Too Early To Determine Cancer Risk from Infertility Treatments
Saturday, March 24, 2012
Too Early To Determine Cancer Risk from Infertility Treatments
As more and more women wait to have children, the use of fertility drugs is rapidly rising, along with concerns about the possible association with increased risk of certain cancers, primarily of the breast, ovary, and uterus.
Such interest was on display when Elizabeth Edwards, the wife of former Sen. John Edwards, died from a recurrence of breast cancer in 2010, years after she had used fertility treatments. Researchers agree that the issue is important, given the millions of women who have been treated with fertility drugs. By one estimate, that number will climb to 7 million by 2025.
But the findings from the few studies that have tried to address the issue have been mixed. Most have been conducted outside the U.S., primarily in European countries with centralized health care systems that can track pharmacy and cancer registries. These studies can have methodological limitations, but researchers say the largest drawback is that, usually, it is too early to tell whether an association exists, especially for drugs used for in vitro fertilization (IVF).
“We are just really now getting into an era where we have enough women who are in the right age range to be able to evaluate their cancer risk,” said Louise Brinton, Ph.D., M.P.H., chief of the hormonal and reproductive epidemiology branch of the Division of Cancer Epidemiology and Genetics at the National Cancer Institute.
But it won’t ever be completely clear whether these drugs cause even a slight increase in cancer risk, says Jennifer Litton, M.D., an assistant professor in the department of breast medical oncology at the University of Texas M. D. Anderson Cancer Center in Houston. “Infertility itself is a risk factor for increases in breast and ovarian cancers, so it is going to be difficult, if …(Blogger's Note: to read further subscription required $$$)
Guidelines needed to address cancer survivorship care, says oncologist
A medical oncologist from the prestigious Fox Chase Cancer Center presented an argument at the ongoing National Comprehensive Cancer Network's 17th Annual Conference that, in light of people with cancer who are living much longer than ever, that they have special health needs that ought to be addressed by national standards of care.
Cancer survivors face a lot of unique and very specific challenges," says Crystal S. Denlinger, M.D., from Fox Chase Cancer Center. "In oncology medicine, there has been a much more concerted effort to address these needs in a systematic way."
For the last five years Denlinger has been the driving force at Fox for the establishment of of such guidelines, developing the Center for Survivorship at Fox Chase to address this for patients of that cancer center.
Together with colleagues from other NCCN institutions, Denlinger would like to see cancer accreditation organizations include survivorship care plans in their accreditation requirements.
abstract: Reduction of population-based cancer survival estimates by trace back of death certificate notifications: An empirical illustration
Reduction of population-based cancer survival estimates by trace back of death certificate notifications: An empirical illustration
Source:European Journal of Cancer, Volume 48, Issue 6
Survival studies using data from population-based cancer registries allow assessing effectiveness of cancer care on a population level. However, population-based cancer registries differ in the proportion of cases first notified by death certificate, as well as in the efforts to trace back such death certificate notifications (DCN). We aimed to assess the impact of such trace back on population-based cancer survival estimates.
Materials and methods
In this study from the population-based Saarland Cancer Registry (Germany) we investigated the survival experience of successfully traced back DCN cases from 1994 to 2003. Five-year relative survival of patients with DCN cancers and the effect of trace back on population-based 5-year relative survival estimates were analysed by age and tumour site.
Twelve percent of all cancers were DCN and such cases occurred most often amongst sites with poor prognosis and amongst elderly patients. Approximately half of DCN cases could be successfully traced back. Five-year relative survival of patients with DCN cancers with trace back was 2%. The inclusion of DCN cancers with additional registrations reduced the 5-year relative survival estimate for all cancers combined by 4% points. Reductions were stronger for older patients and highly fatal cancers.
Trace back results in increased inclusion of patients with very poor prognosis. Varying extent of trace back across registries may compromise comparability of cancer survival estimates and should be taken into account in comparative cancer survival studies.
"Hypercalcemia affects up to 10% to 30% of cancer patients, and cancer-related hypercalcemia is the leading cause of hypercalcemia in hospitalized patients.1,2 Patients with breast cancer, lung cancer, and myeloma are most commonly affected, but hypercalcemia can also occur with other malignancies, including renal, gynecologic, and head and neck cancers.3,4 Unfortunately, cancer-related hypercalcemia has a poor prognosis, as it is most often associated with disseminated disease. Eighty percent of patients will die within a year, and there is a median survival of 3 to 4 months.............
"There are a number of clinical features that can accompany hypercalcemia and many of them are nonspecific (eg, fatigue, nausea, constipation, and confusion). The rapidity of onset is more likely to correlate with the severity of the symptoms rather than the degree of hypercalcemia.3 Untreated severe hypercalcemia can be fatal, but treatment can bring relief of many symptoms and positively affect quality of life. Common clinical features can be general (eg, dehydration, polyuria, polydipsia), gastrointestinal (eg, nausea, vomiting, constipation, anorexia), or neurologic (eg, fatigue, delirium, myopathy). In very severe cases, patients can experience seizures, coma, or cardiovascular collapse.1,4......
The practice of pathology in Canada: dec... [Arch Pathol Lab Med. 2012]
Sections of Gynecological and Cytopathology Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada.
CONTEXT:Pathology organizations in the United States are preparing for a new era of health care reform. Trends in the supply of pathologists in Canada's managed care system may provide some useful insights in any analysis and projection of future pathologist needs in the United States.
OBJECTIVE:In this study, population-based Canadian databases were used to devise a parameter for physician supply, cancer cases per physician. The trend in this supply parameter for pathologists was compared to that for radiation oncologists.
DESIGN:The number of Canadian pathologists and radiation oncologists and the annual number of new cancer cases in each of 2 years, 1999 and 2009, were extracted from reliable databases. Cancer cases per pathologist and oncologist were calculated, and relative trends in supply of physicians in both specialties were identified.
RESULTS:The annual number of new cancer cases increased from 129,300 to 171,000 from 1999 to 2009. The absolute numbers of both pathologists and oncologists also increased in this time period. However, while the increase in the number of radiation oncologists led to an 8.2% decrease in cancer cases per radiation oncologist, the modest increase in the number of pathologists led to an increase of 17.1% in cancer cases per pathologist.
CONCLUSIONS:There is a trend toward a decreasing supply of Canadian pathologists relative to that of cancer demands. This finding confirms an earlier population-based study showing a decreased supply relative to population and number of clinical physicians. It is uncertain whether this decreased supply is a result of appropriate application of new, efficient methods or whether health care has been rationed or adversely impacted. Outcome measures to monitor Canadian pathology practice quality are clearly needed.
Bulletin du Cancer - What management for the asymptomatic men carriers of BRCA1 or 2 mutation? Results of a survey in the French oncogenetic centers
Bulletin du Cancer
Summary : The aim of this survey of practice was to define, in the absence of guideline, the management in France of asymptomatic men bearing a mutation of BRCA1 or 2 genes. A questionnaire was addressed to 90 oncogenetics centers. We obtained the answers of 34 practitioners working in 58 centers. Among the responders, 85.3% offered a systematic genetic test in all cases to determine the risk of transmission to the children and to offer a personal follow-up in 79.4 % of cases. This screening was directed towards prostate cancer, breast cancer and pancreatic cancer in respectively 94.1, 67.6 and 47.1% of cases. The screening of prostate cancer was mainly proposed to men bearing a BRCA2 mutation and from the age of 40 years. It was based on clinical examination and testing of prostate specific antigen. The screening of breast cancer was mainly proposed to men bearing a BRCA2 mutation and based on clinical examination and self-palpation without stating a started age. The screening of pancreatic cancer was mainly proposed to men with familial history of pancreatic cancer and from the age of 40 years. It was based on tomography and MRI. For the majority of answerers, the general practitioner was the best to perform all these screenings. These experts’ opinions can help to establish guidelines for the global management of asymptomatic men carriers of BRCA1 or 2 mutations.
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open access: PLoS ONE: Hormone Treatment, Estrogen Receptor Polymorphisms and Mortality: A Prospective Cohort Study (in women 65yrs+)
PLoS ONE: Hormone Treatment, Estrogen Receptor Polymorphisms and Mortality: A Prospective Cohort Study
Conclusions/SignificanceThe risk of mortality was not associated with HT duration, type or age at initiation. It was however not equal across all women, with some women appearing genetically more vulnerable to the effects of HT in terms of their estrogen receptor genotype. These findings, if confirmed in another independent study, may help explain the differential susceptibility of women to the beneficial or adverse effects of HT.
RELEASE: The Center for American Progress Expands Health Care Policy Team with the Addition of Dr. Donald M. Berwick (patient safety groups)
RELEASE: The Center for American Progress Expands Health Care Policy Team with the Addition of Dr. Donald M. Berwick