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).

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.

Source: http://www.oncotherapynetwork.com/.

Shared by Ramadhani Chambuso

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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.

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.

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).

Breast Cancer Prevention and Control Policy

By Trish Muzenda and Lelani Hobane

Breast cancer is the leading type of cancer diagnosed in women globally. Since 2008, the incidence of breast cancer has been evenly distributed globally, with 50% of breast cancer incidence occurring in the developing world. However of the total cases, approximately 58% of breast cancer mortality occurs in the developing world. Given these statistics, it is ever more important for governments in developing nations to take issues of breast cancer seriously and design contextual prevention and control strategies. In South Africa, the lifetime risk for breast cancer is 1 in 29. This risk is high and therefore requires that the department of health have guidelines that are there for screening of cases so as to improve diagnosis of breast cancer as well as treatment and rehabilitation following breast cancer diagnosis. To mirror the growing importance of breast health care in South Africa, the South African National Department of health has published a revised Breast cancer Policy brief as of June 2017. This policy outlines the guidelines to be used by all stakeholders towards health promotion, screening and treatment of breast cancer. Whilst the policy does touch on prevention of breast cancer, the backbone idea in the breast cancer policy of 2017 lies in improving the screening capacity for breast cancer.

Through the National Health Insurance (NHI) which is the central means by which the government aims to achieve universal coverage, the government is revitalising service delivery, changing the way that health services are financed, ensuring the provision of primary care, improving access to qualified human resources for health, and ensuring the availability of quality assured medical products. For the breast cancer policy, this can be seen in that much thought has been put into the use of all primary healthcare facilities as centres for the opportunistic education of women on general breast health including breast cancer risk factors. The policy also advocates for the education of women on how to practise Breast Self-Examination (BSE) and the importance of receiving a routine clinical breast examination (CBE). Additionally the establishment and maintenance of Specialised Breast Units set up in various tertiary level health facilities are to be used as referral points for suspected breast cancer cases for further diagnosis.

Source link: Breast Cancer Policy 2017.

Study Reveals Significantly Higher Cervical Cancer Mortality Rates among Black Women Compared to White Women

By Harris Onywera

Cervical cancer is the first and second most common cancer type among reproductive-age women in South Africa and world, correspondingly. The incidence rate per 100,000 population is higher in less developed regions (15.7%) than in more developed regions (9.9%). Globally, it is estimated that 527,624 cervical cancer cases reported annually, concomitantly with about 50.4% new cervical cancer deaths.

There is documented evidence for racial disparity in cervical cancer mortality rates. A recent survey estimating the cervical cancer mortality rates in the US from the Surveillance, Epidemiology, and End Results and National Centre for Health Statistics county mortality data (2000-2012) found that after correcting for hysterectomy, Black and White women had 76% and 48% higher cervical cancer mortality rates, respectively, than previously estimated. The prevalence of hysterectomy (surgical removal of the uterus) was higher in Black women than in White women. Prior to excluding women with hysterectomies, (uncorrected) cervical cancer mortality rate was 5.7 and 3.2 per 100,000 in Black and White women, respectively (Figure 1). In the same order, the corrected rates were 10.1 and 4.7 per 100,000. It was also observed that age-specific cervical cancer mortality rates were higher among women aged 65+ years, with up to 126% increase among Black aged 65-69 years. The percentage increase for White women of the same age was 75%. For White women, cervical cancer mortality rate was highest (96%) among women aged 75-79 years. Black women of similar age still exhibited a high increase of 122%.

In my opinion, I think it would be of great public health relevance to perform a similar kind of analysis in sub-Saharan region where cervical cancer mortality rates are underreported, yet very high.

For more information, visit the sources provide below.

Source link: Bruni et al. (2017) and Beavis et al. (2017).

Oncopig  Cancer Model: A New Approach in Cancer Research for Humans

By Ramadhani Chambuso

Oncopig Cancer Model is a novel transgenic swine model that recapitulates human cancer through the development of site and cell specific tumors. For decades, cancer research progress has been markedly hampered by the lack of a phenotypically, genotypically, anatomically, and physiologically relevant large animal models.

On the other hand, small animal models, such as mouse models, have played a major role in our understanding of the genetic basis of cancer and the role of specific genes and gene mutations in the development and progression of cancer. However, due to vast differences between humans and rodents or zebrafish for example, the ability to model complex diseases such as cancer and translate results into clinical practice is quite limited

In a nutshell, large animal models of cancer comprise a smaller portion of cancer models than small animal cancer models. Therefore, these large animal models recapitulate transcriptional hallmarks of the human disease while also exhibiting clinically relevant histologic and genotypic tumor phenotypes.

Source link: Schachtschneider et al. (2017)

Breast Cancer Screening with Mammography in Women Aged 40-49 Years is Still Controversial

By Ramadhani Chambuso

The incidence and mortality rates from breast cancer are expected to rise as a result of the ageing population. To reduce the burden of this disease, many countries have implemented mammography screening for early detection and treatment of breast cancer for all women aged from 50 years for every 2 years. However, there is a debate about whether breast cancer screening should be extended to younger women (i.e., 40–49 years). Generally, for effective cancer screening programme, the benefits should outweigh the harms. Some negative effects of breast cancer screening include radiation exposure from mammography, pain during the mammography procedure, consequences of false positive and false negative tests, and the occurrence of over-diagnosis. Therefore, based on the current evidence from randomised trials, extending mammography screening to younger age groups cannot be recommended.

More information can be accessed from Mammography and Breast Cancer Screening.

Source link: van den Ende et al. (2017)