No Survival Benefit With Mastectomy in Younger, High-Risk Breast Cancer

 Mastectomy did not significantly improve survival for younger women with high-risk locoregionally advanced breast cancer, even though the more aggressive surgery predominated in the age group, data from a prospective study showed.

From 2010-2022, 60% of women ages 45 or younger had mastectomy, which led to a non-significant difference in overall survival (HR 0.74, 95% CI 0.40-1.38). Women younger than age 40 at the time of surgery also did not have a survival benefit with mastectomy. Instead, tumor biology and response to systemic therapy were the only significant determinants of survival.

The findings challenge assumptions about need for mastectomy in younger women with high-risk early breast cancer, reported Jennifer Tseng, MD, of City of Hope Orange County in Irvine, California, at the American Society of Breast Surgeons meeting in Seattle.

"Extent of surgery did not make a difference in how long patients lived or stayed cancer free in their breast and surrounding tissue," Tseng said during a press briefing. "Histological grade and residual cancer burden [after systemic therapy] did make a difference in how long patients lived and their ability to stay cancer free in the breast and surrounding tissues. In other words, tumor biology and response to medical therapy make significant differences, but the choice of breast surgery does not."

"More research is needed to identify the appropriate treatment protocols for younger patients," she added. "Additionally, existing information may not be readily accessible to patients and the complete medical community involved in their care. For this population, in particular, communications and information sharing are powerful cancer care tools."

The study is good news for younger women who value breast preservation, particularly at a time in life "when this might be very important to them," said press briefing moderator Tina Hieken, MD, of the Mayo Clinic in Rochester, Minnesota. More granular data about patient and treatment characteristics in the published manuscript can help breast cancer specialists and patients interpret the findings within the context of current practice.

"It's really nice to see that we've developed some equipoise with advances in systemic therapies, perhaps to permit young women to preserve their breasts," said Hieken.

Historically, younger women with breast cancer have undergone mastectomy more often than older women. Multiple factors can influence choice of breast surgery, including the size of the tumor, a patient's concern about cancer recurrence, family history, and genetic predisposition.

"However, there is an unclear benefit of more extensive breast surgery in cancer treatment success, especially for patients who have neoadjuvant therapy," said Tseng. "This is important in that more extensive surgery can take a toll on women, including permanent loss of chest wall sensation, body image and self esteem issues, impacts on sexual well-being and arousal, mobility issues, and increased financial burden."

To compare outcomes after breast-conserving surgery (BCS) and mastectomy, Tseng and colleagues retrospectively reviewed data from the I-SPY2 clinical trial, an adaptive clinical trial platform designed to improve outcomes in breast cancer by evaluating new and novel neoadjuvant therapies. Data analysis included 1,737 patients who participated in I-SPY2 from April 2010 to June 2022. Women 45 or younger accounted for about 40% of the study population.

The two age-defined cohorts did not differ significantly by patient or tumor characteristics, including race/ethnicity, hormone receptor subtype, tumor/nodal characteristics, or histologic grade. Additionally, residual cancer burden (RCB) class distribution after neoadjuvant therapy did not differ between the groups.

Not unexpectedly, younger patients underwent mastectomy more often (63.2% of cases) as compared with women >45 (51.5%). Over time, however, the BCS rate increased in younger women, after accounting for fewer than 25% of cases in 2010. Extent of axillary surgery did not differ between younger and older patients (sentinel node biopsy 65.0% vs 65.4%, axillary lymph node dissection 35.0% vs 34.6%).

After a median of 5.4 years follow-up or time to death, 80 OS events had occurred in the ≤45 age group versus 120 in the older patients, as well as 58 locoregional relapse events in younger patients and 75 in the >45 group. A multivariable analysis showed no difference in OS (P=0.346) or locoregional relapse-free interval according to the type of surgery.

The only significant influences on OS were histologic grade (III vs I/II, HR 2.46, 95% CI 1.08-5.58, P=0.031) and RCB (increasing hazard with extent of RCB, P=0.003 to P<0.001).

"We know that choice of surgery in breast cancer is multifactorial, and this study supports that young age alone does not necessarily require mastectomy," said Tseng.

Primary Source

American Society of Breast Surgeons

Source Reference: Tseng J, et al "Surgical management of young women with high-risk breast cancer receiving neoadjuvant systemic therapy" ASBrS 2026.

https://www.medpagetoday.com/hematologyoncology/breastcancer/121092

'AP: What to Know About Hantavirus'

 A rodent-borne illness is suspected of causing an outbreak aboard a cruise ship that has killed three people and sickened others.

Studies indicate hantaviruses have been around for centuries, with outbreaks documented in Asia and Europe. In the Eastern Hemisphere, it has been linked with hemorrhagic fever and kidney failure. It wasn't until the early 1990s that a previously unknown group of hantaviruses emerged in the southwestern United States as the cause of an acute respiratory disease now known as hantavirus pulmonary syndrome.

The disease gained attention last year after late actor Gene Hackman's wife, Betsy Arakawa, died from a hantavirus infection in New Mexico.

The World Health Organization (WHO) said in a statement Sunday that detailed investigations of the cruise ship outbreak are ongoing, including further laboratory testing and epidemiological investigations. The virus is also being sequenced.

The Virus Is Spread by Rodents and More Rarely, People

Hantavirus is mainly spread by contact with rodents or their urine, saliva, or droppings, particularly when the material is disturbed and becomes airborne, posing a risk of inhalation. People are typically exposed to hantavirus around their homes, cabins, or sheds, especially when cleaning out enclosed spaces with little ventilation or exploring areas where there are mouse droppings.

The WHO says that while it rarely happens, hantaviruses can also spread directly between people.

The CDC began tracking the virus after a 1993 outbreak in the Four Corners region -- the area where Arizona, Colorado, New Mexico, and Utah meet.

It was an astute physician with the Indian Health Service who first noticed a pattern of deaths among young patients, said Michelle Harkins, MD, a pulmonologist with the University of New Mexico Health Sciences Center who for years has been studying the disease and helping patients.

Most U.S. cases are in Western states. New Mexico and Arizona are hot spots, Harkins said, likely because the odds are greater for mouse-human encounters in rural areas.

The Illness Starts With Flu-Like Symptoms

An infection can rapidly progress and become life-threatening. Experts say it can start with symptoms that include a fever, chills, muscle aches, and maybe a headache.

"Early in the illness, you really may not be able to tell the difference between hantavirus and having the flu," said Sonja Bartolome, MD, of UT Southwestern Medical Center in Dallas.

Symptoms of hantavirus pulmonary syndrome usually show between 1 to 8 weeks after contact with an infected rodent. As the infection progresses, patients might experience tightness in the chest, as the lungs fill with fluid.

The other syndrome caused by hantavirus -- hemorrhagic fever with renal syndrome -- usually develops within a week or 2 after exposure.

Death rates vary by which hantavirus causes the illness. Hantavirus pulmonary syndrome is fatal in about 35% of people infected, while the death rate for hemorrhagic fever with renal syndrome varies from 1% to 15% of patients, according to the CDC.

A Lot of Unknowns About the Illness and Treatment

There is no specific treatment or cure, but early medical attention can increase the chance of survival.

Despite years of research, Harkins said many questions have yet to be answered, including why it can be mild for some people and very severe for others and how antibodies are developed. She and other researchers have been following patients over long periods of time in hopes of finding a treatment.

There are "a lot of mysteries," she said, noting that what researchers do know is that rodent exposure is key.

The best way to avoid the germ is to minimize contact with rodents and their droppings. Use protective gloves and a bleach solution for cleaning up rodent droppings. Public health experts caution against sweeping or vacuuming which can cause virus particles to get into the air.

https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/121093

Summit shares descend as PD-1/VEGF asset misses early survival mark

 

Summit Therapeutics planned an early interim progression-free survival readout for HARMONi-3 in the hope of enabling earlier regulatory engagement—but the early analysis delivered disappointment for the company and shareholders.

Summit made a bold bet earlier this year that the China-developed anti-PD-1/VEGF bispecific antibody ivonescimab could head to regulators early based on interim survival data. That readout arrived last week, showing that the heavily anticipated cancer asset did not meet the mark.

Summit’s shares crashed in the aftermath of the announcement, closing Friday’s trading session nearly 26% down to $16.12 per share.

An independent data board reviewed progression-free survival (PFS) data from Summit’s ongoing Phase 3 HARMONi-3 trial in squamous non-small cell lung cancer (NSCLC) and “recommended that the study continue as planned,” Summit announced in a Thursday news release.

While this update sounds innocuous enough, it indicates that the efficacy of ivonescimab, the anti-PD-1/VEGF bispecific antibody being tested in HARMONi-3, failed to meet a statistical bar that would have enabled an earlier regulatory filing.

“The purpose of this interim analysis was to provide a potential opportunity to speak with the regulatory authorities” ahead of a planned engagement later this year, when more complete PFS data would be available, Summit said. The biotech conceded that for this earlier data assessment, ivonescimab needed to clear “a meaningfully higher bar” than it would have for a later analysis.

Summit remains on-track for a pre-planned final PFS readout in the second half of this year.

A lot is riding on HARMONi-3. The study is testing ivonescimab plus chemotherapy as a first-line regimen in patients with NSCLC, with separate cohorts for squamous and non-squamous tumors. What sets HARMONi-3 apart is its use of Merck’s mega-blockbuster Keytruda as a control, potentially positioning the bispecific antibody as the new cornerstone cancer therapy depending on how the data read out.

“Market optimism is building that a statistically significant PFS result could lead to accelerated FDA approval and begin to erode Merck’s dominance in first-line lung cancer,” analysts at RBC Capital Markets wrote in an April 17 note, referring to ivonescimab’s interim PFS analysis.

Ivonescimab was originally developed by Chinese biotech Akeso. The asset works by targeting both the PD-1 and VEGF pathways—deactivating the cancer cells’ immune evasion and preventing the formation of blood vessels that would otherwise keep the tumor supplied with oxygen and other nutrients.

The drug captured the industry’s attention in September 2024 when it outperformed Keytruda in a late-stage NSCLC study, eliciting significantly better PFS in the late-stage HARMONi-2 study, which was held in China. Additional data from the late-stage HARMONi-6 study, likewise conducted entirely in China, showed significant PFS superiority over BeOne’s Tevimbra, according to an October 2025 readout.

However, concerns began to arise about the future of ivonescimab after a missed overall survival goal in a global Phase 3 trial in May 2025, sparking questions over how effective it is in Western populations.

https://www.biospace.com/drug-development/summit-shares-descend-as-pd-1-vegf-asset-misses-early-survival-mark

UK receives report of vessel on fire

 The United Kingdom Maritime Trade Operations (UKMTO) announced on Monday that it received "information from a third party" that a vessel was on fire.

According to the service's social media post, the incident was reported 14 nautical miles west of Mina Saqr, a United Arab Emirates port located on the eastern coast of the Persian Gulf near the Strait of Hormuz. The UKMTO said that the vessel in question asked nearby ships to "keep a safe distance."

The UKMTO noted that the cause of the fire has not been determined. However, the announcement came after the UAE reported a new wave of drone and missile strikes from Iran.

https://breakingthenews.net/Article/UK-receives-report-of-vessel-on-fire/66211940

3 Dead, 149 Trapped Onboard: Track Cruise Ship With Suspected Deadly Virus Outbreak

 A luxury cruise ship carrying 149 passengers and crew is facing a suspected hantavirus outbreak that has already left three people dead. The vessel is currently anchored offshore near Cape Verde, the island nation in the central Atlantic off the west coast of Africa, as health officials rush to assess the scale of the outbreak.

The MV Hondius is currently anchored offshore near Praia, the capital and largest city of Cape Verde. Ship-tracking data show the vessel anchored just off the coast on Sunday after transiting from Argentina, with its prior voyage originating near the Antarctic Peninsula.

Track the virus-plagued ship.

Hondius's operator, Oceanwide Expeditions, told BBC News that a Dutch husband and wife, as well as a German national, had died but did not reveal the cause of death. However, the Dutch company said hantavirus was confirmed in a 69-year-old UK national who is in intensive care in Johannesburg, South Africa.

The main transmission risk of the deadly virus to humans is through infected rodent urine, droppings, saliva, or contaminated dust, especially in poorly ventilated areas. People can inhale contaminated particles when rodent waste is disturbed.

Oceanwide Expeditions confirmed two other crew members on board "with acute respiratory symptoms, one mild and one severe."

"It is not entirely uncommon for rodents to hitch a ride on a ship, which would be one possibility," Charlotte Hammer, assistant professor and infectious disease epidemiologist at the University of Cambridge, told the UK Science Media Center.

Hammer noted, "People having been infected when the ship last made port in Argentina is another possibility. The last possibility would be human-to- human transmission, which, particularly at scale, would be very unlikely."

Bloomberg quoted the World Health Organization, which is "facilitating coordination between member states and the ship's operators for medical evacuation of two symptomatic passengers, as well as a full public health risk assessment and support to the remaining passengers on board."

This is yet another reminder of why cruises are a terrible way to spend a holiday.

https://www.zerohedge.com/medical/track-cruise-ship-suspected-deadly-virus-outbreak-stuck-cape-verde

Pirates Of The Arabian

 By Stefan Koopman, senior macro strategist at Rabobank

“We landed on top of it. We took over the ship, the cargo, the oil. It’s a very profitable business… We’re like pirates.” President Trump’s remarks were, once again, strikingly blunt and unfiltered, to the point of sounding almost satirical. Yet the irony is real. The US president was openly acknowledging that American naval power in the Arabian Sea is now being used in ways that mirror the practices it was once built to suppress.

Negotiating with pirates is difficult. While this weekend’s headlines finally hint at diplomacy between the US and Iran, the gap between their positions appears wider than the Strait itself. Iran continues to cling to maximalist demands, while the US rejects them as unacceptable. For now, no credible outlines of a deal have emerged.

In the meantime, Washington is trying a different tactic. The US is encouraging neutral commercial vessels to run the blockade, putting Iran’s threats to the test. It has offered to help guide stranded ships through the Strait by sharing information on safer transit routes (e.g. no mines) and, potentially, insurance support. Although US navy vessels may operate nearby, this falls short of formal military escorts, which would likely violate the ceasefire. Even so, the approach carries obvious risks, as it could still result in exchanges of fire with Iranian ships, which might then lead to further escalation.

From Washington’s perspective, that risk is not entirely unwelcome. Any Iranian attack on neutral shipping would strengthen the US public‑relations case and might make it a bit easier to assemble the international coalition that has so far proven elusive.

If some energy does flow out of Hormuz, it will kick the can down further down the road. The deeper problem remains that both sides believe they have won. Washington points to the destruction of much of Iran’s navy and air force, its missile‑launching capacity, and large parts of its military and industrial base. Tehran draws a different conclusion. It has survived a campaign widely seen as aiming at regime collapse, it has demonstrated its ability to strike across the Gulf and into Israel, and it has shown it can place the global economy in a chokehold.

Even as its own economy suffers from the US blockade, Tehran appears convinced it can outlast the US economically and politically, especially as Trump moves closer to the midterm elections. At present neither side holds a strong card, yet both believe time is on its side. That might look like a manageable situation were it not for oil markets losing roughly 10 million barrels a day, with inventories now running uncomfortably low.

This leaves Trump facing a binary choice. He can pursue genuine diplomacy, concede parts of Iran’s demands, and secure outcomes he wants. That path would provoke resistance from Israel and hawks in Washington, but it would also be the fastest way to restore flows through Hormuz. Or he can resume the war, whether being provoked or not, betting that another bombing campaign will achieve what the first 40 days did not.

The problem is that coercion does not stop at Iran. Its oil may be seized, but buyers are punished too. The US Treasury has escalated sanctions by targeting major Chinese oil importers, most notably Hengli, a 400,000‑barrel‑a‑day refinery accused of purchasing billions of dollars of Iranian crude. Beijing pushed back. Its commerce ministry invoked the Blocking Statute, instructing firms not to comply with what it described as unjustified and improper US sanctions. This puts large companies between a rock and a hard place, because they either have to decide to comply with US sanctions or with the Chinese rules. That points at decoupling.

Pirates also have a habit of breaking deals. Over the past year European policymakers persuaded themselves that a durable bargain with this White House was possible. That belief produced the Turnberry deal, a one‑sided concession presented as a truce to stabilize Transatlantic trade. The logic was always questionable. And this weekend president Trump said he will raise its Section 232 tariffs on European car imports back to 25% from Turnberry’s 15%, underlining how little its own deals constrain it.

The Commission’s instinct may be to reopen talks, seeking a return to the lower rate through technical adjustments or promises of rapid implementation. That reaction is understandable, but it may also miss the point. The lesson of the Greenland episode is that this administration responds more to firmness than to appeasement. On paper, Europe has options too. It still holds a list of €93bn in retaliatory tariffs, suspended after Turnberry. It also has the Anti‑Coercion Instrument, the so‑called trade bazooka, which allows restrictions on US investment or the withdrawal of intellectual property protection. The tools exist, but the question ahead is whether Europe is willing to follow China’s lead?

US pressure on Europe, and Germany in particular, is not limited to trade. Days after a call between Trump and Putin, Washington said it would withdraw 5,000 troops from Germany, part of the 37,000 still stationed there. Russia would clearly welcome such a move, as would Iran. Trump appears to see these forces as deployed mainly to protect Germany. In reality, the bases exist to allow the US to project power into Europe, the Middle East, and Africa. Their removal would weaken America’s own strategic reach.

Berlin now faces the same choice as Brussels. One option is deference, flattering a protector in the hope of restraint despite mounting evidence that protection has become transactional and unreliable. The other is acceptance and acceleration, by folding this shock into Europe’s broader defense awakening and pushing faster towards genuine strategic autonomy.

https://www.zerohedge.com/markets/pirates-arabian

Colorblind Constitution: The Roberts Court Ends A 'Sordid Business'

 by Jonathan Turley,

The Supreme Court’s decision in Louisiana v. Callais, barring racial gerrymandering, has many on the left feigning vapors, despite the predictions of many of us that this result was likely.

While figures such as Rep. Jamie Raskin (D-Md.) declared that the court itself has been “gerrymandered” to rig the upcoming elections, this decision is actually the culmination of decades of jurisprudence by various justices — particularly Chief Justice John Roberts.

Indeed, the decision will cement the legacy of the Roberts Court in moving the country toward a colorblind system of laws.

Like most Americans, Roberts abhors racial discrimination in any form. He holds the quaint idea that when the drafters of the 14th Amendment barred discrimination on the basis of race, they meant it. This is why, in 2006, Roberts famously wrote, “It is a sordid business, this divvying us up by race.”

Roberts sees no difference between such discrimination when it disfavors one or another race. It is all a sordid business, and he has spent decades writing eloquent arguments for the court to abandon its conflicted and hypocritical approach to racial discrimination.

The court has struggled to rationalize using race to discriminate when it serves a higher purpose, such as greater equity or affirmative action. Some of those opinions were constitutionally incomprehensible.

For example, in 2003, in Grutter v. Bollinger, the court divided five to four on whether to uphold racial admissions criteria used to achieve “diversity” in a class at the University of Michigan Law School. However, in her opinion with the majority, Justice Sandra Day O’Connor stated that she “expects that 25 years from now, the use of racial preferences will no longer be necessary to further the interest approved today.”

Few of us could understand how O’Connor found a type of expiration date on permissible racial criteria in the Constitution.

Throughout that period, however, certain justices held firm that there is a bright-line rule against such racial criteria. That includes the author of the court’s Callais decision, Justice Samuel Alito, but also Roberts, who in 2007, put it succinctly: “The way to stop discriminating on the basis of race is to stop discriminating on the basis of race.”

One can certainly disagree with this interpretation and the low tolerance for racial criteria. However, this had nothing to do with the midterm elections. It is the result of dozens of opinions building up to this point.

From college admissions to gerrymandering, the court has created the bright line that figures like Roberts have long sought. In doing so, they have moved this country closer to a colorblind jurisprudence than at any time in our history.

The Biden administration was found repeatedly to have violated the Constitution through racial discrimination in federal programs. Democratic leaders have fought this trend and have pledged to reverse these decisions. Some even demand that Democrats pack the Court with a liberal majority as soon as they retake power.

Last year, the Supreme Court ruled unanimously in Ames v. Ohio Department of Youth Services that whites cannot be placed under additional burdens when bringing discrimination lawsuits.

Much of the coverage of the Callais decision is long on rhetoric and short on substance. The court did not “gut” the Voting Rights Act. It also did not strike down Section 2 of the act. Rather, the court held that neither the act nor the Constitution gives legislators authority to manipulate districts so as to effectively guarantee the race of the elected representatives — any race.

For decades, the courts have faced endless litigation over district configurations designed to elect minority representatives. It is a system that gave candidates an advantage based solely on their race. The court held that such racial gerrymandering is unlawful. The Voting Rights Act will now be read to prevent intentional racial discrimination. Courts will still bar any districts designed “to afford minority voters less opportunity because of their race.”

That does not mean that racial discrimination has been eliminated in our nation, or that we do not need to commit ourselves wholly to its eradication. The stain of slavery and segregation remains with us, as does the lingering scourge of racial prejudice. African Americans and other minorities still face invidious discrimination that cannot be tolerated in our system. We still have much work to be done.

In the area of voting rights, the courts have and will continue to strike down any rules designed to suppress or block minority voters.

Despite this ongoing struggle with racism, there are reasons to be hopeful.

As the Rev. Martin Luther King put it, “The arc of the moral universe is long, but it bends toward justice.” Non-whites are now powerful players in American politics. White voters are expected to be a minority in this country within two decades.

We have now elected a black president and a black vice president. Minority Leader Hakeem Jeffries (who declared the Court “illegitimate” after the Callais opinion) expects to be the next Speaker of the House of Representatives.

This progress was hard-fought, and both the Voting Rights Act and the Civil Rights Act played important roles in achieving greater racial diversity in our society.

And the Callais decision is also part of that progress. We are moving into a new era where racial criteria and discrimination are neither rationalized nor tolerated. There is now reason to hope that we will indeed end “this sordid business, this divvying us up by race.”

Jonathan Turley is a law professor and the New York Times best-selling author of “Rage and the Republic: The Unfinished Story of the American Revolution.“

https://www.zerohedge.com/political/colorblind-constitution-roberts-court-ends-sordid-business