Gardasil Passes a 2-Year Safety Check:
"Most parents' concerns about Gardasil were not explicitly related to concerns about vaccine safety."
"Most parents' concerns about Gardasil were not explicitly related to concerns about vaccine safety."
Reflection and Reaction
World Cancer Declaration: a need for partnership
"We can no longer afford to sit on our hands and watch people die needlessly. We all have a personal and common responsibility to help overcome this global challenge and I encourage you to read the World Cancer Declaration, endorse the policy via the UICC website, and think carefully about what changes you can do, however small, in your private and professional lives to bring about change, before we live to regret this moment in history."
"RECOMMENDATIONS
* Patients unable to tolerate aggressive cytoreductive surgery should undergo neoadjuvant chemotherapy first.
* Neoadjuvant chemotherapy should become a standard alternative approach to treating patients with stage IV ovarian cancer.
* Women with stage IIIC disease should be evaluated by a gynecologic oncologist to determine the likelihood of optimal cytoreducibility. If residual macroscopic disease would be expected with surgery alone, the patient should be offered the option of neoadjuvant chemotherapy."
Reference Guide
Therapeutic Agents Mentioned in This Article
Carboplatin
Cisplatin
Cyclophosphamide
Paclitaxel
No province in Canada has legislation defending the rights of patients.
Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. k.hemminki@dkfz.de
An increased risk of second primary cancers may depend on many reasons, including therapy for the first cancer and heritable causation. Population level data are not available exploring the risks of subsequent cancers after breast cancer considering a familial history of breast cancers. We used the nation-wide Swedish Family-Cancer Database to investigate such risks, based on 43,398 first invasive female breast cancers. Standardized incidence ratios (SIRs) were calculated for the second cancer after breast cancer using rates for first cancer as a reference. Many cancers at discordant sites were increased after breast cancer. SIRs for subsequent neoplasms in women who had a family history of breast cancer were increased for ovarian (2.0) and endometrial (1.8) cancers and for acute lymphoid leukemia (12.7) and myelofibrosis (9.4). The data suggest that the familial aggregation of breast and endometrial cancers may be explained by yet unidentified heritable causes. The remarkably high risks for second acute lymphoid leukemia and myelofibrosis, both characterized by chromosomal aberrations, in women with a family history of breast cancer may signal heritable defects in the ability to process DNA damage caused by ionizing radiation and chemotherapy.
Cindy Melancon Spirit of Survivorship AwardProgress in Cancer Care: The Hope,JCO.2008.17.6198v1.pdf (application/pdf Object)
the Hype, and the Gap Between Reality
and Perception
JCO Early Release, published online ahead of print Sep 15 2008
Journal of Clinical Oncology, 10.1200/JCO.2008.17.6198
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Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University, New York, NY

A Systematic Review
JAMA. 2006;296:1507-1517.
Context About 2% of all colorectal cancer occurs in the context of the autosomal dominantly inherited Lynch syndrome, which is due to mutations in mismatch repair genes. Potential risk-reducing interventions are recommended for individuals known to have these mutations.
Objectives To review cancer risks and data on screening efficacy in the context of Lynch syndrome (hereditary nonpolyposis colorectal cancer) and to provide recommendations for clinical management for affected families, based on available evidence and expert opinion.
Data Sources and Study Selection A systematic literature search using PubMed and the Cochrane Database of Systematic Reviews, reference list review of retrieved articles, manual searches of relevant articles, and direct communication with other researchers in the field. Search terms included hereditary non-polyposis colon cancer, Lynch syndrome, microsatellite instability, mismatch repair genes, and terms related to the biology of Lynch syndrome. Only peer-reviewed, full-text, English-language articles concerning human subjects published between January 1, 1996, and February 2006 were included. The US Preventive Services Task Force's 2-tier system was adapted to describe the quality of evidence and to assign strength to the recommendations for each guideline.
Evidence Synthesis The evidence supports colonoscopic surveillance for individuals with Lynch syndrome, although the optimal age at initiation and frequency of examinations is unresolved. Colonoscopy is recommended every 1 to 2 years starting at ages 20 to 25 years (age 30 years for those with MSH6 mutations), or 10 years younger than the youngest age of the person diagnosed in the family. While fully acknowledging absence of demonstrated efficacy, the following are also recommended annually: endometrial sampling and transvaginal ultrasound of the uterus and ovaries (ages 30-35 years); urinalysis with cytology (ages 25-35 years); history, examination, review of systems, education and genetic counseling regarding Lynch syndrome (age 21 years). Regular colonoscopy was favored for at-risk persons without colorectal neoplasia. For individuals who will undergo surgical resection of a colon cancer, subtotal colectomy is favored. Evidence supports the efficacy of prophylactic hysterectomy and oophorectomy.
Conclusions The past 10 years have seen major advances in the understanding of Lynch syndrome. Current recommendations regarding cancer screening and prevention require careful consultation between clinicians, clinical cancer genetic services, and well-informed patients.
Author Affiliations: Departments of Medical Genetics (Drs Lindor and Petersen) and Health Sciences Research (Dr Petersen), Mayo Clinic College of Medicine, Rochester, Minn; Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Mr Hadley); Department of Medicine and Huntsman Cancer Institute, University of Utah, and Veterans Affairs Medical Center, Salt Lake City (Dr Kinney); Medical Oncology, Maine Center for Cancer Medicine and Blood Disorders and Maine Medical Center, Portland (Dr Miesfeldt); Departments of Gynecologic Oncology (Dr Lu) and Gastrointestinal Medicine and Nutrition (Dr Lynch), M. D. Anderson Cancer Center, University of Texas, Houston; Department of Medical History and Ethics, University of Washington, Seattle (Dr Burke); and Schools of Nursing and Medicine, Oregon Health and Science University, Portland (Dr Press).
This Week in JAMA
JAMA. 2006;296:1437.
Prediction of MLH1 and MSH2 Mutations in Lynch Syndrome
Judith BalmaƱa, David H. Stockwell, Ewout W. Steyerberg, Elena M. Stoffel, Amie M. Deffenbaugh, Julia E. Reid, Brian Ward, Thomas Scholl, Brant Hendrickson, John Tazelaar, Lynn Anne Burbidge, and Sapna Syngal
JAMA. 2006;296:1469-1478.
Prediction of Germline Mutations and Cancer Risk in the Lynch Syndrome
Sining Chen, Wenyi Wang, Shing Lee, Khedoudja Nafa, Johanna Lee, Kathy Romans, Patrice Watson, Stephen B. Gruber, David Euhus, Kenneth W. Kinzler, Jeremy Jass, Steven Gallinger, Noralane M. Lindor, Graham Casey, Nathan Ellis, Francis M. Giardiello, Kenneth Offit, Giovanni Parmigiani, and for the Colon Cancer Family Registry
JAMA. 2006;296:1479-1487.
Predicting and Preventing Hereditary Colorectal Cancer
James M. Ford and Alice S. Whittemore
JAMA. 2006;296:1521-1523.
Colon Cancer
John L. Zeller, Cassio Lynm, and Richard M. Glass
JAMA. 2006;296:1552.