Tuesday, March 31, 2009
Management of extracolonic tumours in patients with Lynch syndrome : The Lancet Oncology
Management of extracolonic tumours in patients with Lynch syndrome : The Lancet Oncology
The Lancet Oncology, Volume 10, Issue 4, Pages 400 - 408, April 2009
Summary
Hereditary nonpolyposis colorectal cancer, or Lynch syndrome, is responsible for 2—3% of all colorectal cancers. Lynch syndrome is also associated with a high risk of extracolonic cancers, including endometrial, stomach, small bowel, pancreas, biliary tract, ovary, urinary tract, brain, and skin cancer. In this Review, we discuss the risks, surveillance tests, and guidelines for the management of extracolonic tumours associated with Lynch syndrome. For all types of extracolonic cancer, evidence supporting surveillance is scarce. A benefit of surveillance is evident only for endometrial cancer, where transvaginal ultrasound and endometrial sampling detect tumours in early stages. Surveillance is generally recommended for urinary tract and gastric cancer, especially in families with more than one member with these types of cancer. For the other types of cancer, surveillance is typically not recommended. Prophylactic hysterectomy and bilateral salpingo-oophorectomy should be considered for women with Lynch syndrome who are past childbearing age, especially during surgery for colorectal cancer. No data show efficacy of chemopreventive drugs in reducing the risk of extracolonic cancers for patients with Lynch syndrome.
UK vs Canada: Accessing unfunded cancer drugs in publicly funded hospitals : The Lancet Oncology
Accessing unfunded cancer drugs in publicly funded hospitals : The Lancet Oncology
Providing life extending treatments to some, but not all patients on the same ward could be considered an insult to human dignity.
Editorial note (mine): must be considered
Monday, March 30, 2009
Big Cancer Bill Aims to Increase Biomarker Research and Use - U.S.
"ALERT (Act) also would have NCI report annually on its plans and progress regarding research on cancers with low incidence and survival rates, and would establish a grants program to conduct research on such cancers.
Among other measures, the act also would establish a grant program for the states that would fund colorectal cancer screening and referrals for medical treatment that is similar to the national breast and cervical cancer programs.
The bill also includes a number of measures and programs aimed at the issues surrounding patients and health insurance coverage, including a provision that would enable patients to continue to receive coverage for treatment while they are in clinical trials."
2009 Evidence Updates: Meat Intake and mortality: a prospective study of over a half a million people including commentaries
full free pdf file original article:
http://archinte.ama-assn.org/cgi/reprint/169/6/562.pdf
abstract + commentary:
http://plus.mcmaster.ca/EvidenceUpdates/HitParade.aspx?A=26486
Sunday, March 29, 2009
Early Cancer Detection Fizzles Again Newsweek article
How much less threatening are cancers detected early? Last November, scientists reported that about one quarter of breast cancers detected (early) on mammograms vanish spontaneously. Yet breast-cancer survivors swear early detection saved their life. Some melanomas, kidney cancers and neuroblastomas perform a similar vanishing act, says Kramer. Will doctors' enthusiasm and patients' demand for cancer screening diminish as a result of the science? After the PSA studies came out, a scientist told clinicians he assumed so. They looked at him as if he were crazy. No matter what science says, it will be a cold day in hell before patients let go of the one slender hope they feel they have to beat cancer.
Saturday, March 28, 2009
Cancer incidence in vegetarians: results from the European Prospective Investigation into Cancer and Nutrition (EPIC-Oxford) -- Key et al., 10.3945/ajcn.2009.26736M -- American Journal of Clinical Nut
"Conclusions: The overall cancer incidence rates of both the vegetarians and the nonvegetarians in this study are low compared with national rates. Within the study, the incidence of all cancers combined was lower among vegetarians than among meat eaters, but the incidence of colorectal cancer was higher in vegetarians than in meat eaters."
Friday, March 27, 2009
Knowledge about (Lynch Syndrome) hereditary nonpolyposis colorectal cancer; mutation carriers and physicians at equal levels
Two thirds of physicians and family members alike failed to recognize the increased risk of ovarian cancer in HNPCC
Conclusions
In summary, this study reveals weaknesses in HNPCC knowledge, particularly among physicians. By tradition, the medical perspective dominates and decides on relevant and evidence based interventions. When a majority of the physicians misinterpret hereditary mechanisms, underestimate the risk of cancer, and fail to recognize HNPCC associated tumor types the likelihood of misinformation is high. Physician behaviour may also influence patient adherence to surveillance programmes, and our findings strongly suggest that improved education in genetic medicine is needed for physicians responsible for diagnosis and management of the growing number of individuals at increased risk of cancer [31-33].
Thursday, March 26, 2009
AJG - Abstract of article: Incidence of Right-Sided Colorectal Cancer After Breast Cancer: A Population-Based Study (Manitoba)
note: right sided colorectal cancer specific
Microcystic stromal tumor of the ovary: report of 16 cases of a hitherto uncharacterized distinctive ovarian neoplasms
"These tumors, to date, have occurred over a wide age range in postpubertal females, are characteristically unilateral, and confined to the ovary at presentation. They represent, in addition to the sclerosing stromal tumor (segregated out 3 decades ago), a distinctive subtype of ovarian tumor, likely also belonging to the stromal category based on current evidence."
Wednesday, March 25, 2009
Ovarian cancers detected early may be less aggressive, questioning effectiveness of screening
For this study, researchers examined samples of advanced ovarian cancers from patients who had experienced long-term survival -- over seven years -- and patients who had done extremely poorly, and died within three years of diagnosis.
"We found that certain patterns predicted long-term survival and others predicted a poorer prognosis in advanced stage cases," Berchuck said. "Cancers that were detected at an early stage almost always shared gene expression characteristics with advanced stage cases that were long-term survivors, suggesting a shared favorable biology."
Tuesday, March 24, 2009
Medical News: JAMA Announces Gag Rule on Conflict-of-Interest Whistleblowers
CHICAGO, March 23 -- "Individuals who spot undisclosed conflicts of interest by authors published in the Journal of the American Medical Association are invited to inform the journal's editors -- but telling anyone else is forbidden under a new JAMA policy....."
Monday, March 23, 2009
WISE: Policies of Exclusion, Poverty & Health: Stories from the Front
"We will not give you statistics. We will not say how many of us are
students, retired, single mothers, living alone or living with a spouse,
working or on government assistance. We will say that we have all
those covered. We will not give our ages, since age is irrelevant to
who we are."
Sunday, March 22, 2009
Saturday, March 21, 2009
Quality of Care Review: Some Progress, and Toward What Goal? -- Chu (Correspondence JCO)
"However, patient and family involvement in the decision-making process has been peripheral."
Friday, March 20, 2009
Clinical Follow-up and Presence of Visceral Tumors in 12 Patients With Sebaceous Gland Tumors (Lynch Syndrome & Muir-Torre Syndrome & clear cell)
Excerpts:
Reports of MTS in families with hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch
syndrome,8 appeared for the first time in the 1980s. It was subsequently discovered that patients with MTS and HNPCC had the same genetic defect involving proteins responsible for DNA mismatch repair.9,10 It is now believed that MTS is a clinical form of HNPCC.11
Visceral malignancies in HNPCC typically affect the colon, but they can also be found in the endometrium, the ovary, the stomach, the small intestine, the ureter, the renal pelvis, and the brain.12 Other features of MTS include the presence of multiple tumors, early-age onset of tumors, and, in some cases, improved prognosis when tumors appear spontaneously.11
Nonetheless, it should be borne in mind that breast cancer and indeed other cancers described
in patients with MTS have not been definitively associated with HPNCC,25 meaning that their existence may, on occasions, be purely coincidental. Another group of authors proposed performing a computed tomography scan of the abdomen and pelvis every 2 to 5 years19 because 35% of abdominal tumors in MTS occur at sites other than the colon.27
Dermatologists play a key diagnostic role in MTS. Our findings suggest that some dermatologists underestimate the potential severity of sebaceous tumors, disregard the importance of family history of cancer, and fail to order additional studies to exclude visceral malignancies.
Thursday, March 19, 2009
OWHN - e-Bulletin - archives
Written for the Ontario Women's Health Network with special attention to this section:
IN YOUR OWN WORDS:
(Sandi Pniauskas - Editorial note: These stories are unedited and while some of the details are difficult to imagine, we recognize in each and every one the actual goodness, caring and strengths of the human spirit.)
survivours helping survivours: "I am alive today because of my guardian angel.
My angel {who is an ovarian cancer survivor herself with the courage to learn and lobby for what should be our GIVEN rights) saved my life by validating my condition and personally fighting the system on my behalf."
Alicia : Ovarian cancer for twenty-something "dummies"
Barb B : The first time I saw him I knew I would be in trouble (since died)
Barb L : Our Mom, Faith and Alternatives
Beth : A nurse and her guardian angels
Bonnie: I am a survivour (since died)
David: Heroism....from a husband and an admirer and the goodness within
Donna: Closer bonds: hats, hats and more hats
Heidi: Being adopted complicates the decision-making process
Irene: Written off due to age - Living alone - Supporting Others
Lynda: Same year x 2: Mom and Me
Noreen: Surviving breast cancer twice, ovarian cancer and no options (since died)
Penny: Single, taking charge, my dog and it must have been the rum (since died)
Phil: Married between chemo #3 and #4
Phase II Evaluation of Nanoparticle Albumin–Bound Paclitaxel in Platinum-Sensitive Patients With Recurrent Ovarian, Peritoneal, Fallopian Tube Cancer
Main inclusion criteria were histologically or cytologically confirmed epithelial cancer of the ovary, fallopian tube, or peritoneum (any stage, grade 2 to 3 if stage I) and measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST) or elevated CA-125 (> 70 U/mL) in patients without measurable disease.
Wednesday, March 18, 2009
Tuesday, March 17, 2009
Patient Destiny: One Patient, One Record (OPOR) Symposium
By invitation only - April 21, 2009 symposium (Toronto)
Yet, even though the patient group represents the fundamental foundation of the healthcare system, patients have seldom been viewed as more than a “by-product” or “side-effect”. To illustrate, patients are not typically involved in (i) setting healthcare policy; (ii) conducting and disseminating research; (iii) coordinating patient networks; (iv) providing or managing individual care; and (v) evaluating the performance and outcomes of varied healthcare delivery plans.
Editorial: Health Behaviors Influence Cancer Survival
To date, however, no trial has tested a multiple-component intervention that includes smoking cessation, diet, exercise, and possibly alcohol components
among individuals diagnosed with cancer.
Monday, March 16, 2009
Early Detection Remains Key in Updated NCCN Guidelines for Ovarian Cancer
Press release from NCCN conference
see also: http://www.nccn.org
Sunday, March 15, 2009
eMJA: The benefits of oestrogen following menopause: why hormone replacement therapy should be offered to postmenopausal women
Abstract
Recently, two major epidemiological studies found that hormone replacement therapy (HRT) in postmenopausal women increased the risk of breast cancer. One of the studies also found that HRT increased the risk of cardiovascular disease and thrombosis. As a consequence, women were advised to cease this therapy.
However, detailed analysis of these studies suggests that the conclusions may be erroneous. Other studies suggest that the timing of initiation of HRT for healthy women is critical to achieving a beneficial outcome.
When begun within 5 years of menopause in healthy women, oestrogen-based HRT results in far greater benefits than adverse outcomes.
There is substantial objective evidence that the benefits of HRT include:
Reduced distressing symptoms of menopause.
Reduced risk of osteoporotic fractures, dementia and colorectal cancer.
Improved wellbeing, quality of life; improved vaginal epithelium, sexual enjoyment and bladder capacity.
Improved cardiovascular system, with reduced myocardial ischaemia and cardiovascular-related death.
Increased longevity.
The adverse effects of HRT include:
Oral HRT doubles the risk of thromboembolism.
HRT promotes growth of pre-existing breast cancer.
Genetics in Medicine - Abstract: March 2009 The impact of patents on the development of genome-based clinical diagnostics: an analysis of case studies
2009 abstract: The impact of patents on the development of genome-based clinical diagnostics: an analysis of case studies.
Saturday, March 14, 2009
Genetics in Medicine - Abstract: Volume 10(9) September 2008 p 648-654 Economic methods for valuing the outcomes of genetic testing: beyond cost-effectiveness analysis.
Genetics in Medicine - Abstract: Volume 10(9) September 2008 p 648-654 Economic methods for valuing the outcomes of genetic testing: beyond cost-effectiveness analysis.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 3-14 The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) initiative: methods of the EGAPP Working Group.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 3-14 The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) initiative: methods of the EGAPP Working Group.
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 35-41 Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aime
Genetics in Medicine - Fulltext: Volume 11(1) January 2009 p 35-41 Recommendations from the EGAPP Working Group: genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch Syndrome in relatives
Genetics in Medicine - Abstract: Verification of consumers' experiences and perceptions of genetic discrimination and its impact on utilization of genetic testing
"Conclusion: These first cases of verified genetic discrimination make it essential for policies and guidelines to be developed and implemented to ensure appropriate use of genetic test results in insurance underwriting, to promote education and training in the financial industry, and to provide support for consumers and health professionals undertaking challenges of adverse decisions."
Cancer surveillance behaviors in women presenting presenting for clinical BRCA genetic susceptibility testing
"About 60% of participants engaged in at least the minimum recommended breast cancer surveillance behaviors, but 70% had suboptimal ovarian cancer surveillance behaviors. Lack of physician recommendation was the most frequently reported reason for not having surveillance procedures."
Friday, March 13, 2009
Treatments of epithelial ovarian cancer by histological subtype
note specific reference to clear cell ovarian cancer international trial
Cumulative lifetime incidence of extracolonic cancers in Lynch Syndrome: a eport of 121 families with proven mutations
Cumulative risk for females of an extracolonic tumour is 47.4% (95% CI 43.9-50.8). The risk to males is 26.5% (95% CI 22.6-30.4). There was no reduction in gynaecological malignancies due to gynaecological screening (examination, transvaginal ultrasound scan, hysteroscopy and endometrial biopsy).
Thursday, March 12, 2009
Wednesday, March 11, 2009
Medical News: SGO: Novel Drug Combination Shows Promise in Advanced Ovarian Cancer - in Meeting Coverage, SGO from MedPage Today
Oxaliplatin (Eloxatin), Docetaxel (Taxotere) and Bevacizumab (Avastin)
CBC news report: Tests may detect ovarian cancer sooner: study
Comment: spniauskas
Posted 2009/03/11
at 3:42 PM ET
Dr Jacobs published a randomised trial in the Lancet in 1999. This study was again specific to screening/early detection of ovarian cancer. In this study, now a decade old, 22,000 women enrolled. The abstract can be viewed at: http://www.ncbi.nlm.nih.gov/pubmed/10217079?holding=ukpmc
or: http://tinyurl.com/alo2st
Similar results were found in that of the 22,000 in the prior study (1998), 468 women had an elevated CA125 with 6 actual detections of malignancy. The current study indicates that of the 50,000 women screened with a CA125, 38 were found to have a malignancy. Without having read the full paper recently published, but relying on the abstracts, it would seem the 1999 and 2009 results do not differ in any appreciable way. The only question I might have would be in any technological advances in the ultrasounds which were used. There are several issues here which will and have always impacted decision-making specific to ovarian cancer. One is based on the fact that a public screening (meaning all women) of the CA125 will not be adopted, such as the PSA, because the cost are too high and the results are two low. Even the PSA test for public screening has been debated widely over the years. Assuming patients symptoms are acknowledged and there is a suspicion of ovarian cancer then nothing really has changed as it is the responsibility of the health care professional to order the appropriate tests. This brings us back to the same issues we have faced in ovarian cancer (forever) and that is recognizing the symptoms, however, complicated this may be. Lastly, Australia/UK today are using a test called the HE4 which, when added to the CA125, apparently improves detection of ovarian cancer. It would be most interesting for someone to compare the 2 Jacob trials.
IGF2BP3 (IMP3) Expression Is a Marker of Unfavorable Prognosis in Ovarian Carcinoma of Clear Cell Subtype
"The same prognostic significance is shown and validated here for ovarian clear cell carcinomas, but not other subtypes of ovarian carcinoma, suggesting a unique role of IGF2BP3 in these morphologically similar tumors."
Tuesday, March 10, 2009
AcademyHealth Issues: Consumer Choice
also: 2009 Robert Wood Johnson Foundation - Increasing consumer engagement
http://www.rwjf.org/qualityequality/af4q/focusareas/consumer.jsp
Monday, March 09, 2009
Management of women with clear cell endometrial cancer: a SGO review
"It shares many similarities with clear cell neoplasms of the ovary and kidney."
Saturday, March 07, 2009
Medical societies' recommendations for immunization with HPV and disclosure of conflicts of interest
"One of the Canadian documents did not include any conflict of interest statement, although Merck and GSK are listed among the sponsors.
CONCLUSIONS: Disclosure of conflicts of interest in documents where medical societies issue recommendations on HPV vaccination is very unusual. However, lack of disclosure is more frequent (near twice) when recommendations are in favour of the vaccination."
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA 1 or BRCA 2 gene
Breast and ovarian cancer risk perception after prophylactic salpingo-oophorectomy due to an inherited mutation in the BRCA1 or BRCA2 gene
note:in the absence of the full paper, a small study which confuses the issues/results by using actual numbers and then % results
Friday, March 06, 2009
Inequalities, patient safety, and waste : The Lancet Oncology
"Fragmented decision-making by government departments, agencies, and insurers, often working in isolation and without a common framework of objectives, is causing an increasingly unfair distribution of cancer services. In the current global recession, a root and branch re-evaluation of services, focused on patient-centred medicine rather than government or insurer-imposed medicine, would undoubtedly improve care for patients with cancer; reduce polarisation in accessibility; and possibly even shrink healthcare budgets."
Thursday, March 05, 2009
Genetic Risks: Should Physicians Inform Relatives?
Genetic Risks: Should Physicians Inform Relatives?
Do physicians have an obligation to disclose genetic-risk information to relatives, even without the consent of the patient?
Wednesday, March 04, 2009
Bodies and barriers : The Lancet Oncology - review
Bodies and barriers : The Lancet Oncology
"Take the preface to Whose Life is it Anyway? which informs us that “the hero's actions are an assertion of those contractual rights [between doctor and patient] viewed in terms of current philosophical arguments which hold that the dual principles of autonomy and contract keeping, conceptually linked, provide the sole moral foundation for clinical practice consistent with the social context in which the practice occurs”. I've read this sentence at least twelve times now, and I'm still no nearer to knowing what it means."
"Presented together, the plays form an intriguing whole, each focussed on a different aspect of medicine and mortality. “We are discussing life and death, and not in the abstract either”, explains Vivian Bearing.
They've done a fine job."
Tuesday, March 03, 2009
Cancer Cell - Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis - Sunitinib/SU11248
definition: orthotopic = in the normal position
Accelerated Metastasis after Short-Term Treatment with a Potent Inhibitor of Tumor Angiogenesis
John M.L. Ebos,Christina R. Lee,William Cruz-Munoz,Georg A. Bjarnason,James G. Christensen and Robert S. Kerbel1
Molecular and Cellular Biology Research, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 2M9, Canada
Sunnybrook Odette Cancer Centre, Toronto, ON M5G 2M9, Canada
Pfizer Global Research and Development, La Jolla Labs, La Jolla, CA 92121, USA
Summary
Herein we report that the VEGFR/PDGFR kinase inhibitor sunitinib/SU11248 can accelerate metastatic tumor growth and decrease overall survival in mice receiving short-term therapy in various metastasis assays, including after intravenous injection of tumor cells or after removal of primary orthotopically grown tumors. Acceleration of metastasis was also observed in mice receiving sunitinib prior to intravenous implantation of tumor cells, suggesting possible metastatic conditioning in multiple organs. Similar findings with additional VEGF receptor tyrosine kinase inhibitors implicate a class-specific effect for such agents. Importantly, these observations of metastatic acceleration were in contrast to the demonstrable antitumor benefits obtained when the same human breast cancer cells, as well as mouse or human melanoma cells, were grown orthotopically as primary tumors and subjected to identical sunitinib treatments.
Epithelial ovarian cancer: Does the time interval between primary surgery and postoperative chemotherapy have any prognostic importance?
Worldwide, much effort is used every day to perform optimal surgery in the treatment of epithelial ovarian cancer. Treatment of ovarian cancer is a combination of surgery with optimal debulking followed by chemotherapy. However, the optimal timing of postoperative chemotherapy for ovarian cancer remains poorly defined. The literature is made up of seven studies performed in different ways and which have included varying prognostic factors. The general supposition is that the time interval (TI) does not have a prognostic influence but experimental studies have shown that it does affect the prognosis of the cancer. This commentary focuses on the importance of the TI between surgery and postoperative chemotherapy in this horrible disease.
Steps and Time to Process Clinical Trials at the Cancer Therapy Evaluation Program
At least 296 distinct processes are required for phase III trial activation: at least 239 working steps, 52 major decision points, 20 processing loops, and 11 stopping points. Of the 195 trials activated during the January 1, 2000, to December 31, 2007, study period, a sample of 167 (85.6%) was used for gathering timing data. Median calendar days from initial formal concept submission to CTEP to trial activation by a cooperative group was 602 days (interquartile range, 454 to 861 days). This time has not significantly changed over the past 8 years. There is a high variation in the time required to activate a clinical trial.
Monday, March 02, 2009
Has pain management in cancer patients with bone metastases improved? A seven year review at an outpatient palliative radiotherapy clinic
Sunday, March 01, 2009
Selection Endometrial Carcinomas for DNA Mismatch Repair Protein IMHC Using Patient Age and Tumor Morphology Enhances Detection of MMR Abnormalities
- Am J Surg Pathol. 2009 Feb 20
- Women with hereditary nonpolyposis colorectal cancer (HNPCC) (Lynch Syndrome) have a high risk for endometrial cancer (EC) and frequently present with a gynecologic cancer as their first or sentinel malignancy. Identification of these patients is important given their personal and family risk for synchronous and metachronous tumors........... more frequent synchronous clear cell carcinomas of the ovary..........cont'd
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