BRITAIN is secretly considering whether to introduce a primary school vaccination program against cervical cancer.

Research has found parents have mixed feelings about vaccinating pre-teen girls against the human papilloma virus, which is spread by sex and causes cervical cancer.

Of the 3000 or so British women diagnosed with cervical cancer each year, more than a third die. Most cases are caused by HPV infection.

Experts want all girls and women aged between nine and 55 to receive vaccinations.

Scientists believe the vaccine should be given to girls before they become sexually active to maximise their protection, but there are ethical and moral concerns that vaccinating young girls would encourage sexual promiscuity.

Minutes from the Health Department’s expert committee on vaccination show that parents were “generally very positive”, but there were concerns about vaccinating children at primary school, with a preference instead for vaccinating young teenagers.

It is the first time evidence has emerged of Britain considering such a vaccination program at primary school level.

The vaccine, Gardasil, is 100 per cent effective against the two main virus strains that trigger most cervical cancers.

Cancer Research UK clinical consultant Anne Szarewski, who worked on the trials, advocated giving the drug to young girls, provided its efficacy could be proved to last into adulthood.

“There is an argument for giving it to toddlers, because you get away from any links between sexual activity and the whole ethical question that it poses,” Dr Szarewski said.

She said parents did not like to admit it but “children do have sex before the age of 16 and we know this vaccine can protect against cervical cancer”.

London Metropolitan University medical ethicist Jacqueline Laing said drug makers’ interests should not outweigh “the rights and safety of children”.

Telegraph

Scientists have developed a way of “executing” cancer cells.

Healthy cells have a built-in process which means they commit suicide if something is wrong, a process which fails in cancer cells.

The University of Illinois team created a synthetic molecule which caused cancer cells to self-destruct.

Cancer experts said the study, in Nature Chemical Biology, offered “exciting possibilities” for new ways of treating the disease.

One of the hallmarks of cancer cells is their resistance to the body’s cell suicide signals, which allow them to survive and develop into tumors.

All cells contain a protein called procaspase-3, which the body should be able to turn into caspase-3 – an executioner enzyme.

But this transformation does not happen in cancer cells, even though certain types, such as colon cancer, leukemia, skin and liver cancers paradoxically have very high levels of procaspase-3.

The researchers examined more than 20,000 structurally different synthetic compounds to see if any could trigger procaspase-3 to develop into caspase-3.

They found the molecule PAC-1 did trigger the transformation, and cancer cells from mice and from human tumors could be prompted to self-destruct – a process called apoptosis.

The more procaspase-3 a cancer cell had, the less of the molecule was needed.

Healthy cells, such as white blood cells, were found to be significantly less affected by the addition of PAC-1 because they had much lower levels of procaspase-3, so cell-suicide could not be triggered.

When the scientists tested PAC-1 on cancerous and non-cancerous tissue from the same person, the tumor cells were 2,000-fold more sensitive to PAC-1.

Since different levels of procaspase-3 were found in the cell lines studied, the researchers suggest some patients would be more responsive to this therapy than others, so it might one day be possible to tailor treatments to individual patients.

Professor Paul Hergenrother, who led the research, said: “This is the first in what could be a host of organic compounds with the ability to directly activate executioner enzymes.

“The potential effectiveness of compounds such as PAC-1 could be predicted in advance, and patients could be selected for treatment based on the amount of procaspase-3 found in their tumour cells.”

Cancer Research UK expert Dr Michael Olson, who is based at the Beatson Institute for Cancer Research in Glasgow, said: “These findings present an exciting new therapeutic strategy for the treatment of some cancers.

“It remains to be seen which, if any tumour types consistently express elevated procaspase-3. That will tell us how many patients could potentially benefit from the drug.

“Clinical trials will be needed to confirm whether procaspase-3 causes any adverse effects in humans.”

Source: BBC News

Proton therapy can allow doctors to produce higher levels of radiation while zeroing in on the tumor. Traditional radiation treatment can also pinpoint the tumor but it does so with a lower level of radiation. What is promising about Proton therapy is that it targets the cancer but can spare the healthy tissue surrounding the tumor. Proton therapy can also decrease side effects such as loss of appetite, diarrhea and headaches.

Proton therapy does not come cheap. It is about three times the cost of traditional radiation. Doctors at MD Anderson are using Proton beam treatments mostly on patients who’s cancers are very early in development.

At this point more studies need to be done to see if the Proton therapy is better and worth the higher cost. Traditional radiation has come a long way over the years and recent developments have made it safer to use.

Source: The Cancer Blog

A test used to detect prostate cancer can also help doctors know when treatment is working. A man’s prostate specific antigen, or PSA, level after seven months of hormone therapy for advanced prostate cancer predicted how long he would survive, according to a new multicenter study conducted by the Southwest Oncology Group and led by researchers at the University of Michigan Comprehensive Cancer Center.

The study evaluated 1,345 men with prostate cancer that had spread to distant parts of the body. The men were treated with seven months of androgen deprivation therapy, a treatment designed to block the effects of hormones on the cancer. PSA levels were monitored throughout the treatment. The researchers found that men whose PSA dropped below 4.0 ng/ml had a quarter the risk of dying compared to those whose PSA was more than 4.0.

Results of the study appear in the Aug. 20 issue of the Journal of Clinical Oncology.

“Our analysis showed that a low or undetectable PSA after seven months of androgen deprivation therapy is a powerful predictor of risk of death in patients with new metastatic prostate cancer. This could allow oncologists to identify patients who are unlikely to do well with this treatment long before they develop clinical signs of treatment resistance,” says lead study author Maha Hussain, M.D., professor of internal medicine at the U-M Medical School.

The researchers found 69 percent of the men maintained a PSA level of less than 4.0 ng/ml after seven months of treatment and 43 percent had an undetectable level of PSA at that time. Patients whose PSA was higher than 4.0 at the end of seven months survived 13 months, while patients whose PSA dropped below 4.0 but above 0.2 lived 44 months and those whose PSA was undetectable, below 0.2 ng/ml, lived 75 months.

The men in the study were enrolled in a Phase III SWOG trial in which they would receive additional treatment after the seven months of initial hormone therapy. That study seeks to accrue 1,512 men. The patient’s PSA level before beginning treatment must be at least 5.0 ng/ml to qualify for the study.

A PSA test measures the level in the blood of prostate specific antigen, an enzyme produced by the prostate gland. It is generally used as an initial screening test to detect prostate cancer.

“What is attractive about using PSA to predict survival in metastatic prostate cancer is that it is an easily measurable factor. These findings could help patients avoid ineffective treatment and could help researchers design further trials,” Hussain says.

Some 234,460 men will be diagnosed with prostate cancer this year, and 27,350 will die from it, according to the American Cancer Society.

Source: eMaxHealth

Health Minister Brian Gibbons approved the use of cetuximab in June, making Welsh patients the first in the UK to receive the drug.

But the UK’s health watchdog said on Monday it would not recommend its use as it was not cost effective.

Swansea oncologist Professor John Wagstaff said the decision was a “significant blow” to cancer patients.

Cetuximab can delay the spread of advanced cancer and shrink tumors. It is prescribed to patients when all other forms of cancer therapy have failed.

In Wales, suitable patients can currently receive 18 weeks of treatment on the NHS, costing £600 a week.

But The National Institute for Health and Clinical Excellence (NICE) has published final recommendations which conclude the treatment is not “a good use of scarce NHS resources”.

Deputy chief executive Andrea Sutcliffe said: “The evidence available on cetuximab does not compare it to current standard treatment and therefore we are not able to assess whether it is any better than existing treatments or whether the NHS could justify spending money on the drug.”

Final guidance on the use of the drug is expected in November.

The Welsh Assembly Government said if the recommendations by NICE were finalised, patients in Wales currently receiving the drug would continue to do so.

Prof Wagstaff, from the South West Wales Cancer Institute in Swansea, said the decision was a “significant blow” to patients and oncologists in Wales.

He said: “Cost should not be the deciding factor in how we treat our patients, especially when a drug has proven efficacy and is widely used in the rest of Europe.”

Patient organisations Beating Bowel Cancer and Bowel Cancer UK are “united in anger” by the recommendations.

Hilary Whittaker, chief executive of Beating Bowel Cancer said, “The decision by NICE not to make these drugs routinely available on the NHS to appropriate patients is a scandal and we urge NICE to reconsider its decision.”

Consultees can appeal against the recommendations, but the assembly government has said it is unlikely to do so.

Source: BBC News UK

India: Terminally-ill cancer patients can finally hope to live a pain-free life without the daily needle pricks, thanks to a new mode of pain relief which has been perfected by doctors at the Armed Forces Medical College (AFMC) here.

Medically referred to as the para vertebral neurolytic block, wherein a mixture of local anaesthetic and absolute (100%) alcohol is injected into the spine, this technique has been successfully tested on a large number of cancer patients, including 25 at the malignant disease treatment centre (MTDC) at the Southern Command hospital.

“The injection effectively blocks the nerves carrying pain sensation,” said Colonel C.V.R. Mohan, head of the AFMC’s anaesthesiology, critical care, and pain management department.

“Advanced cancer causes excruciating pain, which leaves patients with no option other than multiple injections of painkillers life-long,” Mohan said.

Although PVNB is being tried and tested at other places, it is probably the first instance where the treatment benefits have been perfected to the fullest, Mohan said.

The injection has been administered in both males as well as females. According to Mohan, the effect of one injection lasts for about two-three months.

“In some patients, the nerves carrying pain sensation regenerate in this time, following which the patient is administered one more shot.” AFMC director and commandant Lt.Gen. Saibal Mukherjee, said: “There is no requirement for the regular painkillers.”

Mayor Bob O’Connor received his first treatment of whole-brain radiation yesterday — several days earlier than expected — and will have another today because of “worsening symptoms” of his rare brain cancer, according to his doctors.

In a prepared statement, Mr. O’Connor’s medical team said his symptoms “included headache and increased lethargy,” and were thought to be the result of fluid buildup overnight Wednesday.

The mayor was diagnosed last month with primary central nervous system T-cell lymphoma.

The fluid increase meant it wasn’t possible to do surgery, planned for yesterday, to internalize a shunt that would channel excess fluid from the brain into the abdomen. Instead, the external drain has been adjusted to accommodate the increased fluid level.

Because of the symptoms and postponement of the shunt procedure, the medical team decided to begin radiation of Mr. O’Connor’s entire brain yesterday. The treatment took about 10 minutes. He is expected to have another treatment today, plus intensity-modulated radiation therapy, or IMRT, on Monday.

Last week, doctors said bleeding from the brain tumors apparently led to a fluid buildup and the need for a shunt. At a press briefing two days ago, they indicated the bleeding had resolved.

Dr. Michael Robertson, director of the lymphoma program at the Indiana University Cancer Center in Indianapolis, said he was unsure why the mayor’s fluid level might have increased. Most patients with primary central nervous system lymphoma don’t have that kind of fluid buildup, he said.

Dr. Robertson, who has no direct knowledge of the mayor’s condition or treatment, said it was difficult to say whether the latest fluid buildup is a negative development.

“I think this is another instance where we’ll have to wait and see,” he said.

The radiation therapy the mayor is getting will target four brain tumors that did not respond to three rounds of high-dose methotrexate chemotherapy.

At Wednesday’s briefing, UPMC Hillman Cancer Center neuro-oncologist Dr. Frank Lieberman said, “At this point, the tumors, which are not shrinking, are causing neurologic problems. In order to improve his level of function, we’re going to have to get rid of those lymphoma masses. That’s what this radiation therapy is designed to do.”

He added, “If the mayor responds to therapy, he’s going to improve neurologically and for a substantial period of time.”

Source: Post Gazette 

Pregnant women with breast cancer can be safely treated with a common chemotherapy combination during both the second and third trimesters, researchers report.

The majority of babies will not experience significant short-term complications linked to maternal treatment, they added.

“Further follow-up of the children is required to determine the potential long-term effects of this exposure,” wrote researchers at the M.D. Anderson Cancer Center, in Houston. “However, our short-term data are reassuring.”

The study was published in the Aug. 7 online edition of Cancer.

As women have babies later in life, experts have hypothesized that more women will be diagnosed with breast cancer while they are pregnant. However, there’s little data on how chemotherapy might affect a child in utero.

To help answer that question, the Texas team undertook a trial involving 57 pregnant breast cancer patients. All were treated with a common chemotherapy protocol (FAC or 5-fluorouracil, doxorubicin, cyclophosphamide) either after surgery or before surgery. More than one-third (35.1 percent) of the women underwent surgery in their second trimester, while 33.3 percent had surgery after delivery. Most of the women were diagnosed with advanced-stage breast cancer.

Of the original group of women, 40 are now alive and disease-free, three have had recurrences of breast cancer, 12 died of the disease, one died of other causes and one was lost to follow-up.

All women who delivered had live births; there were no stillbirths or miscarriages. One child had Down syndrome, and two had congenital abnormalities including club foot. The researchers followed the children’s health for more than three years and found that most of the children were healthy although two had special education needs. Some of the children had breathing difficulties requiring ventilation at the time of birth.

Rather than receiving radiotherapy or having their prostate removed, as is sometimes currently the case, many low-risk prostate cancer patients would be better off if their doctors kept an eye on their cancer until treatment became necessary, say researchers from the University of Michigan in Ann Arbor, USA. You can read about this in the Journal of the National Cancer Institute, August 16 issue.

Past guidelines for early-stage prostate cancer was to remove the prostate. However, as cancers are easier to detect these days, prostate cancers are being detected at ever earlier stages. The researchers suggest that treating the prostate cancer today at a very early stage may not be in the best interests of the patient. In fact, studies have found that early aggressive treatment does nothing to improve patient survival, and could even harm his health.

The researchers looked at data on 71,602 men, all aged over 70, who were diagnosed with prostate cancer in the period 2000-2002. They then broke them down into those who received various therapies and those who were not treated (a ‘wait and see’ approach).

24,825 of them had lower-risk prostate cancers. Assuming waiting for treatment would have been the best approach for these cancers, the team found that 10% of these patients were overtreated with prostate removal and 44% with radiation therapy.

The researchers wrote “Efforts to reduce overtreatment should be a clinical and public health priority.”

Almost one in five children treated for acute lymphoblastic leukemia does not receive the appropriate chemotherapy regimen due to medication errors, according to a new study.

The study reveals that 10% of chemotherapeutic medications for outpatients were prescribed or administered incorrectly. Although most were of little clinical significance, in some patients the errors may have put the patients at risk either for relapse or for overdose-related complications.

In the US, medical errors cause up to 98,000 hospital deaths per year – more deaths than by motor vehicle accidents and breast cancer combined. Medication errors are attributable to almost 7,000 inpatient deaths. Medication errors in the outpatient setting are thought to be some of the most common medical errors, but they are not well-studied, particularly in children.

These mistakes can occur in prescribing by physicians, during interpretation and processing by pharmacists, and when administered by patients or their caregivers. Most mistakes among outpatients are caught before drugs are given to patients, and because most drugs have wide safety ranges, most errors are benign. Children with cancer, however, receive extremely toxic drugs with narrow safe dose ranges and must be prescribed according to specific, sometimes complex, protocols.

Led by Dr James Taylor of the University of Washington and Children’s Hospital and Regional Medical Center in Seattle, researchers studied the rate and types of medications errors that occur in children receiving outpatient chemotherapy regimen for acute lymphoblastic leukemia (ALL). The authors reviewed the administration of drugs and the medications prescribed and dispensed to 69 enrolled patients.

One or more errors were identified in 17 of 172 (9.9%) chemotherapeutic medications and impacted 13 of 69 (19%) pediatric patients. Of the 17 errors, 12 were attributed to how the medications were administered to the patient, and five were attributed to prescribing errors – that is, incorrect dosages. There were no dispensing errors by a pharmacy.

Although there was little clinical impact of the errors in nine of the 13 patients, errors in four children were potentially clinically significant. Three patients failed to receive medications at the appropriate time, increasing the risk of relapse. One patient received an overdose of medication and, consequently, was at greater risk for life-threatening infection.

“It is possible that the efficacy of treatment regimens is reduced or toxicity increased because not all children are receiving the chemotherapeutic agents as indicated,” said Dr Taylor. Moreover, the authors recommended, “in designing new [chemotherapy] protocols, a balance needs to be struck between the precision of dosing regimens and simplification so that medication errors are minimized.”