Regarding Steven Petrow’s Oct. 26 column, “I took the new test that promises to screen for 50-plus cancers. Should you?”:
Petrow raised important questions about the promises and limitations of the Galleri test. Another question deserves attention: Could the DNA that helps detect cancer also affect the body’s immune response to it?
The Galleri test identifies cancer-associated methylation patterns, which are chemical markings on DNA fragments circulating in the blood. These patterns provide clues about the cells that released them. But could those fragments also act as biological signals?
Experimental studies that I co-authored with colleagues at Georgetown University Medical Center and collaborating institutions have found that selected methylated DNA sequences can promote regulatory T-cell responses under defined conditions. Such responses help restrain excessive inflammation, but in cancer they may impede the immune system’s ability to attack malignant cells.
The Galleri test was designed to detect cancer signals, not to measure their effects on immunity. These findings do not establish that tumor-derived DNA suppresses immunity, but they support a testable hypothesis: Certain methylation patterns on extracellular tumor DNA may influence host immune responses and, under particular conditions, help cancer cells evade the body’s immune defenses.
Alongside asking how accurately circulating DNA reveals cancer, researchers should investigate whether certain tumor-derived DNA fragments help tumors evade immune defenses and promote their growth or spread. If confirmed, this mechanism could reveal new treatment targets. Investigating the biological activity of the DNA detected by tests such as Galleri could therefore open a new avenue for cancer therapy — one aimed at restoring the immune system’s ability to combat malignant cells.
Joseph A. Bellanti, Washington
The writer is director of the International Center for Interdisciplinary Studies of Immunology at Georgetown University Medical Center.
Contributors to the health affordability crisis
The Oct. 27 news article “Charged hospital rates without a hospital visit” shined a light on a significant contributor to the health affordability crisis: As hospital systems get bigger and bigger, patients are paying the price through higher costs and facility fees.
Cancer patients already struggling with exorbitant costs shouldn’t have to pay more for the same chemotherapy treatment simply because a hospital has purchased their physician’s office.
Policymakers can and should put a stop to these unfair practices. At the federal level, the Centers for Medicare and Medicaid Services should build on recent efforts to advance site-neutral payment reform, requiring Medicare to pay similar amounts for the same service regardless of where it’s delivered.
Research by the actuarial firm Wakely that was commissioned by the nonprofit Blood Cancer United, where I work, found that site-neutral payments could save patients with multiple myeloma more than $1,200 a year.
It’s encouraging that states have enacted laws limiting facility fees, which New Mexico did earlier this year. More should follow suit, and all states should ensure those limitations apply both to physician offices that are not located at a hospital and to routine care, regardless of where it’s provided. States should also require providers to report facility fees to state officials so they can be better understood and regulated going forward.
Gwen L. Nichols, Washington
The writer, a hematologist-oncologist, is chief medical officer of the nonprofit Blood Cancer United.
Don’t blame the doctors
The Oct. 27 news article “Charged hospital rates without a hospital visit” presented an accurate and unflattering view of the billing practices of hospital-owned outpatient services.
I am a physician, and I work in a private practice that is independent of hospital systems or other corporate structures. On behalf of my colleagues who work in hospital-owned outpatient services, I’d like to make clear that those “doctors’ offices” are no more responsible for the charges than they are for the prices of prescription drugs. I know physicians are often blamed for these charges, but they are set by the hospital administrators who employ the doctors.
John Dooley, Arlington
Prisoners deserve accessible communication
Regarding the Oct. 28 online news article “FCC will vote on letting state prisons block calls from contraband cellphones”:
Preventing criminal activity is a legitimate public safety concern, but state and local correctional agencies should not restrict cellphones without first guaranteeing accessible and reliable alternatives, as that can create obstacles between those imprisoned and their families.
Authorized forms of communication for prisoners are costly and come with privacy concerns, as the article mentioned. Calls can cost between 8 and 18 cents per minute, and conversations can be monitored, recorded or archived. I know from personal experience that communication through traditional mail can be slow and vary by facility. For example, some facilities require postcards instead of letters, adding yet another expense for families trying to maintain relationships.
The federal government should share responsibility with state and local correctional agencies to help reduce financial barriers to communication if contraband cellphone calls are blocked. Public safety is not a good enough justification for making connection an expendable privilege.
Emily Rodriguez, San Jacinto, California
Letter submissions
Send letters to [email protected].
Submissions must be exclusive to The Post and should include the writer’s address and day and evening telephone numbers. Letters are subject to editing and abridgment. Please do not send letters as attachments. Because of the volume of material we receive, we are unable to acknowledge submissions; writers whose letters are under consideration for publication will be contacted.
The post I’ve studied cancer DNA. This test raises a new question. appeared first on Washington Post.
