Category Archives: Uncategorised

del 16 in Acute Myeloid Leukaemia

del 16 in Acute Myeloid Leukaemia (AML) in children: Are the Clinical Implications for Management the Same as for Other Good Risk Cytogenetic Myeloid Leukaemias in Children?

By Marc Hendricks

Recently del 16 has been described in AML in children and adults. According to current guidelines risk stratification for paediatric myeloid leukaemias is based on cytogenetic profiling. Patients with leukaemia with good risk cytogenetic profiles are treated with intensive chemotherapy alone and are not considered candidates for transplantation in first remission. These karyotypes include t(8;21), inv(16), t(16;16) previously described in the association with historical French-American-British M4Eo and t(15;17) in acute promyelocytic leukaemia (APL) along with the other known microvariants.

With the description of the del 16 questions have been raised about whether or not this specific genetic abnormality constitutes a newly discovered good risk variant and whether the same treatment algorithm can be followed as for the other favourable cytogenetic group. The distinction is an important one because it speaks to the need for transplantation to consolidate a remission following intensive chemotherapy: in other words, can transplant be avoided or should children with del16 rather be assigned to a standard risk group and should practitioners then be looking for HLA identical donors to proceed to transplant?

Considering the small number of reported cases there is, as yet, no clear indication that the deletion is interchangeable (as it refers to risk) with inv16 and t(16;16). The source links provided highlight the recent descriptions and the controversial question that it has raised for the management of myeloid leukaemia in children.

Source links: Arthur and Bloomfield (1983),  Rogers et al. (2017)Silva et al. (2004).

HPV Testing in Cervical Cancer Screening

HPV Testing Alone is Better than Co-testing with Pap Smear for Cervical Cancer Screening

By Ramadhani Chambuso

Despite huge research into HPV and the introduction of preventive HPV vaccines, cervical cancer screening will remain important and comprise many millions of tests annually for decades to come.

Screening by HPV testing, which detects a cervicovaginal specimen for the presence of the nucleic acids of carcinogenic types of HPV, is more sensitive than the Pap test which is a microscopic examination of exfoliated cervical cells, for detection of cervical pre-cancers, a new study in the Journal of the National Cancer Institute finds.

However, the reports of rare HPV-negative, Pap-test positive cancers are motivating the continued use of both tests (co-testing) despite increased testing costs. In addition, the HPV test captures the known cancer causing viruses only, but it is believed that there may be other unknown cancer causing viruses and so continue to do the Pap smear plus the HPV testing is crucial.

Thus, if a single screening method were chosen to complement HPV vaccination, primary HPV testing likely would gradually supplant the Pap test.

Source link: Schiffman et al. (2017).

Bowel Cancer Screening Test

Simplified Test for Bowel Cancer Launched

By BBC Tayside and Central Scotland

Shared by Ramadhani Chambuso

Phyllis Weir

Phyllis Weir (centre) said the bowel cancer screening test had saved her life

A simplified screening test to detect the symptoms of bowel cancer has been launched in Scotland following a successful pilot.

The new test only requires collecting one stool sample compared to the six separate samples previously required.

The test will be offered every two years to all men and women in Scotland aged between 50 and 74.

It is hoped the easier process will encourage more people to participate in the screening test.

Bowel cancer is the third most commonly diagnosed cancer in both men and women in Scotland.

About 3,700 new cases were diagnosed in 2015, with 95% of cases occurring in the over-50s.

The UK National Screening Committee recommended that the test is rolled out nationally after a pilot involving 40,000 people.

‘Save your life’

Phyllis Weir from Lanark was diagnosed with bowel cancer in 2013 after taking the screening test.

She told BBC Scotland: “I was shocked at the fact I had bowel cancer because I had absolutely no symptoms at all.

“I would urge people to take this test because it can save your life.

“I wouldn’t be here today if I hadn’t taken the test.

“I have spoken to so many people since then who would still have their tests sitting in their bedroom drawer if they hadn’t heard my story.”

Visiting the Scottish bowel screening lab in Dundee’s Ninewells Hospital, Health Secretary Shona Robison said: “Early diagnosis is crucial to saving lives.

“More than 90% of bowel cancer cases can be treated successfully, if diagnosed early.

“The new test is easier to use than the previous process and this will increase the number of people completing screening.

“This will enable us to detect more conditions at an earlier stage, helping more people to beat bowel cancer than ever before.”

Source link: BBC Tayside and Central Scotland.

HBV Vaccination: Protection against Lymphoma Development

Hepatitis B Virus Vaccination is Protective against Lymphoma Development, a Study Finds

By Ramadhani Chambuso

Hepatitis B virus (HBV) infection has been documented as a risk factor for a certain type of blood cancer called non-Hodgkin lymphoma (NHL), worldwide.

Recently, a large cohort epidemiological study involved a database of one million people for sixteen years, reports that HBV vaccination is protective against lymphoma development in the teenagers in an endemic area in Taiwan, however they suggested longer follow-up is required for older age individuals.

Furthermore, they found that HBV infection increased the risk for developing NHL and specific aggressive lymphoma, with Hazard Ratios of 4.14 and 5.52, with a higher incidence of 17.07 and 13.9 per 100 000 person-years, respectively, compared to the non-HBV cohort.

Interestingly, this study demonstrates, for the first time, universal HBV vaccination reduces the incidence of NHL in adolescent and young adults less than 20 years. Further, it suggests that cancer prevention through HBV vaccination is not only for hepatocellular carcinoma but also NHL in endemic areas of HBV infection.

To conclude, this evidence suggests that HBV could be an etiologic factor for NHL and CD20+aggressive lymphomas, although confirmation of the mechanism needs further studies.

Source link: Huang et al. (2017).

Personalizing Cervical Cancer Screening Based on HPV Vaccination Status

Cervical Cancer Screening Should be Individualized for Women Vaccinated Against High-Risk HPV

By Ramadhani Chambuso

Appropriate cervical cancer screening intervals for women vaccinated against high-risk HPV are yet to be well established and an updated screening algorithm has not been agreed worldwide.

However, a recent simulation study done in England found that the necessary number of lifetime screens for HPV16/18-vaccinated women and HPV16/18/31/33/45/52/ 58-vaccinated women were three for cervical cancer prevention in HPV16/18-vaccinated women, while just two for HPV16/18/31/33/45/52/58-vaccinated women.

Furthermore, these researchers used a microsimulation model calibrated to real published data to determine the appropriate screening intensity for vaccinated women. As well the natural histories in the absence of vaccination were simulated for 300,000 women using 10,000 sets of transition probabilities.

In addition, the linkage of vaccination status to the screening programme was done, a process already recommended earlier in England. For example, the current US guidelines recommend the same screening intervals for women regardless of vaccination status, though this is likely to be updated once vaccinated women enter screening and the data have been evaluated. Assuming future cervical screening guidelines differ for vaccinated and unvaccinated women, countries which do not have a good record of who received the HPV vaccine may wish to consider the potential use of HPV antibody testing as part of a future cervical screening programme.

Therefore, these results clearly demonstrate that the cervical cancer screening programme should be personalised based on HPV vaccination status.

Source link: Landy et al. (2017).

Breast Cancer Targets

Tumor Infiltrating Lymphocytes may be Predictive in African-American Women with Triple-Negative Breast Cancer

By John Schieszer

Shared by Paul Mambwe Chilwesa

High levels of peripheral tumor infiltrating lymphocytes (TILs) may be associated with better prognosis among African-American women with triple-negative breast cancer (TNBC) in the early stages of the disease, according to researchers at Emory University. They reported at the American Association for Cancer Research (AACR) Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved in Atlanta that clinicians may want to consider screening some African-American women with breast cancer for levels of TILs.

“Screening early-stage African-American triple-negative breast cancer patients for levels of tumor infiltrating lymphocytes in the clinic may provide a method for oncologists to predict patient prognosis and devise an optimal treatment plan for these patients at risk for poorer outcomes.” said the study’s lead author, Nikita Wright, BS, a PhD candidate at Georgia State University, Atlanta, Georgia.

TNBC is a highly aggressive breast cancer subtype that afflicts African-American women at a higher rate than white women. Wright said it often involves a worse prognosis and previous research has shown that African-American women tend to develop more aggressive subtypes of TNBC than European-American women, exacerbating the disparity in survival.

“There is a great need for robust, clinically translatable prognostic biomarkers and/or new therapeutic targets for triple-negative cancer patients and especially for those of African descent, who display a more aggressive disease course,” Wright told OncoTherapy Network. “Analyzing racial disparities in the tumor micro-immune environment between African-American and European-American triple-negative breast tumors may allow us to harness the potential prognostic utility of tumor infiltrating lymphocytes as well as their value as a treatment target for promising immunotherapeutic agents.”

Wright and colleagues tested resection samples from 142 TNBC patients and compared stromal TILs between patients of African-American and European-American descent. None of the patients had undergone neoadjuvant chemotherapy. The study showed African-American women harbored significantly more overall TILs than European-American patients. Significant differences were also observed among early-stage TNBC patients, but not among late-stage patients. The study showed that high peripheral TILs were associated with better 10-year survival among early-stage African-American TNBC patients after adjusting for age, Nottingham grade, and stage.

A greater presence of overall and peripheral TILs were also associated with a lack of androgen receptor (AR) expression among African-American patients with early-stage TNBC. Wright said the lack of AR reception classifies some TNBC cases as quadruple-negative, and this subtype is more prevalent among African-American compared with European-American TNBC patients. In addition, she said that among African-American patients with early-stage TNBC, high TIL counts were also associated with younger age at diagnosis, increased intramammary lymph node involvement, and increased BRCA1-associated protein and programmed cell death protein 1 expression.

“Adoptive cell therapy with tumor infiltrating lymphocytes are currently being tested in clinical trials as a treatment option for breast cancer patients to shrink breast tumors and have already shown promising results in melanoma patients. If approved, administering immunotherapy with tumor infiltrating lymphocytes to early-stage African-American triple-negative breast cancer patients may improve outcomes in this patient population and attenuate racial disparities in triple-negative breast cancer,” said Wright.


The Secret Suckiness of Life after Breast Cancer

Shared by Ramadhani Chambuso

News and Information from Email not displaying correctly? View it in your browser.
November 2017
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Black Woman

The Secret Suckiness of Life After Breast Cancer


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Study Looks at Lymphedema Risk Factors


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Vlog Series: What It’s Like to Live With Metastatic Breast Cancer


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Five-Part Video Series: Mastectomy and Breast Reconstruction



Metastatic Breast Cancer Patients Tell Their Stories Through Art and Photography


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Biomarker for Breast Cancer

Less Invasive Serum Biomarker for Diagnosis of Breast Cancer and Therapeutic Targets

By Ramadhani Chambuso

Breast cancer is the most frequent malignancy in women and the second leading cause of cancer-related mortalities worldwide.

It is worth noting that better understanding of potential biomarkers and therapeutic targets of breast cancer will facilitate improvement in the survival rate of patients with breast cancer.

However, a recent study found that beta-thymosin (TMSB10), which is originally found from the thymus gland on the upper front part of the chest, is significantly elevated in human breast cancer cells and tissues. It further correlates with advanced clinicopathological features, metastasis status and poor prognosis.

On the other hand, overexpression of TMSB10 promotes, while silencing of TMSB10 inhibits, proliferation, invasion and migration of breast cancer cells in vitro and in vivo.

In conclusion, these findings indicate that TMSB10 may be potential future valuable serum biomarker for the diagnosis of breast cancer and as a potential therapeutic target for the treatment of the disease.

Source link: Zhang et al., 2017.

Unintended Pregnancy during Radiotherapy

Healthy Child after Accidental Pregnancy during Radiotherapy for Cancer Treatment

By Ramadhani Chambuso

In 2009, a 27-year-old woman gave birth to a healthy child after an unintended pregnancy during cancer treatment for stage II lymphoma, following several cycles of chemo and radiation therapy without even abdominal shielding.

Earlier, her physician advised to terminate the pregnancy, but she decided to continue with it after contacting a teratology information service for further information regarding the risks of radiation exposure for her fetus.

Although the available information on radiation-induced embryonic damage in humans is mainly extrapolated from animal studies and follow-up of individuals exposed to atomic bomb radiation effects in Japan, to date, this case still gives special interests for scientists to re-evaluate the required dose for radiation teratogenic effects on fetal development.

Furthermore, women do occasionally conceive during radiotherapy for oncologic diseases, however, many physicians advise patients to terminate pregnancies for fear of the high risk of teratology from radiation adverse effects.

Therefore, this practical evidence reflects the need for further evaluations on chemo-radiation dose-effect relationship for embryogenesis.

Source link: Nature Reviews Clinical Oncology 6, 175–178(2009). doi:10.1038/ncponc1320.

Detection of Breast Cancer by Mass Screening

Reducing Death from Breast Cancer by Mass Screening: Rethinking Strategies for LMICs

By Christabel Abewe and Vester Gunsaru

Breast cancer is the most common cancer diagnosed in women and the most common cause of death from cancer. Globally, breast cancer incidence, mortality, and survival rates vary considerably between the regions (approximately fourfold). However, what has been unequivocally consistent across the regions is that the incidence of breast cancer is increasing, and in regions without early detection programs, mortality is also increasing. The global trajectory is that breast cancer incidence is higher in the developed countries as compared with the developing countries, yet paradoxically; the breast cancer mortality in the developing countries is almost equal to that in the developed countries. This implies that breast cancer disproportionately affects women in developing countries. The high mortality in developing countries is largely attributed to the fact that about 75% of women diagnosed with breast cancer in low and middle income countries (LMICs) present with clinical stages III & IV of the disease. On the contrary, 70% of women with breast cancer in North America are diagnosed in stages 0 & I. Developing countries now face the challenge of effectively detecting and treating a disease that was previously considered too uncommon to warrant the allocation of finite health care resources.

Mammographic screening is the ONLY technique that has been found to sufficiently reduce breast cancer mortality and while mass screening using mammography has been well established and implemented in developed countries, it has not been replicated in LMICs due to the huge financial and human resources that are required for the technique. Aside from the huge financial resources needed for mammography, the appropriateness of this screening technique among women from sub-Saharan Africa has become a point of debate. The argument against considering mammography as the gold standard for screening for breast cancer is hinged on the fact that the bulk of the women who need screening for breast cancer in sub-Saharan Africa are between 30-45 years. This implies that the proportion of the demographic that requires screening in sub-Saharan Africa is composed of women who have dense breasts making it very difficult to tell abnormal and normal tissue apart on the X-ray film. Mammography is typically recommended and most effective when it is used to screen older women 50-69 years.

The use of Ultrasound scans has been advocated for in some LMICs such as Uganda as a stopgap measure to screen the most at risk women (30-45 years) of breast cancer in the absence of mammographic and other image screening services. Ultrasound scans are almost 50% cheaper than mammograms, easier to use, require less human resource expertise and are up to 10 fold more available than mammograms in most LMICs. Although ultrasonography is not up to par with the gold standard (i.e., lower specificity and sensitivity and higher false positives) it is still better than no screening at all. Breast cancer is and should be viewed as extremely fatal and yet can be cured if detected early and treated properly. The proposition to use ultrasonography for mass screening in LMICs where mammography is out of reach is therefore not to lower the standards of breast cancer diagnosis but rather an interim measure to fill the gap of unmet need until these countries have sufficient resources to afford more effective imaging screening tools. There is therefore need to investigate the efficacy of ultrasonography for breast cancer in LMICs and subsequently estimate the resource requirements for implementing population level screening using this method.

Source link: Okello et al. (2014), Jedy-Agba et al. (2016)Galukande and Kiguli-Malwadde (2010), Lauby-Secretan et al. (2015), Dey (2014), Lee et al. (2010).