OVARIAN CANCER and US

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Friday, April 06, 2012

Happy Easter!



Cancer's epicentre - The Economist



Cancer's epicentre - The Economist:


Cancer's epicentre
The Economist

THE biggest conceptual breakthrough in the war on cancer was the realisation by the 1980s that it is always a genetic disease. Sometimes the genetic flaw is inherited. Sometimes it is the result of exposure to an outside agent such as tobacco smoke or radioactivity. Sometimes it is plain bad luck; a miscopying of a piece of DNA during the normal process of cell division.
Turning that breakthrough into medicine, though, is hard. No one has worked out how to repair DNA directly. It is, rather, a question of discovering the biochemical consequences of the genetic damage and trying to deal with those instead. But recently, another pattern has emerged. It is too early to call it a breakthrough as significant as the cancer-is-caused-by-broken-genes finding, but it might be.......

short video: Kaiser Health (U.S.) Q&A: Should You Have Access To Your Lab Results? - Kaiser Health News



Q&A: Should You Have Access To Your Lab Results? - Kaiser Health News

abstract: Incontinence after colonoscopy - an unrecognized and preventable problem. A cross-sectional study from the Gastronet quality assurance program



 Abstract

"Female patients had a higher risk of incontinence than men."

Background: 
Colonoscopy requires insufflation of gas for visualization of the bowel wall. Worldwide, this is usually done using air. The aim of the present study was to assess the risk of post colonoscopy incontinence, and to investigate whether insufflation of CO2 instead of air may reduce this risk, since it is easily absorbed through the bowel mucosa.
 

Conclusion:
About every 20th patient undergoing colonoscopy using standard air insufflation experiences post examination incontinence. This proportion can be reduced by 60 % by converting from air insufflation to insufflation with the absorbable CO2.

abstract: The effect of hysterectomy on survival of patients with borderline ovarian tumors (repost)



The effect of hysterectomy on survival of patients with borderline ovarian tumor

Objective
The classically recommended surgical treatment of borderline ovarian tumors (BOTs) includes hysterectomy in addition to bilateral adnexectomy. Possible reasons for hysterectomy might be a high frequency of uterine involvement and its favorable effect on survival. The purpose of the present study was to assess the frequency of uterine involvement in patients with BOTs and the effect of hysterectomy on survival.

Methods
All incident cases of histological confirmed BOTs diagnosed in Israeli Jewish women between March 1 1994 and June 30 1999, were identified. Clinical and pathological characteristics were abstracted from medical records. Patients with tumors grossly confined to the ovaries (apparently stage I) were considered to have had surgical staging when at least hysterectomy, bilateral salpingooophorectomy, omentectomy and pelvic lymph node sampling were done.

Results 
The study group comprised 225 patients. Hysterectomy was performed in 147 (65.31%) patients and uterine involvement was present in only 3 (2.0%) of them. The 13 year survival of the total group of patients was 85.8% and of those in apparent stage I, 88.5%. Among patients with tumors apparently confined to the ovaries, no significant survival difference was observed between unstaged and surgically staged patients. There was also no survival difference between the overall staged and unstaged patients and between patients in stages II–III who did and did not undergo hysterectomy.

Conclusions 
Our data indicate that the rate of uterine involvement in BOT is low and that hysterectomy does not favorably affect survival. The necessity of hysterectomy in BOT patients is questioned.

abstract: A phase II evaluation of belinostat and carboplatin in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube, or primary peritoneal carcinoma: A gynecologic oncology group study



A phase II evaluation of belinostat and carboplatin in the treatment of recurrent or persistent platinum-resistant ovarian, fallopian tube, or primary peritoneal carcinoma: A gynecologic oncology group study:

Background
Patients with recurrent ovarian cancer have limited options, especially in the context of relapse less than six months from primary platinum-based therapy. This Gynecologic Oncology Group (GOG) study was conducted to evaluate the impact of the histone deacetylase inhibitor, belinostat, in combination with carboplatin in women with platinum-resistant ovarian cancer.

Methods 
Eligible patients had measurable, recurrent disease within six months of their last dose of a platinum-based combination. Belinostat was dosed at 1000mg/m2 daily for five days with carboplatin AUC 5 on day three of 21-day cycles. The primary endpoint was overall response rate (ORR), using a two-stage design.

Results
Twenty-nine women enrolled on study and 27 were evaluable. The median number of cycles given was two (range 1–10). One patient had a complete response and one had a partial response, for an ORR of 7.4% (95% CI, .9%–24.3%). Twelve patients had stable disease while eight had increasing disease. Response could not be assessed in five (18.5%). Grade 3 and 4 events occurring in more than 10% of treated patients were uncommon and limited to neutropenia (22.2%), thrombocytopenia (14.8%), and vomiting (11.1%). The median progression-free survival (PFS) was 3.3months and overall survival was 13.7months. PFS of at least six months was noted in 29.6% of patients. Due to the lack of drug activity, the study was closed after the first-stage.

Conclusions 
The addition of belinostat to carboplatin had little activity in a population with platinum-resistant ovarian cancer.

abstract: Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy



Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy

Objective 

To evaluate the predictive power of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC).


Conclusions 
Patients who undergo NACT-IDS achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤100U/mL were highly likely to be cytoreduced to no residual disease.

Witnessing, Experiencing Traumatic Events May Worsen Heart Disease - MedicineNet



Witnessing, Experiencing Traumatic Events May Worsen Heart Disease - MedicineNet

WEDNESDAY, April 4 (HealthDay News) -- Large amounts of lifetime exposure to traumatic stress -- even when it doesn't result in post-traumatic stress disorder -- boosts inflammation levels in heart disease patients, a new study suggests.......

no abstract: Obstetrics and Gynecology Clinics of North America | ScienceDirect.com



 Blogger's Note: this journal is subscriber based, this article has no abstract

Obstetrics and Gynecology Clinics of North America (journal)



Trends in Gynecologic Cancer Care in North America

Review Article
In Press, Corrected Proof, Available online 5 April 2012
Clare Reade, Laurie Elit
Close Close preview  |   PDF (705 K)   |   Related articles  |  Related reference work articles    Abstract | Figures/Tables | References

No abstract is available for this article.

Thursday, April 05, 2012

abstract: Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.



Blogger's Note: while this article is specific to BRCA 1/2 it also would apply to other genetic syndromes eg. Lynch Syndrome, Peutz-Jeghers 
             ~~~~~~~~~~~~~~~

Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions.:


Genet Med. 2011 Dec;13(12):998-1005

Abstract
PURPOSE:
Approximately 5-10% of patients who undergo genetic testing of BRCA1 and BRCA2 receive a variant of unknown significance (VUS) result. The ambiguous nature of a VUS may increase difficulty in patient understanding and decision making regarding risk reduction and surveillance options, including cancer risk-reducing surgeries. VUS reclassification to benign or deleterious may occur in time; however, clinical decisions may need to be made expeditiously, and some patients may pursue irreversible treatments before VUS reclassification.

METHODS:
We reviewed the surgical decisions of 107 women postdisclosure of a BRCA VUS result counseled at our institute between 1998 and 2009.

CONCLUSION:
Among women receiving a BRCA VUS result at our center, 11 of 107 (10.3%) pursued cancer risk-reducing mastectomy and 22 of 107 (20.6%) pursued cancer risk-reducing bilateral salpingo-oophorectomy. Reclassification of VUS occurred up to 9 years after testing, and 5 of 22 (22.7%) women followed up for 8 or more years continue to have a VUS result. We discuss considerations for providers of genetic services to discuss with patients who receive a VUS result.



abstract: Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling.



Eligibility criteria in private and public coverage policies for BRCA genetic testing and genetic counseling

Genet Med. 2011 Dec;13(12):1045-50. doi: 10.1097/GIM.0b013e31822a8113.

Abstract

PURPOSE:

Coverage policies for genetic services for hereditary cancers are of interest because the services influence cancer risk reduction for both persons with cancer and their family members. We compared coverage policies for BRCA genetic testing and genetic counseling among selected payers in the United States to illuminate eligibility criteria variation that may explain differential access by insurance type. We compared these policies with policies for breast cancer screening with magnetic resonance imaging to consider whether payers apply a unique policy approach to genetic services.

METHODS:

We conducted a case study of large private and public payers selected on number of covered lives. We examined coverage policies for BRCA genetic testing, genetic counseling, and screening with magnetic resonance imaging and the eligibility criteria for each. We compared eligibility criteria against National Comprehensive Cancer Network guidelines.

RESULTS:

Eligibility criteria for BRCA testing were related to personal history and family history of cancer. Although private payers covered BRCA testing for persons with and without cancer, the local Medicare carrier in our study only covered testing for persons with cancer. In contrast, Arizona's Medicaid program did not cover BRCA testing. Few payers had detailed eligibility criteria for genetic counseling. Private payers have more detailed coverage policies for both genetic services and screening with magnetic resonance imaging in comparison with public payers.

CONCLUSION:

Despite clinical guidelines establishing standards for BRCA testing, we found differences in coverage policies particularly between private and public payers. Future research and policy discussions can consider how differences in private and public payer policies influence access to genetic technologies and health outcomes.

abstract: Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer (HNPCC/Lynch Syndrome) and Siblings Carrying Germline Mismatch Repair Gene Mutations



Microsatellite Instability in Saliva from Patients with Hereditary Non-polyposis Colon Cancer and Siblings Carrying Germline Mismatch Repair Gene Mutations

"Saliva testing, a less-invasive procedure than PBL ( peripheral blood lymphocytes) testing, is more sensitive and appears to be a viable alternative for identifying MSI in carriers with MMR mutations."

abstract: Assessing residents' disclosure of adverse events: traditional objective structured clinical examinations versus mixed reality.



Assessing residents' disclosure of adv... [J Obstet Gynaecol Can. 2012] - PubMed - NCBI


J Obstet Gynaecol Can. 2012 Apr;34(4):367-73.

Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON.

Abstract

Objective: 
The skill of disclosing adverse events is difficult to assess. Assessment of this competency in medical trainees is commonly achieved via the objective structured clinical examination (OSCE) using a standardized patient (SP). We hypothesized that the addition of a simulated clinical adverse event prior to the SP encounter could increase trainees' engagement and empathy, thereby improving performance. The objective of this study was to explore whether experiencing a simulated adverse event prior to an SP encounter alters resident performance on a disclosure OSCE.


Conclusion: 
The assessment of adverse event disclosure was not enhanced by the addition of a simulated experience. Study participants reported that the simulation did not provide the contextual information required to elicit empathy and a sense of being emotionally invested in the adverse event.

press release: Community Oncology Continues Precipitous Consolidation of Cancer Care -- WASHINGTON, April 4, 2012 /PRNewswire/ --



Community Oncology Continues Precipitous Consolidation of Cancer Care -- WASHINGTON, April 4, 2012 /PRNewswire/ --

Community Oncology Practice Impact Report Apr 4, 2013 (U.S. closures etc by state)_4-4-12F.pdf (application/pdf Object)



Community_Oncology_Practice_Impact_Report_4-4-12F.pdf (application/pdf Object)

"This is an update to the last Community Oncology Alliance (COA) Practice Impact Report, which was issued on 3/31/11. This report is derived from a tracking database on the changing oncology treatment landscape. The database is compiled from private and public sources.
Included in this report are a table of impacted practices by state and a map depicting the impact.

• As of the date of this update, 1,254 clinics/practices during the past 4½ years have been impacted as follows:

— 241 Clinics Closed — Denotes individual clinic sites that have closed.
— 442 Practices Struggling Financially — Denotes practices (possibly comprised of multiple clinic sites) that have financial difficulties......

Aprl 5th, 2012: Who Gets Ovarian Cancer? | Mayo Clinic Podcasts



Who Gets Ovarian Cancer? | Mayo Clinic Podcasts


Who Gets Ovarian Cancer?


When it comes to ovarian cancer, are you at risk?  In this Medical Edge Radio episode, Mayo Clinic Dr. Paul Haluska provides some insight.
To listen, click the link below.
Who Gets Ovarian Cancer

Google Scholar search: Low-Grade Ovarian Serous Neoplasms (Low-Grade Serous Carcinoma and Serous Borderline Tumor) Associated With High-Grade Serous Carcinoma - Google Scholar



Blogger's Note: search results may not be totally specific


Scholar      Create email alertResults 1 - 10 of about 72.

repost from Sept 2011 - abstract: Suicide in women with gynecologic cancer(priority posting)



abstract: Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM



Suicide and Cardiovascular Death after a Cancer Diagnosis — NEJM

Free Preview

Background

Receiving a diagnosis of cancer is a traumatic experience that may trigger immediate adverse health consequences beyond the effects of the disease or treatment.

Conclusions

In this large cohort study, patients who had recently received a cancer diagnosis had increased risks of both suicide and death from cardiovascular causes, as compared with cancer-free persons.

abstract: Phase II Study of Gemcitabine and Docetaxel in Recurrent Platinum Resistant Ovarian Cancer



Abstract

To evaluate the activity of gemcitabine and docetaxel in patients with recurrent ovarian cancer.

Methods: 
Patients with platinum-resistant disease and prior treatment with paclitaxel received treatment with docetaxel on day 1 and gemcitabine on days 1 and 8, repeated every three weeks.

Results: 
Twenty patients, with a platinum-free interval of three months, were enrolled. Overall response rate was 25%. Treatment was associated with significant myelosuppression.

Conclusions: 
In chemotherapy-resistant patients, this regimen exhibited encouraging activity. Excessive myelosuppression led to early closure. This was prevented by administering docetaxel on day 8 (instead of day 1) and prophylactic use of G-CSF. (blood products)

abstract: Ovarian cancer: insights into genetics and pathogeny



Abstract

".......The classic conception of ovarian cancer pathogeny, based on the role of the ovarian surface epithelium, is currently reconsidered, and a novel hypothesis is formulated, which supports direct involvement of the Fallopian tubes for the serous type. Although recent research suggests the implication of immune/inflammatory cells by specific mechanisms in ovarian cancer pathogenesis, there is yet reliable evidence concerning their modality of direct action and/or modulation of tumoral growth. Thus, ovarian carcinogenesis remains a research challenge....

abstract: Meta-analysis on the association between non-steroidal anti-inflammatory drug use and ovarian cancer.






Abstract

Aim: 
Animal and in vitro studies suggest that the use of non-steroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk for ovarian cancer; however, results from these studies have been inconsistent. The aim of our study is to review and summarize the evidence provided by longitudinal studies on the association between NSAID use and ovarian cancer risk.

Methods:
A comprehensive literature search for articles published up to December 2011 was performed. Prior to performing a meta-analysis, the studies were evaluated for publication bias and heterogeneity. Relative risk (RR) or odds ratio (OR) were calculated.


Conclusions: 
Our findings indicate that there is no strong evidence of an association between Aspirin/NA-NSAID use and ovarian cancer. However, this subject deserves further investigation.


Wednesday, April 04, 2012

financial news: Arrayit Diagnostics, Inc. Reports Results of Research Study for Ovarian Cancer Diagnostic Test (OvaDx)



Arrayit Diagnostics, Inc. Reports Results of Research Study for Ovarian Cancer Diagnostic Test

" Arrayit Corporation and Arrayit Diagnostics, Inc. ("AD") report significant results from a 257 patient research study on its pre-symptomatic ovarian cancer molecular diagnostic test in development, OvaDx(R). In this study, OvaDx(R) recorded sensitivity of 79.7%, correctly identifying patients known to have cancer, and specificity approaching 100%, correctly identifying the healthy controls, patients known not to have cancer......

NCCN.com - Evidence-Based Cancer Guidelines and Treatment Summaries for Patients (sundry topics)



NCCN.com - Evidence-Based Cancer Guidelines and Treatment Summaries for Patients

NCCN.com Puts the Focus on Living With Cancer...

VIDEO: How to Maintain Good Bone Health During Cancer Treatment

NCCN Guidelines: Ovarian Cancer March 2012



Blogger's Note: the pdf link below requires registration (free), alternatively go to: http://www.nccn.org and click on guidelines 3/2012 version shows (pages 4/5) changes from 2/2012  version; most recent version includes 'language' changes, category recommendations (eg. highly recommended, neoadjuvant therapy, CA125/clinical relapse/re-treatment, LMP, fertility issues, 'malignant' sex chord stromal, stage 1 added (stages 11-1V) to certain pages....) 

NCCN Guidelines: Ovarian Cancer 2012

Phase 2 Study Update of Selumetinib for Ovarian Cancer - MPR



Blogger's Note: more info req'd eg. side effects....

Phase 2 Study Update of Selumetinib for Ovarian Cancer - MPR

Array BioPharma announced results of a Phase 2 trial of selumetinib in women with recurrent low-grade serous ovarian or peritoneal cancer.

In the trial, 52 women each received 100mg doses of selumetinib orally twice daily in four-week cycles until disease progression or toxicity. The median number of cycles received was 4.5; 33% underwent ≥12 cycles. Prior to the trial, 58% of the patients in the trial had received three or more rounds of chemotherapy.

A disease control rate, defined as either complete or partial response or progression-free survival or progression-free survival of greater than 6 months, occurred in 81% of patients. Eight patients had complete (1) or partial (7) responses, and 34 (63%) had progression-free survival of >6 months. The median survival rate without cancer progression was 11 months.

Selumetinib is an anti-cancer drug in Phase 2 development in a range of tumors. It is a small molecule MEK inhibitor that targets a key position in the Ras-Raf-MEK-ERK signaling pathway. MEK has been shown to be frequently activated in cancer, in particular in tumors that have mutations in the RAS and RAF pathways.

For more information call (877) MED-CHEM or visit www.arraybiopharma.com

abstract: Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer - Segelman - 2012 - British Journal of Surgery - Wiley Online Library




Peritoneal Carcinomatosis (Creighton University) includes a variety of tumors that present with extensive metastasis throughout the peritoneal cavity (inside surface of the abdomen) and can be found with gall bladder, liver, colon, appendix, ovarian, pancreas, mesothelioma, pseudomyxoma peritonei, rectal, small bowel and stomach cancers. It is a broad description in which multiple tumors develop in and line the peritoneal abdominal cavity and linings.

          ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

 Incidence, prevalence and risk factors for peritoneal carcinomatosis from colorectal cancer - Segelman - 2012 - British Journal of Surgery

Abstract

Background:

This was a population-based cohort study to determine the incidence, prevalence and risk factors for peritoneal carcinomatosis (PC) from colorectal cancer.

Methods:

Prospectively collected data were obtained from the Regional Quality Registry. The Cox proportional hazards regression model was used for multivariable analysis of clinicopathological factors to determine independent predictors of PC.

Results:

All 11 124 patients with colorectal cancer in Stockholm County during 1995–2007 were included and followed until 2010. In total, 924 patients (8·3 per cent) had synchronous or metachronous PC. PC was the first and only localization of metastases in 535 patients (4·8 per cent). The prevalence of synchronous PC was 4·3 per cent (477 of 11 124). The cumulative incidence of metachronous PC was 4·2 per cent (447 of 10 646). Independent predictors for metachronous PC were colonic cancer (hazard ratio (HR) 1·77, 95 per cent confidence interval 1·31 to 2·39; P = 0·002 for right-sided colonic cancer), advanced tumour (T) status (HR 9·98, 3·10 to 32·11; P < 0·001 for T4), advanced node (N) status (HR 7·41, 4·78 to 11·51; P < 0·001 for N2 with fewer than 12 lymph nodes examined), emergency surgery (HR 2·11, 1·66 to 2·69; P < 0·001) and non-radical resection of the primary tumour (HR 2·75, 2·10 to 3·61; P < 0·001 for R2 resection). Patients aged > 70 years had a decreased risk of metachronous PC (HR 0·69, 0·55 to 0·87; P = 0·003).

Conclusion:

PC is common in patients with colorectal cancer and is associated with identifiable risk factors.

Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients



Cancer effect on periprocedural thromboembolism and bleeding in anticoagulated patients:

Background:
Patients with active cancer are often on chronic anticoagulation and frequently require interruption of this treatment for invasive procedures. The impact of cancer on periprocedural thromboembolism (TE) and major bleeding is not known.

Patients and methods:
Two thousand one hundred and eighty-two consecutive patients referred for periprocedural anticoagulation (2484 procedures) using a standardized protocol were followed forward in time to estimate the 3-month incidence of TE, major bleeding and survival stratified by anticoagulation indication. For each indication, we tested active cancer and bridging heparin therapy as potential predictors of TE and major bleeding.

Results:
Compared with patients without cancer, active cancer patients (n = 493) had more venous thromboembolism (VTE) complications (1.2% versus 0.2%), major bleeding (3.4% versus 1.7%) and reduced survival (95% versus 99%). Among active cancer patients, only those chronically anticoagulated for VTE had higher rates of periprocedural VTE (2% versus 0.16%;) and major bleeding (3.7% versus 0.6%). Bridging with heparin increased the rate of major bleeding in cancer patients (5% versus 1%;) without impacting the VTE rate (0.7% versus 1.4%,).

Conclusions:
Cancer patients anticoagulated for VTE experience higher rates of periprocedural VTE and major bleeding. Periprocedural anticoagulation for these patients requires particular attention to reduce these complications.

abstract: Cancer of unknown primary (CUP): does cause of death and family history implicate hidden phenotypically changed primaries?



Blogger's Note: paid subscription required to view full paper, the 'burning' question in the abstract is what other 7 cancers ??
                           ~~~~~~~~~~~~~~~~~~

Cancer of unknown primary (CUP): does cause of death and family history implicate hidden phenotypically changed primaries?

Abstract

Background: Cancer of unknown primary (CUP) is diagnosed at the metastatic stage. We aimed to identify hidden primary cancers in CUP patients by comparison with cancers in family members. We take use of the fact that the cause of death in CUP patients is often coded as the cancer in the organ of fatal metastasis. 

Patients and methods: Forty-one thousand five hundred and twenty-three CUP patients were identified in the Swedish Family-Cancer Database, and relative risks (RRs) were calculated for cancer in offspring when family members were diagnosed with CUP and died of the cancer diagnosed in offspring. 

Results: The RR for lung cancer in offspring was 1.85 when a family member was diagnosed with CUP and died of lung cancer. Significant familial associations were found for seven other cancers. Many familial associations were also significant when offspring CUP patients died of the cancer diagnosed in family members. 

Conclusions: The cause of death after CUP diagnosis frequently matched the cancer found in a family member, suggesting that the CUP had originated in that tissue. The metastasis had probably undergone a phenotypic change, complicating pathological tissue assignment. These novel data suggest that some CUP cases are phenotypically modified primary cancers rather than cancers of unknown primaries.

Talking to Your Child About Cancer - MD Anderson



Talking to Your Child About Cancer

A cancer diagnosis can create a variety of questions for patients who have children. The first question many parents ask is, "How do I talk to my child about cancer?"

Whether you're wondering how to tell your child about your diagnosis, treatment, progression or recurrence, there are quite a few things to consider before beginning these important discussions.

To start, consider your child's age and developmental stage. Some children are too young to verbalize questions and others may be too afraid to ask. Also, what does your child already know about cancer?

What is the best approach?
It's common for parents to protect their children by withholding information that may be upsetting, but research shows the following:
  1. A parent's cancer diagnosis affects a child whether or not the child is informed of the condition. 1
  2. Anxiety levels are higher in children who aren't informed about their parent's condition, compared to children where the issue is discussed.
  3. For parents of teenagers, an important aspect of coping is ongoing communication between the teens and their parents during the course of the illness. 2
So, what does this research mean to parents? Simply put, it means that honest, age-appropriate communication is best. How do I talk to my child about cancer?
First, it's crucial to say the word "cancer." This is essential so the child will not associate the parent's diagnosis with another illness children can catch, like the flu or a cold. The following are common questions many children have, and they're important points to consider while talking with your child:
  • Can I catch cancer?
  • How does cancer happen?
  • Is it my fault my mom or dad got cancer?
  • Will my mom or dad die from cancer?
Remember that children may not ask these outright, but many will be wondering about them. Because children pick up on social cues, they may sometimes create scenarios in their heads far worse than reality when not given honest communication about what's happening.

Honest and age-appropriate communication with children models the behavior that it's OK to ask and talk about cancer. 

further details: FDA MedWatch - Altuzan (bevacizumab): Counterfeit Product - Contains no Active Ingredient



Subject: Apr 3rd FDA MedWatch - Altuzan (bevacizumab): Counterfeit Product - Contains no Active Ingredient

Altuzan (bevacizumab): Counterfeit Product - Contains no Active Ingredient


ISSUE: FDA lab tests have confirmed that a counterfeit version of Roche’s Altuzan 400mg/16ml (bevacizumab),an injectable cancer medication, found in the U.S. contains no active ingredient. Even if the identified drugs were not counterfeit, Altuzan is not approved by FDA for use in the United States (it is an approved drug in Turkey).

BACKGROUND: Medical practices obtained the counterfeit Altuzan and other unapproved products through foreign sources, in particular from Richards Pharma, also known as Richards Services, Warwick Healthcare Solutions, or Ban Dune Marketing Inc (BDMI).  Many, if not all, of the products sold and distributed through this distributor have not been approved by the FDA. Pictures of the counterfeit version of Altuzan are shown in the FDA statement. Packaging or vials found in the U.S. that claim to be Roche’s Altuzan with lot number B6021 should be considered counterfeit.
RECOMMENDATION: Any medical practice that has obtained unapproved products, in particular from Richards Pharma, Richards Services, Warwick Healthcare Solutions, or Ban Dune Marketing Inc (BDMI), should stop using them and contact the FDA.  The products should be retained and securely stored until further notice by the FDA.
FDA is asking the public to report suspect counterfeit products and other suspect products obtained from Richards Pharma, Richards Services, Warwick Healthcare Solutions, Ban Dune Marketing Inc (BDMI), or other sources:
Call FDA’s Office of Criminal Investigations (OCI) at 800-551-3989, or  
Visit OCI’s Web site (www.accessdata.fda.gov/scripts/email/oc/oci/contact.cfm), or
Email - DrugSupplyChainIntegrity@fda.hhs.gov

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:
  • Complete and submit the report Online: www.fda.gov/MedWatch/report.htm
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178
Read the MedWatch safety alert, including links to the FDA statement, at:
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm298583.htm

You are encouraged to report all serious adverse events and product quality problems to FDA MedWatch at www.fda.gov/medwatch/report.htm

5 Health Problems Linked to Height - ABC News



5 Health Problems Linked to Height - ABC News

 5 Health Problems Linked to Height

Cancer
A new study suggests taller women have heightened risk for ovarian cancer, a disease that kills nearly 15,000 American women each year, according to the U.S. Centers for Disease Control and Prevention.
British researchers reviewed data from 47 studies involving more than 100,000 women. For every 5-centimeter (2-inch) increase in height above the average 5 feet 3, the risk of ovarian cancer rose 7 percent, according to the study published Tuesday in the journal PLoS Medicine.
In July 2011, a study published in the Lancet Oncology found taller women had an increased risk of 10 different cancers, including breast and skin cancer. And taller men have an increased risk of prostate cancer, according to a 2008 study published in the journal Cancer Epidemiology, Biomarkers & Prevention.
"One of the big surprises in cancer has been the potential impact of early life nutritional factors on long-term cancer risk," said Dr. Tim Byers, a professor of preventive medicine and biometrics at the University of Colorado Cancer Center in Denver. "I think height is an indicator of some risk factor, but we don't know what the mechanism is."
The findings offer little comfort for tall men and women, whose height -- guided by genes, nutrition and other environmental influences -- was established in their 20s. But Byers said taller people should not worry any more, nor should shorter people worry any less, about their cancer risk.

Heart Disease

Stroke

Alzheimer's Disease

Diabetes  



open access: Apr 3 - PLoS Medicine: Ovarian Cancer and Body Size: Individual Participant Meta-Analysis Including 25,157 Women with Ovarian Cancer from 47 Epidemiological Studies



 Published: April 3, 2012

PLoS Medicine: Ovarian Cancer and Body Size: Individual Participant Meta-Analysis Including 25,157 Women with Ovarian Cancer from 47 Epidemiological Studies

Background

Only about half the studies that have collected information on the relevance of women's height and body mass index to their risk of developing ovarian cancer have published their results, and findings are inconsistent. Here, we bring together the worldwide evidence, published and unpublished, and describe these relationships.........

Why Was This Study Done?

To date, there is no definitive information about the relevance of women's height, weight, and body mass index to their subsequent risk of developing ovarian cancer. There have been roughly 50 epidemiological studies of ovarian cancer, but only about half of these studies have published results on the association between body size and ovarian cancer risk, and so far, these findings have been inconsistent. Therefore, the researchers—an international collaboration of researchers studying ovarian cancer—re-analyzed the available epidemiological evidence to investigate the relationship between ovarian cancer risk and adult height, weight, and body mass index, and to examine the consistency of the findings across study designs.

Conclusions

Ovarian cancer is associated with height and, among never-users of hormone therapy, with body mass index. In high-income countries, both height and body mass index have been increasing in birth cohorts now developing the disease. If all other relevant factors had remained constant, then these increases in height and weight would be associated with a 3% increase in ovarian cancer incidence per decade.



Lists - Choosingwisely - "Five Things Physicians and Patients Should Question" 9 U.S. specialty society lists (gyn oncology is not specifically listed)



Lists - Choosingwisely

Lists

Nine United States specialty societies representing 374,000 physicians developed lists of "Five Things Physicians and Patients Should Question" in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.
These lists represent specific, evidence-based recommendations physicians and patients should discuss to help make wise decisions about the most appropriate care based on their individual situation. Each list provides information on when tests and procedures may be appropriate, as well as the methodology used in its creation.
What tests and procedures should patients and physicians talk about? Read the lists:

open access: Microsatellite Instability and DNA Mismatch Repair Protein Deficiency in Lynch Syndrome Colorectal Polyps - multinational study



Blogger's Note: as determined by the title, focus is on colorectal cancer in Lynch Syndrome; see also prior posting Diagnosing Lynch Syndrome: More Light at the End of the Tunnel which gives a more comprehensive overall view of Lynch Syndrome

                           ~~~~~~~~~~~~~~~~~

Microsatellite Instability and DNA Mismatch Repair Protein Deficiency in Lynch Syndrome Colorectal Polyps

"Lynch syndrome results from germline mutations in one
of the genes involved with DNA mismatch repair (MMR):
MLH1, MSH2, MSH6, PMS2, or EPCAM/TACSTD."

"The aim of this study was to determine the prevalence
of MSI and loss of MMR protein expression by immunohistochemistry
in colorectal polyps from patients with genetically confirmed Lynch syndrome."






open access: Perspectives - Diagnosing Lynch Syndrome: More Light at the End of the Tunnel



Diagnosing Lynch Syndrome: More Light at the End of the Tunnel

"Lynch syndrome is one of the most commonly inherited
cancer conditions, accounting for 2% to 4% of colorectal
cancer (CRC) cases. The population frequency of Lynch
syndrome is slightly more than one in 500 individuals (1).
In addition to a 50% to 80% lifetime risk of CRC, patients
with Lynch syndrome have a 40% to 60% risk of uterine
cancer and an elevated risk of ovarian, pancreatic, gastric,
upper-urinary tract, renal, biliary, small bowel, and central
nervous system (CNS) malignancies.

"Colorectal surveillance of persons with this condition leads to greatly reduced CRC incidence and mortality. Appropriately timed hysterectomy and ovarectomy likewise results in a reduced incidence of malignancies in these organs. The diagnosis of Lynch syndrome is thus critical to the prevention and early detection of cancer in affected persons and families, notwithstanding that the effectiveness of screening patients with Lynch syndrome for non colorectal and non uterine malignancies remains uncertain. As will be discussed later, the article by Yurgelun and colleagues in this issue of the journal provides an important new tool for the diagnosis of Lynch syndrome (2).
The major issue in Lynch syndrome remains failure to
diagnose for a variety of reasons......."

".....It seems that MSI or immunohistochemical
testing in uterine cancers may be as effective as in
CRCs and therefore should also be considered in evaluating
persons and families for Lynch syndrome (17, 18). Whether
tumor testing in other (nonuterine or noncolorectal)
Lynch-associated malignancies would be as effective is
unclear....."

"............Next generation sequencing also may soon
be available for individual testing at reasonable costs.
Such new testing developments may well make direct-to-genetic
testing based on risk increasingly attractive. At
some point, general testing for an inherited syndrome
without regard to risk may even become a reality, which would get the diagnosis of Lynch syndrome out of the tunnel altogether."

open access: American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs: The Top Five List for Oncology



American Society of Clinical Oncology Identifies Five Key Opportunities to Improve Care and Reduce Costs The Top Five List for Oncology

 1. Do not use cancer-directed therapy for patients with solid tumors
who have the following characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and with no strong evidence supporting the clinical value of further anticancer treatment.
2. Don’t perform PET, CT and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.
3. Don’t perform PET, CT and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis
4. Don’t perform surveillance testing (biomarkers) or imaging (PET, CT and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
5. Don’t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20% risk for this complication

Tuesday, April 03, 2012

Apr 3rd early release: United States Cancer Statistics Public Information Data - Cancer Statiistics (searchable by organ site/state/age....)



United States Cancer Statistics Public Information Data

CDC's Division of Cancer Prevention and Control is pleased to announce the early release of National Program of Cancer Registries (NPCR) cancer incidence data for the years 1999–2009 to facilitate cancer control planning. The data are available through CDC WONDER at http://wonder.cdc.gov/cancer.html.
The data from selected NPCR registries cover between 86% and 96% of the United States population, depending on the specific year of diagnosis. This release is part of the NPCR Data Release Plan and is based on the NPCR Cancer Surveillance System 2012 data submission.
CDC WONDER is an online query system that produces age-adjusted and crude rates in tabular, map, and chart formats. Variables include year of diagnosis, state, region or division of the United States, sex, race, ethnicity, age, primary site, and childhood cancer.



National Program of Cancer Registries (NPCR)
Division of Cancer Prevention and Control (DCPC)
Centers for Disease Control and Prevention (CDC)