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Saturday, March 31, 2012

Hartzband and Groopman on the Rise of the Medical Expertocracy - WSJ.com



 Blogger's Note: a little political commentary thrown in but overall a good article, book reference

Hartzband and Groopman on the Rise of the Medical Expertocracy - WSJ.com

Alex Nabaum


"Patients and doctors can differ with experts and not be ignorant or irrational. Policy makers need to abandon the idea that experts know what is best. In medical care, the "right" clinical decisions turn out to be those that are based on a patient's goals and values."

Screening of symptomatic women for ovarian cancer: 4 articles (correspondence -RECAP OF LINKS) : The Lancet Oncology : Volume 13, Number 4, 1 April 2012



Blogger's Note: with some exceptions, the Lancet is a subscriber based journal ($$$), registration (free) may be required to view abstracts and/or articles

The Lancet Oncology : Volume 13, Number 4, 1 April 2012


e137 - open access
Screening of symptomatic women for ovarian cancer
Christopher P Crum
e137 - open access
Screening of symptomatic women for ovarian cancer
Alicia A Tone, David G Huntsman, Dianne M Miller
e138 - open access
Screening of symptomatic women for ovarian cancer
Aleksandra Gentry-Maharaj, Jatinderpal Kalsi, Matthew Burnell, Ranjit Manchanda, Usha Menon
e139 - open access (authors' response)
Screening of symptomatic women for ovarian cancer – Authors' reply
Lucy Gilbert, Olga Basso, for the DOvE Study Group

Commentary: Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology



Aromatase inhibitors and musculoskeletal adverse events : The Lancet Oncology

".........Because symptom collection is so variable between trials, researchers could look for correlations between changes in patient-reported quality of life and breast-cancer outcomes. Nevertheless, if clinical research confirms a link between emergent symptoms or changes in quality of life and breast-cancer outcomes, further pharmacogenomic and pharmacogenetic studies could help to elucidate the mechanisms. Although confirmation of the association between emergent symptoms with aromatase inhibitors and risk of breast-cancer recurrence would help to guide clinical advice, based on current evidence clinicians should not use the onset of musculoskeletal symptoms to infer which patient will, or will not, benefit from adjuvant treatment with aromatase inhibitors."

(Apr 2012) Commentary: Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology



Link between endometriosis and ovarian-cancer subtypes : The Lancet Oncology


"Previous large epidemiological studies have attempted to identify benign gynaecological disorders that predispose to the development of epithelial ovarian cancer. The only disorder that has been repeatedly1—4 (although not universally5) associated with this cancer is endometriosis. Results of some of these studies have suggested a specific link with endometrioid and clear-cell ovarian cancers, but until now none had the power to allow definitive subgroup analysis based on a contemporary definition of histological subtype.
 
In a study reported in the Lancet Oncology, Celeste Leigh Pearce and colleagues6 assessed self-reported endometriosis data from 13 pooled case—control studies in the Ovarian Cancer Association Consortium (OCAC). They confirm that a history of endometriosis is significantly associated with an increased risk of clear-cell (odds ratio 3·05, 95% CI 2·43—3·84) and endometrioid (2·04, CI 1·67—2·48) ovarian cancers, and for the first time show an association with low-grade serous ovarian cancer (2·11, 1·39—3·20). No association was noted between endometriosis and high-grade serous, mucinous, serous borderline, or mucinous borderline ovarian cancers.
 
With more than 23 000 participants (7911 with a diagnosis of ovarian cancer), the main strengths of this study are its statistical power and its robust methods. Incidences of reported endometriosis differ substantially between the pooled studies. Although clinicopathological and genetic differences between the populations could reasonably be expected, importantly there was no significant heterogeneity of the association with histological subtype in the different studies.
The main truly novel finding is an association between a history of endometriosis and low-grade serous ovarian cancer. Perhaps surprisingly, serous borderline tumours (from which invasive low-grade serous ovarian cancers are believed to arise7) are not also associated with a history of endometriosis.

Commentary: Primary care and diagnosis of cancer : The Lancet Oncology



Primary care and diagnosis of cancer : The Lancet Oncology

"..........These findings raise several questions. Do modes of cancer presentation vary systematically between different groups of patients? Are general practitioners more reluctant to refer young or non-white patients for investigation of possible cancer? Are participants in these groups less willing to accept a referral to investigate possible cancer? Lyratzopoulos and colleagues' study will raise concerns for those involved in diagnosing and treating patients with cancer. This descriptive study suggests several hypotheses concerning pathways to accessing cancer care that deserve to be tested prospectively in future research."

Biology-driven medicine: tissue matters : The Lancet Oncology



Biology-driven medicine: tissue matters : The Lancet Oncology

The Lancet Oncology, Volume 13, Issue 4, Page 319, April 2012
doi:10.1016/S1470-2045(12)70142-0

 "Deciding who to test, how, and when, will help realise the vast potential of personalised medicine for cancer. However, integration of biology-driven therapy into the clinic is becoming increasingly complex and intratumoral heterogeneity could prove to be the Achilles' heel of targeted therapy in an era in which tissue has become an extremely precious resource that must be used sparingly, pragmatically, and within a multidisciplinary decision-making team."

 The Lancet Oncology

 
"Cancer therapy has been revolutionised by the advent of targeted agents. As a result, patient selection through genetic testing is a rapidly growing industry, but this has posed extra challenges for the patient and oncological team including cost, legal obstacles, test accuracy, and management of tissue. In this context, a recent report in the New England Journal of Medicine suggests intra-tumoral heterogeneity might be an even more complex issue than previously thought. The report showed that up to two-thirds of genetic results in renal-cell carcinoma will vary throughout the tumour specimen when tissue is assessed in a multiregional sequencing analysis. So what are the consequences of this finding for the use of single biopsies to guide treatments in the clinic?............
" Furthermore, according to speakers at the 13th European Congress on Perspectives in Lung Cancer held in Amsterdam, Netherlands, on March 9—10, 2012, the role of the pathologist is paramount in ensuring not only that enough tissue is left after histological diagnosis to do essential tests—such as those to predict benefit from the EGFR inhibitors—but also that testing is not done until the evidence linking the target to the efficacy of the drug, and any potential future treatments, are considered. A multidisciplinary environment is therefore essential to ensure an appropriate discussion of the timing of any pathological testing, and, where possible, to enable tissue to be saved to help guide future decision-making. This point was affirmed in a recent comment in the Journal of Clinical Oncology in which the authors suggested that excluding patients without the proposed target for treatment of breast and gynaecological cancer with PI3K/mTOR inhibitors should not be done until “a stronger predictive relationship emerges”. The comment also acknowledged the challenge of testing for rare mutations. Resistance to therapy can also develop, necessitating further testing to select potential responders to subsequent therapy. Use of blood might help overcome some of the difficulties associated with tissue resources, and several studies have been done using serum samples to define predictors of response to treatment, but these investigations are fraught with difficulties, including linking any serum changes to the tumour itself...........

Friday, March 30, 2012

FYI: Ovarian Cancer and Us blog - top 5 most read posts this week





Broad-Novartis Cancer Cell Line Encyclopedia - CCLE



Broad-Novartis Cancer Cell Line Encyclopedia

Broad-Novartis Cancer Cell Line Encyclopedia (CCLE)

The Cancer Cell Line Encyclopedia (CCLE) project is a collaboration between the Broad Institute, and the Novartis Institutes for Biomedical Research and its Genomics Institute of the Novartis Research Foundation to conduct a detailed genetic and pharmacologic characterization of a large panel of human cancer models, to develop integrated computational analyses that link distinct pharmacologic vulnerabilities to genomic patterns and to translate cell line integrative genomics into cancer patient stratification. The CCLE provides public access analysis and visualization of DNA copy number, mRNA expression and mutation data for about 1000 cell lines.

Please be aware that the CCLE is still an ongoing project and the associated data are not final nor complete. The CCLE website will also be subject to frequent changes and improvements. Please visit regularly!

This project is funded by Novartis.

News / Events

Mar 28, 2012: Due to the publication of the paper the CCLE portal is experiencing very heavy load. Please be patient if the server is slow in responding or try again later  

Mar 1, 2012: Mutation data for 1651 genes across 909 cell lines are now available. 

Cancerwise: Obesity and Cancer Risk: Our Expert Weighs In



Obesity and Cancer Risk: Our Expert Weighs In: By Jennifer Montgomery, MD Anderson Staff Writer

A new report shows that cancer death rates are still on the decline in the United States, but increasing obesity remains a concern.

The Annual Report to the Nation on the Status of Cancer, released March 28, notes that for more than three decades, too much weight, too little exercise and unhealthy eating habits have been second only to tobacco as preventable causes of disease and death.

Since the 1960s, the report says, tobacco use has declined by one-third, but obesity rates have doubled. According to the report, 2 in 3 adults and 1 in 3 kids are overweight or obese, which places them at risk for not only heart disease and diabetes, but also cancer. After reviewing more than 7,000 studies, the report's researchers have identified six cancers associated with being overweight or obese:
  • Esophageal adenocarcinoma
  • Colon and rectal cancer
  • Kidney cancer
  • Pancreatic cancer
  • Endometrial cancer
  • Breast cancer among postmenopausal women
This review also finds convincing evidence of an association between lack of sufficient physical activity and increased risk of colon cancer. A probable association is cited for post-menopausal breast and endometrial cancers.The report notes that less than half of adults get enough physical activity. Youths get even less. Lorenzo Cohen, Ph.D., professor in the Department of General Oncology and director of MD Anderson's Integrative Medicine Program, shares his reaction to the annual cancer report, as well as suggestions for how people can take action now to reduce obesity and prevent cancer.



The Annual Report to the Nation on the Status of Cancer looks at U.S. cancer numbers from 1975 and 2008. It's a collaboration of researchers from the Centers for Disease Control and Prevention, the North American Association of Central Cancer Registries, the National Cancer Institute and the American Cancer Society.

Additional highlights from the report:

  • Death rates from all cancers combined for men, women and children continued to decline in the United States between 2004 and 2008.
  • New cancer diagnoses among men fell an average of 0.6% per year over the same period. 
  • New cancer diagnoses among women declined 0.5% per year from 1998 through 2006, but rates leveled off from 2006 through 2008.
  • For the second consecutive year, mortality rates for lung cancer have decreased among women. Lung cancer death rates in men have been decreasing since the early 1990s.
  • Breast cancer incidence rates among women declined from 1999 through 2004 and plateaued from 2004 through 2008.
  • Colorectal cancer incidence rates decreased among men and women from 1999 through 2008.
  • Incidence rates of some cancers, including pancreas, kidney, thyroid, liver and melanoma, increased from 1999 through 2008.
  • Among racial and ethnic groups, the highest cancer incidence rates between 2004 and 2008 were among black men and white women. Cancer death rates from 2004 through 2008 were highest among black men and black women, but these groups showed the largest declines between 1999 and 2008, compared with other racial groups.
  • Among children age 19 or younger, cancer incidence rates increased 0.6% per year from 2004 through 2008, while death rates decreased 1.3% per year during the same period.

science daily: New breast cancer susceptibility gene (brca)



New breast cancer susceptibility gene

"....XRCC2 may also provide a new target for chemotherapy. "A type of drug called a PARP inhibitor appears to kill tumor cells that have gene mutations in a particular DNA repair pathway. XRCC2 is in this pathway, as are BRCA1 and BRCA2. It's reasonably likely that a breast cancer patient who has a mutation in XRCC2 will respond well to treatment with PARP inhibitors," said Tavtigian......."

In cancer science, many discoveries don't hold up | Reuters



In cancer science, many discoveries don't hold up | Reuters