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Updates found with 'year'

SCREENING MAMMOGRAPHY - A UNDERUTILISED TOOL AGAINST BREAST CANCER IN INDIAIndian context of breast cancer:Breast cancer is the most common cancer diagnosed in india, close 1.5 lakh new cases are diagnosed each year.It Constitutes around 10% of all new cancer cases diagnosed in a year.In india approximately 40% of breast cancer patients are younger then 50 years while this could be real but may also be due to underreporting of breast cancer in elderly indian women.Almost half of the indian breast cancer patients present in stages III and IV.Advancing age is the most important risk factor for breast cancer.One of the major reasons for late diagnosis is lack of awareness regarding screening programmes in breast cancer.2016 update US preventive service task force makes for following recommendation:-Recommends screening mammography every 2 years in asymptomatic average risk*women between age 50-74 years.*A women is said to be at average risk of breast cancer provided they do not have any preexisting breast cancer or a high-risk breast lesion and wthout any high risk genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.-For average risk women between age group of 40-49 years, the decision to start screening or not should be an individualised knowing that the absolute benefit in survival is small.- Maximum benefit of screening mammography in terms of prolonging life is seen in age group of 60-69 years. Questions regarding breast cancer screening in indian women?- Cost effectiveness was not taken into consideration by US preventive task force, which may be an important consideration in developing country like india.- As we know indian women are being diagnosed at younger age and probably should benefit more if routine screening age is 40 years.
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Decoding Lynch syndrome -- Colorectal cancer(CRC)Lynch syndrome is the most common cause of inherited Colorectal cancer (CRC-large intestine cancer). It constitutes 3% of all newly diagnosed colorectal cancer burden.In lynch syndrome there is germline mutation in DNA mismatch repair (MMR) genes.It has a autosomal dominant pattern of inheritance.MLH1; MSH2; MSH6; PMS-2 are genes that are commonly mutated which results in changes in repetitive nucleoside sequences known as microsatellite.These changes in microsatellites ie microsatellite instability (MSI) result in change of expression of genes involved in cell growth.MSI is not specific for Lynch syndrome but can be seen in other sporadic CRC patients.Progression of adenoma to carcinoma in these families and patients takes 3 years as compared to a decade or longer in sporadic cancers.Screening for Lynch syndrome is done using IHC or MSI testing from tumor tissue but are confirmed by gene sequencing in somatic or germline specimen.Life time risk of developing CRC in lynch family is 10-47% depending on the gene mutated.CRC in lynch involve usually right colon and the survival in patients with lynch syndrome developing CRC is better.Screening strategy for lynch family include Colonoscopy (every 1-2 years) beginning 5 years prior to the age of the earliest diagnosed CRC patient in family. Prophylactic hysterectomy and bilateral salphingo-oopherectomy after age of 40 years is recommended for preventing endometrial cancer.
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Question- Is it possible to cure CML (CHRONIC MYELOID LEUKEMIA) one of the types of blood cancer with tablets (bcr-abl kinase inhibitor) eg imatinib, nilotinib or dasatinib?Answer- We don’t know the answer yet, but studies are now looking for stopping these tablets in patients who achieve desired response with them. This concept is called TFR (Treatment Free Remission)Question- What is TFR?Answer- TFR is defined as maintenance of less than minimal residual or undetectable BCR-ABL transcript level even after stopping BCR-ABL kinase inhibitors.Question – Which patients are ideal candidates for TFR?Answer- Ideal candidates are CML-Chronic phase patients who maintain stable and continuous DMR (deep molecular response) for more than 2 years, without any history of failure of response to any of the available TKIs (Tyrosine kinase inhibitor).Question – What percentage of these carefully selected patients maintain their TFR?Answer- Close to 50% patients maintain TFR for more than 1 year.Question- Important checklist before offering TFR?Answer- Patient compliance is of paramount importance, because regular BCR-ABL monitoring is required to detect reappearance of BCR-ABL levels and prevent transformation into accelerated or blastic phase of CML.Question- What is imatinib withdrawal syndrome?Answer- An imatinib withdrawal syndrome consist of diffuse myalgia/ arthralgia encountered after stopping TKI. Question – Is maintenance of TFR equivalent to cure?Answer- We do not know yet and longer follow up is required to answer this question.
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Genetic testing for breast and ovarian Cancer1)what is genetic testing?Answer:-Genetic make up of an individual is like a house map.Any abnormality in the house map will lead to a faulty construction of the house, similarly any abnormality in the gene may lead to disease. This abnormality in genes is referred to as mutations.There are tests which can find out these specific mutations.2) Are there genes identified which increase risk of breast and ovarian cancer?Answer:There are several genes but the most well known and commonly tested genes are BRCA1 and BRCA2.several other candidate genes have been identified and research in this area is ongoing.3)Who should have genetic test for breast and ovarian cancer?Answer:we offer genetic test for women who have strong family history of breast or ovarian cancer. which is as follows:-a) two or more relatives with breast or ovarian cancer; especially if diagnosed at age <50 years.b) close family member with cancer of both breast or breast and ovarian cancer in same individual.c) if you have family members from different generation with breast or ovarian cancer.note: STRONG FAMILY HISTORY DOES NOT MEAN YOU HAVE ABNORMAL GENE AND INFACT MOST WOMEN WITH FAMILY HISTORY DO NOT HAVE THESE MUTATIONS.it is important to consult your doctor who will work out your individual risk prior to ordering these tests and discuss the pros and cons of the test as well.Q how can we lower chances of getting cancer if one turn out BRCA positive?Answer:a) getting screened for breast lump using MRI or mammogram as advised by your doctorb) breast and ovaries removal after completing Your family.c) there are tablets available as wellwhich option will be best for an individual is decided on case to case basis by treating doctor and individual preference.
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Maintenance with PARP inhibitor is the way forward in ovarian cancer:Median PFS in platinum sensitive relapse carcinoma ovary is approximately 10 months.20% of high grade serous carcinoma ovary have somatic or germline mutation in BRCA gene.Single stranded DNA breaks are repaired Base excision repair pathways of which PARP ( poly ADP ribose polymerase) enzymes are one of the key members.In presence of PARP inhibitors these single stranded breaks are converted into double stranded breaks and the repair of these double stranded breaks require intact Homologous recombination repair pathway. BRCA proteins are integral part of these Homologous recombination pathway.In presence of BRCA gene muatation the double stranded breaks produced in presence of PARP inhibitor bring about lethal damage to the cancer cells.Olaparib is the most extensively studied PARP inhibitor and it is approved in BRCA mutation positive relapse high grade carcinoma ovary as single agent after 3 or more lines of chemotherapy. Also Olaparib has been approved as maintenance in both BRCA mutated and wild type patients in relapse platinum sensitive high grade carcinoma ovary who attain CR or PR to last line platinum doublet.The reported PFS in this setting is around 18 months in BRCA mutated (SOLO-2 trial-using tablet olaparib 300mg twice daily) v/s 9 months in BRCA wild type based on STUDY- 19 Trial (Capsule Olaparib 400mg twice daily).It is important to note that about 15% patients remain progression free at 5 years in study-19 trial on Olaparib ( these long term progression free survival benefited both BRCA wild type and BRCA mutated subgroup) .Niraparib based on the result of NOVA trial (300 mg once daily) got approval in maintenance for both BRCA mutated and wild type patients in relapse platinum sensitive high grade carcinoma ovary who attain CR or PR to last line platinum doublet. Rucaparib at a dose of 600mg twice daily awaits its approval in similar setting with the promising results of the ARIEL3 presented in ESMO 2017.Main toxicity of Olaparib is anemia, nausea and fatigue. (Discontinuation rate 6%)Main toxicity of Niraparib is nausea and haematological (Thrombocytopenia> Anemia>Neutropenia) (Discontinuation rate 15%)Main toxicity of Rucaparib is anemia and elevation of liver enzyme (Discontinuation rate 13%)
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