Latest advances in medical oncology: highlights from Milan ESMO 2010 annual congress Therapeutic Advances in Medical Oncology January 2011 3: 3-9, doi:10.1177/1758834010390407
Monday, January 17, 2011
Teacher – Learner Contract Gynecologic Surgery Block
Note: question #5 - page 3 (exam while patient under anesthesia)
Cancer Epigenetics - 2010 - CA (includes discussions Lynch Syndrome etc...)
"The term “epigenetics” refers to variability in gene expression, heritable through mitosis and potentially meiosis, without any underlying modification in the actual genetic sequence."
No Gene-Environment Interactions Found in Million Women Study of Breast Cancer 2010 - CA: A Cancer Journal for Clinicians - Wiley Online Library
".....Regarding the question of gene-environment
interactions, lead author Ruth Travis, MD, PhD, adds that “Results from
this study suggest that common genetic and environmental factors
(reproductive and lifestyle factors) act independently on breast cancer
risk, so regardless of common inherited genetic variation, a woman can
still reduce her risk by modifying her lifestyle, for example by
maintaining a healthy body weight and limiting alcohol intake.”
The
absence of interactions means that priorities for risk-reducing
strategies are similar for most women (for example, being based on known
risks associated with lifestyle and reproductive factors) regardless of
the common genetic risk factors for the disease, she says. Dr. Travis
is an epidemiologist, research fellow, and senior scientist in the
cancer epidemiology unit at Oxford University....."
full free access: Poly(ADP-Ribose) polymerase (PARP) inhibitors: Exploiting a synthetic lethal strategy in the clinic - A Cancer Journal for Clinicians - Wiley Online Library
see also:
Table 1. DNA Repair Pathways
(Lynch Syndrome, BRCA 1/2, FANC, ATM, MYH ;
Table 2. PARP Inhibitor Clinical Trials; Other Potential Synthetic Lethal Strategies for PARP Inhibitors.....
Conclusions:
"The synthetic lethal targeting of DNA repair pathways, as exemplified by PARP inhibitors, in cancers bearing HR DNA repair defects is showing considerable potential for delivering selective tumor cell kill while sparing normal cells, and offers a scientifically rational and potentially broad clinical application in oncology.64 Several challenges related to the development of these inhibitors remain, including the identification of robust predictive biomarkers of HR deficiency in cancers. The dissection of the underlying mechanisms of PARP inhibitor resistance and establishment of optimal drug combinations and strategies for chemoprophylaxis with these therapies remain high priorities. It is important to be aware that different PARP inhibitors may have varying potencies on individual members of the PARP superfamily and also affect other targets, resulting in distinct toxicity and efficacy profiles. In the future, it is envisioned that this tumor-specific synthetic lethal strategy with PARP inhibitors may potentially be utilized against cancers with similar molecular defects but diverse anatomical origins.118 Such a paradigm shift in drug discovery may crucially bring us closer to our ultimate goal of personalized medicine."
free full access - Cancer screening in the United States, 2011 - CA: A Cancer Journal for Clinicians - Wiley Online Library
Cancer Screening in the United States, 2011
A Review of Current American Cancer Society Guidelines and Issues in
Cancer Screening
Sunday, January 16, 2011
Free Full-Text - IJMS ( Intl Jnl of Molecular Sciences) Exploring the Immunoproteome for Ovarian Cancer Biomarker Discovery
Published: 14 January 2011
(This article belongs to the Special Issue Cancer Molecules in Ovarian Cancer)
Abstract:
Most
scientific efforts towards early detection of ovarian cancer are
commonly focused on the discovery of tumour-associated antigens (TAA).
Autologous antibodies against TAA, however, may serve as more sensitive
diagnostic markers. They circulate in the blood before TAA and are
usually more abundant than the TAAs themselves as a result of
amplification through the humoral immune response. Accumulating evidence
also suggests that a humoral response already exists during malignant
transformation when aberrant gene expression is translated into
premalignant cellular changes. This article reviews the current
knowledge about autoantibodies against TAA in ovarian cancer and
presents current immunoproteomic approaches for their detection.
full free access: eMJA: When do I know I am cured? Using conditional estimates to provide better information about cancer survival prospects
See also (abstract) reference #7:
Choi M, Fuller CD, Thomas CR Jr, et al. Conditional survival in ovarian cancer: results from the SEER dataset 1988–2001. Gynecol Oncol 2008; 109: 203-209. <PubMed>
Saturday, January 15, 2011
Friday, January 14, 2011
full free text: Targeted Epigenetic Therapies: The Next Frontier? — J. Natl. Cancer Inst. (includes discussion regarding clear cell/ARIDIa mutation
Targeted Epigenetic Therapies: The Next Frontier?
1. Rabiya S. Tuma
When researchers look for mutations associated with cancer, they often expect to come up with alterations in signaling molecules or transcription factors. But an increasing number of the mutations found are in genes that regulate the epigenome—a system that alters DNA structure and regulates gene activity without changing the nucleotide sequence itself.
On Sept. 8, investigators published two independent reports online—one in Science and one in the New England Journal of Medicine—showing that mutations in an epigenetic regulatory gene, ARID1a, were associated with approximately half of the ovarian clear-cell cancers tested.
Randomized Phase III Clinical Trial Evaluating Weekly Cisplatin for Advanced Epithelial Ovarian Cancer
"Thus, increasing dose intensity of cisplatin does not improve PFS or OS compared with standard chemotherapy."
High-grade, chemotherapy-resistant ovarian carcinomas overexpress epithelial cell adhesion molecule (EpCAM) and are highly sensitive to immunotherapy (RNA/IL-2/Adecatumumab)
Abstract
OBJECTIVE: We evaluated the expression of epithelial cell adhesion molecule (EpCAM) and the potential of MT201 (adecatumumab), a human-monoclonal-antibody that targets EpCAM against chemotherapy-resistant ovarian disease.STUDY DESIGN: EpCAM expression was evaluated by real-time polymerase chain reaction and flow cytometry. Sensitivity to MT201 antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity was tested in 4-hour chromium-release assays. The effect of interleukin-2 on MT201 ADCC was also studied.
RESULTS: High messenger RNA expression by real-time polymerase chain reaction and high EpCAM surface expression by flow cytometry was detected in 71% of ovarian cancers (5 of 7 cell lines). Although these cell lines were highly resistant to complement-dependent cytotoxicity and natural killer-dependent cytotoxicity in vitro (range of killing, 0-7%), EpCAM-positive cell lines showed high sensitivity to MT201 ADCC (range of killing, 27-66%). Incubation with interleukin-2 further increased the cytotoxic activity against EpCAM-positive ovarian cancer cell lines.
CONCLUSION: MT201 may represent a novel, potentially highly effective treatment option for patients with ovarian carcinoma whose body is harboring disease refractory to chemotherapy.
Perspectives 2011: Key to Ovarian Cancer Detection - the Endocrine Society Research Affairs Endocrine News Jan 2011 Dr Lee (Chicago)
Perspective: Dr Lee (Chicago)
"About This Series
For the Bi-Point/Tri-Point perspective series of articles in Endocrine News, the topics, authors, and outside reviewers are selected by The Endocrine
Society’s Research Affairs Core Committee to explore subject areas from different angles. The authors write their articles independently and the drafts are then reviewed by contributing co-editors and by independent experts in the specific topic area.
If you have any comments about this feature, please email
endocrinenews@endo-society.org.
For archived copies of this series on more than 26 topics, please visit the
Endocrine News Web site, www.endo-society.org/endo_news/index.cfm"
2011 (pdf/slides) Screening for Ovarian Cancer - University of Manitoba - Dr Lotocki
Epithelial Ovarian Cancer
Cancer Day for Primary Care
Friday, January 14, 2011
Annual Costs of Cancer Care | Cancer Prevalence and Cost of Care Projections - female/male cancer sites (ncluding ovarian)
Chart: Average Annual Costs of Care
Annualized Mean Net Costs of Care by Age, Gender and Phase of Care (Per Patient). Costs in 2010 US Dollars.
Cancer Prevalence and Cost of Care Projections - Interactive Guide NCI (via WSJ link)
Key Facts
- 18.1 million cancer survivors in 2020, 30% more than 2010
- Costs of cancer care: $157 billion in 2010 dollars
- Growth and aging of the U.S. population is the primary cause
Create Your Own Chart
Graph by Cancer Site and Phase of Cancer(See cost of care or prevalence for cancer site, sex, age and year under various assumptions)
Projection Tables for 2020
National Expenditures for Cancer CareCancer Prevalence
Base Data
Average Annual Costs of CareCancer-Care Costs Could Hit $207 Billion in 2020: NCI Study - Health Blog - WSJ
"....Statistical modeling, of course, depends on the assumptions used by the researchers — so check out the full study to see those details. And here’s an interactive tool that allows you to change some of the assumptions."
Projections of the Cost of Cancer Care in the United States: 2010–2020 — J. Natl. Cancer Inst.
excerpt/also see Table 5 for projection (cost) estimates:
Recent and Projected Incidence
For most of the cancer sites, incidence has been decreasing, and we estimated a negative annual percent change (Table 1) during the period 1996–2005. The largest decreases in men were for lung, stomach, and colorectal cancers, respectively, −2.72, −2.24, and −2.22 annual percent change in age-adjusted rates. More dramatic decreases were observed for women for ovarian and cervical cancer, −4.71 and −3.95, respectively, annual percent change in age-adjusted rates. Incidence of kidney cancer and melanoma has been increasing in both men and women, and incidence of lymphoma and brain cancer has been increasing in women (Table 1). Among the five major cancer sites, the largest decreases in incidence were observed for lung and colorectal cancers in men, −2.72 and −2.22, respectively, annual percent change in age-adjusted incidence rates (Figure 1; Similar figures for more cancer sites are available at http://costprojections.cancer.gov.).
View this table:
Incidence and survival trends used in the incidence and survival trend scenario*
Thursday, January 13, 2011
Wednesday, January 12, 2011
website: FIGO | International Federation of Gynecology and Obstetrics
FIGO - the International Federation of Gynecology and Obstetrics - is the only organisation that brings together professional societies of obstetricians and gynecologists on a global basis. Currently it has member societies in 124 countries or territories.
FIGO has a vision that women of the world achieve the highest possible standards of physical, mental, reproductive and sexual health and wellbeing throughout their lives.
FIGO works with the United Nations Population Fund, The Bill & Melinda Gates Foundation and the Swedish International Development Cooperation Agency, among many other organisations.
Read FIGO in brief for a quick overview.
Visit the Members section to find out more about how to join us.
NCI Cancer Bulletin: (The GOG Rare Tumor Committee)
Comparing First-Line Therapies for Mucinous Ovarian or Fallopian Tube Cancer
Name of the TrialPhase III Study of Carboplatin and Paclitaxel with Versus without Bevacizumab Compared to Oxaliplatin and Capecitabine with Versus without Bevacizumab as First-Line Therapy in Patients with Newly Diagnosed Stage II-IV or Recurrent Stage I Mucinous Epithelial Ovarian or Fallopian Tube Cancer (GOG-0241). See the protocol summary.
Tuesday, January 11, 2011
Shattered Chromosome Can Lead to Cancer - NYTimes.com (reference to bone/breast...cancers + commentary link)
Note: theories/research regarding how cancer develops eg; 'one-hit' theory vs multi-step process of malignancy.
Cell (journal link): Featured Article Free
Massive Genomic Rearrangement Acquired in a Single Catastrophic Event during Cancer Development
Monday, January 10, 2011
Survey: GCF/University of Texas MD Anderson Cancer Center (follow-up for those without a recurrence)
The
Gynecologic Cancer Foundation is cooperating with researchers at The
University of Texas MD Anderson Cancer Center to learn your opinion
about follow-up care after your initial treatment if you have not had a
recurrence of your cancer.
This online survey has been approved by the MD Anderson Institutional Review Board and will take about 15 minutes of your time.
The
Gynecologic Cancer Foundation does not share its mailing list and your
contact information, including your e-mail address, will not be placed
into any other database as a result of your participation in this
survey.
Because cancer treatments continue to improve, the number of women surviving is increasing. Researchers
at MD Anderson are interested in learning about how patients with
gynecologic cancers want to be followed after completing their
treatments and your participation in this survey will assist them.
If you have any questions about the survey, please contact Dr. Matthew Schlumbrecht at MD Anderson at 713-563-4583 or mpschlumbrecht@mdanderson.org.
Instructions and consent information are included in the survey information. To participate, please click here.
Sunday, January 09, 2011
full free access: AHRQ Patient Safety Network - Patient Safety in Primary Care (Canada)
Patient Safety in Primary Care.
Kingston-Riechers J, Ospina M, Jonsson E, Childs P, McLeod L, Maxted JM. Edmondton, AB, Canada: Canadian Patient Safety Institute; 2010. ISBN: 9781926541273.
This report analyzed patient safety in Canadian primary care practice to identify themes, priorities, gaps in research, and opportunities for improvement.
Breasts 'monopolising' cancer spotlight - Australia media report
Note: quotes from a 'plain speaking' physician (and advocate)
Saturday, January 08, 2011
Evidence Updates - Interventions for preventing oral mucositis for patients with cancer receiving treatment. Cochrane Database including professional commentaries
also: see PubMed link (abstract w/o commentary) to abstract
BACKGROUND: Treatment of cancer is increasingly more effective but is associated with short and long term side effects. Oral side effects remain a major source of illness despite the use of a variety of agents to prevent them. One of these side effects is oral mucositis (mouth ulcers).
Friday, January 07, 2011
Wednesday, January 05, 2011
Tuesday, January 04, 2011
Editorial :: The role of Cochrane Review authors in exposing research and publication misconduct - The Cochrane Library
Note: while important the real question is the root of the problem - cause
"At the Joint Colloquium of the Cochrane & Campbell Collaborations in Keystone in October 2010, we ran a workshop about the problems of detecting research misconduct,[1] and had a wonderful discussion with participants. The US Office of Research Integrity defines research misconduct as: "fabrication, falsification, or plagiarism in proposing, performing, or reviewing research, or in reporting research results; fabrication is making up data or results and recording or reporting them; falsification is manipulating research materials, equipment, or processes, or changing or omitting data or results such that the research is not accurately represented in the research record; plagiarism is the appropriation of another person's ideas, processes, results, or words without giving appropriate credit; research misconduct does not include honest error or differences of opinion".[2] The Committee on Publication Ethics (COPE) also outlines publication and research misconduct in its flowcharts for editors, and highlights redundant (duplicate) publication, changes in authorship, undisclosed conflicts of interest, and ethical problems as additional types of misconduct.[3] Cochrane Review authors, as they analyse the entirety of primary research evidence in a specific area, are well placed to identify many of these types of research and publication misconduct. Indeed, Professor Sir Iain Chalmers urged systematic reviewers, not so long ago, to harness their unique opportunity to detect plagiarism.[4].....cont'd
Director's Page - National Cancer Institute - Update to the National Cancer Advisory Board (December 2010) 9 minutes
Also: To view the NCAB Meeting discussions in their entirety, visit http://videocast.nih.gov/launch.asp?16326 (5 hrs and 51 minutes)
abstract: Risk of colorectal and endometrial cancers in EPCAM deletion-positive Lynch syndrome: a cohort study : The Lancet Oncology (multi-national study)
Note: (abstract) study includes 194 mutation carriers with references to pancreatic and duodenal cancers; more information on EPCAM genetics can be found by searching this blog
Duodenal cancer - Wikipedia Duodenal cancer is a cancer in the beginning section of the small intestine. It is relatively rare compared to gastric cancer and colorectal cancer. en.wikipedia.org/wiki/Duodenal_cancer
Uncommon Knowledge: Sorry really isn't enough (apology) - The Boston Globe (breast and ovarian cancer gender comments...)
Note: comments regarding breast and ovarian cancer (gender issues)
"...From an early age, we’re taught to apologize. We’re also taught to accept apologies. In theory, an apology should set things right. But does it...."
Monday, January 03, 2011
MGH (blood) test for cancer gets backing - The Boston Globe
"Boston researchers plan to announce today that they are partnering with pharmaceutical giant Johnson & Johnson to develop and bring to market a sophisticated, noninvasive test that can detect tiny traces of cancer cells in a blood sample......."
Saturday, January 01, 2011
About INCTR - INCTR – International Network for Cancer Treatment and Research
INCTR is located in Brussels.
It currently has branches in Brazil, Canada, Egypt, France, Nepal and the USA and offices in Cameroon, India, Tanzania and the UK.
Reports:
2010 newsletter:
"In 2010, cancer overtook ischaemic heart disease as the leading cause of death in the world. While different groupings of diseases (e.g., combining all cardiovascular disease or dividing cancer into many different types) would produce a different rank order, the point should not be missed that cancer can no longer be ignored by global health policy-makers as a major cause of disability or death, as well as economic loss......."
Friday, December 31, 2010
Clinical Care Options website: update includes Avastin - Ovarian Cancer
Note: full free access (requires free registration)
Authors: Maurie Markman, MD
Authors: Maurie Markman, MD
Released: 11/17/10
Last Reviewed: 12/2/10 (What's New)
- Introduction
- BRCA Mutations in Ovarian Cancer
- Screening for Ovarian Cancer
- Symptoms of Ovarian Cancer
- Surgical Staging of Ovarian Cancer
- Primary Surgical Cytoreduction in Ovarian Cancer
- Interval Surgical Cytoreduction and Neoadjuvant Chemotherapy
- Chemotherapy for High-Risk Early-Stage Ovarian Cancer
- Primary Chemotherapy of Advanced Stage Ovarian Cancer
- Second-Line Therapy of Ovarian Cancer
- Platinum-Sensitive vs Platinum-Resistant Recurrent Ovarian Cancer
- Treatment of Platinum-Sensitive Recurrent Ovarian Cancer
- Treatment of Platinum-Resistant Ovarian Cancer
- Intermediate Platinum Sensitivity
- Carboplatin Hypersensitivity Reactions
- Other Management Options in Recurrent/Resistant Ovarian Cancer
- Future Research Directions in Ovarian Cancer
- Tables and Figures
- References
abstract: Prognostic factors in women treated for ovarian yolk sac tumour: A retrospective analysis of 84 cases (typically young women)
Background
"Ovarian yolk sac tumour (OYST) is a very rare malignancy arising in young women. Our study aimed to evaluate long-term outcomes and to identify prognostic parameters likely to help make appropriate risk-based decisions about therapy in this disease....."Correspondence: mTOR Inhibitor Treatment of Pancreatic Cancer in a Patient With Peutz-Jeghers Syndrome
TO THE EDITOR:
"Recently, we successfully used everolimus to
achieve a partial remission in a patient with advanced pancreatic
cancer that was induced by Peutz-Jeghers syndrome (PJS). PJS has
been associated with an increased risk of GI, gynecologic, breast, and
pancreatic cancers. PJS is caused by a tumor-suppressor gene mutation
in the serine threonine kinase gene 11 (STK11, also known as
LKB1 gene), localized on chromosome 19p13.3.1,2 Up to 93% of
patients with PJS develop some form of cancer; 11% to 36% develop
pancreatic carcinoma.3,4......"
Metachronous colorectal cancer risk for mismatch repair gene mutation carriers: the advantage of more extensive colon surgery Gut - abstract (Lynch Syndrome)
Define: metachronous: Multiple separate occurrences, such as multiple primary cancers developing at intervals.
Conclusions: Patients with Lynch syndrome with first colon cancer treated with more extensive colonic resection have a lower risk of metachronous CRC than those receiving less extensive surgery. This finding will better inform decision-making about the extent of primary surgical resection.
Thursday, December 30, 2010
abstract: Ventral hernia following primary laparotomy for ovarian, fallopian tube, and primary peritoneal cancers
An incisional hernia occurs in an area of weakness caused by an incompletely-healed surgical wound. Since median incisions in the abdomen are frequent for abdominal exploratory surgery, ventral incisional hernias are termed ventral hernias. ...
en.wikipedia.org/wiki/Ventral_hernia
OBJECTIVES: To evaluate the incidence and risk factors for ventral hernia development following primary laparotomy for ovarian, fallopian tube, and peritoneal cancers.
CONCLUSIONS: The development of ventral hernia is a significant postoperative morbidity in patients undergoing primary surgery for ovarian, tubal, or peritoneal cancer. Independent associations with hernia development include: BMI and IP chemotherapy by Year 1, and BMI, wound complications and advanced stage by Year 2.
abstract: CA 125 normalization with chemotherapy is independently predictive of survival in advanced endometrial cancer
Abstract
OBJECTIVE: Changes in CA 125 with chemotherapy predict outcome for epithelial ovarian cancer. There is no such data for advanced endometrial cancer.CONCLUSION: As with epithelial ovarian cancer, changes in CA 125 are highly predictive of outcome for advanced, chemotherapy treated endometrial cancer.
full free access: Guidelines Loading... American Society of Hematology Guidelines Epoetin and Darbepoetin
Guidelines
American Society of Hematology Guidelines
Epoetin and Darbepoetin"American Society of Hematology/American Society of Clinical Oncology 2010 clinical practice guideline update on the use of epoetin and darbepoetin"The latest research and evidence-based clinical guidelines about the use of epoetin for the treatment of cancer-related anemia.
- Data Supplement
"Future directions
There is clear evidence regarding the ability of ESAs to increase
Hb and avoid transfusions. There is also evidence of harm
associated with their use. Perhaps the most pressing need for
additional research is studies that further clarify the mechanisms of
harm and, particularly, the groups of patients or circumstances of
clinical use that are least associated with these risks. This understanding
is paramount to the ability of clinicians to extend the
benefit of these drugs while reducing the risks."
full free access: American Society of Clinical Oncology/American Society of Hematology Clinical Practice Guideline Update on the Use of Epoetin and Darbepoetin in Adult Patients With Cancer — JCO
"Editor's Note: This document represents an abridged version of the complete guideline update and contains updated recommendations with a brief discussion of the relevant literature. Readers should refer to the complete guideline update, which includes a comprehensive discussion and analysis of the literature and more evidence tables. The complete guideline is available at www.asco.org/guidelines/esa and http://www.hematology.org/guidelines/esa/."
Wednesday, December 29, 2010
abstract: Activity of Sorafenib in Recurrent Ovarian Cancer and Primary Peritoneal Carcinomatosis: A Gynecologic Oncology Group Trial — JCO
Conclusion: Sorafenib has modest antitumor activity in patients with recurrent OC, but the activity was at the expense of substantial toxicity.
Phase I Study of Pazopanib in Combination with Weekly Paclitaxel in Patients with Advanced Solid Tumors -- Tan et al. 15 (12): 1253 -- The Oncologist
Note: one ovarian cancer patient was included in this phase 1 study (partial response)
2010 NCI Cancer Bulletin Reader Survey Results - National Cancer Institute - Who Reads the NCI Cancer Bulletin?(past survey)
NCI Cancer Bulletin Subscriber Details
Percent
| |
|---|---|
| Health care professional |
47.6
|
| Physician |
20.6
|
| Nurse or nurse practitioner |
15.7
|
| Other medical/health professional |
11.3
|
| Touched by cancer/General public |
24.5
|
| Cancer patient/survivor |
15.5
|
| Cancer patient family member/friend |
5.8
|
| Member of the general public |
2.0
|
| Student |
1.2
|
| Researcher/scientist |
18.7
|
| Principal investigator/lead researcher |
9.1
|
| Research manager/coordinator |
4.0
|
| Research analyst/associate |
1.9
|
| Research assistant |
1.1
|
| Other researcher |
2.5
|
| Other professional |
9.1
|
| Librarian/information professional |
0.6
|
| Information technology professional |
0.3
|
| Journalist |
0.5
|
| Administrator/manager |
3.0
|
| Communications professional |
1.7
|
| Teacher/educator |
0.4
|
| Advocate |
1.6
|
| Other professional |
1.0
|
Cancers | Free Full-Text | Surgery as a Double-Edged Sword: A Clinically Feasible Approach to Overcome the Metastasis-Promoting Effects of Surgery by Blunting Stress and Prostaglandin Responses
(This article belongs to the Special Issue Surgery induced tumorigenesis in breast and other cancers: An inconvenient truth?)
Cancers | Free Full-Text | Familial Pancreatic Cancer (extensive lain english review)
Note: see table 1 for spectrum of genes eg; MSH 1/2/6, FAMM, BRCA2....
Tuesday, December 28, 2010
NCI announces plans to reinvigorate clinical trials, December 23, 2010 News Release - National Institutes of Health (NIH)
Note: see second post for list of groups (international)
"Consolidation of cooperative group program is designed to bring enhanced efficiencies to oncological sciencesThe National Cancer Institute (NCI) has announced major changes to be made in the long-established Clinical Trials Cooperative Group Program ....."
http://www.cancer.gov/cancertopics/factsheet/NCI/clinical-trials-cooperative-group ...... For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237)....."Trying to Estimate Cancer Rates in Ancient Times - NYTimes.com
Note: King Tut (died at the age of 19) is one example of inbreeding (genetics) in 'high society' with some recent and intriguing research findings regarding his family history, marriage and mummified remains of his apparent two children
Link to NY Times article
Link to Nature review (abstract)
Perspectives
Nature Reviews Cancer 10, 728-733 (October 2010) | doi:10.1038/nrc2914
Science and society: Cancer: an old disease, a new disease or something in between?
Monday, December 27, 2010
Histologic artifacts in abdominal, vaginal, laparoscopic, and robotic hysterectomy specimens: a blinded, retrospective review
"....Such artifacts impair the pathologists' interpretation of cell type requiring an increased use of IHC (immunohistochemistry), and displaced epithelial fragments present within vessels or artifactual clefts may result in the misinterpretation of prognostic and staging parameters. Furthermore, there is a significantly higher rate of positive peritoneal cytology in cases that are subjected to uterine manipulation, suggesting dissemination of malignant cells into the abdominal cavity. The clinical significance of this finding needs to be determined."
Canadian Doctors for Medicare - Defending (Canadian) Medicare
Canadian Doctors for Medicare advocates for the maintenance and improvement of Canada's universal, single-payer health care system. ...
full free access: Jnl Interprofessional Care - Interprofessionalism and shared decision-making in primary care: a stepwise approach towards a new model
"Most shared decision-making (SDM) models to date have been limited to the patient–physician dyad. For that reason, they are not always relevant to the increasingly interprofessional nature of the delivery of care......"
Journal of Interprofessional Care - Summary: A critical examination of the role of appreciative inquiry within an interprofessional education initiative
Blogger's Note: any views on this?
"Based on these findings, the article goes on to argue that the
use of AI can overlook a number of structural factors, which will
ultimately limit its ability to actually secure meaningful and lasting
change within health care."
Sunday, December 26, 2010
Friday, December 24, 2010
new quick patient poll on Blog - clear cell/Lynch Syndrome
Missed opportunity ?? - take the poll if you have been diagnosed clear cell/Lynch Syndrome
abstract: Hospital costs associated with adverse events in gynecological oncology (patient safety)
excerpts:
BACKGROUND AND OBJECTIVE: Treatment for gynecological malignancies is complex and may cause unintended or accidental adverse events (AE)....RESULTS: A total of 369 patients had surgical procedures of which 95 patients (26%) had at least one AE.note Blogger's Comment/add yours - abstract: Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases (references Lynch Syndrome)
Blogger's comment/question: any other survivours (or not) of clear cell ovarian cancer and Lynch Syndrome NOT included in this study? A missed opportunity.....
note: absence of a direct reference to Lynch syndrome in abstract
Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases.
*Department of Pathology, Memorial Sloan-Kettering Cancer Center ‡Department of Pathology, Vancouver General Hospital, NY †Department of Pathology, Massachusetts General Hospital, MA §Department of Pathology, University of Calgary, Calgary, Canada.
Abstract
Establishing a diagnosis of ovarian clear cell carcinoma (O-CCC) can be subject to significant interobserver variation. Accurately diagnosing this tumor is important because of its chemoresistance and reported association with Lynch syndrome. The spectrum of the morphologic features of O-CCC has not been well described in a series composed of immunohistochemically characterized cases. A total of 155 cases diagnosed as O-CCC were retrieved from the files of 3 institutions to analyze architectural and cytologic features. The immunohistochemical features of these cases have been reported earlier. A comprehensive list of features was recorded, including, but not limited to, architectural patterns, nuclear appearance, cytoplasmic characteristics, and mitotic index. Between 1 and 13 slides were available for review for each case. The cases were divided into 2 groups based on morphologic characteristics, those with features shared by the large majority (the first group, n=138) and those that showed unusual characteristics (second group, n=17). Tumors in the first group typically showed a mixture of architectural patterns, the most frequent being papillary and tubulocystic. Papillae, usually small and round and lacking hierarchical branching and tufting or stratification of more than 3 cells, were present at least focally in almost 3 of 4 cases. The cell shape was predominantly cuboidal, not columnar. Nuclear pleomorphism and prominent nucleoli were frequently present, but never diffusely. Clear cytoplasm was found in nearly every case and hobnail cells were common. Mitoses exhibited a range from 0 to 13 with an average of 3 to 4 per 10 high power fields. The second group of tumors showed numerous unusual morphologic characteristics, despite the presence of clear cytoplasm, including those typically seen in other ovarian epithelial tumors, such as serous and endometrioid carcinoma. Eighty-nine percent of tumors from the first group showed the expected "O-CCC immunophenotype" [hepatocyte nuclear factor (HNF) positive, and estrogen receptor (ER), progesterone receptor (PR), Wilms tumor 1 (WT1) and p53 negative], whereas 4% of tumors showed HNF positivity along with focal ER or PR expression. Seven percent of tumors were not immunoreactive with these markers. Twenty-nine percent of tumors in the second group showed the O-CCC immunophenotype, whereas 24% of tumors were p53 positive, 5% of tumors were WT1 positive, and the remaining cases were negative for all markers. Ninety-seven percent (112 of 117) of HNF-positive tumors in this series were classical O-CCC. Therefore, O-CCC has characteristic morphologic features and a specific, if not unique, immunophenotype in the vast majority of the cases. Clear cell-rich tumors with features that depart from the classical morphologic appearances described herein should suggest the possibility of an alternative diagnosis.Thursday, December 23, 2010
microRNA's - Revolutionizing Ovarian Cancer Treatment
"...That began to change earlier this decade as scientists discovered that microRNAs might actually be the hidden regulators that control the 30,000 genes in the human body by silencing gene expression.....One in particular, miR-31, discovered by Baylor collaborators and Gunaratne, shows promise as a potent tumor suppressor in ovarian cancer, glioblastoma, osteosarcoma and prostate cancer.......They discovered that miR-31 can specifically target and kill cancer cells that are deficient in p53, a crucial gene that guards the integrity of the genome and prevents cancer. More than half of all cancers and 90 percent of papillary serous tumors - the most common type of malignant ovarian cancer - are p53-deficient."
Reports of Serrated polyps of the colon - (references MSI/Lynch Syndrome) Mayo Clinic
Serrated polyps of the colon
Division of Gastroenterology & Hepatology and Division of Oncology, Mayo Clinic and Mayo College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
Corresponding author
F1000 Med Reports2010, 2:89 (doi: 10.3410/M2-89)
Published: 17 Dec 2010
"....Among the more important findings is that SSAs may be the precursor
lesions for MSI-H colon cancers. Furthermore, there is evidence that
serrated polyps are more likely to be missed during colonoscopy [10,11,22]. As a result, colonoscopic follow-ups for serrated adenomas should be the same as for conventional adenomatous polyps...." Wednesday, December 22, 2010
Ovarian Cancer and Us - updated blog stats - just checking to see who's with us :-)
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Why We Still Kill Patients: Invisibility, Inertia, And Income – Health Affairs Blog (re: patient safety movement....)
"......As Michael says, “There are no villains here.” Everybody means well. Unless assumptions like those above are explicitly exposed and challenged, though, another quotation might be apt: “The road to hell is paved with good intentions.”....
abstract: The Impact of Age on the Treatment and Survival of Ovarian Cancer Patients
Purpose: Although a significant number of patients diagnosed with ovarian cancer are over the age of 65, these patients are less likely to receive standard therapy and are underrepresented in clinical studies. The objective of our study was to evaluate the treatment and survival of patients over the age of 65 years.
abstract: An Internet Survey of Symptoms Associated With Intra-Abdominal Malignancies: Lack of Specificity for Ovarian Cancer
Conclusion: This analysis fails to support the hypothesis that focusing attention on a pattern of nonspecific symptoms will be helpful in the diagnosis of ovarian cancer.
Tuesday, December 21, 2010
abstract/full access: Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995–2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data : The Lancet
Note: Full access to article is free after registration (free)
"Background
Cancer survival is a key measure of the effectiveness of health-care systems. Persistent regional and international differences in survival represent many avoidable deaths. Differences in survival have prompted or guided cancer control strategies. This is the first study in a programme to investigate international survival disparities, with the aim of informing health policy to raise standards and reduce inequalities in survival.
Methods Data from population-based cancer registries in 12 jurisdictions in six countries were provided for 2·4 million adults diagnosed with primary colorectal, lung, breast (women), or ovarian cancer during 1995—2007, with follow-up to Dec 31, 2007.
Risk of colorectal and endometrial cancers in EPCAM deletion-positive Lynch syndrome: a cohort study : The Lancet Oncology
Interpretation
EPCAM deletion carriers have a high risk of colorectal cancer; only those with deletions extending close to the MSH2 promoter have an increased risk of endometrial cancer. These results underscore the effect of mosaic MSH2 deficiency, leading to variable cancer risks, and could form the basis of an optimised protocol for the recognition and targeted prevention of cancer in EPCAM deletion carriers.
Family History of Cancer and Cancer Risks in Women with BRCA1 or BRCA2 Mutations — J. Natl. Cancer Inst.
Note: some stats taken out for ease of reading
"...Among women with a BRCA1 mutation, the risk of breast cancer increased by 1.2-fold for each first-degree relative with breast cancer before age 50 years and the risk of ovarian cancer increased by 1.6 fold for each first- or second-degree relative with ovarian cancer ...cont'd
Cancer - NPCR - USCS - View Data Online - cancer stats U.S.
Note: ovarian cancer - 8th in incidence rate; 5th in death rate |
eHealthServer.com | European Commission Signs eHealth Agreement with US Department of Health
"...The partnership between the EU and the US, the two world leaders in eHealth, sends a strong signal to all stakeholders that common standards and interoperability bring opportunities for a global approach for the benefit of patients, health systems and the market"
Monday, December 20, 2010
Expert Commentaries: Promoting Transparent and Actionable Clinical Practice Guidelines: Viewpoint from the National Guideline Clearinghouse/National Quality Measures Clearinghouse (NGC/NQMC) Editorial Board
eg:
"..........The NGC/NQMC Editorial Board recommends avoiding vague or ambiguous recommendation statements (such as "Physicians may offer…" or "When possible…").
Recommendation statements containing vague or ambiguous language and expressions are not actionable, at least not consistently. This problem fosters subjective and potentially erroneous interpretation and thus can impede decision-making.
* Example:
..."Frequency of follow-up visits is based on the severity of disease presentation, etiology, and treatment.
Wide Genetic Testing for Lynch Syndrome Cost Effective online teleconference from AACR mp3 download Nov 18th, 2010
The American Association for Cancer Research hosted a teleconference on these findings on Thursday, Nov. 18, 2010, at 3:00 p.m. ET.
Download * the mp3 of the teleconference (10.5 MB, 46 minutes and 13 seconds)
*On a PC, right mouse click on the "Download" link and select "Save link as..." in Firefox or "Save Target as..." in Internet Explorer.
Patients Right to Know - Patient Safety U.S. - Transparency laws
The following states currently have some form of Transparency Law on the books:
Arizona
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Georgia
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New York
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Texas
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|---|---|---|---|
California
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Idaho
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North Carolina
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Vermont
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Colorado
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Indiana
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North Dakota
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Virginia
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Connecticut
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Maryland
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Oregon
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West Virginia
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District of Columbia
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Massachusetts
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Rhode Island
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Florida
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New Jersey
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Tennessee
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Salzburg Global Seminar - selected articles
Session Media:
Session Schedule Session Directory
Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention Study (Dominick L. Frosch, David Rincon, Socorro Ochoa, and Carol M. Mangione)
Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice (Benjamin Moulton and Jaime S. King)
Communicating Evidence for Participatory Decision Making (Ronald M. Epstein, Brian S. Alper and Timothy E. Quill)
Helping Doctors and Patients Make Sense of Health Statistics (Gerd Gigerenzer, Wolfgang Gaissmaier, Elke Kurz-Milcke, Lisa M. Schwartz, and Steven Woloshin)
How Do US Journalists Cover Treatments, Tests, Products, and Procedures? An Evaluation of 500 Stories (Gary Schwitzer)
Implementing shared decision making in the NHS. (Glyn Elwyn and colleagues)
Improving productivity in the NHS. Reducing practice variation through better decision making is key (Albert Mulley) - [Article No. 5, if you scroll down the document]
Launching the Century of the Patient (Gerd Gigerenzer and J. A. Muir Gray)
Policy Support For Patient- Centered Care: The Need For Measurable Improvements In Decision Quality (Karen R. Sepucha, Floyd J. Fowler Jr., and Albert G. Mulley Jr.)
Reactions of Potential Jurors to a Hypothetical Malpractice Suit Alleging Failure to Perform a Prostate-Specific Antigen Test (Michael J. Barry, Pamela H. Wescott, Ellen J. Reifler, Yuchaio Chang, and Benjamin W. Moulton)
Rethinking Informed Consent: The Case for Shared Medical Decision- Making (Jaime Staples King and Benjamin Moulton)
Session Schedule
SHARED DECISION-MAKING IN THE MEDICAL ENCOUNTER: WHAT DOES IT MEAN? (OR IT TAKES AT LEAST TWO TO TANGO) by CATHY CHARLES, AMIRAM GAFNV and TIM WHELAN
The Future of Health Journalism (Gary Schwitzer)
The need to confront variation in practice (Albert G Mulley)
Clinicians' concerns about decision support interventions for patients facing breast cancer surgery options: understanding the challenge of implementing shared decision-making (Caldon LJ, Collins KA, Reed MW, Sivell S, Austoker J, Clements AM, Patnick J, Elwyn G; BresDex Group)
(http://www.ncbi.nlm.nih.gov/pubmed/21029281)
HEALTH CROSSROADS / HEALTH DIALOG: Prostate Cancer Screening
(https://www.healthcrossroads.com/example/crossroad.aspx?contentGUID=fc326615-5b29-47f1-87c3-9a3e2d946919)
HEALTH DIALOG: Getting the Healthcare That’s Right for You
(http://www.healthdialog.com/Main/Personalhealthcoaching/Shared-Decision-Making/Getting-The-Care-Thats-Right-For-You)
I Believe, Therefore I Do. (Frosch DL, Elwyn G.)
(http://www.ncbi.nlm.nih.gov/pubmed/21061083)
Implementing shared decision making in the NHS (Elwyn G, Laitner S, Coulter A, Walker E, Watson P, Thomson R.)
(http://www.ncbi.nlm.nih.gov/pubmed/20947577)
SESSION BLOG: e-Patient Dave: A Voice of Patient Engagement (Dave deBronkart)
(http://epatientdave.com/2010/11/29/a-radical-view-of-complianceadherence-from-1977/)
Session Position Paper - with thanks to the British Medical Journal: Do patients want a choice and does it work? by co-chair of the session, Angela Coulter, Director of Global Initiatives, Foundation for Informed Medical Decision Making
(http://www.bmj.com/content/341/bmj.c4989.full.html?ijkey=icrFYTXpKpvq5Bc&keytype=ref&siteid=bmjjournals)
TED: Sheena Iyengar on the art of choosing
(http://www.ted.com/talks/sheena_iyengar_on_the_art_of_choosing.html)
The New Yorker: The Cost Conundrum. What a Texas town can teach us about health care (Atul Gawande June 1, 2009)
(http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all)
Tracking Medicine (John Wennberg)
(http://www.trackingmedicine.com/)
Sunday, December 19, 2010
Genetic Variation at 9p22.2 and Ovarian Cancer Risk for BRCA1 and BRCA2 Mutation Carriers — J. Natl. Cancer Inst.
Conclusion: Common genetic variation at the 9p22.2 locus was associated with decreased risk of ovarian cancer for carriers of a BRCA1 or BRCA2 mutation.
Genomics|Update|Current - Recommendation on Genetic Testing for Risk of Cardiovascular Disease
Recommendation on Genetic Testing for Risk of Cardiovascular Disease
This month the independent Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group
has released a new evidence-based recommendation on the use of “cardiogenomic profiles” (or “heart health”) genetic tests. These tests are being marketed to physicians and the general public as a way to find out a person’s risk for cardiovascular disease, and some can be ordered online without the involvement of a physician. The EGAPP Working Group did not find enough evidence to indicate whether these tests should or should not be used to determine future cardiovascular risk in the general population, and currently discourages the use of this testing except in research settings. Access the EGAPP recommendation. Read more about the EGAPP recommendation.
Docetaxel plus trabectedin appears active in recurrent or persistent ovarian and primary peritoneal cancer after up to three prior regimens: A phase II study of the Gynecologic Oncology Group
CONCLUSIONS: This combination was well tolerated and appears more active than the historical control of single agent taxane therapy in those with recurrent ovarian and peritoneal cancer after failing multiple lines of chemotherapy. Further study is warranted
Saturday, December 18, 2010
full free access: PLoS Medicine: Which Path to Universal Health Coverage? Perspectives on the World Health Report 2010
Box 1. Key Recommendations of the World Health Report 2010
- There is no single path or magic bullet to achieve universal health coverage: each country needs to devise its own route to achieve this goal.
- All countries, but particularly poorer ones, need to reduce reliance on direct, out-of-pocket payments for health care by increasing risk pooling and prepayment for services.
- Countries should address barriers to health care other than direct payments for care: transport costs and lost income can be substantial obstacles to care seeking.
- There is substantial scope to raise further domestic resources for health care, particularly through innovative approaches to financing.
- 20%–40% of health care expenditure is wasted; improved health system efficiency can make a substantial contribution to the achievement of universal health coverage.
- Wealthier countries should provide financial support to low income countries in order for them to achieve universal health care coverage.
- Despite some progress, development assistance for health remains fragmented and unpredictable; efforts to improve the efficiency and coordination of aid must be intensified.
new research: ICON7 Results May Change Practice in Ovarian Cancer | Cancer Survivors Network
OncologySTAT: Dr. Cervantes, what were the most important studies in ovarian cancer that were presented at this year’s ESMO Congress?
Nov 2010: Health Council of Canada / Conseil canadien de la santé - How Do Canadians Rate the Health Care System?
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