PLoS ONE: Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

PLoS ONE: Multiple Miscarriages Are Associated with the Risk of Ovarian Cancer: Results from the European Prospective Investigation into Cancer and Nutrition

Study Population

EPIC is a prospective cohort study initiated in 1992 in 10 European countries: Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom. Between 1992 and 2000, a total of 519,978 men and women were recruited.......

Abstract (and full text)

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010......

Discussion 

In this large prospective cohort study, we observed a 2-fold increased risk of epithelial ovarian cancer among women with 4 of more miscarriages.
This is the first prospective study that investigated the association of multiple miscarriages with ovarian cancer. Most case-control studies only investigated ever versus never had a miscarriage and did not observe an association [5].......

paywalled: Meta-analysis of gene expression profiles associated with histological classification and survival in 829 ovarian cancer samples - International Journal of Cancer

Meta-analysis of gene expression profiles associated with histological classification and survival in 829 ovarian cancer samples - Fekete - 2011 - International Journal of Cancer

Abstract

Transcriptomic analysis of global gene expression in ovarian carcinoma can identify dysregulated genes capable to serve as molecular markers for histology subtypes and survival. The aim of our study was to validate previous candidate signatures in an independent setting and to identify single genes capable to serve as biomarkers for ovarian cancer progression. As several datasets are available in the GEO today, we were able to perform a true meta-analysis. First, 829 samples (11 datasets) were downloaded, and the predictive power of 16 previously published gene sets was assessed. Of these, eight were capable to discriminate histology subtypes, and none was capable to predict survival. To overcome the differences in previous studies, we used the 829 samples to identify new predictors. Then, we collected 64 ovarian cancer samples (median relapse-free survival 24.5 months) and performed TaqMan Real Time Polimerase Chain Reaction (RT-PCR) analysis for the best 40 genes associated with histology subtypes and survival. Over 90% of subtype-associated genes were confirmed. Overall survival was effectively predicted by hormone receptors (PGR and ESR2) and by TSPAN8. Relapse-free survival was predicted by MAPT and SNCG. In summary, we successfully validated several gene sets in a meta-analysis in large datasets of ovarian samples. Additionally, several individual genes identified were validated in a clinical cohort.

Three Abstracts on the ChemoFx(R) Drug Response Marker Accepted by ASCO - MarketWatch

Three Abstracts on the ChemoFx(R) Drug Response Marker Accepted by ASCO - MarketWatch

".....The third abstract titled, In Vitro Chemoresponse Assay Results and Population Clinical Response Rates in Women with Ovarian Cancer, determines whether in vitro platinum sensitivity rates are similar to published population response rates for ovarian cancer and examines differences in platinum sensitivity across histologic subtypes."

"We are very pleased with the outcomes to date from these three studies," says Dr. Karl Williams, Chief Medical Director for Precision Therapeutics, Inc. "We look forward to watching these projects progress and further analyzing the value of ChemoFx for these difficult to treat patients." 

For more information, visit: www.precisiontherapeutics.com or www.chemofx.com .

SOURCE: Precision Therapeutics Inc.

Editorial: Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

Blogger's Note: read the whole editorial for further information regarding colonoscopies, this blog also has trial data on colonoscopies/research/opinions

Why You Should Care about Screening Flexible Sigmoidoscopy — NEJM

"...The real question for U.S. (blogger's note: and others)  clinicians is whether we are prepared to refocus attention on a screening strategy that has been likened to performing mammography on one breast..."

...Where does this leave us with regard to screening flexible sigmoidoscopy? First, it should be acknowledged that flexible sigmoidoscopy reduces colorectal-cancer incidence and mortality for the portion of the colon that it is designed to examine. Next, high-quality evidence must show the superiority of colonoscopy over other screening tests before we dismiss the use of flexible sigmoidoscopy and fecal occult-blood testing, both of which have randomized, controlled trials supporting their benefit. Especially critical are data that confirm the ability of colonoscopy to reduce mortality from proximal cancers. Finally, patient preferences for screening tests should be identified and respected — in this case, the best test is the one that gets done.

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

New Data Concludes Wait Times for Patients With Gastrointestinal Disease Are Increasing Across Canada - MarketWatch

OAKVILLE, ONTARIO, May 17, 2012 (MARKETWIRE via COMTEX) -- The Canadian Association of Gastroenterology (CAG) today joined the Ontario Association of Gastroenterology (OAG) in voicing their objection to the Government of Ontario's May 7, 2012 decision to overhaul the fee structure for approximately 40 medical procedures and services that Ontario doctors provide. Colonoscopies are among the medical tests for which professional fees face a cut of 10%.

Pointing to new initial data gathered in April 2012 from the Canadian Association of Gastroenterology Survey of Access to GastroEnterology (SAGE), Desmond Leddin, Lead of the SAGE, says "a comparison of data from surveys performed in 2005 and 2008 shows that wait times for patients with gastrointestinal disease have increased across Canada."

"This CAG national survey information combined with the new fee structure in Ontario gives us cause for concern about patient safety," says CAG President Dan Sadowski.

"With evidence in hand that patient wait times have been increasing over the past seven years, we can't support any government decision - in Ontario or elsewhere in Canada - that results in reduced access to, or longer wait times for, important medical procedures including colonoscopy, which can prevent and reduce cancer rates.".....

Roche will report new data on important progress for people with advanced cancers at ASCO 2012 - AURELIA trial ovarian/Avastin+

Roche will report new data on important progress for people with advanced cancers at ASCO 2012

Data from AURELIA, the first Phase III study of Avastin plus chemotherapy in people with platinum-resistant recurrent ovarian cancer will be presented. This study will be highlighted as part of ASCO’s official press program.

Another coffee observational study - another round of misplaced emphasis - Health News Review

Another coffee observational study - another round of misplaced emphasis - Health News Review

Trying to keep up with health care ethics (mis)adventures - Health News Review

Trying to keep up with health care ethics (mis)adventures - Health News Review

Petitions | The White House re: free access to scientific journal articles....

Petitions | The White House

we petition the obama administration to:

Require free access over the Internet to scientific journal articles arising from taxpayer-funded research.

Genetic Testing and Counseling Nevada Surgery and Cancer Care

Genetic Testing and Counseling | NVSCC: Nevada Surgery and Cancer Care

 Genetic Testing and Counseling

We offer:

Genetic Counseling and Genetic Screening for Breast, Ovarian and Colorectal Cancer.

• Personal or Family History of Breast and Ovarian Cancer*

Do you have any of the following?......
( * Hereditary Breast and Ovarian Cancer (HBOC) syndrome is an inherited condition that causes an increased risk for ovarian, breast, pancreatic and prostate cancer. The vast majority of hereditary breast and ovarian cancer is due to an alteration or gene mutation in either the BRCA1 or BRCA2 genes. These gene mutations can be inherited from either your mother or father.)

• Personal and Family History of Colorectal Cancer

Do you have any of the following?.......
(* Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC), is an inherited condition that causes an increased risk for early onset colorectal cancer (often before age 50) as well as other related cancers†. The majority of Lynch Syndrome is due to a mutation in the MLH1, MSH2 or MSH6 genes. These mutations can be inherited from either your mother or father.
† colorectal, endometrial, stomach, ovarian, kidney/urinary tract, brain, small bowel, pancreatic, sebaceous adenoma/carcinoma)

U.S. Medicare - new - 'Blue Button' MyMedicare.gov: Portal of Personalized Information

MyMedicare.gov: Portal of Personalized Information

 What's New?

Blue Button is here! Blue Button allows you to download your data to a text file. Look for the Blue Button as you search claims and view your On the Go Report.

• Learn More

What does it mean to say that something causes 16% of cancers? | Not Exactly Rocket Science | Discover Magazine

What does it mean to say that something causes 16% of cancers? | Not Exactly Rocket Science | Discover Magazine

Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.

 Blogger's Note: varying studies show different %'s of ARID1A gene expression in clear cell ovarian cancer
                         ~~~~~~~~~~~~~~~~~~~~~~~~
Loss of ARID1A expression is related to shorter progression-free survival and chemoresistance in ovarian clear cell carcinoma.:

Mod Pathol. 2012 Feb;25(2):282-8

Abstract
Recently, the ARID1A gene has been identified as a novel tumor suppressor in ovarian clear cell carcinoma. The prognostic significance of the loss of ARID1A expression is not known. The current study was designed to evaluate whether ARID1A was a prognostic factor for progression, survival, and chemoresistance in ovarian clear cell carcinoma.

Microscopic Hematuria Not Predictive of Cancer

Microscopic Hematuria Not Predictive of Cancer

"In 4414 patients with asymptomatic microscopic hematuria, the rate of urinary tract cancer was 2.1%, (compared with the 0.43% the researchers previously found)."

American Urological Association (AUA) 2012 Annual Scientific Meeting: Abstract 62. Presented May 19, 2012

Canadian breast implant cohort: Extended follow-up of cancer incidence - Pan - 2012 - International Journal of Cancer - Wiley Online Library

Canadian breast implant cohort: Extended follow-up of cancer incidence -  International Journal of Cancer

Abstract

Cosmetic breast implants are not associated with increased breast cancer incidence, but variations of risk according to implant characteristics are still poorly understood. As well, the assessment of cancer risk for sites other than breast needs to be clarified. The purpose of this study was to fill these research gaps. This study presents an extended analysis of 10 more years of follow-up of a large Canadian cohort of women who received either cosmetic breast implants (n = 24,558) or other cosmetic surgery (15,893). Over 70% of the implant cohort was followed for over 20 years. Cancer incidence among implant women was compared to those of controls using multivariate Poisson models and the general female population using the standardized incidence ratios (SIRs). Women with breast implants had reduced rates of breast and endometrial cancers compared to other surgery women. Subglandular implants were associated to a reduced rate of breast cancer compared to submuscular implants [incidence rate ratio (IRR) = 0.78, 95% confidence interval (CI) = 0.63–0.96] and this reduction persisted over time. We observed a sevenfold increased rate (IRR = 7.36, 95% CI = 1.86–29.12) of breast cancer in the first 5 years after the date of surgery for polyurethane-coated subglandular implant women but this IRR decreased progressively over time (p value for trend = 0.02). We also observed no increased risk of rarer forms of cancer among augmented women. A reduction in breast cancer incidence was observed for women with subglandular implants relative to women with submuscular implants. Possible increase of breast cancer incidence shortly after breast augmentation with polyurethane implants needs to be verified.

paywalled: Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy.

Quality of Life After Surgery for Colon Cancer in Patients With Lynch Syndrome: Partial Versus Subtotal Colectomy

BACKGROUND:: Lynch syndrome is a disorder caused by mismatch repair gene mutations. Mutation carriers have a high risk of developing colorectal cancer. In patients with Lynch syndrome in whom colon cancer has been diagnosed, in general, subtotal colectomy instead of partial colectomy is recommended because of the substantial risk of metachronous colorectal cancer. However, the effect of more extensive surgery on quality of life and functional outcome is unknown. 

 OBJECTIVE:: The aim of this study was to investigate quality of life and functional outcome in patients with Lynch syndrome after partial colectomy and subtotal colectomy.

paywalled: Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.

Antigen-specific immunotherapy in ovarian cancer and p53 as tumor antigen.:

Abstract
Immunotherapy for ovarian cancer is one of the new treatment strategies currently investigated in epithelial ovarian cancer. This review discusses the results of different immunization strategies, identifies possible drawbacks in study design and provides potential solutions for augmentation of clinical efficacy. A potential target for cancer immunotherapy is p53, as approximately 50% of ovarian cancer cells carry p53 mutations. Therefore we review the immunological and clinical responses observed in ovarian cancer patients vaccinated with p53 targeting vaccines in particular. In most studies antigen-specific vaccine-induced immunological responses were observed. Unfortunately, no clinical responses with significant reduction of tumor-burden have been reported. Based on the currently available results we emphasize the necessity of multimodality treatment of ovarian cancer, combining classical cytoreductive surgery, (neo) adjuvant chemotherapy, immunotherapy and/or targeted therapy.

paywalled: Models of care in outpatient cancer centers [Nurs Econ. 2012 Mar-Apr] - PubMed - NCBI

Nurs Econ. 2012 Mar-Apr;30(2):108-16.

Models of care in outpatient cancer centers.

Abstract

While rapid changes in the treatment of cancer have been driven by research-based evidence, innovations in cancer care delivery have lagged behind that seen in cancer treatment. A literature review and ten semi-structured interviews were conducted to identify models of care in the ambulatory oncology setting to be adopted by a comprehensive cancer center. Four models were identified from the literature review but none were widely recognized or adopted by administrators. Findings suggested some common themes that should be included in an optimal model of care. These themes are in support of the burgeoning efforts seen in the promotion of interprofessional education and practice for quality improvement. Unique challenges related to the contextual factors in the ambulatory oncology settings suggest quality improvement interventions should be tailored to meet the specific needs of the care facility and its workforce.

2nd report: Stats Canada - Conditional survival analyses across cancer sites

 Blogger's Note: html version; stop reading if looking for ovarian cancer specfic references

Conditional survival analyses across cancer sites

For this article...

• Abstract
• News release in The Daily
• Tables and figures
• References
• To extract charts and tables
• Download PDF of article

"Survival statistics are an indicator of the effectiveness of cancer detection and treatment.¹  These statistics are used to compare cancer control over time² and across jurisdictions.^3,4  They are also of interest to clinicians providing direct care and to patients, who usually want an estimate of their prognosis.⁵
Survival estimates are typically presented as the probability—or the ratio of observed and expected probabilities in the case of relative survival—of surviving a given length of time (for example, five years) after diagnosis.  However, these estimates are less informative for people who have survived one or more years, as the risk of death due to cancer is often greatest in the first few years.  After this initial period, the prognosis can improve substantially, so the earlier estimates no longer apply.⁶ The outlook for such people can be estimated more appropriately using conditional survival.
For the first time in Canada, predicted conditional relative survival estimates are presented for a large number of cancers.  Cancers with the greatest relative improvement in prognosis since diagnosis are highlighted.  Cancers showing less improvement are also identified. (See The data)

2012 Canadian trends in cancer prevalence - Stats Canada

Blogger's Note: aside from 2 lines of stats, there is no specific reference/s to ovarian cancer (use search term: ovary)

(html version) http://www.statcan.gc.ca/pub/82-003-x/2012001/article/11616-eng.htm

 pdf - Canadian trends in cancer prevalence

"In Canada, the rate at which new cancer cases are diagnosed continues to
rise,4 and survival is also increasing.5-7 A recent study provided a detailed report of cancer prevalence in Canada as of January 1, 2005.8 However, cancer prevalence trends are rarely published, and until now, have not been reported for Canada......

Conclusion
This study presents the f rst Canadian cancer prevalence trend estimates to be reported. Trends in prevalence for an extensive list of cancers by time since diagnosis, sex and age group signachanges in the extent of disease in the Canadian population. Rising cancer prevalence proportions are due to increases in incidence, which partly result from the aging of the population, and to improvements in survival. Information about the degree to which changes in prevalence are occurring, and for which cancers in particular, is valuable for
resource planning

Chapter 22: Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf

Integration of Herbal Medicine into Evidence-Based Clinical Practice - Herbal Medicine - NCBI Bookshelf

In this Page

• INTRODUCTION
• CURRENT STATUS AND MAJOR ISSUES OF INTEGRATION OF HERBAL MEDICINE IN EVIDENCE-BASED MEDICAL THERAPY
• FACTORS RELEVANT TO/AFFECTING INTEGRATION OF HERBAL MEDICINE INTO MODERN MEDICAL PRACTICES
• RESEARCH NEEDS
• CONCLUSIONS
• REFERENCE

"....However, proof of efficacy or safety for the vast majority of herbal medicine has not been fully established through an evidence-based approach. Further, other issues, such as scientific, cultural, educational, economical, and legal, need to be addressed. In this chapter, we examine the current status and major scientific issues or factors that affect the integration of herbal medicine into evidence-based medical therapy."

 

ACKNOWLEDGMENTS

The authors wish to thank the WHO Collaborating Centre for Traditional Medicine at the School of Health Sciences, RMIT University, Bundoora, Victoria, Australia, and the WHO Collaborating Centre for Traditional Medicine at the College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, for their consent and encouragement to undertake the present collaboration.

 

Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance

Multiple VEGF Family Members are Simultaneously Expressed in Ovarian Cancer: a Proposed Model for Bevacizumab Resistance.:


Curr Pharm Des. 2012 May 14;

Abstract
Objective Insight into the expression of multiple vascular endothelial growth factor (VEGF) family members can support the implementation of anti-angiogenic therapy. This study aimed to assess VEGF family member expression in ovarian cancers and related omental metastases.

Methods Tissue microarrays encompassing 270 primary cancers and 112 paired metastases were immunostained for VEGF-A, VEGF-B, VEGF-C and VEGF-D. Staining intensities were categorized as absent, weak, moderate or strong. Expression was related to clinicopathological characteristics and survival.

Results Immunohistochemical positivity (defined as moderate or strong expression) was observed for VEGF-A in 90%, VEGF-B in 4%, VEGF-C in 41% and VEGF-D in 55% of the primary ovarian cancers. ....... VEGF family member expression showed no independent prognostic significance in multivariate survival analysis.

Conclusion VEGF-A, VEGF-C and VEGF-D are widely and often simultaneously expressed in ovarian cancer, which may contribute to bevacizumab resistance. Measuring their expression could support a rational, individualized choice of anti-angiogenic therapy and might be of predictive value. Studies are warranted to determine whether combinatorial analysis of VEGF family member expression can be used to predict anti-angiogenic drug efficacy.

The role of bevacizumab in advanced epithelial ovarian cancer.

The role of bevacizumab in advanced epithelial ovarian cancer.:

The role of bevacizumab in advanced epithelial ovarian cancer.
Curr Pharm Des. 2012 May 14;

Abstract
Background: There is a strong rationale for usage of anti-angiogenic agents in epithelial ovarian cancer. Bevacizumab is the most widely investigated anti-VEGF agent and has shown promising results in recent clinical trials.

Objective: To review the rationale and usage of bevacizumab in advanced epithelial ovarian cancer; as mono-therapy, in combination with chemotherapy both as first line and for recurrent ovarian cancer as well as in combination with other targeted therapies.

Results: In epithelial ovarian cancer, angiogenesis promotes tumor growth, ascites formation and metastasis. Targeting VEGF in ovarian cancer patients may have indirect and direct cytotoxic effects. Results of placebo controlled phase III trials, the GOG-218 and ICON7, of carboplatin-paclitaxel alone or combined with bevacizumab in chemo-naive patients and the OCEAN trial comparing carboplatin-gemcitabine with or without bevacizumab in women with recurrent platinum-sensitive epithelial ovarian cancer all suggest a benefit for the addition of bevacizumab on progression free survival. Additionally, bevacizumab in combination with other targeted therapies, such as sorafenib and everolimus are under investigation in phase II trials and the current knowledge of molecular predictors is discussed.

In conclusion: Until now no survival benefit has been observed, but bevacizumab is the first anti-angiogenic agent demonstrating a progression free survival benefit in addition to standard chemotherapy regimens in advanced epithelial ovarian cancer, both in the upfront and recurrent setting. Mature overall survival data and the search for predictive biomarkers are important for the future role of bevacizumab in epithelial ovarian cancer.

paywalled: Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]

Guideline-Based Peer-to-Peer Consultation Optimizes Pegfilgrastim Use With No Adverse Clinical Consequences [Original Contributions]:

Purpose:
Practice guidelines do not recommend the routine use of colony-stimulating factors when there is a low risk (< 10%) of febrile neutropenia (FN). We prospectively determined whether expert peer-to-peer consultation with prescribing oncologists would improve adherence to guidelines and whether there would be any adverse events associated with that adherence.

Methods:
Commencing in March 2010, we reviewed requests for pegfilgrastim from 22 community oncology practices comprising 78 physicians providing service to approximately 97,000 Medicare members. Paid claims data on all chemotherapy and supportive care medications were reviewed from fourth quarter (Q4) 2009 through third quarter (Q3) 2010. In total, 82 patients received pegfilgrastim. If the prescribed chemotherapy was associated with a low risk (< 10%) for FN, then a peer review was initiated. The treating physician made the final decision to use, or not use, pegfilgrastim, and no denials were issued.

Results:
A total of 245 units (1 unit = 6 mg) of pegfilgrastim were administered during the four quarters analyzed. Use in the low-risk category decreased from 52 units in Q4 2009 to 15 units in Q3 2010. The per-member per-month (PMPM) cost of pegfilgrastim decreased across quarters, with an average cost of $1.07 PMPM for Q4 2009 and $0.57 PMPM for Q3 2010. No studied patient was admitted for neutropenic fever.

Conclusion:
Active expert peer-to-peer consultation with prescribing oncologists can promote adherence to guidelines and potentially lead to significant cost reductions without significant risk of neutropenic fever, with or without hospitalization, for patients with cancer.

paywalled: Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]

Patient Out-of-Pocket Payments for Oral Oncolytics: Results From a 2009 US Claims Data Analysis [Original Contributions]:

Purpose:
Oral oncolytics are an increasingly important treatment option for cancer. These agents often fall within the pharmacy benefit, with the potential for increased out-of-pocket (OOP) cost burden for patients. The purpose of this study was to evaluate patient OOP payments for oral oncolytic therapies in US managed care plans.

Conclusion:
Among 21 oral oncolytics, average OOP cost ranged from $15 to > $500. These results confirm previous findings showing OOP payments differing widely among oral oncolytic options. As cost for therapy becomes a greater part of treatment decisions, an understanding of patient OOP cost will be critical in informing choices.