Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case–control study and meta-analysis

PLOS MEDICINE – 21st March 2023

Why was this study done?

• Use of combined oral contraceptives has been associated with a small transient increase in breast cancer risk, but there is limited data about the effect of progestagen-only contraceptives on breast cancer risk.
• Use of progestagen-only hormonal contraceptives has increased substantially over the last decade, and in 2020, there were almost as many prescriptions in England for oral progestagen-only contraceptives as for combined oral contraceptives.
• Given the increasing use of progestagen-only contraceptives, it is important to understand how their use is associated with breast cancer risk.

What did the researchers do and find?

• We carried out a nested case–control study in the Clinical Practice Research Datalink (CPRD), including almost 10,000 women aged <50 years with breast cancer, to assess the relationship between a woman’s recent use of hormonal contraceptives and her subsequent risk of breast cancer.
• In our study, current or recent use of hormonal contraceptives was associated with a similarly increased risk of breast cancer regardless of whether the preparation last used was oral combined, oral progestagen-only, injectable progestagen, progestagen implant, or progestagen intrauterine device.
• When our findings for progestagen-only contraceptives were combined with those of previous studies, there was evidence of a broadly similar increased risk of breast cancer in current and recent users of all four types of progestagen-only preparations.

Further information – Combined and progestagen-only hormonal contraceptives and breast cancer risk: A UK nested case–control study and meta-analysis

Lung cancer: diagnosis and management

National Institute for Health and Care Excellence – Last updated: 14 March 2023

Guidance updated to include NICE TA855 for use of mobcertinib for EGFR exon 20 insertion mutation +ve non-small-cell lung cancer. Treatment pathway summaries now also include details of the various agents recommended according to histology and mutation status.

Guidance – Lung cancer: diagnosis and management

How can cancer teams ensure that patients’ preferences inform treatment decisions?

NIHR – 17th March 2023

Teams of professionals working together (multidisciplinary teams) have improved outcomes for people with many different conditions, including cancer. But a study found that this way of working may not support patient preferences. It calls for professionals to ensure that people with cancer take part in decisions about their treatment.

Multidisciplinary teams bring together different specialists involved in a patient’s care. In team meetings, professionals may discuss treatment options in a patient-centred way, but they rarely include patients themselves.

This study focused on head and neck cancer. Researchers observed multidisciplinary teams making treatment decisions and assessed patients’ engagement with their recommendations.

The study found that team meetings were frequently dominated by doctors’ opinions on the best treatment. Patients tended to be presented with the team’s preferred treatment option, rather than all treatment options; their preferences often did not inform treatment decisions. Patients may, for example, choose treatments that allow them to do things they love, rather than to live longer.

The researchers call for healthcare professionals to find ways to ensure that patient preferences inform decision-making. Training for professionals on shared decision-making could help; as could re-structuring team meetings. People could benefit from dedicated time or other support tools to help them fully explore their treatment options.

Further information – How can cancer teams ensure that patients’ preferences inform treatment decisions?

This Alert was based on: Hamilton DW, and others. How do patients make decisions in the context of a multidisciplinary team: an ethnographic study of four head and neck cancer centres in the north of England. BMJ Open 2022;12:e061654.

Dose-escalated radiotherapy for curative treatment in men with clinically localized prostate cancer

Cochrane – March 8th 2023

How does a higher radiation dose compare to a lower dose when treating prostate cancer that is limited to the prostate gland? 

Background

Treatment for prostate cancer includes surgery, radiation therapy, hormone therapy, and chemotherapy. Radiation therapy (RT) is a treatment that uses beams of intense energy to kill cancer cells. So-called dose-escalated RT has an increased radiation dose compared to usual or ‘normal’ (conventional) dose RT, in order to better kill cancer, but that may also increase unwanted effects that come from the radiation hitting other organs like the bladder and rectum. We did this study to better understand how the two types of radiation compare. 

Kim S, Kong JH, Lee Y, Lee JY, Kang TW, Kong TH, Kim MH, You SH. Dose-escalated radiotherapy for clinically localized and locally advanced prostate cancer. Cochrane Database of Systematic Reviews 2023, Issue 3. Art. No.: CD012817. DOI: 10.1002/14651858.CD012817.pub2.

Revolutionary new bone cancer drug could save children’s lives

University of Sheffield – 8 March 2023

• Researchers at the University of Sheffield and University of East Anglia have developed a new drug that works against the main types of primary bone cancer
• Cancer that starts in the bones, rather than cancer that has spread to the bone, predominantly affects children and young adults
• The breakthrough drug increases survival rates in preclinical models by 50 per cent without the need for surgery or chemotherapy

A new drug that works against the main types of primary bone cancer has been developed by researchers at the University of East Anglia and University of Sheffield.

Cancer that starts in the bones, rather than cancer that has spread to bone, predominantly affects children and young adults.      

Current treatment is brutal, with outdated chemotherapy cocktails and limb amputation leading to life-long disabilities.

Even after these gruelling treatments, the five-year survival rate is still poor at just 42 per cent – largely because of how rapidly bone cancer spreads to the lungs. These rates haven’t changed in nearly half a century.

But a new study published in the Journal of Bone Oncology shows how a new drug called ‘CADD522’ blocks a gene associated with driving the cancer’s spread, in mice implanted with human bone cancer.

The breakthrough drug increases survival rates by 50 per cent without the need for surgery or chemotherapy. And unlike chemotherapy, it doesn’t cause toxic side effects like hair loss, tiredness and sickness.

Further information – Revolutionary new bone cancer drug could save children’s lives

Research – Green, Darrell, et al. “YBX1-interacting small RNAs and RUNX2 can be blocked in primary bone cancer using CADD522.” Journal of Bone Oncology (2023).

Ending smoking could free up 75,000 GP appointments each month

Cancer Research UK – 7th March 2023

New analysis, published today by Cancer Research UK, has revealed that up to 75,000 GP appointments could be freed up each month in England if the UK Government put an end to smoking.

Smoking remains the biggest cause of cancer and death and uses a considerable amount of NHS resource, the charity said.

The analysis shows that one person is admitted to hospital every minute in England due to smoking, which amounts to the same number of people admitted to the Manchester Royal Infirmary and University College London Hospital combined annually.

Ahead of next week’s spring budget, the charity is calling on the Chancellor, Jeremy Hunt MP, to reduce pressures on the NHS and provide a boost to the UK economy, by taking swift action on tobacco control.

Michelle Mitchell, chief executive of Cancer Research UK, said: “In his forthcoming budget, the Chancellor has the chance to reduce the number of people suffering with and dying from smoking-related cancers, grow the economy, and best use NHS resources in England.

Further information – Ending smoking could free up 75,000 GP appointments each month