Archive for the ‘Gynaecology’ Category

Recommendations for prostate cancer active surveillance

With active surveillance, patients undergo regular visits with prostate-specific antigen (PSA) tests and repeated prostate biopsies rather than aggressive treatment. It is distinguished from watchful waiting, in which treatment for localized disease is withheld and palliative treatment for systemic disease is initiated.

“Active surveillance is an important management option for men with low-risk prostate cancer,” says lead author Mahul Amin, MD, FCAP, Chair, Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA. “Vital to this process is the critical role pathologic parameters play in identifying appropriate candidates for active surveillance.”

Dr. Amin spearheaded the team that highlighted the pathologic parameters key for the successful identification of patients likely to succeed with active surveillance. The key parameters, at a general level, address: •Sampling, submission, and processing issues in needle biopsies used to diagnose prostate cancer •Tumor extent in needle biopsies •Biopsy reporting for all and special cases •Gleason scores, the system for grading prostate cancer tissue based on how it looks under a microscope •Precision medicine markers •Other pathologic considerations

The team further concluded that the key parameters to be reported by the surgical pathologists: 1) need to be reproducible and consistently reported and 2) highlight the importance of accurate pathology reporting.

Recommendations from the United States Preventive Services Task Force, an independent group of national experts in prevention and evidence-based medicine, and randomized trials have drawn attention to overtreatment of localized, low-risk prostate cancer. PSA screening and changing consensus on PSA testing practices are among the many factors that contribute to prostate cancer’s overdiagnosis and overtreatment.

The pathology recommendations are included in the Archives article: The Critical Role of the Pathologist in Determining Eligibility for Active Surveillance as a Management Option in Patients with Prostate Cancer: Consensus Statement with Recommendations Supported by the College of American Pathologists, International Society Of Urological Pathology, Association of Directors of Anatomic and Surgical Pathology, the New Zealand Society of Pathologists, and the Prostate Cancer Foundation.

source : http://www.sciencedaily.com/releases/2014/08/140826100651.htm

HPV home tests could identify cancer risk

Sweden has a system of regular gynaecological smear tests, which has halved the number of cases of cervical cancer. Most of the patients who die from the disease are therefore either above the screening age, or part of the 20% who fail to attend their screenings. The figures are similar in other countries with equivalent screening programs.

"We are usually able to cure cases of cancer that are identified through smear tests. For those women who have not been for smear tests, the cancer has progressed considerably further by the time it is diagnosed. It is these women who are at risk of dying from the disease," says Dr Lotten Darlin at Lund University in Sweden.

The most common response when asked why they haven’t attended cervical smear tests is that the tests are unpleasant, that the women felt healthy and/or that they haven’t had time, according to one of Lotten Darlin’s studies. She therefore investigated the possibility of home testing, but the testing kits that are currently available have been shown to be either complicated or expensive.

Dr Darlin and her colleagues have therefore developed their own test, which comprises a simple cotton bud and a test tube. The test is sent off to a lab, where it has been shown to produce just as clear results as HPV tests taken by a doctor. HPV tests measure levels of human papilloma virus, a virus that in the long run can cause cervical cancer.

In one study, self-testing kits were sent to 1,000 women who had not had a smear test for over nine years. Fifteen per cent of them used the test and sent in samples for analysis.

"That may not seem like many. But for this group, who have failed to go for a smear test for so many years, it is nonetheless a significant improvement," says Lotten Darlin.

She believes that the simple self-testing kit could also be used in countries that do not have a program of regular cervical smear tests:

"It doesn’t require a lot of resources or a well-developed health care system to analyze the results. The women just need a basic knowledge of their bodies to take the test correctly."

Other studies that Dr Darlin has conducted concern the end of the regular screening program. The tests are discontinued at different ages in different parts of Sweden, but usually end between the ages of 60 and 65.

Lotten Darlin’s studies show that many cases of cervical cancer are diagnosed in women in their sixties — a quarter of cases after the age of 65. She thinks the health service therefore shouldn’t let older women leave the screening program without a special exit test for HPV.

source : http://www.sciencedaily.com/releases/2013/12/131218112918.htm