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Breast cancer screening panels continue to confuse the facts and inject their own biases

breastcancerby D.B. Kopans, MD, Breast Imaging Division, Department of Radiology, Massachusetts General Hospital, Avon Comprehensive Breast Center, Boston

Perspectives in Oncology, originally printed in Current Oncology 

 

Additional confusion has been added to the “debate” about breast cancer. Women, their doctors, and the media are being misled, and women will die, unnecessarily, as a result. I recently outlined the scientific errors that I was concerned would be made by the U.S. Preventive Services Task Force (USPSTF) and the International Agency for Research on Cancer (IARC) panels in their reviews of breast cancer screening guidelines. Based on the draft proposal by the USPSTF, and now IARC, my concerns have been realized. Because the panels include few (if any) experts in screening, they are unable to sort out the validity of the various analyses involved, and they give credibility to analyses that have major flaws.

One of the other major problems with the panels is that their deliberations are held in secret. If anything should be completely transparent, it should be discussions of health care guidelines. It is my understanding that the IARC panel did not unanimously agree, and that a number of panel members felt that the data supported screening women starting at the age of 40. There should be transparency, and IARC should provide full disclosure, as well as any minority reports.

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The Best Available Breast Cancer Evidence … All in One Place

CKN is committed to offering our readers the most current evidence-based cancer research available.  We are pleased to offer this Special Supplement on Breast Cancer published by Multimed Inc., in its peer review journal Current Oncology entitled Updated Guidelines, Consensus and Evidence-Based Reports in Breast Cancer.  Here is a list of chapters included in this supplement:

  • Outcome of patients with pregnancy during or after breast cancer: a review of the recent literature
  • Targeted therapy in HER2-positive metastatic breast cancer: a review of the literature
  • Systemic treatment approaches in HER2-negative advanced breast cancer—guidance on the guidelines
  • A Canadian national expert consensus on neoadjuvant therapy for breast cancer: linking practice to evidence and beyond
  • Locoregional therapy of locally advanced breast cancer: a clinical practice guideline
  • Optimal systemic therapy for early breast cancer in women: a clinical practice guideline
  • Adjuvant chemotherapy for early female breast cancer: A systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline
  • Systemic targeted therapy for her2-positive early female breast cancer: a systematic review of the evidence for the 2014 Cancer Care Ontario systemic therapy guideline

 

An Introduction by M.E. Trudeau , MD, Sunny-brook Health Sciences Centre

 

I was delighted to be asked to act as guest editor of this Current Oncology supplement dedicated to breast cancer; it was the opportune time to publish the adjuvant breast cancer guidelines recently completed for Cancer Care Ontario’s Program in Evidence-Based Care. Finding, in any one place, guidelines and consensus documents that are up to date and evidence-based can be challenging, especially given that the data on breast cancer treatments are constantly changing as new evidence accumulates. In fact, information from the soft and text trials was added just before publication of this supplement because the evidence had not been reported when the guideline recommendations were initially being developed.

Evidence-based reviews or consensus recommendations on both the locoregional management and systemic treatment of locally advanced breast cancer were also sought for the supplement. Over the last few years, a Canadian group of content experts has been working on appropriate algorithms for neoadjuvant treatment. Their just-completed set of recommendations is included here, as is another just-completed set of Cancer Care Ontario guidelines on the locoregional management of locally advanced disease. For up-to-date approaches to metastatic disease, we asked Canadian experts with a special interest in the treatment of HER 2 -positive and HER 2 -negative disease to provide summaries based on already-published international guidelines, but with a Canadian flavour. Lastly, a review of pregnancy-related breast cancer—that is, breast cancer during pregnancy, or pregnancy after breast cancer—was included as a topic of special interest for practitioners managing the many young women presenting in such circumstances.

Many thanks go to all the contributing oncologists for their work on this special edition and also to Glenn Fletcher, guideline methodologist for the Program in Evidence-Based Care at Cancer Care Ontario. We all hope that this supplement will be an important tool for practising breast cancer oncologists.

 

Read the full Current Oncology Supplement:  Updated Guidelines, Consensus and Evidence-Based Reports in Breast Cancer

 

Doctor Assisted Death: New Supreme Court Ruling

Supreme Court rules Canadians have right to doctor-assisted death

Canadian adults in grievous, unending pain have a right to end their life with a doctor’s help, the Supreme Court ruled in February.

The unanimous ruling, by establishing that the “sanctity of life” also includes the “passage into death,” extends constitutional rights into a new realm. The courts have used the 1982 Charter of Rights to establish gay marriage and to strike down a federal abortion law. The new ruling will change the way some Canadians are permitted to die.

Read the full article

 


 

My Right to Death with Dignity – CNN – by Brittany Maynard

 


 

Current Oncology Hot Debate:

Should There be a Legal Right to Die?

A legal right to die: responding to slippery slope and abuse arguments

Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls

Assisted death and the slippery slope—finding clarity amid advocacy, convergence, and complexity

Pereira’s attack on legalizing euthanasia or assisted suicide: smoke and mirrors


 

Join the conversation…post your comments below.

 


 

 

New Impact Factor of 1.643 for Current Oncology

currentoncologyWe are pleased to announce to our readers that Current Oncology’s 2013 Impact Factor has increased to 1.643! This is an increase from our 2012 stats, when we received an impact factor of 1.625.

 

The journal impact factor is a measure of citation frequency that reflects the average number of citations to articles published in science and social science journals. Impact factors are calculated annually for those journals that are indexed in Thomson Reuters Journal Citation Reports. The impact factor of a journal in a given year is the average number of citations a paper published in that journal received during the two previous years. The impact factor is often used to rank the relative importance and scientific caliber of a journal within its field.

 

Our 2013 Impact Factor is a significant achievement for the journal, and demonstrates the increased recognition of Current Oncology in the field, and the improved relevance and quality of our articles. Thank you to our team of Editors and Section Editors, Reviewers and Authors for their valuable contribution to the journal. We look forward to continued success in 2014 as the journal continues to strengthen and grow!

 

Multimed Inc.

Publisher of Current Oncology

The Unique Story of CKN and Current Oncology

multimedlogo

Why We Care:  A Testimony to our readers

 

by Lorne Cooper, Founder Current Oncology; Cancer Knowledge Network, Founder/CEO Multimed Inc.

As Current Oncology approaches its 20th year of publication, the time is right to share with our readers a brief history of its humble beginnings.

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The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

DavidPalma

Dr. David Palma, stands with an X-ray machine at the London Regional Cancer centre in London, Ontario, Aug. 7, 2013. “You don’t have to be promiscuous to get this cancer,” he says.
Photo Credit: Geoff Robins, National Post

 

 

 

Read the article the National Post is talking about in Current Oncology.

 

 

 

 

 

 

 


 

Abstract

Background

Sexually transmitted infection with the human papillomavirus ( hpv ) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv -positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.

Methods

Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpvtypes 16 and 18. The study cohort was divided into three time periods: 1993–1999, 2000–2005, and 2006–2011.

Results

Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993–1999 to 2006–2011 (32 vs. 68), and the proportion of cases that were hpv -positive substantially increased (25% vs. 62%, < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993–1999 vs. 84% in 2006–2011, < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.

Interpretation

The present study is the first to provide direct evidence that hpv -related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.