USPSTF recommends bowel cancer screening for ages 45+
In May this year, the USPSTF (the United States Preventive Services Task Force) have now recommended that everyone commence bowel cancer screening after reaching Age 45 up to Age 75
In May this year, the USPSTF (the United States Preventive Services Task Force) have now recommended that everyone commence bowel cancer screening after reaching Age 45 up to Age 75
Bowel scope screening is a new test for people aged 55 where a thin, flexible tube with a camera at the end is used to look inside your bowel.
It’s done to look for and remove any small growths called polyps. These could eventually turn into cancer if they’re not removed.
The test is also called a flexible sigmoidoscopy or “flexisig”.
Bowel scope screening is being rolled out to all men and women in England aged 55. Depending on where you live, it may not be offered in your area yet.
If you’re registered with a GP and live in an area where the test is available, you’ll automatically be sent an invitation. Call the free bowel cancer screening helpline on 0800 707 60 60 to check if it’s available in your area.
It’s a one-off test, and you’ll only be invited to have it once.
If you decide not to have the test straight away, you can have it at any point up to your 60th birthday. Call the free bowel cancer screening helpline on 0800 707 60 60 to arrange an appointment.
From 60 onwards, you’ll be invited to do a bowel cancer screening home test kit every 2 years instead.
About 2 weeks before the test:
On the day of the test:
For the test:
You’re awake during the test.
It’s usually painless, although some people find it uncomfortable. If you do have any pain, it usually only lasts a few moments.
The test only takes a few minutes. Your whole appointment may last about 90 minutes.
You can usually go home soon after the test is finished. You don’t need to stay in hospital overnight.
Most people can return to their normal activities the same day.
Late last week, the investigators of the large international MINDACT (Microarray in Node Negative and 1-3 Positive Lymph Node Disease May Avoid Chemotherapy) Trial, published in the New England Journal of Medicine, proved that potentially 46% of women with clinically high risk oestrogen positive HER2 negative early breast cancer with up to three lymph nodes involved, may receive no benefit from chemotherapy if they return a low risk 70 gene signature (MammaPrint) genomic result.
According to Dr Hingston, he believes that this is the best news in breast cancer management in 2016. “As of late last week, the world of breast cancer treatment has undergone another paradigm shift. We should now manage women with breast cancer differently, by incorporating the 70 gene MammaPrint signature testing in all women who are being considered for chemotherapy – if they have T1c or T2 oestrogen receptor positive HER2 negative disease with up to three nodes involved. We now have Level 1A data confirming the significant clinical utility of MammaPrint testing, and therefore we should all now routinely use this test on the approximately 4,000 Australian women who each year develop this type of breast cancer.”
He is not alone in this view. Dr Clifford Hudis, the current Chief Executive Officer of the American Society of Clinical Oncology (ASCO) has stated in an accompanying editorial in last week’s New England Journal of Medicine that “On the basis of the MINDACT study, clinicians may consider ordering the 70-gene signature for patients in line for chemotherapy who hope to forgo it on the basis of a possibly low genomic risk.”
Dr Hingston is now calling on all medical oncologists to consider using MammaPrint due to the publication of the Level 1A data late last week confirming that the envisaged benefit of chemotherapy in a selected subgroup of Australian women with breast cancer may not actually be present. MammaPrint testing could potentially benefit around 2,000 Australian women each year, preventing them needlessly suffering the risks of chemotherapy – namely long term cardiotoxicity, secondary leukemia, impairment in cognitive function and neurotoxicity.
Further, he is renewing his call to the Australian Government Department of Health Medical Services Advisory Committee, asking that MammaPrint be funded in full by the Government. “MINDACT has now clearly shown that MammaPrint is both prognostic and predictive, and Australian women should join women from all over the world who are now benefitting from this new genomic microarray technology. Approximately 2,000 Australian women each year could benefit from MammaPrint testing, and they should not undergo the harms of chemotherapy if there is no significant benefit to this treatment, just because they can not afford this new test”. The price of MammaPrint has been stable at $USD4,200 for the last several years.
Dr Hingston introduced fixed formalin paraffin embedded (FFPE) MammaPrint testing into Australia in late 2013, and he has personally seen the benefits of this genomic test on many of his own patients. A small part of the breast cancer (either one core of the preoperative core biopsy or a small piece of the surgically resected tumour) is sent overseas to the MammaPrint laboratory located in Los Angeles for testing. There is a 12 – 14 day turn around, and the result is returned as either low risk or high risk. Testing is ordered online by medical or surgical oncologists looking after women with a new diagnosis of early breast cancer.
The 70 gene signature MammaPrint microarray test was initially developed in Holland by Dr Laura Van’t Veer on a sample group of 100 women who had breast cancer. She first published her findings in Nature back in 2002. Since then, MammaPrint testing has been approved by the FDA, and has now been proven in many large retrospective studies. However, MammaPrint is now the first genomic test to provide Level 1A prospective randomized data from a large Phase 3 trial of women with an early diagnosis of breast cancer who have been followed for five years. MINDACT tested MammaPrint on 6,693 women from 111 medical centres from 9 European countries. No other genomic test has yet provided Level 1A prospective randomized data to support its use in clinical practice.
The authors of the MINDACT publication state that “The primary goal of MINDACT was to assess whether, among patients with high-risk clinical features and a low-risk gene expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval, for the rate of 5-year survival without distant metastasis would be 92% (i.e. the noninferiority boundary) or higher.”
The MINDACT results have shown that out of 1,550 women who were allocated to the high clinical risk:low genomic risk subgroup, that the rate of survival without distant metastasis was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The authors of MINDACT therefore conclude that “Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy” if they return a low genomic risk MammaPrint result.
MINDACT has now confirmed beyond any reasonable doubt that MammaPrint genomic testing represents a new paradigm shift in modern breast cancer management. Dr Bernard Fisher published back in 2002 the National Surgical Adjuvant Breast and Bowel Project (NSABP) 25 year follow up data confirming that partial mastectomy and radiotherapy had the same long term survival rates as mastectomy. This was the first major paradigm shift in modern breast cancer management, and sentinel node biopsy has now been accepted as being the second significant paradigm shift, replacing axillary clearance in the majority of women with breast cancer. Dr Hingston now states that MammaPrint testing, as shown by the Level 1A prospective randomized MINDACT data, is being recognized as being the next significant paradigm shift in modern breast cancer management, and clinicians the world over are now embracing this MammaPrint technology on behalf of their patients.
Dr Guy Hingston is a surgical oncologist with nearly 20 years experience in the management of women with breast cancer. He resides in Port Macquarie providing comprehensive breast cancer surgical service in a private capacity to women from northern New South Wales. He is currently setting up a breast cancer genomic study through the University of Newcastle’s Hunter Medical Research Institute, using next generation sequencing and droplet digital polymerase chain reaction equipment to individually characterise mutations in breast cancer, and he is hoping to shortly commence measurement of circulating tumour DNA in women with breast cancer. He is a new breed of breast cancer surgeon who believes that modern genomic assessment (like MammaPrint) is now part of the future management of all women who develop breast cancer. He is also currently the surgical oncology representative on the TransTasman Radiation Oncology Group Scientific Trials Independent Data Safety & Monitoring Committee.
by Kate Aubusson, The Sydney Morning Herald
It’s a gruelling decision every breast cancer patient and their doctor must consider: do we need to start chemotherapy, or could we spare you the ravages of the toxic, yet potentially life-saving treatment?
A genetic test could see thousands of Australian women with early-stage breast cancer safely avoid chemotherapy, a landmark trial shows.
Based the genetic profile of their tumours, nearly half of women (46 per cent) with early-stage breast cancer who are at high clinical risk of the cancer returning may not require chemo, found one of the largest and most robust studies of genetic testing published.
The trial investigated whether the test (dubbed MammaPrint in Europe and Australia) could identify which patients had a low genetic risk of their cancer re-emerging among women in the early stages of the most common type of breast cancer: HER2 negative tumours.
Researchers screened more than 6600 patients and found 1550 had a high clinical risk, but low genetic risk, of their cancer returning.
Women deemed to have a high clinical risk of recurrence are usually treated with chemo.
The researchers randomly assigned these women to chemo treatment or no chemo after their first-line treatments (surgery, hormone therapy and radiation).
After five years, 94.4 per cent of the women who did not receive chemo had no distant metastasis; their cancer hadn’t spread, found the study published in the New England Journal of Medicine on Thursday.
There was only 1.5 percentage points that separated them from the women who did receive chemo, with 95.9 per cent of these patients showing no distant metastasis at the five-year mark.
“We found that chemotherapy with its toxic effects could be avoided in these patients,” the authors concluded. They plan to follow the women for another five years to document their ongoing survival rates.
“Given these findings, approximately 46 per cent of women with breast cancer who are at high clinical risk might not require chemotherapy, they said.
The risks from certain types of chemo increase with the patient’s age. The risk of leukemia is about 0.5 per cent to 1 per cent, and the heart risk can reach 4 per cent or 5 per cent in older women, Dr Freedman said.
Australian oncologist Dr Guy Hingston – who pioneered access to MammaPrint for Australian women – recommended all Australian women who were about to undergo chemo should check with their oncologist to see if they would benefit from the test.
Between 4000 and 5000 Australian women diagnosed with breast cancer every year would be eligible for the test. The study results suggest roughly 2000 to 2500 women could be spared chemo every year.
“We now live and work in a different world of breast cancer management. Women already shattered with a new diagnosis of breast cancer, should not needlessly be put through chemotherapy, if genomically their cancer can be shown to have a low risk of recurrence,” Dr Hingston said.
“As a medical profession, we are here to help women, not hurt them, and this form of genomic testing is a great step forward in our ability to more accurately target treatment and provide personalised cancer therapy.”
But MammaPrint is not universally accessible. Australian samples are sent to Los Angeles for testing and come with an out of pocket cost of roughly $5500 in Australia.
The medical services advisory committee is assessing an application for government funding.
A sobering editorial published alongside the study findings warned the trial was not the final proof that chemotherapy could be tossed aside for this group of patients.
“The immediate question for many observers is this: Was withholding chemotherapy in such patients actually safe?” wrote Drs Clifford Hudis and Maura Dickler at the Memorial Sloan Kettering Cancer Center, New York.
“[A] difference of 1.5 percentage points, if real, might mean more to one patient than to another.
“What doctors and their patients do with the results of such testing will be highly individualised — and will inevitably be finessed by the findings from future studies,” they wrote.
Dr Martine Piccart and her colleagues have today published in the New England Journal of Medicine their results of the landmark international prospective randomized Microarray In Node negative Disease May Avoid Chemotherapy (MINDACT) study. MINDACT assessed MammaPrint genomic testing of nearly 7,000 women with early breast cancer. In Australia, Dr Guy Hingston says that this is the biggest news in breast cancer management in 2016!
Going against the prevailing Australian view at the time, Dr Guy Hingston commenced using this modern international genomic test in northern NSW in 2014, and published his initial MammaPrint results back then in the Asia Pacific Journal of Oncology. However, with the publication of MINDACT today, Dr Guy Hingston considers that MammaPrint is now set to become the international standard of care in genomic testing in breast cancer. “MammaPrint testing has now been shown to be the most reliable international testing platform for the genomic assessment (of approximately one third) of women who present with a new diagnosis of early breast cancer. This means that each year in Australia, around 5,000 Australian women could benefit from this new technology.”
“MammaPrint is the first genomic test in early breast cancer that has been shown through a prospective randomised international five year follow up cohort of nearly 7,000 women to be both prognostic and predictive.” As of today, Dr Guy Hingston recommends that all Australian women who are about to undergo chemotherapy for early breast cancer should now check with their medical oncologist to see if they could benefit from MammaPrint testing. He has made this bold statement because MINDACT has shown that there is a 46% reduction in the need for adjuvant chemotherapy in the subgroup of women who have hormone positive breast cancers between 20mm and 50mm in diameter, including those with node negative or node positive disease (with up to three nodes involved).
According to Dr Guy Hingston, MINDACT has shown that there is no advantage for undergoing chemotherapy if the MammaPrint genomic test returns a low risk result, as the large group of women in MINDACT randomized to receive or not receive chemotherapy obtained no statistically significant benefit in terms of 5 year distant metastasis free survival or overall survival. Therefore, Dr Guy Hingston asks why women should needlessly undergo all of the side effects, and run the risk of major complications of having chemotherapy, if no benefit is to be obtained? More information about MINDACT and MammaPrint testing can be obtained online at www.mammaprint.com.au.
Back in late 2013, and to help Australian women access this new technology, Dr Guy Hingston set up a company called Genome Investigation Pty Ltd which now assists Australian women to obtain this form of breast cancer testing. Genome Investigation also commenced an application for public funding of MammaPrint through the Australian Government Department of Health Medical Services Advisory Committee. While this application remains afloat, it is Dr Guy Hingston’s view that today’s publication of MINDACT means that the Department of Health should now immediately commence funding of MammaPrint testing for those women who are eligible, after appropriate referral from a specialist oncologist.
“As of today, and because of MammaPrint testing proven through MINDACT, we now live and work in a different world of breast cancer management. Women already shattered with a new diagnosis of breast cancer, should not needlessly be put through chemotherapy, if genomically their cancer can be shown to have a low risk of recurrence. As a medical profession, we are here to help women, not hurt them, and this form of genomic testing is a great step forward in our ability to more accurately target treatment and provide personalized cancer therapy.”
Further, Dr Guy Hingston states that we are now heading into an exciting era of breast cancer management, where over-treatment is being replaced with targeted treatment. Surgical oncologists initially lead the way with partial mastectomy (avoiding mastectomy), and then sentinel node biopsy (avoiding unnecessary axillary clearance). However, proven MammaPrint genomic testing is now leading the way with more personalized targeted medical treatment options, and this is great news for all those involved in breast cancer management, both patients and clinicians alike.”
Dr Guy Hingston is an expert in the clinical management of breast cancer, with nearly 20 years of clinical experience as a specialist surgical oncologist. He currently resides in Port Macquarie, where he maintains a private practice in breast care. However, he is currently trying to establish a significant breast cancer research project through the Hunter Medical Research Institute, and is focused on establishing the genomic basis of breast cancer using next generation sequencing technology looking for the underlying somatic breast cancer mutations. He sees this as the next important practical step which is needed to help women with a new diagnosis of breast cancer. For further information on Dr Guy Hingston, please visit www.drguy.com.au.
Article by Wayne Kuznar
A 70-gene signature (MammaPrint) demonstrated a high level of accuracy at identifying a large subset of women with clinically high-risk early stage breast cancer for whom adjuvant chemotherapy was unlikely to produce benefit, according to findings from a phase III trial presented at the AACR Annual Meeting 2016.
In the study known as MINDACT, patients deemed high risk clinically but low risk by the gene signature had a similar 5-year rate of distant metastasis-free survival (DMFS) whether randomized to adjuvant chemotherapy or not, said Martine Piccart, MD, PhD. “The important message here is among the clinically high-risk patients, the clinical use of MammaPrint is associated with almost a halving of the use of chemotherapy,” she said
The rate of 5-year DFMS in women who were clinically high risk/genomically low risk and randomized to no chemotherapy was the primary statistical test for MINDACT. In this group, in which 48% of the women had positive nodes, the 5-year DMFS was 94.7% (95% CI, 92.5%-96.2%), which passed the bar for significance of 92%.
Overtreatment with adjuvant therapies, especially chemotherapy, is common for patients with breast cancer, in an attempt to eradicate micrometastases. In this setting, overtreatment is considered adjuvant chemotherapy that is associated with a small survival benefit, in the range of 2%, while exposing the patient to long-term risks such as secondary cancers, secondary leukemia, and congestive heart failure, said Piccart, Head, Department of Medicine, Jules Bordet Institute in Brussels, Belgium, and Co-Founder and Chair of the Breast International Group.
The MINDACT trial was opened in 2007 and originally included women with negative nodes, but was amended in 2009 to enroll women with one to three positive nodes. “Essentially, we got very confident that the genomic assay would outperform the clinical criteria by reducing the prescription of adjuvant chemotherapy without impairing patient outcome,” said Piccart. As such, MINDACT is the only clinical trial pitting tumor biology against tumor anatomy with a few biological features added, she said.
MINDACT enrolled 6693 patients with early breast cancer from 112 centers in nine European countries who had their risk of tumor recurrence following surgery assessed in two ways: through use of MammaPrint, performed on frozen tumor tissue, and also via Adjuvant! Online. Overall, 2745 women were categorized as low risk using both methods, 1806 were categorized as having high risk of recurrence by both methods, 592 were categorized as high risk of recurrence by MammaPrint and low risk of recurrence by Adjuvant! Online, and 1550 were categorized as low risk of recurrence by MammaPrint and high risk of recurrence by Adjuvant! Online.
Patients characterized by both assessments as low risk were spared adjuvant chemotherapy while chemotherapy was advised for those characterized as high risk by both methods. Those with discordant results were randomized to adjuvant chemotherapy or no adjuvant chemotherapy.
Altogether, 88% of the patients enrolled had hormone receptor (HR)-positive tumors and 10% had biologically aggressive HER2-positive disease. After a median follow-up of 5 years, 3% of the study population died and 5.4% experienced either distant metastases or death.
Five-year DMFS was 97.6% among the women who were low risk by both assessment methods. In contrast, DMFS was 90.6% among the women who were high risk by both methods and received adjuvant chemotherapy. “The low-risk patients were mostly node-negative [with] small tumors with hormone receptors,” said Piccart. The high-risk patients had larger tumors, were node-positive in 25% of the cases, and triple-negative in about one third of cases, she added.
The “discordant” groups, meaning low by one measure and high by another, had a rate of DMFS in between that of the “concordant” groups (low-low and high-high). The 5-year DMFS rates were 94.8% and 95.1% in the patients who were clinically low risk/genomically high risk and clinically high risk/genomically low risk, respectively.
The trial was not powered to detect a clinical benefit to chemotherapy in discordant risk groups, she explained, but on intent-to-treat analysis, a 22% relative reduction in the risk of 5-year DMFS with chemotherapy was observed “which would translate into a very small absolute benefit that would not justify the risks of chemotherapy,” she said.
Among the entire MINDACT population, using a clinical strategy to assign chemotherapy would result in 50% of patients receiving chemotherapy, compared with only 36% using the genomic strategy, for an absolute reduction of 14% in chemotherapy prescription, Piccart noted.
“MINDACT provides level 1A evidence of the clinical utility of MammaPrint,” she concluded. This is the highest level of evidence shown to date for a risk assessment tool for determining whether chemotherapy should be used.
Because nearly all ER-negative or HER2-postive tumors would be expected to rate as both clinically and genomically high risk, MammaPrint and the MINDACT results bear mostly on the heterogeneity within ER-positive, HER2-negative cancers, commented Harold Burstein, MD, PhD, clinical oncologist at Dana-Farber Cancer Institute, Boston.
The study “confirms the primary hypothesis that integration of genomic signature permits identification of a cohort of ER-positive tumors with good prognosis with endocrine therapy alone, regardless of larger T stage and N1 status,” he said, advocating that most ER-positive, HER2-negative stage 1 and 2 cancers, including N1, warrant tumor genomic profiling for optimal adjuvant decision-making.
The Prostate Cancer Foundation of Australia (PCFA) and the Cancer Council Australia gathered all the disciplines involved in testing – urologists, pathologists, epidemiologists, GPs, radiation oncologists, medical oncologists and allied health professionals – and produced consensus guidelines.
It took three years, it cost $1 million (although experts gave their time gratis) and its recommendations have now been approved by Australia’s highest scientific body, the National Health and Medical Research Council.
Called PSA Testing and the Early Management of Test-detected Prostate Cancer, it is intended for general practitioners, working with middle-aged and older men who have no symptoms of prostate cancer but are considering having a blood test for the cancer.
The PSA test measures for a protein called prostate specific antigen in the blood which is an unreliable marker for cancer but the best we have.
Prostate cancer is the second-most important cause of cancer death in Australian men and these guidelines should give them the confidence to go to their GP and discuss the benefits and harms of testing before making a decision.
Some of the old rules of thumb have changed. It’s known that any mortality benefit from early diagnosis of prostate cancer due to PSA testing is not seen within the first six or seven years following testing.For this reason, the guidelines recommend no PSA testing for men, with other health issues who are unlikely to live another seven years.
The guidelines also say harms of testing – it can lead to unnecessary treatment which can, in turn, lead to urinary incontinence, erectile dysfunction and bowel problems – may outweigh benefits.
The area is complex but their simple message is that Australian men at average risk of prostate cancer who decide to have regular testing should be offered PSA test every two years from the ages of 50 to 69.
If, on this test, their PSA is greater than 3 nanograms per millilitre.
The recommendation is different for those with a family history of prostate cancer who may be at higher risk and should be offered testing every two years from the age of 40 or 45 depending on the strength of the history.
The removal of the standard rectal examination conducted by GPs on men without symptoms will be widely welcome.
Landmark Queensland research has found almost a third of cancers could be prevented by simple lifestyle changes.
Researchers found that 37,000 cancers were preventable, following research of 13 known cancer risk factors, including smoking, diet, obesity and UV light exposure.
The QIMR Berghofer Medical Research Institute study, funded by Cancer Council Australia, used statistics analysis to track just how many cancers were caused by each risk factor.
Smoking was by far the leading cause but lead author Professor David Whiteman and his team found 7000 new cancer cases were attributable to low fruit and vegetable intake, low fibre intake and eating excess red meat.
The epidemiologist said it meant if people followed the cancer council’s lifestyle guidelines they could reduce their cancer risk by a third.
“There are many benefits from following the guidelines and the advice but reducing the cancer risk is one of them,” he said.
“And having 37,000 fewer people each year being diagnosed with cancer would make a huge economic impact each year for the country in days of working life lost, as well as just the direct treatment cost, financial and economic benefits.”
Alcohol caused 3200 incidences of cancer and not eating enough fruit was responsible for 1550 cases, the study found.
The researchers used a common statistical formula to work out how responsible each of the 13 risk factors was for each of 24 cancer types, which when combined with patient data helped to estimate the total number of cancers caused.
Many risk factors were linked to multiple cancer types.
The researchers found 32 per cent of cancers diagnosed in Australia in 2010 were attributable to the 13 risk factors, one percentage point higher in men and one lower in women.
It was the first time such a study had been done in Australia and one of the first applications of the technique in the world.
A look at cancer epidemiology in the UK a few years ago found a similar percentage were preventable but Professor Whiteman said the results were still striking.
“It’s quite sobering to realise that in an ideal world we could relieve 37,000 people each year of being given a diagnosis of cancer,” he said.
“Prevention takes a long time.
“It’s not a quick fix and prevention of cancer requires people to change their lifestyle but also requires government and society to recognise this is a priority and to encourage people to not take up these exposures.”
Cancer Council Australia CEO Professor Sanchia Aranda was hopeful the research would help more Australians avoid cancer.
“Of 13 identified risk factors, smoking, UV radiation, body weight, poor diet and alcohol caused around 90 per cent of all preventable cancers,” she said.
“It’s time to bust the myth that everything gives you cancer and do more to reduce the risks that we know cause cancer.”
The research was published in the Australian and New Zealand Journal of Public Health on Wednesday.
This user-friendly, interactive calculator is intended for use by women who have not had breast or ovarian cancer. It will help you to gain a good understanding of your level of risk for breast cancer compared to another woman of your age group. National Breast Cancer Centre* has based the questions in this calculator on the most important risk factors for breast cancer based on an up-to-date review of international evidence.
The calculator only takes a few minutes to complete, and the relevant risk factor is explained at each stage.
It is important to remember that the results of this calculator are not a guarantee of your risk levels, and that all women are at risk for breast cancer, no matter what their risk category. Some women at increased risk never develop breast cancer, and some women at low risk may develop the disease.
An Australian-designed vaccine against cervical cancer is showing the first signs it is reducing serious abnormalities in young women. Health experts say the results from a Victorian study published in The Lancet today, give the first reassurance the Federal Government-funded vaccine program introduced in 2007 for schoolgirls is paying off.
The vaccine, Gardasil, protects against several strains of the human papilloma virus known to be responsible for most cervical cancers.
While experts say more research is needed to confirm the link, data from Victorias Pap test registry show that after the vaccine became available the rate of high grade abnormalities, or precursors to cervical cancer almost halved in young women aged 17 and under.
The rate of smoking is at an all-time low and alcohol consumption has fallen but illicit drug-use has risen, a government study reveals. An Australian Institute of Health and Welfare report released today, has found the proportion of people aged over 14 who smoke daily fell to 15.1 per cent, from 16.6 per cent in 2007.
The snapshot of the nation’s drug habits found the biggest falls in smoking rates were among people in their early 20s to mid-40s.
The link between high blood pressure and salt intake have been made for the first time in Australians. A study of 783 older Australians by Deakin University and Cancer Council Victoria found those who ate large amounts of salt were twice as likely to have high blood pressure. While various overseas studies have made links between salt intake and blood pressure, it is the first time an Australian study has demonstrated the association.
Cancer patients are in collective denial, attributing to stress, genetics or other factors beyond their control diseases more likely to be triggered by lifestyle choices such as obesity or smoking, the first Australian study into the question has found.
Smoking was mentioned less than half as often as stress among possible causes, even though there is little evidence linking psychological stress with cancer.
Cancer Council NSW surveyed nearly 3000 people in the state, all of whom had received a cancer diagnosis at some time within the previous 18 months.
It was possible people might be using the term stress as a catch-all for other factors more directly related to cancer, said the study leader, Dr Freddy Sitas
Eating vegetables such as brussels-sprouts, cabbage, cauliflower and broccoli decreases the risk of proximal and distal colon cancers, an international study carried out in Perth has revealed.
Published in the Journal of the American Dietetic Association, the study also found that eating more fruit and vegetables, especially apples and dark yellow vegetables, helped reduce the risk of distal colon cancer.
Many women at high risk of breast cancer may be failing to protect themselves, a Melbourne study suggests. About 30,000 Australian women are at moderate or high risk of breast cancer due to family history, with no identified genetic factor. The Melbourne University study looked at women who have at least one close relative who was diagnosed with breast cancer before age 50, but with no known cancer causing gene mutation.
The wind is changing on testing men for prostate cancer. Traditionally there has been a tension between urologists who support testing and public health experts who caution against it.
Now, one of Australia’s leading public health experts has surprised everyone by changing his mind. Bruce Armstrong is a pre-eminent international cancer epidemiologist who has been director of the Australian Institute of Health and Welfare. After analyzing new evidence, he has become the first Australian public health specialist to say the benefits of screening are highly likely. Last year, Armstrong reviewed results from a trial conducted in Goteborg, Sweden and says they were a game changer.
Published in The Lancet Oncology the results showed testing reduced deaths from prostate cancer by almost half over 14 years.
It appears daily doses of vitamin E may increase the risk of developing prostate cancer. A study in the Journal of the American Medical Association has shown men who took 400 international units of vitamin E daily were 17 per cent more likely to develop the cancer than those on a placebo. Experts say these results and those from large cardiovascular studies using vitamin E suggest there is no reason for men in the general population to be taking this dose of vitamin E as it confers no benefit and has some risks.
A type of oral cancer associated with sexual behavior has increased dramatically in the United States, according to a report in the Journal of Clinical Oncology. Oropharyngeal cancer, which occurs around the base of the tongue, the soft palate, tonsils and the side and back walls of the throat, has been increasingly linked with the human papillomavirus, HPV. During the 1980s only 16 per cent of these cancers were linked. Twenty years later, 70 per cent have been linked. Almost all HPV-positive oropharynx cancer are caused by the type of HPV that is targeted by vaccines for cervical cancer prevention.
The number of Australian women killed by cervical cancer has halved since the introduction of the national screening program a decade ago, as indicated by figures released today. According to an Australian Institute of Health and Welfare report, cervical cancer mortality has declined from 5.5 deaths per 100,000 women in 1982, to 1.9 deaths per 100,000 in 2007. The report also found that the incidence of cervical cancer in eligible women aged 20 to 69 has almost halved since 1991.
The rate of new lung cancer cases in Australia is raising sharply for women while dropping for men, new government data shows. The report, Lung Cancer in Australia: An overview, was released yesterday by the Australian Health and Welfare Institute and Cancer Australia. It revealed that the rate of new lung cancer diagnoses rose by 72 percent for women but fell by 32 per cent for men between 1982 and 2007.
Cancer Council Australia launched a new website this week called www.iheard.com.au. The site is designed to field questions from the public about whether cancer claims they have heard or seen (eg. on the web) have evidence to support them.
Making small lifestyle changes might prevent more than four in 10 cancers, a major British study reveals. Scientists have calculated that at least 134,000 cases diagnosed in Britain last year were triggered by such causes as smoking, obesity, poor diet, alcohol or not breastfeeding. Researchers analysed hundreds of studies on the causes of the most common forms of the disease to work out how many were the result of lifestyle or environmental factors. They calculated 40 per cent of cancers in women and 45 per cent in men were preventable. Smoking was by far the biggest cause, responsible for nearly 61,000 cases diagnosed last year, nearly a fifth of the total.
Just over half of women in the target age group for breast screening actually have the procedure, a report shows. The Australian Institute of Health and Welfare report, released today, found 55 per cent of women aged 50-69 are undergoing approved mammography screening. The figure is below the 70 per cent target, and has remained steady since 1996-97. This means that 45% choose not to undergo regular breast cancer screening, thus meaning that many lives are lost from breast cancer each year in Australia due to unnecessary late presentations of this disease.
Researchers at the Mayo Clinic in Arizona and the University of Georgia (UGA) have developed a vaccine that dramatically reduces tumors in a mouse model that mimics 90 percent of human breast and pancreatic cancer cases. “This is the first time that a vaccine has been developed that trains the immune system to distinguish and kill cancer cells based on their different sugar structures on proteins such as MUC1,” Dr. Gendler says. This has exciting possibilities for treating cancer in men and women.
Some 4,500 Australian women have the breast implants made by Poly Implant Prothese (PIP), which was ordered by French authorities to withdraw its implants from the market in 2010 after it was revealed it used unapproved industrial-grade silicone in some products. Australia’s Therapeutic Goods Administration (TGA) said all breast implants, not just PIP implants, have a 10 percent risk of rupture over a 10-year period after insertion. The PIP rate of rupture reported to the TGA was approximately 0.4 percent or 37 ruptures in 9,054 implants between 2002 and 2011.
Solariums will be banned in NSW from 2014 because of fear they cause melanomas. The ban on commercial ultraviolet (UV) solarium tanning units will come into effect from December 31, 2014, to give tanning businesses time to adjust. Environment Minister Robyn Parker will announce the proposal, which will affect 103 solariums in NSW. Australia has the highest melanoma rate in the world.
A drug that delivers a powerful poison to tumours without some of the side effects of traditional treatments can delay the worsening of breast cancer and also appears to prolong lives, according to a new study. The drug, known as T-DM1, consists of powerful toxins linked to proteins called antibodies. The antibodies latch on to cancer cells and deliver the toxic payload directly into those cells. Since the toxin is not active until it reaches the tumour, side effects are reduced.
Exercise can reduce the risk of breast cancer by up to 30 per cent, a study has found. US researchers have found that women who exercise at any level of intensity from 10 to 19 hours a week are most likely to cut the risk. The results have been welcomed by Cancer Council SA, which states the study provides further evidence of the benefits of regular exercise in cancer prevention. Researchers found a limitation of the study was the results were “not readily applicable to all women” because participants were more affluent and educated than the average, and future studies into the relationship between exercise and breast cancer should be expanded with a more diverse selection.
The life-saving National Bowel Cancer Screening Program will be expanded under the 2012-13 Budget to provide additional screenings to people aged 60 and 70. The program will receive a $49.7 million boost and be extended to screen Australians turning 60 from 2013 and 70 from 2015. This achieves regular five yearly screening for the at-risk population between 50 and 70 years of age. The program will be further extended in 2017-18, when a phased implementation of biennial screening will commence, beginning with 72 year olds. Invitations to undergo screening every two years will then be progressively extended to all Australians between 50 and 74 years of age. Currently, bowel cancer screening is provided free to people aged 50, 55 and 65.
Eating 40 per cent less food could extend a person’s life by 20 years, according to scientists. Age-related diseases such as cardiovascular disease, cancer and neurodegeneration could be combated by reducing food intake, it is claimed. Researchers at the Institute of Health Ageing at University College London is looking at how the life of a rat can be increased by up to 30 per cent by reducing its food. One of the study’s lead researchers said: “If you reduce the diet of a rat by 40 per cent it will live for 20 or 30 per cent longer. So we would be talking 20 years of human life.”
One of the largest breast screening studies in the world found women halve their risk of dying from breast cancer if they are screened regularly. The research involving about 4000 women from the Western Australian BreastScreen program found screening rates were much lower among women who died from breast cancer. The results were similar to studies carried out in South Australia and around the world, according to the study just published in the journal Cancer Epidemiology, Biomarkers and Prevention.
By comparing the results with other studies, researchers estimated regular breast screens reduced the risk of death by 49 per cent.
The Royal Australian College of General Practitioners has just launched the 8th Edition of the Guidelines for Preventive Activities in General Practice (the red book). This is a synthesis of evidence-based guidelines from Australian and international sources and provides recommendations for everyday use in general practice. The red book provides a single entry point to common conditions seen in Australian general practice and offers practical advice on the kind of screening and services that should be provided to the general population.
Scientists have for the first time created cells capable of killing cancer. The dramatic breakthrough was made by researchers in Japan, who created cancer-specific killer T cells, paving the way for the cells to be directly injected into cancer patients. The cells occur naturally in small numbers, but it is hoped injecting huge quantities into a patient could turbo-charge the immune system. Researchers at the RIKEN Research Centre for Allergy and Immunology said they had created cancer-specific immune system cells called killer T lymphocytes.
Australians are shunning the cancer test that could save their lives with about half those eligible refusing the chance to be screening for bowel, breast and cervical cancer. The latest data shows just 40 per cent of the three million Australians aged over 50 who were sent a free bowel cancer test in the mail completed it in the first five years of the government program. This is despite researchers estimating 20-30 lives per week could be saved by a higher take-up rate. Similarly, only 55 per cent of women are undergoing breast screens and just 57 per cent are having tests for cervical cancer, the Department of Health and Ageing told a Senate estimates committee. Guy Hingston.
A vaccine given to Australian teenage girls has caused a significant drop in signs of the human papillomavirus, giving hope it could eventually eradicate a range of the cancers it causes. New research from the University of Melbourne and University of NSW reveals a 93 per cent drop in genital wart diagnoses in women vaccinated against HPV. These are exciting times in the science of HPV, and the world can confidently look forward to the virtual elimination of genital warts, recurrent laryngeal papilloma, most genital cancers, and some 60 per cent of head and neck cancers, an accompanying editorial in the British Medical Journal said. The introduction of the male vaccine in Australia could virtually eliminate the virus. Guy Hingston.
It was courageous of Angelina Jolie to go public on her bilateral mastectomy & reconstruction, although we are now doing this surgery more often for women who are breast cancer gene (BRCA1 or 2) positive. Preventing breast cancer is much better than trying to cure it! Guy Hingston.
Smokers will be asked to quit their habit before surgery and will be referred for help while on waiting lists under new medical guidelines. In an effort to better protect patients, a strengthened smoking policy from the Australian and New Zealand College of Anesthetists will require all elective surgery patients to be asked whether they smoke, and for tobacco users to be given referrals to help them quit before their operations.
ANZCA president Dr Lindy Roberts said the guidelines would offer smokers the best chance to avoid life-threatening complications by providing them with support. Dr Guy Hingston.
Women who want to avoid breast, ovarian and endometrial cancer should avoid booze and cigarettes, keep their weight low, have children early and avoid oral contraceptives. A breakthrough new tool developed at the National Cancer Institute in the USA released today allows women to predict their absolute risk of developing breast ovarian and endometrial cancer. Dr Guy Hingston.
Smoking rates in Victoria continue to fall with just 13 per cent of Victorians now smoking regularly and young people turning their back on the habit, new figures show. This means less people will have an early demise due to lung cancer, chronic airways disease, heart attack, stroke, etc. etc.
A paper, published today in the Journal of the National Cancer Institute, shows alcohol intake between a woman’s first period and her first pregnancy – when breast tissue is undergoing rapid growth – is associated with her likelihood of developing breast cancer.
The Cancer Council WA wants public UV index meters installed in school playgrounds and at popular beaches, parks and sporting grounds to warn of sunburn and skin cancer risks.
Australia’s first public UV index meter, which measures solar radiation intensity every minute, was switched on at Deep Water Point in Mt Pleasant this week. The real-time UV index meter, which only recently became possible with new technology, would show when the UV level was above three – the level when people are advised to protect themselves from the sun.
Sounds like a good idea – to help people know how much radiation they are receiving from the big radiator in the sky.
Dr Guy Hingston.
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One in two women are increasing their risk of breast cancer by skipping regular mammograms simply because they are too busy, according to alarming new research. Breast Screen NSW recently surveyed 1000 women aged 50-74 and found half missed their regular appointment, with most citing a “lack of time” as the reason despite 95 per cent agreeing the free screening could save their life. “Twelve women get diagnosed every day in NSW and 17 a week die of breast cancer, and many of these deaths don’t need to happen because screening can pick up a cancer as small as a grain of rice before it’s even able to be felt,” Cancer Institute of NSW deputy CEO Professor Sanchia Aranda said.
I consider breast cancer screening time well spent, particularly if it saves your life! Dr Guy Hingston.
The HPV jab has halved the number of the precancerous lesions in young vaccinated Victorian women. Research shows that five years after the immunisation program started, the number of serious cervical abnormalities has fallen. Previous studies have shown a decrease in the prevalence of human papillomavirus in the population but Victorian Cytology Service (VCS) study director Professor Marion Saville said this was the first study to prove that the decline was due to vaccination. The study, published in the journal BMC Medicine, found that a population-based HPV vaccination program in schools significantly reduced cervical abnormalities for vaccinated women.
New breast cancer research incorporating the Symphony® suite of genomic tests (MammaPrint®, BluePrint® and TargetPrint®) will be presented in 10 scientific posters at the upcoming 2013 San Antonio Breast Cancer Symposium (SABCS), Dec. 10-14.
“These ten studies further demonstrate Agendia’s continued commitment to providing the oncology community and their breast cancer patients with the most comprehensive and validated picture of tumor biology available in the market,” said Neil Barth, M.D., Agendia’s Chief Medical Officer.
Symphony is the only widely available test suite providing molecular subtyping — a recent advancement in breast cancer prognosis and treatment that is highlighted in several SABCS posters. The second-generation MammaPrint test provides definitive High Risk or Low Risk information about breast cancer recurrence, with no “intermediate” results.
Obesity has become the biggest preventable risk factor for cancer in Australia after smoking, experts have warned. A World Health Organisation report has confirmed the huge global toll from cancer, which is now the world’s biggest killer, responsible for 8.2 million deaths a year and rising. The World Cancer Report predicts that the number of cases will increase 75 per cent over the next two decades, topping 20 million new cases a year by 2025.
Almost a billion people in the developing world are now overweight or obese as they start to eat like people in the West. South Africa and Mexico have higher obesity rates than Britain, while rates have doubled in China in three decades, an analysis by the Overseas Development Institute has found. People in North Africa, the Middle East and Latin America are just as likely to be overweight as Europeans after an obesity explosion, says a study of statistics from the World Health Organisation and elsewhere. Rising incomes in poorer countries account for some of the change, but that does not mean governments could not do more to stem the rising ride of obesity. One in four adults in the developing world is now obese or overweight; numbers rose from 250 million in 1908 to 904 million in 2008.
Rates of non-melanoma skin cancer are finally dropping among younger Australians, according to a Queensland study. While the incidence of non-melanoma skin cancer continued to increase in older Australians during the period studied, the QIMR found the first recorded drop in Australians aged under 45 – down 1.5 per cent a year and more than 10 per cent over the decade – with even more rapid decreases in younger age groups. This is Great News for all working to prevent the unnecessary suffering caused by skin cancer. Dr Guy Hingston.
The melanoma rate is plummeting among the slip, slap, slop generation, according to an 18-year study of teenagers and young adults. It shows the effectiveness of the sun safety messages, research leader Professor Adele Green said.”It has been one of the most successful cancer prevention campaigns”, said Professor Green, whose team reviewed melanoma cases among 15 to 24 year olds in Queensland from 1982 to 2010. The success would be similar for the rest of Australia, said Professor Green, who has spent more than three decades studying skin cancer at the QIMR Berghofer Medical Research Institute in Queensland. Despite the fall, Queensland still has the highest rate of melanoma in the world. For people aged 20 to 24, the rate has fallen from 25 cases per 100,000 in 1996 to 14 per 100,000 in 2010.
Only a third of Australians who were sent a bowel cancer screening kit returned a sample for testing, despite the disease being the second greatest cause of cancer-related deaths.
The federal government sends a free kit to eligible Australians aged 50, 55, 60 and 65, but figures released by the Australian Institute of Health and Welfare on Monday showed only 33.5 per cent of these people sent back a faecal sample for laboratory analysis last financial year. Of those who returned a sample, 7.5 per cent required a follow-up visit with a medical practitioner.
Almost 4000 Australians died from bowel cancer in 2012, making it the second most common cause of cancer-related death after lung cancer. In the budget, the government committed $96 million to implement biennial bowel cancer screening for Australians aged 50 to 74 by 2020.
“About 80 Australians die each week from bowel cancer, despite the fact that, if it’s detected early, it’s one of the most treatable cancers there is,” Health Minister Peter Dutton said. “Test kits were sent to 964,000 people, and about 333,000 returned a sample. The participation rate in 2012-13 was slightly lower than in the previous year, when 35 per cent of people returned a sample.