Tag Archives: oncology

October: Breast Cancer Awareness Month is here

When examining cancer morbidity and mortality, if you separate the sexes, acknowledging that men also get breast cancer, among women, breast cancer is the top culprit.

The first step is to make sure that there is widespread awareness for the disease, both among the public, but also in government. That way, men and women can conduct breast exams, and try to get as early a diagnosis as possible.

Secondly, governments around the world can set aside more funding, both for breast cancer research, as well as for breast cancer treatments. At least in the developing world, the disease is not as debilitating as it once was.

Just the other day, we found out everyone’s sweetheart Julia Louis-Dreyfus came forward letting us all know she has been diagnosed with breast cancer. Thus, you have a clear view of a disease that spares neither the rich, nor the poor, and does not care for any other classification.

It is also the hope that a cure for breast cancer can be extended to other cancers. This has happened to a certain extent with some of the medication and therapies.

Therefore, join me this month, as I try to rack up a few posts on Breast Cancer – the statistics, therapies, diagnosis, prevention and more.

New Drug Approved: abemaciclib

Let us start with good news for today. “abemaciclib” is a new drug just approved by the FDA for breast cancer therapy. You can read about it in the reference. However, let’s break it down a bit here.

CDK (cyclin-dependent kinase) inhibitor

For starters, abemaciclib belongs to a class called CDK Inhibitors. There are two other drugs in this class, that were also approved for the treatment of a specific sub-type of breast cancer, the “receptor-positive, HER2-negative breast cancer”. This is one of the good things about breast cancer research and treatment today. Breast cancer has been typed and classified genetically enough that we have left behind the “let’s throw stuff on the wall and see what sticks” mostly.

Of course, there is more work to be done. To exemplify that, abemaciclib, is specific to patients who are on endocrine therapy and the disease continues to progress. Not only that, while the drug is to be administered along with another drug, fulvestrant, it has been specifically been approved to be used as a monotherapy (standalone treatment) for patients who have previously had both endocrine therapy and conventional chemotherapy, but in whom, breast cancer has metastasized.

While this can all certainly seem overwhelming, it is an example of both how far we have come, and how far we have to go.

Key Takeaways

Some key takeaways for the Breast Cancer Awareness Month, something, which I will try to repeat as many times as possible:

  1. Awareness is supreme. Awareness helps us to be rid of fear, and to get women to quicker and earlier diagnoses, which is a very important consideration in survival.
  2. Governments and private philanthropies should focus on provide funding for all cancer research in general, and breast cancer in particular. This is where awareness comes into play again.
  3. Support medicine, clinical research and science in general. We need to be able to genetically weed out breast (and hopefully, ALL) cancer, not just do things based on family history and other factors. This is a lofty, achievable goal. We do it with other diseases, we need to be able to do this with cancer as well.
  4. Prevention, is always better than cure. Therefore, along with awareness, must come campaigns that urge people to live healthier lifestyles – less drinking, avoiding cigarettes, avoid harmful drugs, eating well, exercising and more.

Subscribe and Support Please!

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References: 

  1. The approval of abemaciclib: https://www.medpagetoday.com/HematologyOncology/BreastCancer/68204?xid=nl_mpt_%20SRCardiology_2017-09-30&eun=g101584d0r&pos=3311133
  2. Image, Courtesy Pexels: https://www.pexels.com/photo/awareness-cancer-design-pink-579474/

 

GOC2: A PRO study on open vs. minimally invasive endometrial cancer surgeries

MDedge and MDLinx separately alerted me to a very interesting study based on GOC 2 (Gynecological Oncology), a Canadian research program. In this particular study (cost comparisons  apparently will be reported separately – MDedge has a video of an interview of the study lead), open surgery for Endometrial Cancer was compared to laparoscopic and robotic surgery techniques. The study was reported at the Society of Gynecologic Oncology 2017 Meeting.

This study is another example where women were recruited across multiple sites, and they answered survey questions, and thus, is a Patient Reported Outcomes (PRO) study on Quality of Life (QOL) following procedures of varying invasiveness.

As a reference, Endometrial Cancer represents about 3.6% of all new cancer cases in the US, occurring as new cases in an estimated 61,380 women in 2017, with a projected mortality for about 10, 920 women. The 5 year survival rate is approximately 81.3%, making Quality of Life an important concern for survivors. An NCI link is available below if you wish to explore more.

The Current Study

Patients with confirmed stage I or stage II endometrial cancer  were recruited across 8 centers in Canada. 106 patients from the open surgery arm, and 414 from the minimally invasive surgery arm participated, with the breakdown amounting to 168 laparoscopic and 246 robotic surgery patients.

Approximately 80% of patients completed the QOL questionnaires. Only about 25 – 50% of the patients responded to the sexual-function questionnaires. Those responding were found to be young, pre-menopausal and sexually active.

The study itself was not randomized, but adjustments were made to accommodate this.

Also, quoting Dr. Ferguson from MDedge below, about sexual function:

Both of the surgical groups “met the clinical cutoff for sexual dysfunction” on the Female Sexual Function Index questionnaire, she said.

Results

The results can be viewed as three distinct sets:

  1. There was no statistical significance in QOL or sexual function, between laparoscopic and robotic procedures.
  2. At 3 weeks, patients in all groups fared better in terms of pain, but Quality of Life was worse for Open Surgery Patients. Novel to this study, this extended to the 3 month period as well, both clinically and statistically. (Please watch video on the MDedge link)
  3. While fewer patients responded to the questionnaires on sexual function, there was no significant difference between the open and minimally invasive surgery groups for up to 26 weeks. I am puzzled by this honestly. If you have reduced Quality of Life, your sexual function ought to be reduced. If it is not, then how would you have a significant difference in one case and not the other? The lower number of responses might be the confounding factor here, and honestly as the paper sits behind a paywall, there is only so much I can glean from reading articles and the abstract.

References:

  1. The MDedge Article (along with the video): http://www.mdedge.com/oncologypractice/article/134206/gynecologic-cancer/video-pain-and-impaired-qol-persist-after-open
  2. Abstract 51 from SGO: https://www.sgo.org/wp-content/uploads/2016/12/SGO-AM17-abstract_titles.pdf
  3. Some Endometrial Cancer Statistics: https://seer.cancer.gov/statfacts/html/corp.html
  4. Image Courtesy of Pexels: https://www.pexels.com/photo/woman-sitting-by-the-seashore-during-day-89820/

Total Body Fat Vs. Belly Fat in Breast Cancer Risk

I came across this very interesting study through a Medical News Today article (link below). The paper manuscript itself is free, but comes across as a little difficult to read on the downloadable PDF version , because of the way it appears to be output by the journal. However, it is always good to be able to access the full paper, and not simply the summary.

The premise

Among several risk factors, body fat is a breast cancer risk. There apparently have been contentions about where specific biomarkers that indicate breast cancer are produced, with some previous studies. This study has shown that overall weight loss is more beneficial in terms of breast cancer biomarker production reduction, rather than focusing on belly fat alone.

The current study

The current study is limited to post-menopausal women. Conducted in the Netherlands, 243 overweight women were recruited. They lost 5 – 6kg over a period of 16 weeks. A set of biomarkers, indicative of sex hormones, leptin and inflammation were compared before and after the weight loss. The fat changes themselves were measured using X-ray and MRI scans.

The latter appears to be important. The MNT article includes a statement that this study is different than previous ones that used waist measurements. I can see this being quite an important difference. X-rays and MRI scans definitely appear to be more fastidious methods of assessing fat changes, specific to a body region.

Results

Increased belly fat, according to Dr. Evelyn Monninkhof, the lead in the study indicates, increases the risk for several chronic diseases, independent of total body fat. She indicates however, that sex hormones, are more affected by total body fat and not just localized fat, as concluded from the study.

She also points that their next steps is to look at how to reduce levels of total fat and abdominal fat. This said, it appears that women, especially those postmenopausal and those approaching menopause can benefit from exercise and nutritional changes that lead to total fat loss, and hopefully, abdominal fat loss along the way. It is always important to contact licensed medical and/or nutritional professionals when considering exercise and/or dietary changes.

References:

  1. The MNT Article: http://www.medicalnewstoday.com/releases/317498.php
  2. The Endocrinology Paper: http://erc.endocrinology-journals.org/content/early/2017/05/16/ERC-16-0490.abstract?sid=9f3c9977-0e81-4583-bdf5-07b3f182f911
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-with-umbrella-on-beach-247304/

Delay in Breast Cancer Diagnosis and Increase in Mortality

In the United States, it is National Women’s Health Week. I am going to try to post about a different and key area of Women’s Health through this week.

Today, I am going to point you to the summary of some important results from a very interesting paper on breast cancer diagnosis delays. I only have the summary to offer as the paper itself sits behind a pay wall. Still, even the summary should give one pause and suggestions of key demographics to aim at, in trying to bring up the diagnosis.

Study Limitation

This study, like the one mentioned in yesterday’s blog is also an ecological study and therefore, does not have the strength and rigor of a prospective, clinical study. However, the study results are still very valuable and informative.

Summary of Key Findings (Quoted)

Delays in diagnosis could possibly affect survival as well. While it is possible to quote from the summary, the mdedge article that originally pointed me to the paper has a nice summary, and I am going to quote it here. The article itself is linked below:

  • Women who received Medicaid or were uninsured were more than twice as likely to be diagnosed at a later stage, vs those with commercial insurance.
  • Blacks were 18% more likely than whites to experience such.
  • Unmarried women were 25% more likely than their married counterparts to be diagnosed later.
  • Younger patients were 25% more likely than older individuals to experience delayed diagnosis.
  • Compared with commercially insured patients, death rates from breast cancer in Medicaid and uninsured women were 40% and ~60% higher, respectively.
  • This rate was nearly 40% higher in blacks vs whites, and nearly 20% higher in unmarried vs married women.

Conclusion

As you can see, social status, insurance, and even marital status as well as age make significant contributions to delay in diagnosis. Similar issues exist with survival and mortality. As the authors state in the study, it is important to explore these demographic and social status differences further. When separated by sex, Breast Cancer is the leading cause of cancer based mortality among women in the United States. Every effort must be made to ensure increased awareness, early diagnosis and treatment of breast cancer!

References: 

  1. Summary of the Study: http://onlinelibrary.wiley.com/doi/10.1002/cncr.30722/full
  2. The mdedge article: http://www.mdedge.com/oncologypractice/clinical-edge/summary/practice-management/these-factors-impact-breast-cancer?group_type=2-month&topic=278&utm_source=News_Power_eNL-B_051417&utm_medium=email&utm_content=ClinicalEdge%20Top%2010:%20Editor%27s%20Picks%20for%20May
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/woman-in-black-tank-top-holding-an-umbrella-in-front-of-yellow-concrete-wall-57851/

A seemingly surprising increase in incidence of Endometrial Cancer

The ACOG 2017 saw several interesting results come out. One surprising result, presented at an oral presentation, appears to be a presentation about the increase in the incidence of Endometrial Cancer.

It appears that Endometrial Cancer rates were stable from 1999 to 2002, but then, since 2006 to 2014, the rates appear to have increased by 10%.

The authors were curious, as you and I might be, so they examined EC incidence through the Surveillance, Epidemiology, and End Result Program database from 1975 through 2014.

Factors affecting Endometrial Cancer

It appears that FDA approved hormonal therapies have dropped in number, and therefore the use of non FDA approved combinations of estrogen and estrogen+progesterone, which may not be enough to stop endometrial cancer.

Obesity, which has been increasing consistently, already a known risk factor, might be aggravated.

Study Limitations

The study, as stated by the authors themselves, is clearly not a randomized clinical trial, but an ecological study. Therefore, it is not sufficient to draw conclusions and yet, the findings, especially the coincidence of the use of non-approved hormonal therapy and the increase in endometrial cancer as well as factors such as obesity is quite interesting, and this should be flushed out further, perhaps with targeted studies. Women, in particular should be aware of risk factors and seek medical help in advance.

References

  1. A report on the study: http://www.mdedge.com/clinicalendocrinologynews/article/137805/gynecologic-cancer/endometrial-cancer-rates-increased?channel=247&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
  2. The ACOG summary of the study: http://journals.lww.com/greenjournal/Abstract/2017/05001/Increased_Incidence_of_Endometrial_Cancer.19.aspx
  3. Image Courtesy, Pexels: https://www.pexels.com/photo/beach-woman-sunrise-silhouette-40192/

Some results on breast reconstruction following mastectomy

The Preface

One of my life goals, and specifically, as it pertains to this site, is to spread the news about free and open, well composed, peer-reviewed scientific publications. Following that tradition, today’s blog focuses on another key area of women’s health – breast cancer, mastectomy and post-mastectomy reconstruction.

The Paper

ASCO and MedPage Today are reporting this paper in the Journal of Clinical Oncology, available on MedPage Today for free (link below), that highlights one year, post operative patient survey results, that highlight differences in satisfaction with breasts, among women who opted for two forms of breast reconstructive surgery.

The two forms are Autologous Recovery or Flap Recovery and Implant Reconstruction.

Autologus Recovery

Autologous Recovery, as some of you might guess, involves tissue from the patient’s own body, reconstructed and used as breast tissue. There are two types of tissue recovery possible: free flap, where the tissue is severed from its blood vessel connections and moved or, a pedicled flap, where the blood vessels are still attached as the tissue is moved. Tissue usually arises from areas such as the belly or the back. A link with details is supplied below.

Implant Reconstruction

Implant reconstruction doesn’t last a life time, the key difference between this and autologous recovery, and may need multiple surgeries. Usually composed of silicone and saline, these implants are sized and implanted into the body. This method is less invasive, and easier with delayed reconstructive options, and provides the patients with multiple breast shape options, allowing for the most suitable form to be chosen and used. Formerly, this was the best option for women with smaller breasts, because they also usually had less tissue available for reconstruction, but autologous recovery has made strides in this area, so this is no longer seen as a big advantage. Refer to the link below for more information.

The present study

The present study enrolled a large number of patients, 1632, in total, across 11 sites; that were undergoing immediate postmastectomy reconstruction for either invasive cancer and/or carcinoma in situ. There is some argument over whether carcinoma in situ is actually cancer. Regardless of the status of this debate, this is the title for a group of cells/tissue that is precancerous and has not metastasized but is expected to. This is common in breast and a few other cancers, and patients many times choose to undergo mastectomy to fend off cancer.

Patient Reported Outcomes (PRO)

The study was conducted by evaluating Patient Reported Outcomes, also known as PRO. This is a method where validated questionnaires are used, to assess treatments and/or symptoms, from the patients’ perspectives, going beyond clinical measurements, which, for the longest time where the mainstay of medical comparative evaluation. There are barriers to the prevalence of PROs, as internet access, data availability, etc. remain challenges, however it is becoming an accepted research form, especially where patients themselves would be the best judges of outcomes.

Care must be taken when interpreting patient reported outcomes, valuable as they are, and especially so, when using them for labeling claims. The FDA has also weighed in.

In this study, using  a generic PRO measure, Patient-Reported Outcomes Measurement Information System–29, patients were quizzed before, and one year after surgery. If you want to read and learn more about PROMIS, I have appended a link below.

The Results and Conclusions

Using the scoring system, and based on the response of 1183 patients, the researchers concluded that patients with Autologous Recovery/Reconstruction had better satisfaction  with their breasts and mental well being. Anxiety and depression were reduced in both groups, however, neither group had fully recovery of chest health. There was increased pain with Autologous Recovery, while patients with Implant Reconstruction had reduced fatigue. overall, it appears patients who underwent Autologous Reconstruction had a slight edge. I have attached links to the summary and the article below.

References:

  1. The ASCO study summary: https://www.medpagetoday.com/reading-room/asco/breast-cancer/64962?xid=NL_ASCORR_2017-05-11&eun=g5100781d39r&pos=1111 Note: The full paper link is available on the same page. 
  2. Autologous Recovery: http://www.breastcancer.org/treatment/surgery/reconstruction/types/autologous
  3. Implant Reconstruction: http://www.breastcancer.org/treatment/surgery/reconstruction/types/implants
  4. PROMIS: http://www.nihpromis.com/?AspxAutoDetectCookieSupport=1#1
  5. A Paper on Patient-Reported Outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3227331/
  6. Carcinoma in situ: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46488
  7. FDA Guidance on the use of Patient-Reported Outcome Measures: https://www.fda.gov/downloads/drugs/guidances/ucm193282.pdf
  8. Image Courtesy, Pexels: https://www.pexels.com/photo/flower-pink-peony-blouse-112324/

 

Interesting MIT Research on Ovarian Cancer Detection

The teal ribbon, pictured above, is used to represent the Fight Against Ovarian Cancer

I am back to my favorite Qmed today. They led me to a neat article on MIT News.

Ovarian cancer, while rare, still affects a number of women. According to the National Cancer Institute (NCI – link below), approximately 1.3 % of women will be diagnosed to cancer during their lifetime, and in 2014, they approximated that 222,060 women were living with Ovarian Cancer in the United States.

In addition, as detailed both in the Qmed Article and MIT News (links below), Ovarian Cancer detection is challenging, and usually detection doesn’t occur well after the disease has reached a certain size.

Consequently, this represents an important challenge in healthcare, and with the support of some much needed funding and the investment of great scientific minds, MIT might have used synthetic biomarkers, that, if transferred successfully from the current mouse models to humans, can shave diagnostics time by about 5 months! And five months, can definitely mean a lot for disease detection, treatment and/or management.

Read more about synthetic biomarkers, the challenges with Ovarian Cancer detection, and other interesting information through the links below.

References: 

  1. The Qmed Article: http://www.qmed.com/mpmn/medtechpulse/better-way-find-ovarian-cancer?cid=nl.x.qmed02.edt.aud.qmed.20170503
  2. The MIT News Article: http://news.mit.edu/2017/new-technology-detect-tiny-ovarian-tumors-0410
  3. Some NCI stats on Ovarian Cancer: https://seer.cancer.gov/statfacts/html/ovary.html