Irregular menses predicts ovarian cancer: Prospective evidence from the Child Health and Development Studies

Cirillo. P.M. et al. International Journal of Cancer. DOI: 10.1002/ijc.30144

We tested the hypothesis that irregular menstruation predicts lower risk for ovarian cancer, possibly due to less frequent ovulation.

We conducted a 50-year prospective study of 15,528 mothers in the Child Health and Development Studies cohort recruited from the Kaiser Foundation Health Plan from 1959-1966. Irregular menstruation was classified via medical record and self-report at age 26. We identified 116 cases and 84 deaths due to ovarian cancer through 2011 via linkage to the California Cancer Registry and Vital Statistics.

Contrary to expectation, women with irregular menstrual cycles had a higher risk of ovarian cancer incidence and mortality over the 50-year follow-up. Associations increased with age (p <0.05). We observed a 2-fold increased incidence and mortality by age 70 (95% Confidence Interval (CI) = 1.1, 3.4) rising to a 3-fold increase by age 77 (95% CI = 1.5, 6.7 for incidence; 95% CI = 1.4, 5.9 for mortality). We also found a 3-fold higher risk of mortality for high-grade serous tumors (95% CI = 1.3, 7.6) that did not vary by age.

 

This is the first prospective study to show an association between irregular menstruation and ovarian cancer – we unexpectedly found higher risk for women with irregular cycles. These women are easy to identify and many may have polycystic ovarian syndrome. Classifying high-risk phenotypes such as irregular menstruation creates opportunities to find novel early biomarkers, refine clinical screening protocols and potentially develop new risk reduction strategies. These efforts can lead to earlier detection and better survival for ovarian cancer.

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Specific gene in the tumor determines the effectiveness of cancer treatment

B0006254 Human colon cancer cells
Image source: Annie Cavanagh, Wellcome Images//CC BY-NC-ND 4.0

Image shows Human colon cancer cells in culture

A cancer treatment can be basically effective but, equally, it may have negative consequences. Therefore, it has not been possible to determine prior to treatment whether a patient will benefit from standard cancer treatment or not. However, a specific gene, which is frequently mutated in cancer, seems to determine the effectiveness of the treatment, researchers show after a large study conducted with colorectal cancer patients. The main finding: the effect of standard chemotherapy was dependent upon whether the TP53 gene in the tumor was mutated or not.

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First cancer patient in Europe scanned in Cambridge using new technique showing whether drugs work

CRUK. Published online: 11th April 2016.

http://wellcomeimages.org/indexplus/obf_images/6b/fc/2a078539144821c0d4479b7430ed.jpg
Image source: Khuloud T. Al-Jamal, Rebecca Klippstein & Izzat Suffian – Wellcome Images // CC BY-NC-ND 4.0

Image shows confocal micrograph of prostate cancer cells treated with curcumin.

The first cancer patient in Europe has been scanned with a revolutionary imaging technique that could enable doctors to see whether a drug is working within a day or two of starting treatment.

The patient is the first to take part in a new metabolic imaging trial* of patients across a wide range of cancer types to be carried out by Cancer Research UK-funded scientists at Addenbrooke’s Hospital, part of Cambridge University Hospitals. The study, which is funded by a Wellcome Trust Strategic Award, could show whether patients can stop taking drugs that aren’t working for them, try different ones and receive the best treatment for their cancer as quickly as possible.

The rapid scan will allow doctors to map out molecular changes in patients, opening up potential new ways to detect cancer and monitor the effects of treatment.

The technique uses a breakdown product of glucose called pyruvate. The pyruvate is labelled with a non-radioactive form of carbon, called carbon 13 (C-13) which makes it 10,000 times more likely to be detected in a magnetic resonance imaging (MRI) scan. Pyruvate is injected into the patient and tracked as the molecule moves around the body and enters cells. The scan monitors how quickly cancer cells break pyruvate down – a measure of how active the cells are that tells doctors whether or not a drug has been effective at killing them.

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Advance care planning – a multi-centre cluster randomised clinical trial

Rietjens, J. A. C. et al. BMC Cancer2016 16:264

Background: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients’ values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potential to improve current and future healthcare decision-making, provide patients with a sense of control, and improve their quality of life.

Methods/Design: We will study the effects of the ACP program Respecting Choices on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicenter cluster randomised controlled trial, 22 hospitals in 6 countries will be randomised. In the intervention sites, patients will be offered interviews with a trained facilitator. In the control sites, patients will receive care as usual. In total, 1360 patients will be included. All participating patients will be asked to complete questionnaires at inclusion, and again after 2.5 and 4.5 months. If a patient dies within a year after inclusion, a relative will be asked to complete a questionnaire on end-of-life care. Use of medical care will be assessed by checking medical files. The primary endpoint is patients’ quality of life at 2.5 months post-inclusion. Secondary endpoints are the extent to which care as received is aligned with patients’ preferences, patients’ evaluation of decision-making processes, quality of end-of-life care and cost-effectiveness of the intervention. A complementary qualitative study will be carried out to explore the lived experience of engagement with the Respecting Choices program from the perspectives of patients, their Personal Representatives, healthcare providers and facilitators.

Discussion: Transferring the concept of ACP from care of the elderly to patients with advanced cancer, who on average are younger and retain their mental capacity for a larger part of their disease trajectory, is an important next step in an era of increased focus on patient centered healthcare and shared decision-making.

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Radiation therapy chemotherapy combination improves survival in adults with low-grade brain cancer

ScienceDaily. Published online: 7th April 2016

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Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows magnetic resonance imaging scan showing cystic cerebellar astrocytoma.

Patients with a low-grade type of brain tumor called glioma who received radiation therapy plus a chemotherapy regimen, including procarbazine, lomustine and vincristine (PCV), experienced a longer progression-free survival and overall survival than patients who received radiation therapy alone, according to the results of the clinical trial.

Between October 1998 and June 2002, 251 patients with low-grade glioma were enrolled in the RTOG 9802 trial. Patients enrolled were at high risk, compared to other patients with low-grade glioma, because they were 40 or older, or had a less-than-complete surgical removal of their tumor.

Patients were randomized to 1 of 2 trial arms, radiation therapy plus six cycles of PCV chemotherapy or radiation therapy alone. Before treatment, researchers conducted a pathology review on tumor samples and prepared for samples for correlative laboratory studies to assess mutational status and identify prognostic variables.

At a median follow-up time of 11.9 years, 67 percent of enrolled patients were identified as having tumor progression, and 55 percent of patients had died. Patients in the radiation therapy plus PCV chemotherapy arm had longer median survival times, compared with those in the trial arm who received radiation therapy alone (13.3 versus 7.8 years, respectively; p=0.003). Median progression- free survival time for patients receiving radiation therapy plus PCV chemotherapy versus radiation therapy alone was 10.4 years and 4.0 years, respectively. Ten-year, progression-free survival and overall survival rates for patients in the radiation therapy plus PCV chemotherapy arm versus those in the radiation therapy alone arm were 51 percent versus 21 percent and 60 percent versus 40 percent, respectively.

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Read the research article abstract here

Systematic review: brain metastases from colorectal cancer—Incidence and patient characteristics

Christensen, T. D. et al. BMC Cancer 16:260. Published online 1st April 2016

http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=10&_IXSR_=dwyorqPGRWg&_IXSS_=_IXMAXHITS_%3d15%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3dbrain%2bmetastases%26IXFROM%3d%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d11&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft
Image source: Wellcome Images // CC BY-NC-ND 4.0 

Image shows magnetic resonance image (MRI), pre-contrast axial slice showing brain metastasis from primary cancer.

Background: Brain metastases (BM) from colorectal cancer (CRC) are a rare event. However, the implications for affected patients are severe, and the incidence has been reported to be increasing. For clinicians, knowledge about the characteristics associated with BM is important and could lead to earlier diagnosis and improved survival.

Method: In this paper, we describe the incidence as well as characteristics associated with BM based on a systematic review of the current literature, following the PRISMA guidelines.

Results: We show that the incidence of BM in CRC patients ranges from 0.6 to 3.2 %. BM are a late stage phenomenon, and young age, rectal primary and lung metastases are associated with increased risk of developing BM. Molecular markers such as KRAS, BRAF, NRAS mutation as well as an increase in CEA and CA19.9 levels are suggested predictors of brain involvement. However, only KRAS mutations are reasonably well investigated and associated with an increased risk of BM.

Conclusion: The incidence of BM from CRC is 0.6 to 3.2 % and did not seem to increase over time. Development of BM is associated with young age, lung metastases, rectal primary and KRAS mutation. Increased awareness of brain involvement in patients with these characteristics is necessary.

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A Study into the Benefits of Medication Usage Reviews (MURs) in Patients being Treated for Prostate Cancer

Smith, T. et al. Clinical Oncology. Volume 28, Issue 5, May 2016, Pages e14

In the UK, more people are living into old age, where cancer is more common. It is estimated that the average cancer patient over the age of 65 years suffers from at least one chronic condition. This can lead to polypharmacy, increased adverse drug reactions, non-adherence and sub-optimal healthcare outcomes.

Medicine reviews have been shown to have a positive impact in optimising patient medication. This study therefore aimed to investigate the potential benefits of MURs in an older cancer patient population.

Read the abstract here

9 in 10 don’t link alcohol and cancer

Cancer Research UK. Published online: 1st April 2016

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Almost 90 per cent of people in England don’t associate drinking alcohol with an increased risk of cancer, according to a new report commissioned by Cancer Research UK.

Drinking alcohol is linked to an increased risk of seven different cancers – liver, breast, bowel, mouth, throat, oesophageal (food pipe), laryngeal (voice box) – but when people were asked “which, if any, health conditions do you think can result from drinking too much alcohol?” just 13 per cent of adults mentioned cancer.

The survey also highlighted a lack of understanding of the link between drinking alcohol and the risk of developing certain types of cancer. When prompted by asking about seven different cancer types, 80 per cent said they thought alcohol caused liver cancer but only 18 per cent were aware of the link with breast cancer. In contrast alcohol causes 3,200 breast cancer cases each year compared to 400 cases of liver cancer.

The report, produced by researchers at the University of Sheffield, comes ahead of the consultation closing on how well new drinking guidelines proposed by the UK’s Chief Medical Officers in January 2016, are communicated. These drew attention to the link between alcohol and cancer, and highlighted the need for greater public awareness of this risk. The findings are based on a nationally representative online survey of 2,100** people conducted in July 2015.

The study also showed that only one in five people could correctly identify the previous recommended maximum number of units that should not be exceeded in a day, as recommended at that time in 2015. Among drinkers, as few as one in 10 men (10.8 per cent) and one in seven women (15.2 per cent) correctly identified these recommended limits and used them to track their drinking habits.

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What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study

McNair, A.G.K. et al. BMC Cancer2016 16:258.

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Background: 
The information surgeons impart to patients and information patients want about surgery for cancer is important but rarely examined. This study explored information provided by surgeons and patient preferences for information in consultations in which surgery for oesophageal cancer surgery was discussed.

Methods: Pre-operation consultations in which oesophagectomy was discussed were studied in three United Kingdom hospitals and patients were subsequently interviewed. Consultations and interviews were audio-recorded, transcribed in full and anonymized. Interviews elicited views about the information provided by surgeons and patients’ preferences for information. Thematic analysis of consultation-interview pairs was used to investigate similarities and differences in the information provided by surgeons and desired by patients.

Results: Fifty two audio-recordings from 31 patients and 7 surgeons were obtained (25 consultations and 27 patient interviews). Six consultations were not recorded because of equipment failure and four patients declined an interview. Surgeons all provided consistent, extensive information on technical operative details and in-hospital surgical risks. Consultations rarely included discussion of the longer-term outcomes of surgery. Whilst patients accepted that information about surgery and risks was necessary, they really wanted details about long-term issues including recovery, impact on quality of life and survival.

Conclusions: This study demonstrated a need for surgeons to provide information of importance to patients concerning the longer term outcomes of surgery. It is proposed that “core information sets” are developed, based on surgeons’ and patients’ views, to use as a minimum in consultations to initiate discussion and meet information needs prior to cancer surgery.

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