Interferon after surgery for women with advanced (Stage II-IV) epithelial ovarian cancer - The Cochrane Library - Lawal - Wiley Online Library

Abstract

This is the protocol for a review and there is no abstract. The objectives are as follows:

To assess the effectiveness and safety of interferon after surgery in the treatment of advanced (stage II-IV) epithelial ovarian cancer.

Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance (risk reducing surgery - breasts/bilateral salpino-oophorectomies)

Abstract

BACKGROUND:

For BRCA1/BRCA2 gene testing to benefit public health, mutation carriers must initiate appropriate risk management strategies. There has been little research examining the long-term use and prospective predictors of the full range of risk management behaviors among women who have undergone BRCA1/2 testing. We evaluated long-term uptake and predictors of risk-reducing mastectomy (RRM), risk-reducing bilateral salpingo-oophorectomy (RRBSO), chemoprevention, and cancer screening among women at a mean of 5.3 years after testing.

METHODS:

The study participants comprised 465 women who underwent BRCA1/2 testing. Prior to genetic counseling, we measured family/personal cancer history, sociodemographics, perceived risk, cancer-specific distress, and general distress. We contacted patients at a mean of 5.3 years after testing to measure use of RRM, RRBSO, chemoprevention, and breast and ovarian cancer screening.

RESULTS:

Among participants with intact breasts and/or ovaries at the time of testing, BRCA1/2 carriers were significantly more likely to obtain RRM (37%) and RRBSO (65%) compared with women who received uninformative (RRM, 6.8%; RRBSO, 13.3%) or negative (RRM, 0%; RRBSO, 1.9%) results. Among carriers, precounseling anxiety was associated with subsequent uptake of RRM. RRO was predicted by age. Carriers were also more likely have used breast cancer chemoprevention and have undergone magnetic resonance imaging screening.

CONCLUSION:

This prospective evaluation of the uptake and predictors of long-term management outcomes provides a clearer picture of decision making in this population. At a mean of 5.3 years after testing, more than 80% of carriers had obtained RRM, RRBSO, or both, suggesting that BRCA1/2 testing is likely to have a favorable effect on breast and ovarian cancer outcomes.

Earlier age of onset of BRCA mutation-related cancers (breast and ovarian cancers)... [Cancer. 2012] - PubMed - NCBI

Earlier age of onset of BRCA mutation-related cancers in subsequent generations.

Abstract

BACKGROUND:

Women who are diagnosed with a deleterious mutation in either breast cancer (BRCA) gene have a high risk of developing breast and ovarian cancers at young ages. In this study, the authors assessed age at diagnosis in 2 generations of families with known mutations to investigate for earlier onset in subsequent generations.

METHODS:

Of the 132 BRCA-positive women with breast cancer who participated in a high-risk protocol at The University of Texas MD Anderson Cancer Center (Gen 2), 106 women could be paired with a family member in the previous generation (Gen 1) who was diagnosed with a BRCA-related cancer (either breast cancer or ovarian cancer). Age at diagnosis, location of the mutation, and year of birth were recorded. A previously published parametric anticipation model was applied in these genetically predisposed families.

RESULTS:

The median age of cancer diagnosis was 42 years (range, 28-55 years) in Gen 2 and 48 years (range, 30-72 years) in Gen 1.
In the parametric model, the estimated change in the expected age at onset for the entire cohort was 7.9 years. Statistically significant earlier ages at diagnosis also were observed within subgroups of BRCA1 and BRCA2 mutations, maternal inheritance, paternal inheritance, breast cancer only, and breast cancer-identified and ovarian cancer-identified families.

CONCLUSIONS:

Breast and ovarian cancers in BRCA mutation carriers appeared to be diagnosed at an earlier age in later generations. The authors concluded that patients who are younger at the onset of BRCA-related cancers should continue to be tracked to offer appropriate screening modalities at appropriate ages.

CureToday.com: Winter 2011 Article - "Connecting the Dots: Why It's So Hard to Pin Down Environmental Causes of Cancer"

 "Connecting the Dots: Why It's So Hard to Pin Down Environmental Causes of Cancer"

"Today, the list of possible environmental carcinogens reads like a catalog of modern conveniences, including cellphones, plastic bottles, styrene in Styrofoam, imported drywall, high-voltage power lines, light at night. Other environmental causes of cancer may be rooted in lifestyle factors, such as obesity, drinking alcohol, a fondness for suntans and smoking. Or infections with viruses and bacteria. In fact, knowing all the ways the environment can conspire to fuel cancer growth, perhaps the real wonder is how so many people can remain cancer-free for so long......

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ACP Calls for Colon Cancer Screening at 50 - in Primary Care, Preventive Care from MedPage Today

Action Points

• Explain that colorectal cancer screening should begin at age 50 for all average-risk individuals, according to a new clinical guideline from the American College of Physicians (ACP), and options include fecal occult blood testing (FOBT), flexible sigmoidoscopy, and colonoscopy.
• Point out that high-risk patients should begin screening at 40 (or 10 years younger than the age when the youngest affected relative was diagnosed), and colonoscopy is the recommended screening modality.

A Heart Helper May Come at a Price for the Brain - NYTimes.com

"Statins are the most prescribed drugs in the world, and there is no doubt that for people at high risk of cardiovascular problems, the drugs lower not only cholesterol but also the risk of heart attack and stroke. But for years doctors have been fielding reports from patients that the drugs leave them feeling “fuzzy,” and unable to remember small and big things, like where they left the car, a favorite poem or a recently memorized presentation. Last week, the Food and Drug Administration finally acknowledged what many patients and doctors have believed for a long time: Statin drugs carry a risk of cognitive side effects. The agency also warned users about diabetes risk and muscle pain...........

March 6, 2012 - Screening for Colorectal Cancer: A Guidance Statement From the American College of Physicians (pdf) including high risk

Blogger's Note: if searching for Lynch Syndrome, the older term 'HNPCC' will need to be used


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"Genetic or clinical diagnosis of hereditary nonpolyposis colorectal cancer (HNPCC): colonoscopy every one to two years beginning at age 20 to 25 years or 10 years before the age of the youngest case in the immediate family."

UK - March is Ovarian Cancer Awareness Month

March is Ovarian Cancer Awareness Month

For Doctors, Luck Can Explain What They Themselves Cannot - NYTimes.com

"The hospital I work at has no 13th floor.

The absence can be a bit awkward to explain to people. I mean, here sits a building at the center of the modern evidence-based scientific empire. Yet as soon as we set foot in the elevator, it is clear that we have decided to hedge our bets a little, and play the dark side too.....

abstract: Knowledge engineering for health: A new discipline required to bridge the ‘ICT Gap’ between research and healthcare

Knowledge engineering for health: A new discipline required to bridge the ‘ICT Gap’ between research and healthcare:

Abstract

Despite vast amounts of money and research being channelled towards biomedical research, relatively little impact has been made on routine clinical practice.
At the heart of this failure is the information and communication technology (ICT) 'chasm' that exists between research and healthcare. A new domain of 'knowledge engineering for health' is needed to facilitate knowledge transmission across the research-healthcare gap. This discipline is required to engineer the bi-directional flow of data: research data and knowledge processed to identify clinically relevant advances and delivered into healthcare use; conversely, outcomes from the practice of medicine made suitably available for use by the research community. This system will be able to self-optimise, in that outcomes for patients treated by decisions that were based on the latest research knowledge will be fed back to the research world. A series of meetings, culminating in the 'I-Health 2011' workshop, have brought together interdisciplinary experts to map the challenges and requirements for such as system. Here we describe the main conclusions from these meetings.
An 'I4Health' interdisciplinary network of experts now exists to promote the key aims and objectives, namely “integrating and interpreting information for individualised healthcare”, by developing the 'knowledge engineering for health' domain.

news: FDA clears UELS contactless breast cancer imaging tool

"UE LifeSciences Inc. plans to offer NoTouch BreastScan™ services to Gynecology, Medical Oncology and Radiology clinics in the U.S. starting from New York, New Jersey and Pennsylvania regions."

Fallopian Tube Removal as a Method of Ovarian Cancer Prevention: A Descriptive Study - Full Text View - ClinicalTrials.gov

Fallopian Tube Removal as a Method of Ovarian Cancer Prevention: A Descriptive Study

This study is currently recruiting participants.

Verified February 2012 by University of Washington

First Received on February 28, 2012. Last Updated on March 2, 2012 History of Changes

Purpose

The purpose of this study is to better understand why women choose to have their fallopian tubes removed as a method for ovarian cancer prevention. This will be done through a paper questionnaire and phone interviews. The investigators hope to gain information that will allow us to better counsel women about ovarian cancer prevention.

Sponsor:	University of Washington
Information provided by (Responsible Party):	Elizabeth Swisher, University of Washington
ClinicalTrials.gov Identifier:	NCT01544049

phase 11 - Trial of Adjuvant FANG™ Vaccine for High Risk Stage IIIc Ovarian Cancer - Full Text View - ClinicalTrials.gov

Primary Outcome Measures:

• To determine and compare time to recurrence (TTR) [ Time Frame: Participants will be followed for life. ] [ Designated as safety issue: No ]
  • To determine and compare time to recurrence (TTR) following the administration of bi-shRNAfurin and GMCSF autologous tumor cell (FANG™) vaccine in high risk patients with stage IIIc ovarian cancer NED following tumor debulking surgery and chemotherapy to standard of care post treatment observation.
  
  

Secondary Outcome Measures:

• Immune Function [ Time Frame: Blood will be collected at baseline, Months 2, 4, 6, 9, 12, 18 and EOT ] [ Designated as safety issue: Yes ]
  • To identify and determine the effect of FANG™ autologous tumor cell vaccine on immune surrogate markers in this group of patients.
  • To enlarge the safety database of FANG™ autologous tumor cell vaccine in patients with minimal disease.
  
  

Estimated Enrollment:	60
Study Start Date:	February 2011
Estimated Study Completion Date:	January 2016
Estimated Primary Completion Date:	February 2014 (Final data collection date for primary outcome measure)

abstract: Alternative and complementary therapies for the menopause

Alternative and complementary therapies for the menopause:

"Despite a re-evaluation of risks in recent years, hormone replacement therapy is still surrounded by controversy. Almost 30% of women in a recent survey sought a natural approach to combat climacteric symptoms. Nevertheless, a large proportion of patients felt that they wanted a good safety profile and strong evidence base for treatment. This article seeks to review the evidence supporting non-hormonal approaches to treatment. There is only conflicting evidence at best to support alpha-2 agonists, e.g. clonidine and limited evidence for dihydroepiandrosterone and natural progesterones. There is limited randomized controlled trial data for gabapentin, selective norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs), many of these studies being related to breast cancer patients. Of the herbal medicinal products, the largest evidence base rests with phytoestrogens. A Cochrane Database review looking at all types of phytoestrogens, e.g. red clover extracts, dietary soya and soya extracts concluded that there was no evidence to support improvement in climacteric symptoms and the meta-analysis of a 178 studies on soy products was inconsistent. Nevertheless, other studies disagree. Mammographic density is not affected by soy or phytoestrogen products and recent in vitro work shows only a weakly proliferative effect of soy isoflavone on breast cancer cells and evidence that soy isoflavone blocks the proliferative effect of estradiol on these cells. There are no studies looking at clinical outcome measures for cardiovascular disease but a number of studies looking at biochemical markers including arterial wall stiffness and apolipo protein B. Recent studies have also looked at the effects of red clover isoflavone on mood and depression, using specific depression rating scales. Finally, it is important to note that herbal medicinal products should not be used without caution. Some may produce quite marked side-effects in high doses and others can interact with pre-existing medication. A strategy for which patients are suitable for herbal medicinal products is reviewed."

Understanding Evidence-based Healthcare: A Foundation for Action | US Cochrane Center - 6 modules

Course Description:
In these six modules, we will illustrate key concepts with compelling real-world examples, covering the following topics and issues. Run times do not take into account interruptions or a second review of selected slides.

• Module 1. INTRO: What is evidence-based healthcare and why is it important? (45 minutes)
• Module 2. ASK: The importance of research questions in evidence based healthcare. (40 minutes)
• Module 3. ALIGN: Research design, bias and levels of evidence. (1 hour)
• Module 4. ACQUIRE: Searching for healthcare information. Assessing harms and benefits. (1 hour 10 minutes)
• Module 5. APPRAISE: Behind the numbers: Understanding healthcare statistics. Science, speed and the search for best evidence. (1 hour 20 minutes)
• Module 6: APPLY: Critical appraisal and making better decisions for evidence-based healthcare, Determining causality. (1 hour)

The Power of Observational Studies (critical commentaries)

The Power of Observational Studies (GoozNews)

(article and responses)

Greg Pawelski

We tend to forget that medicine and most of its discoveries have been observational. .......
I think both Gooznews and Healthnewsreview have been invaluable resources in pointing out the various calamities of health journalism.