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Focus on Breast Cancer

10 Dezembro 2009

Medscape Oncology MedPulse®

Top Stories

Selected Articles

Fertility Preservation for Breast Cancer Patients — Oktem, O. & Oktay, K. Semin Reprod Med 2009; 27(6): 486-492

Breast cancer is the most common neoplasm in women and accounts for 26% (182,460) of all new cancer cases among women. With the use of screening mammography and advancement in other diagnostic modalities, many cases of breast cancer now can be diagnosed and treated at early stages of the disease. Unfortunately, adjuvant chemotherapy regimens commonly used in the treatment of breast cancer may cause premature ovarian failure due to their cytotoxic effects on the germ cells in the ovary. Therefore preservation of fertility in breast cancer survivors at reproductive age has become an important quality of life issue. Fertility preservation is a recently emerged field of reproductive medicine that may help protect the reproductive capability of the cancer survivors and allow them to have children in the future. Embryo freezing is the most established fertility preservation strategy. But conventional ovarian stimulation protocols are contraindicated in breast cancer patients because of the rise of estrogen and its metabolites to supraphysiological levels. Recently developed ovarian stimulation protocols with aromatase inhibitor letrozole and tamoxifen appear to provide a safe stimulation with endogenous estrogen levels comparable with those achieved in the natural cycle. Oocyte freezing can be considered in single women and in those who do not wish donor sperm. Ovarian tissue freezing could also be an option in breast cancer patients who do not wish or have a time for an in vitro fertilization cycle, which requires 10 to 14 days of ovarian stimulation.

Relationship Between Potentially Modifiable Lifestyle Factors and Risk of Second Primary Contralateral Breast Cancer Among Women Diagnosed With Estrogen Receptor–Positive Invasive Breast Cancer - Li, Christopher I. et al. JCO 27, 5312-5318(2009).

An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited. We evaluated the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors.

Utilizing a population-based nested case-control study design, we enrolled 365 patients diagnosed with an estrogen receptor–positive (ER+) first primary invasive breast cancer and a second primary contralateral invasive breast cancer, and 726 matched controls diagnosed with only an ER+ first primary invasive breast cancer. Obesity, alcohol use, and smoking data were ascertained from medical record reviews and participant interviews. Using conditional logistic regression we evaluated associations between these three exposures and second primary contralateral breast cancer risk.

Obesity, consumption of ≥ 7 alcoholic beverages per week, and current smoking were all positively related to risk of contralateral breast cancer (odds ratio [OR], 1.4; 95% CI, 1.0 to 2.1; OR, 1.9; 95% CI, 1.1 to 3.2; and OR, 2.2; 95% CI, 1.2 to 4.0, respectively). Compared with women who consumed fewer than seven alcoholic beverages per week and were never or former smokers, women who consumed ≥ 7 drinks per week and were current smokers had a 7.2-fold (95% CI, 1.9 to 26.5) elevated risk of contralateral breast cancer.

Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

Uptake of Colorectal Cancer Screening: System, Provider and Individual Factors and Strategies to Improve Participation — Power, E. et al. Future Oncology, 5(9), 1371–1388.

Colorectal cancer (CRC) accounts for 9% of all new cancer cases worldwide and affects over 1 million people each year. Screening can reduce the mortality associated with the disease, yet participation rates are suboptimal. Compliers with CRC screening are less deprived; they have higher education than noncompliers and tend to be male, white and married. Likely reasons for nonparticipation encompass several ‘modifiable’ factors that could be targeted in interventions aimed at increasing participation rates. Successful intervention strategies include organizational changes, such as increasing access to fecal occult blood test (FOBT) kits, providing reminders to healthcare providers or users about screening opportunities, and educational strategies to improve awareness and attitudes towards CRC screening. Multifactor interventions that target more than one level of the screening process are likely to have larger effects. The biggest challenge for future research will be to reduce inequalities related to socio-economic position and ethnicity in the uptake of screening.

Convection-enhanced Delivery for the Treatment of Brain Tumors — Debinski, W. & Tatter, S.B. Expert Rev Neurother. 2009 Oct;9(10):1519-27.

The brain is highly accessible for nutrients and oxygen, however delivery of drugs to malignant brain tumors is a very challenging task. Convection-enhanced delivery (CED) has been designed to overcome some of the difficulties so that pharmacological agents that would not normally cross the BBB can be used for treatment. Drugs are delivered through one to several catheters placed stereotactically directly within the tumor mass or around the tumor or the resection cavity. Several classes of drugs are amenable to this technology including standard chemotherapeutics or novel experimental targeted drugs. The first Phase III trial for CED-delivered, molecularly targeted cytotoxin in the treatment of recurrent glioblastoma multiforme has been accomplished and demonstrated objective clinical efficacy. The lessons learned from more than a decade of attempts at exploiting CED for brain cancer treatment weigh critically for its future clinical applications. The main issues center around the type of catheters used, number of catheters and their exact placement; pharmacological formulation of drugs, prescreening patients undergoing treatment and monitoring the distribution of drugs in tumors and the tumor-infiltrated brain. It is expected that optimizing CED will make this technology a permanent addition to clinical management of brain malignancies.

Characteristics of Non-Hodgkin Lymphoma Arising in HIV-Infected Patients With Suppressed HIV Replication — Gérard, L. et al. AIDS. 2009 Nov 13;23(17):2301-8.

Despite effective treatment of HIV infection, some patients still develop non-Hodgkin lymphoma (NHL). We analysed patients with HIV-associated NHL and undetectable plasma HIV-RNA, according to the duration of HIV suppression.

Out of 388 patients included in a prospective cohort of HIV-associated NHL from 1996 to 2008, 128 (33%) had a plasma HIV-RNA below 500 copies/ml and were included in the study. Patients with long-term HIV suppression (>18 months) were compared with patients with recent HIV suppression (< or = 18 months).

All patients but three were treated with combination antiretroviral therapy, with a median duration of 2.2 years. The median duration of HIV suppression was 10.1 months. Most cases (65%) occurred within 18 months following HIV suppression. In the more than 18 months group, patients developed NHL at a higher CD4 cell count than patients with 18 months or less of HIV suppression (359 versus 270 cells/microl, P = 0.02). None of the NHL characteristics were different between the two groups. Outcome was similar in the two groups (complete remission, 64 versus 72.5%; P = 0.35 and 3-year survival, 46 versus 56%; P = 0.08). In addition, 52% of the tumours were Epstein-Barr virus or human herpesvirus 8 associated, without any difference in the proportion of virus-associated tumours according to the duration of HIV suppression.

In patients with undetectable HIV-RNA, NHL occurred mainly within the first 18 months following HIV suppression. In patients developing NHL after long-term HIV suppression, the level of CD4 cell count was higher, but the association with Epstein-Barr virus or human herpesvirus 8 and the prognosis were similar to that observed in patients with recent HIV suppression.

Intraoperative Cell Salvage Versus Allogeneic Transfusion During Abdominal Aortic Surgery: Clinical and Financial Outcomes — Vascular 2009

The objective of this study was to assess the clinical and financial outcomes of intraoperative cell salvage (ICS) during abdominal aortic surgery. In this study, 90 patients were operated on with the use of ICS (group 1, prospective) and 90 patients without ICS (group 2, historical control). According to the type of operation, the patients were subdivided into three consecutive 30-patient subgroups (1, aortoiliac occlusive disease [AOD]; 2, elective abdominal aortic aneurysm [AAA]; or 3, ruptured abdominal aortic aneurysm [RAAA]). Transfusion requirements and postoperative complications were recorded. The total amounts of perioperatively transfused allogeneic blood were higher in all patient subgroups that underwent surgery without ICS (p = .0032). In the ICS group, 50% of AOD patients and 60% of elective AAA patients received no allogeneic transfusions. There were no significant differences in the incidence of postoperative complications in any group examined. ICS significantly reduced the necessity for allogeneic transfusions during abdominal aortic surgery. ICS use was most valuable in urgent situations with high blood losses, such as RAAA, for which only small amounts of allogeneic blood were initially available. In patients with more than 3 units of autologous blood reinfused, this method was cost effective.

A Comparison of a Spiritually Based and Non-Spiritually Based Educational Intervention for Informed Decision Making for Prostate Cancer Screening Among Church-Attending African-American Men — Holt, C.L. et al. Urol Nurs. 2009 Jul-Aug;29(4):249-58.

This pilot study examined the efficacy of a spiritually based educational intervention for increasing informed decision making for prostate cancer screening among African-American men. The intervention appeared to be effective for some study outcomes, such as knowledge and self-efficacy for screening informed decision making.

Key Articles and Guidelines in the Treatment of Venous Thromboembolism — Dobesh, P.P. et al. Pharmacotherapy. 2009 Nov;29(11):1385.

Venous thromboembolism (VTE) is a significant medical diagnosis that affects millions of patients each year. Appropriate management of VTE can help treat the initial event as well as reduce the frequency of complications such as postthrombotic syndrome, pulmonary hypertension, and death. Due to increasing regulatory requirements, hospitals nationwide are developing necessary documentation of appropriate and safe use of anticoagulants for the management of VTE. It is essential that a wide range of clinicians have an understanding of what constitutes appropriate VTE treatment in various patient populations. With the existence of numerous pharmacologic agents, abundance of major clinical trials, and nationally recognized clinical guidelines, compiling the needed reference material to make evidence-based decisions on appropriate VTE treatment can be difficult for clinicians. Therefore we have provided bibliographies of key articles and guidelines related to the treatment of VTE with a number of different strategies in a variety of special patient populations. It is our hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with VTE.

The Case of the Peripatetic Physician: A Strategy to Avoid Accountability — Medscape Internal Medicine 2009

Peripatetic: itinerant, moving around, ambulatory Webster’s Online Dictionary

Dr. N is a 55-year-old male physician. He graduated from a state university in the Southwestern United States in 1978, and obtained a medical degree in 1984 from a school in Mexico. Between 1984 and 1986, he participated in and successfully graduated from a rotating internship at a large metropolitan hospital affiliated with the medical school that he attended. He then participated in postgraduate year two (PGY2) training at a social health service hospital in another Mexican city. In mid-1988 he returned to the United States and secured a position in a family medicine residency at a local community hospital in Oklahoma. After 1 year, he reported that he was not happy with the training program, although he offered no specifics about his unhappiness. He moved on to another family medicine residency in Texas, where he remained for only 6 months. He reported that “an increasing interest in obstetrics and conflicts with the faculty” impelled him to join a family medicine training program in New Mexico that was responsible for a large population of obstetric patients. He completed 2 years of training in that program and was recommended as a candidate for certification to the American Board of Family Medicine (ABFM). He denied having any academic or behavioral problems during medical school or residency training and was certified by the ABFM in 1995 and recertified in 2002. (Read the complete article following the link above)

Office Embezzlement: Are You Losing Money You Do Not Even Know About? — Medscape Business of Medicine 2009

Just as surely as squirrels can reach the most well-protected bird feeder, a determined employee will find a way to steal from you, experts say.

And not just once.

The office manager of a Kansas cardiologist charged roughly $323,000 in personal expenses over 9 years on a practice credit card before she was caught, convicted, and sentenced to 27 months in prison last year. In addition, an employee of an Ohio practice was recently convicted of stealing $361,000 from her employer over 5 years by altering bank deposit slips. (Read the complete article following the link above)

PSA Test and Younger Men - Medscape Medical News 2009

December 1, 2009 — The American Urological Association (AUA)’s updated Prostate-Specific Antigen Best Practice Statement, first presented at the annual meeting of the AUA in April, has been published in the November issue of the Journal of Urology.

The statement includes the controversial guidance that the prostate-specific antigen (PSA) test should be offered to men starting at the age of 40 years — which one critic has said is not supported by “any convincing evidence.”

The update also reiterates the AUA’s position that prostate cancer screening with PSA is a matter of individual choice.

There is no single standard that applies to all men. (Read the complete article following the link above)

Post originally published on Pharmakon.

P.S. 2025: some links of the original post could nor be found or retrieved. All others were updated.

Focus on Breast Cancer - December 10, 2009 - fhcflx