Posts Tagged ‘university’

Increase seen in use of double mastectomy, although not associated with reduced death

Randomized trials have demonstrated similar survival for patients with early-stage breast cancer treated with breast-conserving surgery and radiation or with mastectomy. However, previous data show increasing use of mastectomy, and particularly bilateral mastectomy (removal of both breasts) among U.S. patients with breast cancer. Evidence for a survival benefit with this procedure appears limited to rare patient subgroups. “Because bilateral mastectomy is an elective procedure for unilateral breast cancer [in one breast] and may have detrimental effects in terms of complications and associated costs as well as body image and sexual function, a better understanding of its use and outcomes is crucial to improving cancer care,” according to background information in the article.

Allison W. Kurian, M.D., M.Sc., of the Stanford University School of Medicine, Stanford, Calif., and colleagues used data from the California Cancer Registry from 1998 through 2011 to compare the use of and rate of death after bilateral mastectomy, breast-conserving therapy with radiation, and unilateral mastectomy (removal of one breast).

The analyses included 189,734 patients. The researchers found that the rate of bilateral mastectomy increased from 2.0 percent in 1998 to 12.3 percent in 2011, an annual increase of 14.3 percent. The increase in bilateral mastectomy rate was greatest among women younger than 40 years: the rate increased from 3.6 percent in 1998 to 33.0 percent in 2011, increasing by 17.6 percent annually. Use of unilateral mastectomy declined in all age groups

Bilateral mastectomy was more often used by non-Hispanic white women, those with private insurance, and those who received care at a National Cancer Institute-designated cancer center; in contrast, unilateral mastectomy was more often used by racial/ethnic minorities and those with public/Medicaid insurance.

Compared with breast-conserving surgery with radiation, bilateral mastectomy was not associated with a mortality difference, whereas unilateral mastectomy was associated with higher mortality.

“In a time of increasing concern about overtreatment, the risk-benefit ratio of bilateral mastectomy warrants careful consideration and raises the larger question of how physicians and society should respond to a patient’s preference for a morbid, costly intervention of dubious effectiveness,” the authors write.

“These results may inform decision-making about the surgical treatment of breast cancer.”

Editorial: Contralateral Prophylactic Mastectomy: Is It a Reasonable Option?

In an accompanying editorial, Lisa A. Newman, M.D., M.P.H., of the University of Michigan, Ann Arbor, discusses the issues involved with the use of contralateral prophylactic mastectomy (risk-reducing mastectomy for the unaffected breast).

“The need for patients to be accurately informed regarding safe and oncologically acceptable treatment options is indisputable. The dense fog of complex emotions that accompanies a new cancer diagnosis can impair the ability to process this information. Patients should be encouraged to allow the intensity of these immediate reactions to subside before committing to mastectomy prematurely. Physicians should not permit excessive treatment delays to compromise outcomes, but the initial few weeks surrounding the diagnosis are more effectively utilized by time invested in patient education and procedures that contribute to comprehensive treatment planning as opposed to hastily coordinating impulsive, irreversible surgical plans.”

source : http://www.sciencedaily.com/releases/2014/09/140902171150.htm

Invisible blood in urine may indicate bladder cancer

Scientists at the University of Exeter Medical School found that one in 60 people over the age of 60 who had invisible blood in their urine (identified by their GP testing their urine) transpired to have bladder cancer. The figure was around half those who had visible blood in their urine — the best known indicator of bladder cancer. However, it was still higher than figures for other potential symptoms of bladder cancer that warrant further investigation.

Lead author Sarah Price, a PhD student at the University of Exeter Medical School, led the first robust study to investigate whether invisible blood in urine can indicate bladder cancer. Speaking as the study is published in the British Journal of General Practice on September 1 2014, she said: “It is well known that if you see blood in your urine you should contact your GP, who is likely to refer you for tests. But there is no clear guidance for GPs on what to do if they detect blood that is not visible during routine tests. We are hopeful that our findings will now lead to robust guidance that it warrants further investigation. Early diagnosis is crucial to have the best chance of successfully treating bladder cancer. The three-quarters of patients who are diagnosed early have much better outcomes than those whose disease is diagnosed late. Anything we can do to boost early detection is crucial to help save lives.”

The study examined more than 26,000 people whose anonymized data contributed to the Clinical Practice Research Datalink; this is a large research database used by the Exeter team in several cancer studies. The team found that the risk of bladder cancer was 1.6 per cent in people over 60 who had invisible blood in their urine.

Around 10,000 people in the UK are diagnosed with bladder cancer each year. The condition is more common in men than women and in older people, with the average age of diagnosis at 68. Smoking is among the main causes.

source : http://www.sciencedaily.com/releases/2014/09/140901090731.htm

Drug shows promise for subset of stage III colon cancer patients

When added to the standard chemotherapy treatment — fluorouracil and leucovorin — adjuvant irinotecan therapy improved overall survival rates for patients with the CpG island methylator phenotype (CIMP). CIMP is seen in about 10 to 20 percent of colorectal cancers. Patients with CIMP-negative tumors, however, exhibited significant harm from the addition of irinotecan — overall survival was 68 percent compared with 78 percent for those receiving the standard treatment alone.

“Our results serve as an example that the molecular characterization of individual tumors may help to determine the most appropriate treatment for patients with colon cancer,” said lead study author Stacey Shiovitz, MD, from the department of medicine, University of Washington, Seattle, WA, and the clinical research division of Fred Hutchinson Cancer Research Center, also in Seattle. “Based on our findings, identification of a tumor’s CIMP status should play a greater role in the clinical setting.”

Researchers analyzed data from patients with stage III colon cancer randomly assigned to groups given fluorouracil and leucovorin or adjuvant irinotecan after surgery, from April 1999 through April 2001. Patients were followed for eight years. Patients with CIMP-positive tumors demonstrated a trend toward improved overall survival when treated with irinotecan versus the standard treatment alone, 69 percent versus 56 percent, respectively. Results were most pronounced among patients with stage III CIMP-positive, mismatch repair intact (MMR-I) colon cancer.

No significant associations or interactions between CIMP and KRAS or BRAF mutations were observed, suggesting that the effectiveness of this treatment is not influenced by KRAS/BRAF mutation status.

“This analysis serves to increase our understanding of which subset of patients might benefit from irinotecan adjuvant therapy. This research is an important step in the medical community’s work to classify tumors into groups that would result in optimized treatment strategies, thus delivering a higher level of personalized care to patients,” added Dr. Shiovitz.

Future studies are needed to better understand the origin of the CIMP phenotype and to test these findings in a larger subset.

source : http://www.sciencedaily.com/releases/2014/08/140828110824.htm