While the traditional view of cancer development focuses on the genetic mutations within the cell, Mina Bissell, Distinguished Scientist at the Berkeley Lab, conducted pioneering experiments that showed that a malignant cell is not doomed to become a tumor, but that its fate is dependent on its interaction with the surrounding microenvironment. Her experiments showed that manipulation of this environment, through the introduction of biochemical inhibitors, could tame mutated mammary cells into behaving normally.
Cancer
CHOP to be Chopped?
Once the most common treatment for indolent non-Hodgkin’s Lymphoma, the combination chemotherapy known as CHOP is rapidly falling to the wayside in Germany – replaced by bendamustine (Treanda), frequently combined with rituximab (Rituxan), researchers reported here.
via New Combo Replaces CHOP for Lymphoma.
NOTE the commercial interests disclosures at the end of the original article.
Melanoma on Rise with Indoor Tanning
Overall, there was a 20% increased risk for melanoma with any indoor tanning (RR 1.20, 95% CI 1.08 to 1.34), according to Mathieu Boniol, PhD, of the International Prevention Research Institute in Lyon, France, and colleagues.
But the risk nearly doubled when sunbed use began before age 35 (RR 1.87, 95% CI 1.41 to 2.48), they reported online in BMJ.
Flex Sigmoidoscopy and Colorectal Cancer
Teaching Topic
Flexible Sigmoidoscopy and Colorectal Cancer
Original Article
R.E. Schoen and Others
Colorectal cancer is the second leading cause of cancer-related deaths in the United States. Colorectal-cancer mortality and incidence are reduced with screening by means of fecal occult-blood testing. Endoscopic screening with flexible sigmoidoscopy or colonoscopy is more sensitive than fecal testing for the detection of adenomatous polyps, the precursor lesions of colorectal cancer.
Clinical Pearls
What were the results of this randomized trial comparing flexible sigmoidoscopy to usual care for screening of colorectal cancer?In this randomized study, flexible sigmoidoscopy, as compared with usual care, was associated with a 26% reduction in overall colorectal-cancer mortality and a 21% reduction in the incidence of colorectal cancer. Mortality related to distal colorectal cancer was reduced by 50%, and the incidence was reduced by 29%. A significant 14% reduction in the incidence of proximal colorectal cancer was observed, but there was no significant reduction in mortality related to proximal cancer.
According to the authors, what were the numbers needed to invite for screening via flexible sigmoidoscopy to prevent one diagnosis of colorectal cancer and one colorectal-cancer death?In this study, the number needed to invite for screening in order to prevent 1 case of colorectal cancer was 282 (95% CI, 210 to 427). The number needed to invite for screening to prevent 1 colorectal-cancer death was 871 (95% CI, 567 to 1874).
Morning Report Questions
Q. How did study participants differ from the usual-care group?
A. Participants in the intervention group were offered two screenings with flexible sigmoidoscopy, 3 to 5 years apart. Median follow up was 11.9 years. In the intervention group, 86.6% of participants (67,071) underwent at least one flexible sigmoidoscopic screening, and 50.9% (39,440) underwent two screenings. The estimated rate of endoscopy in the usual-care group during the screening phase was 25.8% (95% CI, 23.6 to 28.0) for flexible sigmoidoscopy, 34.4% (95% CI, 32.0 to 36.8) for colonoscopy, and 46.5% (95% CI, 43.9 to 49.1) for either flexible sigmoidoscopy or colonoscopy.
Q. How did screening-detected cancers differ from those diagnosed among participants who were never screened in terms of location and stage?
A. Screening-detected cancers accounted for 24.1% of colorectal cancers (244 of 1012) in the intervention group. Among participants with screening-detected cancers, 82.8% of the cancers were distal, whereas among participants who were never screened, 52.8% were distal, and among participants with cancers not detected by screening, 31.6% were distal (P<0.001). Participants with screening-detected cancers were more likely to have early-stage cancer (stage I or II) than participants who were never screened or those whose tumors were not detected by screening (75.4% vs. 50.9% and 50.7%, respectively; P<0.001).
Table 3. Colorectal-Cancer Incidence and Stage According to Means of Detection.
Medical News: Death Rate High Long After VTE – in Cardiovascular, Venous Thrombosis from MedPage Today
The risk of death for patients with thrombosis was highest in the first year after the event, with a hazard ratio of 14.4 95% CI 7.1 to 29.2, according to Frits R. Rosendaal, MD, PhD, and colleagues from Leiden University in the Netherlands.But the risk remained elevated eight years later HR 3.8, 95% CI 0.5 to 30.8, the researchers reported in PLoS Medicine.
“Remarkably,” the mortality rate was five times higher among patients with malignancy and thrombosis than among those who had a malignancy without thrombosis (SMR 5.5, 95% CI 5 to 6.1), the researchers observed.
Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM
These approaches to managing serial PSA levels reflect either a fundamental misunderstanding of — or an unwillingness to acknowledge — PSA’s limitations as a marker for early prostate cancer. Observational studies show clearly that PSA levels fluctuate spontaneously, moving above or below whatever threshold clinicians deem worrisome. In addition, random biopsies can detect prostate cancer in 12% of men with PSA levels below 2 ng per milliliter and in 25% of men with levels between 2.1 and 4.0 ng per milliliter4; the latter figure approximates the prevalence often reported for men with levels between 4.0 and 10.0 ng per milliliter. When the PSA goes up — for example, from 3.0 to 4.0 ng per milliliter — and triggers a biopsy that reveals cancer, clinicians refer to “PSA-detected cancer.” But many of these cancers are not really detected by PSA screening; they are incidental findings against a background of randomly fluctuating PSA levels and an age-related increase in prostate-cancer incidence.
via Prostate-Cancer Screening — What the U.S. Preventive Services Task Force Left Out — NEJM.
Stratifying Risk — The U.S. Preventive Services Task Force and Prostate-Cancer Screening — NEJM.
I realize today is the day after Thanksgiving and I’m working. But medicine never stops and a life underwriter has to do what a life underwriter does on her day off. Read medical journals! Check out these articles from NEJM. Time to change our PSA underwriting guidelines? I think so. Call me if you need help with this. I have a mortgage, one undergraduate, and one medical student to support.
Speaking of the medical student I was trapped this Thanksgiving in the car and listened to over five hours of lectures on neurology and hematology during the ride. To tell the truth, I enjoyed the lectures.
Medicine never takes a day off nor do expert life underwriters.
Barrett”s Preferred !!!
DM Increases Cancer Risk
Diabetes Increases Risk of Cancer Death – NYTimes.com
“Researchers from the National Cancer Institute collected diet, lifestyle and health data from 500,000 people ages 50 to 71 and followed the patients for 11 years. They found that having diabetes was associated with an 11 percent increased risk of dying from cancer among women and a 17 percent increased risk of cancer death among men.”
Breast Implants and Anaplastic Large Cell Lymphoma (ALCL)
FDA announced a possible association between saline and silicone gel-filled breast implants and anaplastic large cell lymphoma (ALCL), a very rare type of cancer. Data reviewed by the FDA suggest that patients with breast implants may have a very small but significant risk of ALCL in the scar capsule adjacent to the implant.
Prostate Cancer Biomarker
The results, published in the Public Library of Science (PLoS) ONE journal, showed that MSMB is found at significantly lower levels in the urine of men diagnosed with prostate cancer than those without the disease. They also showed men with aggressive tumors were also likely to have lower levels of the protein in their urine.
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