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Self-Testing for Cervical Cancer Increases Screening Rates

By Robert Preidt
HealthDay Reporter

FRIDAY, Nov. 8, 2019 (HealthDay News) — Mailing self-sampling kits to test for the cervical cancer-causing virus HPV significantly increased screening rates for the cancer, according to a new study.

The research included nearly 20,000 women in the Kaiser Permanente Washington (state) system who hadn’t been screened for cervical cancer in more than three years.

About half got an HPV (human papillomavirus) self-sampling kit in the mail, which they could complete instead of undergoing a Pap screening. The other half received only standard reminders to get a Pap test from a health care provider.

Screening rates were 26% in the self-testing group and 17% in the standard reminder group. Of the women who used the self-testing kits, 88% tested negative for HPV, meaning they had a low risk of cervical cancer.

“Many studies have shown that an HPV test on a sample that a woman collects for herself performs as well as an HPV test done on a physician-collected sample,” said lead author Rachel Winer, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

“Randomized trials in other countries have shown that offering home-based HPV testing increases screening participation, but this was the first U.S. trial to study the impact of mailed kits in a real-world health system setting,” Winer said in a university news release. Winer is also an affiliate investigator at the Kaiser Permanente Washington Health Research Institute.

Previous research shows that half of the 12,000 cervical cancers diagnosed each year in the United States are in women who have not be screened for more than three years, which makes them high-priority to get screened, the study authors said.

“We found that mailing unsolicited self-collection kits for HPV testing increased cervical cancer screening by 50% in women who were underscreened for cervical cancer, and that’s a particularly hard population to reach,” study co-author Diana Buist. She is director of research and strategic partnerships at the institute.

“So, it’s a good news story,” Buist said in the release. “And now that HPV-only testing is a recognized screening strategy in the United States, it really opens up the possibility for home testing to be a widespread option for women.”

The study was published Nov. 6 in the journal JAMA Network Open.

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Sources

SOURCE: University of Washington, news release, Nov. 6, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Self-Testing for Cervical Cancer Increases Screening Rates

FRIDAY, Nov. 8, 2019 — Mailing self-sampling kits to test for the cervical cancer-causing virus HPV significantly increased screening rates for the cancer, according to a new study.

The research included nearly 20,000 women in the Kaiser Permanente Washington (state) system who hadn’t been screened for cervical cancer in more than three years.

About half got an HPV (human papillomavirus) self-sampling kit in the mail, which they could complete instead of undergoing a Pap screening. The other half received only standard reminders to get a Pap test from a health care provider.

Screening rates were 26% in the self-testing group and 17% in the standard reminder group. Of the women who used the self-testing kits, 88% tested negative for HPV, meaning they had a low risk of cervical cancer.

“Many studies have shown that an HPV test on a sample that a woman collects for herself performs as well as an HPV test done on a physician-collected sample,” said lead author Rachel Winer, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

“Randomized trials in other countries have shown that offering home-based HPV testing increases screening participation, but this was the first U.S. trial to study the impact of mailed kits in a real-world health system setting,” Winer said in a university news release. Winer is also an affiliate investigator at the Kaiser Permanente Washington Health Research Institute.

Previous research shows that half of the 12,000 cervical cancers diagnosed each year in the United States are in women who have not be screened for more than three years, which makes them high-priority to get screened, the study authors said.

“We found that mailing unsolicited self-collection kits for HPV testing increased cervical cancer screening by 50% in women who were underscreened for cervical cancer, and that’s a particularly hard population to reach,” study co-author Diana Buist. She is director of research and strategic partnerships at the institute.

“So, it’s a good news story,” Buist said in the release. “And now that HPV-only testing is a recognized screening strategy in the United States, it really opens up the possibility for home testing to be a widespread option for women.”

The study was published Nov. 6 in the journal JAMA Network Open.

More information

The U.S. National Cancer Institute has more on cervical cancer screening.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

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Staying Slim After Weight-Loss Surgery Could Cut Cancer Risk in Half

WEDNESDAY, Nov. 6, 2019 — The drastic weight loss that occurs with successful bariatric surgery could have an extra benefit — it may slash your risk of cancer.

People with severe obesity who dropped more than 20% of their total body weight following surgery wound up cutting their risk of cancer by more than half, compared with those who didn’t lose as much weight after the procedure, a new study reports.

“Those who lost more weight had a significantly reduced risk of cancer,” said lead researcher Dr. Angela Stroud, an assistant professor with the Oregon Health & Science University School of Medicine’s division of bariatric surgery.

Previous studies have linked obesity to cancer, so these researchers set out to see exactly how much weight loss might protect a person.

Stroud and her colleagues turned to a long-term study of bariatric surgery, gathering data on more than 2,100 people treated at 10 medical centers across the United States. The type of surgery could either be gastric bypass or gastric banding.

People who underwent the surgery and didn’t lose weight had an overall higher risk of cancer during seven years of follow-up. Those whose body mass index (BMI) dropped under 30, the threshold for obesity, had a 40% reduced risk of cancer compared with those who remained obese.

Further, researchers found that the more weight a person lost, the less likely they were to develop cancer.

About 6.2% of those who lost less than 20% of their body weight received a cancer diagnosis within seven years of their surgery, compared with 3.6% of patients who lost 20% or more, researchers reported.

Those who lost between 20% and 35% of their total weight following bariatric surgery had a 56% reduction in their overall cancer risk, compared with those who lost less than 20% of their initial weight.

The results indicate that people who want to lower their cancer risk should opt for gastric bypass surgery, since the average person who underwent gastric banding did not lose anywhere near as much weight, Stroud said.

This also shows that obese people who are worried about cancer likely need weight-loss surgery to reduce their risk, said Dr. Eric DeMaria, president of the American Society for Metabolic and Bariatric Surgery. Diet and exercise likely can’t lead to the sort of dramatic weight loss that’s required.

“Here we have a study that says you’ve got to be more aggressive with the weight loss to really see the impact, and that really puts it in the terrain of bariatric surgery,” said DeMaria, chief of general and bariatric surgery at the East Carolina University Brody School of Medicine in Greenville, N.C. He wasn’t involved with the study.

Breast cancer was the most common among the patients, followed by thyroid, melanoma, colon, kidney, uterine and lung.

Dramatic weight loss might be reducing cancer risk by lowering rates of type 2 diabetes, Stroud said.

“There’s definitely an association between type 2 diabetes and cancer, so if we’re making diabetes better that might be one of the bigger players in all of this,” she said.

People who lose more weight also might be benefitting from much lower levels of inflammation, as well as healthier gut bacteria, Stroud said.

But researchers also found that metabolic changes directly linked to weight and appetite were associated with lower cancer risk.

For example, for each 20% reduction in leptin — a hormone that decreases hunger — there was a 20% reduction in cancer, researchers said.

Decreases in diabetes-related fasting glucose and insulin also were associated with reduced cancer risk, as were increases in ghrelin, the “hunger hormone.”

Studies like this shine a light on an underappreciated risk associated with obesity, compared with the risk of heart disease or diabetes, DeMaria said.

The link between obesity and cancer “is not widely appreciated among the public, I think,” DeMaria said. “People don’t intuitively say you’re at high risk for cancer if you’re obese. They don’t think that way. It’s not as known. “

The new study was presented Tuesday at the American Society for Metabolic and Bariatric Surgery’s annual meeting, in Las Vegas. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more about obesity and cancer.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

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Mom With Breast Cancer Has Healthy Baby After Chemo

Nov. 4, 2019 — Jade Devis was just a few months pregnant when she learned she had a fast-growing type of breast cancer. Her OB-GYN™s outlook was grim, she says: œMy baby was too young to save, and it was life-and-death for me.”

œWithin an hour of leaving the office and her telling me that, I was crying in the car, parked somewhere,” Devis says.

But today, after getting a lumpectomy and months of chemotherapy during her pregnancy, this 36-year-old bookkeeper in California is a happy first-time mom to Bradley, a 3-month-old boy. œWe™re doing really good right now,” she says.

photo of mom and newborn

She™s still getting chemo, with her final infusion scheduled for the end of November. Then she™ll get radiation therapy for a month. These treatments, along with surgery, are the main therapies for triple-negative breast cancer (TNBC), the disease Devis is battling.

œHoping for the best “ [a] cure!!” says her oncologist, Gayathri Nagaraj, MD, of Loma Linda University Cancer Center in California.

TNBC is an aggressive type of breast cancer that™s more common among women under 40, like Devis. It™s called triple negative because it isn™t fueled by the hormones estrogen or progesterone, or by a protein called HER2. That means hormone therapy and HER2-targeted drugs that treat other types of breast cancer don™t work for TNBC, which leaves those who have it with fewer treatment options.

Devis says she suspected something was wrong before her doctor diagnosed her with cancer. In January, just weeks into her pregnancy, she noticed a hard, painful lump above her left breast. The area felt like it was burning. She says her doctor at the time told her it was probably a clogged milk duct. But Devis was skeptical, and she kept voicing her concerns until she got a biopsy. It showed that she had cancer.

œI don™t think anybody understood my symptoms,” she says.

Triple-negative breast cancer can have the same signs as other types of breast cancer, and a new lump or mass is the most common red flag. Other symptoms of breast cancer are breast swelling, dimpling, or a nipple turning inward. Since there are a lot of warning signs, it™s important to have your doctor check any changes you notice.

After Devis got surgery to remove her cancerous lump and 10 nearby lymph nodes — operations that are generally safe for pregnant women — she went to the Loma Linda University Cancer Center in May to get the first of several rounds of chemotherapy.

œI was very upset because I thought I™d gone through so much already with the surgery, and my body was already bruised and injured and tired, and I was 6 months pregnant,” she says.

While chemotherapy isn™t safe for an unborn baby during the first 3 months of pregnancy, certain chemo drugs seem safe during months 4 through 9, the American Cancer Society says. Research shows that they don™t raise the chances of birth defects, stillbirths, or health problems soon after birth, though they could make an early delivery more likely. Also, researchers aren™t sure if chemo drugs could affect a baby™s health later in life.

In Devis™s case, her oncologist, Nagaraj, took safety measures to protect her and her baby. Nagaraj and her team made sure all the medications they gave Devis — including the chemo and meds to treat its side effects — were safe for her. They also carefully planned when they™d start and stop her chemo so they could pause it a safe number of weeks before Devis was scheduled to be induced. In general, the American Cancer Society says that getting chemo after 35 weeks of pregnancy or within 3 weeks of delivery is risky because it can lead to complications like bleeding or an infection during childbirth.

Devis also had a whole team caring for her. Nagaraj says maternal-fetal medicine specialists kept close tabs on the baby™s health. Pharmacists double-checked the safety of all her medicines. A dietitian gave her nutrition advice. Social workers provided psychological support through counseling. Nurses helped coordinate her care.

photo of woman receiving chemo

Even though the baby™s father wasn™t there for Devis, she got support from her mother and sisters, who did things like cook meals and go to the market for her. That was important to Devis, œbecause at the time I was hiding,” she says. She™d lost her hair during chemo and œdidn™t want to walk around, go out pregnant and bald — a lot of insecurities there.”

Uncertainty plagued her during treatment. Would the baby be OK? Would the chemo harm him? œI didn™t have a nursery yet set up because I wasn™t sure what the outcome was going to be,” she says. œAnd I was refusing baby gifts from everybody because I didn™t want to come home and have to return all these baby gifts in the worst-case scenario.”

œThe whole time I felt like I was being punished. I would sit in my room like I was in a jail cell, just waiting for the verdict,” she says.

Her worst fears didn™t come true. In late July, she gave birth to a healthy son. œWhen the baby was born, and I heard crying, and the NICU cleared him, it was like the verdict was in,” she says. œIt™s like that ˜we made it™ feeling, you know? ˜We™re here, we did it.™”

photo of baby birth announcement

Sources

SOURCES:

Jade Devis, Rancho Cucamonga, CA.

Gayathri Nagaraj, MD, oncologist, Loma Linda University Cancer Center, Loma Linda, CA.

CDC: œTriple-Negative Breast Cancer.”

American Cancer Society: œTreating Breast Cancer During Pregnancy,” œTreatment of Triple-negative Breast Cancer,” œTriple-negative Breast Cancer.”

Breastcancer.org: œTriple-Negative Breast Cancer.”

Up to Date: œER/PR negative, HER2-negative (triple-negative) breast cancer.”

National Breast Cancer Foundation: œTriple Negative Breast Cancer.”

Johns Hopkins Medicine: œTriple Negative Breast Cancer.”

National Cancer Institute: œNCI Dictionary of Cancer Terms.”

© 2019 WebMD, LLC. All rights reserved.

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Many Cancer Docs Don’t Discuss Costs of Pricey Gene Tests

FRIDAY, Nov. 1, 2019 — Fighting cancer can be a long, hard battle, not to mention expensive. Now, new research shows that a quarter of oncologists don’t discuss the cost of expensive tests with their patients.

Genomic tests on cancer cells can help determine which types of treatment might work, and which ones might not. However, such testing can be expensive, and not all tests and related treatments are covered by health insurance, the researchers noted.

Costs of cancer care are rising, and there are increasing concerns about high patient out-of-pocket costs for cancer treatment.

Discussions with their oncologists can help patients make informed decisions about treatment and prepare for potentially high costs. So, the study authors wanted to find out how often oncologists discuss costs of genomic testing and treatment with patients.

They analyzed data from 1,220 U.S. oncologists who took part in a national survey on precision medicine in cancer care.

Half of them said they often discussed the likely costs of testing and related treatments with patients; 26.3% said they sometimes discussed costs; and 23.7% said they never or rarely discussed costs.

Further investigation showed that oncologists trained in genomic testing or who worked in practices with electronic medical record alerts for genomic tests were about two times more likely to discuss costs with patients sometimes or often.

Other factors associated with being more likely to discuss costs with patients included: treating patients with solid tumors; using next-generation sequencing gene panel tests; having higher patient volume; and working in practices with higher percentages of patients with Medicaid, private insurance or no insurance.

“Initiating a discussion about the expected out-of-pocket costs of genomic testing and related treatment is a necessary first step, but is not sufficient to ensure that patients and their families can make fully informed decisions about treatment options,” said lead researcher Robin Yabroff, from the American Cancer Society.

“In the context of rising costs of cancer care, interventions targeting modifiable physician and practice factors may help increase the frequency of physician-patient cost discussions, contributing to more informed patient decisions and higher-quality cancer care,” the researchers said in a society news release.

The study was published Nov. 1 in the Journal of the National Cancer Institute.

More information

The American Cancer Society has more on the costs of cancer treatment.

© 2019 HealthDay. All rights reserved.

Posted: November 2019

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Don’t Delay Very Early-Stage Breast Cancer Surgery

By Robert Preidt
HealthDay Reporter

THURSDAY, Oct. 24, 2019 (HealthDay News) — Delaying surgery for a noninvasive breast cancer can have dire consequences, a new study shows.

Longer delays in surgery for ductal carcinoma in situ (DCIS) breast cancer lead to a higher risk of invasive ductal carcinoma and a slightly lower survival rate, researchers found.

“For each month of delay, there was well under a 1% difference in survival. But for each month of delay, there was an approximate 1% increase in the finding of invasive cancer,” said study author Dr. Richard Bleicher, a professor of surgical oncology at Fox Chase Cancer Center, in Philadelphia.

“The survival difference with a delay is small,” Bleicher noted in a center news release. “While it’s not an emergency to get treated immediately, delays do have an effect and long delays should be avoided.”

DCIS occurs when abnormal cells form in the milk duct of the breast and is the earliest stage of breast cancer. When cancerous cells spread beyond the milk duct, it becomes invasive ductal carcinoma.

Standard treatment for DCIS is surgery and radiotherapy, along with endocrine therapy. But research suggests that some DCIS may never progress to invasive disease, and clinical trials are being conducted to determine whether DCIS can be observed, rather than surgically removed.

This study “suggests that delays in operative management of DCIS are associated with invasion and slightly worse short-term outcomes,” Bleicher said. “Since observation represents infinite delay, it suggests that observation should not yet be pursued outside of a clinical trial in patients who will tolerate excision.”

The study included more than 140,600 U.S. women (123,947 with DCIS, 16,668 with invasive ductal carcinoma). They were diagnosed between 2004 and 2014.

Survival was compared with five time intervals in delays to have surgery: less than 30 days, 31-60 days, 61-90 days, 91-120 days, or 121-365 days.

Overall survival was 95.8%, with a median time from diagnosis to surgery of 38 days. However, each increase in diagnosis-to-surgery interval was associated with a 7.4% increase in the risk of death.

The study was published Oct. 21 in the Annals of Surgical Oncology.

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Sources

SOURCE: Fox Chase Cancer Center, news release, Oct. 21, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Don’t Delay Surgery for Very Early-Stage Breast Cancer, Study Suggests

THURSDAY, Oct. 24, 2019 — Delaying surgery for a noninvasive breast cancer can have dire consequences, a new study shows.

Longer delays in surgery for ductal carcinoma in situ (DCIS) breast cancer lead to a higher risk of invasive ductal carcinoma and a slightly lower survival rate, researchers found.

“For each month of delay, there was well under a 1% difference in survival. But for each month of delay, there was an approximate 1% increase in the finding of invasive cancer,” said study author Dr. Richard Bleicher, a professor of surgical oncology at Fox Chase Cancer Center, in Philadelphia.

“The survival difference with a delay is small,” Bleicher noted in a center news release. “While it’s not an emergency to get treated immediately, delays do have an effect and long delays should be avoided.”

DCIS occurs when abnormal cells form in the milk duct of the breast and is the earliest stage of breast cancer. When cancerous cells spread beyond the milk duct, it becomes invasive ductal carcinoma.

Standard treatment for DCIS is surgery and radiotherapy, along with endocrine therapy. But research suggests that some DCIS may never progress to invasive disease, and clinical trials are being conducted to determine whether DCIS can be observed, rather than surgically removed.

This study “suggests that delays in operative management of DCIS are associated with invasion and slightly worse short-term outcomes,” Bleicher said. “Since observation represents infinite delay, it suggests that observation should not yet be pursued outside of a clinical trial in patients who will tolerate excision.”

The study included more than 140,600 U.S. women (123,947 with DCIS, 16,668 with invasive ductal carcinoma). They were diagnosed between 2004 and 2014.

Survival was compared with five time intervals in delays to have surgery: less than 30 days, 31-60 days, 61-90 days, 91-120 days, or 121-365 days.

Overall survival was 95.8%, with a median time from diagnosis to surgery of 38 days. However, each increase in diagnosis-to-surgery interval was associated with a 7.4% increase in the risk of death.

The study was published Oct. 21 in the Annals of Surgical Oncology.

More information

The American Cancer Society has more on treatment of DCIS.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Study Links Asbestos in Talcum Powder to Deadly Cancer

MONDAY, Oct. 21, 2019 — As concerns about baby powder being contaminated with asbestos mount, a new study finds a link between such contamination and a rare and deadly cancer.

A group of 33 people developed mesothelioma after long-term use of talcum powder and no exposure to other sources of asbestos, the report stated.

“All of them had significant exposure to talcum powder,” said lead researcher Dr. Jacqueline Moline, a professor with Northwell Health’s Feinstein Institutes for Medical Research in Manhasset, N.Y.

“It wasn’t like they sprinkled it on once a month. These were people who used it daily or many times a day for many, many years. They all used the powders, and then over time they developed the cancers,” Moline said.

Just last week, Johnson & Johnson recalled a shipment of baby powder after U.S. authorities found it had been contaminated with asbestos — the first such recall in the company’s history, a spokesman said.

Johnson & Johnson did not respond to a request for comment on Moline’s study, but said in its recall announcement that it has rigorous testing standards in place to ensure the safety of its baby powder.

“Thousands of tests over the past 40 years repeatedly confirm that our consumer talc products do not contain asbestos,” the company’s statement said.

Mesothelioma is a cancer of the lining that covers the outer surface of most internal organs, according to the American Cancer Society. It most often occurs in the lining around the lungs or the abdomen.

Asbestos is the main risk factor for mesothelioma, the cancer society says. It’s fairly rare in the United States, with about 3,000 new cases diagnosed each year. But it has an average five-year relative survival rate of just 9%.

People usually inhale asbestos fibers, which are so small that 200,000 fibers fit on Abraham Lincoln’s nose on a penny, Moline said. The inhaled asbestos makes its way into the lining around the lungs and abdomen, where it causes DNA damage that triggers cancer.

Although most mesotheliomas can be tracked back to asbestos exposure, there always have been a number of cases that couldn’t be explained that way, Moline said.

Researchers have suspected that talcum powder could be one potential source of asbestos exposure, Moline said. Both minerals are mined from the earth, and sometimes asbestos and talc deposits overlap.

“The talc, when it’s mined, can be contaminated with asbestos when both minerals are present,” Moline said.

There’s no way to remove asbestos from talc, so the only way to protect consumers is to test what’s coming out of the mine, she said.

To examine the possible link between mesothelioma and talcum powder, Moline and her colleagues gathered information on 33 different people with the deadly cancer who’d not been exposed to asbestos in any other way.

They determined that talcum powder use was the only possible source of asbestos exposure among all 33 cases.

Further, a closer examination of six specific cases revealed the presence of asbestos in their tissues after decades-long use of talcum powder.

“They all had the same type of asbestos that is seen in talc in their tissues and in their mesothelioma,” Moline said. “The type of asbestos we found is not the type typically seen in commercial applications. It’s the type of asbestos you’d find in talc.”

In one case, a 65-year-old woman was diagnosed with mesothelioma around her left lung after she complained of a dry cough and short-windedness. She started using talc around age 8 or 9, and regularly used it throughout her life. Researchers found asbestos fibers in the tissue of her lungs and lymph nodes.

In another case, a 44-year-old man developed chest pain after playing hockey in 2012. Doctors found mesothelioma in the lining around his lungs. The man regularly used talcum powder after showering, as well as dousing his hockey gear with talc before donning it.

It’s hard for consumers to judge on their own whether a specific brand of talcum powder is safe, Moline said.

“The question is where does it come from and how rigorously has it been tested,” she said. “There are some mines that don’t have any asbestos, but it’s unclear whether those are being used by different manufacturers.

“The most prudent thing for folks is either to use talc-free powders, which are on the market, or cornstarch-based products,” Moline concluded.

The new study was published Oct. 17 in the Journal of Occupational and Environmental Medicine.

More information

The American Cancer Society has more about mesothelioma.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Beyonce’s Dad Puts Spotlight on Male Breast Cancer

TUESDAY, Oct. 15, 2019 — Beyonce Knowles’ father first suspected something was wrong when he noticed a dot of blood that kept appearing on his shirts and bedsheets.

“Imagine a piece of white paper and you took a red pen and just put a dot,” Mathew Knowles told the New York Times. “That’s what it looked like in my T-shirt.”

Knowles scheduled a mammogram in July after he squeezed a nipple and a bit of bloody discharge came out. The diagnosis: stage 1A breast cancer.

Knowles is one of about 2,670 cases of breast cancer that will occur among men in 2019, according to the American Cancer Society. About 500 men die from breast cancer every year.

“Most men who get breast cancer usually present with a mass behind the nipple,” said Dr. Hank Schmidt, an associate professor of surgery with the Icahn School of Medicine at Mount Sinai.

It’s an extremely rare form of cancer in men, and male breast cancer accounts for just 1% of all breast cancer cases, said Dr. Siddhartha Yadav, a hematology-oncology fellow with the Mayo Clinic in Rochester, Minn.

Men just don’t have as much breast tissue in which a tumor could grow, Yadav said. They also don’t have high levels of the female hormone estrogen, which can fuel breast cancer.

“Men just don’t have that kind of exposure,” Yadav said.

About 9 out of 10 male patients with breast cancer have estrogen receptor-positive tumors, making their cancers more sensitive to the smaller levels of estrogen typically found in men, according to a new review Yadav and colleagues conducted of nearly 11,000 men with breast cancer.

Because of this, treatment options for men are largely constrained to those developed for women, Yadav and Schmidt said. Not enough male patients are available to conduct solid clinical trials.

Men with breast cancer typically undergo either a lumpectomy combined with radiation treatment or a full mastectomy, the experts said.

Knowles chose a mastectomy, which he underwent the same month as his diagnosis. Lymph nodes removed at the same time showed that the cancer hadn’t spread elsewhere in his body. He plans to undergo a second mastectomy early next year to reduce his future risk.

That is one major difference between male and female treatment for breast cancer, according to the review by Yadav and colleagues published Oct. 7 in the journal Cancer.

More than 7 out of 10 men choose to undergo a full mastectomy for their breast cancer, while in women about two-thirds will choose a breast-sparing lumpectomy, Yadav said.

Even though male breast cancer is rare, most of these cancers appear to be caught at an early stage, Yadav’s review concluded.

About 38% of men are diagnosed at stage 1, while about 43% are diagnosed at stage 2, the researchers found.

This might be related to the fact that men just don’t have a lot of breast tissue, said Schmidt, who wasn’t involved with the review.

“If there is a tumor, people may be more likely to notice it,” Schmidt explained.

About 44% of male breast cancer patients receive chemotherapy, and 62% with estrogen receptor-positive tumors get anti-estrogen therapy, according to the study authors.

“Roughly one-third of men with ER-positive tumors aren’t getting anti-estrogen therapy,” Yadav said. “That is an area for improvement.”

Screening all men for breast cancer simply wouldn’t be effective, given the disease’s rarity, Yadav said.

But since genetics appear to play a large role in male breast cancer, it might make sense to screen men who carry BRCA1 or BRCA2 mutations or have a family history of breast cancer, Yadav said.

“We could potentially screen that population,” Yadav said. “That would be a very limited number of people.”

Knowles learned that he has a BRCA2 mutation, which is more common among male breast cancer patients. He has urged his daughters to undergo genetic testing as well.

Although it’s pretty well-known that men can develop breast cancer, there’s a stigma that remains, Yadav said.

Yadav related the story of a recent male patient who went in for a mammogram and became embarrassed that he was surrounded by women there for the same screening.

“He felt so uncomfortable that he asked the people at the mammogram place if he could come in after the office closed,” Yadav said.

Removing this stigma could go a long way toward men getting the treatment they need, Yadav said.

More information

The American Cancer Society has more about breast cancer in men.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Childhood TB Shot May Offer Long-Term Protection from Lung Cancer

TUESDAY, Oct. 1, 2019 — A tuberculosis vaccine commonly used in other parts of the world might reduce a person’s risk of developing lung cancer if given early in childhood, a six-decade-long study reports.

The Bacille Calmette-Guerin (BCG) vaccine is the only vaccine approved for preventing tuberculosis (TB) — a potentially fatal infectious disease that typically attacks the lungs. Because TB risk is low in the United States, the vaccine isn’t often given to American children, according to the U.S. Centers for Disease Control and Prevention.

But the new study suggests the vaccine may have some positive side effects.

“BCG-vaccinated participants had a significant 2.5-fold lower rate of lung cancer,” said study senior author Dr. Naomi Aronson, director of infectious diseases at Uniformed Services University in Bethesda, Md.

She said lower lung cancer rates persisted in those who received the vaccine no matter where they lived, and whether they smoked, drank alcohol or had tuberculosis.

Aronson said BCG affects the immune system somehow and may provide even more benefit in the lungs.

The initial study was conducted in 3,000 American Indian and Alaska Native children in the 1930s. If the findings are confirmed in different groups, Aronson said the use of BCG vaccine in childhood “might be considered for risk reduction for lung cancer over a lifetime.”

Dr. Len Lichtenfeld, interim chief medical officer of the American Cancer Society, reviewed the study and called the findings fascinating. “And you rarely see this duration of follow-up,” he added. “The authors went to great lengths to validate their information.”

But, he said, it’s unlikely that BCG will be used for lung cancer prevention. While the study found a statistically significant reduction in the rate of lung cancer, the actual number of cases was very low. Just 42 people in the study were diagnosed with lung cancer.

There’s also a serious, ongoing shortage of BCG vaccine that would limit any such efforts, Lichtenfeld said. The vaccine is an effective treatment for a certain type of bladder cancer, and doctors find it hard to get enough for that purpose.

In addition, the BCG vaccine has been tested as a treatment in a number of other cancers with mixed results. In some cases, it looked as if lesions had shrunk, but the vaccine didn’t prolong survival, he explained.

Plus, Lichtenfeld said, there’s a very effective way to prevent many cases of lung cancer — don’t smoke. And, if you do, quit. “Tobacco causes most, but not all lung cancers. Not smoking helps prevent many cancers,” he said.

The initial study was conducted between 1935 and 1938. About 3,000 children from nine American Indian and Alaska Native tribes at multiple U.S. sites were randomly given the BCG vaccine or a placebo.

None of the youngsters had had tuberculosis. They were vaccinated between 5 and 11 years of age, with a median age of 8 years. Half were younger when they got the shot, half were older.

From 1992 to 1998, researchers reviewed health information from the trial participants.

There was no statistically significant differences in overall cancer rates between the vaccine and placebo groups. But the odds of lung cancer were significantly lower, the study found.

Researchers noted that lung cancer is a leading cause of death for Alaska Natives and Native Americans.

The study was published Sept. 25 in the journal JAMA Open.

More information

Read more about ways to prevent lung cancer from the American Cancer Society.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

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Link Seen Between Infertility, Prostate Cancer

By Alan Mozes
HealthDay Reporter

FRIDAY, Sept. 27, 2019 (HealthDay News) — Could male infertility contribute to a higher risk for prostate cancer?

Yes, according to new Swedish research that suggests that men who become fathers through assisted reproduction treatments may be more likely to develop prostate cancer in midlife.

The conclusion follows a review of data collected by a Swedish national registry between 1994 and 2014. In all, 1 million children had been born during that time frame, mostly to men in their 30s.

Most (97%) were conceived through natural means. But 1.7% of the fathers (about 20,600 men) had undergone in vitro fertilization, while another 1.3% (nearly 15,000 men) conceived through intracytoplasmic sperm injection (ICSI) techniques.

Prostate cancer risk during the two decades following birth was less than 1% across the board. However, while just 0.28% of dads who had conceived naturally went on to develop the disease, that figure was 0.37% among those from the in vitro group.

Prostate cancer affected an even greater percentage (0.42%) of men in the sperm injection group. The team pointed out that sperm injection is usually reserved for men struggling with the most serious types of infertility.

The findings held up even after taking into account a range of factors, including age, educational background and history of prior cancer.

The team was led by researchers Yahia Al-Jebari, now at Stanford University in California, and Yvonne Lundberg Giwercman, from Lund University in Sweden. In the Sept. 25 issue of the BMJ, they concluded that “men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at high risk for early-onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.”

Still, the study authors cautioned that they only tracked prostate cancer risk up to an average age of 45, so the investigation could not assess risk across an entire lifetime. And they stressed that while they identified an association between the two, they did not prove that infertility actually causes prostate cancer.

As to what might explain the link, the study team members noted that prostate cancer and many types of infertility are both related to testosterone levels. It’s also possible that both share abnormalities on the male Y chromosome, they said.

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Sources

SOURCE:BMJ, news release, Sept. 25, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Doubt Over Long-Term Use of Hormone Rx for Recurrent Prostate Cancer

TUESDAY, Sept. 17, 2019 — Running contrary to current guidelines, new research suggests that use of hormone-suppressing treatment over the long term may not help some men battling recurrent prostate cancer, and may even cause harm.

In fact, the study found that long-term hormone therapy was tied to a raised risk of death from other causes for some patients who received it.

Blood levels of prostate-specific antigen (PSA) may help predict which men might benefit — and which men might not — from long-term hormone therapy following surgery, said a team led by Dr. Daniel Spratt of the University of Michigan Cancer Center, in Ann Arbor.

“We found that the lower the PSA, the more harm the patient experienced,” explained Spratt, who is research professor of radiation oncology and chair of the Genitourinary Clinical Research Program at the center. “The higher the PSA, the more likely the patient was to benefit from hormone therapy because it decreased their chances of dying from prostate cancer and resulted in improved overall survival rates.”

The study was presented Sunday at the annual meeting of the American Society for Radiation Oncology (ASTRO), in Chicago.

Because prostate tumors grow faster in the presence of hormones such as testosterone, therapies that lower hormone levels are often offered to men as a way to slow the cancer’s spread. However, these treatments can come with side effects, such as urinary incontinence or sexual dysfunction.

Still, clinical trial results first reported in 2017 found that — after surgical removal of the prostate tumor — adding two years of hormone therapy, along with radiation treatment, appeared to boost patients’ long-term survival.

Those findings led to the recommendation that men with recurrent prostate cancer be treated with both radiation and long-term hormone therapy after surgery.

Would those benefits last, however? To find out, Spratt’s team reanalyzed data from the clinical trial of 760 prostate cancer patients that spurred the new guidelines. Men in the trial were treated at centers across North America between 1998 and 2003. All had seen their cancer return after surgery, and they received radiation therapy along with either two years of hormone-suppressing therapy called bicalutamide, or a “dummy” placebo.

Looking at the data more closely, Spratt’s team found that for men with low PSA blood levels after prostate surgery, long-term hormone therapy offered no cancer survival benefit, and was associated with a doubling of the risk that these men would die from causes other than their cancer.

Patients with both low PSA and long-term hormone therapy were also three to four times more likely to experience a combination of severe heart events and neurological problems, the team reported.

“We went into this study expecting that men with low PSAs probably would derive minimal benefit from hormone therapy, but we were surprised at the magnitude of harm that these patients experienced,” Spratt said in an ASTRO news release.

“A lot of these side effects have been reported over the past few decades, but demonstrating this in a clinical trial to this extent has not been done before,” he noted.

“What we showed for the first time is that a patient’s PSA level is a predictive biomarker,” Spratt said. “That is, you can use a patient’s PSA to better select which men should receive hormone therapy, and to predict who will benefit and who will not benefit from this treatment, and who may actually be harmed by it.”

Spratt believes that, based on the new analysis, clinical guidelines for treating men with recurrent prostate cancer should be reconsidered.

“For post-operative patients with low PSAs, they do very well with just radiation therapy after surgery. They actually have very good long-term outcomes,” Spratt said.

Two experts in prostate cancer care said decisions around hormone therapy remain tough for patients and doctors, but the new study offers a bit more clarity.

Dr. Manish Vira is vice chair of urologic research at Northwell Health’s Arthur Smith Institute for Urology, in Lake Success, N.Y. He said the study “wades into the muddy waters” surrounding the risks and benefits of hormone therapy, and questions still remain.

“The results of the current study may not be generalizable to all hormonal therapy, as this study specifically used high-dose bicalutamide,” he said, and other hormone-suppressing medicines might work differently.

“That being said, the study suggests that for patients undergoing radiation therapy with lower PSA values, radiation [alone] may be more prudent,” Vira said.

Urologist Dr. Elizabeth Kavaler agreed.

“This is a very useful study, in that it gives clinicians clear guidelines on how to treat men with high-risk prostate cancer who have elevated PSA after surgery and radiation,” said Kavaler, who practices at Lenox Hill Hospital in New York City.

“Many of these patients do very well post-treatment, and do not need further hormone therapy, which will save many of them from the side effects that hormone-deprivation causes,” she added.

Because the study was presented at a medical meeting, its findings should be considered preliminary until they are published in a peer-reviewed journal.

More information

The U.S. National Cancer Institute has more on prostate cancer treatment.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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Cervical Cancer Outcomes Worse Where Clinics Close

By Robert Preidt
HealthDay Reporter

MONDAY, Sept. 16, 2019 (HealthDay News) — As government funding dried up and many women’s health clinics across America closed, cervical cancer screening rates fell and deaths from the disease rose, a new report shows.

Nearly 100 women’s health clinics in the United States closed between 2010 and 2013, researchers said — often due to the passage of more restrictive laws or the loss of Title X government funding.

In all, 37 states nationwide saw a decrease in the number of women’s health clinics during this time.

“As these clinics closed over time, it appears that fewer women were getting screened [for cervical cancer], and this trend appears to be associated with a greater number of women ultimately dying from cervical cancer,” said lead author Dr. Amar Srivastava. He’s a resident physician in radiation oncology at Washington University School of Medicine in St. Louis.

According to the American Cancer Society, each year more than 13,000 new cervical cancer cases are diagnosed in the United States, and an estimated 4,250 women die from the disease.

In the new study, Srivastava’s team analyzed 2008-2015 data from an ongoing federal health study. The investigators found that states where clinics closed had a 2% drop in cervical cancer screenings compared to states without clinic closures.

The largest declines in screenings occurred among women without insurance, Hispanic women, women aged 21 to 34 and unmarried women, the researchers reported Monday at the annual meeting of the American Society for Radiation Oncology (ASTRO).

At the same time, there was a significant rise in the risk of cervical cancer deaths for women living in states where clinics had closed, especially among urban women. In contrast, cervical cancer survival rates actually rose in states that hadn’t seen clinics shut down.

Clinic closures also seemed to affect the timing of cervical cancer diagnosis for women living in affected states. Diagnoses of cervical cancer in its early stage, when it is most curable, fell by 13% among women aged 18 to 34 in states where clinics closed, compared to women living in states with no clinic closures. Late-stage diagnoses of the disease were 8% higher in states with clinic closures than those with no clinic closures, Srivastava’s team found.

Continued

The study can’t prove that the clinic closures were behind these trends, but the speed at which these cervical cancer statistics are changing is alarming, the research team said.

“In order to see a difference in cancer survival rates, you usually need very mature, long-term follow-up data,” Srivastava noted in an ASTRO news release. “It can be 15 to 20 years in some cases. What is surprising about this study is that even though these closures occurred just a few years ago, we are already seeing clear differences in death versus survival from cervical cancer. That was both surprising and scary.”

Patients diagnosed with later stages of cancer generally have a worse prognosis and undergo more aggressive treatment, he said.

Overall, “the data are troubling,” Srivastava said. “Reducing the availability of cervical cancer screening has very real, negative consequences for women.”

The news is especially disconcerting since “cervical cancer is largely preventable because of the wide availability of the HPV [human papillomavirus] vaccine and screening that can detect precancerous lesions,” Srivastava added.

“I really do think these findings should give us some pause,” he said. “Overall, we’re seeing improved survival for cervical cancer relative to other cancers, but in the states with clinic closures we are seeing just the opposite. It should make us think — not just as medical providers and practitioners, but as people broadly — about why this is happening and what we can do to increase rather than limit access to health care.”

Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

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Sources

SOURCE: American Society for Radiation Oncology, news release, Sept. 16, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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What Is Your Risk for Prostate Cancer?

THURSDAY, Sept. 12, 2019 — Prostate cancer is the second most common cancer in American men, so it’s important to know the risk factors and warning signs, an expert says.

The American Cancer Society estimates there will be nearly 175,000 new prostate cancer cases in the United States this year and over 31,000 deaths. One in nine men will be diagnosed with prostate cancer in their lifetime.

“The disease can be successfully treated when detected early, typically when it is still within the prostate gland,” said Dr. Alexander Kutikov, chief of urologic oncology at the Fox Chase Cancer Center in Philadelphia. “However, some types are aggressive and can spread quickly. In these cases, there may be a lesser chance of successful treatment.”

September is National Prostate Cancer Awareness month.

Men between 55 and 69 years of age should consider prostate cancer screening, according to the American Urological Association.

“Because screening has its advantages and disadvantages, not every man should be screened for prostate cancer,” Kutikov said. “Men should discuss their risk factors, screening options and preferences with their health care provider before deciding whether to be screened.”

Symptoms of prostate cancer may include trouble urinating, including a slow or weak stream or the need to urinate more often, especially at night; blood in the urine; and pain or burning during urination.

The risk for prostate cancer rises quickly after age 50. About six out of 10 prostate cancers are diagnosed in men older than 65, according to a news release from the cancer center.

Race is another risk factor. Compared to whites, blacks have a higher risk and are more than twice as likely to die from prostate cancer. Asian-American and Hispanic men have a lower risk than white men.

Having a father or brother with prostate cancer more than doubles a man’s odds for developing the disease. The risk is much higher for men with several affected relatives, particularly if they were young when diagnosed.

More information

The U.S. National Cancer Institute has more on prostate cancer.

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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AHA News: Scientists Find Biological Link Between High Blood Pressure and Breast Cancer

FRIDAY, Sept. 6, 2019 (American Heart Association News) — Researchers have identified a protein that may be a risk factor for both high blood pressure and breast cancer.

Previous studies have found women with high blood pressure have about a 15% increased risk of developing breast cancer compared to women with normal blood pressure. High levels of the protein GRK4 (G-protein coupled receptor kinase 4) have been shown to cause high blood pressure, also called hypertension. The new study, presented Friday at the American Heart Association’s Hypertension Scientific Sessions in New Orleans, showed the GRK4 protein was present in breast cancer cells but not in normal breast cells.

“Cancer and hypertension share common risk factors,” said Dr. Wei Yue, the study’s lead investigator and a research scientist at the University of Virginia School of Medicine in Charlottesville. “Our laboratory’s previous research on GRK4 found that it is regulated by an oncogene called c-Myc, which plays a role in many cancers, including breast cancer. This led us to hypothesize that GRK4 could be a link.”

Nearly half of all adults with high blood pressure are women. After age 65, women are more likely than men to have high blood pressure. Pregnancy, birth control medications and menopause can all increase the risk of developing high blood pressure. If left untreated, it can cause health problems such as heart disease, stroke and vision loss.

In women, breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death.

“While previous studies have shown that breast cancer risk is increased in hypertensive women, this study adds to the current knowledge by providing the molecular mechanisms that underlie this association,” said Dr. Vesna D. Garovic, chair of the division of Nephrology and Hypertension Research at the Mayo Clinic in Rochester, Minnesota.

Garovic, who was not involved in the new research, said studies like this one that identify the molecular mechanisms and signaling pathways that cause a disease to develop can provide new insights into treatment options.

Not all breast tumors are the same. The study looked for GRK4 in two specific types of breast cancer, known as hormone-sensitive and triple-negative.

“Our conclusion may not be applicable to other types of breast cancer,” said Yue.

Garovic noted GRK4 genetic variations may not be the same in all racial groups. Studies that look for GRK4 in women with breast cancer across racial and ethnic groups, she said, may provide insights into previously reported race-based differences in tumor type, treatment response and outcomes.

GRK4 is one of seven GRK proteins. Other studies have looked for GRK2 and GRK5 in different types of cancers, but Yue said their group is the first to look for a link between GRK4, high blood pressure and breast cancer. “No one else is working on this,” she said.

Yue said this molecule is unique because it’s not normally expressed – meaning made into a protein by a gene – in breast tissues, making it a potential target for drug development.

“A drug that targeted GRK4 could potentially be used to treat the patients with hypertension and breast cancer.”

© 2019 HealthDay. All rights reserved.

Posted: September 2019

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