Prevention, is by far the largest evaluation of this issue, and suggests that the avoidance of adjuvant therapy is significant and is linked to a general distrust in the healthcare system.

“If we want more women with breast cancer to complete their treatment, we’ll need to deal with their beliefs about the healthcare system—and I do think we can modify those beliefs,” says Lorraine T. Dean, ScD, assistant professor in the Bloomberg School’s Department of Epidemiology and the study’s lead author.

Adjuvant therapy for breast cancer normally consists of a course of chemotherapy, hormone therapy or radiation treatment, and is meant to kill any cancer cells not removed by the initial surgery. Research has shown that adjuvant therapy on average reduces the lihood of breast cancer’s recurrence and increases patients’ chances of long-term survival.

Yet it has long been clear that many patients either do not start their prescribed adjuvant therapy or start it but do not complete it. Cancer epidemiologists would to know the causes of this treatment discordance, or noncompliance, in the hopes of improving treatment compliance, and thus improving patients’ long-term outcomes.

Prior studies, which were smaller in sample size and geographic scope, have linked breast cancer adjuvant treatment discordance to patients’ lack of trust in the general healthcare system, but have not been clear about whether or not distrust in the system is separate from distrust in physicians.

Dean and colleagues sought to clarify this issue of trust with a large survey of breast cancer patients in two major U.S. states.

The researchers mailed survey questions to all women in Pennsylvania and Florida cancer registries who were diagnosed with invasive but still localized breast cancer between 2005 and 2007 and were under the age of 65 at the time of diagnosis.

The response rate was 61 percent and the final sample included 2,754 women. Sixty-nine percent of patients were white, 27 percent were Black/African-American and four percent identified as another race or ethnicity. About 69.8 percent of these women indicated that they had received all of the adjuvant treatments their doctor had recommended.

The remainder, 30.2 percent, indicated that they had elected not to receive at least one prescribed adjuvant treatment.

More than half of the latter, or 18 percent of the cohort, had not undergone some or all of the recommended hormone therapy; the rest were evenly split between discordance with radiation treatment and discordance with chemotherapy.

“While it is surprising in general that nearly one-third of patients are not following up with recommended adjuvant treatment, some earlier, more localized studies have reported even higher discordance rates, and it’s possible that our own figures would have been higher if we had followed patients for more than two years,” Dean notes.

The survey asked participants about their trust in their doctors and in the healthcare system in general.

The researchers used the patients’ responses to place them into high and low categories of general healthcare system distrust, and found that those in the “high-distrust” category, compared to those in the lower-distrust category, were about 22 percent more ly to report not having followed their doctor’s full set of recommended treatments.

Treatment discordance was also significantly less common among married women, but more common among people with higher incomes, patients with stage 1 breast cancer, which has the best prognosis, and patients living in Florida at the time of diagnosis—the latter possibly due to Florida’s insurance laws, which cover a “second opinion” evaluation after a cancer diagnosis, Dean says.

The results confirm the link seen in prior, smaller studies between breast cancer treatment discordance and general distrust in the healthcare system.

The findings also suggest that this general distrust of medical institutions and the associated treatment discordance aren’t significantly influenced by the patient’s attitude towards her own doctor—whom many patients trusted even when they did not trust the broader healthcare system.

“Improving healthcare system distrust may require strategies that are not solely focused on boosting physician trust,” Dean says.

A decision to avoid or stop adjuvant therapy would be a rational one in cases where treatment is unnecessary, she notes.

However, in keeping with prior studies of adjuvant effectiveness, she and her colleagues found that patients reporting treatment discordance were 40 percent more ly to have a cancer recurrence during the study period—underscoring the importance of improving treatment compliance and, to that end, trust in the healthcare system.

“If ordinary businesses can learn to increase trust in their brands, why not the same with health care institutions?” Dean says.

“Healthcare System Distrust, Physician Trust, and Patient Discordance with Adjuvant Breast Cancer Treatment Recommendations,” was written by Lorraine T. Dean, Shadiya L. Moss, Anne Marie McCarthy, and Katrina Armstrong.

Support for the researchers was provided by the National Cancer Institute (K01CA184288, 5-R01-CA133004-3), the Sidney Kimmel Cancer Center (P30CA006973), Johns Hopkins University Center for AIDS Research (P30AI094189), the National Institute of Mental Health (R25MH083620), the National Institutes of Health (R25GM062454) and the National Institute of Drug Abuse (T32DA031099).

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or and Robin Scullin at 410-955-7619 or


Andrew Ewald, Ph.D

Breast Cancer | Johns Hopkins Medicine

Hasnain Z, Fraser AK, Georgess D, Choi A, Macklin P, Bader JS, Peyton SR, Ewald AJ, Newton PK. OrgDyn: Feature and Model Based Characterization of Spatial and Temporal Organoid Dynamics. Bioinformatics 2020 Feb 24[Online ahead of print]. DOI: 10.1093/bioinformatics/btaa096.

Jiao Z, Cai H, Long Y, Sirka OK, Padmanaban V, Ewald AJ, Devreotes PN (2020). Statin-induced GGPP depletion blocks macropinocytosis and starves cells with oncogenic defects. Proc Natl Acad Sci U S A, 117(8), 4158-4168. doi: 10.1073/pnas.1917938117. 

Padmanaban V, Tsehay Y, Cheung KJ, Ewald AJ, Bader JS. Between-tumor and Within-Tumor Heterogeneity in Invasive Potential. PLOS Comput Biol, 16 (1), e1007464, 2020 Jan 21.  

Georgess D, Padmanaban V, Sirka OK, Coutinho K, Choi A, Frid G, Neumann NM, Inoue T, Ewald AJ. Twist1-induced epithelial dissemination requires Prkd1signaling. Cancer Res, 2020 Jan 15, 80 (2), 204-218. 

Yang J, Duan X, Fraser AK, Choudhury MI, Ewald AJ, Li R, Sun SX. Microscale Pressure Measurements an Immiscible Fluid/Fluid Interface. Sci Rep. 2019 Dec 27;9(1):20044. doi: 10.1038/s41598-019-56573-x. 

Padmanaban V, Suhail Y, Bader JS, Ewald AJ, “E-cadherin suppresses invasion and promotes metastasis in multiple breast cancer models,” Accepted in Principle at Nature, 2019. 

Hickey JW, Dong Y, Chung JW, Salathe SF, Pruitt HC, Li X, Chang C, Fraser AK, Bessell CA, Ewald AJ, Gerecht S, Mao HQ, Schneck JP, ” Engineering an Artificial T-Cell Stimulating Matrix for Immunotherapy,” Adv Mater. 2019 Apr 10:e1807359. 

Li L, Knutsdottir H, Hui K, Weiss MJ, He J, Philosophe B, Cameron AM, Wolfgang CL, Pawlik TM, Ghiaur G, Ewald AJ, Mezey E, Bader JS, Selaru FM, “Human primary liver cancer organoids reveal intra-tumor and inter-patient drug response heterogeneity,” JCI Insight. 2019 Jan 24;4(2). pii: 121490.  

Liu X, Cheng Y, Wang Z, Abraham J, Wang Z, Ke X, Yan R, Zhang G, Khashab M, Shin EJ, McNamara G, Ewald AJ, Lin DC, Liu Z, Meltzer S, “Modeling Wnt signaling in Barrett's neoplasia using human Barrett's epithelial organoids and CRISPR-Cas9 genome editing,” Cancer Lett. 2018 Nov 1;436:109-118. 

Sirka OK, Shamir ER, Ewald AJ, “Myoepithelial cells are a dynamic barrier to epithelial dissemination,” Journal of Cell Biology, 2018 Oct 1;217(10):3368-3381. 

Kim DH, Ewald AJ, Park JS, Kshitiz, Kwak M, Gray RS, Su CY, Seo J, An SS, Levchenko A, “Biomechanical interplay between anisotropic re-organization of cells and the surrounding matrix underlies transition to invasive cancer spread”, Sci Rep. 2018 Sep 21;8(1):14210.  

Neumann NM, Perrone MC, Veldhuis JH, Huebner RJ, Zhan H, Devreotes PN, Brodland GW, and Ewald AJ. 2018. Coordination of receptor tyrosine kinase signaling and interfacial tension dynamics drives radial intercalation and tube elongation. Dev Cell Apr 9;45(1):67-82.e6. doi: 10.1016/j.devcel.2018.03.11. 

Asrani K, Sood A, Torres A, Georgess D, Phatak P, Kaur H, Dubin A, Talbot CC Jr, Elhelu L, Ewald AJ, Xiao B, Worley P, Lotan TL. 2017. mTORC1 loss impairs epidermal adhesion via TGF-β/Rho kinase activation. J Clin Invest. 2017 Nov 1;127(11):4001-4017. doi: 10.1172/JCI92893. Epub 2017 Sep 25. Yochum ZA, Cades J, Mazzacurati L, Neumann NM, Khetarpal SK, Chatterjee S, Wang H, Attar MA, Huang EH, Chatley SN, Nugent K, Somasundaram A, Engh JA, Ewald AJ, Cho YJ, Rudin CM, Tran PT, Burns TF. 2017. A First-in-Class TWIST1 Inhibitor with Activity in Oncogene-Driven Lung Cancer. Mol Cancer Res. 2017 Dec;15(12):1764-1776. doi: 10.1158/1541-7786.MCR-17-0298. Epub 2017 Aug 29.

Xian L, Georgess D, Huso T, Cope L, Belton A, Chang YT, Kuang W, Zhang X, Senger S, Fassano A, Huso DL, Ewald AJ, Resar LMS. 2017. HMGA1 Amplifies Wnt Signaling and Expands the Intestinal Stem Cell Compartment and Paneth Cell Niche. Nat Communications, 2017 Apr 28;8:15008

Ewald AJ. 2017. Pulling cells tumors. Nat Cell Biol. 2017 Mar 1;19(3):147-149. 

Lindberg OR, McKinney A, Engler JR, Koshkakaryan G, Gong H, Robinson AE, Ewald AJ, Huillard E, James CD, Molinaro AM, Shieh JT, Phillips JJ. 2016. GBM heterogeneity as a function of variable epidermal growth factor receptor variant III activity. Oncotarget. 2016 Nov 29; 7(48):79101-79116

Teo WW, Merino V, Cho S, Korangath P, Liang X, Wu R, Neumann NM, Ewald AJ, Sukumar S. 2016.  HOXA5, a regulator of cell fate transition, impedes tumor initiation and progression in breast cancer. Oncogene. 2016 Oct 20; 35(42):5539-5551. 

Shamir ER, Coutinho K, Auer M, Ewald AJ. 2016. Twist1+ epithelial cells retain adhesive and proliferative capacity during dissemination. Biol Open. 2016 Sep 15; 5 (9):1216-1228. 

Cheung KJ, Ewald AJ, “A collective route to metastasis: Seeding by tumor cell clusters,” Science. 2016 Apr 8;352(6282):167-9.

Huebner RJ, Neumann NM, Ewald AJ, “Mammary epithelial tubes elongate through MAPK-dependent coordination of cell migration,” 2016, Feb 2, Development.

Ellison D, Mugler A, Brennan M, Lee SH, Huebner RJ, Shamir ER, Woo LA, Kim J, Amar P, Nemenman I, Ewald AJ, Levchenko A, “Cell-cell communication enhances the capacity of cell ensembles to sense shallow gradients during morphogenesis”, 2016, Jan 20, PNAS

Cheung KJ, Padmanaban VP, Silvestri V, Schipper K, Cohen JD, Fairchild AN, Gorin MA, Verdone JE, Pienta KJ, Ewald AJ, “Polyclonal breast cancer metastases arise from collective dissemination of keratin 14-expressing tumor cell clusters,” 2016, Feb 1, PNAS.

Ewald AJ, “An arresting story about basement membrane invasion,” Dev Cell. 2015 Oct 26;35(2):143-4

Kim M, Shewan A, Ewald AJ, Werb Z, Mostov KE, “P114RhoGEF governs cell motility and lumen formation during tubulogenesis via ROCK-myosin II pathway,” J Cell Sci. 2015 Oct 19.

Shamir ER and Ewald AJ, “Adhesion in mammary development: novel roles for E-cadherin in individual and collective cell migration,” Curr Top Dev Biol. 2015;112:353-82.

Chapiro J, Sur S, Savic LJ, Ganapathy-Kniappan S, Reyes J, Duran R, Chettiar-Thiruganasambandam S, Moats CR, Lin M, Luo W, Tran PT, Herman JM, Semenza GL, Ewald AJ, Vogelstein B, Geschwind JF, “Systemic delivery of microencapsulated 2-bromopyruvate for the therapy of pancreatic cancer, Clinical Cancer Research 2014 Dec 15;20(24):6406-17.

Cheung KJ and Ewald AJ, “Illuminating breast cancer invasion: diverse roles for cell-cell interactions”, Current Opinion in Cell Biology, 2014, Oct; 30:99-111.

Bryant DM, Roignot J, Datta A, Orvereem A, Kim M, Yu W, Peng X, Eastburn D, Ewald AJ, Werb Z, and Mostov K, “A molecular switch for the orientation of epithelial cell polarization,” Dev Cell, 2014 Oct 27;31(2):171-87.

Shamir ER and Ewald AJ, “3D Organotypic Culture: Experimental Models of Mammalian Biology and Disease,” Nature Reviews Molecular Cell Biology, 2014 Oct;15(10):647-64.

Huebner RJ, Lechler T, Ewald AJ, “Mammary epithelial stratification occurs through symmetry breaking vertical divisions of luminal cells,” Development. 2014 Mar;141(5):1085-94

Shamir ER, Papallardo E, Jorgens DM, Coutinho K, Tsai WT, Aziz K, Auer M, Tran PT, Bader JS, Ewald AJ, “Twist1-induced dissemination preserves epithelial identity and requires E-cadherin,” JCB 2014 Mar 3;204(5):839-56 (Selected for cover). 

Chen Q, Zhang N, Gray RS, Li H, Ewald AJ, Zahnow CA, and Pan DJ, “A temporal requirement for Hippo signaling in mammary gland differentiation, growth and tumorigenesis”, Genes Dev. 2014 Mar 1;28(5):432-7.

Cheung KJ, Gabrielson, E, Werb Z, Ewald AJ, “Collective invasion in breast cancer requires a conserved basal epithelial program,” Cell, 2013 Dec;155(7):1639-51.

Beck JN, Singh A, Rothenberg AR, Elisseeff JH, Ewald AJ, The independent roles of mechanical, structural and adhesion characteristics of 3D hydrogels on the regulation of cancer invasion and dissemination, Biomaterials, 2013 Dec;34(37):9486-95.  

Nguyen-Ngoc KV and Ewald AJ, “Mammary epithelial elongation and myoepithelial migration are regulated by the composition of the extracellular matrix,” J Microsc. 2013 Sep;251(3):212-23.

Nguyen-Ngoc KV, Cheung KJ, Brenot A, Shamir ER, Gray RS, Hines WC, Yaswen P, Werb Z, Ewald AJ, “The ECM microenvironment regulates collective migration and local dissemination in normal and malignant mammary epithelium” Proc Natl Acad Sci U S A. 2012 Sep 25;109(39):E2595-604. PMC3465416.  

Ewald AJ, Huebner RJ, Palsdottir H, Lee JK, Perez MJ, Jorgens DM, Tauscher AN, Cheung KJ, Werb Z, Auer M, “Mammary collective cell migration involves transient loss of epithelial features and individual cell migration within the epithelium”, J Cell Sci. 2012 Jun 1;125(Pt 11):2638-54. PMC3403234.

Egeblad* M, Ewald* AJ, Asketraud HA, Truitt M, Welm B, Bainbridge E, Peeters G, Krummel M, Werb Z, “Imaging stromal cells in different tumor microenvironments by spinning disk confocal microscopy”, Disease Models and Mechanisms. 2008 Sep/Oct; 1(2/3): 155-67. * = Co-First Authors. PMC2562195

Ewald, AJ, Brenot, A, Duong, M, Chan, BC, Werb, Z. Collective epithelial migration and cell rearrangements drive mammary branching morphogenesis. Developmental Cell, 2008 Apr; 14(4): 570-81.


Johns Hopkins Hospital | Society of Surgical Oncology

Breast Cancer | Johns Hopkins Medicine

Baltimore, MD

Training Program Director: David M. Euhus, M.D., F.A.C.S.

To serve our local and global communities by training exceptional physicians to provide state-of-the-science breast care. Our graduates will be recognized for their exceptional compassion, patient advocacy, knowledge, and technical skill.

Program Description and Rotations
This is a multidisciplinary fellowship designed to expose fellows to every specialty involved in the care of breast patients.

Five months are devoted to breast surgery and seven to medical oncology, radiation oncology, plastic surgery, breast imaging, pathology, genetics, research and other disciplines. Fellows learn from world-class faculty.

The required reading is intensive, providing a comprehensive survey of the most influential clinical trials that guide contemporary practice.

Johns Hopkins is a Regional Health Care System. Most of the rotations occur on the historic East Baltimore campus.

Fellows will also spend one month on the breast surgery services at Johns Hopkins Howard County General Hospital, Johns Hopkins Sibley Memorial Hospital in Washington, D.C.

, and Johns Hopkins Suburban Hospital in Bethesda, Maryland. Local accommodations will be provided for the two months spent in Bethesda and Washington.  

Patient Volume
The Johns Hopkins Regional Health Care System comprises five hospitals, totaling more than 1,800 beds, with nearly 100,000 admissions annually. The Breast Surgery program includes nine full-time breast surgeons, who see more than 1,500 new breast cancer patients each year.

Courses and Meetings
Fellows are expected to complete at least one course in clinical trial design/analysis through the Johns Hopkins Bloomberg School of Public Health. Optional recurring local programs include: Translational Research, Cause-to-Cure, and the Fundamentals of Cancer courses.

The Fellow will attend the School of Breast Oncology (SOBO), the Society of Surgical Oncology Fellows Institute, and the American Society of Breast Surgeons Annual Meeting. 

Expectations of the Fellow
The fellow will work closely with faculty mentors, providing patient care on each service. The fellow will organize his or her time to ensure that didactic requirements are met, even on the busiest clinical services.

Completion of required reading, BESAP modules and case logs will be documented. The fellow will run the Multidisciplinary Breast Tumor Board. The fellow will submit at least one research abstract to a national meeting and complete at least one manuscript.

Detailed rotation-specificexpectations are spelled out in our Goals, Objectives and Curriculum document (available on request).

Our Teaching Philosophy
Johns Hopkins Medicine’s vision, “Together, we will deliver the promise of medicine,” is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, Johns Hopkins Medicine educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness.

Number of Positions:  One

Length of Fellowship:  One Year

Contact Information

Training Program Director: David M. Euhus, M.D., F.A.C.S.
Address: Johns Hopkins Department of SurgeryDivision of Surgical OncologyBreast Surgery600 North Wolfe Street, Blalock 688Baltimore, MD 21287
Phone: 410-955-2803
Fax: 410-630-7884
Email: Sr. Administrative Coordinator Kristie Viands,


Johns Hopkins Magazine

Breast Cancer | Johns Hopkins Medicine

Shockney was 34 when she became director of performance improvement at Johns Hopkins Hospital, measuring and assessing the quality of care delivered to Hopkins patients for the entire institution.

She supervised a team of nurses who reviewed patients' medical records and then identified ways to improve quality by implementing initiatives that reduced post-operative wound infections, and decreased the time it took to deliver test results.

Four years after starting that job at Hopkins, Shockney was diagnosed with breast cancer. She was so certain that her biopsy would be benign, she looked up her own pathology report in the hospital's database while her doctor was town.

She read the words “breast carcinoma” 12 times. She was terrified. “I thought the Grim Reaper was staring back at me,” she says.

As director of performance improvement, she had thought well of the care at Hopkins. “But flipping over to the other side of the bedrail and becoming a patient changed my perspective,” Shockney says. When she woke up in the recovery room after her first mastectomy, unable to feel either breast, she remembers becoming hysterical.

“Please tell me what you've done,” she pleaded with the nurse. “Please tell me you didn't remove both breasts.” The nurse told her she was wearing a binder, a compression dressing designed to prevent pockets of fluids from forming after surgery. “Why couldn't they have told me about the binder before surgery?” Shockney asks now.

She remembers being told that she would feel nauseated after her mastectomy. But the vomiting caused her to rupture her sutures, which made her need pain medication, which made her nauseated all over again. She remembers thinking, I not only lost my breast today but I can't get my head an emesis basin.

“We needed to prevent nausea from the outset,” she says.

After her surgery, she wanted to talk to other women who'd had breast cancer. She says, “I had hope from my doctor, but I needed it from a survivor.

” The American Cancer Society's Reach to Recovery program sent a survivor to talk to her, but it wasn't a good match. Shockney, whose breasts were size 44D, asked the woman, who was a 32AA, whether she should wear prostheses.

The woman told her that she found them unnecessary. Shockney replied, “Well, honey, for you they probably aren't necessary, but for me they are going to be.”

One day, a doctor she knew at the hospital asked her to talk to his secretary, who had just been diagnosed with breast cancer and was devastated.

“I felt really good after I spoke with her,” Shockney says, and remembers thinking, “I've done oncology nursing. I oversee quality of care.

Why can't I combine the two and volunteer so that women who come after me, who wear my bra, have a better experience than I did? It just seemed a natural thing to do.”

There was no model to follow. Shockney simply jumped in.

She volunteered in the just-formed Breast Center 24 hours a week, doing patient satisfaction surveys and writing pamphlets for women on how to read pathology reports and what to expect after surgery.

At home in the evening, she talked on the telephone with newly diagnosed patients. Within three years, she left her job as director of performance improvement and joined the Breast Center's staff, first as its breast health educator.

Caring for patients is more than being empathetic, she says.

Pat Williford, a former breast cancer patient at Hopkins who now works as part of the center's team of Survivor Volunteers, says Shockney has unparalleled concentration: “What impresses me most about Lillie is that she has this ability to make you feel you are the most important person in the world at that particular moment. It's nobody else exists.” Theodore Tsangaris, chief of breast surgery at Hopkins and the medical director of the Breast Center since 2002, says, “Imagine your life is falling apart and here comes this powerful, dynamic woman, and she pretty much takes over your life. She puts out her hand and she grabs you and she walks you through it and gets you over the hump and feeling better. That's a real gift. I used to think I was really good at it. Lillie is better than me.”

Shockney listens carefully to patients and families and has a knack for explaining complex medical information. She is as positive as she can be, given the diagnosis, and s to tell patients that their treatment is “doable.” But she refrains from telling them what they should do.

Instead she looks to the patient for direction. When Gail Shapira was diagnosed last year, she remembers feeling as though everything was her control. “That first visit was so hard,” Shapira says. Shockney was in the exam room with Shapira and her husband.

When the surgeon left, Shockney turned to her and asked, “Now what do you want to do?” Shapira told her that she wanted a bilateral mastectomy, not the lumpectomy the surgeon told her was a possibility, depending on what he found during surgery. Shockney listened to her reasoning.

Then she told the North Baltimore school nurse that she would support her decision in all future meetings with the team responsible for her care.

“Even to be given the smallest bit of control was so important,” says Shapira, a school nurse who lives in North Baltimore. “Lillie gave me that.”

Shockney's devotion to her patients extends long after their diagnosis. When one of them had to be isolated due to a drop in her white-blood-cell count, the woman couldn't hold her young children and became depressed.

Shockney grabbed a pair of pink pom-poms from her office shelf, recruited Deb Stewart, an oncology nurse and breast cancer survivor herself, and headed out to a parking garage rooftop within view of the patient's hospital window.

It was 18 degrees, but the two nurses stayed out there for 30 minutes and cheered for the woman's cell count to rise. “Laughing strengthens your immune system,” says Shockney, citing research studies. “It boosts your T-cells.”


These Johns Hopkins students are slashing breast cancer biopsy costs – TechCrunch

Breast Cancer | Johns Hopkins Medicine

Over 2 million women were diagnosed with breast cancer in 2018. And while the diagnosis doesn’t have to be a death sentence for women in countries the United States, in developing countries three times as many women die from the disease.

Breast cancer survival rates range from 80% or over in North America, Sweden and Japan to around 60% in middle-income countries and below 40% in low-income countries, according to data provided the World Health Organization.

And the WHO blames these low survival rates in less developed countries on the lack of early detection programs, which result in a higher proporation of women presenting with late-stage disease. The problem is exacerbated by a lack of adequate diagnostic technologies and treatment facilities, according to the WHO.

A group of Johns Hopkins University undergraduates believe they have found a solution. The four women, none of whom are over 21-years-old, have developed a new, low-cost, reusable core needle biopsy technology for physicians and nurses that could dramatically reduce cost and waste, thereby increasing the availability of screening technologies in emerging markets.

They’ve taken the technology they developed at Johns Hopkins University and created a new startup called Ithemba, which means “hope” in Swahili, to commercialize their device.

While the company is still in its early days, the women recently won the undergraduate Lemelson-MIT Student Prize competition, and has received $60,000 in non-dilutive grant funding and a $10,000 prize associated with the Lemelson award.

Students at Johns Hopkins had been working through the problem of developing low-cost diagnostic tools for breast cancer for the past three years, spurred on by Dr. Susan Harvey, the head of Johns Hopkins Section of Breast Imaging.

While Dr. Harvey presented the problem, and several students tried to tackle it, Ithemba’s co-founders — the biomedical engineering undergrads Laura Hinson, Madeline Lee, Sophia Triantis, and Valerie Zawicki — were the first to bring a solution to market.

Ithemba co-founders Laura Hinson, Madeline Lee, Valerie Zawicki and Sophia Triantis

The 21-year-old Zawicki, who grew up in Long Beach, Calif., has a personal connection to the work the team is doing.

When she was just five years old her mother was diagnosed with breast cancer, and the cost of treatment and toll it took on the family forced the family to separate. “My sister moved in with my grandparents,” Zawicki says, while her mother underwent treatment.

“When I came to college I was looking for a way to make an impact in the healthcare space and was really inspired by the care my mom received.”

The same is true for Zawicki’s co-founder, Triantis.

“We have an opportunity to  solve problems that really need solving,” says Triantis, a 20-year-old undergraduate. “Breast cancer has affected so many people close to me… It is the most common cancer among women [and] the fact that women in low resource settings do not have the same standard of diagnostic care really inspired me to work on a solution.”

What the four women have made is a version of a core-needled biopsy that has a lower risk of contamination than the reusable devices that are currently on the market and is cheaper than the expensive disposable devices that are the only other option, the founders say.

“We’ve designed a novel, disposable portion that attaches to the reusable device and the disposable portion has an ability to trap contaminants that would come back through the needle into the device,” says Triantis. “What we’ve created is a way to trap that and have that full portion be disposable and making the device as easy to clean as possible… with a bleach wipe.”

Ithemba’s low-cost reusable core-needle biopsy device

The company is currently in the process of doing benchtop tests on the device, and will look to file a 510K to be certified as a Class 2 medical device. Already a clinic in South Africa and a hospital in Peru are on board as early customers for the new biopsy tool.

At the heart of the new tool is a mechanism which prevents blood from being drawn back into a needle. The team argues it makes reusable devices much less susceptible to contamination and can replace the disposable devices that are too expensive for many emerging market clinics and hospitals.

Zawicki had been working on the problem for a while when Hinson, Lee, and Triantis joined up. “I joined the team when the problem was presented,” says Zawicki. “The project began with this problem that was pitched three years ago, but the four of us are really those that have brought this to life in terms of a device.”

Crucially for the team, Johns Hopkins was fully supportive of the women taking their intellectual property and owning it themselves. “We received written approval from the tech transfer office to file independently,” says Zawicki. “That is really unique.” 

Coupled with the Lemelson award, Ithemba sees a clear path to ownership of the intellectual property and is filing patents on its device.

Zawicki says that it could be anywhere from three to five years before the device makes it on to the market, but there’s the potential for partnerships with big companies in the biopsy space that could accelerate that time to market.

“Once we get that process solidified and finalize our design we will wrap up our benchtop testing so we can move toward clinical trials by next summer, in 2020,” Zawicki says.


Johns Hopkins Breast Center adds MarginProbe® to Breast Care Program

Breast Cancer | Johns Hopkins Medicine

July 30, 2019 09:00 AM Eastern Daylight Time

ALPHARETTA, Ga.–(BUSINESS WIRE)–The Johns Hopkins Breast Center at Johns Hopkins Hospital, the #3 hospital in the U.S.

News & World Report’s 2018–19 Best Hospitals list, announced that it will be adding MarginProbe® as a regular part of its program after its participation in Dune Medical’s MarginProbe® Post Approval Study (PAS).

The center was able to validate previous results through the study that demonstrated MarginProbe’s efficacy in reducing re-excision rates during breast cancer surgery.

“I know from experience that one of the most difficult conversations with a patient after breast conserving surgery is the one that tells them 'we didn't get it all,'” stated Dr. Mehran Habibi, Medical Director of the Johns Hopkins Breast Center and Lead Principal Investigator (PI) for the study.

“While we recognize that 10-50% of patients must return to the operating room to ensure clean margins, this is a hard thing to explain to a patient. These are women who have plans for their life after cancer.

A second surgery at best means this life is put further on-hold, so if utilizing MarginProbe as a tool for margin assessment during lumpectomy surgery can assist in reducing re-excision rates, then it’s an avenue we definitely want to pursue.”

The Johns Hopkins Breast Center is part of the John Hopkins Kimmel Cancer Center, a world leader in deciphering the mechanisms of cancer and developing new ways to treat it.

The organization became one of the first to earn recognition as a “Center of Excellence” by the National Cancer Institute, and the innovations that take place within the center often become the standards of care for the industry.

The Johns Hopkins Breast Center seeks to unify the traditionally fragmented systems of care and places all resources and specialists within a single location for a highly coordinated experience to provide the best possible care at an affordable cost.

This approach achieves the primary goals of the Triple Aim of healthcare: to lower the per-capita cost of care, improve the health of populations and create a better patient experience. It’s also why Johns Hopkins Breast Center added MarginProbe to its standard of care.

MarginProbe reduces re-excision rates to improve the health of individuals and populations as a whole.

The reduction in re-excisions helps to improve the cost of care, while avoiding additional surgeries removes a great burden from patients to dramatically improve their experience with treatment.

“We are honored that Johns Hopkins Breast Center is using MarginProbe for lumpectomy surgery,” explained Lori Chmura, CEO of Dune Medical, the company behind MarginProbe.

“Patients are often faced with delays in radiation and sometimes chemotherapy which can further disrupt survivorship, as suggested by some recent studies.

By enabling real time margin assessment in the operating room, we’re allowing surgeons to raise their confidence level that they are achieving clean margins the first time. To date, we’ve had multiple studies with more than 2,700 patients demonstrate that MarginProbe reduces re-excisions by 50 percent or more.”

About Dune Medical Devices

Dune Medical Devices offers surgeons the ability to identify clean margins in the operation room. Our primary technology is developed on a first-of-its-kind RF Spectroscopy platform that can differentiate cancerous from healthy tissue electromagnetic properties.

This approach can help achieve all three goals of Triple Aim by reducing the need for costly and unnecessary surgeries while improving health outcomes that reduce the emotional burden on both patients and families. For more information, contact