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Many Doctors Don’t Follow Ovarian-Cancer Screening Guidelines

By on February 7th, 2012

The government estimates that more than 15,000 women died last year from ovarian cancer.

But routine screening of women with no symptoms isn’t recommended by the United States Preventive Services Task Force, American Congress of Obstetricians and Gynecologists or other professional groups, even for women at high risk for the disease. That’s because the benefits of the available tests — a transvaginal ultrasound and a blood test that detects an antigen called CA-125 — haven’t been shown to outweigh their risks (such as complications from unnecessary surgery), or to reduce the number of deaths.

Despite that evidence, a new study finds that when presented with a scenario of a woman coming to her annual check-up, a significant percentage of physicians surveyed would screen for ovarian cancer.

Some 28.5% of the 1,088 primary-care docs — OB/GYNs, family physicians and general internists — surveyed said they “sometimes” or “almost always” offered or ordered ovarian-cancer screening tests for low-risk women. When the vignette involved a woman at medium risk of the disease, that proportion jumped to 65.4% of physicians.

About a third of physicians reported believing that ultrasound or CA-125 blood testing is an effective screening test for ovarian cancer, the study found. It’s unclear why that is, and more research is needed to discover why, says Laura-Mae Baldwin, an author of the study and professor of family medicine at the University of Washington.

“We know that in medicine we have an enthusiasm for screening,” she says. “We want to find diseases before they can cause harm.”

The study also found that physicians were more likely to say they’d order screening for patients who requested it — even if the doctor herself didn’t believe screening was effective.

In that scenario, physicians may be trying to maintain a relationship with the patient, or they “may lack confidence in explaining why the test is more harmful than beneficial,” says Baldwin. She says there’s an important role for clinical tools that could accurately illustrate the level of risk faced by a particular woman and also illustrate the harms and benefits of the test.

The study is published in the Annals of Internal Medicine.

There are limitations to the research: doctors were reporting how they’d react to the scenarios presented to them, not discussing actual patients. And while there was a 62% response rate to the initial questionnaire sent to physicians, the results may not generalize to the doctors who didn’t respond, the authors write. …source … more about ovarian cancer


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Rates of Repeat Breast Cancer Surgery Vary Widely

By on February 6th, 2012

Among women who undergo breast-conserving surgery for invasive breast cancer, the likelihood of having a second surgery varies by institution and by surgeon. These results were published in the Journal of the American Medical Association.

Breast-conserving surgery (also referred to as a lumpectomy or partial mastectomy) is commonly used for the treatment of early-stage breast cancer. It involves removal of the cancer as well as some surrounding normal tissue. The amount of surrounding normal tissue that is removed is referred to as the surgical margin. If the surgical margin is very small, or if cancer is found at the edge of the removed issue (what is referred to as a “positive” margin), additional surgery may be performed in order to ensure that all of the cancer was removed.

To explore the rate of repeat surgery after breast-conserving surgery, researchers collected information about 2,206 breast cancer patients treated at four largeUSinstitutions. All of the women had undergone initial treatment with breast-conserving surgery.

  • Overall, 23 percent of patients underwent additional breast surgery.
  • Among women with positive surgical margins, 86 percent underwent additional surgery. Since positive margins increase the risk of cancer recurrence, it’s uncertain why 14 percent of women with positive margins did not undergo additional surgery. There was also notable variability across institutions: the rate of additional surgery among women with positive margins ranged from a low of 74 percent to a high of 94 percent.
  • Additional surgeries were also performed in women with negative margins, although the benefit of additional surgery in these women is uncertain. The rates of additional surgery were 48 percent when the surgical margin was very small (less than 1.0 mm), 20 percent when the surgical margin was between 1.0 and 1.9 mm, and 6 percent when the surgical margin was between 2.0 and 2.9 mm. And once again, rates of additional surgery varied substantially by institution and by surgeon.

These results highlight the ongoing uncertainty about when additional surgery is necessary after breast-conserving surgery. Different institutions and different surgeons take very different approaches. Research that better defines optimal care—and that encourages more consistent care—could benefit women with early breast cancer. …source …more about early breast cancer


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Battling Lung Cancer With Combination Drug Therapy

By on February 5th, 2012

Combination drug therapy may be needed to combat non-small cell lung cancer (NSCLC), according to a study by the Translational Genomics Research Institute (TGen) and Van Andel Research Institute (VARI).

The study, “STAT3 is Activated by JAK2 Independent of Key Oncogenic Driver Mutation in Non-Small Cell Lung Carcinoma,” was published online by the Public Library of Science (PLoS) ONE.

The study found that in NSCLC – the most common form of lung cancer – that the STAT3 gene is activated in some NSCLC cell lines by the JAK2 protein. This signaling can play a crucial role in tumor-cell behavior that may not be effectively inhibited by drugs that selectively target these mutations, the study concluded.

“This suggests that there may be a potential role for combination therapy, so you have a better chance of knocking out select NSCLC tumors driven by STAT3-JAK2, or keeping it at bay,” said Dr. Glen Weiss, Co-Unit Head of TGen’s Lung Cancer Research Laboratory and Director of Thoracic Oncology at Virginia G. Piper Cancer Center Clinical Trials at Scottsdale Healthcare, a partnership between TGen and Scottsdale Healthcare that treats cancer patients with promising new drugs.

The JAK2 protein can activate the gene called STAT3, part of a family of genes that provide instructions for making proteins that are part of the essential chemical signaling pathways that control growth and development in cells. STAT3 has been found to be overactive in cases of several types of cancer, including breast, prostate, pancreas, leukemia and lymphoma.

In laboratory tests involving seven NSCLC cell lines, the TGen-VARI study found that STAT3 was activated in some cell lines by JAK2, independent of key oncogenic, or potentially cancer-causing, genes.

“JAK2-STAT3 signaling plays crucial roles in tumor-cell behavior that may not be effectively inhibited by drugs that selectively target these mutations,” said Dr. Jeff MacKeigan, Head of VARI’s Laboratory of Systems Biology. VARI is TGen’s affiliate in Grand Rapids, Mich.

This study, funded by a TGen-VARI integration grant, should benefit future lung cancer research because of the study’s clinically annotated tissue microarray, MacKeigan said. …source … more about small-cell lung cancer