Although cervical screening programmes have cut deaths, not all women take up the invite from the GP.

But self-test kits for human papillomavirus (HPV) could double the number of women diagnosed, the British Medical Journal reported.

Trials of self-testing for HPV are currently being done in the UK.

There are more than 100 types of HPV, which is sexually transmitted, but only 13 of them are known to cause cancer.

Although most HPV infections clear up by themselves, in some women it persists and cause damage to cells which may eventually develop into cervical cancer.

A vaccine against the two main types of HPV was introduced in the UK in 2008 for schoolgirls.

But the NHS has also been piloting HPV testing as an “add-on” to traditional screening – to pick out those most at risk.

Test kit

In the latest study almost 28,000 Dutch women who had not responded to two invites to attend the regular screening programme were sent an at-home screening kit for HPV.

A smaller group were sent a third invitation for routine screening.

More than a quarter of those sent kits returned a completed test kit, compared with only one in seven who responded in the recall group.

Those who self-tested and had a positive result were then referred for further tests.

Importantly, those women who had also not taken up the offer of the previous round of screening had a higher risk of abnormal changes in their cervix.

The researchers said more than half of cervical cancers in countries with screening programmes are diagnosed in women who have not attended routine testing.

Stephen Duffy, Cancer Research UK’s professor of cancer screening, said: “While it’s important for women to attend cervical screening appointments, some find it difficult to do so for cultural or other reasons.

“For these women, self-sampling for HPV may be an option.

“Its acceptability and effectiveness are currently being researched here in the UK.”

Source: BBC NEWS

An initial study showed the test detected 70 percent of breast cancer cases, and correctly cleared 100 percent of women who did not have breast cancer, the team at Chronix Biomedical, a privately-owned company in San Jose, California, said.

The experimental test is not ready to develop into a product but provides a basis for further research, they wrote in the journal Molecular Cancer Research.

“It is based on finding the unique DNA fingerprints from dead and dying cells,” Chronix CEO Howard Urnovitz said in a telephone interview.

Technological advances in DNA sequencing made the test possible, Urnovitz said. His team sequenced the entire genomes of 26 breast cancer patients and of 67 apparently healthy women.

They were looking for extra DNA in the blood of the breast cancer patients that would come from cells dying because of the tumors.

“If a breast cell is injured, it will overexpress the genes that make it a breast cell,” Urnovitz said. In theory, if a patient has excess DNA from breast cells that are dying, there is something going on that is killing breast cells.

The search is not easy. “The entire genome can be found in the blood,” Urnovitz said. And billions of cells die every day in the human body.

But eventually the Chronix team found what they believe is tell-tale DNA from dying breast cells.

“This study supports the potential of an entirely new approach to identifying cancer at its earliest stages when therapies may be most effective,” Dr. William Mitchell of Vanderbilt University School of Medicine in Tennessee, who worked on the study, said in a statement.

SCREENING AND MONITORING

“Laboratory tests using this approach may have the potential both to screen large populations for cancer before symptoms appear and to monitor patients for the recurrence of cancer once treated,” Mitchell added.

Much more testing needs to be done, Urnovitz said. But so far the test seems to specifically home in on breast cells. Unpublished data shows, for instance, that the DNA signature is not found in men with prostate cancer.

The cost of genetic sequencing will have to come down more before the test would be practical, Urnovitz added.

His team used Roche AG’s 454 sequencer at a cost of thousands of dollars per person, but companies are working to speed up sequencing and get the costs down.

The tests might be used to screen women for breast cancer and to tailor treatments, Urnovitz said.

“Imagine we can come in and say ‘you have damage to the protein kinase gene that would preclude you from these 10 cancer drugs, but here are 20 others that should work’,” he said.

“You would be selecting drug treatment based on each person’s lesions. This would be a really good example of personalized medicine.”

Urnovitz also hopes such a test could monitor patients who have completed treatment for cancer. Instead of coming to a cancer center to undergo a PET scan to check for tumors that may have returned, patients could get a blood test at their convenience and have it sent in for analysis.

“You could have one blood test for everything that is going on,” he said.

Source: Reuters

This is problematic, the study’s authors say, because none of the options now available for treating localized prostate cancer have been shown to be any better than the others.

“The different treatments for prostate cancer…entail different side effects, different recovery profiles, and they require different time commitments,” Dr. Thomas L. Jang of The Cancer Institute of New Jersey in New Brunswick, one of the study’s authors, told Reuters Health. For this reason, he and his colleagues say, it should be the patient’s preferences — rather than the physician’s specialty — that guides treatment decisions.

Current options available for treating prostate cancer that has not spread include watchful waiting, in which a patient receives no treatment but is monitored closely; hormone therapy; radiation therapy; or surgery to remove the prostate. Radiation and surgery both carry the risk of urinary incontinence and impotence; hormone therapy can cause hot flashes, breast tenderness, and loss of sex drive; while watchful waiting may lead to anxiety in men who fear their cancer will spread.

Surveys have suggested that specialists are more likely to recommend the type of treatment they provide; for example, radiation oncologists prefer radiation therapy, while urologists choose surgery.

To investigate whether the type of physician a prostate cancer saw would actually influence the type of treatment he got, Jang and his team looked at Medicare data on more than 85,000 men 65 and older diagnosed between 1994 and 2002 with localized prostate cancer. Within nine months of diagnosis, 21 percent had undergone prostate removal; 42 percent had radiation; 17 percent had hormone therapy; and 20 percent watchful waiting. Jang conducted the study, which is published in the Archives of Internal Medicine, while at Memorial-Sloan Kettering Cancer Center in New York City.

Half of the men had only seen a urologist, while 44 percent had seen a radiation oncologist and a urologist, 3 percent had seen a urologist and a medical oncologist, and 3 percent had seen all three specialists.

One-third of the men who had only seen a urologist underwent prostate surgery, and surgery was the most common treatment for the men who were 65 to 74 years old and only saw a urologist. However, among men of any age who saw a radiation oncologist as well as a urologist, radiation therapy was the most common treatment; 83 percent of these men received radiation therapy.

And men who had been seen by a urologist and a medical oncologist, or a urologist only, were more likely to receive watchful waiting or hormone therapy than men who had seen both urologists and radiation oncologists.

Only about one in five men saw their primary care physician after their diagnosis of prostate cancer and before they received treatment (or within nine months of diagnosis). Nearly 60 percent of these men received watchful waiting, compared to 7 percent of men who hadn’t seen their primary care doctor.

When the researchers looked at individual urologists who had cared for at least 10 of the study participants, they found sharp doctor-to-doctor differences in whether a patient was referred to a radiation oncologists; some urologists frequently made these referrals, while others did so much less often.

Men newly diagnosed with prostate cancer face “a lot of confusion,” Jang noted, because there are so many treatment options available. “The physician who is providing the counseling for these patients should go to great lengths to provide a balanced perspective, an unbiased perspective, on these treatment options.”

And if patients don’t feel they are getting unbiased advice, Jang added, they should get a second opinion. “It’s really our responsibility to provide these men with every single available treatment option.”

SOURCE: Archives of Internal Medicine, March 8, 2010.

After reviewing the recent scientific literature, there’s still no evidence that routine screening for men of any age makes sense, according to the committee that issued the guidelines.

They continue to recommend that men of average risk receive information and weigh the “uncertainties, risks, and potential benefits” of screening starting at age 50. Higher-risk individuals — African-Americans or those with one relative diagnosed with prostate cancer before age 65 — should be presented with the information at age 45. Men with a strong family history should start thinking about screening at age 40.

The group also emphasizes the importance of joint decision-making between the patient and his doctor about whether to be screened for prostate cancer. Men don’t always get the information they need to make such decisions about prostate screening, according to the cancer society and findings from other studies.

“Men without access to regular care should not be tested unless high-quality informed decision-making as well as appropriate counseling and follow-up care for those who test positive can be assured,” Otis Brawley, chief medical officer of the American Cancer Society said in a statement. “Without those, community-based screening should not be initiated.”

Prostate cancer screening has long been debated. That’s because screening for slow-growing diseases, like prostate cancer tends to be, may lead to unnecessary treatment.

Source: The Wall Street Journal

Starting with 829 genes in breast cancer cells, the team whittled down the possibilities to six genes which had an impact on whether a drug worked.

They then showed that these genes could be used to predict the effectiveness of a drug called paclitaxel in patients.

It is hoped the approach, reported in The Lancet Oncology, can be replicated for other cancers and treatments.

The international project, including researchers from Cancer Research UK’s London Research Institute, opens the way for breast cancer treatment to be targeted to those who will benefit the most.

To find which genes, if missing or faulty, could prevent the drug from working, they deleted them one by one from cancer cells in the laboratory.

They eventually highlighted the six genes which if absent or not working prevent paclitaxel from properly killing breast cancer cells.

Spare treatment

More than 45,500 women are diagnosed with breast cancer in the UK each year – and it is estimated that around 15% of these women will be prescribed paclitaxel.

The researchers estimate they could potentially spare half of the patients currently receiving this drug from treatment which would not be effective.

Study leader, Dr Charles Swanton, head of translational cancer therapeutics at the Institute, said one of the great challenges in cancer medicine is determining which patients will benefit from particular cancer drugs, which are in themselves toxic and carry severe side effects.

“Our research shows it is now possible to rapidly pinpoint genes which prevent cancer cells from being destroyed by anti-cancer drugs and use these same genes to predict which patients will benefit from specific types of treatment.”

Further studies will now be done to see if the technique can be developed into a simple diagnostic test to be given to patients to help inform doctors about whether or not to prescribe paclitaxel.

He said the challenge will be to apply these methods to other drugs in cancer medicine.

“These could include treatments that are currently deemed too expensive to fund on the NHS – however, in the future, treating only the patients that will benefit from certain treatments will save the NHS money in the long term.”

Dr Lesley Walker, Cancer Research UK’s director of cancer information, said: “New techniques such as these can enable drugs to be tailored to individual patients, and this could potentially improve cancer survival in the long term.

“Health professionals may in the future be able to use this information to direct treatment to patients most likely to benefit, and avoid giving treatment that is less likely to be effective to patients with drug resistant cancers.”

Source: BBC NEWS

Tamoxifen is given to most women diagnosed with breast cancer to prevent the cancer returning.

But not all women respond to the drug – experts estimate a third get no benefit.

The work in the journal Cancer Research suggests the problem is too much of a gene called FGFR1.

This discovery could lead to new treatments for these women as scientists “switch off” the action of FGFR1, enabling Tamoxifen to work.

The team of scientists in the Breakthrough Breast Cancer Research Centre at The Institute of Cancer Research have already shown this is possible in the lab.

They introduced a drug which “switched off” the action of FGFR1.

Once FGFR1 was stopped, hormone-based treatments like Tamoxifen could get back to work in destroying cancer cells, they found.

The researchers believe this could ultimately help thousands of women each year.

They say one in 10 breast cancer patients has too much of the FGFR1 gene.

Dr Nick Turner, who led the research, said: “Understanding how this gene can cause Tamoxifen resistance reveals a new drug target for treating breast cancers in patients who would otherwise have a poor outcome.

“There are a number of drugs in development that stop FGFR1 working, and clinical studies are investigating whether these drugs work against cancers with too many copies of this gene.

“The next step is to set up a clinical trial to see whether a drug that blocks the action of this gene can counteract hormone therapy resistance in breast cancer patients.

“If these trials confirm our lab work we could be on the verge of a potentially exciting new treatment for breast cancer.”

Dr Lesley Walker of Cancer Research UK, the charity which helped fund the work, said: “Cracking the problem of resistance to treatments such as Tamoxifen would be a major advance in treating breast cancer.”

Breast cancer is the most common cancer in the UK affecting more than 45,500 women each year.

Tamoxifen blocks the female sex hormone oestrogen that fuels the growth of some breast tumours.

Source: BBC NEWS

The test identifies tumour DNA “rearrangements” which are specific to the individual patient.

In the future, this “genetic fingerprint” could be used to pick out tiny remnants of a tumour, Science Translational Medicine reports.

Such techniques are currently very expensive but costs are falling.

The researchers hope that one day the technology could be used to spot cancer recurrence before they would be picked up by scans.

DNA from volunteer patients was scanned for rearrangements of large chunks of genetic information which occur in cancer cells but not normal cells.

Known as personalised analysis of rearranged ends (Pare), the technique was developed using six sets of cancerous and normal tissue samples taken from four patients with bowel cancer and two with breast tumours.

They found between four and 15 DNA rearrangements in each of the six samples.

Using blood samples from two of the colorectal cancer patients, they found the test was sensitive enough to detect this marker or “fingerprint” DNA that had been shed by tumours into the bloodstream.

In tests on one patient, after surgery the levels of the marker DNA dropped due to the removal of the main tumour.

Then they rose again, suggesting that some cancer remained.

After chemotherapy and another round of surgery levels of the DNA markers fell once more.

The test was still picking up signs of the tumour which tallied with a small cancerous lesion in the patient’s liver where the cancer had spread.

Cost

Further research is needed to ensure such a test could accurately detect cancer recurrence.

One current drawback is the expense with genetic sequencing costing about £3,200 per patient but, say researchers, costs are falling as the technology improves making the approach potentially more feasible.

Study leader Dr Victor Velculescu, from Johns Hopkins Kimmel Cancer Center in Baltimore, said: “I’m quite optimistic that within five years this approach could be turned into something that’s widely applicable.

“Cancer more and more is becoming a chronic disease, and to manage a chronic disease you have to know how it’s doing – is it getting better or worse?

“We haven’t had any good ways of measuring how a cancer is doing up until now.”

Co-author Dr Luis Diaz said: “Eventually we believe this type of approach could be used to detect recurrent cancers before they are found by conventional imaging methods like CT scans,”

Professor Peter Johnson, Cancer Research UK’s chief clinician, said: “The detection of DNA changes, unique to individual cancers, has proved to be a powerful tool in guiding the treatment of leukaemia.

“If this can be done for other types of cancer like bowel, breast and prostate it will help us to bring new treatments to patients better and faster than ever.”

Source: BBC NEWS

The study of more than 4,000 nurses showed that those who took aspirin — usually to prevent heart disease — had a 50 percent lower risk of dying from breast cancer and a 50 percent lower risk that the cancer would spread.

“This is the first study to find that aspirin can significantly reduce the risk of cancer spread and death for women who have been treated for early stage breast cancer, ” said Dr. Michelle Holmes of Harvard Medical School, who led the study published in the Journal of Clinical Oncology.

“If these findings are confirmed in other clinical trials, taking aspirin may become another simple, low-cost and relatively safe tool to help women with breast cancer live longer, healthier lives,” Holmes added in a statement.

Holmes and her team studied 4,164 female registered nurses taking part in the Nurses’ Health Study, an ongoing analysis of a wide range of health issues.

They started in 1976, looking at who took aspirin, watching for breast cancer and all causes of death until 2006.

Over this time, 341 of the nurses died of breast cancer.

Women who took aspirin two to five days a week had a 60 percent reduced risk of their cancer spreading and a 71 percent lower risk of breast cancer death. Six to seven aspirins a week lowered the risk of spread by 43 percent and the risk of breast cancer death by 64 percent.

Most of the women were taking low-dose aspirin to prevent heart attacks and stroke.

Other drugs in the same class as aspirin also apparently lowered the risks, too. These drugs, called non-steroidal inflammatory drugs or NSAIDs, include ibuprofen and naproxen but not acetaminophen, also known as paracetamol.

But there was not enough data on these drugs to give a clear answer.

The researchers said they are not sure how aspirin and other NSAIDS may affect tumors but it could be by lowering inflammation. Other studies have shown that aspirin and ibuprofen can lower colon cancer risk, for instance.

“Aspirin has relatively benign adverse effects compared with cancer chemotherapeutic drugs and may also prevent colon cancer, cardiovascular disease, and stroke,” the researchers wrote. It affected both estrogen-positive tumors and those not fueled by the hormone.

Holmes’ team stressed that patients should not take aspirin while undergoing radiation or chemotherapy because of the risk of side effects.

And aspirin can cause stomach bleeding so it should not be taken without a doctor’s supervision.

Source: Reuters

SRC-3 is reportedly overexpressed in two-thirds of breast cancers. It is also known that SRC-3 enhances estrogen-dependent growth of cancer cells by activating and encouraging the transcription of a genetic message into a protein. However, how the message to invade other cells gets from the epidermal growth factor receptor (EGFR) to the activating enzyme called FAK (focal adhesion kinase) found on the cell’s membrane had not been determined, notes Bert O’Malley, M.D., chair of molecular and cellular biology at BCM and the report’s senior author.

Dr. O’Malley’s current research uncovered new activity for SRC-3 at the cell’s periphery. They found that the gene can produce a shorter form of its co-activator protein that is missing the part that keeps it in the nucleus. With this exon gone, it is free to travel into the cytoplasm and to the membrane, Dr. O’Malley explains. “At the membrane, the enzyme PAK1 phosphorylates SRC-3, allowing it to function at the membrane.”

The finding explains how the epidermal growth factor receptor at the membrane gets a signal to the enzyme that tells the cell to move and ultimately grow, allowing the cancer to invade surrounding tissue, Dr. O’Malley adds.

“Now we have a final picture as to why epidermal growth factor receptor and the estrogen receptor are the most dangerous combination of molecules overproduced in breast cancer. When they are both overfunctioning, people die quickly and are resistant to therapy,” Dr. O’Malley points out.

Source: GEN News

A study of 1,623 women with breast cancer found that those who have a conventional triple assessment of their cancer are no more likely to be told they need a repeat operation than those assessed using magnetic resonance imaging (MRI) as well.

“Our results have important implications in routine clinical practice for the appropriate use of health-service resources and patient burden on health services,” said Lindsay Turnbull of Britain’s Hull University and Hull Royal Infirmary, who led the study. “MRI is an expensive procedure.”

Turnbull said that since the use of MRI scans in breast cancer patients is similar in many countries worldwide, her findings should be taken into account by all health authorities.

“We believe that our findings are generalisable to all healthcare providers, and show that MRI might not be necessary in this population of patients in terms of reduction of reoperation rates,” she wrote in the Lancet medical journal.

Siemens, General Electric and Philips Electronics are among the major makers scanning technology like magnetic resonance imaging, computed tomography (CT) and positron emission tomography (PET).

The industry has drawn some criticism in the United States where use of expensive scans has risen sharply in recent years.

Critics say many scans are unnecessary and often don’t improve results.

Turnbull’s study took place in 45 centers across Britain where the 1,623 women were all given a standard triple assessment — a clinical examination, an x-ray or ultrasound image of the breast, and lab tests to assess the tumor’s pathology — and then received either MRI or no further scans.

The researchers found 19 percent in the MRI group needed reoperation versus 19 percent of those who had no MRI.

Yet while the outcomes for patients were virtually the same, the costs — both in terms of hospital resources and patient time — were higher for those who had MRI scans, they said.

Breast cancer is the most common cancer in women worldwide, accounted for around 16 percent of all female cancers.

It kills around 519,000 people globally each year, but the World Health Organization says survival rates vary widely from more than 80 percent in the United States, Sweden and Japan to under 40 percent in low-income countries.

The researchers said their findings should benefit Britain taxpayer-funded National Health Service (NHS) since they show MRI might be unnecessary in some scenarios and “could assist in improved use of NHS services.”

Source: Reuters