Physicians’ Misunderstanding of Genetic Test Results May Hamper Mastectomy Decisions

Excerpt:

“A recent survey of over 2,000 women newly diagnosed with breast cancer found that half of those who undergo bilateral mastectomy after genetic testing don’t actually have mutations known to confer increased risk of additional cancers, according to a study by researchers at the Stanford University School of Medicine and four other U.S. medical centers.

“Instead the women had what are known as variants of uncertain significance, or VUS, that are often eventually found to be harmless. A bilateral mastectomy is a surgical procedure in which both of a woman’s breasts are removed after a diagnosis of in one breast.”

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Surgery May Be Best for Advanced Melanoma

Excerpt:

“Surgery to remove melanoma—the deadliest form of skin cancer—can extend the lives of patients whose disease has spread to the abdomen area, new research suggests.

“Patients who get and to remove their cancer live twice as long—18 months on average—as those who only get medication, researchers found.

” ‘Now that there are better options systemically, the decision-making about treatment has become more complex. Having this data available could potentially impact discussions about treatment and benefit long-term,’ said study leader Dr. Gary Deutsch, a cancer surgeon at Northwell Health in Great Neck, N.Y.”

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When the Doctor Recommends Against the Surgery a Breast Cancer Patient Wants

Excerpt:

“More women with breast cancer are electing to have both breasts removed, even when cancer affects only one breast. The procedure, called contralateral prophylactic mastectomy (CPM), is a more complex surgery that has not been shown to improve survival.

“A new study from the University of Michigan Comprehensive Cancer Center examines the complex interaction between patients’ desires for the most extensive and surgeons’ responsibility to minimize harm.

“The population-based survey, published in JAMA Surgery, found that few patients sought a second opinion or went to a different hospital when their surgeon recommended against CPM. Further, patients were overwhelmingly satisfied with their treatment, even when their surgeon dismissed CPM with little discussion.”

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More Women With Breast Cancer Opt to Remove Healthy Breast

Excerpt:

“One in three breast cancer patients under 45 removed the healthy breast along with the breast affected by cancer in 2012, a sharp increase from the one in 10 younger women with breast cancer who had double mastectomies eight years earlier, a new study reports.

“The rate is especially high in some parts of the country, the study in JAMA Surgery found. Nearly half of younger women in five neighboring states — Nebraska, Missouri, Colorado, Iowa and South Dakota — had double mastectomies in 2010-12. Women often remove the healthy breast so they don’t have to worry about developing another cancer, even though there is no evidence that removing the healthy breast extends lives.”

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Clinical Trial Looks at Targeted Genetic Therapies for Lung Cancer

Excerpt:

“Researchers at the University of Cincinnati (UC) College of Medicine are enrolling patients in a clinical trial looking at targeted gene therapies in patients with early stage lung cancer who have had surgery.

“This could help researchers gain insight into genetic targets that could aid in earlier intervention and better outcomes for patients.

” ‘Despite therapeutic advances in recent years, cancer remains the second leading cause of death in the United States, and effective new therapies are still desperately needed. Additionally, lung cancer is the leading cause of cancer deaths for women and for men,’ says Sandra Starnes, MD, Dr. John B. Flege Jr. Chair in Cardiothoracic Surgery, associate professor of surgery and co-director of the UC Cancer Institute’s Comprehensive Lung Cancer Center. ‘Targeted genetic therapy holds great promise for improved efficacy in treating patients. In this trial, researchers will evaluate the use of a newer targeted therapy for early stage who have had surgery and completed post-operative chemotherapy.’ ”

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Adding Antiandrogen Therapy to Radiation Improves Survival in Recurrent Prostate Cancer

Excerpt:

“The addition of hormonal therapy to radiation treatment following surgery significantly improved survival in patients with recurrent prostate cancer, according to the results of a study published in The New England Journal of Medicine.

“In the multicenter trial—which initially enrolled 760 men with biochemical recurrence after radical prostatectomy—patients were randomly assigned to treatment with bicalutamide or placebo for 2 years, along with 6.5 weeks of radiation therapy.”

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Breast Conserving Surgery Plus RT Better Than Mastectomy in Some Patients

Excerpt:

“A large registry study found that certain breast cancer patients gain a significant survival benefit with breast conserving surgery plus radiation therapy (BCT) compared with mastectomy. This includes patients over the age of 50 with T1–2N0–1 disease, and other factors.

“Studies comparing those options have often excluded elderly patients, or those with existing comorbidities. The new study involved two time cohorts from a Netherlands registry, one with 55,802 patients diagnosed between 1999 and 2005, and another with 65,394 patients diagnosed between 2006 and 2012. The results were presented by Mirelle Lagendijk, MD, of the Erasmus MC Cancer Institute in Rotterdam, at the European Cancer Congress 2017 in Amsterdam.”

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Why Doctors May Keep a Patient Awake for Brain Surgery

Excerpt:

“Anthony Munoz has a brain tumor that is not cancerous.

“Neurosurgeon Dr. Jennifer Moliterno, who specializes in brain tumors, is focused on the massive one just above his left temple.

” ‘The more tumor you remove the better outcome the patient has,’ said Moliterno.

“Taking a more aggressive approach like Awake Craniotomy, Dr. Moliterno says, is a growing trend among those experienced, armed with high-tech tools, all done with the patient’s safety in mind.”

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Trial Explores Eliminating Breast Cancer Surgery in Exceptional Responders to Neoadjuvant Therapy

Excerpt:

“A prospective study is investigating whether breast cancer surgery can be eliminated in patients who respond well to neoadjuvant systemic therapy.

“The phase II single-center trial, conducted out of The University of Texas MD Anderson Cancer Center (NCT02945579), aims to determine how often breast cancer recurs in patients who previously received chemotherapy and follow-up radiation therapy, but not surgery, and have no evidence of disease. Forty patients with early-stage, triple-negative or HER2-positive breast cancer care underwent image-guided biopsy after completing chemotherapy and before beginning radiation therapy to see if surgery is necessary.”

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