This report provides a detailed insight into the status of ovarian cancer in England. It is the first report from the Cancer Audit Feasibility Pilot project which runs for two years and includes details of disease incidence, mortality and survival.
Matthews, C. E. et al. | Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk | Journal of Clinical Oncology | published online December 26th 2019.
To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.
Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).
A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.
Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.
Full document available at Journal of Clinical Oncology
Queen Mary University | September 2019 | New blood test for prostate cancer is highly-accurate and avoids invasive biopsies
A blood test developed by experts at Queen Mary University marks a ‘paradigm shift’ in the way prostate cancer is diagnosed.
The new prostate cancer test detects early cancer cells, or circulating tumor cells (CTCs), that have left the original tumour and entered the bloodstream prior to spreading around the body. By measuring intact living cancer cells in the patient’s blood, rather than the PSA protein which may be present in the blood for reasons other than cancer, it potentially provides a more accurate test for prostate cancer.
The study tested the use of the CTC test in 98 pre-biopsy patients and 155 newly diagnosed prostate cancer patients enrolled at St Bartholomew’s Hospital in London.
The research team found that the presence of CTCs in pre-biopsy blood samples were indicative of the presence of aggressive prostate cancer, and efficiently and non-invasively predicted the later outcome of biopsy results.
When the CTC tests were used in combination with the current PSA test, it was able to predict the presence of aggressive prostate cancer in subsequent biopsies with over 90 per cent accuracy, better than any previously reported biomarkers.
Additionally, the number and type of CTCs present in the blood was also indicative of the aggressiveness of the cancer. Focusing on more aggressive prostate cancer may reduce over-treatment and unnecessary biopsies for benign and non-aggressive conditions.
(Source Queen Mary University)
Full reference: Xu, L. | 2019|Non-invasive Detection of Clinically Significant Prostate Cancer Using Circulating Tumor Cells | Journal of Urology | https://doi.org/10.1097/JU.0000000000000475
PSA testing results in unnecessary biopsy and over-diagnosis with consequent over-treatment. Tissue biopsy is an invasive procedure, associated with significant morbidity. More accurate non- or minimum-invasive diagnostic approaches should be developed to avoid unnecessary prostate biopsy and over-diagnosis. We investigated the potential of using circulating tumor cell analysis in cancer diagnosis, particularly in predicting clinically significant prostate cancer in pre-biopsy patients.
Material and Methods:
We enrolled 155 treatment naïve prostate cancer patients and 98 pre-biopsy patients for circulating tumor cell numeration. RNA was extracted from circulating tumor cells from 184 patients for gene expression analysis. Kruskal-Wallis, Spearman’s rank, multivariate logistic regression and random forest were applied to assess the association of circulating tumor cells with aggressive prostate cancer.
In localized prostate cancer patients, 54% were scored as circulating tumor cell positive, which was associated with higher Gleason score ( p=0.0003), risk group ( p<0.0001) and clinically significant prostate cancer. In pre-biopsy group, positive circulating tumor cell score in combination with PSA predicted clinically significant prostate cancer with AUC=0.869. A 12-gene panel prognostic for clinically significant prostate cancer was also identified. Combining PSA level, circulating tumor cell-score and the 12-gene panel, AUC for clinically significant prostate cancer prediction was 0.927 and in cases with multi-parametric MRI data, adding these to multi-parametric MRI significantly increased the prediction accuracy.
Circulating tumor cell analysis has the potential to significantly improve patient stratification by PSA and/or multi-parametric MRI for biopsy and treatment.
The Library can provide the full article to Rotherham NHS Staff, request here
NICE | August 2019 | Ribociclib with fulvestrant for treating hormone receptor-positive, HER2-negative, advanced breast cancer| Technology Appraisal Guidance
NICE has published Evidence-based recommendations on ribociclib (Kisqali) for hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer in adults who have had previous endocrine therapy.
NICE | August 2019 | Olaparib for maintenance treatment of BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after response to first-line platinum-based chemotherapy
Olaparib (Lynparza) is available through the Cancer Drugs Fund. It is a possible treatment for advanced ovarian, fallopian tube or peritoneal cancer in adults, if:
- they have a BRCA mutation and
- the cancer has been treated with 1 course of platinum-based chemotherapy.
More evidence on olaparib is being collected, until September 2023. After this, NICE will decide whether or not to recommend it for use on the NHS and update the guidance. It will be available through the Cancer Drugs Fund until then.
Full details from NICE
New study concludes that GPs appear to be diagnosing cancers earlier, helping to reduce the numbers of cancer patients receiving their diagnosis in accident and emergency (A&E) departments, thereby improving their chance of survival | British Journal of General Practice | via OnMedica
In this large study, the researchers studied Routes to Diagnosis data on 554,621 patients with cancer in England who presented as emergencies between 2006 to 2015. They found there was a decline in the annual rate of emergency presentations, with emergency referrals from GPs falling by about a half.
The authors suggested this was likely to reflect increasing use by GPs of the two week wait referral pathways, as well as reductions in emergency presentations following a GP referral, likely indicating a trend towards earlier diagnosis in general practice.
Full story at OnMedica
Full article: Herbert A, Abel GA, Winters S, et al. | Cancer diagnoses after emergency GP referral or A&E attendance in England: determinants and time trends in Routes to Diagnosis data, 2006–2015 | British Journal of General Practice 2019
Researchers behind a population-based study of oral antibiotic exposure and risk looked at the association between oral antibiotic use and (colorectal cancer) CRC risk have published their findings in the BMJ Journal Gut.
Background Microbiome dysbiosis predisposes to colorectal cancer (CRC), but a population-based study of oral antibiotic exposure and risk patterns is lacking.
Objective To assess the association between oral antibiotic use and CRC risk.
Design A matched case–control study (incident CRC cases and up to five matched controls) was performed using the Clinical Practice Research Datalink from 1989 to 2012.
Results 28 980 CRC cases and 137 077 controls were identified. Oral antibiotic use was associated with CRC risk, but effects differed by anatomical location. Antibiotic use increased the risk of colon cancer in a dose-dependent fashion. The risk was observed after minimal use, and was greatest in the proximal colon and with antibiotics with anti-anaerobic activity. In contrast, an inverse association was detected between antibiotic use and rectal cancers, particularly with length of antibiotic exposure more than 60 days as compared with no antibiotic exposure. Penicillins, particularly ampicillin/amoxicillin increased the risk of colon cancer, whereas tetracyclines reduced the risk of rectal cancer. Significant interactions were detected between antibiotic use and tumour location. The antibiotic–cancer association was found for antibiotic exposure occurring more than 10 years before diagnosis.
Conclusion Oral antibiotic use is associated with an increased risk of colon cancer but a reduced risk of rectal cancer. This effect heterogeneity may suggest differences in gut microbiota and carcinogenesis mechanisms along the lower intestinal tract. (Source: Zhang et al, 2019)
The full article is available from BMJ Gut
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