Archives – November, 2011
4.5 (two votes)
Healthcare Prof:
5 (1 votes)
A new $2.95 million Brumby Labor Government grant is helping Victorian researchers collaborate to find an alternative to silicon in breast reconstruction right after mastectomy.
Innovation Minister Gavin Jennings stated the project was essential within the remedy and recovery of ladies with breast cancer.
“The Brumby Labor Government is taking action to help researchers find a procedure to reconstruct breasts following mastectomy that avoids using silicon,” Mr Jennings said.
“The technique involves the insertion of a customised biodegradable chamber which is contoured to match the woman’s natural breast shape within which the permanent fat located in breasts can be grown.
“Where there is insufficient fat, the researchers intend to develop Myogel, a muscle derived tissue that induces fat tissue production. This technique provides a safe and more natural way of reconstructing the breast.”
The Australian Tissue Engineering Centre will lead the breast reconstruction project in partnership with Anatomics, Cogentum, Bernard O’Brien Institute of Microsurgery, St Vincent’s Hospital Melbourne, the University of Melbourne’s Department of Chemical and Biomolecular Engineering and the Victorian Institute of Forensic Medicine Tissue Bank.
The project is 1 of 10 new wellness projects getting funded under the $41 million Victoria’s Science Agenda (VSA) Investment Fund, part of the Brumby Labor Government’s innovation statement.
The other wellness projects to be funded under the VSA Investment Fund are:
-Australian Collaborative Care Cluster for chronic disease;
-Collaboration to develop next generation pharmaceutical formulations;
-High-value clinical items for oncology diagnosis and therapy;
-Electronic tracking for cryogenic storage of cord blood and stem cells;
-Capturing the therapeutic value of dairy bioactives;
-A continence management technologies program;
-Nanosecond laser remedy for vision loss from age-related macular degeneration;
-Early stage ovarian cancer diagnosis; and
-The Victorian stroke telemedicine program for rural and regional Victoria.
Mr Jennings said that breast cancer survivors can knowledge a range of difficulties, ranging from physical limitations to psychosocial problems. Self esteem derived from feeling better about their bodies by way of breast reconstruction was an essential factor in their recovery.
“Breast cancer could be the most common cancer among ladies in Australia. Far more than 13,600 new instances are expected this year although about 106 Australian men are also expected to be diagnosed,” he stated.
Source
Brumby Labor Government
November 30, 2011
Healthcare Prof:
5 (1 votes)
The Avon Foundation for Females has awarded the Clemson University Institute for Biological Interfaces of Engineering a $195,000 grant to support study to develop new ways to improve reconstructive breast surgery using engineered tissue that contains anti-cancer properties.
“We’re working on an injectable cell-based biomaterial that will be designed to reduce tumor recurrence,” said Karen Burg, institute director and Hunter Endowed Chair of Bioengineering. “Our investigation is in the intersection of biology and engineering. We are particularly excited due to the fact it really is the first time that the Avon Foundation for Girls has funded this form of interdisciplinary study, and it is wonderful that they’ve recognized the possible of collaborative work.”
The project is focused on improving reconstructive surgery performed on breast tissue following a lumpectomy. Healthy cells from the patient would be combined with a degradable biomaterial that has anti-cancer properties. The tissue-biomaterial would be injected, following the lumpectomy, into the patient. Prior studies have shown the creating tissue fills the tissue defect as the material is gradually absorbed into the body.
Burg said the concept of an injectable biomaterial for breast tissue reconstruction is becoming tested in animal models and the anti-cancer biomaterial is being developed in a laboratory-engineered tissue method in the institute.
The grant was awarded to Burg and Clemson research assistant professor Brian Booth. The announcement of the grant was produced in Charlotte, N.C., at the 2009 Avon Walk for Breast Cancer, which raised $2.3 million to advance access to care and finding a cure for breast cancer.
Located at Clemson University, the Institute for Biological Interfaces of Engineering can be a South Carolina-based interdisciplinary investigation and educational unit integrating faculty member activities from the five Clemson University colleges. Its goal will be the development of laboratory-engineered tissue systems that can be employed to study new medical implants and disease processes or to develop new therapies and preventatives.
Source: Susan Polowczuk
Clemson University
November 29, 2011
5 (two votes)
Healthcare Prof:
5 (1 votes)
Metastases are responsible for more than 90% of cancer deaths. Inside the upcoming issue of G&D, Dr. Robert Weinberg (MIT) and colleagues lend molecular insight into how microRNAs suppress tumor metastasis.
Scott Valastyan, lead author on the study, describes it as presenting “detailed mechanistic insight regarding the process of tumor metastasis, and identifies many key regulators of this process that might prove to be intriguing diagnostic and/or therapeutic targets in breast cancer.”
Dr. Weinberg’s group previously showed that the human microRNA, miR-31, suppresses breast cancer metastasis and that its expression is associated with patient outcome. miR-31 regulates the expression of almost 200 genes. However, in this new paper, the authors identify that re-introduction of 3 miR-31 targets is sufficient to completely reverse miR-31′s influence on metastasis.
The researchers characterized both the individual and overlapping contributions that each and every of these three miR-31 effectors makes to the metastatic process. While three distinct steps are affected by this cohort of miR-31 targets (namely nearby invasion, early post-intravasation events and metastatic colonization), of particular interest was the finding that two of the three effectors regulate metastatic colonization – the final and rate-limiting step of metastasis.
Scott Valastyan emphasizes that “Our finding that miR-31, integrin-alpha5, and radixin affect the process of metastatic colonization might be of particular interest in light of the fact that colonization efficiency is strongly associated with patient survival outcome in many human tumor types – including breast cancer”.
Source:
Heather Cosel-Pieper
Cold Spring Harbor Laboratory
November 28, 2011
Healthcare Prof:
4.five (2 votes)
Despite a recent study finding that an increasing number of women who had cancer in 1 breast are opting to have the other breast removed, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology(TM) for Breast Cancer discourages prophylactic mastectomy in ladies except for those considered high danger. This recommendation is noted inside the lately updated NCCN Guidelines for Breast Cancer along with a new regimen for adjuvant chemotherapy and recommendations for utilizing sentinel node mapping and excision in females with clinically negative lymph nodes.
In the updated NCCN Guidelines, it states that prophylactic mastectomy (the removal of a noncancerous breast) contralateral to a known unilateral breast cancer is not recommended except as outlined in the NCCN Guidelines for Genetics/Familial High-Risk Assessment: Breast and Ovarian and also the NCCN Guidelines for Breast Cancer Danger Reduction. When prophylactic mastectomy is getting considered, the NCCN Guidelines note that the tiny rewards must be balanced using the threat of recurrent disease from the recognized breast cancer, the psychological and social issues associated with bilateral mastectomy, as well as the overall risks of contralateral mastectomy.
The practice of removing noncancerous breasts to reduce the danger or prevent cancer has grow to be increasingly widespread among girls. A study lately published within the journal Cancer located that amongst women who had cancer in one breast, the number who opted to have the other breast removed, a lot more than doubled from 1995 via 2005 in New York state. However, there is no data to demonstrate that having prophylactic mastectomy actually improves survival.
The NCCN Guidelines Panel suggests that high-risk girls considering a prophylactic mastectomy should be evaluated by a multi-disciplinary team and counseled on the risks of the procedure.
Perhaps the most clinically important update towards the NCCN Guideline could be the removal of the recommendation for a full axillary lymph node dissection as an option for girls with clinically negative lymph nodes. The updated NCCN Guidelines now recommend that ladies with stage 1 or two invasive breast cancer with clinically negative lymph nodes, undergo sentinel node mapping and excision provided they are being treated by a team of clinicians with knowledge in sentinel node biopsy.
Sentinel node biopsy is really a diagnostic procedure utilised to determine whether or not breast cancer has metastasized to axillary lymph nodes (e.g., lymph nodes under the arm). Sentinel node biopsy requires the removal of only a few lymph nodes compared to a full axillary lymph node dissection, and might decrease the threat of lymphedema and pain associated with surgery.
Another critical update to the NCCN Guidelines could be the addition of a brand new regimen for adjuvant chemotherapy for invasive breast cancer. The NCCN Guidelines now consist of FEC [fluorouracil (Adrucil(R), Pfizer Inc.) / epirubicin (Ellence(R), Pfizer Inc.) / cyclophosphamide (Cytoxan(R), Bristol-Myers Squibb Firm)] followed by weekly paclitaxel (Taxol(R), Bristol-Myers Squibb Firm) as an option for adjuvant therapy, therapy given after surgery.
Although the incidence of breast cancer has elevated steadily in the United States over the past few decades, breast cancer mortality appears to be declining suggesting a benefit from early detection and a lot more effective therapy.
NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated by way of an evidence-based process with explicit review of the scientific evidence integrated with professional judgment by multidisciplinary panels of physicians from NCCN Member Institutions.
About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world’s leading cancer centers, is dedicated to enhancing the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical pros at NCCN Member Institutions, NCCN develops resources that present valuable details to the numerous stakeholders inside the wellness care delivery program. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other wellness care decision-makers. The main objectivein the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Study Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Study Institute, Tampa, FL; The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children’s Analysis Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at the Nebraska Medical Center, Omaha, NE; The University of Texas
M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN.
Source: National Comprehensive Cancer Network
November 27, 2011
5 (1 votes)
Healthcare Prof:
5 (1 votes)
An professional in cancer proteomics at Fred Hutchinson Cancer Analysis Center has received $4.8 million in federal stimulus funding from the National Cancer Institute to co-lead a pilot study to assess the feasibility and scalability of a project that aims to measure all of the proteins inside the human body.
“If successful, this study could help to stimulate a bigger international endeavor that would be comparable towards the Human Genome Project,” said Amanda Paulovich, M.D., Ph.D., a geneticist and oncologist inside the Hutchinson Center’s Clinical Research Division who is co-leading the effort with Steven Carr, Ph.D., a senior scientific leader in protein biochemistry and proteomics at the Broad Institute in Cambridge, Mass. A senior adviser on the project is N. Leigh Anderson, Ph.D., founder and chief executive officer of the Plasma Proteome Institute in Washington, D.C.
“In exactly the same way that the Human Genome Project has had a tremendous impact on our ability to measure the expression levels of all 21,000 genes in human cells, we hope that the long-term output of this effort – the human Proteome Detection and Quantitation (hPDQ) project – will allow us to build a method to measure the merchandise of those genes, which are the a lot more than 100,000 proteins inside the human body,” Paulovich stated.
Understanding the body’s protein landscape is critical since proteins are the workhorses of the cell that carry out genetic instructions. Changes inside the structure or abundance of proteins are associated with genetic mutations that cause diseases like cancer.
Currently there is no good way to simultaneously measure large numbers of human proteins, which presents a major obstacle to progress in both basic and applied translational investigation, in which fundamental scientific findings are translated into clinically useful results, from diagnostic and screening tests to drug development.
“You can’t study what you can’t measure,” Paulovich said. “Currently the biomedical study enterprise is severely hindered by its inability to measure the vast majority of human proteins.” Unlike gene signals, which can be amplified in the laboratory, protein volume cannot be dialed up. Simply because many proteins are present in very low quantities – like a needle in a haystack – they are below the limits of detection with current techniques.
This study is designed to change that. “This pilot has the prospective of developing the very first step toward making the entire human proteome clinically accessible,” stated Henry Rodriguez, Ph.D., director of Clinical Proteomic Technologies for Cancer in the Office of the Director in the NCI.
“If we can create ways to measure a large fraction of human proteins, particularly those in very low abundance, this will facilitate the development of new drugs and personalized medicine,” Paulovich said.
Ultimately, the “holy grail” of proteomics could be the discovery of protein biomarkers that could be utilised to create reliable and inexpensive blood tests to identify the onset and threat of a wide range of cancers and other diseases so they could be prevented or treated in the earliest possible stage, when cure rates are highest.
For the project, Paulovich and colleagues will use a highly sensitive and targeted analytical technology – several reaction monitoring mass spectrometry – to develop 400 assays, or tests, to measure the levels of 200 proteins identified in breast-cancer cells. Even though the purpose of the study is to test the feasibility of scaling this technology to a a lot broader scale, a side benefit may be to determine regardless of whether certain proteins are associated with specific subtypes of breast cancer.
This sort of mass spectrometry is not new – it has been utilised for years in clinical laboratories worldwide to measure drug metabolites and small molecules associated with inborn errors of metabolism. What is new is Paulovich and colleagues’ pioneering use of this technologies, also known as triple quadropole mass spectrometry, to measure proteins.
Unlike traditional mass spectrometry, which attempts to detect all proteins in a biological sample in a scattershot fashion, this technologies is highly targeted, allowing researchers to calibrate the equipment to specifically look for peptides, or protein fragments, of interest, filtering out the rest as white noise.
The method utilised in the Hutchinson Center/Broad Institute collaboration is complementary to other ongoing protein-discovery initiatives including the Human Proteome Project of the Human Proteome Organization (HUPO) along with the Swedish Human Proteome Resource. “While these other groups are identifying proteins expressed in different human cell types, we will complement their work by quantifying the expression of proteins beginning with those of potential clinical interest,” Paulovich said. “We’ll measure these proteins to see if their abundance changes in relation to disease.”
The project also contains collaborators at Massachusetts General Hospital in Boston as well as the University of North Carolina at Chapel Hill, at the same time as a commercial partnership with Applied Biosystems of Life Technologies, whose AB Sciex triple quadrupole mass-spectrometry equipment will be used for the project.
To maximize productivity, Paulovich and colleagues also will closely coordinate activities and share their outcomes with Robert Moritz, Ph.D., a faculty member and director of proteomics in the Institute for Systems Biology in Seattle, who recently received federal stimulus funding to lead a related human proteome project.
Source:
Kristen Woodward
Fred Hutchinson Cancer Research Center
November 26, 2011
Healthcare Prof:
At the end of a 10-year, coast-to-coast study of girls with an unusual form of breast cancer, Richard J. Barth Jr., M.D., and 3 fellow researchers are making the case for a particular combination of treatments to stop the tumors in their tracks.
In the August 2009 issue of the Annals of Surgical Oncology, Barth, an associate professor of surgery at Dartmouth Medical School (DMS), and his colleagues – amongst them Wendy Wells, M.D., a professor of pathology at DMS – recommend using adjuvant radiotherapy on patients who undergo breast-conserving surgery to control borderline-malignant and malignant phyllodes tumors. Following the progress of 46 girls who received follow-up radiotherapy at 30 different institutions in 18 states, the investigation team located that none developed new tumors in the locations in which surgeons performed margin-negative resection. Among nearly 500 ladies nationwide who are diagnosed using the condition each year and undergo only the surgery, the researchers say, tumors recur in 24 percent of patients with borderline malignant tumors and 20 percent of those with malignant tumors.
Barth is section chief of general surgery at Dartmouth-Hitchcock Medical Center (DHMC), and Wells is a breast pathologist at DHMC, where 13 females participated inside the study. The Dartmouth researchers work inside the Comprehensive Breast Care Program at Dartmouth-Hitchcock’s Norris Cotton Cancer Center.
The journal article can be viewed here.
Source:
David A. Corriveau
Dartmouth Medical School
November 25, 2011
2 (1 votes)
Healthcare Prof:
Cancer Study UK scientists have utilised a cutting edge microscopy technique to identify genes whose activity could be blocked by drugs to stop the spread of the breast cancer. The analysis is published in Nature Cell Biology* .
The scientists from Cancer Research UK’s London Analysis Institute and Breast Cancer Campaign analysed the role of cell ‘messengers’ controlled by Transforming Growth Factor Beta (TGF-beta) – which regulates cell growth and movement – to see how it affected the spread of breast cancer cells in mice.
A ‘reporter’ protein within the cancer cells glowed blue when the TGF-beta cell messenger system was active.
The findings showed that TGF-beta controlled a set of genes that need to have to be 1st turned on and then off to enable breast cancer cells to spread by way of the blood.
An understanding of how cancer cells spread will help scientists design remedies to stop this happening.
The researchers located that within the presence of a signal from TGF-beta, single cells broke away from the main tumour and spread via the blood to other tissues and organs, including the lungs. But the absence of a TGF-beta signal prevented single cells breaking away. Instead the tumour spread via clumps of cells in the lymphatic program which could only spread locally and could not spread towards the blood or lungs.
Lead author Dr Erik Sahai, head of the Tumour Cell Biology Laboratory at Cancer Investigation UK’s London Study Institute said: “We have utilised cutting-edge filming techniques to study the behaviour of cancer cells. The results helped us to find the set of genes which are behind the spread of breast cancer – and that the genes require to be very first turned on and then off in order for single cancer cells to be able to ‘relocate’.
“Surprisingly little is identified about the way cancer cells spread via the body since it truly is so incredibly difficult to study. In a medium-sized tumour there could be a billion cells – and only a little proportion might break away and spread. So it truly is like trying to find – and understand – a moving needle in a very big haystack.”
In the UK in 2006 far more than 45,500 ladies were diagnosed with breast cancer – around 125 females a day. Breast cancer may be the second most frequent cause of death from cancer in women soon after lung.
Pamina Brassey, 49, West London, stated: “I was diagnosed with breast cancer in 2008 and had a mastectomy in my right breast to get rid of the tumour.
“My cancer was caught early and I was told there was a 90 per cent chance that the cancer would not return.
“I feel lucky simply because it can be much more difficult to treat breast cancer once it has spread. I think it really is fantastic news that researchers have located out how breast cancer cells can spread around the body simply because this will open the doors for study into new possible drugs to prevent this happening – and increase survival from advanced disease.
“I feel back to where I was physically before I was diagnosed – I’m back into rollerblading and feel fantastic. It would be great to hear that much more girls inside the future could have exactly the same wonderful news.”
Arlene Wilkie, director of study and policy, Breast Cancer Campaign stated: “This groundbreaking investigation can be a major step forward in understanding how breast cancer spreads to other parts of the body, the primary cause of death from this disease.”
Dr Helen George, head of science details at Cancer Analysis UK, stated: “This crucial analysis unravels for the initial time how single breast cancer cells leave a tumour and start to move about the body – something that until now has not been fully understood. Sadly the majority of women who die from breast cancer do so since their disease has spread from the breast to other parts of the body.
“This investigation opens doors to enable scientists to find ways to block the spread of cancer – and improve survival.
“More girls are surviving breast cancer than ever before thanks to earlier diagnosis and better therapy – and we hope investigation like this will play a crucial role in helping more people survive this disease within the future.”
Reference
Silvia Giampieri et al. Localised and reversible TGFB signalling switches breast cancer cells from cohesive to single cell motility. Nature Cell Biology 2009
Source
Cancer Research UK
November 24, 2011
1 (1 votes)
Healthcare Prof:
5 (1 votes)
First lady Michelle Obama framed well being care reform as a women’s issue at a breast cancer event on Friday, “marking the third time in recent weeks she has weighed in on the health debate so directly,” Politico reports. Obama was joined by many Property members, breast cancer survivors and advocates in the White House event. Jill Biden, wife of Vice President Biden and founder of the Biden Breast Well being Initiative, also spoke. The event coincided with the White House’s release of a new video featuring the very first lady discussing women and wellness care reform (Henderson, Politico, 10/26).
“We have a wellness care program in this country that simply is not working for too many people with breast cancer and too many people who are surviving with breast cancer,” Obama stated in the event. She added, “It’s a system that only adds to the fear and stress that already comes with the disease.” She said that health care reform legislation supported by the president would benefit girls by requiring insurers to cover preventive screenings, like mammograms, and prohibiting insurers from denying coverage according to pre-existing conditions. The legislation also would limit out-of-pocket charges and prevent insurers from capping coverage, Obama stated, adding, “Because in this country, getting sick shouldn’t mean going bankrupt” (Swarns, “The Caucus,” New York Times, 10/23).
Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women’s Wellness Policy Report, search the archives, or sign up for email delivery here. The Daily Women’s Wellness Policy Report is actually a free service of the National Partnership for Ladies & Households, published by The Advisory Board Organization.
? 2009 The Advisory Board Business. All rights reserved.
November 23, 2011
Healthcare Prof:
For girls just diagnosed with breast cancer, one of the essential decisions confronting them is no matter whether to have a lumpectomy or mastectomy. A diagnosis of breast cancer will have an effect on one in each and every eight females within the United States, according to the American Cancer Society, causing them to have to decide quickly about treatment.
Most studies investigating how girls make this selection have surveyed girls months and sometimes even years after their decision was created. Lately, however, the publication of a new University at Buffalo study, one of the few to focus on the time period among women’s breast cancer diagnosis and surgery, provides insight into what women are thinking when faced with this decision.
In the study published inside the September issue of Oncology Nursing Forum, girls who had been diagnosed with early-stage breast cancer were interviewed throughout the period just right after surgical consultation and before surgery. Performing the interviews at this time allowed for an in-the-moment snapshot of how ladies arrived at their decisions. These interviews were then transcribed, coded and analyzed to identify themes inside the participants’ thought processes.
“This is among the very few studies to be conducted inside the pretreatment period when ladies were actually engaged within the decision-making process, regardless of whether they had declared a decision or were still contemplating — these thoughts were fresh and appointments with physicians still ongoing,” based on main investigator Robin Lally, PhD, RN, assistant professor of nursing within the UB School of Nursing and adjunct assistant professor at Roswell Park Cancer Institute.
One of the study’s most exciting findings was that when women had been presented with possibilities and felt they had control over their choices they considered this to be a positive prognostic indicator — or an encouraging sign of their future survival. “Women reported gaining confidence in their decision-making role by means of the confidence and support they felt from their surgeon and staff,” Lally stated. “The females in the study valued receiving alternatives, even if they had 1 already in mind, and though they may not have observed themselves as a person who is typically good at making decisions, they drew confidence from the support provided to them by their health care team although making the decision.”
Most usually, women’s surgical therapy decision making has been studied using a structured response format that limits the nature of the answers by providing predetermined choices (several choice or yes/no answers). This structured approach eliminates the context in which decisions are created and limits women’s ability to reveal their thoughts behind how and why they make certain choices.
In contrast, the qualitative analysis method employed by Lally in this study assembles participants who can provide rich insight and expert knowledge on a particular phenomenon so that it can be better understood in a real-world context.
“This analysis provides insight into what ladies newly diagnosed with breast cancer could do, think about and expect even before they see the surgeon in the clinic for the first time,” Lally said.
Specifically, Lally’s analysis showed that ladies felt that info about breast cancer was critical, but that they needed to manage the amount and timing of the details they took in, so that you can prevent themselves from becoming overwhelmed. Much more was not necessarily better. Some ladies preferred to use only the verbal data provided by their care team on which to base their decision and put the breast cancer literature away until just days before their surgery.
Age was not a defining factor in how considerably data females wanted or whether they employed what was provided. Women of all ages employed info that answered their questions and tended to avoid details that upset them emotionally.
Lally identified that many girls already had a plan in mind when they entered the surgeon’s office which they then weighed against the surgeon’s input. Their surgical therapy decisions had been motivated by the desire to: eliminate future inconvenience and worry about cancer balanced by avoiding mastectomy unless medically required; maintain physical function and appearance; and recover rapidly. Most females felt that mastectomy should be reserved only for the worst breast cancers. Older ladies saw advanced age as an advantage — age protected them from worry of recurrence and/or the considerable concern over loss of their breast even though they nonetheless chose lumpectomy.
Women of all ages expressed surprise that their surgeons did not make a definitive recommendation, but that the selection of mastectomy or lumpectomy was ultimately their own. Even women who wanted to make their own decision nonetheless desired a recommendation from the surgeon. When making a option, however, they drew confidence from the surgeons’ support of their decision.
Lally hopes that surgeons and nurses will be inspired by her findings to assess their breast cancer patients’ expectations and understanding regarding their choices as well as the decision-making process at the beginning of every consultation and be aware of the critical role providers play in supporting women’s ability to make this decision.
Breast cancer survivors can also benefit from this research. Lally hopes that, “survivors reading this study may possibly find ‘a little of themselves’ within the women’s narratives and feel comforted in the realization that others also had moments of feeling overwhelmed, uncertain or surprised by the surgical decision-making process — you are not alone.”
Lally at present has a grant under review in collaboration with Roswell Park Cancer Institute’s Breast Center to study the thought processes of African-American girls in response to their breast cancer diagnosis. She intends to use all of her investigation to develop assessment and intervention tools for wellness care professionals to be able to identify girls who may be at danger for ongoing distress beyond this early time period.
Source:
Sara Saldi
University at Buffalo
November 22, 2011
Healthcare Prof:
3.67 (3 votes)
Drawing on years of expertise in cancer investigation and patient care, The University of Texas M. D. Anderson Cancer Center have just released one of the most comprehensive, risk-based screening guidelines publicly available to date for breast, cervical and colorectal cancers.
The new recommendations represent the first wave of an effort by M. D. Anderson to improve the effectiveness of efforts to prevent and detect cancer at its earliest, most treatable stage by reconstructing and expanding its screening, danger reduction and diagnostic guidelines across eight disease sites.
Available on M. D. Anderson’s Web site, the recommendations translate best practices in cancer prevention employed at M. D. Anderson into accessible guidelines the public can follow, with threat categories identified and information about when to begin and discontinue screening exams.
According to the American Cancer Society, more than 40 percent of Americans will develop cancer throughout their lifetime, and cancers that can be prevented or detected earlier by screening account for at the very least half of all new cancer situations.
“Cancer screening is not one-size-fits-all,” stated Therese Bevers, M.D., medical director of M. D. Anderson’s Cancer Prevention Center. “Our new risk-based recommendations are markedly far more personalized and precise, offering detailed guidance than what has previously been produced available to the public here or by other cancer organizations.”
Until now, cancer screening recommendations were targeted largely to individuals at average risk for creating cancer according to characteristics like age, family history or genetic predisposition. However, average threat was not previously defined and recommendations for individuals at elevated or high risk were not outlined. The new screening guidelines define danger and offer recommendations for those at elevated and high danger of developing cancer. For example, there are now five different sets of screening recommendations for those at increased risk for breast cancer; four categories of age-based risk recommendations for cervical cancer; and for colorectal cancer, there are 3 categories defining those at increased threat and 3 categories defining those at high threat.
The new guidelines build on established cancer screening practices and now a lot more specifically offer the following recommendations:
Breast Cancer
Starting at age 20, females at all danger levels should practice breast self-awareness by getting familiar with how their breasts look and feel and immediately reporting any changes to their doctor. Females aged 40 years and older at average danger should get annual mammograms and breast exams.
For girls at increased danger, the type and frequency of exams – such as clinical breast exams, mammograms and breast MRI – depend on factors putting them at elevated danger, including: history of radiation remedy to the chest;
genetic predisposition;
diagnosis of lobular carcinoma in situ;
Gail Model score of greater than 1.7 percent;
or family history. Cervical Cancer
For women at average threat, it’s now recommended that females under age 21 get a liquid-based Pap test within 3 years of initiating vaginal intercourse. She should continue to have Pap tests annually until she has had three consecutive negative test results. Right after that, M. D. Anderson recommends screening every two years unless she is at increased risk of cervical cancer based on danger factors, such as: history of cervical cancer or severe cervical dysplasia;
persistently testing positive for Human Papilloma Virus (HPV);
exposure to diethylstilbestrol (DES) before birth;
Human Immunodeficiency Virus (HIV) infection;
or an immune method that does not function properly. Beginning at age 30, adding HPV testing can be a preferred option towards the Pap test, and if both are negative, a woman could go to each and every three years unless she is at increased risk according to the risk factors cited above or unless the optional HPV test was not done.
Colorectal Cancer
M. D. Anderson recommends a colonoscopy every single 10 years (preferred screening), a virtual colonoscopy every 5 years, or a yearly Fecal Occult Blood Test (FOBT) for men and women aged 50 years and older who are at average risk. For men and ladies at increased or high threat, the form and frequency of exams – such as colonoscopy and flexible sigmoidoscopy – depend on the following factors: personal history of precancerous (adenomatous) polyps;
personal history of colorectal cancer;
family history of colorectal cancer or precancerous (adenomatous) polyps;
genetic diagnosis of Familial Adenomatous Polyposis;
genetic history of Hereditary Nonpolyposis Colorectal Cancer or a clinical history suggesting such;
or inflammatory bowel disease (ulcerative colitis or Crohn’s disease). “Because of the investigation being conducted in laboratories and clinics at M. D. Anderson and around the world, our understanding of how cancer develops and spreads is steadily increasing,” stated Ernest T. Hawk, M.D., M.P.H., vice president for Cancer Prevention and Population Sciences.
More knowledge about how doctors make decisions about threat levels and screening tests will give patients a deeper understanding of the disease process and enable them to put their own cancer threat in perspective, he added.
“For colorectal cancer screenings, patients want to be proactive about obtaining results from their screening tests. For example, if a colonoscopy reveals polyps, it truly is crucial for the patient to know what kind, how many and what size, considering that this data factors heavily into what risk category they fall into for colorectal cancer,” Bevers said.
The risk categories and related guidelines were developed by multidisciplinary panels of M. D. Anderson disease site experts across a number of areas, including: medical oncology, surgical oncology, cancer prevention, imaging and others. Risk-based screening guidelines for prostate, liver, skin, endometrial and ovarian cancers are currently in development along with a new online threat assessment tool integrating the new screening guidelines will be launched on the M. D. Anderson Web site in early 2010.
Breast, Cervical and Colorectal Cancer Statistics
In 2009, the American Cancer Society estimated: New circumstances of breast cancer will be diagnosed in 192,370 females and 40,170 will die from breast cancer;
11,270 new cases of cervical cancer will be diagnosed in females and 4,070 ladies will die from cervical cancer;
New cases of colorectal cancer will be diagnosed in 106,100 men and women and 49,920 men and girls will die from colorectal cancer. Source:
Robyn Stein
University of Texas M. D. Anderson Cancer Center
November 21, 2011
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