Study Challenges Colon Cancer Surgery Follow-Up
TUESDAY, Nov. 13 (HealthDay News) -- A new study is questioningthe conventional wisdom of checking on the health of 12 lymph nodes aftercolon cancer surgery.
These post-op checks have been thought to be a good indicator ofpatient survival, but new data is casting that notion in doubt.
"What we are finding is that focusing on this quality indicator may nothave much positive value for predicting patient outcome," said the study'slead author, Dr. Sandra L. Wong, assistant professor of surgery at theUniversity of Michigan, Ann Arbor.
Wong's team published its report in the Nov. 14 issue of the Journalof the American Medical Association.
The routine examination of 12 lymph nodes after colon cancer surgeryhas been endorsed by the National Quality Forum, a respected organizationbacked by such prestigious bodies as the American Cancer Society and theAmerican Society of Clinical Oncology.
However, the Michigan study of more than 30,000 people who underwentcolon cancer surgery provided no support for the protocol.
One expert wasn't surprised by the results.
"People have been interpreting information relating the number of nodesexamined and survival in a very simplistic way," said Dr. Nancy N. Baxter,assistant professor of surgery at the University of Toronto and co-authorof an accompanying editorial. "That relationship is probably prettycomplex, due at least in part to the underlying biology of the tumor," shesaid.
Using information from the Medicare-linked National Surveillance andEnd Results data base, Wong's team divided hospitals where the surgery wasdone into four groups, based on the proportion of patients who had 12 ormore lymph nodes examined.
They then assessed patient survival rates for each group of hospitals,adjusting for patient and doctor characteristics.
Hospitals with the highest proportion of patients with 12 or more lymphnodes examined tended to treat lower-risk patients and have a highervolume of surgery. After adjusting for these factors, the researchersfound no statistically significant relationship between the number oflymph nodes examined and patients' survival after surgery.
The idea of examining lymph nodes to estimate survival does make sense,experts say. That's because death is more likely if the cancer spreadsbeyond the colon, and the route of spread is typically through the lymphnodes.
However, Wong and her colleagues found that hospitals in the studytended to find the same number of lymph nodes positive for cancer, nomatter how many nodes they examined.
There are several possible explanations for this seeming paradox,including individual variations in dissection or surgical techniques, Wongsaid. More studies looking at further clinical details may get an answer,she said.
Meanwhile, Wong said, the findings indicated a need to reconsider the12-node rule, because there is a limit to the resources that can beexpended per patient, she said. "If we spend a lot of resources to exactthe 12-node exam as the standard of care, we're going to miss theopportunity to improve in other ways," she said.
It would be a mistake to focus entirely on this one indicator ofquality, she said.
"Further studies are important, but what we need are better qualityindicators," Wong said. She said she had no immediate suggestions aboutthe sort of characteristics that should be examined, except that "we needto look at broader indicators."
For her part, Baxter said that perhaps too much emphasis was beingplaced on node numbers and diagnoses.
"I don't think setting benchmarks for the number of nodes to beexamined will change the outcome for a substantial number of patients,"she said. "We should concentrate on things we know will help. For example,we know that many patients with stage 3 colon cancer don't getchemotherapy." Stage 3 cancer has spread to the lymph nodes but not beyondthem.
"There is a lot of work to be done in terms of getting treatment weknow helps patients, to patients," Baxter said.
But the relationship between the number of nodes examined and patientsurvival should continue to be explored, Baxter said. "There may be someunderlying biological factor we could use," she added.
Another expert also said more research needs to be done.
"In many ways, this study confirms a lot of prior findings about lymphnodes and survival," said Dr George Chang, assistant professor of surgicaloncology at the University of Texas M. D. Anderson Cancer Center inHouston. "But it highlights the complexity of that relationship."
Even in the quarter of hospitals in which the largest number of lymphnodes were examined, "only 61 percent of patients had 12 looked at," Changsaid. "Perhaps examination of a considerably larger number is required topredict survival."
More information
There's more on colon cancer at the U.S. National Library of Medicine.
Showing posts with label cancer. Show all posts
Showing posts with label cancer. Show all posts
Tuesday, January 1, 2008
Side effects vary by breast cancer maintenance therapy
Side effects vary by breast cancer maintenance therapy
NEW YORK (Reuters Health) - Among postmenopausal womenreceiving adjuvant therapy for early breast cancer, exemestaneis associated with fewer hot flashes than is tamoxifen, but italso causes more sleep problems, according to a study publishedthe Journal of Clinical Oncology.
"Hormonal breast cancer treatment increases menopausalsymptoms in women," note Dr. Stephen E. Jones and colleaguesfrom US Oncology Research Inc., Houston.
The investigators used questionnaires, completed by morethan 1,500 women to assess 10 common symptoms in the first yearof a clinical trial of tamoxifen or exemestane. Tamoxifen issold under the trade name Nolvadex, and exemestane is soldunder the trade name Aromasin.
The patients had completed surgery and chemotherapy forearly breast cancer. All of the women had hormonereceptor-positive cancers, which respond to these two agents.
The prevalence of the initial symptoms ranged from 2percent (for vaginal bleeding) to 75 percent (for fatigue).
Patients who received tamoxifen experienced significantlymore vaginal discharge than those who received exemestane.Those who received exemestane had more bone and muscle aches,vaginal dryness, difficulty sleeping and decreased libido.
In both treatment groups, hot flash scores peaked at about3 months and decreased thereafter. As mentioned, patients inthe tamoxifen group had a significantly higher mean hot flashscore at 12 months than those in the exemestane group.
"These are common complaints and the treatments used makesome worse," Jones commented to Reuters Health. "Oncologistsand other oncology health professionals need to be aware of thecommonplace nature (of these side effects) and attempt to helpwherever possible," he said. For example, he suggested it maybe necessary to treat the hot flashes if they are affecting thepatient's of life.
SOURCE: Journal of Clinical Oncology, October 20, 2007.
NEW YORK (Reuters Health) - Among postmenopausal womenreceiving adjuvant therapy for early breast cancer, exemestaneis associated with fewer hot flashes than is tamoxifen, but italso causes more sleep problems, according to a study publishedthe Journal of Clinical Oncology.
"Hormonal breast cancer treatment increases menopausalsymptoms in women," note Dr. Stephen E. Jones and colleaguesfrom US Oncology Research Inc., Houston.
The investigators used questionnaires, completed by morethan 1,500 women to assess 10 common symptoms in the first yearof a clinical trial of tamoxifen or exemestane. Tamoxifen issold under the trade name Nolvadex, and exemestane is soldunder the trade name Aromasin.
The patients had completed surgery and chemotherapy forearly breast cancer. All of the women had hormonereceptor-positive cancers, which respond to these two agents.
The prevalence of the initial symptoms ranged from 2percent (for vaginal bleeding) to 75 percent (for fatigue).
Patients who received tamoxifen experienced significantlymore vaginal discharge than those who received exemestane.Those who received exemestane had more bone and muscle aches,vaginal dryness, difficulty sleeping and decreased libido.
In both treatment groups, hot flash scores peaked at about3 months and decreased thereafter. As mentioned, patients inthe tamoxifen group had a significantly higher mean hot flashscore at 12 months than those in the exemestane group.
"These are common complaints and the treatments used makesome worse," Jones commented to Reuters Health. "Oncologistsand other oncology health professionals need to be aware of thecommonplace nature (of these side effects) and attempt to helpwherever possible," he said. For example, he suggested it maybe necessary to treat the hot flashes if they are affecting thepatient's of life.
SOURCE: Journal of Clinical Oncology, October 20, 2007.
Drug Helps Fight Late-Stage Colon Cancer in Some Patients
Drug Helps Fight Late-Stage Colon Cancer in Some Patients
WEDNESDAY, Nov. 14 (HealthDay News) -- A highly targeted biologicdrug called cetuximab (Erbitux) is the first to extend the survival ofpatients with advanced colon cancer who have otherwise proved resistant toconventional chemotherapy, Canadian researchers confirmed.
But the drug, which costs $12,000 a month in the United States, appearsto be effective in only about one-third of colon tumors, based on theirspecific gene profile, experts added.
"That's a significant number, but it still leaves a large proportion[of patients] who aren't benefiting," noted lead researcher Dr. DerekJonker, assistant professor of medicine at the University of Ottawa and amedical oncologist at the Ottawa Hospital.
Nevertheless, the success of any new drug is welcome, he added.
"Until now, no anticancer therapy had demonstrated an improvement insurvival in patients for whom chemotherapy was no longer effective, andfor whom supportive care was the only available treatment," Jonker said."So, cetuximab provides new hope for these patients."
The findings were reported in the Nov. 15 issue of the New EnglandJournal of Medicine. The study was funded by the National CancerInstitute of Canada, as well as ImClone Systems and Bristol-Myers Squibb,the two companies that developed the drug.
Colorectal cancer is the third most common kind of cancer and the thirdleading cause of cancer death in the United States. As Jonker explained,most patients are treated with either surgery or conventionalchemotherapy, which typically targets cellular DNA.
Unfortunately, almost all patients with advanced or metastasized coloncancer will develop resistance to standard chemotherapy drugs, hesaid.
"However, now we have a new class of drugs known as the biologicallytargeted therapies, such as cetuximab, and these drugs are targeted todifferent aspects of the tumor biology," Jonker explained. "Many of themare targeted at receptors or signals that trigger a cancer cell togrow."
In the case of cetuximab, the drug's target is the epidermal growthfactor receptor (EGFR), which is found in especially high concentrationson colon cancer cells. Because biologic drugs are finely targeted toaffect cancer cells and not healthy cells, they typically have fewer sideeffects than standard chemotherapy.
In 2004, the U.S. Food and Drug Administration granted cetuximabconditional approval for use in patients with late-stage,chemotherapy-resistant colon cancer. At the time, the agency stated thatfull approval hinged on the outcome of the Canadian trial.
In October, and based on the new findings, the agency followed throughand gave the drug its full approval for this new indication.
In the trial, Jonker's team administered individualized doses ofcetuximab to 287 colon cancer patients treated between late 2003 andAugust 2005. All of the patients had proven resistant to standardchemotherapy. Another 285 patients received supportive/palliative careonly -- the usual option for patients in this situation.
Compared to those who didn't receive the drug, overall survival forpatients receiving cetuximab improved by 23 percent, while survivalwithout any sign of disease progression rose by 32 percent, the researchteam reported.
The incidence of side effects -- including skin rash -- was 78.5percent in the cetuximab group versus about 59 percent for the controlgroup.
One key point, however, was that increases in survival were found onlyamong the 31.4 percent of patients who actually responded to cetuximab,meaning that their cancer stopped growing.
That's probably due to the fact that cetuximab (as well as a relateddrug, panitumumab) only works against a specific subtype of colon cancercell -- those carrying an unmutated version of a particular gene calledKRAS.
"Mutated KRAS almost guarantees no benefit" from cetuximab, said oneexpert, Dr. Axel Grothey, a professor of oncology and chairman of thecolorectal cancer group at the Mayo Clinic, in Rochester, Minn.
For that reason, he said, pre-treatment gene testing may prove crucialto decisions as to whether a particular patient receives cetuximab ornot.
Because it is so expensive -- the costliest drug used today againstcolon cancer -- and because it can induce side effects, "I would likecetuximab to be used in a more individualized way," Grothey said.
He said that most cancer centers, including the Mayo Clinic, do not yethave technologies in place to test tumors for KRAS, but many are lookinginto it.
Jonker agreed that, ideally, KRAS testing and the use of cetuximabwould go hand-in-hand. That way, he said, "We wouldn't have to put[patients] through treatment, and we wouldn't have to suffer the cost oftreatment for people who may not even respond to the drug."
Studies are already under way to see if adding cetuximab to othertherapies will boost survival even further, Jonker said. "The future ofcetuximab is likely to be in combination with chemotherapy or otherbiologically targeted therapies, where the benefits of cetuximab might befurther enhanced," he said.
The drug might also work better if given earlier in the diseaseprocess, before patients have developed resistance to chemotherapy.
In any case, the Canadian trial does give colon cancer patients somenew reason for hope, Grothey said. "We need this drug," he said, "and weprobably need it even earlier."
WEDNESDAY, Nov. 14 (HealthDay News) -- A highly targeted biologicdrug called cetuximab (Erbitux) is the first to extend the survival ofpatients with advanced colon cancer who have otherwise proved resistant toconventional chemotherapy, Canadian researchers confirmed.
But the drug, which costs $12,000 a month in the United States, appearsto be effective in only about one-third of colon tumors, based on theirspecific gene profile, experts added.
"That's a significant number, but it still leaves a large proportion[of patients] who aren't benefiting," noted lead researcher Dr. DerekJonker, assistant professor of medicine at the University of Ottawa and amedical oncologist at the Ottawa Hospital.
Nevertheless, the success of any new drug is welcome, he added.
"Until now, no anticancer therapy had demonstrated an improvement insurvival in patients for whom chemotherapy was no longer effective, andfor whom supportive care was the only available treatment," Jonker said."So, cetuximab provides new hope for these patients."
The findings were reported in the Nov. 15 issue of the New EnglandJournal of Medicine. The study was funded by the National CancerInstitute of Canada, as well as ImClone Systems and Bristol-Myers Squibb,the two companies that developed the drug.
Colorectal cancer is the third most common kind of cancer and the thirdleading cause of cancer death in the United States. As Jonker explained,most patients are treated with either surgery or conventionalchemotherapy, which typically targets cellular DNA.
Unfortunately, almost all patients with advanced or metastasized coloncancer will develop resistance to standard chemotherapy drugs, hesaid.
"However, now we have a new class of drugs known as the biologicallytargeted therapies, such as cetuximab, and these drugs are targeted todifferent aspects of the tumor biology," Jonker explained. "Many of themare targeted at receptors or signals that trigger a cancer cell togrow."
In the case of cetuximab, the drug's target is the epidermal growthfactor receptor (EGFR), which is found in especially high concentrationson colon cancer cells. Because biologic drugs are finely targeted toaffect cancer cells and not healthy cells, they typically have fewer sideeffects than standard chemotherapy.
In 2004, the U.S. Food and Drug Administration granted cetuximabconditional approval for use in patients with late-stage,chemotherapy-resistant colon cancer. At the time, the agency stated thatfull approval hinged on the outcome of the Canadian trial.
In October, and based on the new findings, the agency followed throughand gave the drug its full approval for this new indication.
In the trial, Jonker's team administered individualized doses ofcetuximab to 287 colon cancer patients treated between late 2003 andAugust 2005. All of the patients had proven resistant to standardchemotherapy. Another 285 patients received supportive/palliative careonly -- the usual option for patients in this situation.
Compared to those who didn't receive the drug, overall survival forpatients receiving cetuximab improved by 23 percent, while survivalwithout any sign of disease progression rose by 32 percent, the researchteam reported.
The incidence of side effects -- including skin rash -- was 78.5percent in the cetuximab group versus about 59 percent for the controlgroup.
One key point, however, was that increases in survival were found onlyamong the 31.4 percent of patients who actually responded to cetuximab,meaning that their cancer stopped growing.
That's probably due to the fact that cetuximab (as well as a relateddrug, panitumumab) only works against a specific subtype of colon cancercell -- those carrying an unmutated version of a particular gene calledKRAS.
"Mutated KRAS almost guarantees no benefit" from cetuximab, said oneexpert, Dr. Axel Grothey, a professor of oncology and chairman of thecolorectal cancer group at the Mayo Clinic, in Rochester, Minn.
For that reason, he said, pre-treatment gene testing may prove crucialto decisions as to whether a particular patient receives cetuximab ornot.
Because it is so expensive -- the costliest drug used today againstcolon cancer -- and because it can induce side effects, "I would likecetuximab to be used in a more individualized way," Grothey said.
He said that most cancer centers, including the Mayo Clinic, do not yethave technologies in place to test tumors for KRAS, but many are lookinginto it.
Jonker agreed that, ideally, KRAS testing and the use of cetuximabwould go hand-in-hand. That way, he said, "We wouldn't have to put[patients] through treatment, and we wouldn't have to suffer the cost oftreatment for people who may not even respond to the drug."
Studies are already under way to see if adding cetuximab to othertherapies will boost survival even further, Jonker said. "The future ofcetuximab is likely to be in combination with chemotherapy or otherbiologically targeted therapies, where the benefits of cetuximab might befurther enhanced," he said.
The drug might also work better if given earlier in the diseaseprocess, before patients have developed resistance to chemotherapy.
In any case, the Canadian trial does give colon cancer patients somenew reason for hope, Grothey said. "We need this drug," he said, "and weprobably need it even earlier."
Cell Structure Helps Direct Cancer Gene 'Switch'
Cell Structure Helps Direct Cancer Gene 'Switch'
WEDNESDAY, Nov. 14 (HealthDay News) -- U.S. scientists say theyhave uncovered a biological "switch" for key genes in cancer cells.
They found that genes in cancer cells are silenced by distinct changesin the density of structures called nucleosomes within the cells.
"The study shows for the first time exactly how genes get shut down incancer cells. It identifies what the target looks like, so that newtherapies can be designed to turn them back on," study lead author PeterA. Jones, director of the USC/Norris Comprehensive Cancer Center andDistinguished Professor at the Keck School of Medicine of USC, said in aprepared statement.
According to a statement from the university, "The study showed thatsilencing of transcription start sites in some cancer cells involvesdistinct changes in nucleosomal occupancy -- or the density ofnucleosomes -- in the cell."
A process called "DNA cytosine methylation -- the addition of a groupof specific chemicals to a stretch of DNA that can lock or silence agene -- may ultimately lead to [gene] silencing by enabling the stablepresence of nucleosomes at the start sites of cancer-related genes," therelease said.
The study was published in the Nov. 13 issue of the journal CancerCell.
More information
The U.S. National Cancer Institute has more about cancer.
WEDNESDAY, Nov. 14 (HealthDay News) -- U.S. scientists say theyhave uncovered a biological "switch" for key genes in cancer cells.
They found that genes in cancer cells are silenced by distinct changesin the density of structures called nucleosomes within the cells.
"The study shows for the first time exactly how genes get shut down incancer cells. It identifies what the target looks like, so that newtherapies can be designed to turn them back on," study lead author PeterA. Jones, director of the USC/Norris Comprehensive Cancer Center andDistinguished Professor at the Keck School of Medicine of USC, said in aprepared statement.
According to a statement from the university, "The study showed thatsilencing of transcription start sites in some cancer cells involvesdistinct changes in nucleosomal occupancy -- or the density ofnucleosomes -- in the cell."
A process called "DNA cytosine methylation -- the addition of a groupof specific chemicals to a stretch of DNA that can lock or silence agene -- may ultimately lead to [gene] silencing by enabling the stablepresence of nucleosomes at the start sites of cancer-related genes," therelease said.
The study was published in the Nov. 13 issue of the journal CancerCell.
More information
The U.S. National Cancer Institute has more about cancer.
Ultrasound Beats Blood Test for Gauging Ovarian Cancers:Study
Ultrasound Beats Blood Test for Gauging Ovarian Cancers:Study
THURSDAY, Nov. 15 (HealthDay News) -- Ultrasound exams are betterthan blood tests at identifying whether ovarian tumors are benign ormalignant, a team of international researchers reports.
Ultrasound correctly identified 93 percent of tumors as benign orcancerous, while the blood test was correct 83 percent of the time.
Results of the study, by the International Ovarian Tumor Analysiscollaboration group (IOTA), were published online Nov. 13 in theJournal of the National Cancer Institute.
"To my knowledge, the IOTA study is the first study that clearlydemonstrated that in experienced hands, ultrasound is significantly betterthan blood tests,'" said study leader Dr. Dirk Timmerman, a researcher atKatholieke Universiteit Leuven in Belgium.
An estimated 22,430 new cases of ovarian cancer are expected to bediagnosed in 2007 in the United States, according to the American CancerSociety, with about 15,280 deaths. The disease typically strikes womenover age 55. Symptoms include bloating, pelvic or abdominal pain,difficulty eating or feeling full quickly, or urinary symptoms such as afrequent need to urinate.
Because the symptoms are often similar to less serious conditions, onlyabout 20 percent of ovarian cancers are found at an early stage, thecancer society estimates. This makes the quest for the best techniques todetect the cancer early even more important.
For the IOTA study, Timmerman and his colleagues compared ultrasoundwith blood tests to decide if the ovarian masses discovered in 1,066 womenwere benign or malignant.
Experts examined patterns in ultrasound images, and then compared thoseresults with blood tests that detect an elevated level of the proteinCA-125, considered an indicator of whether an ovarian tumor is cancerousor benign.
The ultrasound exams, including transvaginal gray-scale and colorDoppler ultrasound exams, were given within 120 days of surgery to removethe tumors. Before surgery, 809 of the women gave blood, and the sampleswere analyzed later for CA-125 levels.
When the results from both methods were compared with the findings atsurgery, the researchers found that ultrasound correctly classified 93percent of tumors as cancerous or not, while the blood test was correct inonly 83 percent of cases.
"The IOTA study not only demonstrated that ultrasound is better thanblood tests but also that the blood tests do not give additional benefitin mathematical models developed to distinguish between benign andmalignant masses," Timmerman said.
Timmerman emphasized that the study only looked at the best method todecide if a tumor was cancerous after the mass had already beendiscovered. "Of course, this is different from screening," he said. "Inscreening studies, a healthy population is screened for a specificdisease, for example, ovarian cancer. In that setting, a blood test mightprove to be useful in the future." He noted that two large studiesexploring that issue are expected to conclude in about five years.
Dr. Robert Morgan, co-director of the gynecologic oncology/peritonealmalignancy program at the City of Hope Cancer Center in Duarte, Calif.,said the study results confirm what doctors have known for a long time."CA-125 is only elevated in about 50 percent of early stage ovariancancer, and the data in this paper confirms that," he said.
The study's bottom line: Most of these cancers are being picked up withultrasound, not the blood test, Morgan said. "And, most of the time, when[the ultrasound] says it's not malignant, it's not," he said.
''C-125 tests are not cheap and, particularly when you do them in ahuge number of patients, the costs add up. And, apparently, they don'tseem to be adding anything to the diagnostic accuracy," he added.
Sherry Salway Black, executive director of the Ovarian Cancer NationalAlliance, called the new study results exciting. "It gives moreinformation, more evidence that a transvaginal ultrasound can be effectiveunder these circumstances."
Still, she said, the blood test might prove to have some benefit. "Itmay not be the best stand-alone diagnostic tool. This [study] appears tosay transvaginal ultrasound is definitely better." But the study authorsdid find that CA-125 levels in women found to have cancer were higher forpostmenopausal women than premenopausal women, for instance. And suchdetails, Black said, might prove valuable.
Meanwhile, a study from Boston's Brigham and Women's Hospital has foundthat regular consumption of foods containing the flavonoid kaempferol,including nonherbal tea and broccoli, was associated with a reduced riskof ovarian cancer. The study, funded by the National Cancer Institute andpublished in the Nov. 15 issue of the International Journal ofCancer, also found a decreased risk in women who consumed largeamounts of the flavonoid luteolin, found in carrots, peppers and cabbage.
"This is good news, because there are few lifestyle factors known toreduce a woman's risk of ovarian cancer," first author Margaret Gates, aresearch fellow at the hospital, said in a prepared statement. "Althoughadditional research is needed, these findings suggest that consuming adiet rich in flavonoids may be protective."
"Other flavonoid-rich foods, such as onions, beans and kale, may alsodecrease ovarian cancer risk, but the number of women who frequentlyconsumed these foods was not large enough to clearly evaluate theseassociations. More research is needed," concluded Gates, who is also aresearch fellow at the Harvard School of Public Health.
THURSDAY, Nov. 15 (HealthDay News) -- Ultrasound exams are betterthan blood tests at identifying whether ovarian tumors are benign ormalignant, a team of international researchers reports.
Ultrasound correctly identified 93 percent of tumors as benign orcancerous, while the blood test was correct 83 percent of the time.
Results of the study, by the International Ovarian Tumor Analysiscollaboration group (IOTA), were published online Nov. 13 in theJournal of the National Cancer Institute.
"To my knowledge, the IOTA study is the first study that clearlydemonstrated that in experienced hands, ultrasound is significantly betterthan blood tests,'" said study leader Dr. Dirk Timmerman, a researcher atKatholieke Universiteit Leuven in Belgium.
An estimated 22,430 new cases of ovarian cancer are expected to bediagnosed in 2007 in the United States, according to the American CancerSociety, with about 15,280 deaths. The disease typically strikes womenover age 55. Symptoms include bloating, pelvic or abdominal pain,difficulty eating or feeling full quickly, or urinary symptoms such as afrequent need to urinate.
Because the symptoms are often similar to less serious conditions, onlyabout 20 percent of ovarian cancers are found at an early stage, thecancer society estimates. This makes the quest for the best techniques todetect the cancer early even more important.
For the IOTA study, Timmerman and his colleagues compared ultrasoundwith blood tests to decide if the ovarian masses discovered in 1,066 womenwere benign or malignant.
Experts examined patterns in ultrasound images, and then compared thoseresults with blood tests that detect an elevated level of the proteinCA-125, considered an indicator of whether an ovarian tumor is cancerousor benign.
The ultrasound exams, including transvaginal gray-scale and colorDoppler ultrasound exams, were given within 120 days of surgery to removethe tumors. Before surgery, 809 of the women gave blood, and the sampleswere analyzed later for CA-125 levels.
When the results from both methods were compared with the findings atsurgery, the researchers found that ultrasound correctly classified 93percent of tumors as cancerous or not, while the blood test was correct inonly 83 percent of cases.
"The IOTA study not only demonstrated that ultrasound is better thanblood tests but also that the blood tests do not give additional benefitin mathematical models developed to distinguish between benign andmalignant masses," Timmerman said.
Timmerman emphasized that the study only looked at the best method todecide if a tumor was cancerous after the mass had already beendiscovered. "Of course, this is different from screening," he said. "Inscreening studies, a healthy population is screened for a specificdisease, for example, ovarian cancer. In that setting, a blood test mightprove to be useful in the future." He noted that two large studiesexploring that issue are expected to conclude in about five years.
Dr. Robert Morgan, co-director of the gynecologic oncology/peritonealmalignancy program at the City of Hope Cancer Center in Duarte, Calif.,said the study results confirm what doctors have known for a long time."CA-125 is only elevated in about 50 percent of early stage ovariancancer, and the data in this paper confirms that," he said.
The study's bottom line: Most of these cancers are being picked up withultrasound, not the blood test, Morgan said. "And, most of the time, when[the ultrasound] says it's not malignant, it's not," he said.
''C-125 tests are not cheap and, particularly when you do them in ahuge number of patients, the costs add up. And, apparently, they don'tseem to be adding anything to the diagnostic accuracy," he added.
Sherry Salway Black, executive director of the Ovarian Cancer NationalAlliance, called the new study results exciting. "It gives moreinformation, more evidence that a transvaginal ultrasound can be effectiveunder these circumstances."
Still, she said, the blood test might prove to have some benefit. "Itmay not be the best stand-alone diagnostic tool. This [study] appears tosay transvaginal ultrasound is definitely better." But the study authorsdid find that CA-125 levels in women found to have cancer were higher forpostmenopausal women than premenopausal women, for instance. And suchdetails, Black said, might prove valuable.
Meanwhile, a study from Boston's Brigham and Women's Hospital has foundthat regular consumption of foods containing the flavonoid kaempferol,including nonherbal tea and broccoli, was associated with a reduced riskof ovarian cancer. The study, funded by the National Cancer Institute andpublished in the Nov. 15 issue of the International Journal ofCancer, also found a decreased risk in women who consumed largeamounts of the flavonoid luteolin, found in carrots, peppers and cabbage.
"This is good news, because there are few lifestyle factors known toreduce a woman's risk of ovarian cancer," first author Margaret Gates, aresearch fellow at the hospital, said in a prepared statement. "Althoughadditional research is needed, these findings suggest that consuming adiet rich in flavonoids may be protective."
"Other flavonoid-rich foods, such as onions, beans and kale, may alsodecrease ovarian cancer risk, but the number of women who frequentlyconsumed these foods was not large enough to clearly evaluate theseassociations. More research is needed," concluded Gates, who is also aresearch fellow at the Harvard School of Public Health.
Cell Insights May Predict Breast Cancer's Spread
Cell Insights May Predict Breast Cancer's Spread
FRIDAY, Nov. 16 (HealthDay News) -- U.S. researchers believethey're on the way to solving a major question about breast cancer: Whichwomen have a type of lesion in their breast duct that will progress toinvasive disease?
"It's an exciting step forward -- people have been trying to gettraction on this big clinical problem for about 40 years, and this is abig crack in the door," said lead researcher Thea Tlsty, a professor ofpathology at the University of California, San Francisco.
Ductal carcinoma in situ (DCIS), as this type of lesion is officiallyknown, is diagnosed in about 47,000 American women every year, accordingto the U.S. National Cancer Institute. To prevent its recurrence asinvasive breast cancer, DCIS generally is treated by lumpectomy alone(approximately 25 percent of cases) or lumpectomy with adjunctivetreatments such as radiation, chemotherapy, and/or hormones (approximately40 percent).
In about 25 percent of cases, complete mastectomies are performed. Lessthan an estimated 5 percent of women choose "watchful waiting" in lieu ofa surgical intervention, Tlsty said.
But doctors are still confronted with a guessing game when it comes topredicting those patients at highest risk for recurrence, Tlsty said."Only about 12 to 15 percent of women diagnosed with DCIS are going tohave a future invasive cancer, and all the others won't. Up until now, theproblem was that we couldn't distinguish the 12 to 15 percent from thosewho were not [at risk]," explained Tlsty.
Consequently, some women unknowingly are overtreated by having amastectomy, and others are undertreated if they chose a course of watchfulwaiting rather than surgical intervention, Tlsty added.
In their pilot study, published in the November issue of CancerCell, the UCSF team looked at how a collection of biomarkers,including molecules called p16 and ki67, interact to predict invasivetumors, she explained.
Because this initial study was done on tissue samples from 70 women, alarger retrospective study is under way at UCSF to validate the initialresults, Tlsty said.
Further research, including a large prospective trial, is also neededbefore the findings can be ready for clinical use, she added. If that workupholds the results of the pilot study, the biomarkers could be ready forclinical use within four to five years, Tlsty said.
Dr. Joseph Geradts, a professor of pathology at Duke University inDurham, N.C., said that finding biomarkers that predict the conversion ofDCIS into invasive cancer is "the holy grail of breast cancer research."He said there have been a number of previous studies that have beenpublished, but, so far, they've been "mostly a fruitless effort."
According to Geradts, the UCSF study "is valuable," because "theauthors propose two new biomarkers that in the past have not been lookedat." The UCSF team's findings "are intriguing preliminary data" that"merit confirmation and subsequent studies," he added.
Geradts said his own lab currently is researching whether changes inDNA may identify a tumor's capacity to metastasize or become invasive.Other researchers are looking at other DCIS biomarkers, he said.
"DCIS itself is a non-life threatening condition" with rare exceptions,noted Dr. Eric Winer, director of breast oncology at the Dana-FarberCancer Institute in Boston, and women are usually treated to help preventinvasive cancer. If the findings of the initial UCSF study are confirmed,then with "careful investigation, we may get to the point where we don'thave to treat all women with DCIS, and we may be able to tailor it so somewomen get less, and some women get more" depending upon their risk forinvasive breast cancer, Winer said.
"It's a very complex and interesting study" added Dr. Richard Bleicher,a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We needto be cautiously optimistic."
Bleicher added that while the findings have "significant potential,"women at this point shouldn't "pin all your hopes on it," because the p16assay is not something they can ask their doctors for at this point intime.
FRIDAY, Nov. 16 (HealthDay News) -- U.S. researchers believethey're on the way to solving a major question about breast cancer: Whichwomen have a type of lesion in their breast duct that will progress toinvasive disease?
"It's an exciting step forward -- people have been trying to gettraction on this big clinical problem for about 40 years, and this is abig crack in the door," said lead researcher Thea Tlsty, a professor ofpathology at the University of California, San Francisco.
Ductal carcinoma in situ (DCIS), as this type of lesion is officiallyknown, is diagnosed in about 47,000 American women every year, accordingto the U.S. National Cancer Institute. To prevent its recurrence asinvasive breast cancer, DCIS generally is treated by lumpectomy alone(approximately 25 percent of cases) or lumpectomy with adjunctivetreatments such as radiation, chemotherapy, and/or hormones (approximately40 percent).
In about 25 percent of cases, complete mastectomies are performed. Lessthan an estimated 5 percent of women choose "watchful waiting" in lieu ofa surgical intervention, Tlsty said.
But doctors are still confronted with a guessing game when it comes topredicting those patients at highest risk for recurrence, Tlsty said."Only about 12 to 15 percent of women diagnosed with DCIS are going tohave a future invasive cancer, and all the others won't. Up until now, theproblem was that we couldn't distinguish the 12 to 15 percent from thosewho were not [at risk]," explained Tlsty.
Consequently, some women unknowingly are overtreated by having amastectomy, and others are undertreated if they chose a course of watchfulwaiting rather than surgical intervention, Tlsty added.
In their pilot study, published in the November issue of CancerCell, the UCSF team looked at how a collection of biomarkers,including molecules called p16 and ki67, interact to predict invasivetumors, she explained.
Because this initial study was done on tissue samples from 70 women, alarger retrospective study is under way at UCSF to validate the initialresults, Tlsty said.
Further research, including a large prospective trial, is also neededbefore the findings can be ready for clinical use, she added. If that workupholds the results of the pilot study, the biomarkers could be ready forclinical use within four to five years, Tlsty said.
Dr. Joseph Geradts, a professor of pathology at Duke University inDurham, N.C., said that finding biomarkers that predict the conversion ofDCIS into invasive cancer is "the holy grail of breast cancer research."He said there have been a number of previous studies that have beenpublished, but, so far, they've been "mostly a fruitless effort."
According to Geradts, the UCSF study "is valuable," because "theauthors propose two new biomarkers that in the past have not been lookedat." The UCSF team's findings "are intriguing preliminary data" that"merit confirmation and subsequent studies," he added.
Geradts said his own lab currently is researching whether changes inDNA may identify a tumor's capacity to metastasize or become invasive.Other researchers are looking at other DCIS biomarkers, he said.
"DCIS itself is a non-life threatening condition" with rare exceptions,noted Dr. Eric Winer, director of breast oncology at the Dana-FarberCancer Institute in Boston, and women are usually treated to help preventinvasive cancer. If the findings of the initial UCSF study are confirmed,then with "careful investigation, we may get to the point where we don'thave to treat all women with DCIS, and we may be able to tailor it so somewomen get less, and some women get more" depending upon their risk forinvasive breast cancer, Winer said.
"It's a very complex and interesting study" added Dr. Richard Bleicher,a surgical oncologist at Fox Chase Cancer Center in Philadelphia. "We needto be cautiously optimistic."
Bleicher added that while the findings have "significant potential,"women at this point shouldn't "pin all your hopes on it," because the p16assay is not something they can ask their doctors for at this point intime.
Sunday, December 30, 2007
New Drug Option for Late-Stage Breast Cancer Patients (American Cancer Society)
New Drug Option for Late-Stage Breast Cancer Patients (American Cancer Society)
There's good news for advanced breast cancer patients whohaven'tresponded to current chemotherapy drugs.
RESOURCES:
Detailed Guide: BreastCancer
UnderstandingChemotherapy: A Guide For Patients And Families
BreastCancer Treatment Decision Tools
After a swift 6-month priority review, the Food and DrugAdministration put its stamp of approval on ixabepilone(IxempraTM), a new chemotherapy drug shown to reduce tumor sizeand slow tumorgrowth in some patients with metastatic or locally advanced breastcancer.
The new drug, developed by Bristol-Myers Squibb, is approved for use incombination with another chemotherapy drug capecitabine, in patientswho haven't had success with an anthracycline (like doxorubicin orepirubicin) and a taxane (like paclitaxel or docetaxel), and as astandalone option for patients who have exhausted all 3 options (ananthracycline, a taxane, and capecitabine).
The FDA review was based on studies of ixabepilone alone andin combination with capecitabine. In a study of 126 breast cancerpatients who received ixabepilone alone, 12% saw a significant decreasein the size of their tumors. In a randomized trial of 752 patients whotook both ixabepilone and capecitabine, tumor growth slowedsignificantly compared to patients who were taking capecitabine alone.
Ixabepilone belongs to a class of drugs known as epothiloneanalogs, which work by binding to and interfering with microtubules,structures that play a key role in cell division. The net effect is aslowing of the growth of cancer cells in the body.
Ixabepilone is given by intravenous infusion over 3 hoursevery 3 weeks. One of the possible side effects of taking ixabepiloneis bone marrow suppression, so it is not recommended for patients whohave low white blood cell or platelet counts. Other possible sideeffects include numbness or tingling in the hands or feet,constipation, nausea, vomiting, and muscle and joint pain.
There's good news for advanced breast cancer patients whohaven'tresponded to current chemotherapy drugs.
RESOURCES:
Detailed Guide: BreastCancer
UnderstandingChemotherapy: A Guide For Patients And Families
BreastCancer Treatment Decision Tools
After a swift 6-month priority review, the Food and DrugAdministration put its stamp of approval on ixabepilone(IxempraTM), a new chemotherapy drug shown to reduce tumor sizeand slow tumorgrowth in some patients with metastatic or locally advanced breastcancer.
The new drug, developed by Bristol-Myers Squibb, is approved for use incombination with another chemotherapy drug capecitabine, in patientswho haven't had success with an anthracycline (like doxorubicin orepirubicin) and a taxane (like paclitaxel or docetaxel), and as astandalone option for patients who have exhausted all 3 options (ananthracycline, a taxane, and capecitabine).
The FDA review was based on studies of ixabepilone alone andin combination with capecitabine. In a study of 126 breast cancerpatients who received ixabepilone alone, 12% saw a significant decreasein the size of their tumors. In a randomized trial of 752 patients whotook both ixabepilone and capecitabine, tumor growth slowedsignificantly compared to patients who were taking capecitabine alone.
Ixabepilone belongs to a class of drugs known as epothiloneanalogs, which work by binding to and interfering with microtubules,structures that play a key role in cell division. The net effect is aslowing of the growth of cancer cells in the body.
Ixabepilone is given by intravenous infusion over 3 hoursevery 3 weeks. One of the possible side effects of taking ixabepiloneis bone marrow suppression, so it is not recommended for patients whohave low white blood cell or platelet counts. Other possible sideeffects include numbness or tingling in the hands or feet,constipation, nausea, vomiting, and muscle and joint pain.
Cannabis Compound May Stop Metastatic Breast Cancer
Cannabis Compound May Stop Metastatic Breast Cancer
MONDAY, Nov. 19 (HealthDay News) -- A non-toxic, non-psychoactivecompound in marijuana may block the progress of metastatic breast cancer,according to a new study by researchers in California.
"This is a new way to treat a patient that is not toxic likechemotherapy or radiotherapy. It is a new approach for metastatic cancer,"said lead researcher Sean D. McAllister, an associate scientist at theCalifornia Pacific Medical Center Research Institute in San Francisco.
The compound found in cannabis, called cannabidiol (CBD), inhibits agene, Id-1, that researchers believe is responsible for the metastaticprocess that spreads cells from the original tumor throughout thebody.
Opting for a musical metaphor, senior researcher Pierre-Yves Desprezlikened Id-1 to "an [orchestra] conductor. In this case, you shoot theconductor, and the whole orchestra is going to stop. If you shoot theviolinist, the orchestra just continues to play."
In humans, the Id-1 gene is found only in metastatic cancer cells, saidDesprez, a staff scientist at the institute. Before birth, they arepresent and involved in the development of human embryos, but after birth,they go silent -- and should stay that way, he said.
But in metastatic cancer "when [the genes] wake up, they are very bad,"he said. "They push the cells to behave like embryonic cells and grow.They go crazy, they proliferate, they migrate." Desprez said, "We need tobe able to turn them off."
According to the study, CBD does exactly that.
"We are focusing on the latest stages of cancer," Desprez added. Thecancer cell itself is not the problem, because a tumor can be "removedeasily by surgery," he said. The problem is the development of metastaticcells which is "conducted" by Id-1.
McAllister and Desprez said they are not suggesting thatpatients with hormone-independent metastatic breast cancer smokemarijuana. For one thing, a sufficient amount of CBD could never beobtained in that way, they said.
The research that has been done on marijuana and its compounds,however, is helpful, McAllister, said. CBD has been around for a longtime, and researchers have found it is not psychoactive, and its "toxicityis very low," he added.
The new findings are published in the November issue of MolecularCancer Therapeutics.
If McAllister's and Desprez's work results in the development of acancer treatment, someone with metastatic cancer might be placed on CBDfor several years. That means low toxicity is important, McAllisterexplained.
McAllister also suggested that Id-1 is "so important in providing the[metastatic] mechanism in these cells in so many types of cancers" thatthey "provide us an opportunity potentially to target other types ofcancers."
The study's findings were "were a serendipitous discovery, in a way,"McAllister said. Desprez noted that he had been working on the Id-1 genefor 12 years. His lab had demonstrated that it was a key gene for invasivebreast cancer and tumor progression, and Desprez had found a way toinhibit it in mice, but not in humans.
Then, two years ago, McAllister -- an expert on cannabinoids -- andDesprez, a cancer researcher, started to work together. Through theircombined forces "what we found is actually what I was looking for for thelast 12 years," Desprez said.
Further study is needed before CBD can be conclusively identified as atreatment option, McAllister and Desprez said. "We need to involve a teamof physicians, because we are bench [basic] scientists," McAllistersaid.
One expert called the findings intriguing but preliminary.
"This is the first evidence that a cannabinoid can target theexpression of an important breast cancer metastasis gene," noted ManuelGuzman, a Spanish expert on cannabinoids and cancer. He described theCalifornia study as giving "preliminary insight into the question ofwhether CBD could be used clinically to treat metastatic breastcancer."
However, "all the experiments in the paper have been conducted incultured cells and none of them in any animal model of breast cancer,which would be one of the steps for further research," added Guzman, whois a professor of biochemistry and molecular biology at ComplutenseUniversity in Madrid.
Guzman also noted that "Id-1 is just one of many genes involved inbreast cancer metastasis" and that future research also needs to examinethe impact of CBD on these other metastasis genes.
More information
There's more on breast cancer at the U.S.National Cancer Institute.
MONDAY, Nov. 19 (HealthDay News) -- A non-toxic, non-psychoactivecompound in marijuana may block the progress of metastatic breast cancer,according to a new study by researchers in California.
"This is a new way to treat a patient that is not toxic likechemotherapy or radiotherapy. It is a new approach for metastatic cancer,"said lead researcher Sean D. McAllister, an associate scientist at theCalifornia Pacific Medical Center Research Institute in San Francisco.
The compound found in cannabis, called cannabidiol (CBD), inhibits agene, Id-1, that researchers believe is responsible for the metastaticprocess that spreads cells from the original tumor throughout thebody.
Opting for a musical metaphor, senior researcher Pierre-Yves Desprezlikened Id-1 to "an [orchestra] conductor. In this case, you shoot theconductor, and the whole orchestra is going to stop. If you shoot theviolinist, the orchestra just continues to play."
In humans, the Id-1 gene is found only in metastatic cancer cells, saidDesprez, a staff scientist at the institute. Before birth, they arepresent and involved in the development of human embryos, but after birth,they go silent -- and should stay that way, he said.
But in metastatic cancer "when [the genes] wake up, they are very bad,"he said. "They push the cells to behave like embryonic cells and grow.They go crazy, they proliferate, they migrate." Desprez said, "We need tobe able to turn them off."
According to the study, CBD does exactly that.
"We are focusing on the latest stages of cancer," Desprez added. Thecancer cell itself is not the problem, because a tumor can be "removedeasily by surgery," he said. The problem is the development of metastaticcells which is "conducted" by Id-1.
McAllister and Desprez said they are not suggesting thatpatients with hormone-independent metastatic breast cancer smokemarijuana. For one thing, a sufficient amount of CBD could never beobtained in that way, they said.
The research that has been done on marijuana and its compounds,however, is helpful, McAllister, said. CBD has been around for a longtime, and researchers have found it is not psychoactive, and its "toxicityis very low," he added.
The new findings are published in the November issue of MolecularCancer Therapeutics.
If McAllister's and Desprez's work results in the development of acancer treatment, someone with metastatic cancer might be placed on CBDfor several years. That means low toxicity is important, McAllisterexplained.
McAllister also suggested that Id-1 is "so important in providing the[metastatic] mechanism in these cells in so many types of cancers" thatthey "provide us an opportunity potentially to target other types ofcancers."
The study's findings were "were a serendipitous discovery, in a way,"McAllister said. Desprez noted that he had been working on the Id-1 genefor 12 years. His lab had demonstrated that it was a key gene for invasivebreast cancer and tumor progression, and Desprez had found a way toinhibit it in mice, but not in humans.
Then, two years ago, McAllister -- an expert on cannabinoids -- andDesprez, a cancer researcher, started to work together. Through theircombined forces "what we found is actually what I was looking for for thelast 12 years," Desprez said.
Further study is needed before CBD can be conclusively identified as atreatment option, McAllister and Desprez said. "We need to involve a teamof physicians, because we are bench [basic] scientists," McAllistersaid.
One expert called the findings intriguing but preliminary.
"This is the first evidence that a cannabinoid can target theexpression of an important breast cancer metastasis gene," noted ManuelGuzman, a Spanish expert on cannabinoids and cancer. He described theCalifornia study as giving "preliminary insight into the question ofwhether CBD could be used clinically to treat metastatic breastcancer."
However, "all the experiments in the paper have been conducted incultured cells and none of them in any animal model of breast cancer,which would be one of the steps for further research," added Guzman, whois a professor of biochemistry and molecular biology at ComplutenseUniversity in Madrid.
Guzman also noted that "Id-1 is just one of many genes involved inbreast cancer metastasis" and that future research also needs to examinethe impact of CBD on these other metastasis genes.
More information
There's more on breast cancer at the U.S.National Cancer Institute.
Saturday, December 29, 2007
Obesity can skew key prostate cancer test results
Obesity can skew key prostate cancer test results
WASHINGTON (Reuters) - Doctors reading the results of ablood test widely used to screen for prostate cancer can befooled into thinking obese men are disease-free, researcherssaid on Tuesday.
The test may yield falsely reassuring results because obesepeople have more blood in their bodies due to their girth, thusdiluting the concentration of the protein doctors use to detectthe presence of prostate tumors, the researchers said.
The prostate gland produces a protein calledprostate-specific antigen, or PSA. Only prostate cells produceit and if levels are higher it suggests the cells are growing-- which can be a sign of cancer although an enlarged prostatecan also send PSA levels up.
The researchers examined medical records for nearly 14,000men who had undergone surgery to treat prostate cancer between1988 and 2006 at Johns Hopkins Hospital in Maryland, DukeUniversity in North Carolina or five U.S. Veterans Affairshospitals in California, Georgia and North Carolina.
Men with a body mass index, or BMI, indicating obesity hada higher blood volume and lower PSA concentrations. The mostobese men had PSA concentrations 11 to 21 percent lower thanthose recorded in men of normal weight, the researchersreported in the Journal of the American Medical Association.
These men could have a total amount of PSA in the bloodthat might signal prostate cancer, but because they had so muchmore blood, the PSA concentration was so diluted that the testresults seemed to show no cause for alarm, they added.
Thus, PSA concentrations that might be no worry for a thinman might suggest cancer for an obese one. "It's not that PSAis a bad test in obese men. Rather, we just need to learn howto use it better," Duke urologist Dr. Stephen Freedland, one ofthe researchers, said in a telephone interview.
"So whatever (PSA level) you consider abnormal, you justhave got to adjust it by about 15 to 20 percent downwards forobese people," Freedland added, or risk missing many cancers.
The prostate is a walnut-sized gland that produces seminalfluid. It is found below the bladder.
Dr. Carmen Rodriguez, an American Cancer Societyepidemiologist who participated in the study, said the findingswere particularly important considering the rising rates ofobesity in the United States and worldwide.
Rodriguez said doctors had known obese men were at higherrisk of developing more aggressive prostate cancer. She saidthis study indicates one of the reasons may be that some obesemen could have had false negative results in PSA tests, withtheir cancer then detected much later after it had grown moreadvanced and more dangerous.
Freedland said the findings could affect the way doctorslook at other tests for cancer and other diseases that dependon concentrations of disease markers like PSA in the blood.
He said it might be helpful to consider the total amount ofa disease marker in the body rather than its concentration in acertain volume of blood, in order to account for the dilutionthat can occur in the obese.
Worldwide, prostate cancer is estimated to kill about221,000 people annually, with 679,000 new cases diagnosed.
The American Cancer Society estimates that about 27,000 menwill die from prostate cancer in the United States this yearand about 219,000 men will be diagnosed with it.
(Editing by Maggie Fox)
WASHINGTON (Reuters) - Doctors reading the results of ablood test widely used to screen for prostate cancer can befooled into thinking obese men are disease-free, researcherssaid on Tuesday.
The test may yield falsely reassuring results because obesepeople have more blood in their bodies due to their girth, thusdiluting the concentration of the protein doctors use to detectthe presence of prostate tumors, the researchers said.
The prostate gland produces a protein calledprostate-specific antigen, or PSA. Only prostate cells produceit and if levels are higher it suggests the cells are growing-- which can be a sign of cancer although an enlarged prostatecan also send PSA levels up.
The researchers examined medical records for nearly 14,000men who had undergone surgery to treat prostate cancer between1988 and 2006 at Johns Hopkins Hospital in Maryland, DukeUniversity in North Carolina or five U.S. Veterans Affairshospitals in California, Georgia and North Carolina.
Men with a body mass index, or BMI, indicating obesity hada higher blood volume and lower PSA concentrations. The mostobese men had PSA concentrations 11 to 21 percent lower thanthose recorded in men of normal weight, the researchersreported in the Journal of the American Medical Association.
These men could have a total amount of PSA in the bloodthat might signal prostate cancer, but because they had so muchmore blood, the PSA concentration was so diluted that the testresults seemed to show no cause for alarm, they added.
Thus, PSA concentrations that might be no worry for a thinman might suggest cancer for an obese one. "It's not that PSAis a bad test in obese men. Rather, we just need to learn howto use it better," Duke urologist Dr. Stephen Freedland, one ofthe researchers, said in a telephone interview.
"So whatever (PSA level) you consider abnormal, you justhave got to adjust it by about 15 to 20 percent downwards forobese people," Freedland added, or risk missing many cancers.
The prostate is a walnut-sized gland that produces seminalfluid. It is found below the bladder.
Dr. Carmen Rodriguez, an American Cancer Societyepidemiologist who participated in the study, said the findingswere particularly important considering the rising rates ofobesity in the United States and worldwide.
Rodriguez said doctors had known obese men were at higherrisk of developing more aggressive prostate cancer. She saidthis study indicates one of the reasons may be that some obesemen could have had false negative results in PSA tests, withtheir cancer then detected much later after it had grown moreadvanced and more dangerous.
Freedland said the findings could affect the way doctorslook at other tests for cancer and other diseases that dependon concentrations of disease markers like PSA in the blood.
He said it might be helpful to consider the total amount ofa disease marker in the body rather than its concentration in acertain volume of blood, in order to account for the dilutionthat can occur in the obese.
Worldwide, prostate cancer is estimated to kill about221,000 people annually, with 679,000 new cases diagnosed.
The American Cancer Society estimates that about 27,000 menwill die from prostate cancer in the United States this yearand about 219,000 men will be diagnosed with it.
(Editing by Maggie Fox)
PET Scans Can Spot Cervical Cancer's Return
PET Scans Can Spot Cervical Cancer's Return
TUESDAY, Nov. 20 (HealthDay News) -- Whole-body positron emissiontomography (PET) scans three months after cervical cancer patients havecompleted therapy can help determine whether they're cancer-free orrequire further treatment, U.S. researchers say.
It can be difficult to determine if treatment has eliminated cervicaltumors, noted study author Dr. Julie K. Schwarz, a Barnes-Jewish Hospitalresident in the department of radiation oncology at Washington UniversitySchool of Medicine, St. Louis. Small tumors are difficult to detect withpelvic exams and obvious symptoms such as leg swelling don't occur untiltumors are quite large.
CT and MRI scans aren't able to differentiate between tumor tissue andsurrounding tissue, the expert added. There's also no blood test toindicate the presence of cervical cancer, and Pap tests can be inaccuratebecause of tissue changes caused by radiation therapy.
However, Schwarz and her colleagues found that cervical tumors glowbrightly in FDG-PET scans, which detect emissions from radioactivelytagged blood sugar (glucose). Tumor tissue traps more of this glucose thannormal tissue.
"This is the first time we can say that we have a reliable test tofollow cervical cancer patients after therapy," Schwarz said in a preparedstatement. "We ask them to come back for a follow-up visit about threemonths after treatment is finished, and we perform a PET scan. If the scanshows a complete response to treatment, we can say with confidence thatthey are doing to do extremely well."
If the PET scan reveals cervical tumors that haven't responded totreatment, patients can discuss further treatment options with theirdoctor.
The study was published in the Nov. 21 issue of the Journal of theAmerican Medical Association.
More information
The U.S. National Women's Health Information Center has more about cervicalcancer.
TUESDAY, Nov. 20 (HealthDay News) -- Whole-body positron emissiontomography (PET) scans three months after cervical cancer patients havecompleted therapy can help determine whether they're cancer-free orrequire further treatment, U.S. researchers say.
It can be difficult to determine if treatment has eliminated cervicaltumors, noted study author Dr. Julie K. Schwarz, a Barnes-Jewish Hospitalresident in the department of radiation oncology at Washington UniversitySchool of Medicine, St. Louis. Small tumors are difficult to detect withpelvic exams and obvious symptoms such as leg swelling don't occur untiltumors are quite large.
CT and MRI scans aren't able to differentiate between tumor tissue andsurrounding tissue, the expert added. There's also no blood test toindicate the presence of cervical cancer, and Pap tests can be inaccuratebecause of tissue changes caused by radiation therapy.
However, Schwarz and her colleagues found that cervical tumors glowbrightly in FDG-PET scans, which detect emissions from radioactivelytagged blood sugar (glucose). Tumor tissue traps more of this glucose thannormal tissue.
"This is the first time we can say that we have a reliable test tofollow cervical cancer patients after therapy," Schwarz said in a preparedstatement. "We ask them to come back for a follow-up visit about threemonths after treatment is finished, and we perform a PET scan. If the scanshows a complete response to treatment, we can say with confidence thatthey are doing to do extremely well."
If the PET scan reveals cervical tumors that haven't responded totreatment, patients can discuss further treatment options with theirdoctor.
The study was published in the Nov. 21 issue of the Journal of theAmerican Medical Association.
More information
The U.S. National Women's Health Information Center has more about cervicalcancer.
Thailand may get cancer drug free from Novartis: minister
Thailand may get cancer drug free from Novartis: minister
BANGKOK (AFP) - Thailand could get a cancer medicine from Norvatis for free if it slows its drive for generic versions of patented drugs, the country's health minister said Wednesday.
Thailand is at the forefront of an international battle with pharmaceutical companies over so-called compulsory licenses, which temporarily suspend patent protections.
The government has already issued compulsory licenses to get copycat versions of a heart drug and two key AIDS medicines. In September, it announced that it would also seek generic versions of four cancer drugs.
During talks with Novartis over its cancer-fighting Imatinib, Health Minister Mongkol Na Songkhla said the company had offered to provide the drug for free if Thailand halts its drive to expand its generic drug programme.
If a deal were reached, the government could provide unlimited amounts of the drug through its universal health care scheme, he said.
Imatinib currently costs as much as 100,000 baht (2,950 dollars) per patient per month.
"Novartis proposed to us to give free Imatinib without condition and limit in amount and time. We are in the final process of discussion," Mongkol told a seminar on compulsory licensing (CL) in Bangkok.
He said talks with two other drugmakers on cheaper prices for cancer drugs were also making progress.
"If this is successful, there will be no need for the government to implement more CL" on other drugs, he added.
Thailand has so far imposed compulsory licenses for the blockbuster heart drug Plavix and the AIDS medicines Kaletra and Efavirenz.
It has already begun importing cheaper versions from India, a major source of generic drugs.
Mongkol refused to rule out the possibility that the country would seek generic versions of other drugs in extraordinary circumstances.
"I won't say that we will do it again or not. We will do more CL only (on an) exceptional basis," he told reporters.
He also said that the government was considering legal action against Abbott, which withdrew an advanced version of Kaletra from the Thai market after the compulsory license was issued.
Thailand has a law that bars pharmaceutical companies from limiting access to their drugs if the medicine is available in other countries.
"The commerce ministry has been under negotiations with Abbott and considering a chance for legal action against the company," he said.
BANGKOK (AFP) - Thailand could get a cancer medicine from Norvatis for free if it slows its drive for generic versions of patented drugs, the country's health minister said Wednesday.
Thailand is at the forefront of an international battle with pharmaceutical companies over so-called compulsory licenses, which temporarily suspend patent protections.
The government has already issued compulsory licenses to get copycat versions of a heart drug and two key AIDS medicines. In September, it announced that it would also seek generic versions of four cancer drugs.
During talks with Novartis over its cancer-fighting Imatinib, Health Minister Mongkol Na Songkhla said the company had offered to provide the drug for free if Thailand halts its drive to expand its generic drug programme.
If a deal were reached, the government could provide unlimited amounts of the drug through its universal health care scheme, he said.
Imatinib currently costs as much as 100,000 baht (2,950 dollars) per patient per month.
"Novartis proposed to us to give free Imatinib without condition and limit in amount and time. We are in the final process of discussion," Mongkol told a seminar on compulsory licensing (CL) in Bangkok.
He said talks with two other drugmakers on cheaper prices for cancer drugs were also making progress.
"If this is successful, there will be no need for the government to implement more CL" on other drugs, he added.
Thailand has so far imposed compulsory licenses for the blockbuster heart drug Plavix and the AIDS medicines Kaletra and Efavirenz.
It has already begun importing cheaper versions from India, a major source of generic drugs.
Mongkol refused to rule out the possibility that the country would seek generic versions of other drugs in extraordinary circumstances.
"I won't say that we will do it again or not. We will do more CL only (on an) exceptional basis," he told reporters.
He also said that the government was considering legal action against Abbott, which withdrew an advanced version of Kaletra from the Thai market after the compulsory license was issued.
Thailand has a law that bars pharmaceutical companies from limiting access to their drugs if the medicine is available in other countries.
"The commerce ministry has been under negotiations with Abbott and considering a chance for legal action against the company," he said.
Transition from polyp to cancer age-dependent
Transition from polyp to cancer age-dependent
NEW YORK (Reuters Health) - Men and women with advancedcolorectal polyps have a similar risk of progressing tocolorectal cancer (CRC) and the risk increases with age in bothsexes, according to a study conducted in Germany.
Colorectal polyps (also called adenomas) are found in up to40 percent of adults over 50. Fewer than 5 percent of them turncancerous.
To come up with age- and sex-specific estimates oftransition rates from advanced polyps to CRC, Dr. HermannBrenner from the German Cancer Research Center, Heidelberg andcolleagues used combined data from 840,149 screeningcolonoscopies and from national population-based cancerregistries.
They report in the journal Gut that annual transition ratesincrease from 2.6 percent in women aged 55 to 59 years to 5.6percent in women aged 80 and older. For men in these agegroups, transition rates increase from 2.6 percent to 5.1percent.
In their analyses, estimates of 10-year cumulative riskincreased from 25.4 percent at age 55 years to 42.9 percent atage 80 years in women, with corresponding increases from 25.2percent to 39.7 percent in men.
"Our finding that advanced adenoma transition rates arestrongly age-dependent could have important clinicalimplications, possibly including a higher age at firstscreening or differential endoscopy intervals according toage," Brenner and colleagues write.
"However, additional risk factors, such as family historyof CRC, also have to be taken into account," they note.
SOURCE: Gut, November 2007.
NEW YORK (Reuters Health) - Men and women with advancedcolorectal polyps have a similar risk of progressing tocolorectal cancer (CRC) and the risk increases with age in bothsexes, according to a study conducted in Germany.
Colorectal polyps (also called adenomas) are found in up to40 percent of adults over 50. Fewer than 5 percent of them turncancerous.
To come up with age- and sex-specific estimates oftransition rates from advanced polyps to CRC, Dr. HermannBrenner from the German Cancer Research Center, Heidelberg andcolleagues used combined data from 840,149 screeningcolonoscopies and from national population-based cancerregistries.
They report in the journal Gut that annual transition ratesincrease from 2.6 percent in women aged 55 to 59 years to 5.6percent in women aged 80 and older. For men in these agegroups, transition rates increase from 2.6 percent to 5.1percent.
In their analyses, estimates of 10-year cumulative riskincreased from 25.4 percent at age 55 years to 42.9 percent atage 80 years in women, with corresponding increases from 25.2percent to 39.7 percent in men.
"Our finding that advanced adenoma transition rates arestrongly age-dependent could have important clinicalimplications, possibly including a higher age at firstscreening or differential endoscopy intervals according toage," Brenner and colleagues write.
"However, additional risk factors, such as family historyof CRC, also have to be taken into account," they note.
SOURCE: Gut, November 2007.
Thursday, December 27, 2007
Prostate Cancer Treatments Often Compound Existing HealthProblems
Prostate Cancer Treatments Often Compound Existing HealthProblems
MONDAY, Nov. 26 (HealthDay News) -- More than a third of prostatecancer patients may receive treatments that are inappropriate because ofproblems they are already having with urinary, bowel or sexual function, anew study suggests.
These mismatches might occur, because patients don't give enoughinformation to their doctor or because their doctor favors a particulartype of treatment, according to the report in the Nov. 26 online editionof Cancer.
"We found an awful lot of patients whose treatment seemed to becontraindicated by urinary, bowel or sexual problems they had before theygot treated," said lead researcher Dr. James Talcott, from the Center forOutcomes Research at Massachusetts General Hospital Cancer Center inBoston. "That's pretty good evidence that information wasn't transmittedor didn't factor in with the treatment decision."
Unlike other cancers, there are several treatment options for prostatecancer. The treatment that is best for an individual patient is based onseveral factors, including stage at which the cancer is diagnosed, age ofthe patient, and existing problems with urinary, bowel or sexual functionthat the patient has.
Treatments include external radiation therapy; brachytherapy, in whichtiny radioactive particles are implanted into the prostate gland, and thesurgical removal of the prostate gland.
Although these treatments are effective, each has a different set ofside effects. External radiation can lead to bowel dysfunction,brachytherapy can cause urinary problems, and surgery can damage nervesinvolved in sexual function.
Treating patients who already have problems in these areas with aprocedure that could exacerbate their problem is usually notrecommended.
For example, treatment designed to preserve normal functions, such asnerve-sparing, prostate-removal surgery, is not appropriate for patientswho have already lost sexual function, Talcott said.
To find the extent of treatment mismatches, Talcott's team collecteddata on 438 prostate cancer patients. Patients were asked to completequestionnaires that included questions about urinary incontinence andother urinary problems, and bowel and sexual dysfunction.
The researchers found that 89 percent of the patients had some level ofurinary, bowel or sexual problem before starting treatment. Among thesepatients, 34 percent of those with one serious symptom had a mismatchedtreatment, as did 37 percent who had a less serious symptom. Moreover, 40percent of those who had several symptoms also received contraindicatedtherapy.
In addition, among patients with significant dysfunction in all threeareas for whom no treatment would be recommended, only 5 percent chosewatchful waiting. In this strategy, patients are not treated but arefollowed closely.
These mismatches appear to occur because doctors and patients don'tcommunicate well. Patients are often reluctant to talk about urinary,bowel and sexual problems, Talcott said. "And, sometimes patients overridetheir doctor's recommendation," he added.
Talcott also thinks that physicians can be wedded to a particulartreatment at the exclusion of others. "Surgeons believe in surgery, andradiation oncologists believe in radiation," he said. "That may be part ofthe problem."
To counterbalance physician bias, patients should get another opinion,Talcott said. "Patients should always get a second consult," he said."It's a good idea to talk with a surgeon, a radiation oncologist andpossible a medical oncologist."
One expert thinks that patients need to make an informed decision aboutwhich treatment is best.
"The kind of doctor that you see often predetermines the treatment youreceive," said Dr. Durado Brooks, director of prostate and colorectalcancer at the American Cancer Society. "Urologists are much more likely tohave a surgical solution, and those who see a radiation oncologist aremore likely to have radiation."
Patients need to be well-informed about their condition and thepossible treatments and their side effects, Brooks said. "Patients need toarm themselves with as much information as possible about what theirtreatment options are, and what some of the contraindications ofparticular treatments are," he said.
Men also need to know what all the treatment options are, Brooks said."Men need to be aware that, in some cases, depending on their overallmedical condition and the stage of their cancer, that it is, at times,appropriate not to have any active treatment," he said. "Watchful waitingis a legitimate option in a significant proportion of men."
"In addition, doctors need to work with their patient to choose thebest treatment option, Brooks said.
"If one takes the time to have a discussion, educate the patient andnot rush them into a decision, then you may be able to allow them to getpast their emotional response and make a more educated, logic-basedresponse," Brooks said.
Brooks noted that because there are so many treatment options inprostate cancer, patients may insist on a particular treatment even thoughit's not the best choice for them.
"Where treatments are contraindicated in other places in medicine,doctors don't provide a treatment for a patient just because that's whatthey say they want," Brooks said. "You explain that that treatment issimply the wrong treatment for you, and therefore, we are not going totake that approach."
More information
For more on prostate cancer, visit the American Cancer Society.
MONDAY, Nov. 26 (HealthDay News) -- More than a third of prostatecancer patients may receive treatments that are inappropriate because ofproblems they are already having with urinary, bowel or sexual function, anew study suggests.
These mismatches might occur, because patients don't give enoughinformation to their doctor or because their doctor favors a particulartype of treatment, according to the report in the Nov. 26 online editionof Cancer.
"We found an awful lot of patients whose treatment seemed to becontraindicated by urinary, bowel or sexual problems they had before theygot treated," said lead researcher Dr. James Talcott, from the Center forOutcomes Research at Massachusetts General Hospital Cancer Center inBoston. "That's pretty good evidence that information wasn't transmittedor didn't factor in with the treatment decision."
Unlike other cancers, there are several treatment options for prostatecancer. The treatment that is best for an individual patient is based onseveral factors, including stage at which the cancer is diagnosed, age ofthe patient, and existing problems with urinary, bowel or sexual functionthat the patient has.
Treatments include external radiation therapy; brachytherapy, in whichtiny radioactive particles are implanted into the prostate gland, and thesurgical removal of the prostate gland.
Although these treatments are effective, each has a different set ofside effects. External radiation can lead to bowel dysfunction,brachytherapy can cause urinary problems, and surgery can damage nervesinvolved in sexual function.
Treating patients who already have problems in these areas with aprocedure that could exacerbate their problem is usually notrecommended.
For example, treatment designed to preserve normal functions, such asnerve-sparing, prostate-removal surgery, is not appropriate for patientswho have already lost sexual function, Talcott said.
To find the extent of treatment mismatches, Talcott's team collecteddata on 438 prostate cancer patients. Patients were asked to completequestionnaires that included questions about urinary incontinence andother urinary problems, and bowel and sexual dysfunction.
The researchers found that 89 percent of the patients had some level ofurinary, bowel or sexual problem before starting treatment. Among thesepatients, 34 percent of those with one serious symptom had a mismatchedtreatment, as did 37 percent who had a less serious symptom. Moreover, 40percent of those who had several symptoms also received contraindicatedtherapy.
In addition, among patients with significant dysfunction in all threeareas for whom no treatment would be recommended, only 5 percent chosewatchful waiting. In this strategy, patients are not treated but arefollowed closely.
These mismatches appear to occur because doctors and patients don'tcommunicate well. Patients are often reluctant to talk about urinary,bowel and sexual problems, Talcott said. "And, sometimes patients overridetheir doctor's recommendation," he added.
Talcott also thinks that physicians can be wedded to a particulartreatment at the exclusion of others. "Surgeons believe in surgery, andradiation oncologists believe in radiation," he said. "That may be part ofthe problem."
To counterbalance physician bias, patients should get another opinion,Talcott said. "Patients should always get a second consult," he said."It's a good idea to talk with a surgeon, a radiation oncologist andpossible a medical oncologist."
One expert thinks that patients need to make an informed decision aboutwhich treatment is best.
"The kind of doctor that you see often predetermines the treatment youreceive," said Dr. Durado Brooks, director of prostate and colorectalcancer at the American Cancer Society. "Urologists are much more likely tohave a surgical solution, and those who see a radiation oncologist aremore likely to have radiation."
Patients need to be well-informed about their condition and thepossible treatments and their side effects, Brooks said. "Patients need toarm themselves with as much information as possible about what theirtreatment options are, and what some of the contraindications ofparticular treatments are," he said.
Men also need to know what all the treatment options are, Brooks said."Men need to be aware that, in some cases, depending on their overallmedical condition and the stage of their cancer, that it is, at times,appropriate not to have any active treatment," he said. "Watchful waitingis a legitimate option in a significant proportion of men."
"In addition, doctors need to work with their patient to choose thebest treatment option, Brooks said.
"If one takes the time to have a discussion, educate the patient andnot rush them into a decision, then you may be able to allow them to getpast their emotional response and make a more educated, logic-basedresponse," Brooks said.
Brooks noted that because there are so many treatment options inprostate cancer, patients may insist on a particular treatment even thoughit's not the best choice for them.
"Where treatments are contraindicated in other places in medicine,doctors don't provide a treatment for a patient just because that's whatthey say they want," Brooks said. "You explain that that treatment issimply the wrong treatment for you, and therefore, we are not going totake that approach."
More information
For more on prostate cancer, visit the American Cancer Society.
Radiation scans in pregnancy increase: US study
Radiation scans in pregnancy increase: US study
A pregnant woman receives a prenatal screening. Pregnant women are getting exposed to higher doses of radiation as radiological scans on them have more than doubled in a decade, according to a US study released Tuesday.(AFP/File/Joel Robine)WASHINGTON (AFP) - Pregnant women are getting exposed to higher doses of radiation as radiological scans on them have more than doubled in a decade, according to a US study released Tuesday.
"Through medical imaging examinations, we are exposing pregnant women to twice the amount of radiation as we did 10 years ago," said Elizabeth Lazarus, a doctor at Brown University in Providence, Rhode Island, in a report introducing the study.
"Overall, the levels of radiation to which we are exposing pregnant women are low, but they do carry a slight risk of harm to the developing fetus," said Lazarus, lead author of the study presented Tuesday at the annual meeting of the Radiological Society of North America.
Researchers reviewed different types of imaging examinations carried out over 10 years at the university.
They found that from 1997 to 2006, the number of imaging exams on pregnant women increased 121 percent, while the number of births rose by only seven percent.
The greatest increase was in the number of CT (computerized tomography) scans, "which deliver more radiation than many other radiologic procedures," the report said. CT scans increased by a quarter.
An ultrasound scan, on the other hand, does not expose the mother and fetus to the kind of radiation that can harm cells.
Lazarus said the increase was partly due to the development of new imaging techniques for diagnosing abnormalities -- and partly because hospitals and insurers wanted to make faster diagnoses.
A pregnant woman may have a CT scan to detect suspected life-threatening conditions such as bleeding in the brain, blood clots in the lungs or appendicitis.
"CT can be a safe, effective test for pregnant patients," Lazarus said. "However, there are alternatives that should at least be explored. Pregnant patients should ask their doctors about other imaging or diagnostic tests that may not expose the fetus to radiation."
A pregnant woman receives a prenatal screening. Pregnant women are getting exposed to higher doses of radiation as radiological scans on them have more than doubled in a decade, according to a US study released Tuesday.(AFP/File/Joel Robine)WASHINGTON (AFP) - Pregnant women are getting exposed to higher doses of radiation as radiological scans on them have more than doubled in a decade, according to a US study released Tuesday.
"Through medical imaging examinations, we are exposing pregnant women to twice the amount of radiation as we did 10 years ago," said Elizabeth Lazarus, a doctor at Brown University in Providence, Rhode Island, in a report introducing the study.
"Overall, the levels of radiation to which we are exposing pregnant women are low, but they do carry a slight risk of harm to the developing fetus," said Lazarus, lead author of the study presented Tuesday at the annual meeting of the Radiological Society of North America.
Researchers reviewed different types of imaging examinations carried out over 10 years at the university.
They found that from 1997 to 2006, the number of imaging exams on pregnant women increased 121 percent, while the number of births rose by only seven percent.
The greatest increase was in the number of CT (computerized tomography) scans, "which deliver more radiation than many other radiologic procedures," the report said. CT scans increased by a quarter.
An ultrasound scan, on the other hand, does not expose the mother and fetus to the kind of radiation that can harm cells.
Lazarus said the increase was partly due to the development of new imaging techniques for diagnosing abnormalities -- and partly because hospitals and insurers wanted to make faster diagnoses.
A pregnant woman may have a CT scan to detect suspected life-threatening conditions such as bleeding in the brain, blood clots in the lungs or appendicitis.
"CT can be a safe, effective test for pregnant patients," Lazarus said. "However, there are alternatives that should at least be explored. Pregnant patients should ask their doctors about other imaging or diagnostic tests that may not expose the fetus to radiation."
BRCA genes raise breast cancer risk for men too
BRCA genes raise breast cancer risk for men too
NEW YORK (Reuters Health) - Mutations in the BRCA1 andBRCA2 genes that increase the risk of breast cancer for womenalso do the same in men.
Men can develop breast cancer, although they account foronly about 1 percent of breast cancer cases. Previous studieshave shown that men who carry mutations in the BRCA2 gene areat greater risk of developing breast cancer than men in thegeneral population. Now, new research suggests that the same istrue for men with BRCA1 mutations.
Dr. Sining Chen from Johns Hopkins School of Medicine inBaltimore, Maryland, and colleagues studied data on 1,939families that included 97 male patients with breast cancer.
"At all ages, the cumulative risks of male breast cancerwere higher in both BRCA1 and BRCA2 mutation carriers than innoncarriers," the researchers report in the Journal of theNational Cancer Institute.
The likelihood of developing breast cancer was highest formen in their 30s and 40s and decreased with increasing age. Forexample, for BRCA2 mutation carriers, 30-year-old men were 22times more likely to develop breast cancer than carriers at 70years of age.
The risk was higher for BRCA2 than BRCA1 mutation carriers.The investigators calculate that, by age 70, the chances ofdeveloping breast cancer are 1.2 percent for male BRCA1mutation carriers and 6.8 percent for men with the BRCA2mutation.
They point out that these estimates of risk are "importantfor determining appropriate risk management strategies" formale members of families with mutations in BRCA1 or BRCA2.
SOURCE: Journal of the National Cancer Institute, December5, 2007.
NEW YORK (Reuters Health) - Mutations in the BRCA1 andBRCA2 genes that increase the risk of breast cancer for womenalso do the same in men.
Men can develop breast cancer, although they account foronly about 1 percent of breast cancer cases. Previous studieshave shown that men who carry mutations in the BRCA2 gene areat greater risk of developing breast cancer than men in thegeneral population. Now, new research suggests that the same istrue for men with BRCA1 mutations.
Dr. Sining Chen from Johns Hopkins School of Medicine inBaltimore, Maryland, and colleagues studied data on 1,939families that included 97 male patients with breast cancer.
"At all ages, the cumulative risks of male breast cancerwere higher in both BRCA1 and BRCA2 mutation carriers than innoncarriers," the researchers report in the Journal of theNational Cancer Institute.
The likelihood of developing breast cancer was highest formen in their 30s and 40s and decreased with increasing age. Forexample, for BRCA2 mutation carriers, 30-year-old men were 22times more likely to develop breast cancer than carriers at 70years of age.
The risk was higher for BRCA2 than BRCA1 mutation carriers.The investigators calculate that, by age 70, the chances ofdeveloping breast cancer are 1.2 percent for male BRCA1mutation carriers and 6.8 percent for men with the BRCA2mutation.
They point out that these estimates of risk are "importantfor determining appropriate risk management strategies" formale members of families with mutations in BRCA1 or BRCA2.
SOURCE: Journal of the National Cancer Institute, December5, 2007.
Freezing tumors eases cancer pain in study
Freezing tumors eases cancer pain in study
CHICAGO (Reuters) - Freezing tumors may help relieve theextreme pain of cancer that has spread to the bone, which isoften untouched by narcotics or radiation, U.S. researcherssaid on Tuesday.
This freezing process, called cryoablation, is often usedto destroy kidney, prostate and other tumors, but researchersat the Mayo Clinic in Rochester, Minnesota, found it easedcancer pain in 80 percent of patients in a small study, and theeffect lasted for up to six months.
About 100,000 people in the United States each year havecancer that metastasizes, or spreads, to the bones. Radiationtherapy is the most common treatment for localized pain inmetastatic cancer.
"Two key parts of this study are that the reduction in painlasts and their quality of life improves after receiving thetreatment," Dr. Matthew Callstrom, a radiologist, said in astatement. He presented his results at the annual meeting ofthe Radiological Society of North America in Chicago.
The study, funded by medical device maker Endocare Inc,involved 34 patients who had failed to find relief fromconventional pain management treatments or refused them.
They had different primary cancers, including colorectal,renal cell, ovarian, thyroid and melanoma -- all of which hadspread to the bone.
Doctors used CT imaging scanners to guide tiny, needle-likeprobes to the tumor. Argon gas was then injected through a tinytube into a larger chamber in the probe, causing it to becomecold enough to freeze the tumor.
"You have very good control and you can see exactly whatyou are doing," Callstrom said in a telephone interview.
Patients in the study started out with an average painscore of 7.2 on a scale of 10, which is considered moderatelysevere. That was reduced by roughly half (about 3.6) eightweeks later. For patients followed for 24 weeks, the scoredropped to an average of 1.7.
"That's a pretty good drop in their pain," said Callstrom,who was not paid by Endocare.
"The technique is very well tolerated. It does not increasepain and you can do it with very high precision."
He and colleagues plan to study the pain managementapproach in a larger study funded by Endocare and the NationalCancer Institute, comparing cryoablation and radiation.
(Editing by Maggie Fox and Mohammad Zargham)
CHICAGO (Reuters) - Freezing tumors may help relieve theextreme pain of cancer that has spread to the bone, which isoften untouched by narcotics or radiation, U.S. researcherssaid on Tuesday.
This freezing process, called cryoablation, is often usedto destroy kidney, prostate and other tumors, but researchersat the Mayo Clinic in Rochester, Minnesota, found it easedcancer pain in 80 percent of patients in a small study, and theeffect lasted for up to six months.
About 100,000 people in the United States each year havecancer that metastasizes, or spreads, to the bones. Radiationtherapy is the most common treatment for localized pain inmetastatic cancer.
"Two key parts of this study are that the reduction in painlasts and their quality of life improves after receiving thetreatment," Dr. Matthew Callstrom, a radiologist, said in astatement. He presented his results at the annual meeting ofthe Radiological Society of North America in Chicago.
The study, funded by medical device maker Endocare Inc,involved 34 patients who had failed to find relief fromconventional pain management treatments or refused them.
They had different primary cancers, including colorectal,renal cell, ovarian, thyroid and melanoma -- all of which hadspread to the bone.
Doctors used CT imaging scanners to guide tiny, needle-likeprobes to the tumor. Argon gas was then injected through a tinytube into a larger chamber in the probe, causing it to becomecold enough to freeze the tumor.
"You have very good control and you can see exactly whatyou are doing," Callstrom said in a telephone interview.
Patients in the study started out with an average painscore of 7.2 on a scale of 10, which is considered moderatelysevere. That was reduced by roughly half (about 3.6) eightweeks later. For patients followed for 24 weeks, the scoredropped to an average of 1.7.
"That's a pretty good drop in their pain," said Callstrom,who was not paid by Endocare.
"The technique is very well tolerated. It does not increasepain and you can do it with very high precision."
He and colleagues plan to study the pain managementapproach in a larger study funded by Endocare and the NationalCancer Institute, comparing cryoablation and radiation.
(Editing by Maggie Fox and Mohammad Zargham)
Cancer institute updates risk calculator
Cancer institute updates risk calculator
Silhouettes representing breast cancer victims. Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.(AFP/File/Greg Wood)WASHINGTON - A widely used tool for predicting a woman's risk of breast cancer is getting an update — to better reflect black women's risk. At issue is the National Cancer Institute's online risk calculator. Answer a few questions — such as current age, age when your first child was born, family history of breast cancer — and learn your odds of getting breast cancer in the next five years.
But the calculator has a caveat: It was created using studies of breast cancer in white women. A warning flashes telling non-white women that the answer they're about to get comes with some uncertainty.
Now scientists are updating the calculations to reflect newer data on black women and cancer.
It turns out the original calculator had been slightly underestimating risk for black women 45 and older — and slightly overestimating risk for younger black women, NCI researchers reported Tuesday in the Journal of the National Cancer Institute.
Dr. Mitchell Gail and colleagues reexamined the records of 20,000 black women who were screened for a government study comparing cancer-protective drugs. To qualify, women had to have at least a 1.66 percent risk of breast cancer in the next five years.
Using the old calculator, these women's average risk was 1.19 percent. Using the new one, their average risk was 1.75 percent, a small difference.
But overall, just 14 percent of these women qualified for the study using the old risk calculator. Had the new one been in use, 30 percent would have qualified — an important difference, Gail concluded.
The NCI will have its online risk calculator — at http://www.cancer.gov/bcrisktool/ — updated with the new statistics for black women by spring, Gail said.
Silhouettes representing breast cancer victims. Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.(AFP/File/Greg Wood)WASHINGTON - A widely used tool for predicting a woman's risk of breast cancer is getting an update — to better reflect black women's risk. At issue is the National Cancer Institute's online risk calculator. Answer a few questions — such as current age, age when your first child was born, family history of breast cancer — and learn your odds of getting breast cancer in the next five years.
But the calculator has a caveat: It was created using studies of breast cancer in white women. A warning flashes telling non-white women that the answer they're about to get comes with some uncertainty.
Now scientists are updating the calculations to reflect newer data on black women and cancer.
It turns out the original calculator had been slightly underestimating risk for black women 45 and older — and slightly overestimating risk for younger black women, NCI researchers reported Tuesday in the Journal of the National Cancer Institute.
Dr. Mitchell Gail and colleagues reexamined the records of 20,000 black women who were screened for a government study comparing cancer-protective drugs. To qualify, women had to have at least a 1.66 percent risk of breast cancer in the next five years.
Using the old calculator, these women's average risk was 1.19 percent. Using the new one, their average risk was 1.75 percent, a small difference.
But overall, just 14 percent of these women qualified for the study using the old risk calculator. Had the new one been in use, 30 percent would have qualified — an important difference, Gail concluded.
The NCI will have its online risk calculator — at http://www.cancer.gov/bcrisktool/ — updated with the new statistics for black women by spring, Gail said.
PET Scans Could Boost Lung Cancer Diagnosis
PET Scans Could Boost Lung Cancer Diagnosis
TUESDAY, Nov. 27 (HealthDay News) -- The use of PET imaging mayimprove the diagnosis and treatment of lung cancer, say Canadianresearchers who reviewed several recent studies.
Tumor imaging is frequently used to diagnosis lung cancer and to maketreatment decisions. Imaging technologies such as MRI and CT detectanatomical changes, while PET is based on biochemical processes that mayalert doctors to the presence of disease before any anatomical changesoccur, the researchers noted.
In this review, a team led by Dr. Yee Ung of the Odette Cancer Centerin Toronto concluded that PET can accurately distinguish between benignand malignant tumors as small as one centimeter. In addition, theavailable data suggests that PET can accurately differentiate betweenlimited and extensive disease and appears to be better than CT for makingtreatment decisions for non-small-cell lung cancer.
"Further research is needed to determine not only if PET should beintegrated into the standard staging and diagnostic processes of lungcancer but also how PET would be incorporated into the staging algorithm,"Ung and colleagues wrote.
The review appears online Nov. 27 in the Journal of the NationalCancer Institute.
In an accompanying editorial, Dr. Giuseppe Giaccone of the U.S.National Cancer Institute wrote that PET imaging "is being increasinglyused in lung cancer and has acquired a relevant role in staging patients,assessing treatment strategies, and monitoring treatment effects. Although(PET) has not replaced more accurate and invasive procedures, improvementsin the integration of (PET) with other imaging modalities are promisingand likely to affect the management of patients with lung cancer in thefuture."
More information
The U.S. National Cancer Institute has more about lungcancer.
TUESDAY, Nov. 27 (HealthDay News) -- The use of PET imaging mayimprove the diagnosis and treatment of lung cancer, say Canadianresearchers who reviewed several recent studies.
Tumor imaging is frequently used to diagnosis lung cancer and to maketreatment decisions. Imaging technologies such as MRI and CT detectanatomical changes, while PET is based on biochemical processes that mayalert doctors to the presence of disease before any anatomical changesoccur, the researchers noted.
In this review, a team led by Dr. Yee Ung of the Odette Cancer Centerin Toronto concluded that PET can accurately distinguish between benignand malignant tumors as small as one centimeter. In addition, theavailable data suggests that PET can accurately differentiate betweenlimited and extensive disease and appears to be better than CT for makingtreatment decisions for non-small-cell lung cancer.
"Further research is needed to determine not only if PET should beintegrated into the standard staging and diagnostic processes of lungcancer but also how PET would be incorporated into the staging algorithm,"Ung and colleagues wrote.
The review appears online Nov. 27 in the Journal of the NationalCancer Institute.
In an accompanying editorial, Dr. Giuseppe Giaccone of the U.S.National Cancer Institute wrote that PET imaging "is being increasinglyused in lung cancer and has acquired a relevant role in staging patients,assessing treatment strategies, and monitoring treatment effects. Although(PET) has not replaced more accurate and invasive procedures, improvementsin the integration of (PET) with other imaging modalities are promisingand likely to affect the management of patients with lung cancer in thefuture."
More information
The U.S. National Cancer Institute has more about lungcancer.
Combo PET/CT Scan Helps Spot Breast Cancer's Spread
Combo PET/CT Scan Helps Spot Breast Cancer's Spread
TUESDAY, Nov. 27 (HealthDay News) -- A technique that combines aPET scan with a CT scan can help spot the spread of inflammatory breastcancer, a rare but very aggressive form of the disease, researchersreport.
"It is a quicker way of assessing everything," said lead researcher Dr.Selin Carkaci, assistant professor of radiology at The University of TexasM.D. Anderson Cancer Center in Houston. "Our results show it is veryuseful," she said.
Carkaci was expected to present her findings Monday at the annualmeeting of the Radiological Society of North America, in Chicago.
According to the American Cancer Society, IBC accounts for 1 percent to5 percent of all breast cancer cases in the United States. Often by thetime it is discovered, it has spread. The five-year survival rate forthose with IBC is 25 percent to 50 percent, according to the cancersociety.
The new combo technology has been used in recent years for assessingother cancers as well, Carkaci noted. While the separate technologies ofPET (positron emission tomography) and CT (computed tomography) have beenin use since the early 1970s, their combined use came into practice onlyabout eight years ago. Patients being treated at cancer centers across theUnited States should have access to this test, which is becoming morecommon, Carkaci said.
The technique she used is called FDG-PET/CT -- for "F-18fluorodeoxyglucose positron emission tomography and computed tomography".
In a PET scan, a small amount of the radioactive drug F-18-labeledglucose is injected into the body. Fast-growing cancer cells feed onsugars and absorb it more quickly than do normal cells, Carkaci explained,so they "light up" on the images created by the PET scanner.
On the other hand, "the CT scanner takes a series of X-ray pictures,which are combined by a computer to create an extremely detailed image ofthe internal organs or other parts of the body," she said.
The scan gives great anatomical detail including the size, shape andlocation of the tumor. Together, the tests provide the most complete dataon the tumor and its spread, Carkaci said.
In the study, doctors scanned 41 women newly diagnosed withinflammatory breast cancer. They found metastases in 20 patients, or 49percent. They used biopsy or additional imaging to confirm the resultswhen possible. Biopsy confirmation of metastases were available in four of13 patients and additional imaging confirmation in nine.
"We found that FDG-PET/CT is 95 percent accurate in identifying distantmetastases and 98 percent accurate in identifying regional lymph nodemetastases," Carkaci said.
"This [scanning] is done immediately after diagnosis, and thenfollowing the chemotherapy, to evaluate the response to treatment," shesaid.
The hope is to stop the cancer in its tracks.
One co-author, Dr. Homer Macapinlac, chair and professor of nuclearmedicine at M.D. Anderson, reported being a consultant for GeneralElectric Company and Siemens AG. Both companies produce scanners.
The study findings are "significant for the high rate of metastaticdisease, with almost one half of the women with PET/CT able to identifythe tumors at an early stage," said Dr. David Bluemke, professor ofradiology and medicine and clinical director, MRI, Johns Hopkins MedicalInstitution, Baltimore.
"The data is very compelling for routine and early use of PET/CT forpatients with inflammatory breast cancer," he said. "Although the studywas small, the high accuracy rate appears promising for patients with thiscondition."
More information
To learn more about inflammatory breast cancer, visit the U.S. National Cancer Institute.
TUESDAY, Nov. 27 (HealthDay News) -- A technique that combines aPET scan with a CT scan can help spot the spread of inflammatory breastcancer, a rare but very aggressive form of the disease, researchersreport.
"It is a quicker way of assessing everything," said lead researcher Dr.Selin Carkaci, assistant professor of radiology at The University of TexasM.D. Anderson Cancer Center in Houston. "Our results show it is veryuseful," she said.
Carkaci was expected to present her findings Monday at the annualmeeting of the Radiological Society of North America, in Chicago.
According to the American Cancer Society, IBC accounts for 1 percent to5 percent of all breast cancer cases in the United States. Often by thetime it is discovered, it has spread. The five-year survival rate forthose with IBC is 25 percent to 50 percent, according to the cancersociety.
The new combo technology has been used in recent years for assessingother cancers as well, Carkaci noted. While the separate technologies ofPET (positron emission tomography) and CT (computed tomography) have beenin use since the early 1970s, their combined use came into practice onlyabout eight years ago. Patients being treated at cancer centers across theUnited States should have access to this test, which is becoming morecommon, Carkaci said.
The technique she used is called FDG-PET/CT -- for "F-18fluorodeoxyglucose positron emission tomography and computed tomography".
In a PET scan, a small amount of the radioactive drug F-18-labeledglucose is injected into the body. Fast-growing cancer cells feed onsugars and absorb it more quickly than do normal cells, Carkaci explained,so they "light up" on the images created by the PET scanner.
On the other hand, "the CT scanner takes a series of X-ray pictures,which are combined by a computer to create an extremely detailed image ofthe internal organs or other parts of the body," she said.
The scan gives great anatomical detail including the size, shape andlocation of the tumor. Together, the tests provide the most complete dataon the tumor and its spread, Carkaci said.
In the study, doctors scanned 41 women newly diagnosed withinflammatory breast cancer. They found metastases in 20 patients, or 49percent. They used biopsy or additional imaging to confirm the resultswhen possible. Biopsy confirmation of metastases were available in four of13 patients and additional imaging confirmation in nine.
"We found that FDG-PET/CT is 95 percent accurate in identifying distantmetastases and 98 percent accurate in identifying regional lymph nodemetastases," Carkaci said.
"This [scanning] is done immediately after diagnosis, and thenfollowing the chemotherapy, to evaluate the response to treatment," shesaid.
The hope is to stop the cancer in its tracks.
One co-author, Dr. Homer Macapinlac, chair and professor of nuclearmedicine at M.D. Anderson, reported being a consultant for GeneralElectric Company and Siemens AG. Both companies produce scanners.
The study findings are "significant for the high rate of metastaticdisease, with almost one half of the women with PET/CT able to identifythe tumors at an early stage," said Dr. David Bluemke, professor ofradiology and medicine and clinical director, MRI, Johns Hopkins MedicalInstitution, Baltimore.
"The data is very compelling for routine and early use of PET/CT forpatients with inflammatory breast cancer," he said. "Although the studywas small, the high accuracy rate appears promising for patients with thiscondition."
More information
To learn more about inflammatory breast cancer, visit the U.S. National Cancer Institute.
New breast cancer risk prediction model for black women in US
New breast cancer risk prediction model for black women in US
Silhouettes representing breast cancer victims. Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.(AFP/File/Greg Wood)WASHINGTON (AFP) - Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.
The Breast Cancer Risk Assessment Tool, also widely known as the Gail model, has been used for years to determine breast cancer risk in all racial groups, and in the United States to determine eligibility for participation in clinical testing of cancer treatments and preventive care.
But much of the model is based on breast cancer data only from white women.
The new study, called the Women's Contraceptive and Reproductive Experiences (CARE) study, was run to gather data on African American women with and without breast cancer.
Mitchell Gail of the National Cancer Institute in Bethesda, Maryland, who developed the old model, and colleagues, "used data from the CARE study and the Surveillance, Epidemiology, and End Results (SEER) program to build a new model for estimating breast cancer risk in African American women," they said in a statement.
They used data from two trials, the Women's Health Initiative and the Study of Tamoxifen and Raloxifene (STAR), to test the model, they said.
The new model found that 30 percent of African American women over 45 had an at least 1.66 percent chance of developing breast cancer over a five-year period, twice as high as in the Gail model (14.5 percent).
Still "the CARE model is not recommended for women with a previous history of breast cancer, and it may underestimate breast cancer risks in certain other women," the doctors warned in their statement.
Silhouettes representing breast cancer victims. Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.(AFP/File/Greg Wood)WASHINGTON (AFP) - Scientists have developed a new, more accurate risk assessment model for breast cancer in African American women, a risk they said had been underestimated, in a new study out Wednesday.
The Breast Cancer Risk Assessment Tool, also widely known as the Gail model, has been used for years to determine breast cancer risk in all racial groups, and in the United States to determine eligibility for participation in clinical testing of cancer treatments and preventive care.
But much of the model is based on breast cancer data only from white women.
The new study, called the Women's Contraceptive and Reproductive Experiences (CARE) study, was run to gather data on African American women with and without breast cancer.
Mitchell Gail of the National Cancer Institute in Bethesda, Maryland, who developed the old model, and colleagues, "used data from the CARE study and the Surveillance, Epidemiology, and End Results (SEER) program to build a new model for estimating breast cancer risk in African American women," they said in a statement.
They used data from two trials, the Women's Health Initiative and the Study of Tamoxifen and Raloxifene (STAR), to test the model, they said.
The new model found that 30 percent of African American women over 45 had an at least 1.66 percent chance of developing breast cancer over a five-year period, twice as high as in the Gail model (14.5 percent).
Still "the CARE model is not recommended for women with a previous history of breast cancer, and it may underestimate breast cancer risks in certain other women," the doctors warned in their statement.
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