Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.

The cost of hormone replacement therapy is not in question. Of the 34,433 HRT users, 193 were diagnosed with colon cancer during the study period; that compared with 151 cases among the 13,778 women who had never used hormone replacement. HRT — with either estrogen alone or a combination of estrogen and progestin — was linked to a lower colon cancer risk even when the researchers accounted for the women’s age, weight, exercise levels and race.
Hormone replacement tied to lower colon cancer risk

Clearly, the costs involved in cancer treatment already are high. By removing a layer of treatment from an estimated 40,000 patients, those costs would have to drop, but it is unclear from the story by how much. Also, it would have been worth mentioning whether this is likely to affect how insurance companies handle lymph node removals. The story did a good job providing some numbers on benefits, but we wish it had provided more and explained some things a bit more. It says, for example, “In 27 percent of the women who had additional nodes removed, those nodes were cancerous.” How many women had additional nodes removed and, of those, how many had cancerous nodes? A figure like 27% means 1 out of every 4 women had nodes that were, indeed, cancerous, which seems to conflict with other statements in the story about chemotherapy and radiation wiping out the cancer. The story discusses several harms from lymph node removal, and shows that the difference in survival for women who had nodes removed and those who did not was not significant. “Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.” This is where the story really outperformed some of the competition covering the same news. It placed the study into the broader context of a movement in cancer care away from surgeries that don’t provide a clear benefit, and it also explained the study design and the limitations of the study in several ways. “The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years. … One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact. It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.” It was too bad that it did not mention limitations in terms of lack of enrollment. The targeted enrollment was 1900. There also was an imbalance in the randomization that should have been mentioned. The story is careful to explain to readers that the research findings only apply to a subset of women with breast cancer. “Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.” The Q&A that ran with the story provided more detail about the different types of cancers and cancer patients, noting, for example, “First of all, 20 percent (the estimate of the study’s lead author, Dr. Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about 207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in the study, in terms of tumor status, affected lymph nodes and course of treatment.”  The story also says, “The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.” Good quotes including from Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, but also a few fromindependent experts toward the end. Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, provides some soul-searching context by saying that, in taking out so many lymph nodes, “I have a feeling we’ve been doing a lot of harm.” Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said, “It’s definitely practice-changing.” And Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said, “In the past, surgeons thought our role was to get out all the cancer. … Now he’s saying we don’t really have to do that.” The story does a great job explaining the history of this form of treatment and how it has evolved over time. “But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.” The story goes on to do something that stories like this rarely do, it compares compares the harms from different forms of treatment, saying “After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.” The story makes it clear that removing all under-arm lymph nodes is the standard of care for women with breast cancer and that feelings about that standard are entrenched. The story establishes that a change in treatment protocol away from removing all the lymph nodes under the arms of women with breast cancer would be novel. There is some nuance, here, though that could be missed by a casual reader. Women who have one to two positive lymph nodes would avoid having additional lymph node surgery. The overall tone of the story may make it appear to some readers that women get to avoid lymph node surgery altogether, but they don’t. The story goes well beyond any news release.
Lymph Node Study Shakes Pillar of Breast Cancer Care

"Distinguished legal minds of the U.S. Supreme Court will soon hear oral arguments over whether the federal government can compel businesses to cover contraceptives at no cost to women through the Affordable Care Act. It’s a serious issue. And Comedy Central’s The Daily Show is all over it. Correspondent Samantha Bee took viewers into the debate in a segment host Jon Stewart described as the rare intersection of health care, the economy, aging and penises -- ""the issues of greatest consequence to you, the American people."" Some conservatives and Catholics argue the contraceptives mandate violates the religious rights of business owners who would have to provide coverage for a medication they do not agree with, and that women who want it should get it on their own. Bee sat down with Ilyse Hogue, president of NARAL Pro-Choice America, a group that supports birth control and the morning-after pill being made available to everyone. Hogue said women use birth control for a number of reasons, including avoiding unintended pregnancies, regulating menstrual cycles and treating endometriosis. The contraception mandate addresses a disparity with the federal government paying for men’s sexual health treatments, she argued. ""The existing system is absolutely a double-standard,"" Hogue said. ""Medicare has spent $172 million on penis pumps in the last five years at $360 a pop."" Bee considered the information. ""Wait, Medicare funds penis pumps?"" Truth be told, we were curious too. Can Hogue’s numbers be right, or are they inflated? ""Vacuum erection systems"" (that’s a more technical term) are one of several ways a man might treat erectile dysfunction, which affects 30 million men, according to the National Kidney and Urologic Diseases Information Clearinghouse. We found an inspector general report from the Department of Health and Human Services detailing the issue. (A spokeswoman for NARAL Pro-Choice America later pointed us in the same direction.) The December 2013 report didn’t weigh in on whether it was inappropriate for Medicare to pay for penis pumps. The crux of the review was to find out if Medicare was paying exorbitant rates for them. The devices are among medical supplies eligible for Medicare Part B, which offers supplementary health insurance for medically necessary and preventive services for seniors. The cost of a device like a penis pump is subtracted from a beneficiary’s deductible, and Medicare picks up 80 percent of the cost after that. The auditors’ findings: Medicare payments for vacuum erection systems are more than twice the average payment rate for non-Medicare payers. The difference is ""grossly excessive,"" the report says. From 2006 to 2011, Medicare paid a total of $172.4 million for 473,629 claims for pumps, or about $364 a pump. That’s almost exactly what Hogue said (though spending was measured over a six-year period ending in 2011, not the last five, as she said). Over those six years, annual claims payouts almost doubled, jumping from $20.6 million in 2006 to $38.6 million in 2011, the report says. Medicare would save $18 million a year, and its beneficiaries would pocket $4.5 million, if the program retooled its fee schedule rate to be more in line with other programs and the private market. The report suggests the Centers for Medicare and Medicaid Services either establish a payment limit or to seek authority from Congress to include the products in its competitive bidding program. Our ruling Hogue said, ""Medicare has spent $172 million on penis pumps in the last five years at $360 a pop."" We’ll stay out of saying whether it’s legitimate for Medicare to cover vacuum erection systems for older men, and whether it’s unfair that many health plans would have to cover contraception. The Daily Show was trying to make a humorous point about tax money paying for some male sexual health products, which hasn’t been a source of controversy. As for Hogue’s statement, she gets the dollars right but misses on the timeframe. An inspector general’s report measured six years ending in 2011, not the most recent five years. That’s a minor point in judging her overall claim."

Medicare has spent $172 million on penis pumps in the last five years at $360 a pop.