Tuesday, June 30, 2009
Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2 : Abstract : Nature Genetics
Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2 : Abstract : Nature Genetics: "Newly discovered breast cancer susceptibility loci on 3p24 and 17q23.2"
Saturday, June 27, 2009
Women hear advances in breast/ovarian cancer research
"Dr. Joanne Jeter said it’s important to identify and manage genetic risk factors.
She said Hispanic women face a higher risk of breast cancer than the general population; Jewish women of Ashkenazi descent, those who have ancestors from Germany, Poland, Lithuania, Ukraine and Russia, have a higher incidence of specific mutations increasing the risk of developing breast and ovarian cancer."
Center for Genomics and Public Health - EGAPP - What is EGAPP?
What is EGAPP?
The Evaluation of Genomic Applications in Practice and Prevention (EGAPP) is a project launched in 2004 by the Centers for Disease Control and Prevention (CDC) to put selected genetic tests to the test. Hundreds of genetic tests, which could give information about susceptibility to major diseases such as cancer, diabetes and heart disease, are in development. It is important for the public health community that a reliable method, based on reliable scientific evidence, be found for evaluating these tests. The EGAPP project is a key step.
EGAPP follows in the footsteps of an earlier CDC-funded project, ACCE. The ACCE project took its name from four key components of test evaluation - analytic validity, clinical validity, clinical utility, and associated ethical, legal and social implications. Evaluating five genetic tests between 2000 and 2004, ACCE served as a model for investigating the availability and quality of data on the safety and effectiveness of all DNA-based genetic tests.
Building on the knowledge gained from the ACCE project and existing U.S. recommendations for action, CDC started the EGAPP project. The intent is to both objectively assess selected tests and also to begin developing a model process for assessing all genetic tests in the future. An independent, non-federal, multidisciplinary working group is the focus of EGAPP. This working group is comprised of 13 people from the U.S. with expertise in areas such as evidence-based review, clinical practice, public health, laboratory practice, genomics, and health technology assessment.
EGAPP focuses on the process of assessing new genetic tests for their safety and usefulness. Outcomes to be considered include benefits and harms to the patient and family, as well as societal and public health issues (e.g., availability or access to testing, and adequacy of consumer and provider education).
EGAPP is commissioning evidence-based reviews of selected tests that have the potential for broad application and health impact. Genetic tests selected for review include ones that predict response to therapy, detect susceptibility for a disease in family members, or predict risk of certain diseases in healthy populations. In late 2005 EGAPP began evaluating genetic tests related to depression, colorectal cancer, and ovarian cancer. Evaluations of more tests began in the summer of 2006.
All of the evidence-based reviews conducted for EGAPP will include assessments of available information on analytic and clinical validity, and the impact of testing and subsequent interventions or treatments. Evidence reports, published summaries of evidence, and published EGAPP working group recommendations are proposed products of EGAPP.
Evidence-based reviews, which involve the systematic assessment of all of the current published, relevant medical literature, can include clinical trials and other studies of interventions. EGAPP also will consider emerging tests with limited information, as a way to identify gaps in available data.
It is expected that the EGAPP working group will include not only assessments of certain tests, but also reports on its methodological approaches to evaluating the selected tests.
Friday, June 26, 2009
Thursday, June 25, 2009
CDC's Office of Public Health Genomics Recruiting Docs for Survey on EGAPP Plans | The Sample | GenomeWeb
CDC's Office of Public Health Genomics Recruiting Docs for Survey on EGAPP Plans
June 25, 2009
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By Kirell Lakhman
CDC's Office of Public Health Genomics today said it is recruiting "health care providers from multiple disciplines" — genetic counselors, general practitioners, oncologists, surgeons, pathologists, gastroenterologists, nurse practitioners, physicians’ assistants — "to participate in a health message survey for educational materials on the new EGAPP recommendations for Lynch Syndrome genetic testing.
The survey, to be conducted in July and August, will take about one hour to complete, OPHG says. Participants are asked to contact Sara Bedrosian.
The results should be interesting if there's any truth to what most medical societies, genetic test marketers, and individual physicians claim to be the average doc's knowledge of genetics: roughly none.
Wednesday, June 24, 2009
Cancer agency hires new doctor - news item - Darlene Gray and ovarian cancer survivours of Saskatchewan - way to go!!!
Cancer agency hires new doctor: "Currently the agency, the Ministry of Health, the Saskatoon and Regina Qu'Appelle health regions and the University of Saskatchewan college of medicine and advocacy groups are working collaboratively to put together a more comprehensive program for gynecologic oncology in Saskatchewan, Popkin said."
Technology assessment and resource allocation for predictive genetic testing: A study of the perspectives of Canadian genetic health care providers
Conclusions
Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate.
Tuesday, June 23, 2009
Sunday, June 21, 2009
Evidence and Values: Requirements for Public Reimbursement of Drugs for Rare Diseases - a Case Study in Oncology
Conclusion:
There should be a greater commitment by reimbursement agencies to a fair and transparent decisionmaking process with appropriate community input. Criteria should be developed to validate surrogate
markers for rare diseases. It should also be acknowledged that the traditional measures of benefit in
economic studies do not incorporate all elements of social value. The need should be recognized to balance equity with an efficient use of resources.
Measuring Response with FDG-PET: Methodological Aspects
Note reference to PET/CT; 1 small mention of ovarian cancer
Prognostic relevance of c-MYC gene amplification and polysomy for chromosome 8 in suboptimally-resected, advanced stage epithelial OC: GOG
"CONCLUSIONS: c-MYC amplification and polysomy 8 have limited predictive or prognostic value in suboptimally-resected, advanced stage EOC treated with platinum-based combination chemotherapy."
Saturday, June 20, 2009
Hereditary non-polyposis colorectal cancer or Lynch syndrome: the gynaecological perspective.
Dr Karen Lu, MDA, also noted the same risk results regarding Endometrial cancer in Lynch Syndrome women.
Avoidable waste in the production and reporting of research evidence : The Lancet
Within specific health problems there is little research on the extent to which questions addressed by researchers match questions of relevance to patients and clinicians. In an analysis of 334 studies, only nine compared researchers' priorities with those of patients or clinicians
Friday, June 19, 2009
Validation of serum biomarkers for detection of early-stage ovarian cancer
Prospective
analysis of the panel in clinical setting is
needed next to validate this panel of
biomarkers as an effective screening tool
for ovarian cancer.
A randomized trial in ovarian cancer (OC) of early treatment of relapse based on CA125 level alone versus delayed treatment based on conventional clinical indicators
This is the Rustin study which was widely debated when presented at ASCO - the one key word in the conclusion (based on the abstract) is: "alone"
Thursday, June 18, 2009
OCATS press release: June 18, 2009 Ovarian/Gyn Cancer Patient Advocates in Saskatchewan
REGINA, June 18, 2009 – Today OCATS learned that Dr. Maryam Al-Hayki, Gynecologic Oncologist for southern Sask has been contracted to provide gynecologic cancer care services for the women of Southern Saskatchewan, including chemotherapy. Many details are yet to be determined and the group of gynecologic cancer patients look forward to hearing more from the Minister of Health Don McMorris. The Ministry, SaskHealth, Sask Cancer Agency and the Health Regions all working towards the implementation of a proper Gynecologic Oncology Program for Saskatchewan, with a Unit each in Regina and Saskatoon, and now with this contract; we hope that all four of Saskatchewan’s gynecologic cancer specialists will be retained for a long time to come. With this progress it is also hopeful that additional gynecologic oncologists can be recruited.
A long time request of the OCATS group to meet with the Minister of Health, Don McMorris has now been scheduled for Monday, June 29th at 11:00 a.m. A Director of OCATS, Darlene Gray said, “we are so relieved to hear that a contract has been extended to Dr. Al-Hayki and we hope it is a contract that will keep her here for a long time. Hopefully, this will result in immediate oncologist availability for patients of all cancers. Patients also need to be assured that a proper gyne oncology program is established to ensure the retention of both Dr. Al-Hayki and Dr. Brydon in Regina and the two specialists in Saskatoon. We are pleased but still have many questions.”
The OCATS group expects to hear more at a meeting with all the stakeholders including SaskHealth, Sask Cancer Agency, the health regions and the women’s cancer specialists this coming week as soon as all the participants can meet. Ms. Gray said, “We are very much appreciative of this opportunity to hear about the program in full and also to provide our input, since all we have right now is a theory. Women need to know that all the resources and funding will be in place to ensure the gynecologic oncology Units in Regina and Saskatoon will have all specialists, support staff, technical and diagnostic testing and tools are in place. We hope to see a plan for trained or a training program for technicians to run the new ultrasounds, pathology and educational instruments and programs required for a true gynecologic oncology program.”
Darlene was clear in stating that, “This has been a stressful time for the volunteers in our group and a very worrisome time for patients needing chemotherapy and other treatment, as it has been for the doctors and administrators. We are relieved, happy and a bit shell shocked. It’s comforting, for all I’m sure, to know that the specialists can go back to the business of treating patients. We want to thank the Ministry and all the bureaucracies involved for doing the right thing for women in Saskatchewan, current and future patients. We feel that once the administrators understood how urgent and critical the gynecologic cancer situation in Saskatchewan was, everyone moved very quickly to put a solution together. We hope to make our gratitude known at these upcoming meetings. Still, we feel that a patient’s experience must be included in the process and we look forward to providing that to the Minister of Health personally on June 29th, and to the team in the upcoming week. This is a wonderful beginning.”
For more information contact Darlene Gray in Regina at 306-775-1848, cell 529-3199 or in Fort San at 306-332-3957, or darlenegray@sasktel.net
Wednesday, June 17, 2009
Hormone Replacement Therapy: Real Concerns and False Alarms : The Cancer Journal
Hormone Replacement Therapy: Real Concerns and False Alarms : The Cancer Journal: "Hormone Replacement Therapy: Real Concerns and False Alarms"
Tuesday, June 16, 2009
Effect of Surgeon Training, Specialization and Experience on Outcomes for Cancer Surgery-a Systematic Review of the Literature
"RESULTS:
The 29 articles that met the inclusion criteria examined
nine different types of cancers including colorectal, ovarian,
melanoma, breast, bladder, lung, esophageal, gastric,
and hepatocellular.12–36 Fifteen different physician specialties
were assessed, including colorectal surgery,
transplant surgery, vascular surgery, dermatology, general
practitioners, plastic surgery, surgical oncology, hepatopancreaticobiliary,
urology, urologic oncology, thoracic
surgery, cardiothoracic surgery, obstetrics and gynecology,
gynecologic oncology, and general surgery. Four articles
examined outcomes based on the surgeon’s years of
experience. The main outcome measures assessed were
perioperative morbidity, mortality, recurrence, and longterm
survival. Characteristics and results of each study are
summarized in Table 1."
AJCC Cancer Staging Manual/Handbook Nov 2009 ($$)
"The AJCC Cancer Staging Manual and Handbook, prepared by the American Joint Committee on Cancer, are used throughout the world to facilitate the uniform description of neoplastic diseases.
The fully revised and updated 7th Edition is uniform between the AJCC and UICC and brings together all currently available information on staging of cancer at various anatomic sites and incorporates newly acquired knowledge on the etiology and pathology of cancer."
AJCC Cancer Staging Manual
http://www.springer.com/medicine/surgery/book/978-0-387-88440-0?cm_mmc=AD-_-Enews-_-CLM11050_V1-_-0
AJCC Cancer Staging Handbook
http://www.springer.com/medicine/surgery/book/978-0-387-88442-4?cm_mmc=AD-_-Enews-_-CLM11050_V1-_-0
Monday, June 15, 2009
Cancer Genome Sequencing--An Interim Analysis
Most significantly, however, the cancer genome sequencing strategy, as currently applied, fails to characterize the most relevant genomic features of cancer—the mutational heterogeneity within individual tumors.
Saturday, June 13, 2009
Friday, June 12, 2009
Thursday, June 11, 2009
Lung Cancer Risks Rise With Nanoparticles, Lung Cancer
Editorial comment (mine):
I had written concerning this issue before, but new info/repeat for newer members. Some years ago, I had spoken with a well known researcher while discussing family histories of ovarian cancer because in a small non-scientific study we had done, it seemed certain cancers were very prevelant and outside of what might be considered the norm. Lung cancer was one. The researcher at the time said that they believed there is was/is a genetic component between ovarian and lung cancer, aside from both being epithelial (the lining of an organ) cancers. It seems, although not specific, this article is starting to document these concerns/advances. Anyway, a FYI, but mostly it is because over years I have witnessed lung cancer patients being ostracized not only by the public by others. I hope some now take a reflective look when judging those most in need. Anyway, a bit off topic but I think it important not only for cancer communities but for all.
....................................................................................
http://www.emaxhealth.com/1075/99/31666/lung-cancer-risks-rise-nanoparticles.html
> More recent studies point to the cause of lung cancer as possibly genetic. While researchers insist environmental factors, such as smoking, asbestos exposure, etc., play a role in the development of the disease, there is growing evidence that the answer to the question is at the gene level.
Lung Cancer Risks Rise With Nanoparticles, Lung Cancer: "More recent studies point to the cause of lung cancer as possibly genetic. While researchers insist environmental factors, such as smoking, asbestos exposure, etc., play a role in the development of the disease, there is growing evidence that the answer to the question is at the gene level."
abstract: Palliative care in gyn oncology
Article Outline
Introduction
Pain relief
Nausea and vomiting
Constipation
Bowel obstruction
Recurrent ascites
Genital fistulas
Bleeding
Psychosocial issues
Conclusion
Further Reading
Sanofi-aventis Regeneron Announce Results from Phase 2 Study with Aflibercept (VEGF Trap) in Advanced Ovarian Cancer Patients with Recurrent Symptomatic Malignant Ascites
"The results of this Phase 2, placebo-controlled study demonstrate that aflibercept is a clinically active agent in patients with advanced ovarian cancer with symptomatic malignant ascites. However, given the small number of patients enrolled in this study and the fragile health status of these advanced ovarian cancer patients, who had a median survival of only about three to four months, it is difficult to definitively assess the overall clinical benefit that might be derived from treatment in the real-world clinical practice setting," stated George D. Yancopoulos, M.D., Ph.D., President of Regeneron Research Laboratories. "Therefore, we and sanofi-aventis have decided not to submit these Phase 2 data for accelerated approval in symptomatic malignant ascites.
We will focus our efforts on completing the current Phase 3 program which combines aflibercept with standard chemotherapy regimens for the treatment of earlier stage metastatic colorectal, non-small cell lung, pancreatic, and prostate cancers, which should begin delivering data in 2010."
Clear cell carcinoma compared to serous carcinoma in early ovarian cancer: same prognosis in a large randomized trial.
Title: Clear cell carcinoma compared to serous carcinoma in early ovarian cancer: same prognosis in a large randomized trial.
Author: Timmers PJ; Zwinderman AH; Teodorovic I; Vergote I; Trimbos JB
Journal: Int J Gynecol Cancer; 2009 Jan; 19(1):88-93. PubMed ID: 19258948
Abstract:
BACKGROUND: An analysis was performed comparing survival of patients with clear cell carcinoma (CCC) to patients with serous adenocarcinoma (SAC) in early ovarian cancer. Furthermore, a literature search was done to clarify the clinical and histopathological features of clear cell tumors of the ovary. METHODS: Between November 1990 and March 2000, 448 patients with ovarian cancer International Federation of Gynecology and Obstetrics stages I to IIa were enrolled in the European Organisation for Research and Treatment of Cancer-Adjuvant Chemotherapy in Ovarian Neoplasm Trial, a randomized study comparing adjuvant platinum-based chemotherapy to observation after surgical treatment in patients with early ovarian cancer. RESULTS: Sixty-three patients (14.1%) with CCC were compared with 156 patients (34.8%) with serous tumors. A significant difference was found in the International Federation of Gynecology and Obstetrics stage Ic with capsule rupture, 28 (44.4%) of 63 patients with CCC and 29 (18.6%) of 156 patients with SAC
Found: One in Three Billion : BC Cancer Agency The spelling mistake in the genetic code that causes a type of Ovarian Cancer
06/10: Found: One in Three Billion : BC Cancer Agency: "The spelling mistake in the genetic code that causes a type of Ovarian Cancer"
Wednesday, June 10, 2009
Tuesday, June 09, 2009
Raitt wanted credit for fixing 'sexy' isotope crisis: tape
Raitt wanted credit for fixing 'sexy' isotope crisis: tape: "sandipn, 09:09 AM EDT � Tuesday, June 9th, 2009
"What I think cannot be published. Cancer Survivor"
the key point: Making trials matter: pragmatic and explanatory trials and the problem of applicability
"....Readers need to know ‘who, what, when and where’...."
Monday, June 08, 2009
Sunday, June 07, 2009
Saturday, June 06, 2009
Friday, June 05, 2009
The Director's Notes for June 4, 2009 - National Cancer Institute
The Director's Notes for June 4, 2009 - National Cancer Institute: "Last Monday, I met with a new coalition of advocacy organizations concerned with a group of cancers - brain, esophagus, liver, lung, myeloma, pancreas, ovarian, and stomach - each with a survival rate of less than 50 percent. Representing 20 different organizations, the group presented data showing that 276,040 deaths (49.1 percent of the cancer deaths predicted in 2009) will come from those eight forms of cancer. The advocates are concerned that those same cancers only account for approximately 18 percent of the NCI funded research portfolio, and they seek a greater emphasis on these cancers........."
Thursday, June 04, 2009
Facebook | Ovarian Cancer Awareness & Treament in Saskatchewan (OCATS)
Facebook | Ovarian Cancer Awareness & Treament in Saskatchewan (OCATS)
June 2nd, 2009
OCATS has just become OCATS Inc., a non-profit organization in Sask. We are just this week applying for status as a charitable organization with the federal government. You could really help us out by becoming a formal member, this requires only a $10 fee and the complete an application which I can only send you by email or snail mail. Please consider helping us this way - not only would it help with our expenses but would also help us widen our base so we can raise awareness with a greater number of people. Thank you for your consideration.
Darlene, darlenegray@sasktel.net
Prospective study of physical activity and the risk of ovarian cancer
Conclusions Neither moderate nor vigorous physical activity showed a statistically significant association with ovarian cancer in this large cohort of women.
Clinical Care Options Oncology - 2009 American Society of Clinical Oncology Annual Meeting audio - re: CA125 Dr Thigpen
J. Tate Thigpen, MD, discusses important findings in ovarian cancer, including findings from the CALYPSO trial, outcomes of a study evaluating delayed or early treatment of patients with rising CA-125, and findings from a phase III trial of gemcitabine plus cisplatin and radiation in cervical cancer patients. (7 minutes)
Wednesday, June 03, 2009
NEJM -- A Strategy for Health Care Reform -- Toward a Value-Based System
NEJM -- A Strategy for Health Care Reform -- Toward a Value-Based System: "strategy centered on value. This undertaking is complex, but the only real solution is to align everyone in the system around a common goal: doing what's right for patients."
Dr Maurie Markman's comments: re: CA125/survival ASCO....
Cancerwise | A blog featuring Cancer News and Insights from M. D. Anderson
Surveillance of CA-125 in Women With Advanced Ovarian Cancer
By Cancerwise Blogger on June 2, 2009 9:34 AM
By Maurie Markman, M.D., Vice President for Clinical Research, from ASCO 2009
The abstract from Rustin, et al, dealing with the clinical utility of routine surveillance of CA-125 in women with advanced ovarian cancer who attain a complete clinical remission following cytotoxic chemotherapy has the potential to change the standard management paradigm in this clinical setting.
This well-designed and conducted Phase III randomized trial revealed that patients who initiated treatment for recurrent disease solely based on an elevated CA-125 antigen (in the complete absence of any signs or symptoms of cancer) did not experience superior survival compared to women who experienced recurrence but whose therapy was started due to other manifestations of the malignancy (for example, a return of abdominal symptoms).
However, it is critically important to recognize what this study does not state.
First, there is no statement that patients treated in this trial failed to experience benefit from the treatment of recurrence, but only that it was possible to delay reintroduction of treatment until symptoms developed.
Second, there is no statement that CA-125 should be avoided in a patient who experiences symptoms. In fact, in this setting, a serum CA-125 level can be particularly helpful since symptoms of recurrent ovarian cancer can be quite non-specific. In a woman who has previously undergone a major abdominal surgical procedure, interference with bowel function (often due to adhesions) can appear to be due to progressive cancer when in reality the discomfort is secondary to the effects of the previous surgery.
The finding of a normal CA-125 antigen level in this situation can be helpful, while an elevated value would likely lead to future investigation (e.g., abdominal/pelvic CT scan) and possible re-introduction of anti-neoplastic treatment.
Adaptive Therapy -- reference to Carboplatin
Major Findings:
We present mathematical analysis of the evolutionary dynamics of tumor populations with and without therapy. Analytic solutions and numerical simulations show that, with pretreatment, therapy-resistant cancer subpopulations are present due to phenotypic or microenvironmental factors; maximum dose density chemotherapy hastens rapid expansion of resistant populations. The models predict that host survival can be maximized if "treatment-for-cure strategy" is replaced by "treatment-for-stability." Specifically, the models predict that an optimal treatment strategy will modulate therapy to maintain a stable population of chemosensitive cells that can, in turn, suppress the growth of resistant populations under normal tumor conditions (i.e., when therapy-induced toxicity is absent). In vivo experiments using OVCAR xenografts treated with carboplatin show that adaptive therapy is feasible and, in this system, can produce long-term survival.
Tuesday, June 02, 2009
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