Wednesday, January 30, 2013
Risk of Asynchronous Contralateral Breast Cancer in Noncarriers of BRCA1 and BRCA2 Mutations With a Family History of Breast Cancer: A Report From the Women's Environmental Cancer and Radiation Epidemiology Study
Risk of Asynchronous Contralateral Breast Cancer in Noncarriers of BRCA1 and BRCA2 Mutations With a Family History of Breast Cancer: A Report From the Women's Environmental Cancer and Radiation Epidemiology Study
Conclusion
Young women with breast cancer who have a family history of breast cancer and who test negative for deleterious mutations in BRCA1 and BRCA2 are at significantly greater risk of CBC than other breast cancer survivors. This risk varies with diagnosis age, family history of CBC, and degree of relationship to an affected relative. Women with a first-degree family history of bilateral disease have risks of CBC similar to mutation carriers. This has important implications for the clinical management of patients with breast cancer with family history of the disease.
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Estimating the Risk for Contralateral Breast Cancer as a Guide for Surgical Treatment
by Steven Narod
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Incidental Genitourinary Findings on Obstetrics/Gynecology Ultrasound
Incidental Genitourinary Findings on Obstetrics/Gynecology Ultrasound
Abstract
Abstract: Ultrasound is the standard-of-care imaging
modality for initial imaging in obstetrics and gynecology. Given the
close proximity of the genitourinary system to the uterus and adnexa, it
is not surprising that these studies can result in the discovery of
incidental genitourinary findings such as ureterocele, ectopic ureter,
bladder mass, ureteral stones, cystitis, bladder diverticulum, and
pelvic kidney. Recognition of the etiology of these findings is
important for appropriate diagnosis and, at times, patient care. Many of
these findings are truly incidental and clinically unimportant but
other times can be related to the patient’s chief complaint.
ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass.
From Wikipedia, the free encyclopedia
| Adnexal mass | |
|---|---|
~~~~~~~~~~~~~~
ACR Appropriateness Criteria® Clinically Suspected Adnexal Mass.:
Abstract
ABSTRACT:
Adnexal masses are a common problem clinically and imaging-wise, and transvaginal US (TVUS) is the first-line imaging modality for assessing them in the vast majority of patients. The findings of US, however, should be correlated with the history and laboratory tests, as well as any patient symptoms. Simple cysts are uniformly benign, and most warrant no further interrogation or treatment. Complex cysts carry more significant implications, and usually engender serial ultrasound(s), with a minority of cases warranting a pelvic MRI. Morphological analysis of adnexal masses with gray-scale US can help narrow the differential diagnosis. Spectral Doppler analysis has not proven useful in most well-performed studies. However, the use of color Doppler sonography adds significant contributions to differentiating between benign and malignant masses and is recommended in all cases of complex masses. Malignant masses generally demonstrate neovascularity, with abnormal branching vessel morphology. Optimal sonographic evaluation is achieved by using a combination of gray-scale morphologic assessment and color or power Doppler imaging to detect flow within any solid areas.The ACR Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Erythropoiesis-stimulating agents (ESAs): Do they still have a role in chemotherapy-induced anemia (CIA)?
Erythropoiesis-stimulating agents (ESAs): Do they still have a role in chemotherapy-induced anemia (CIA)?
Abstract
PURPOSE:
Anemia in cancer patients can be a result of the underlying cancer or related to treatment. Erythropoiesis-stimulating agents (ESAs) are an important option for many patients with chemotherapy-induced anemia, but are immersed in controversy. This article aims to reconcile conflicting opinions and provide expert guidance for appropriate ESA use.METHODS:
Teleconference, email, and a face-to-face meeting were used to assess ESA therapy "interpretive" data, which included two current meta-analyses, expert guidelines, and regulatory approved indications from Canada, Europe, and the USA.RESULTS:
Risks and benefits are associated with both red blood cell transfusions and ESA therapy, including improvements in hemoglobin levels and quality of life. ESAs have been associated with concerns regarding survival and progression of cancer, particularly when used in patients with cancer-related anemia.CONCLUSION:
Although safety concerns do exist, ESA therapy can be considered for use in patients with chemotherapy-induced anemia in accordance with Health Canada labeling.Attributable causes of breast cancer and ovarian cancer in china: reproductive factors, oral contraceptives and hormone replacement therapy.
Attributable causes of breast cancer and ovarian cancer in china: reproductive factors, oral contraceptives and hormone replacement therapy.
Abstract
OBJECTIVE:
To provide an evidence-based, consistent assessment of the burden of breast cancer attributable to reproductive factors (RFs, including nulliparity, mean number of children, age at first birth and breastfeeding), use of oral contraceptives (OCs, restricted to the age group of 15-49 years), and hormone replacement therapy (HRT), as well as of the burden of ovarian cancer attributable to the mean number of children in China in 2005.METHODS:
We derived the prevalence of these risk factors and the relative risk of breast and ovarian cancer from national surveys or large-scale studies conducted in China. In the case of RFs, we compared the exposure distributions in 2001 and counterfactual exposure.RESULTS:
Exposure of RFs in 2001 was found to account for 6.74% of breast cancer, corresponding to 9,617 cases and 2,769 deaths, and for 2.78% of ovarian cancer (711 cases, 294 deaths). The decrease in mean number of children alone was responsible for 1.47% of breast cancer and 2.78% of ovarian cancer. The prevalence of OC use was 1.74% and the population attributable fraction (PAF) of breast cancer was 0.71%, corresponding to 310 cases and 90 deaths. The PAF of breast cancer due to HRT was 0.31%, resulting in 297 cases and 85 deaths.CONCLUSION:
RFs changes in China contributed to a sizable fraction of breast and ovarian cancer incidence and mortality, whereas HRT and OCs accounted for relatively low incidence of breast cancer in China.Tuesday, January 29, 2013
Patient-Centered Outcomes Research Institute Seeks Applications for Advisory Panels -- WASHINGTON, Jan. 29, 2013 /PRNewswire-USNewswire/ --
Patient-Centered Outcomes Research Institute Seeks Applications for Advisory Panels -- WASHINGTON, Jan. 29, 2013 /PRNewswire-USNewswire/ --
WASHINGTON, Jan. 29, 2013
/PRNewswire-USNewswire/ -- The Patient-Centered Outcomes Research
Institute (PCORI) today began inviting applications for its first four PCORI Advisory Panels as part of its ongoing effort to engage a broad range of healthcare stakeholders as partners in its research agenda.
PCORI
is seeking patients, caregivers, clinicians, researchers, other members
of the healthcare community and the general public to serve on advisory
panels on Assessment of Prevention, Diagnosis, and Treatment Options;
Improving Healthcare Systems; Addressing Disparities; and Patient
Engagement...........
open access: BJC - Implementing improved post-treatment care for cancer survivors in England, with reflections from Australia, Canada and the USA
British Journal of Cancer - Implementing improved post-treatment care for cancer survivors in England, with reflections from Australia, Canada and the USA
Defining cancer survivorship
- Defining cancer survivorship
- The challenges around cancer survivorship
- Traditional follow-up for cancer patients
- Barriers to ideal post-treatment care
- The National Cancer Survivorship Initiative
- Reflections from Australia
- Reflections from Canada
- Reflections from the United States of America
- Other countries
- Conclusions
- References
- Figures and Tables
The Value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration
The Value of 18F-FDG PET/CT in recurrent gynecologic malignancies prior to pelvic exenteration
Results
33
patients(mean age 56 years,range:28–81) were included; primary sites of
disease were the cervix (n = 18), uterus (n = 8) and vagina/vulva
(n = 7). AUCs for organ invasion ranged from 0.74-0.96. There was a
significant association between FDG uptake metrics incorporating tumor
volume (TLG and MTV) and OS (p ≤ 0.001) as well as between MTV and PFS
(p = 0.001). No significant association was identified between SUVmax
and OS/PFS (p = 0.604/0.652). Inter-reader agreement for organ invasion
was fair to substantial (k = 0.36-0.74) and almost perfect for FDG
quantification (ICC = 0.97-0.99).
Conclusion
In patients undergoing pelvic exenteration for recurrent gynecological malignancies, 18 F-FDG
PET/CT is useful for preoperative assessment of disease extent.
Furthermore, quantitative metrics of FDG uptake incorporating MTV serve
as predictive biomarkers of progression-free and overall survival in
this population.
Highlights
►
18 F-FDG PET/CT had high accuracy for the evaluation of disease extent
prior to pelvic exenteration for recurrent gynecological cancer.
► Quantitative FDG uptake metrics incorporating tumor volume (total lesion glycolysis and metabolic tumor volume) are significantly associated with overall survival.
► No significant association was identified between SUVmax and overall survival.
► Quantitative FDG uptake metrics incorporating tumor volume (total lesion glycolysis and metabolic tumor volume) are significantly associated with overall survival.
► No significant association was identified between SUVmax and overall survival.
Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer
Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer
Conclusions
Malignant bowel
obstruction is a common complication of ovarian cancer. Management is
palliative; risks and benefits of any therapy must be considered.
Percutaneous decompressive therapy provides relief from associated
symptoms, and allows patients to be discharged home. Median survival in
this group is limited, and decisions regarding aggressive therapy should
be individualized.
The Effect of the APPRISE Mandate on Use of Erythropoiesis-Stimulating Agents and Transfusion Rates in Patients With Ovarian Cancer Receiving Chemotherapy
The Effect of the APPRISE Mandate on Use of Erythropoiesis-Stimulating Agents and Transfusion Rates in Patients With Ovarian Cancer Receiving Chemotherapy:
Objective: Erythropoiesis-stimulating agents (ESAs) support chemotherapy-induced anemia in patients with epithelial ovarian cancer (EOC). In response to research demonstrating that ESAs increase tumor growth and shorten survival, the Food and Drug Administration mandated the new APPRISE (Assisting Providers and Cancer Patients with Risk Information for the Safe use of ESAs) guidelines for consenting patients before ESAs administration. We sought to quantify the change in ESA and red blood cell (RBC) transfusion use after the APPRISE mandate was instituted.Methods/Materials: After institutional review board approval, a retrospective chart review compared patients with EOC undergoing chemotherapy before and after the APPRISE mandate. Abstracted data included patient demographics, chemotherapy treatment status and regimen, and number of patients requiring ESAs or RBCs. A cost savings analysis was also performed.
Results: Eighty-four patients who underwent 367 cycles of chemotherapy after the APPRISE guidelines were compared with a matched set of 88 patients receiving 613 cycles of chemotherapy before the APPRISE guidelines. There were no statistically significant differences between the groups. Most patients had advanced stage disease and received primary taxane-/platinum-based chemotherapy. Of 88 patients, 45 (51%) in the pre-APPRISE group received a total of 196 ESA injections compared with 0 patients in the post-APPRISE group. Red blood cell transfusion in the post-APPRISE group was similar to that in the pre-APPRISE group (8.3% vs 14.8%, P = 0.28). Omission of ESAs in the post-APPRISE group resulted in a roughly $700,000 savings in billable charges.
Conclusions: In our institution, the APPRISE guidelines have resulted in complete cessation of the use of ESAs in patients with primary or recurrent EOC, resulting in considerable cost savings. Importantly, RBC transfusion rates did not significantly increase after the guidelines were imposed.
Weekly Administration of Bevacizumab, Gemcitabine, and Oxaliplatin in Patients With Recurrent and Refractory Ovarian Cancer: A Preliminary Result of 19 Cases
Weekly Administration of Bevacizumab, Gemcitabine, and Oxaliplatin in Patients With Recurrent and Refractory Ovarian Cancer: A Preliminary Result of 19 Cases:
Objective: Combination therapy using gemcitabine with oxaliplatin (GEMOX) showed moderate activity in recurrent ovarian cancers. However, severe toxicities have been observed in patients who received full-dose therapy of GEMOX. On the other hand, bevacizumab enhances chemotherapeutic efficacy in various cancers. Here, we evaluated the effect of weekly low-dose administration of GEMOX in combination with bevacizumab (B-GEMOX) for patients with recurrent and refractory ovarian cancers (ROCs).Methods: A total of 19 patients with ROC were treated with B-GEMOX: 2 mg/kg of bevacizumab, 300 mg/m2 of gemcitabine, and 30 mg/m2 of oxaliplatin, 3 weeks on and 1 week off, q4weeks. The treatment was continued until development of severe toxicities or progressive disease. Tumor responses were assessed using the Response Evaluation Criteria in Solid Tumors and Gynecologic Cancer Intergroup criteria.
Results: Median number of the B-GEMOX therapy was 5 cycles. Response was observed in 4 (34%) cases by Response Evaluation Criteria in Solid Tumors, and in 2 (29%) cases by Gynecologic Cancer Intergroup criteria, resulting in overall response rate of 32%. Clinical benefit excluding progressive disease was obtained in 79% of the patients. Median progression-free survival was 4.5 months (range, 2–16+ months). Toxicities were mild and mainly consisted of hematologic, gastrointestinal, and neuropathy; however, there were no nonhematologic toxicities more than grade 1.
Conclusions: Weekly administration of B-GEMOX was active for patients with ROC and showed mild toxicities. These results warrant further prospective studies for patients with ROC.
British Columbia: The Impact of Geographic Variations in Treatment on Outcomes in Ovarian Cancer
The Impact of Geographic Variations in Treatment on Outcomes in Ovarian Cancer:
Objective: There are significant regional differences in survival outcomes across British Columbia among women with ovarian cancer. The age-adjusted hazard ratio for mortality is 1.27 (95% confidence interval, 1.08–1.49) in 1 health authority region compared to the provincial mean. The objective of this study was to look at variations in the treatment of epithelial ovarian cancer among the 5 health authority regions in the province of British Columbia and determine their effect on survival.Methods and Materials: This was a population-based retrospective cohort study of all incident cases of epithelial ovarian cancer diagnosed in British Columbia from 2005 to 2008. Health authority regions were compared with the χ2 test for demographic and disease characteristics, as well as treatment practices including assessment by a gynecologic oncologist, rate of optimal debulking, and proportion receiving platinum-based combination chemotherapy. Multivariable Cox regression analysis evaluated the effect of covariates on survival.
Results: There were 854 evaluable patients. Across health authority regions, there were significant differences in disease characteristics, including the proportion with serous histotype (44.0%–60.7%, P = 0.043) and stage IIIC/IV disease (50.3%–69.4%, P = 0.0048). There were also significant differences in treatment, including the proportion of patients assessed by a gynecologic oncologist (56.8%–79.4%, P = 0.0003), rate of suboptimal debulking, (21.4%–60.2%, P = 0.0036), and the proportion receiving combination chemotherapy, (61.5%–81.9%, P < 0.0001). Cox regression model revealed that stage, grade, optimal debulking, and combination chemotherapy were significantly associated with survival. The health authority region with the highest mortality had the lowest rate of optimal debulking and combination chemotherapy.
Conclusions:
Differences in survival rates for ovarian cancer across British Columbia can be attributed to variations in disease characteristics and treatment, particularly rates of optimal debulking and combination chemotherapy.
Nomogram to Predict the Probability of Relapse in Patients Diagnosed With Borderline Ovarian Tumors
Nomogram to Predict the Probability of Relapse in Patients Diagnosed With Borderline Ovarian Tumors:
Objective: This study aimed to develop a nomogram predicting the probability of relapse in individual patients who have surgery for borderline ovarian tumors (BOTs).
Methods: This retrospective study included 801 patients with BOT diagnosed between 1985 and 2008 at 6 gynecologic cancer centers. We analyzed covariates that were associated with the risk of developing a recurrence by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The 5 most significant or clinically important variables associated with an increased risk of recurrence were included in the nomogram. The nomogram was internally validated.
Results: Fifty-one patients developed a recurrence after a median observation period of 57 months. Age at diagnosis, the International Federation of Gynecology and Obstetrics stage, cell type, preoperative serum CA125, and type of surgery (radical vs fertility-sparing) were associated with an increased risk of recurrence and were used in the nomogram. Bootstrap-corrected concordance index was 0.67 and showed good calibration.
Conclusions: Five factors that are commonly available to clinicians treating patients with BOT were used in the development of a nomogram to predict the risk of recurrence. The nomogram will be useful to counsel patients about risk-reduction strategies to minimize the risk of recurrence or to inform patients about a very low risk of recurrence making intensive follow-up unwarranted.
Survivin Status Affects Prognosis and Chemosensitivity in Epithelial Ovarian Cancer
Survivin Status Affects Prognosis and Chemosensitivity in Epithelial Ovarian Cancer:
Objective: The objective of this study was to explore the clinical significance of survivin expression in epithelial ovarian cancer (EOC) and the effect of survivin small hairpin RNA (shRNA) on survivin expression, apoptosis, and chemosensitivity in the human ovarian cancer cell line OVCAR3.Methods: A retrospective review of 90 consecutive EOC patients with a median follow-up time of 51 months was conducted. Survivin expression was examined by immunohistochemistry.....
Results: Positive cytoplasmic expression of survivin was associated with advanced International Federation of Gynecology and Obstetrics (FIGO) stage, nonmucinous type, high grade, and recurrence. Positive survivin expression was also associated with platinum resistance (r = 0.306, P = 0.003). Statistical results indicated that FIGO stage (hazard rate = 1.649, P = 0.047) and cytoplasmic expression of survivin (hazard rate = 1.734, P = 0.010) were independent prognostic factors. Survivin mRNA and protein levels were lower in OVCAR3S (ovarian cancer cells transfected with a survivin recombinant vector) cells at 24 hours after transfection as compared with controls. The flow cytometric analysis revealed that survivin shRNA induced accumulation of cells in the G0/Gl phase, with a decrease in G2/M phase cells following 24 hours of culture as compared with a nontransfected group (P < 0.01). Furthermore, survivin shRNA increased the sensitivity of OVCAR3 cells to paclitaxel 15-fold (P < 0.05), whereas it had no significant effect on cisplatin (P > 0.05).
Conclusions: In addition to FIGO stage, cytoplasmic survivin protein expression is an independent molecular marker for predicting EOC prognosis. Sequence-specific shRNA targeting survivin can effectively suppress survivin expression, enhance apoptosis, and increase the sensitivity of ovarian cancer cells to paclitaxel but not to cisplatin.
Long Term Survival of Ovarian Endometriosis Associated Clear Cell and Endometrioid Ovarian Cancers
Abstract
Objective: This study aimed to analyze long-term
survival of clear cells (CCs) and endometrioid (E) ovarian cancer cases
according to presence of endometriosis in the pathologic report.
Methods: This is a retrospective analysis of 47 CC and
66 E ovarian cancer cases observed consecutively at our center between
1990 and 2010. All cases had first surgery at our center or were referred to it for treatment and follow-up. Cases were identified according to the original diagnosis reported in clinical records. All pathologic reports were reviewed, and cases were
classified with or without pathologic evidence of endometriosis on the
basis of the pathologic report. Follow-up was updated in March 2011. The follow-up median was 147 months (range, 116–171).
Results: Endometriosis-associated ovarian cancer cases
were more frequently diagnosed at stage I to II than cases without
endometriosis: among the 36 endometriosis-associated ovarian cancer
cases, 25 (69%) were at stage I or II, and the corresponding value was
35 (46%) of 77 among cases without endometriosis (P = 0.0173).
The presence of endometriosis tended to be associated
with a higher 10-year survival rate: after taking the potential
confounding effect of stage into account, the finding was not
statistically significant (hazards ratio, 0.7; 95% confidence interval,
0.3–1.5).
Conclusions: This analysis shows that EA CCs and E
ovarian cases are diagnosed at an earlier stage than cases without
endometriosis. No clear association emerged between presence of
endometriosis and survival.
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