CDC report: Genomics|Genetic Testing|EGAPP Recommendations|Lynch Syndrome

Centers for Disease Control and Prevention (U.S.)

April 2010: Genomics|Genetic Testing|EGAPP Recommendations|Lynch Syndrome

EGAPP Working Group Recommendation

Genetic testing strategies in newly diagnosed individuals with colorectal cancer aimed at reducing morbidity and mortality from Lynch syndrome in relatives
Approximately 3% of people who develop colorectal cancer have an autosomal dominant inherited condition known as Lynch syndrome, sometimes referred to as Hereditary Nonpolyposis Colorectal Cancer or HNPCC. Individuals with this condition have a greatly increased chance to develop colorectal and other cancers, especially under age 50. Screening for Lynch syndrome in all patients with newly diagnosed colorectal cancer has been proposed to improve outcomes for patients and/or family members.
EGAPP Recommendation Statement: The EGAPP™ Working Group found sufficient evidence to recommend offering genetic testing for Lynch syndrome to individuals with newly diagnosed colorectal cancer (CRC) to reduce morbidity and mortality in relatives. We found insufficient evidence to recommend a specific genetic testing strategy among the several examined.

Note:  See website for access to the pdf files below (full free access):

• EGAPP Recommendation  (PDF 220KB) (Jan 2009)

• Evidence Report (May 2007)

• Supplementary Evidence Report (PDF 664KB) (Jan 2009)

• CDC Summary of Lynch Syndrome EGAPP Recommendation (Apr 2010)

Abstract/full free access: Evolution and cancer: a mathematical biology approach

"This thematic series is concerned with various ways Evolution is intertwined with cancer. A group of cancer researchers and mathematical modelers, with an interest in the subject, was invited to contribute papers on topics ranging from carcinogenesis through progression of cancer through therapy." ....cont'd

U.S. Consumer Representatives Needed for FDA Advisory Committees: Learn More at Public Meeting

Healthcare Events UK (London): Patient Involvement and Empowerment May 2010

Combination versus sequential cytotoxic chemotherapy in recurrent ovarian cancer: Time for an evidence-based comparison

Note: no abstract/subscriber based journal ($$)
Combination versus sequential cytotoxic chemotherapy in recurrent ovarian cancer: Time for an evidence-based comparison.
Markman M

Webcast/CME - Institute for Continuing Healthcare Education - Ovarian Cancer Screening and Management to Improve Patient Survival Apr 16, 2010

Webast/CME
OVERVIEW
Ovarian cancer is the leading cause of death from gynecologic malignancy and the fifth leading cause of cancer‐related death among women in the United States. The high mortality rate associated with ovarian cancer is due in part to the lack of effective screening strategies to detect the disease in early stages (I or II) when the cancer is confined to the ovary. Since symptoms associated with ovarian cancer are typically nonspecific, a clinical diagnosis is difficult to make until the disease has advanced. The Institute for Continuing Healthcare Education has identified a number of areas related to the screening, diagnosis, and treatment of ovarian cancer where education is vital in order to address the need for improvement in professional care.

SGO: Change in Antigen Predicts Ovarian Cancer Outcomes - in Meeting Coverage early stage ovarian cancer

"The Gynecologic Oncology Group (GOG) 157 trial provided an opportunity to examine the change in CA-125 and its relationship to outcomes in women with early-stage ovarian cancer. The trial involved 427 women with stage I-II epithelial ovarian cancer. They were randomized to receive three or six cycles of chemotherapy with carboplatin and paclitaxel.
All patients had detailed surgical staging before randomization. Chan said detailed information about CA-125 levels was available for 350 participants in the trial."

"There is a lack of data in early-stage ovarian cancer on the pattern of CA-125," said Chan. "Previous studies generally had no comprehensive staging and no central pathology review."
"An elevated level that declined to normal after the first cycle of chemotherapy was associated with recurrence-free and overall survival of 87% and 88%, respectively.
Patients with an elevated CA-125 before and after the first cycle of chemotherapy had recurrence-free survival of 68% and overall survival of 77%."

abstract: New technologies for the detection of circulating tumour cells.

"The vast majority of cancer-related death is due to the metastatic spread of the primary tumour. Circulating tumour cells (CTC) are essential for establishing metastasis and their detection has long been considered as a possible tool to assess the aggressiveness of a given tumour and its potential of subsequent growth at distant organs.
Conventional markers are not reliable in detecting occult metastasis and, for example, fail to identify approximately 40% of cancer patients in need of more aggressive or better adjusted therapies. Recent studies in metastatic breast cancer have shown that CTC detection can be used as a marker for overall survival and assessment of the therapeutic response. The benefits of CTC detection in early breast cancer and other solid tumours need further validation.
Moreover, optimal CTC detection techniques are the subject of controversy as several lack reproducibility, sensitivity and/or specificity. Recent technical advances allow CTC detection and characterization at the single-cell level in the blood or in the bone marrow. Their reproducibility propels the use of CTC in cancer staging and real-time monitoring of systemic anticancer therapies in several large clinical trials.
CTC assays are being integrated in large clinical trials to establish their potential in the management of cancer patients and improve our understanding of metastasis biology. This review will focus on the techniques currently used, the technical advancements made, the limitations of CTC detection and future perspectives in this field."

Characteristics of older newly diagnosed cancer patients refusing cancer treatments.

Surgeon Recommendations and Receipt of Mastectomy for Treatment of Breast Cancer

"These findings demonstrate the choice between BCS (breast conserving surgery) and mastectomy as initial treatment for breast cancer is a multifactorial decision with patient preference, surgical recommendation, and failure of BCS all playing an important role."

Analysis of 136 Ureteral Injuries in Gynecological and Obstetrics Surgery From Completed Insurance Claims

"...Most injuries were found postoperatively; only 17 were discovered during surgery. The investigators conclude from these findings that most if not all ureteral injuries occurring through negligence are potentially avoidable with use of established surgical practices, especially dissecting out the ureter when indicated."