MedicalResearch.com Interview with: Gregory J. Tsongalis, PhD, HCLD, CC, FNACB
Professor of Pathology
Director, Molecular Pathology
Co-Director, Translational Research Program
Department of Pathology
Dartmouth Hitchcock Medical Center and
The Audrey and Theodor Geisel School of Medicine at Dartmouth Lebanon, NH 03756
MedicalResearch: What are the main findings of the study?
Dr. Tsongalis: This was the first study of its kind looking at multiple genes and multiple mutations in tumors of the appendix. Many of the identified mutations may be clinically actionable with respect to response to therapy or selection of therapy.
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MedicalResearch.com Interview with: Dr. Carlo Riccardo Rossi, MD
Melanoma and Sarcoma Unit, Veneto Institute of Oncology
Surgery Branch, Department of Surgery
Oncology, and Gastroenterology, University of Padova,
Padova, Italy
MedicalResearch: What are the main findings of the study?
Dr. Rossi: A total of 90% patients undergone lymph node dissection for melanoma had 12, 7, 14, 6 and 13 excised lymph nodes (10th percentile of the distribution) after 3 level axillary, 3 level or less neck, 4 level or more neck, inguinal, or ilio-inguinal dissections, respectively.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Rates of bilateral mastectomy are higher in hospitals with immediate breast reconstruction available. Bilateral mastectomy rates were highest in hospitals with high volumes of immediate breast reconstruction. Large, teaching, urban, and Northeastern hospitals were more likely to have higher immediate breast reconstruction volumes.
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MedicalResearch.com Interview with: Dr. Ignacio F. San Francisco
Departamento de Urología, Facultad de Medicina,
Pontificia Universidad Católica de Chile, Santiago, Chile
MedicalResearch: What are the main findings of the study?Answer: Increasingly, men with low-risk prostate cancer are undergoing a close monitoring regimen called active surveillance, instead of moving forward immediately with treatment. However it is still unclear which men will develop evidence for worsening or more aggressive disease during active surveillance. In this study of 154 men with Gleason 6 prostate cancer followed for 38 months, we found that low levels of free testosterone were significantly associated with increased risk of developing more aggressive disease. We found no significant association with total testosterone concentrations, although there was a general trend towards increased risk with lower levels.
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MedicalResearch.com Interview with:Amit Singal MD MS
Assistant Professor of Medicine
Medical Director, Liver Tumor Program
Dedman Scholar of Clinical Care
Division of Digestive and Liver Diseases
University of Texas Southwestern
Dallas TX 75201 - 8887
MedicalResearch: What are the main findings of the study?Dr. Singal: We conducted a meta-analysis of current studies to characterize the association between hepatocellular carcinoma surveillance and early detection, curative treatment rates, and overall survival in patients with cirrhosis. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had hepatocellular carcinoma detected by surveillance. Hepatocellular carcinoma surveillance was associated with improved early stage detection (OR 2.08, 95% CI 1.80–2.37) and curative treatment rates (OR 2.24, 95% CI 1.99–2.52). These associations were robust to several sensitivity analyses, including study design, study location, and study period. Hepatocellular carcinoma surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67–2.17), which remained significant in the subset of studies adjusting for lead-time bias. Three-year survival rates were 50.8% among patients who underwent surveillance, compared to only 28.2% among hepatocellular carcinoma patients with tumors detected outside of a surveillance program.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery.
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MedicalResearch.com Interview with: Dr Andrea Schuessler
QIMR Berghofer Medical Research Institute
Herston, Queensland 4006
MedicalResearch.com: What are the main findings of the study?Dr . Schuessler: Recurrent glioblastoma is a very aggressive brain cancer and most patients do not survive much longer than 6 months. Our study has assessed a novel immunotherapy and treated 10 patients with late stage cancer. The treatment did not have any serious side effects and most of the patients have survived much longer than the expected 6 months. Importantly, four of the 10 patients have not shown signs of disease progression during the study period with one of them still being cancer free four years after the treatment.
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MedicalResearch.com Interview with:Arturo Araujo, PhD IMO
Moffitt Cancer Center
Tampa, FL 33612
MedicalResearch: What are the main findings of the study?Dr. Araujo: Using in vivo approaches it is often challenging to study the multiple simultaneous interactions occurring at various time points in the setting of bone metastasis. However, integrating biological data with a powerful computational model allowed us to build a tool that could not only mimic the in vivo growth of cancer in bone but also to determine how the disease was behaving at any given time point. The key finding for us was that the computational model demonstrated the phasic or cyclical nature of how the prostate cancers grow in bone. For example, a wave of osteoclast mediated bone resorption would be followed by sustained bone formation by osteoblasts, followed again by bone reposition. We think these findings could provide novel insights into when the best time to apply therapies might be in order to obtain maximum efficiency.
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MedicalResearch.com Interview with:Rajeev Desai
SpR Gastroenterology, City Hospital Birmingham
Honorary Clinical Research Fellow
University Hospital Birmingham / NHS Blood and Transplant, Bristol
MedicalResearch: What are the main findings of the study?Dr. Desai: This study of a large national cohort of organ donors shows that, following careful assessment and selection, organs from some donors with a previous history of cancer can be used safely for transplantation. The risks of accepting such organs for transplantation should be balanced with risks of non-acceptance and its consequences including delayed transplantation or non-transplantation.
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MedicalResearch.com Interview with: Tina Hieken, M.D.
Associate Professor of Surgery
Mayo Clinic,Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation.
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MedicalResearch.com Interview with: Hui Wang, M.D., Ph.D., Professor
Principal Investigator
Director, Food Safety Research Center
Institute for Nutritional Sciences, SIBS, CAS
MedicalResearch.com: What are the main findings of the study? Dr. Wang: This meta-analysis has systematically reviewed 25 relevant studies composed of 17,332 cancer cases to give a comprehensive perspective on the relationship between vitamin D and cancer patient outcomes. Our result demonstrated that vitamin D levels are linked to better outcomes in several types of cancer patients. The strongest link was found in breast cancer, lymphoma and colorectal cancer. There was less evidence of a connection in people with lung cancer, gastric cancer, prostate cancer, leukemia, melanoma or Merkel cell carcinoma, but the available data were positive. We also found that a 10 nmol/L increase in vitamin D levels was tied to a 4 percent increase in survival among people with cancer.
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MedicalResearch.com Interview with:Dr. Yvonne Bombard, PhD
Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital
Assistant Professor, Institute of Health Policy, Management and Evaluation,
Faculty of Medicine, University of Toronto
MedicalResearch.com: What are the main findings of the study?Dr. Bombard: The main finding of the study is that gene expression profiling tests play a critical role when women with early-stage breast cancer decide whether to have chemotherapy, but many of them do not fully understand what some of the test results mean. For many the gene expression profiling test was the main factor in their treatment decision.
The women we interviewed understood the test would indicate whether chemotherapy would be beneficial to them. But many thought the test reflected their unique circumstances and did not understand that their test result was based on larger population statistics. Patients often viewed their gene expression profiling results as providing information that was more scientifically valid, uniquely personalized and emotionally significant than any other information they had received. For many, the test was a transformational element that empowered them, allowed them to feel confident in their decisions and may even have rescued them from unnecessary chemotherapy.
Patients described emotionally and socially complex reasons why they valued gene expression profiling testing in making their treatment decisions. Patients valued the test because it provided them with certainty amidst confusion, with options and a sense of empowerment, and with personalized, authoritative information.
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MedicalResearch.com Interview with:Alice Dragomir, MSc, PhD
Assistant Professor,
Urology/Surgery, McGill University
Scientist, RI-MUHC
MedicalResearch.com: What are the main findings of the study?Authors’ response: Our study demonstrates that for eligible patients, active surveillance could offer not only the known clinical advantages from the patient’s perspective, but also economic benefits from the health care system’s perspective. At the national level, the cost savings of an annual cohort of incident prostate cancers managed with active surveillance over a first year and 5 years of follow-up could be substantial. These are estimated at $96 million.
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MedicalResearch.com Interview with:Danielle Blanch Hartigan, PhD, MPH
Cancer Prevention Fellow
National Cancer Institute
MedicalResearch.com: What are the main findings of the study?Dr. Blanch-Hartigan: Results from this nationally-representative survey of oncologists and PCPs suggest that discussion of survivorship care planning with cancer survivors does not always occur. Training and knowledge specific to survivorship care and coordinated care between PCPs and oncologists were associated with increased survivorship discussions with survivors.
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MedicalResearch.com Interview with:Daniel I. Sessler, M.D.
Michael Cudahy Professor and Chair, Department of Outcomes Research
Cleveland Clinic, Cleveland, OH
MedicalResearch.com: What are the main findings of the study?Dr. Sessler: Free fatty acids, arachidonic acid and linoleic acid, and their metabolites hydroxyeicosatetraenoic acids (5-HETE, 11-HETE, 12-HETE, and 15-HETE) were 1.8 to 5.7-fold greater in 37 patients with adenocarcinoma versus 111 patients without cancer (all P<0.001). Areas under the receiver operating characteristics (ROC) curve were significantly greater than 0.50 discriminating lung cancer patients and controls for all biomarkers and phospholipids, and ranged between 0.69 and 0.82 (all P<0.001) for lung cancer patients versus controls. Arachidonic acid, linoleic acid, and 15-HETE showed sensitivity and specificity >0.70 at the best cutpoint. Concentrations of free fatty acids and their metabolites were similar in 18 squamous-cell carcinoma patients and 54 non-cancer controls.
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MedicalResearch.com Interview with:
Allison W. Kurian, M.D., M.Sc.
Assistant Professor of Medicine and of Health Research and Policy
Divisions of Oncology and Epidemiology
and
James M. Ford, MD
Associate Professor of Medicine
Pediatrics and Genetics, Division of Oncology,
Stanford University School of Medicine
MedicalResearch.com: What are the main findings of the study?Answer: We found that 11% of women who met standard clinical criteria for BRCA1 and BRCA2 (BRCA1/2) mutation testing, yet had tested negative, actually carried an actionable mutation in another cancer-related gene. We found that patients were highly motivated to learn about their genetic test results and new recommendations for cancer risk reduction. Over a short follow-up period, colonoscopy screening resulted in early detection of a tubular adenoma in a patient found to have a high-risk MLH1 mutation, and thus the multiple-gene testing in our study has likely prevented at least one cancer to date. We conclude that multiple-gene sequencing can benefit appropriately selected patients.
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MedicalResearch.com Interview with:Angelo M. De Marzo MD PhD
Professor of Pathology
Johns Hopkins School of Medicine
Baltimore, MD 21231
MedicalResearch.com: What are the main findings of the study?Dr. De Marzo: Working as a team with Dr. Elizabeth Platz and a group of other investigators we found that men with chronic inflammation in their benign areas of their prostate biopsies had a higher chance of prostate cancer, and especially higher grade cancers, which are associated with disease aggressiveness. A key unique aspect of the study is that the samples were taken from man who were enrolled in the Prostate Cancer Prevention Trial (PCPT), a trial in which all men entering the study had a relatively low PSA, and, all men at the end of study who did not already have a diagnosis of prostate cancer were offered a prostate biopsy regardless of their PSA. This study design, unlike a standard association study, allowed us to minimize the potential bias whereby inflammation is associated itself with elevations in PSA. In this standard design approach, when cancer is detected it could artifactually appear that inflammation is associated with cancer because the inflammation was in part driving the PSA elevation, which prompted the biopsy in which cancer was detected.
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MedicalResearch.com Interview with:Dr. Lorraine R. Reitzel Ph.D
Associate Professor in the Health Program of the Department of Educational Psychology
College of Education, University of Houston in Houston, Texas.
MedicalResearch.com: Please tell us about your study.Dr. Reitzel: The current study represented a secondary analysis of data that were collected by Dr. Lorna McNeill and colleagues at The University of Texas MD Anderson Cancer Center. The parent study was focused on better understanding factors associated with cancer risk among African American adults, and several faculty members including myself contributed ideas about the variables we thought might play a role. The current study represents one of several studies emerging from these data. The current study was led by Ms. Pragati S. Advani, a graduate student on my research team, who was interested in better understanding the associations between financial strain and modifiable behavioral risk factors for cancer among African American adults. Financial strain represents an unfavorable income to needs ratio and was assessed using a questionnaire that tapped into current difficulty affording things that represent pretty basic components of life, including suitable food, clothing, and housing for the respondent and their family. The modifiable behavioral risk factors for cancer examined included smoking cigarettes, at-risk alcohol use, being overweight/obese, getting insufficient physical activity, and having inadequate fruit and vegetable intake. We also included a tally of the total number of these factors (0 to 5) as an outcome variable of interest.
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MedicalResearch.com Interview InvitationDorna Jafari, M.D. and
Michael J Stamos, MD
Professor of Surgery
John E. Connolly Chair,
Department of Surgery
University of California, Irvine
Orange, CA 92868
MedicalResearch.com: What are the main findings of the study?Answer: Surgeons are faced with an aging population and data regarding outcomes is rare given that many studies preclude the elderly from the study population. Therefore, it is difficult to accurately discuss risk of surgical resection given the lack of data. Therefore we aimed to report the national trends and outcomes of colorectal cancer treatment in the elderly population.
We demonstrated that the majority of resections are performed in patients >65yeras old. There is a trend towards a decrease in incidence of colorectal resection and a decrease in rate of mortality during 2001-2010. However, the unique physiological changes associated with aging contribute to increase morbidity and morality as demonstrated by our findings. In fact patients >85 years have a 472% increase in risk-adjusted mortality during a hospital admission compared to younger patients. However, despite the substantially higher mortality and morbidity associated with age, there has been a marked improvement in surgical outcomes in the elderly population.
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MedicalResearch.com Interview with:Renda Soylemez Wiener, MD, MPH
Assistant Professor of Medicine
The Pulmonary Center
Boston University School of Medicine
Center for Healthcare Organization & Implementation Research
Edith Nourse Rogers Memorial VA Hospital
MedicalResearch.com: What are the main findings of the study?Dr. Soylemez Wiener: The main finding is that evaluation of pulmonary nodules to determine whether or not they are cancerous is inconsistent with clinical practice guideline recommendations in almost half of cases, suggesting there is room for improvement in clinical care of these patients. Patients with pulmonary nodules are sometimes evaluated more aggressively than they should be (18%), which can cause harms to patients from unnecessary invasive tests (biopsies or surgery) or unneeded radiation exposure from imaging studies. Still more patients (27%) are followed less aggressively than they should be, which in the worst case scenario could lead to delays in the diagnosis and treatment of cancer. It is particularly important to improve care of these patients now, because new guidelines from the US Preventive Services Task Force recommend CT screening for lung cancer screening, which often finds pulmonary nodules that require evaluation. (more…)
MedicalResearch.com Interview with:Barbara A. Cohn, Ph.D.
Director, Child Health and Development Studies
A Project of the Public Health Institute
Berkeley, CA 94709
MedicalResearch.com: What are the main findings of the study?
Women with irregular menses had a statistically significant 2.4 fold increase in risk of death due to any form ovarian cancer, and a statistically significant 3-fold increase in risk of death due to late stage serous disease. Consistent with these findings, the incidence of late stage disease at diagnosis, and late stage serous cancer was increased about 2-fold in women with irregular menses.
Irregular menses was defined as irregular cycles (variation of 10 days or more) or infrequent cycles (>35 days) or history of annovulatory cycles identified during an in-person interview with women at an average age of 26 years or mentioned in their medical records.
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MedicalResearch.com Interview with:
Julian Benito-Leon
University Hospital “12 de Octubre”,
Madrid, Spain
MedicalResearch.com: What are the main findings of the study?
Dr. Benito-León: It...
MedicalResearch.com Interview with:Sabina Sieri, PhD
Epidemiology and Prevention Unit
Department of Preventive & Predictive Medicine
Fondazione IRCCS Istituto Nazionale dei Tumori
20133 Milan – Italy
MedicalResearch.com: What are the main findings of this study?Dr. Sieri: In our study we found that there was an increased risk of developing breast cancer from high saturated fat intake. High total and saturated fat intake were associated with greater risk of ER PR positive breast cancer. High saturated fat intake was also associated with a greater risk of HER2 negative disease. So, a high-fat diet increases breast cancer risk and, most conspicuously, a high saturated fat intake increases the risk of developing hormone-sensitive diseases, suggesting saturated fat involvement in the etiology of hormone-sensitive breast cancer.
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MedicalResearch.com Interview with Dr. Judy C. Boughey MD
Professor of Surgery
Mayo Clinic, Rochester MN
MedicalResearch.com: What are the main findings of the study? Dr. Boughey: This study showed that the rate of reoperation after lumpectomy for breast cancer was significantly lower at Mayo Clinic in Rochester compared to national data. Mayo Clinic in Rochester uses frozen section analysis of margins at time of lumpectomy to direct any margin re-excisions during the surgery and therefore has a significantly lower rate of need for a second operation to ensure clean margins. The rate of reoperation was four times higher in the national data set than in the Mayo Clinic data set. (more…)
MedicalResearch.com Interview with: Dr. Heather Wakalee MD
Associate Professor of Medicine (Oncology)
Stanford University Medical Center
MedicalResearch.com: What are the main findings of the study?Dr. Wakalee: CO-1686, with the new hydrobromide formulation, has been active at multiple dose levels (500, 750 or 1000 mg orally twice daily). The response rate in patients with EGFR mutant (non-small-cell Lung Cancer) NSCLC that has progressed after therapy with EGFR TKI, and has centrally confirmed T790M, is 64% per RECIST. The majority of responses are ongoing at the time of this report. The drug has been overall very well tolerated.
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MedicalResearch.com Interview with:
Dr. LydiaPace, MD, MPH
Division of Women’s Health, Brigham and Women’s Hospital
Boston, Massachusetts
MedicalResearch.com: What are the main findings of the study?Dr. Pace: We reviewed the existing literature about the benefits and harms of mammography, focusing on the reduction of breast cancer deaths associated with mammography, as well as the two most often-discussed harms: false positive results and overdiagnosis. We also reviewed the literature about interventions to help patients make informed decisions. We found that the literature suggests that routine screening mammography does reduce mortality associated with breast cancer, across all age groups. However, it is also associated with high rates of false positive results, and considerable rates of overdiagnosis. Overdiagnosis is the most concerning potential risk of mammography screening. Overdiagnosis is the detection of a tumor through screening that would never have caused problems for a patient. It occurs either because of a very slow-growing tumor, or because a woman has medical problems (or is old enough) such that she will likely die of another cause before the cancer became apparent. Overdiagnosis is concerning because we cannot know when a cancer is overdiagnosed, and thus a patient who is overdiagnosed will receive unnecessary treatment for cancer. The scientific literature on mammography is complex, and there are important limitations to the studies both of mammography’s benefits and harms. However, we feel that the best available data suggest that among 10,000 50 year old women undergoing annual mammography for 10 years, 5 deaths will be averted through screening mammography, while about 6130 women will experience at least one positive result. Furthermore, there is about a 19% chance that, if that woman is diagnosed with cancer detected by a mammogram, that cancer is one that would never have caused her problems. Lastly, our review showed that we need more studies to guide us in how an individual woman’s risk should dictate her mammography decisions, and how to support women in making those decisions. However, we know that most women with higher risk for breast cancer will experience higher benefit from mammography screening. (more…)
MedicalResearch.com Interview with: Jan Akervall, M.D., Ph.D.
Co-director, Head and Neck Cancer Multidisciplinary Clinic
Beaumont Hospital, Royal Oak
Clinical Director of Beaumont’s BioBank
MedicalResearch.com: What are the main findings of the study?Dr. Akervall: We identified biomarkers that can predict who will have an unfavorable response from radiation for head and neck cancer. These can be analyzed using standard laboratory techniques on biopsies that routinely are taken for diagnosis.
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MedicalResearch.com Interview with:Dr. Thomas M. Pisansky MD
Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What are the main findings of the study?Dr. Pisansky:This patient-reported outcomes research did not identify a beneficial effect of once-daily tadalafil to prevent radiotherapy-related erectile dysfunction in men with prostate cancer.
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MedicalResearch.com Interview with:M.S. Reimers, MD PhD Student
and
Dr. Jan Liefers MD
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
MedicalResearch.com: What are the main findings of the study?Answer: Aspirin use was associated with an improved survival, as we have published before when investigating this cohort (Bastiaannet et al, Brit J Cancer 2012/ Reimers et al. J Am Geriatr Soc. 2012. In this study we have focused on investigating which patients will benefit from aspirin treatment by investigating some tumor markers, such as PTGS2 expression, HLA class I expression and PIK3CA mutation status. Interestingly, only patients with HLA class I expression on their tumor membrane will benefit from aspirin treatment and have a better outcome. We raise the hypothesize that aspirin inhibits platelet aggregation to circulating tumors cells. By interfering with this process, the metastatic potential of these circulating tumour cells is inhibited, thereby preventing metastasis and colon cancer death.HLA class I expression might be needed for signalling between platelets and circulating tumor cells. If this hypothesis is confirmed by others or in vitro studies, than this might explain the finding that aspirin seems not only beneficial as an adjuvant therapy for colorectal cancer patients, but also for patients with other malignancies (oesophagus, breast, etc). Interestingly, preliminary findings from our team investigating aspirin use in oesophageal cancer also showed that aspirin use in these tumors was associated with an improved survival.
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MedicalResearch.com Interview with:Hanna Sanoff MD, MPH
Lineberger Comprehensive Cancer Center
Department of Medicine
University of North Carolina, Chapel Hill, NC
MedicalResearch.com: What are the main findings of the study?Dr. Sanoff: We measured p16, a protein that increases with cellular aging, in blood cells of women receiving chemotherapy for breast cancer. We found that a standard course of chemotherapy led to an increase in p16 expression equivalent to what we have previous seen in people over the course of 10-15 years of chronological aging. This increase persisted in cancer survivors an average of three and half years after treatment.
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