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Ellen Fearnley has over 20 years of experience in medical billing and collections. She earned an Associate of Science in Radiology from North Shore Community College and has experience billing for workers compensation claims at Seacoast Orthopedics & Sports Medicine, where she communicated with adjusters and followed up on payments and collections. Previously, she served as an Account Representative/Biller at Coastal Neurology Services, where she oversaw accounts, billing, and accounts receivable.
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Angela R. Johnson is seeking a position as a Medical Reimbursement/Billing or Office Manager. She has over 25 years of experience working in medical offices, most recently as Medical Office Manager for Greer Neurosurgery Clinic from 1987 to 2013. Her experience includes filing insurance claims, posting payments and charges, overseeing billing policies and procedures, supervising staff, and training in medical office assisting. She has proficiency in medical software applications and office software.
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Angela R. Johnson is seeking a position as a Medical Reimbursement/Billing or Office Manager. She has over 25 years of experience working in medical offices, most recently as Medical Office Manager for Greer Neurosurgery Clinic from 1987 to 2013. Her experience includes filing insurance claims, posting payments and charges, overseeing billing policies and procedures, supervising staff, and training in medical office assisting. She has proficiency in medical software applications and office software.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Ellen fearnley kbw (1)
- 1. ELLEN FEARNLEY EDUCATION: Associate of Science: Radiology North Shore Community College - Beverly, MA Professional Coders Course-2002 EXPERIENCE: Seacoast Orthopedics & Sports Medicine - Somersworth, NH 2001 - 2015 Medical Accounts Receivable with Billing and Collections of Workers Compensation Billing for Workers Compensation Communicated with adjustors on the compensability of the claim and whether the claim had been received for processing of payment or denial Posted payments and follow through in the collection process Acquired precertification of MRI's and surgical procedures Documented all communication from adjustors and patients In back up to the Precertification Department for surgical procedures of commercial insurances which included: o Verifying eligibility and deductibles of insurances o Checked that insurance referrals were in place o Entered referrals or called and obtained them o Called insurance companies for criteria of the procedure Coastal Neurology Services, Inc. 1993-2001 Account Representative/Biller In charge of all accounts Billing Accounts Receivable