Cancer

Posted on Cancer, Diabetes

How are immunocompromised patients dealing with the pandemic? | COVID-19 Special

How are immunocompromised patients dealing with the pandemic? | COVID-19 Special - YouTube


our immune system is critical for fighting off disease, but millions of people around the world are immunocompromised. This means their immune systems have been weakened either by a genetic disorder or by chronic illnesses like AIDS, Cancer or Diabetes. Living with such diseases is hard enough at the best of times, but in the age of COVID-19 a positive test could be a death sentence. As nations race to get their populations vaccinated those with an already compromised immune system are often not at the top of the list. How can overburdened medical systems keep these at risk people from falling behind?

Posted on Cancer, Diabetes

Metformin may affect risk of breast cancer in women with type 2 diabetes

Are there actually 5 types of diabetes?

A study of 44,541 women has found that there appears to be no association between type 2 diabetes and developing breast cancer overall. This may be because most women in the study with type 2 diabetes were taking metformin, a medication widely used to treat type 2 diabetes, whose actions may help to reduce the risk of developing oestrogen positive (ER-positive) breast cancer.

ER-positive breast cancer (cancer that has receptors on cell surfaces for the hormone oestrogen) accounts for about 80% of breast cancer diagnosed in the USA. Associations uncovered in the study suggested that the link between type 2 diabetes and breast cancer varied by breast cancer subtype and was affected by the use of metformin to treat diabetes. The study is published in the leading cancer journal Annals of Oncology [1] today (Friday).

Over the period of the study, which had an average of more than eight years of follow-up, the researchers found that type 2 diabetes was associated with a 40% increased risk of triple negative breast cancer (TNBC, breast cancer that lacks receptors for the hormones oestrogen and progesterone and the HER2 protein) when compared with women who did not have diabetes. In contrast, there was a small (8%) decrease in risk for ER-positive breast cancer. These results were not statistically significant.

When the researchers considered women according to the type of treatment they received, type 2 diabetes treated with metformin was associated with a 14% decreased risk of developing ER-positive breast cancer but a 25% increased risk of developing ER-negative breast cancer (breast cancer that lacks receptors for the hormone oestrogen) when compared to non-diabetic women. These results were also not statistically significant. However, there was a statistically significant 74% increased risk of developing TNBC among those treated with metformin.

Professor Dale Sandler, chief of the Epidemiology Branch at the US National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (USA), who led the research, said: “We also found that having type 2 diabetes for 15 years or more seemed to be associated with a 39% reduced risk of ER-positive breast cancer, and we think this is most likely to be because of long-term use of metformin. We found that, compared to non-diabetic women, the risk of developing ER-positive breast cancer was reduced by 38% among women with type 2 diabetes who had used metformin for ten years or more.

“Taken together, these findings suggest that having type 2 diabetes may increase the risk of developing breast cancer, but that taking metformin may protect against developing ER-positive breast cancer, the most common type of breast cancer. Metformin did not appear to protect against ER-negative or triple negative breast cancer. We can’t say for sure if the increased risk of triple negative breast cancer is because metformin doesn’t protect women against the negative effects of having type 2 diabetes or because metformin use can cause triple negative breast cancer. Since there are no mechanistic data supporting a causal effect of metformin, the former interpretation seems more likely.”

The researchers also found that among women who developed type 2 diabetes after joining the study, those who were treated with medications other than metformin had twice the risk of developing any type of breast cancer compared to non-diabetic women, and 2.6 times the risk of developing ER-positive breast cancer. However, the numbers in this group were small, only 13 women developed any type of breast cancer, and so this result needs to be treated with caution.

Previous studies have reported an increase risk of breast cancer in women with type 2 diabetes, but there has been conflicting evidence from more recent studies and on the association between metformin and breast cancer. The current study analysed data from the Sister Study, which enrolled women from the USA and Puerto Rico between 2003 and 2009 using follow-up data through to the end of 2017 (although women continue to be followed after that date). At enrolment, the women were 35-74 years old, had no previous diagnosis of breast cancer, but were sisters or half-sisters of women diagnosed with breast cancer. The women completed annual health updates and follow-up questionnaires every three years.

The first author of the study, Dr Yong-Moon Mark Park, a postdoctoral fellow at the NIEHS, NIH, when the study was conducted (now an assistant professor at the University of Arkansas for Medical Sciences, USA), said: “Our study is the first to try to disentangle the effects of type 2 diabetes and the effects of metformin use. Having information about subtypes of breast cancer that may have different causes helped us to reach our conclusions. However, it’s important to note that some of our findings, especially for triple negative breast cancer, were based on a small number of cases and those results need replication. Further studies are needed to discover whether the apparent increased risk of triple negative breast cancer is caused by metformin or is due to the absence of protection from metformin.”

Possible mechanisms by which metformin may reduce breast cancer risk include that it improves insulin sensitivity, and corrects high insulin levels by reducing the amount of insulin and insulin-like growth factor circulating in the body, which may activate cell signals involved in cancer; it may slow breast cancer growth by activating an enzyme called adenosine monophosphate activated protein kinase (AMPK), which inhibits a pathway involved in the proliferation of cancer cells; and it may reduce the risk of ER-positive breast cancer by inhibiting oestrogen receptors that plays a role in the development and progression of breast cancer.

Strengths of the study include its prospective design, a large group of women and high rates of follow-up (90%). Limitations include the fact that the researchers were unable to account for glucose control and progression or improvement of type 2 diabetes, which could affect the risk of breast cancer; it was difficult to disentangle the effects of diabetes from the effects of medication as so many women were prescribed metformin and used it for many years; there was no information on metformin dose, which could reflect severity of diabetes or duration, but also might play a role in the degree of protection it provided.

In an accompanying editorial [2], Dr Ana Lohmann from the University of Western Ontario, and Dr Pamela Goodwin from the University of Toronto, Canada, write: “Despite the inclusion of 44,541 subjects, there were only 277 BCs [breast cancers] diagnosed in women with T2D [type 2 diabetes], including 25 TNBC; 177 and 20, respectively of these received metformin. The significant association of T2D with risk of TNBC in the subgroup treated with metformin (n=20) may have reflected chance and/or uncontrolled bias and confounding.”

They conclude: “The report by Park adds to the growing evidence linking T2D and its treatment to BC risk but definitive conclusions regarding these associations are not yet possible. Clearly, this is an important area and additional research is needed to untangle the web of inter-related associations of T2D, its treatment and BC risk . . . Over time, consistency of associations across studies should be sought and the biologic plausibility of any associations that are identified established.”

Posted on Cancer

World Cancer Day 2020: International survey reveals unacceptable cancer awareness divide

Today’s World Cancer Day, led by the Union for International Cancer Control (UICC), aims to mobilise urgent action from individuals, governments, and the global cancer community to close the clear and unacceptable gaps in cancer risk awareness between higher and lower socioeconomic groups and the subsequent impact on their health-promoting behaviours.

To mark the 20th anniversary of World Cancer Day, UICC commissioned a global survey to form an up-to-date picture of the public’s experiences, views, and behaviours around cancer. Conducted by Ipsos, the survey includes more than 15,000 adults across 20 countries in the first multi-country public survey on cancer perceptions in a decade. The survey’s results, detailed in UICC’s report released today, International Public Opinion Survey on Cancer 2020: What people feel, think and believe about cancer today, indicate a clear divide between higher and lower socioeconomic groups when it comes to knowledge and awareness of cancer risks and, as a result, the practice of behaviours to limit such risk.


Chief Executive Officer, Union for International Cancer Control, Dr Cary Adams said:

“It is unacceptable that millions of people have a greater chance of developing cancer in their lifetime, because they are simply not aware of the cancer risks to avoid and the healthy behaviours to adopt – information that many of us take for granted. And this is true around the world.”

Awareness of cancer risks

The survey’s results show that there is generally a high level of cancer awareness among the surveyed population globally. Tobacco use (63%), exposure to harmful UV rays (54%) and exposure to tobacco smoke from others (50%) appear to be the most recognised factors that can increase a person’s risk of cancer. Meanwhile, a lack of exercise (28%), exposure to certain viruses or bacteria (28%) and being overweight (29%) appear to be the least recognised cancer risk factors.

However, individuals from a lower-income household bracket in the countries surveyed are less likely to recognise cancer risk factors than those from higher-income households. In all areas except tobacco use, this trend can also be seen when comparing people surveyed who have not completed a university education to those with university educations.

Practicing cancer prevention

Irrespective of where people live in the world, those surveyed with a lower education and those on lower incomes appear less aware of the main risk factors associated with cancer and appear less likely to proactively take the steps needed to reduce their cancer risk than those from a high income household or with a university education.

What should be done: Prioritising awareness raising to support health-promoting behaviours

An overwhelming 84% of individuals surveyed felt that governments should be taking action in relation to cancer whilst nearly a third of individuals surveyed believed that it is most important for governments to improve the affordability of cancer services – a measure notably emphasised by people surveyed in lower middle-income countries.

UICC President HRH Princess Dina Mired of Jordan said: “To tackle the global cancer burden now and for the future, governments and decision makers across the international cancer community must come together to ensure that everyone is afforded every opportunity to take control over their cancer risk – no matter their education or income level.”

To help raise greater awareness around cancer and to support health-promoting behaviours so that no one gets left behind, UICC is calling for all governments to:

  • Prioritise cancer awareness raising and prevention through progressive health policies and education to support healthy decisions and health-promoting behaviour, with a focus on engaging lower socioeconomic populations
  • Ensure the public is provided with up-to-date information on cancer risks and cancer prevention, and importantly that the information is presented and delivered in a way that is accessible by individuals from lower socioeconomic backgrounds
  • Implement policy to help reduce the consumption of known cancer-causing products (e.g. tobacco, sugary food and beverages), to encourage health-promoting behaviours, particularly among lower socioeconomic groups
  • Invest proactively in national cancer control planning and the establishment of population-based registries to ensure the most effective resource allocation that benefits all groups
  • Continue to raise awareness with each new generation to help ensure that up-to-date information on cancer risks and cancer prevention is not taken for granted

As part of World Cancer Day’s ‘I Am and I Will’ campaign, which calls on each person to make a commitment – big or small – UICC recommends that everyone:

  • Use World Cancer Day as an opportunity to improve your understanding of cancer risk factors and share your knowledge with others
  • Make a personal commitment to reduce your cancer risks like quitting smoking, eating healthily, exercising regularly, and using sunscreen
  • Take advantage of what your health system can provide, including getting a check-up, getting screened, and getting vaccinated
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What are the early signs and symptoms of a melanoma?




A melanoma

A melanoma

The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole.

Normal moles are usually round or oval, with a smooth edge, and no bigger than 6mm (1/4 inch) in diameter (see first photo).




See your GP as soon as possible if you notice changes in a mole, freckle or patch of skin, particularly if the changes happen over a few weeks or months (see second photo, below).

Signs to look out for include a mole that’s:

getting bigger

changing shape

changing colour

bleeding or becoming crusty

itchy or sore

The ABCDE checklist should help you tell the difference between a normal mole and a melanoma:

Asymmetrical – melanomas have two very different halves and are an irregular shape.

Border – melanomas have a notched or ragged border.

Colours – melanomas will be a mix of two or more colours.

Diameter – melanomas are larger than 6mm (1/4 inch) in diameter.

Enlargement or elevation – a mole that changes size over time is more likely to be a melanoma.

See ABCDE of moles for a visual guide.

Melanomas can appear anywhere on your body, but they most commonly appear on the back in men and on the legs in women. They can also develop underneath a nail, on the sole of the foot, in the mouth, or in the genital areas, but these types of melanoma are rare.

Melanoma of the eye

In rare cases, melanoma can develop in the eye. It develops from pigment-producing cells called melanocytes.

Eye melanoma usually affects the eyeball. The most common type is uveal or choroidal melanoma, which occurs at the back of the eye. Very rarely it can occur on the conjunctiva (the thin layer of tissue that covers the front of the eye) or in the iris (the coloured part of the eye).




Noticing a dark spot or changes in vision can be signs of eye melanoma, although it’s more likely to be diagnosed during a routine eye examination.

Read more about melanoma of the eye.

Posted on Cancer

Cervical cancer ‘could become a thing of the past’




Cervical cancer

Cervical cancer

“Cervical cancer could be eliminated in most countries by 2100,” reports The Guardian.




The headline is prompted by a new study that predicted what might happen to cervical cancer over the next 50 years.

Most cases of cervical cancer are caused by the human papillomavirus (HPV), and there are effective vaccines that can protect people from contracting HPV.

It’s hoped that the number of cases of cervical cancer will be greatly reduced in countries where the vaccine is widely used.

But vaccination rates are much lower in poorer parts of the world.

Also, while vaccination protects young people who have never come into contact with HPV, it does not treat established infections.

That means women who may have been infected with HPV in the past still need to be screened for cervical cancer.

Pre-cancerous cells spotted in screening can be removed.




The researchers looked at what might happen to cervical cancer worldwide under different situations.

For example:

carrying on at current rates of screening and vaccination

introducing rapid, widespread vaccination and screening

introducing vaccination and screening more gradually

They worked out that, if nothing changes, 44.4 million women will get cervical cancer between 2020 and 2069.

If vaccination and screening were introduced rapidly from 2020, 12.4 to 13.4 million of these cases could be avoided.

This could bring the rate of cervical cancer down to 4 per 100,000 women a year or lower in most countries around the world, which the researchers say is virtual elimination.

Read more about HPV vaccination and cervical screening.

Where did the story come from?

The researchers who carried out the study came from the Cancer Council of New South Wales in Australia, the International Agency of Research into Cancer in France, and the Albert Einstein College of Medicine in the US.

It was funded by the National Health and Medical Research Council of Australia and published in the peer-reviewed journal Lancet Oncology.

The Guardian’s coverage of the study was balanced and accurate.

What kind of research was this?

This statistical trends analysis and modelling study used data on cancer diagnoses, along with research about the impact of vaccines and cancer screening, to predict what might happen in the future under different scenarios.

This type of modelling is useful for governments and healthcare organisations to get an idea of the potential impact of policies.

But these studies have to make a lot of assumptions about what might happen, any one of which could turn out to be wrong.

This means they may not be particularly accurate predictions of the future.

What did the research involve?

Researchers used data from 37 cancer registries in 8 global regions, ranging from very high income to low income, along with data about population growth and ageing patterns, to predict what would happen if current levels of vaccination and screening stayed the same during the 50 years from 2020 to 2069.

They then used assumptions from research into vaccine and screening effectiveness, and about the “herd immunity” effect that reduces infection spread in a population once a proportion of them are protected by vaccination.

They used this information to feed into a statistical model, which allowed them to predict the possible effects of future global vaccination and screening programmes.

From these results, they calculated the number of cases of cervical cancer that might be prevented by different programmes, and when countries might hit the 4 in 100,000 cancer rate at which they consider the cancer virtually eliminated.

What were the basic results?

Without change, the researchers calculated that 44.4 million women would get cervical cancer between 2020 and 2069, with an annual rate by 2069 of 1.3 million cancers, up from 600,000 in 2020.

The increase would be because the progress already made in vaccination and screening would be offset by expected population growth and ageing during that time.

The most positive scenario was the introduction of rapid vaccination coverage, so 80 to 100% of 12-year-old girls were vaccinated, plus HPV screening of 70% of women aged 35 and 45 (twice in a lifetime).

If both were rapidly introduced from 2020, between 12.5 million and 13.4 million cases of cervical cancer could be prevented.

Under this scenario, cancer would be virtually eliminated from high-income countries like the UK by 2060, and from most countries around the world by 2100.

But it would remain at slightly higher levels in some east African countries, which would require additional measures to reach elimination.

If both vaccination and screening was improved, but more slowly, the benefits would take longer to show, meaning fewer cases of cancer could be averted.

Under a scenario where 20 to 45% of girls were vaccinated by 2030 and 40 to 90% by 2050, and 25 to 70% of women were screened by 2030 and 90% by 2050, cervical cancer rates in low-income countries would remain at 14 per 100,000 by the end of the century, although the cancer would have been eliminated in high-income countries.

If the improvements were only in vaccine roll-out, only 6.7 to 7.7 million cases of cancer would be averted.

How did the researchers interpret the results?

The researchers say their models show “devastating consequences” of an additional 44.4 million cervical cancers over 50 years if current levels of vaccination and screening are not changed.

They say their research will aid the production of a global strategy to prevent cervical cancer, due to be considered by the World Health Organization in 2020.

“The findings presented here have helped inform initial discussions of elimination targets, and ongoing comparative modelling with other groups is supporting the development of the final goals and targets for cervical cancer elimination,” they say.

Conclusion

There were 3,126 cases of cervical cancer in the UK in 2015. Almost all cases of cervical cancer are preventable through vaccination and screening.

The HPV vaccine has been shown to be highly effective, and future generations of women in the UK are expected to be well-protected against cervical cancer.

Sadly, many women around the world do not have access to vaccination or screening.

Most cases of cervical cancer (85% in 2012) happen to women in low- or middle-income countries.

That’s why increasing vaccine coverage and screening is important if we want to eliminate cervical cancer worldwide, not just in wealthy countries.

This study shows what a difference these programmes could make if they were adopted quickly and widely.

This study is based on modelling and statistics, so it may not be an accurate prediction of what would happen.

The study’s limitations include:

it’s unable to take account of all the global events and changes of trend that could potentially affect cervical cancer rates, such as the age at which women or girls marry, sexual behaviour patterns, the effect of wars on healthcare campaigns, and natural disasters

assumptions about the long-term effectiveness of the vaccine (the researchers assume lifelong 100% effectiveness) may be too high

there’s little good-quality information on rates of cervical cancer in many low-income countries

the research does not adjust for the effects of HIV infection, which can affect the rate at which HPV infections convert into cervical cancer

Find out more about cervical cancer screening and HPV vaccination

Analysis by Bazian
Edited by NHS Website