Thursday, June 11, 2009
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
Monday, June 01, 2009
Sunday, May 31, 2009
my response regarding Andy Pollack's patient views on the CA125 (prior to the science paper)
May 31st, 2009 submitted electronically:
The issue of ultimate survival benefit and the psychological impact of living with and dying with ovarian cancer are at odds with each other.
Ovarian cancer patients/caregivers, for the most part, understand the limitations of this only and less than effective monitoring/diagnostic tool. However, it is well established that the CA125 can forecast recurrent disease months in advance of current imaging tests (CT scans etc).
It is the psychological burden which is a mixed 'blessing' BUT it is the one thing which ovarian cancer patients hold onto because that is all that we have in the daily nanoseconds while dealing with ovarian cancer. It can be said and felt that some healthcare professionals are unable or unwilling to deal with the psychological impact of the CA125 due primarily from a time perspective (workload stresses).
In fact, until we have a better test for ovarian cancer, whether it is for screening high risk women or disease recurrence, this issue will never go away, irrespective of the science involved.
I believe that we need to say no to any further research regarding the CA125 because at this point we are simply regurgitating what is already know. It is important to move forward in the research and find sooner, rather than later, a test which will be more accurate for ovarian cancer. Illusive, but possible, if the coordinated and cooperative venues can be improved.
On a personal perspective, this will be my 10th year anniversary of disease-free/no recurrence clear cell ovarian cancer. This week I asked my family doctor (an exceptional physician) for a CA125 and even she raised her eyebrows at the request, but graciously proceeded with the requisition.
I consider myself well versed in the science of the CA125, but you see? It doesn't matter, the issue is personal, very personal.It is one of the burdens of the disease, assuming one survives ovarian cancer. Acknowledging the impact of the personal will relieve many science questions and management decisions.
Sandi Pniauskas
Letter of thanks for participation from NY Times journalist Andy Pollack - re: CA125 patient opinions
Sandi,
I have been overwhelmed with calls and emails from women offering thoughtful comments and telling of their own experiences. I used a couple in my article.
There are so many I might not be able to get back to everyone. So I was hoping you could send out a message, perhaps this message, thanking all of those women who so generously responded. The article should be on our website, http://www.nytimes.com, by Monday morning, probably Sunday night. There might be a way for readers to comment on the issue on our website.
Again, thanks for your help and to all the women who responded. I hope everyone does well in fighting this disease.
Best regards,
Andy Pollack
Biotechnology reporter
The New York Times
URGENT RESPONSE REQUIRED TODAY - CA125 Patients'/Caregivers' Views
Correspondence received today (May 31st, 2009:
Dear Sandi,
I cover biotechnology for the New York Times. I’m covering a study being presented at ASCO today showing that using CA-125 to check for recurrence and then treating when CA-125 starts to rise does not provide any survival benefit over just waiting for symptoms and starting treatment then. The lead investigator said there would thus be no need for women to constantly have their CA-125 tested, saying it only leads to anxiety and increased chemo without any benefit. He seemed to suggest that women, particularly in the US, have almost a “CA-125 psychosis’’ obsessing over their test scores. (This study does not refer to using CA125 to monitor therapy, only to detect recurrence.
I’m wondering if you or someone such as a woman with ovarian cancer would be willing to comment on this. Even if they don’t know the study results in detail I’m interested in the phenomenon, if it’s true, of constantly testing for CA-125.
The deadline is today so I would have to speak to people by about 5 p.m. eastern time today. My number is below so you or anyone can call me directly. Or reply by email.
Thanks for any help you can provide.
Best regards,
Andrew Pollack
Biotechnology reporter
The New York Times
917-679-5920
pollack@nytimes.com
Saturday, May 30, 2009
Informing women about HRT: the Consensus conference statement
Conclusions
This CC led to the identification of specific information drawbacks. Women are
exposed to messages that are often partial, non evidence-based nor transparently
developed. The structured and participative methodology of this CC allowed a
multidisciplinary perspective and a substantial lay people input.
Friday, May 29, 2009
Canadian Health Reference Guide: 23rd out of 32 countries: How Canada compares to Europe on health care
Dr. Björnberg pointed out that "Patients rights, access to information, and choice and services without delay are underdeveloped in Canada and deliver low value for the money spent."
Thursday, May 28, 2009
Wednesday, May 27, 2009
Tuesday, May 26, 2009
Survey of unaffected BRCA and mismatch repair (MMR) mutation positive individuals
"Results suggest fear of GD is prevalent, yet data do not support evidence that GD exists."
Southwest Oncology Group Trial S9912: Intraperitoneal cisplating and paclitaxel plus IV paclitaxel and PLD as priary chemo of small volume residual OC
"CONCLUSION: Both the overall trial outcome, and specifically the excessively severe systemic toxicity of this regimen would prevent its future development in this exact form."
Monday, May 25, 2009
Sunday, May 24, 2009
Saturday, May 23, 2009
Hope dies last
Hope dies last: "But Canadians with rare cancers aren't in as strong a position as those with common cancers, in part because they 'don't have a strong lobby group"
Thursday, May 21, 2009
Wednesday, May 20, 2009
Tuesday, May 19, 2009
Letter to Saskatchewan Minister of Health: Ovarian Cancer Awareness & Treatment in Saskatchewan
May 19, 2009
Honorable Don McMorris
Minister of Health
Government of Saskatchewan
Room 302, Legislative Building
2405 Legislative Drive
Regina, SK
S4S 0B3
Dear Minister McMorris:
It has been an interesting time since we first wrote to you November 2008, and since we provided our
recommendations for gynecological oncology care for the women of Saskatchewan earlier in the spring of 2008.
We have learned so much more about how the medical profession operates, how medical care is delivered in
Saskatchewan, about guidelines, standards and recommendations by governing bodies and other jurisdictions.
And thank you to the good help of Sophie Ferre of your office, we have initiated relationships with some of the core executives responsible for decision making regarding gynecological oncology in our province. And we will continue to do this of course.
Also since our beginning with your office our group has more than doubled and support for our work is coming from many different directions, and we are able to provide support for more patients and their families.
This is all very positive and provides us with hope and motivation to continue.
Also hopeful is the fact not one single person, professional, executive, representative we have met with is against our recommendations. In fact, quite the reverse is true. We have been told that our recommendations are essential to improved survival outcomes for a very lethal cancer, that our recommendations are credible, that other groups concerned about gynecologic cancers has similar recommendations.
While other jurisdictions in Canada may not have written recommendations such as ours, all jurisdictions in Canada except Saskatchewan provide the care we are looking for from gynecologic
oncology units including intraperitoneal chemotherapy (IP).
The reasons for not doing this yet vary and have included the gaps between bureaucracies prevent it in various ways (jurisdictions, funding), the government needs to agree to funding, awareness needs to be improved.
We fully expected that on May 14th the meeting between the Saskatchewan gynecologic oncologists and the various bureaucracies would lead to some positive announcements for the women in our province.
Rather, we hear that there has been an agreement to continue to discuss Gynecologic Oncology units only until June 30th. No agreement ensuring we would not be losing our two specialists in Regina. No announcement about working groups that involve patient input.
We understand that the Regina gynecologic oncologists have not changed their plans to close their office September 1st. And we want to know what is happening with new patients.
Throughout, we have been very patient but now we feel it is urgent that we meet with you, as we requested back in November.
Please, Minister McMorris, it is time for us to present our case to you and find out what the barriers are to keeping our specialists in Saskatchewan.
Thank you for your consideration. We feel this is an urgent matter and would appreciate hearing back from
you very soon.
Sincerely,
Darlene Gray
A Director Of
Ovarian Cancer Awareness & Treatment in Saskatchewan
OCATS
6438 – 7th Avenue N, Regina, SK, S4T 6X7, Ph 306-775-1848, Fx 306-775-1853, darlenegray@sasktel.net Facebook
Editorial: Prognostic Tools for Cancer Survival: A Secondary Role for Quality-of-Life Measurement
"...But let us not regress back to our old ways and attach
significance to HRQOL only in relation to our attachment to survival
as a clinical outcome. Measuring HRQOL should have value in its own
right. As the field evolves, it should acquire greater clinical importance
and expand the lessons we take away from clinical trials."
Monday, May 18, 2009
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary an
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary and Metastatic Carcinoma.
Sunday, May 17, 2009
Special Feature: Swing and Miss?!? Efforts in Front-line Ovarian Cancer Chemotherapy Development.
A closer look at the components of these positively sloped survival curves demonstrates that most of the benefit afforded women is in life gained in the presence of disease, rather than cure. Indeed, the cure rates from ovarian cancer have remained relatively flat over these 3 decades, adding no more than approximately 2 weeks per year in the overall gain of life expectancy. This is clearly due to the unmovable percentage of advanced stage cases still indicative of the most common clinical presentation (stage III/IV), and underscores the immense impact even a slight stage migration could have on the overall clinical performance of women with this disease.
The temporal stability of the Symptom Index among ...[Gynecol Oncol. 2009] - PubMed Result
- Gynecol Oncol. 2009 May 6
-
The temporal stability of the Symptom Index among women at high-risk for ovarian cancer.
Molecular Diagnostics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Exponent Health Sciences, Seattle, Washington, USA.
OBJECTIVE: To evaluate the temporal stability of self-reported symptoms known to be associated with ovarian cancer.
METHODS: This report is a longitudinal analysis of symptom reporting from 123 women who participated in the Seattle-based Ovarian Cancer Early Detection Study (OCEDS). The OCEDS population includes women at increased risk of ovarian cancer based on a family history of cancer or a BRCA I/II mutation. Data on symptoms were collected at two time points using a Symptoms Index that included abdominal pain, pelvic pain, feeling full quickly, inability to eat normally, abdominal bloating, and increased abdominal size.
RESULTS: There was a median of 101 days between the two time points, with a range of 72-332 days. The median age of the women was 51, with a range of 32-79 years. Abdominal bloating was the most commonly reported symptom at both time points. The symptom least commonly reported at the two time points was inability to eat normally. The Symptoms Index was negative at both time points for 86% of all women and positive at both time points for 2% of all women. There were no statistically significant patterns of change for symptom reporting between time points.
CONCLUSIONS: The Symptoms Index and women's report of abdominal pain, pelvic pain, feeling full quickly, unable to eat normally, abdominal bloating, increased abdominal size were stable between two time points in this sample. These findings provide evidence that longitudinal measurements of symptoms reporting by women in a screening study are likely to be reliable.
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary an
Ovarian Pathology in Risk-reducing Salpingo-oophorectomies From Women With BRCA Mutations, Emphasizing the Differential Diagnosis of Occult Primary and Metastatic Carcinoma
Friday, May 15, 2009
Thursday, May 14, 2009
Wednesday, May 13, 2009
The temporal stability of the Symptom Index among women at high-risk for ovarian cancer.
Molecular Diagnostics Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Exponent Health Sciences, Seattle, Washington, USA.
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| OBJECTIVE: To evaluate the temporal stability of self-reported symptoms known to be associated with ovarian cancer. METHODS: This report is a longitudinal analysis of symptom reporting from 123 women who participated in the Seattle-based Ovarian Cancer Early Detection Study (OCEDS). The OCEDS population includes women at increased risk of ovarian cancer based on a family history of cancer or a BRCA I/II mutation. Data on symptoms were collected at two time points using a Symptoms Index that included abdominal pain, pelvic pain, feeling full quickly, inability to eat normally, abdominal bloating, and increased abdominal size. RESULTS: There was a median of 101 days between the two time points, with a range of 72-332 days. The median age of the women was 51, with a range of 32-79 years. Abdominal bloating was the most commonly reported symptom at both time points. The symptom least commonly reported at the two time points was inability to eat normally. The Symptoms Index was negative at both time points for 86% of all women and positive at both time points for 2% of all women. There were no statistically significant patterns of change for symptom reporting between time points. CONCLUSIONS: The Symptoms Index and women's report of abdominal pain, pelvic pain, feeling full quickly, unable to eat normally, abdominal bloating, increased abdominal size were stable between two time points in this sample. These findings provide evidence that longitudinal measurements of symptoms reporting by women in a screening study are likely to be reliable. PMID: 19427026 | ||||||||
Tuesday, May 12, 2009
Monday, May 11, 2009
IAPO Member, the Lance Armstrong Foundation, invites you to join the LIVESTRONG Global Cancer Campaign | A global voice for patients includes pts
IAPO | IAPO Member, the Lance Armstrong Foundation, invites you to join the LIVESTRONG Global Cancer Campaign | A global voice for patients:
"Organizations and individuals making extraordinary commitments will be invited to share the stage with world leaders in a high profile display of unity against cancer."
Sunday, May 10, 2009
Saturday, May 09, 2009
Friday, May 08, 2009
Thursday, May 07, 2009
Wednesday, May 06, 2009
Cochrane Collaboration review/commentaries: Interventions for psychosexual dysfunction in women treated for gyn malignancy
| Comments from Clinical Raters |
|---|
GynecologyA very useful review that confirms the need for proper randomised studies to answer this important question. My misgivings on the apparent lumping of all gynaecological malignancies together is that it creates an obviously flawed impression that sexual problems after treatment of gynaecological cancer of any kind might have a common solution. |
Oncology - GeneralI was surprised to find that there was any evidence at all from randomised studies that addressed questions in this important area. The authors rightly draw attention to the paucity of evidence and its poor quality. As interest increases in what is now called cancer survivorship, we can anticipate an increasing need for solid evidence on which to base management for the complex difficulties experienced by patients successfully treated for cancer. This paper indicates that it is not going to be easy to assemble the necessary evidence. |
Screening Tests Missing Early Signs of Ovarian Cancer - Oncology Nursing News
Screening Tests Missing Early Signs of Ovarian Cancer - Oncology Nursing News
Comment:
S. Pniauskas
Please also, and importantly, reference the recently published early detection ovarian cancer clinical trial by Dr Jacobs from the U.K.. Further, Dr Jacobs completed a study of 22,000 women over a decade ago with the same results. So, nothing has changed even after all of this time which is very sad. So much time has elapsed, so many deaths and sufferings. A coordinated international effort is needed badly and while new research is hopeful, our ovarian cancer communities have faced extreme dissapointments with even new and 'apparent' early detection tests of recent years. It would be seriously disconcerting to know that another decade may lapse without any definitive results. This does not take away from the goodwill and integrity of the research/ers, but a more effective and coordinated effort is needed.
Tuesday, May 05, 2009
Monday, May 04, 2009
Sunday, May 03, 2009
Saturday, May 02, 2009
Peutz-Jeghers Syndrome: eMedicine Gastroenterology updated Apr 2009
Peutz-Jeghers Syndrome: eMedicine Gastroenterology: "Almost 50% of patients with Peutz-Jeghers syndrome (PJS) develop and die from cancer by age 57 years. The mean age at first diagnosis of cancer is 42.9 years, /– 10.2 years.
* The cumulative risk for developing any cancers associated with Peutz-Jeghers syndrome (PJS) in patients aged 15–64 years is 93%.
* The cumulative risks of developing a particular cancer from ages 15-64 years are as follows: esophagus, 0.5%; stomach, 29%; small intestine, 13%; colon, 39%; pancreas, 36%; lung, 15%; testes, 9%; breast, 54%; uterus, 9%; ovary, 21%; and cervix, 10%."
Review Transition from acute to chronic postsurgical pain: risk factors and protective factors
However, a rarely appreciated fact is that every chronic pain was once acute.
Wrong Approach to Obesity Can Alienate Patients - Physicians can unintentionally de-motivate black patients
Editorial note: it takes a study to understand this?
"patients may respond unexpectedly if approached in a manner they perceive as disrespectful, condescending, emotionless, or non-supportive,' the authors write."
Friday, May 01, 2009
Webcasts - AACR
Webcasts: "More than 90 hours of selected Annual Meeting talks will be made available as free online webcasts approximately 10 business days* after the AACR 100th Annual Meeting 2009 and will remain accessible for two years. Sessions that are to be webcast will include audio and, if available, slides from the talks.
Note: Only individual talks within a session that AACR has received permission to webcast will be included. For example, if there are four talks in a session and only two speakers give their permission to be webcast, then only those two talks will be made available.
*The Opening Plenary and the Spotlight on Breakthroughs in Cancer Research session will both be available as webcasts approximately 24 hours after they conclude."
Multiple Regions Of Chromosome 8 Found To Be Associated With Different Cancers
this link above is previous research (2008) regarding chromosome 8q24 region and it's wider scope of impact:
The authors' analysis suggests that there may be five distinct subregions within 8q24, separated by sites of frequent recombination, and each associated with different types of cancer. The first subregion is associated with an increased risk of prostate cancer but not with risk of breast, colorectal, or ovarian cancer. The second is associated only with an increased risk of breast cancer. The third subregion is associated with the risk of prostate, colorectal and ovarian cancers, but not breast, and subregions four and five were associated with prostate cancer, but not with the other three malignancies.
"We have shown there are at least five independent loci within this gene desert with different associations with particular cancers," the authors write. "Further studies of the region may identify additional loci associated with specific cancers and possibly refine our understanding of the mechanisms underlying the associations reported here."
Thursday, April 30, 2009
Patient Involvement in Decisions to Limit Treatment: The Crucial Role of Agreement Between Physician and Patient
"Conclusion Only half of the patients were involved in DLT. Surprisingly, the main predictor of patient involvement was not their medical condition, but agreement with physicians' palliative treatment goals. These results show that if physicians switch to comfort care in terminally ill patients and patients are not yet prepared to follow this line, treatment limitations are often decided without involving the patient."
Wednesday, April 29, 2009
Wait times for chemotherapy in Ontario growing, say advocacy groups
Working On IT! a book in progress: Dana Martinez (husband Ron)
I don't mind making this journey as long as I know that I am helping someone else. Every Cancer survivor I have ever met, has felt this way. There is something that happens to you once you have Cancer, you become part of a larger family-- a family bound by a common thread- "survival".
Tuesday, April 28, 2009
Let Me In!
power point presentation: Let Me In!
access link below:
www.scribd.com/doc/13044110/Ovarian-Cancer-Let-Me-In
Ovarian Cancer: Let Me In!
"Doc, Should I See You or My Oncologist?" A Primary Care Perspective
“Doc, Should I See You or My Oncologist?” A
Primary Care Perspective on Opportunities and
Challenges in Providing Comprehensive Care for
Cancer Survivors
Monday, April 27, 2009
Saturday, April 25, 2009
Friday, April 24, 2009
A Rapid and Reliable Test for BRCA1 and BRCA2 Founder Mutation Analysis in Paraffin Tissue Using Pyrosequencing
The founder mutations in BRCA (BRCA1*185delAG, BRCA1*5382insC, and BRCA2*6174delT) account for 95% of the detectable BRCA mutations in breast and ovarian cancer families of Ashkenazi Jewish ancestry.
Thursday, April 23, 2009
Intercepting pelvic cancer in the distal fallopian tube: theories and realities
This review summarizes the recent data supporting the distal fallopian tube as an important site for serous carcinogenesis, stressing both the presence of a novel precursor (the p53 signature) and the application of this model to all women irrespective of BRCA status. The challenges and unmet needs unmasked by this paradigm shift in ovarian cancer research are discussed.
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Revisiting perioperative chemotherapy: the critical importance of targeting residual cancer prior to wound healing
Wednesday, April 22, 2009
Tuesday, April 21, 2009
April 21, 2009 - NCI Ovarian Cancer Markers Validated for Early Detection
NCI Cancer Bulletin for April 21, 2009 - National Cancer Institute: "The current guidelines of the U.S. Preventive Services Task Force do not recommend ovarian cancer screening with CA-125. Earlier this month another study using PLCO data concluded that screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages."
Monday, April 20, 2009
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
CO Early Release, published online ahead of print Apr 20 2009
Journal of Clinical Oncology, 10.1200/JCO.2008.20.4883
Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors
M. Elisabeth Del Giudice,* Eva Grunfeld, Bart J. Harvey, Eugenia Piliotis, and Sunil Verma
Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre; Ontario Institute of Cancer Research and Cancer Care Ontario, Health Services Research Program; and Divisions of Hematology and Medical Oncology, Department of Medicine, Odette Cancer Centre, Toronto, Ontario, Canada.
* To whom correspondence should be addressed. E-mail: lisa.delgiudice@sunnybrook.ca
Purpose: Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown.
Methods: A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined.
Results: A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence.
Conclusion: With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.
Press release: Cochrane Library free access to all Canadians
Ottawa, April 15, 2009— The Canadian Cochrane Network and Centre announces today
that everyone in Canada with access to the Internet will be able to view the full content of
The Cochrane Library, an on-line resource that provides evaluations on health
treatments.
The Canadian Cochrane Network and Centre, in partnership with the Canadian Health
Libraries Association, has successfully secured a national license to The Cochrane
Library. In essence, the license provides a subscription for every Canadian with access to
the Internet to benefit from the immense volume of health information found in The
Cochrane Library. Everybody will be one click away from the best available evidence on
the effectiveness of treatment procedures including which ones may be harmful.
Sunday, April 19, 2009
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Hum Pathol. 2009 Apr 13
Hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms.
Ohishi Y, Oda Y, Kurihara S, Kaku T, Yasunaga M, Nishimura I, Okuma E, Kobayashi H, Wake N, Tsuneyoshi M.
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan; Department of Diagnostic Laboratory, Kyushu University Hospital at Beppu, Beppu 874-0838, Japan.
Hobnail-like cells, which suggest a diagnosis of clear cell carcinoma, are also focally observed in serous borderline tumor of the ovary, causing diagnostic confusion. However, the precise nature of hobnail-like cells in serous borderline tumor has not been well characterized. The purpose of this study was to clarify whether or not hobnail-like cells in serous borderline tumor represent concomitant incipient clear cell neoplasms. First, we carefully reviewed hematoxylin and eosin slides taken from 115 ovarian tumors diagnosed as clear cell carcinoma (73 cases), mixed adenocarcinoma containing clear cell carcinoma (5 cases), and serous borderline tumor (37 cases) to clarify the frequency of coexistence of typical clear cell carcinoma and serous borderline tumor. Through the hematoxylin and eosin review, we paid special attention to the cytologic features of hobnail-like cells in serous borderline tumor and serous borderline tumor-like papillary areas in clear cell carcinoma. Second, we selected 19 serous borderline tumors and 16 clear cell carcinomas, in which hobnail-like cells were easily recognizable, and investigated the immunohistochemical expression of estrogen receptor and Wilms tumor gene protein. No coexistence of clear cell carcinoma and serous borderline tumor was evident in any of the above 115 ovarian tumors. Hobnail-like cells were focally positive for estrogen receptor and Wilms tumor gene protein in nearly all serous borderline tumors. Hobnail-like cells in all clear cell carcinomas were completely negative for estrogen receptor and Wilms tumor gene protein, although estrogen receptor expression was very focally observed (less than 5% area) in non-hobnail cells of only one clear cell carcinoma. In conclusion, hobnail-like cells in serous borderline tumor do not represent concomitant incipient clear cell neoplasms because (1) clear cell carcinoma and serous borderline tumor do not coexist and (2) hobnail-like cells in clear cell carcinoma and serous borderline tumor are immunophenotypically distinct. Recognition of our conclusion may protect a patient with "conspicuous hobnail-like cells in serous borderline tumor" from an erroneous overdiagnosis of "concomitant clear cell carcinoma admixed with serous borderline tumor."
Saturday, April 18, 2009
article: Guidelines needed for optimal vitamin D supplementation in cancer patients
"There may be specific benefits and harms associated with vitamin D supplementation in cancer patients that are not present in the general population, despite the fact that these benefits and harms have not been conclusively demonstrated,” Dr. Goodwin writes. “As a result, oncologists making recommendations to individual patients should take a cautious approach.”
Bias in the exchange of arguments: the case of scientists' evaluation of lay viewpoints- Public Understanding of Science
Note: a bit off topic but the last point taken:
"Abstract
Most perspectives on public participation share the notion that dialogues should be open, allowing participants to articulate and evaluate different views and knowledge claims. We hypothesize that participants' evaluation of claims may be biased because participants have a preference for a particular type or source of a claim. This would hamper an open dialogue.....
Contrary to our expectation, scientists evaluated claims of the public more positively than claims of experts."
The risk of colorectal cancer with symptoms at different ages and between sexes: a case-control study
Differences with age and sex are important; current guidance for referral ignores age
The diagnosis of colorectal cancer in patients with symptoms: finding a needle in a haystack
Table 1. Presenting symptoms and signs for 194 patients with colorectal cancer
Symptom Percentage of patients:
Fecal occult blood test positive 77
Rectal bleeding 58
Anemia* 57
Abdominal pain 52
Weight loss 39
Anorexia 27
Constipation 27
Altered stools 25
Fatigue 25
Diarrhea 22
Nausea and vomiting 22
Tenesmus 8
Mucus in stools 6
Rectal pain 5
Obstruction 4
Adapted from . Majumdar et al. [1].
*Anemia = a hemoglobin of <13.4g/dl in men or <12.3g/dl in women.
Friday, April 17, 2009
Inhibition of functional HER family members increases the sensitivity to docetaxel in human ovarian cancer cell lines.
In conclusion, a combination of docetaxel with inhibitors of HER family members, such as cetuximab plus pertuzumab, may be considered for a clinical trial in ovarian carcinomas with functional receptors.
Parity and the risk of breast and ovarian cancer in BRCA1 and BRCA2 carriers
This is the third independent study to find that, as in the general population, parity appears to be associated with protection from breast cancer in women with mutations in BRCA1 and BRCA2. Parity appears to be protective for ovarian cancer in BRCA1 mutation carriers, but its role in BRCA2 mutation carriers remains unclear. Whether later age at first birth is also protective for ovarian cancer in mutation carriers requires further confirmation.
Cochrane Collaboration: Interval debulking surgery for advanced epithelial
* Rates of toxic reactions to chemotherapy were similar in both arms (RR = 1.3, 95%CI: 0.4 to 3.6), but little information is available for other adverse events.
* Only one trial reported quality of life (QOL), which was generally similar in both treatment arms.
* No conclusive evidence was found to determine whether IDS between cycles of chemotherapy would improve or decrease the survival rates of women with advanced ovarian cancer, compared with conventional treatment of primary surgery followed by adjuvant chemotherapy. IDS appeared to yield benefit only in the patients whose primary surgery was not performed by gynecologic oncologists or was less extensive.
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
OCATS: Cancer survivor helps launch awareness campaign
media article:
Cancer survivor helps launch awareness campaign
e-letter of response:
Now, after close to a decade as one of the minority who has survived ovarian cancer, it is apparent that the message concerning this highly lethal woman's cancer, still is not receiving the respect nor attention it deserves. How, as a society, is it that we fail and continue to fail not only ovarian cancer women/families, but, all those who envision best care for this woman's cancer? The impact of hearing: "well, they are going to die anyway" is distressingly commonplace even today. Those are infuriatingly painful words to hear time and time again. Yet, here we have a small group of women fighting not only for themselves but for the future of Saskatchewan's children - your children. Each time we lose an ovarian cancer woman to this deadly cancer, a part of us dies with her - again and again. In good and bad economic times, little has changed, so it should be obvious that funding is not the issue. Policy makers need to be reminded that these women are not number-crunching statistics, but walking, breathing, caring Mothers, Sisters, Grandmothers and Citizens who have much Hope in the face of extreme adversity. Stick your neck out on this issue and make the obvious right decisions! You could make worse decisions. Sandi Pniauskas
Thursday, April 16, 2009
Caring for the Morbidly Obese GYN Oncology Patient - Oncology Nursing News
"“In addition, there are obesity bias issues,” Ms Stuckwisch revealed, explaining that many studies exist indicating that nurses view obese patients as overindulgent, lazy, noncompliant, and unsuccessful. Other research shows 31% of nurses would prefer not to care for an obese patient and 24% say obese patients repulse them."
“Obesity can happen to anyone,” Ms. Stuckwisch reminded the attendees. “Overweight is a product of many factors. Overweight is not just related to overeating. There are multiple issues and no real answer to what causes people to cross over to extreme morbid obesity.”
Wednesday, April 15, 2009
Novogen 'Ovature' trial hit by crisis - Phenoxodiol
Novogen 'Ovature' trial hit by crisis
April 15, 2009 - 2:54PM
Biotech Novogen Ltd's US subsidiary has decided to undertake an interim analysis of its phase III "Ovature" trial, saying slowing patient recruitment rates and the global financial crisis has made it imprudent to fund the trial to completion.
The Ovature (Ovarian Tumour Response) study is trialling the anti-cancer drug phenoxodiol in women with advanced ovarian cancer to determine its safety and effectiveness when used in combination with chemotherapy drug carboplatin.
Novogen said its US subsidiary, Marshall Edwards Inc, had announced that new patient recruitment to the Ovature trial would cease and available data from the 141 completed and current patients would be analysed for safety and efficacy outcomes.
"The company has decided to assess these data from the Ovature trial at this time as the current downturn in the global financial markets makes raising further equity or debt in the near term to fund the trial through to completion most unlikely," Marshall Edwards said....cont'd
Tuesday, April 14, 2009
Monday, April 13, 2009
PharmaLive: Manhattan Research Releases Digital DTC Relevance Rankings, Revealing Which Condition Groups Are Most Likely to Adopt eHealth
New York, April 8, 2009 - More than 60% of U.S. adults turn to the Internet as a decision support tool in healthcare and disease management, and certain condition groups are more likely to use online health resources than others, according to pharmaceutical and healthcare market research company Manhattan Research.
Conscience vs. Conscience - Blog - NYTimes
The clause, called the Provider Refusal Rule, allows heath care providers to refuse to participate in procedures they find objectionable for moral or religious reasons.
It is called the “conscience clause” because it affirms the claims of conscience — one’s inner sense of what is right — against the competing claims of professional obligations.
Saturday, April 11, 2009
Chemotherapy toxicity in gynecologic cancer patients with a body surface area (BSA) >2m(s)
"...women with a BSA>2 m(2) on paclitaxel dosed by ABW do not experience excess toxicity in comparison to women on paclitaxel capped at a maximum BSA or women in published trials of adjuvant P/C. Empiric dose reduction is unnecessary and may result in suboptimal treatment...."
Ovarian Cancer Screening Resulted in Many Unnecessary Surgeries
Screening women for ovarian cancer often led to unnecessary surgeries and failed to detect the disease in its early stages, according to new results from the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial. The analysis focused on the 34,000 women in the NCI-sponsored trial who were screened annually for signs of ovarian cancer using transvaginal ultrasound and/or the CA-125 blood test.
Friday, April 10, 2009
Prognostic and predictive factors in epithelial ovarian cancer (Bull)
[Prognostic and predictive factors in epithelial ovarian cancer.]
[Article in French]
Comité de gynécologie, Institut Gustave-Roussy, 39, rue Camille-Desmoulins, 94800 Villejuif, France.
Even if prognosis of epithelial ovarian cancer remains very bad, survival and response to treatment are variable according to the patients. Determination of new prognostic markers helps us to adapt therapeutics for each patient and is necessary for the elaboration and the interpretation of clinical research studies. Many prognostic factors related to the tumor, the patient or the treatment, have been evaluated. The goal of this work is to review these parameters. So far, the most powerful variables are volume of residual disease after cytoreductive surgery, FIGO tumor stage, histologic type and grade of differentiation. The progress and accessibility to novel technologies applied to biology will make possible in the future the assessment of new prognostic profiles-based on genetic and/or proteomic tumor characteristics. The future also relies on the identification of predictive factors of response to treatment, but force is to note that on the last hundred publications testing predictive factors (p53, HER2, Topo-2-alpha, BRCA...), none have modified today our clinical practices.
Thursday, April 09, 2009
Alcohol intake and cigarette smoking and risk of a contralateral breast cancer: the Women's Environmental Cancer and Radiation Epidemiology Study
Microarray Analysis of Early Stage Serous Ovarian Cancers Shows Profiles Predictive of Favorable Outcome
"Conclusions: These data suggest that serous ovarian cancers detected at an early stage generally have a favorable underlying biology similar to advanced-stage cases that are long-term survivors. Conversely, most late-stage ovarian cancers seem to have a more virulent biology. This insight suggests that if screening approaches are to succeed it will be necessary to develop approaches that are able to detect these virulent cancers at an early stage."
New ACOG Guidelines Recommend Routine Genetic Risk Assessment
Some families are at particularly high risk of cancer due to hereditary cancer syndromes. These families often have multiple family members with cancer and are more likely to develop cancer at a young age. In the case of breast and ovarian cancers, inherited mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Mutations in these genes can be passed down through either the mother’s or the father’s side of the family. The lifetime risk of ovarian cancer is estimated to be 39-46% among women with a BRCA1 mutation and 12-20% among women with a BRCA2 mutation. Lifetime risk of breast cancer among BRCA1 or BRCA2 carriers is 65-74%.[1]
An estimated 1 in 300 to 1 in 800 people in the United States have a BRCA1 or BRCA2 mutation. Questions about personal and family history of breast and ovarian cancer can help identify women who are at increased risk of carrying a BRCA mutation.Tuesday, April 07, 2009
On the Rock, in a Hard Place: Challenges in Working with Advocacy and Care Provider Groups :: Vol. 2 No. 1 2006 :: Healthcare Policy / Politiques de Santé :: Longwoods Pub
"Lessons Learned
This experience taught us valuable lessons about KT in practice. Decision-making and knowledge translation occur in a complex, dynamic environment where the partners' interest in, and perspective towards, the research findings, the researchers, and other partners continually evolve. The desire to use evidence in decision-making competes with other organizational and personal motivations, not the least of which are self-preservation and self-promotion."
Monday, April 06, 2009
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Published Online: 28 Mar 2008 © Japanese Cancer Association
Review Article
Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma
Clear cell carcinoma (CCC) accounts for 4% to 12% of epithelial ovarian cancer in Western countries and, for some unknown reasons, it comprises more than 20% of such cancers in Japan. CCC shows unique clinical features such as a high incidence of stage I disease, a large pelvic mass, an increased incidence of vascular thromboembolic complications, and hypercalcemia. It is frequently associated with endometriosis.
Compared to serous adenocarcinoma (SAC), CCC is relatively resistant to conventional platinum, or taxane-based chemotherapy which is associated with its poor prognosis. However, the mechanisms underlying CCC's resistance to chemotherapy have not been understood...... Therefore, lower proliferation of the tumor cells may contribute to their resistance to chemotherapy...."
Sunday, April 05, 2009
eMJA: What is the health service for?
"To the Editor: “What is the health service for?”1 In essence, this is a question of definition and ownership. What is the definition of quality health care and who decides how it is defined? Who are the recipients of health services, the funders, those who stand to lose or benefit from the way in which health care is delivered? The answer is citizens"
Saturday, April 04, 2009
Cystic and Adenofibromatous Clear Cell Carcinomas of the Ovary: Distinctive Tumors That Differ in Their Pathogenesis and Behavior: 122 cases
Friday, April 03, 2009
The Clearity Foundation - Improving Treatment Options For Ovarian Cancer Patients
"The Clearity Foundation seeks to improve treatment outcomes in recurrent and progressive patients by providing diagnostic services that determine the molecular profile of the individual patient. Having this profile may help match your patient with an appropriate clinical trial or other treatment. We also maintain a database of results that over time, may help identify new treatments. The Clearity Foundation is a 501(c)(3) not-for-profit and sponsors molecular profiling diagnostic tests at no cost to patients."
Thursday, April 02, 2009
news item: Medical skeptic wins top award Dr David Sackett - Gairdner Wightman Award
Medical skeptic wins top award
A pioneer of McMaster University's medical school has been recognized with a prestigious international award for his groundbreaking research, which he dedicated to the millions of patients in history who have been wronged by doctors prescribing "dumb treatments."
Wednesday, April 01, 2009
Comparisons of Patient and Physician Expectations for Cancer Survivorship Care
Purpose: To compare expectations for cancer survivorship care between patients and their physicians and between primary care providers (PCPs) and oncologists.
Conclusion: Patients and physicians have discordant expectations with respect to the roles of PCPs and oncologists in cancer survivorship care. Uncertainties around physician roles and responsibilities can lead to deficiencies in care, supporting the need to make survivorship care planning a standard component in cancer management.
2009 publication: American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008 (including risk categories)
Alternatively, reference the NCCN Guidelines (http://www.nccn.org)
2009 Hon Justice Margaret A. Cameron: Commission of Inquiry on Hormone Receptor Testing Canada
About the Inquiry
The Commission of Inquiry on Hormone Receptor Testing was established by the Government of Newfoundland and Labrador under the Public Inquiries Act, 2006 on July 3, 2007. The Honourable Margaret A. Cameron was appointed Commissioner.
Genetic testing for Lynch Syndrome in the first year of colorectal cancer: a review of the psychological impact
Conclusion:
This review identifies the psychological impact of colorectal
cancer during the first year after treatment and
indicates specific subgroups of patients with colorectal
cancer who could be vulnerable for genetic-testing-related
distress. Most of the retrieved studies on diagnostic genetic
testing for Lynch syndrome exclusively measured distress
prior to genetic test disclosure and focused on patients who
were diagnosed with colorectal cancer several years ago.
Therefore, we are still unable to identify the psychological
impact of genetic testing for Lynch syndrome in recently
diagnosed patients with colorectal cancer.
Vancouver Coastal Health Research Institute - News Releases - $15 Million Donation Launches Research Centre at VGH - Wed Apr 1, 2009
The seven-storey, 69,350 sq. ft. (6,442 sq.m.) facility will house three of VGH's key research programs: the Vancouver Prostate Centre at VGH; the Centre for Hip Health and Mobility; and the Ovarian Cancer Research Initiative.
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."
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