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.

He’s not sure when the second-year starter will be healthy enough to be cleared to play. Allen was placed in the NFL’s concussion protocol after taking a helmet-to-helmet hit by Patriots defensive back Jonathan Jones in the opening minute of the fourth quarter of a 16-10 loss to New England on Sunday. Putting aside the three interceptions Allen threw, McDermott’s biggest question was why Jones wasn’t ejected. “There’s no room in football for that,” McDermott said. “I thought he should have been thrown out. But other than that, I’m not going to get into that. That’s for the league to get into.” The hit occurred when Allen scrambled out of the pocket and burst through a hole up the middle while facing third-and-8 at the New England 45. He gained 7 yards before Jones closed in on him, lowered his helmet and struck the quarterback in the crown of his helmet. Jones was flagged for a personal foul for unnecessary roughness. Allen lay on the field for several minutes before hopping up on his own. He was briefly evaluated on the sideline before being escorted up the tunnel. Allen was spotted in the locker room chatting with teammates following the game. NFL officiating chief Al Riveron told a pool reporter the decision to not eject Jones came because the hit did not rise to the level of the league standard for disqualification. “There was a foul called and obviously the penalty stood, but we did not feel this contact rose to that level,” Riveron said, who also noted Jones was turning his head just before hitting Allen. Bills safety Micah Hyde questioned the official’s judgment saying he or any of his teammates would have been ejected for a similar hit on New England’s Tom Brady. “That’s our quarterback. We ride or die with him,” Hyde said. “To see that happen, Josh didn’t slide, but at the end of the day it doesn’t matter if you’re a running back, you can’t head to the head.” Jones defended the hit saying it was never his intent to hurt Allen. “No malice or intent. Just a part of football,” Jones said. “We’re just running around playing football. I hope he’s OK. I’m going to check on him.” Allen finished going 13 of 28 for 153 yards, and scored on a 1-yard touchdown dive. Allen’s uncertain status leaves Buffalo with veteran backup Matt Barkley the only quarterback on the active roster in preparing to play at Tennessee next weekend. Buffalo then enters its bye week. The loss prevented Buffalo (3-1) from getting off to its first 4-0 start since 2008. Though the Bills defense held Brady in check, their offense was busy coughing up the ball at critical moments for the third time in four games. Allen threw three interceptions, two of which translated into a touchdown and a field goal. Punter Corey Bojorquez also had a punt blocked by J.C. Jackson, which led to Matthew Slater returning it 11 yards for a touchdown to put the Patriots up 13-0 in the first quarter. McDermott was unhappy with Allen’s continuing string of committing turnovers. He’s now thrown six interceptions and lost two fumbles in four starts this season. “He’s a young quarterback and sometimes they have to learn those lessons. Those are hard lessons and we have to continue to coach it up,” McDermott said. The game was decided on Buffalo’s fourth turnover with 1:27 left. Facing third-and-9 on the New England 39, Barkley was pressured by linebacker Kyle Van Noy, who got his hand on the quarterback’s chest. That forced Barkley to throw the ball up into the air, and have it easily picked off by Jamie Collins. The loss spoiled a stout effort by a Bills defense which limited the Patriots to just 11 first downs and 224 yards. Brady finished 18 of 39 for 150 yards and an interception. He was picked off by Hyde in the end zone on third-and-goal from the 2 in the second quarter. Brady’s 45.9 passer rating was the sixth lowest of his career and lowest since finishing with a 34 rating in a 27-20 loss to Indianapolis on Nov. 5, 2006. Barkley lamented how the Bills let the Patriots off the hook. “Especially with the way our defense played and where we had the ball at the end of the game, it’s tough,” Barkley said. “This is a tough one.” ___ More AP NFL: https://apnews.com/NFL and https://twitter.com/AP_NFL
Bills fall to Pats, and lose QB Josh Allen to head injury.

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

Cancer patients increasingly are having their care guided by gene tumor boards, a new version of the hospital panels that traditionally decided whether surgery, radiation or chemotherapy would be best. These experts study the patient’s cancer genes and match treatments to mutations that seem to drive the disease. “We dissect the patient’s tumor with what I call the molecular microscope,” said Dr. Razelle Kurzrock, who started a board at the University of California, San Diego, where Cairnes is treated. It’s the kind of care many experts say we should aim for — precision medicine, the right drug for the right person at the right time, guided by genes. There are success stories, but also some failures and many questions: Will gene-guided care improve survival? Does it save money or cost more? What kind of gene testing is best, and who should get it? “I think every patient needs it,” especially if cancer is advanced, said Kurzrock, who consults for some gene-medicine companies. “Most people don’t agree with me — yet. In five years, it may be malpractice not to do genomics.” Few people get precision medicine today, said Dr. Eric Topol, head of the Scripps Translational Science Institute. “The only thing that’s gone mainstream are the words.” HOW IT WORKS NOW If you have a cancer that might be susceptible to a gene-targeting drug, you may be tested for mutations in that gene, such as HER2 for breast cancer. Some breast or prostate cancer patients also might get a multi-gene test to gauge how aggressive treatment should be. Then most patients get usual guideline-based treatments. If there’s no clear choice, or if the disease has spread or comes back, doctors may suggest tumor profiling — comprehensive tests to see what mutations dominate. That’s traditionally been done from a tissue sample, but newer tests that detect tumor DNA in blood — liquid biopsies — are making profiling more common. The tests cost about $6,000 and many insurers consider them experimental and won’t pay. Gene tumor boards analyze what the results suggest about treatment. They focus on oddball cases like a breast cancer mutation in a colon cancer patient, or cancers that have widely spread and are genetically complex. The only options may be experimental drugs or “off-label” treatments — medicines approved for different situations. But as tumor profiling grows, it’s revealing how genetically diverse many tumors are, and that oddball cases are not so rare, said Dr. John Marshall. He heads the virtual tumor board at Georgetown Lombardi Comprehensive Cancer Center that also serves cancer centers in Pennsylvania, North Carolina, Michigan and Tennessee. “There is a little bit of faith” that testing will show the right treatment, but it’s not a sure thing, said Dr. Lee Schwartzberg, who heads one participating center, the West Cancer Center in Memphis. Dr. Len Lichtenfeld, the American Cancer Society’s deputy chief medical officer, is optimistic yet wary. Drugs that target BRAF mutations work well for skin cancers called melanomas, but less well for lung or colon cancers. “Just because a mutation occurs it doesn’t mean that drug is going to work in that cancer,” he said. LUCKY CASES When it does, results can be dramatic. Cairnes’ cancer was between her stomach and esophagus, and had spread to her liver, lungs and lymph nodes. Tissue testing found 10 abnormal genes, but on the liquid biopsy only EGFR popped out as a good target. Two drugs aim at that gene but aren’t approved for her type of cancer. A tumor board advised trying both — Erbitux and Tarceva, the drug her husband also had taken. Within two weeks, she quit using pain medicines. After two months, her liver tumor had shrunk roughly by half. There are signs that cancer may remain, but it is under control. She feels well enough to travel and to take care of her granddaughter. “I’m very, very grateful to have a targeted therapy,” Cairnes said. “I cannot expect a better outcome than what we’re seeing right now,” said her doctor, Shumei Kato. WHAT STUDIES SHOW But is gene-guided treatment better than usual care? French doctors did the first big test, with disappointing results. About 200 patients with advanced cancer were given whatever their doctors thought best or off-label drugs based on tumor profiling. Survival was similar — about two months. Another French study, reported in June, was slightly more encouraging on survival but exposed another problem: No drugs exist for many gene flaws. Tests found treatable mutations in half of the 2,000 participants and only 143 got what a tumor board suggested. Some doctors worry that tumor boards’ recommending off-label treatments diverts patients from research that would benefit all cancer patients. For example, the American Society of Clinical Oncology’s TAPUR study tests off-label drugs and shares results with their makers and federal regulators. LETTING PATIENTS CHOOSE Ann Meffert, who lives on a dairy farm in Waunakee, Wisconsin, endured multiple standard treatments that didn’t defeat her bile duct cancer. “She was going to be referred to hospice; there was not much we could do,” said Dr. Nataliya Uboha, who took the case to a tumor board at the University of Wisconsin-Madison. The panel gave several options, including off-label treatment, and Meffert chose a study that matches patients to gene-targeting therapies and started on an experimental one last October. “Two weeks in, I started feeling better,” she said, and when she saw test results, “I couldn’t believe the difference.” Many lung spots disappeared and the liver tumor shrank 75 percent. She is not cured, though, and doctors are thinking about next steps. And that could involve a fresh look at her tumor genes. ___ Marilynn Marchione can be followed at @MMarchioneAP __ This Associated Press series was produced in partnership with the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Ultra-personal therapy: Gene tumor boards guide cancer care.