Saturday, March 31, 2007
Sunday, March 25, 2007
Saturday, March 24, 2007
Gynecologic Oncology : A cost–effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian
ScienceDirect - Gynecologic Oncology : A cost–effectiveness analysis of chemotherapy for patients with recurrent platinum-sensitive epithelial ovarian cancer:
"Conclusions.
Second-line chemotherapy is cost-effective for patients with platinum-sensitive recurrent EOC. Due to minimal improvements in overall survival, third- and fourth-line chemotherapy are not cost-effective strategies."
Genentech: Avastin - Full Prescribing Information
Genentech: Avastin - Full Prescribing Information
Sandi's note: increased attention needs to be paid to nasal perforations ( Respiratory: nasal septum perforation) in patient populations
JAMA -- Abstract: Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome: A Systematic Review
JAMA -- Abstract: Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome: A Systematic Review, September 27, 2006, Lindor et al. 296 (12): 1507
CLINICIAN'S CORNER
Recommendations for the Care of Individuals With an Inherited Predisposition to Lynch Syndrome
A Systematic Review
JAMA. 2006;296:1507-1517.
Context About 2% of all colorectal cancer occurs in the context of the autosomal dominantly inherited Lynch syndrome, which is due to mutations in mismatch repair genes. Potential risk-reducing interventions are recommended for individuals known to have these mutations.
Objectives To review cancer risks and data on screening efficacy in the context of Lynch syndrome (hereditary nonpolyposis colorectal cancer) and to provide recommendations for clinical management for affected families, based on available evidence and expert opinion.
Data Sources and Study Selection A systematic literature search using PubMed and the Cochrane Database of Systematic Reviews, reference list review of retrieved articles, manual searches of relevant articles, and direct communication with other researchers in the field. Search terms included hereditary non-polyposis colon cancer, Lynch syndrome, microsatellite instability, mismatch repair genes, and terms related to the biology of Lynch syndrome. Only peer-reviewed, full-text, English-language articles concerning human subjects published between January 1, 1996, and February 2006 were included. The US Preventive Services Task Force's 2-tier system was adapted to describe the quality of evidence and to assign strength to the recommendations for each guideline.
Evidence Synthesis The evidence supports colonoscopic surveillance for individuals with Lynch syndrome, although the optimal age at initiation and frequency of examinations is unresolved. Colonoscopy is recommended every 1 to 2 years starting at ages 20 to 25 years (age 30 years for those with MSH6 mutations), or 10 years younger than the youngest age of the person diagnosed in the family. While fully acknowledging absence of demonstrated efficacy, the following are also recommended annually: endometrial sampling and transvaginal ultrasound of the uterus and ovaries (ages 30-35 years); urinalysis with cytology (ages 25-35 years); history, examination, review of systems, education and genetic counseling regarding Lynch syndrome (age 21 years). Regular colonoscopy was favored for at-risk persons without colorectal neoplasia. For individuals who will undergo surgical resection of a colon cancer, subtotal colectomy is favored. Evidence supports the efficacy of prophylactic hysterectomy and oophorectomy.
Conclusions The past 10 years have seen major advances in the understanding of Lynch syndrome. Current recommendations regarding cancer screening and prevention require careful consultation between clinicians, clinical cancer genetic services, and well-informed patients.
Author Affiliations: Departments of Medical Genetics (Drs Lindor and Petersen) and Health Sciences Research (Dr Petersen), Mayo Clinic College of Medicine, Rochester, Minn; Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Mr Hadley); Department of Medicine and Huntsman Cancer Institute, University of Utah, and Veterans Affairs Medical Center, Salt Lake City (Dr Kinney); Medical Oncology, Maine Center for Cancer Medicine and Blood Disorders and Maine Medical Center, Portland (Dr Miesfeldt); Departments of Gynecologic Oncology (Dr Lu) and Gastrointestinal Medicine and Nutrition (Dr Lynch), M. D. Anderson Cancer Center, University of Texas, Houston; Department of Medical History and Ethics, University of Washington, Seattle (Dr Burke); and Schools of Nursing and Medicine, Oregon Health and Science University, Portland (Dr Press).
This Week in JAMA
JAMA. 2006;296:1437.
Prediction of MLH1 and MSH2 Mutations in Lynch Syndrome
Judith Balmaña, David H. Stockwell, Ewout W. Steyerberg, Elena M. Stoffel, Amie M. Deffenbaugh, Julia E. Reid, Brian Ward, Thomas Scholl, Brant Hendrickson, John Tazelaar, Lynn Anne Burbidge, and Sapna Syngal
JAMA. 2006;296:1469-1478.
Prediction of Germline Mutations and Cancer Risk in the Lynch Syndrome
Sining Chen, Wenyi Wang, Shing Lee, Khedoudja Nafa, Johanna Lee, Kathy Romans, Patrice Watson, Stephen B. Gruber, David Euhus, Kenneth W. Kinzler, Jeremy Jass, Steven Gallinger, Noralane M. Lindor, Graham Casey, Nathan Ellis, Francis M. Giardiello, Kenneth Offit, Giovanni Parmigiani, and for the Colon Cancer Family Registry
JAMA. 2006;296:1479-1487.
Predicting and Preventing Hereditary Colorectal Cancer
James M. Ford and Alice S. Whittemore
JAMA. 2006;296:1521-1523.
Colon Cancer
John L. Zeller, Cassio Lynm, and Richard M. Glass
JAMA. 2006;296:1552.
Friday, March 23, 2007
Thursday, March 22, 2007
Wednesday, March 21, 2007
Tuesday, March 20, 2007
Monday, March 19, 2007
March 2007 news item: What Couldn't Get Worse On the News Just Did
The Evening Bulletin - What Couldn't Get Worse On the News Just Did: "What Couldn't Get Worse On the News Just Did"
Saturday, March 17, 2007
this is not a singular issue - as reported in the Toronto Star: "The Unkindest Cut"
Here is what this particular article today (link at the end of this note)
does not say with respect to other gynecologists all working in my own
area in the past few years:
1) Centenary Hospital (Scarborough, Ontario) vs Armstrong: case before
the courts (I am not aware if the courts have made their final decision
on this one):
Hansard:
http://www.canlii.org/eliisa/simpleSearch.do?language=en&requestOrigin=requestSimpleOrAdvanced&defaultQuery=armstrong+vs+centenary&queryMethod=allQuery&Search=Search
http://www.canlii.org/on/cas/onca/2005/2005onca10427.html
Armstrong v. Centenary Health Centre
Citation : 2002 CanLII 42546 (ON S.C.) Date: December 20, 2002
Language: en
Ontario > Superior Court of Justice
Armstrong v. Centenary Health Centre
Citation : 2005 CanLII 20712 (ON C.A.) Date: June 13, 2005 Language: en
Ontario > Court of Appeal for Ontario
2) Whitby (Ontario) obstetrician-gynecologist Dr. Errol Wai-Ping
http://www.cbc.ca/fifth/donoharm.html
3) Dr. Richard Neale, a gynecologist and obstetrician, who worked in
Durham Region (Ajax/Pickering) and was prohibited from practicing in
Ontario before
he returned to England. (note: his licence was taken away while
practicing in England)
http://www.cmaj.ca/cgi/content/full/163/5/584-a
4) Toronto obstetrician and gynecologist Dr. Richard Austin
http://www.thestar.com/printArticle/193080
_*The unkindest cut TheStar.com - News - The unkindest cut*_
March 17, 2007
Tuesday, March 13, 2007
Saturday, March 10, 2007
2007 A new varian database for mismatch repair genes associated with Lynch Syndrome: Memorial University of Newfoundland - Faculty of Medicine
Memorial University of Newfoundland - Faculty of Medicine
Hum Mutat. 2007 Mar 8
A new variant database for mismatch repair genes associated with Lynch syndrome.
* Woods MO,
* Williams P,
* Careen A,
* Edwards L,
* Bartlett S,
* McLaughlin JR,
* Younghusband HB.
Discipline of Genetics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
Mutations in some mismatch repair (MMR) genes are associated with Lynch syndrome (LS; also called hereditary nonpolyposis colorectal cancer [HNPCC]), an autosomal dominant cancer susceptibility syndrome. Colorectal cancer (CRC) is the most frequent cancer observed in LS. However, tumors occur at a variety of extracolonic sites and individuals may have multiple primary cancers. LS is the most common hereditary form of CRC, accounting for approximately 1% of all CRC. Since the first account of mutations in MSH2 causing this cancer susceptibility syndrome in 1993, mutations in three additional MMR genes, MLH1, MSH6, and PMS2, have been shown to cause LS. More than 1,500 different variants have been identified in these four genes and approximately 80% of the alterations have been identified in MLH1 and MSH2. There have been a few previous attempts to systematically record MMR variants associated with LS patients; however, they were not complete nor were they continuously updated. Thus, it was our goal to generate and maintain a comprehensive catalogue of MMR variants from genes known to be mutated in LS (http://www.med.mun.ca/MMRvariants; last accessed 8 February 2007). Providing such a resource should aid investigators in understanding the significance of the variants. Hum Mutat 0, 1-5, 2007. (c) 2007 Wiley-Liss, Inc.
PMID: 17347989
Thursday, March 01, 2007
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