Understanding GP attitudes to cancer preventing drugs

A study by Cancer Research UK concludes that GPs want more support when offering drugs that lower the risk of certain cancers. It finds that GPs are more comfortable to discuss drugs, and more willing to prescribe or recommend drugs when they are supported by secondary care clinicians. Cancer Research UK

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Understanding GP attitudes to cancer preventing drugs is aimed at increasing understanding GP attitudes towards offering the use of tamoxifen and aspirin to lower the risk of cancer, or prevent cancer. This is an area where there is little research around clinician attitudes and knowledge.

The study surveyed 1,007 GPs from across the UK. It found nearly half of GPs were unaware of the potential benefits of tamoxifen to prevent breast cancer among women with a clear family history of the disease who are therefore at higher risk.

The study also showed that more needs to be done to promote the evidence and guidance on chemoprevention. The research suggests that ensuring evidence based chemoprevention is routinely discussed with and offered to the people who may benefit should be a priority across the UK.

Executive summary: Understanding GP Attitudes to Cancer Preventing Drugs 

Full report: Understanding GP Attitudes to Cancer Preventing Drugs

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NICE: Women with family history of breast cancer should take pill

Hundreds of thousands of healthy women should take pills to cut their risk of breast cancer, says NHS watchdog NICE | BBC News

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The draft guidelines for England say women predisposed to breast cancer because of a strong family history of the disease need this protection.

There are now three drugs to choose from – tamoxifen, raloxifene and, for the first time, anastrozole. Anastrozole is cheaper than the other two and, for some women, has fewer side-effects and is more effective.

Read the full news story here

Read the NICE draft guidelines here

Sun protection for preventing basal cell and squamous cell skin cancers

Sanchez, G. et al. Cochrane Skin Group. Published online:  25 September 2016

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Keratinocyte cancer (BCC and cSCC of the skin) is the most commonly identified type of skin cancer. The main risk is exposure to ultraviolet radiation, which is a component of sunlight. Prevention has become an important way to manage this cancer, so it is important to assess the effectiveness of methods used to prevent keratinocyte cancer in the general population. In this review, we assessed the effects of using topical sunscreen and physical barrier methods (such as sun-protective clothing, hats, sunglasses, and the active search for shade when outdoors) compared with no specific precautionary interventions aimed at preventing the development of BCC and cSCC in adults and children.

We searched the medical literature up to May 2016 for randomised controlled trials that evaluated preventive strategies. We found only one study suitable for inclusion. This study compared the daily application of sunscreen (with or without beta-carotene, which is a precursor of vitamin A) compared with the occasional use of sunscreen (with or without beta-carotene) in the general population, without restriction by gender or age. The study was undertaken in Australia, where 1621 participants, 55% of them with fair skin, were monitored for 4.5 years for new cases of BCC or cSCC assessed by histopathology (which is a method used to detect cancerous cells under the microscope).

We found no difference between the number of people who developed BCC or cSCC in the two groups over the time period of the trial. So, there did not seem to be a difference in applying sunscreen daily compared with using it occasionally.

Read the full review here

Delivering world class cancer services

NHS pushes forward with ambition to create world class cancer services

The NHS in England has set out its plans to deliver world class cancer services, which includes a fund to find new ways of speeding up diagnosis with the potential to save thousands more lives every year.

The National Cancer Transformation Board has published a wide ranging plan designed to increase prevention, speed up diagnosis, improve the experience of patients and help people living with and beyond cancer.

This follows the release last year of the report of the NHS’s Independent Cancer Taskforce  which identified how the NHS can achieve world-class cancer outcomes and save 30,000 lives a year by 2020.

Read more from NHS England here

Precision prevention of colorectal cancer

Fred Hutchinson Cancer Research Center. ScienceDaily. Published online: 18 April 2016.

In work presented at the American Association for Cancer Research’s annual meeting in New Orleans, Hsu and other researchers from Fred Hutch, the University of Michigan and other research groups debuted their latest progress in precision prevention — an in-the-works method to predict risk of colorectal cancer that integrates genetic, lifestyle and environmental risk factors.

This research is not yet ready to move into clinical practice, said Fred Hutch epidemiologist Dr. Ulrike “Riki” Peters, one of the study authors. But it’s the first attempt at combining so many different areas of colorectal cancer risk into one convenient risk predictor.

Read the commentary here

Cancer expert says public health, prevention measures are key to defeating cancer

ScienceDaily March 3, 2016

Is investment in research to develop new treatments the best approach to controlling cancer? Would emphasizing prevention bring about more return on investment? Should we channel what we are learning about precision medicine and the genome into cancer prevention, not treatment alone?

Many people believe that the time is right for another big push to defeat cancer, including President Obama, who called for a major cancer-fighting campaign in his final State of the Union address. But in the latest paper, “Targeting the Cancer Moonshot” in JAMA Oncology, this kind of effort will never cure cancer without public health and prevention.

While there have been some important and notable cures for certain types of cancer in the last half-century, Alfred I. Neugut, MD, PhD, Myron M. Studner Professor of Cancer Research and professor of Epidemiology at Columbia University’s Mailman School of Public Health, and co-author Cary P. Gross, MD, Yale University School of Medicine, drive home the point that these cures are responsible for only a small fraction of improvements in mortality.

Read the full commentary here

Long term aspirin may reduce overall cancer risk

Wise, J. BMJ 2016;352:i1319

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Image source: Shannon

Taking low dose aspirin regularly for at least six years is associated with a modest but significant reduction in the risk of cancer, especially cancer of the gastrointestinal tract, research published in JAMA Oncology has shown.1

The study found that taking aspirin at least twice a week was associated with a 3% lower incidence of developing any type of cancer. This was primarily due to a 15% lower risk of gastrointestinal tract cancers and a 19% lower risk of cancers of the colon and rectum. But regular aspirin use was not associated with a lower risk of breast, advanced prostate, or lung cancer.

The new study used data from two large prospective studies: the Nurses’ Health Study and the Health Professionals Follow-Up Study. Among the 88 084 women and 47 991 men who underwent follow-up for as long as 32 years, the researchers found 20 414 cancers in women and 7571 in men.

The study found that, compared with non-regular use, regular aspirin was associated with a lower incidence of gastrointestinal tract cancers (relative risk 0.85 (95% confidence interval 0.80 to 0.91)), especially colorectal cancers (0.81 (0.75 to 0.88)). The benefit of aspirin in patients with gastrointestinal tract cancer was seen with the use of at least 0.5-1.5 standard aspirin tablets a week. The minimum duration associated with benefit was six years.

Read the full commentary here

Read the original research abstract here