The document summarizes a study that calculated breast cancer risk scores for a woman using her genotype data from 72 identified genetic loci. It found that her partially known risk score of 2.295 and absolute risk of 34.58% were almost 3 times higher than the average risk of 12.68%. While not particularly high risk, such individualized risk scores could help target preventative measures. Currently identified loci only explain about half of familial risk, so true risks may differ from calculated scores. The highest risk group is approximately 12% of the population with a risk above 12%.
This document analyzes defects in asthma management based on a study of patients in Egypt. It finds that 13.8% of cases were misdiagnosed as asthma. General practitioners made up 41.3% of those managing asthma patients but had the highest rate of misdiagnosis at 22.1%. Guidelines for diagnosis, classification, and management were not properly followed in the majority of cases. Non-compliance was highest in patients treated by general practitioners at 100% compared to 85.5% for chest specialists. The main reasons for non-compliance were issues with inhaler therapy and corticosteroid therapy. Treatment failure occurred in nearly half of cases.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Treating Human Cancers with Medicinal Mushroom Preparations (Croatian Experie...Neven Jakopovic
This scientific presentation details the results of a 3 year human cohort study of 51 cases of colorectal adenocarcinoma and 105 cases of breast cancer, where medicinal mushroom extracts from Myko San company have been used in conjunction with the usual oncological therapy.
The regimen showed clear, dose-dependent benefits to including appropriate medicinal mushroom extracts for improved cancer status, survival and reduction of therapy side effects.
This work was presented by Dr. Ivan Jakopovic at the 4th International Medicinal Mushroom Conference in Ljubljana, Slovenia, in 2007.
This document discusses case-control study design and calculating odds ratios. It provides examples of 3 case-control studies examining suspected risk factors for cervical cancer, lung cancer, and esophageal cancer. For each study, it constructs a 2x2 contingency table and calculates the odds ratio to assess the strength of association between the disease and suspected risk factor. Odds ratios greater than 1 indicate the exposure increases disease risk.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
Chemotherapy+with+or+without+gefitinib+in+patients+with+advanced+non small-ce...Mina Max
This meta-analysis examined 12 randomized controlled trials involving 6,844 patients with advanced non-small cell lung cancer (NSCLC). The analysis compared chemotherapy with or without gefitinib. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The meta-analysis found that gefitinib therapy significantly improved PFS compared to chemotherapy alone, but only modestly improved OS and this difference was not statistically significant. Gefitinib therapy was associated with higher objective response rates. The most common adverse events with gefitinib were rash, diarrhea, and dry skin.
This document discusses how to interpret a forest plot used in a meta-analysis. A forest plot visually displays the results of individual studies and the overall meta-analysis. It shows the odds or risk ratio for each study with confidence intervals, along with a diamond representing the combined results. The location of the diamond in relation to the line of no effect indicates whether the overall effect is statistically significant. Heterogeneity between studies is also assessed using the forest plot and quantitative measures.
This document analyzes defects in asthma management based on a study of patients in Egypt. It finds that 13.8% of cases were misdiagnosed as asthma. General practitioners made up 41.3% of those managing asthma patients but had the highest rate of misdiagnosis at 22.1%. Guidelines for diagnosis, classification, and management were not properly followed in the majority of cases. Non-compliance was highest in patients treated by general practitioners at 100% compared to 85.5% for chest specialists. The main reasons for non-compliance were issues with inhaler therapy and corticosteroid therapy. Treatment failure occurred in nearly half of cases.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Treating Human Cancers with Medicinal Mushroom Preparations (Croatian Experie...Neven Jakopovic
This scientific presentation details the results of a 3 year human cohort study of 51 cases of colorectal adenocarcinoma and 105 cases of breast cancer, where medicinal mushroom extracts from Myko San company have been used in conjunction with the usual oncological therapy.
The regimen showed clear, dose-dependent benefits to including appropriate medicinal mushroom extracts for improved cancer status, survival and reduction of therapy side effects.
This work was presented by Dr. Ivan Jakopovic at the 4th International Medicinal Mushroom Conference in Ljubljana, Slovenia, in 2007.
This document discusses case-control study design and calculating odds ratios. It provides examples of 3 case-control studies examining suspected risk factors for cervical cancer, lung cancer, and esophageal cancer. For each study, it constructs a 2x2 contingency table and calculates the odds ratio to assess the strength of association between the disease and suspected risk factor. Odds ratios greater than 1 indicate the exposure increases disease risk.
This document reviews treatments for neuroendocrine tumors (NETs), including peptide receptor radionuclide therapy (PRRT). It summarizes the evidence for various NET treatment options such as surgery, somatostatin analogs, PRRT, chemotherapy, and targeted therapies. It also provides an overview of a PRRT treatment day and integrates PRRT with other NET therapies. Clinical trial data is presented demonstrating the efficacy of PRRT and targeted therapies such as everolimus and sunitinib in extending progression-free survival for NETs. The conclusion emphasizes treating NETs only when necessary and considering surgery first followed by somatostatin analogs, PRRT, intra-arterial therapies,
Chemotherapy+with+or+without+gefitinib+in+patients+with+advanced+non small-ce...Mina Max
This meta-analysis examined 12 randomized controlled trials involving 6,844 patients with advanced non-small cell lung cancer (NSCLC). The analysis compared chemotherapy with or without gefitinib. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The meta-analysis found that gefitinib therapy significantly improved PFS compared to chemotherapy alone, but only modestly improved OS and this difference was not statistically significant. Gefitinib therapy was associated with higher objective response rates. The most common adverse events with gefitinib were rash, diarrhea, and dry skin.
This document discusses how to interpret a forest plot used in a meta-analysis. A forest plot visually displays the results of individual studies and the overall meta-analysis. It shows the odds or risk ratio for each study with confidence intervals, along with a diamond representing the combined results. The location of the diamond in relation to the line of no effect indicates whether the overall effect is statistically significant. Heterogeneity between studies is also assessed using the forest plot and quantitative measures.
This document summarizes recent cancer assessments of glyphosate and epidemiological studies and animal carcinogenicity studies on glyphosate. It notes that IARC and Portier et al. classified glyphosate as a probable human carcinogen while EFSA, FAO/WHO JMPR, and draft EPA assessments found it unlikely to pose a carcinogenic risk. Meta-analyses of epidemiological studies found a statistically significant increased risk of non-Hodgkin lymphoma. Animal studies found increased incidences of renal tumors, malignant lymphomas, and hemangiosarcomas in male mice, with statistical significance. Rat studies had mixed or inadequate findings.
Clinical trials are studies that compare the effectiveness of two or more treatments. They are important for determining if a new treatment is better than no treatment, an old treatment, or a placebo. Key features of clinical trials include randomization of patients, use of controls, appropriate sample size, blinded assessment, and intention-to-treat analysis. Proper design and conduct of clinical trials can limit bias, but biased interpretation of results remains a risk.
This study analyzed data from 5 clinical trials comparing the effects of filgrastim and pegfilgrastim (G-CSF) to placebo in patients receiving chemotherapy. The results showed:
1) Patients receiving G-CSF had significantly lower rates of severe neutropenia and febrile neutropenia after the first cycle of chemotherapy compared to placebo.
2) Median overall survival was greater for patients receiving G-CSF versus placebo in one lung cancer trial, but the differences were not statistically significant.
3) A meta-analysis of the 3 placebo-controlled trials found a hazard ratio for overall survival of 0.77 favoring G-CSF over placebo, but again the result was not statistically significant. Further studies are
The values of clinical practice - Jordi VarelaJordi Varela
Three key principles will guide clinical practice: adding value to patient health, organizing doctors according to clinical processes, and measuring outcomes adjusted for risk and cost. Right care considers benefits and harms, is patient-centered, and evidence-based. Half of surgeries and clinical trials lack evidence to support them. Overdiagnosis leads to unnecessary treatment complications. Fragmented care for chronic patients results in clinical instability, unnecessary tests and costs. Clinical value practices aim to reduce wasteful spending through protocols, teamwork and learning from errors.
1) The WHI study found small increases in cardiovascular risks and breast cancer for women taking combined estrogen and progestin HRT. However, the absolute risks for individual women were very small.
2) The results do not necessarily apply to lower drug doses, different formulations, or non-oral routes of administration. Absolute risks were far smaller than relative risks suggested.
3) The main goal for women's health practitioners should be maintaining overall health and disease prevention for postmenopausal women, not long-term hormonal treatment alone. Alternative non-hormonal strategies also exist.
The document defines and explains how to calculate and interpret an odds ratio. An odds ratio is a measure of association used in case-control studies to compare the odds of exposure to a risk factor in cases versus controls. It is calculated by dividing the odds of exposure in cases by the odds of exposure in controls. An odds ratio of 1 indicates no association, while a ratio greater than 1 means the risk factor is associated with higher odds of the health outcome. The document provides an example of using a 2x2 table to calculate the odds ratio to determine if drug abuse is associated with higher odds of having a stroke.
This document discusses different types of clinical studies used in evidence-based medicine, including case reports/series, ecological studies, cross-sectional studies, case-control studies, cohort studies, randomized clinical trials, systematic reviews, and meta-analyses. It provides details on study designs, strengths and limitations, and how to interpret results including risk ratios, odds ratios, confidence intervals, and p-values. Key concepts covered include biases, confounding factors, prevalence versus incidence, and how study size influences precision.
This document summarizes a re-analysis of meta-analysis data from the Cochrane Library. It examines the performance of different methods for estimating between-study heterogeneity and explores model selection in published meta-analyses. Simulation studies were conducted to compare heterogeneity estimators. Over 57,000 meta-analyses from the Cochrane Library were also analyzed. Results showed that the DerSimonian-Laird estimator often failed to detect high between-study heterogeneity, particularly in small meta-analyses. Bayesian methods performed well for very small meta-analyses. In the Cochrane data, over 30% of meta-analyses had only 2 studies and the random-effects model was more commonly used with larger numbers of studies.
- The document discusses the evolution of lung cancer diagnosis and treatment over the past 20 years, from identifying high-risk populations and diagnosing small nodules to advances in targeted therapies and immunotherapy.
- Key developments include the identification of driver mutations in NSCLC like EGFR, ALK, and ROS1 which enabled genetically-driven targeted therapies. Drugs like gefitinib, erlotinib, and osimertinib have significantly improved progression-free survival for patients with EGFR mutations compared to chemotherapy.
- However, resistance often develops through secondary mutations like T790M, prompting continued research into new targeted agents and combination therapies to further extend patient outcomes. Immunotherapy has also emerged as an important
An evaluation of the clinical utility of a panel of variants in DPYD and ENOS...Oxford Cancer Biomarkers
This document summarizes a study evaluating the clinical utility of a genetic panel for predicting toxicities from capecitabine chemotherapy. The panel included variants in DPYD and ENOSF1 genes. The study found the panel had high sensitivity and specificity for predicting death or severe hematological toxicity. However, the panel only had moderate ability to predict risk of hand-foot syndrome. Including additional variants associated with hand-foot syndrome may help clinicians manage this side effect. Overall, the genetic panel shows promise for predicting serious adverse events from capecitabine chemotherapy.
This document discusses adjuvant chemotherapy for colorectal cancer. It finds that for stage III cancer, 6 months of FU-FA + oxaliplatin is the standard treatment, based on evidence from trials like MOSAIC showing a 5-6% improvement in disease-free and overall survival rates. For stage II cancer, evidence is less clear but trials like QUASAR showed a small (~3%) overall survival benefit from chemotherapy. The document questions whether shorter treatment durations could be equally effective.
This systematic review analyzed data from four randomized controlled trials (HIT 1-4) and one additional study to determine the effect of the drug nimodipine on outcomes in patients with traumatic subarachnoid hemorrhage. The review included a total of 1074 patients and found that the occurrence of poor outcome, defined as death, vegetative state or severe disability, was similar between patients treated with nimodipine (39%) and those treated with placebo (40%). Mortality rates also did not differ between the nimodipine group (26%) and placebo group (27%). These results contradict an earlier Cochrane review that reported nimodipine improved outcomes in this patient group.
This document summarizes a study on T1G3 superficial bladder cancers from the Egyptian experience. The study reviewed 100 cases of superficial bladder cancer, finding that 22% were T1G3 tumors. T1G3 cancers had high recurrence rates within 6 months and often progressed to muscle invasion within 2-36 months. Based on these findings, the study concluded that T1G3 tumors represent a high-risk group that may require early radical cystectomy rather than adjuvant therapy alone. Clear follow-up and treatment protocols are needed for managing T1G3 superficial bladder cancers.
This study compared different chemotherapy and radiotherapy regimens for patients with early unfavorable Hodgkin's lymphoma. The study found:
1) 4 cycles of ABVD chemotherapy followed by 30Gy radiotherapy was as effective as 4 cycles of BEACOPP chemotherapy followed by either 30Gy or 20Gy radiotherapy.
2) However, 4 cycles of ABVD followed by a reduced radiotherapy dose of 20Gy was inferior to the other regimens and resulted in worse patient outcomes.
3) A reduction of radiotherapy dose from 30Gy to 20Gy is only possible when combined with a more intensive chemotherapy regimen like BEACOPP, not a less intensive regimen like ABVD.
Chapter 25 assessment of clincal responsesNilesh Kucha
The document discusses guidelines for assessing clinical response in cancer patients based on tumor size changes. The RECIST (Response Evaluation Criteria in Solid Tumors) criteria provide a standardized approach for measuring lesions and determining objective tumor responses. Key points include defining measurable vs. non-measurable lesions, methods for measurement and assessment, and criteria for complete response, partial response, stable disease and progressive disease based on tumor burden changes. The guidelines aim to improve consistency in evaluating clinical trial outcomes.
This document describes a nested case-control study conducted within a cohort. A nested case-control study selects cases and controls from individuals enrolled in a cohort study and follows them over time. An example is given of a cohort study of 90,000 women being followed for breast cancer. To efficiently study the risk of past pesticide exposure, the nested case-control study would examine stored blood samples from the 1439 women who developed breast cancer (cases) and a sample of others who did not (controls).
1) The document discusses evaluating medical literature to answer a clinical question about whether duct tape is an effective treatment for warts in children.
2) A randomized controlled trial studied 61 patients comparing duct tape to cryotherapy treatment for common warts. It found that duct tape was significantly more effective, with an absolute risk reduction of 25%.
3) Key points to evaluate in studies include similarity of patients, interventions and outcomes measured, study design, results, and statistics reported like absolute risk reduction and number needed to treat.
This document discusses the history and evolution of vasopressor use for treating maternal hypotension during spinal anesthesia for cesarean section. It describes how ephedrine was originally used but was found to be associated with worse fetal outcomes compared to phenylephrine or metaraminol. Phenylephrine then emerged as the preferred vasopressor due to studies showing it improved fetal acid-base status. Recent research has focused on optimizing phenylephrine administration, comparing continuous infusions to bolus doses and investigating optimal infusion rates and regimens. However, the ideal method to both control blood pressure and minimize side effects like hypertension is still unclear.
The document summarizes the treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC). It discusses several key trials that have established the benefit of primary intensification with the addition of docetaxel, abiraterone, enzalutamide, or apalutamide to androgen deprivation therapy (ADT). Trials like CHAARTED, LATITUDE, and STAMPEDE showed improved overall survival with these combinations compared to ADT alone. There is ongoing debate around the appropriate definition of high-volume versus low-volume disease and which patients most benefit from the triplet combination of ADT plus docetaxel plus a second agent. Overall, primary intensification beyond ADT alone is now
This document summarizes recent cancer assessments of glyphosate and epidemiological studies and animal carcinogenicity studies on glyphosate. It notes that IARC and Portier et al. classified glyphosate as a probable human carcinogen while EFSA, FAO/WHO JMPR, and draft EPA assessments found it unlikely to pose a carcinogenic risk. Meta-analyses of epidemiological studies found a statistically significant increased risk of non-Hodgkin lymphoma. Animal studies found increased incidences of renal tumors, malignant lymphomas, and hemangiosarcomas in male mice, with statistical significance. Rat studies had mixed or inadequate findings.
Clinical trials are studies that compare the effectiveness of two or more treatments. They are important for determining if a new treatment is better than no treatment, an old treatment, or a placebo. Key features of clinical trials include randomization of patients, use of controls, appropriate sample size, blinded assessment, and intention-to-treat analysis. Proper design and conduct of clinical trials can limit bias, but biased interpretation of results remains a risk.
This study analyzed data from 5 clinical trials comparing the effects of filgrastim and pegfilgrastim (G-CSF) to placebo in patients receiving chemotherapy. The results showed:
1) Patients receiving G-CSF had significantly lower rates of severe neutropenia and febrile neutropenia after the first cycle of chemotherapy compared to placebo.
2) Median overall survival was greater for patients receiving G-CSF versus placebo in one lung cancer trial, but the differences were not statistically significant.
3) A meta-analysis of the 3 placebo-controlled trials found a hazard ratio for overall survival of 0.77 favoring G-CSF over placebo, but again the result was not statistically significant. Further studies are
The values of clinical practice - Jordi VarelaJordi Varela
Three key principles will guide clinical practice: adding value to patient health, organizing doctors according to clinical processes, and measuring outcomes adjusted for risk and cost. Right care considers benefits and harms, is patient-centered, and evidence-based. Half of surgeries and clinical trials lack evidence to support them. Overdiagnosis leads to unnecessary treatment complications. Fragmented care for chronic patients results in clinical instability, unnecessary tests and costs. Clinical value practices aim to reduce wasteful spending through protocols, teamwork and learning from errors.
1) The WHI study found small increases in cardiovascular risks and breast cancer for women taking combined estrogen and progestin HRT. However, the absolute risks for individual women were very small.
2) The results do not necessarily apply to lower drug doses, different formulations, or non-oral routes of administration. Absolute risks were far smaller than relative risks suggested.
3) The main goal for women's health practitioners should be maintaining overall health and disease prevention for postmenopausal women, not long-term hormonal treatment alone. Alternative non-hormonal strategies also exist.
The document defines and explains how to calculate and interpret an odds ratio. An odds ratio is a measure of association used in case-control studies to compare the odds of exposure to a risk factor in cases versus controls. It is calculated by dividing the odds of exposure in cases by the odds of exposure in controls. An odds ratio of 1 indicates no association, while a ratio greater than 1 means the risk factor is associated with higher odds of the health outcome. The document provides an example of using a 2x2 table to calculate the odds ratio to determine if drug abuse is associated with higher odds of having a stroke.
This document discusses different types of clinical studies used in evidence-based medicine, including case reports/series, ecological studies, cross-sectional studies, case-control studies, cohort studies, randomized clinical trials, systematic reviews, and meta-analyses. It provides details on study designs, strengths and limitations, and how to interpret results including risk ratios, odds ratios, confidence intervals, and p-values. Key concepts covered include biases, confounding factors, prevalence versus incidence, and how study size influences precision.
This document summarizes a re-analysis of meta-analysis data from the Cochrane Library. It examines the performance of different methods for estimating between-study heterogeneity and explores model selection in published meta-analyses. Simulation studies were conducted to compare heterogeneity estimators. Over 57,000 meta-analyses from the Cochrane Library were also analyzed. Results showed that the DerSimonian-Laird estimator often failed to detect high between-study heterogeneity, particularly in small meta-analyses. Bayesian methods performed well for very small meta-analyses. In the Cochrane data, over 30% of meta-analyses had only 2 studies and the random-effects model was more commonly used with larger numbers of studies.
- The document discusses the evolution of lung cancer diagnosis and treatment over the past 20 years, from identifying high-risk populations and diagnosing small nodules to advances in targeted therapies and immunotherapy.
- Key developments include the identification of driver mutations in NSCLC like EGFR, ALK, and ROS1 which enabled genetically-driven targeted therapies. Drugs like gefitinib, erlotinib, and osimertinib have significantly improved progression-free survival for patients with EGFR mutations compared to chemotherapy.
- However, resistance often develops through secondary mutations like T790M, prompting continued research into new targeted agents and combination therapies to further extend patient outcomes. Immunotherapy has also emerged as an important
An evaluation of the clinical utility of a panel of variants in DPYD and ENOS...Oxford Cancer Biomarkers
This document summarizes a study evaluating the clinical utility of a genetic panel for predicting toxicities from capecitabine chemotherapy. The panel included variants in DPYD and ENOSF1 genes. The study found the panel had high sensitivity and specificity for predicting death or severe hematological toxicity. However, the panel only had moderate ability to predict risk of hand-foot syndrome. Including additional variants associated with hand-foot syndrome may help clinicians manage this side effect. Overall, the genetic panel shows promise for predicting serious adverse events from capecitabine chemotherapy.
This document discusses adjuvant chemotherapy for colorectal cancer. It finds that for stage III cancer, 6 months of FU-FA + oxaliplatin is the standard treatment, based on evidence from trials like MOSAIC showing a 5-6% improvement in disease-free and overall survival rates. For stage II cancer, evidence is less clear but trials like QUASAR showed a small (~3%) overall survival benefit from chemotherapy. The document questions whether shorter treatment durations could be equally effective.
This systematic review analyzed data from four randomized controlled trials (HIT 1-4) and one additional study to determine the effect of the drug nimodipine on outcomes in patients with traumatic subarachnoid hemorrhage. The review included a total of 1074 patients and found that the occurrence of poor outcome, defined as death, vegetative state or severe disability, was similar between patients treated with nimodipine (39%) and those treated with placebo (40%). Mortality rates also did not differ between the nimodipine group (26%) and placebo group (27%). These results contradict an earlier Cochrane review that reported nimodipine improved outcomes in this patient group.
This document summarizes a study on T1G3 superficial bladder cancers from the Egyptian experience. The study reviewed 100 cases of superficial bladder cancer, finding that 22% were T1G3 tumors. T1G3 cancers had high recurrence rates within 6 months and often progressed to muscle invasion within 2-36 months. Based on these findings, the study concluded that T1G3 tumors represent a high-risk group that may require early radical cystectomy rather than adjuvant therapy alone. Clear follow-up and treatment protocols are needed for managing T1G3 superficial bladder cancers.
This study compared different chemotherapy and radiotherapy regimens for patients with early unfavorable Hodgkin's lymphoma. The study found:
1) 4 cycles of ABVD chemotherapy followed by 30Gy radiotherapy was as effective as 4 cycles of BEACOPP chemotherapy followed by either 30Gy or 20Gy radiotherapy.
2) However, 4 cycles of ABVD followed by a reduced radiotherapy dose of 20Gy was inferior to the other regimens and resulted in worse patient outcomes.
3) A reduction of radiotherapy dose from 30Gy to 20Gy is only possible when combined with a more intensive chemotherapy regimen like BEACOPP, not a less intensive regimen like ABVD.
Chapter 25 assessment of clincal responsesNilesh Kucha
The document discusses guidelines for assessing clinical response in cancer patients based on tumor size changes. The RECIST (Response Evaluation Criteria in Solid Tumors) criteria provide a standardized approach for measuring lesions and determining objective tumor responses. Key points include defining measurable vs. non-measurable lesions, methods for measurement and assessment, and criteria for complete response, partial response, stable disease and progressive disease based on tumor burden changes. The guidelines aim to improve consistency in evaluating clinical trial outcomes.
This document describes a nested case-control study conducted within a cohort. A nested case-control study selects cases and controls from individuals enrolled in a cohort study and follows them over time. An example is given of a cohort study of 90,000 women being followed for breast cancer. To efficiently study the risk of past pesticide exposure, the nested case-control study would examine stored blood samples from the 1439 women who developed breast cancer (cases) and a sample of others who did not (controls).
1) The document discusses evaluating medical literature to answer a clinical question about whether duct tape is an effective treatment for warts in children.
2) A randomized controlled trial studied 61 patients comparing duct tape to cryotherapy treatment for common warts. It found that duct tape was significantly more effective, with an absolute risk reduction of 25%.
3) Key points to evaluate in studies include similarity of patients, interventions and outcomes measured, study design, results, and statistics reported like absolute risk reduction and number needed to treat.
This document discusses the history and evolution of vasopressor use for treating maternal hypotension during spinal anesthesia for cesarean section. It describes how ephedrine was originally used but was found to be associated with worse fetal outcomes compared to phenylephrine or metaraminol. Phenylephrine then emerged as the preferred vasopressor due to studies showing it improved fetal acid-base status. Recent research has focused on optimizing phenylephrine administration, comparing continuous infusions to bolus doses and investigating optimal infusion rates and regimens. However, the ideal method to both control blood pressure and minimize side effects like hypertension is still unclear.
The document summarizes the treatment landscape for metastatic hormone-sensitive prostate cancer (mHSPC). It discusses several key trials that have established the benefit of primary intensification with the addition of docetaxel, abiraterone, enzalutamide, or apalutamide to androgen deprivation therapy (ADT). Trials like CHAARTED, LATITUDE, and STAMPEDE showed improved overall survival with these combinations compared to ADT alone. There is ongoing debate around the appropriate definition of high-volume versus low-volume disease and which patients most benefit from the triplet combination of ADT plus docetaxel plus a second agent. Overall, primary intensification beyond ADT alone is now
This document discusses case-control and cohort study designs for investigating statistical associations between suspected factors and diseases. It provides details on the key aspects of conducting a case-control study, including selecting cases and controls, measuring exposure, and calculating exposure rates, odds ratios, and relative risks. A cohort study approach is also outlined, with steps like selecting and collecting data on study subjects, comparing to internal or external groups, follow up, and analyzing incidence rates and relative risks.
1. The document analyzes the pathogenesis of lung adenocarcinoma in relation to current treatment guidelines and future developments. It finds that genomic analysis has identified recurrent dysregulation of the MAPK and PI3K/mTOR pathways, which drive cell cycle progression and pathogenesis.
2. Current targeted therapies against EGFR and PD-L1 have improved survival rates compared to non-targeted therapies, but an underappreciation of copy number alterations may be limiting progress. Future treatments are exploring targets like HER-2, KRAS, and CDK4/6 inhibitors.
3. While progress has been made, rapid further advances are still needed due to poor survival rates and a lack of defined patient cohorts
A cohort study examines the incidence of a disease in two groups over time - an exposed group and an unexposed group. It begins by identifying the exposure status (exposed vs unexposed) and then follows the groups to determine the development of disease. The key strength is the ability to establish temporal relationships between exposure and disease by observing incidence rates before the outcome occurs. Some limitations include losses during follow up, the need for large sample sizes, and long study durations.
This document provides an overview of case-control study designs in epidemiology. It defines a case-control study as one that selects participants based on disease status, including cases who have the disease and controls who do not. Exposure is then assessed retrospectively. Key strengths are efficiency and ability to study rare diseases, while weaknesses include vulnerability to selection bias and inability to directly estimate incidence. Measures of association from case-control data estimate incidence odds ratios when cases are incident. Recall bias can also influence odds ratio estimates if differential between cases and controls.
This document summarizes a presentation on diagnosing pulmonary embolism (PE) in the emergency department. It discusses guidelines for PE diagnosis and reasons clinicians may not follow guidelines. It also looks at using D-dimer tests and Wells criteria to evaluate patients and focuses on managing younger patients, pregnant patients, and diagnosing subsegmental PE.
Breast cancer oncotype-dx.. by dr.Kamel Farag, MDKamelFarag4
This document discusses factors oncologists consider when determining if a patient with hormone receptor-positive breast cancer can skip chemotherapy.
It begins by explaining the three main breast cancer subtypes and that chemotherapy is usually only necessary for triple-negative and HER2-positive cancers. For hormone receptor-positive cancers, chemotherapy may have a lesser role since patients benefit greatly from anti-estrogen medications.
It then discusses tools oncologists use to assess risk, such as genomic tests like Oncotype DX that provide recurrence scores, and clinicopathologic factors like tumor grade and size. Large clinical trials like TAILORx and RxPONDER helped establish cut-offs for recurrence scores below which chemotherapy provided little additional benefit
Estudio Paramount cáncer de pulmón 2014Martín Lázaro
1) The PARAMOUNT study evaluated pemetrexed maintenance therapy after induction with pemetrexed/cisplatin doublet chemotherapy in patients with advanced non-squamous non-small cell lung cancer (NSCLC).
2) The study met its primary endpoint, finding that pemetrexed maintenance significantly reduced the risk of disease progression compared to placebo (HR=0.62, p<0.0001).
3) Updated results showed pemetrexed maintenance also significantly improved overall survival compared to placebo, with median OS of 13.9 months vs 11 months (HR=0.78, p=0.0199).
Secondary Malignancy after Treatment of Prostate Cancer. Radical Prostatectom...asclepiuspdfs
Background: This study aims to determine whether the treatment of locally confined prostate cancer (PCa) with external radiotherapy (EBRT) increases the risk to develop secondary malignancies (SM) compared to radical prostatectomy (RPE). Materials and Methods: Data from patients who were treated curatively with RPE or EBRT from 2010 to 2018 and who did not have distant metastases, previous malignancy, or previous treatment with radiotherapy or chemotherapy at the time of diagnosis were reviewed to determine the incidence of SM over a median follow-up period of 47 months (range 12–96 months). Regression models were used to correlate the clinicopathological factors with the incidence of SM.
The document summarizes the potential of T-cell engaging bispecific antibodies (TCEs) for the treatment of solid tumors. It discusses how TCEs directly link T-cells to tumor cells expressing a target antigen like DLL3, which is expressed in over 80% of small cell lung cancer (SCLC) tumors. The document outlines ongoing clinical trials of TCEs targeting DLL3 for the treatment of SCLC and neuroendocrine tumors.
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEKanhu Charan
Dr Kanhu Charan Patro provides summaries of statistical concepts in 3 sentences or less, beginning each summary with the date. Summaries from January 19th to February 15th are presented, covering topics such as p-values, censoring in survival analysis, hazard ratios, and ISRS guidelines for stereotactic radiosurgery. On February 15th, a 3 sentence summary of World Cancer Day is provided, noting the date it is held, the organization that leads it, and the 2024 slogan of "Close the care gap".
- The document discusses pancreatic cancer epidemiology and molecular biology. Some key points:
- Worldwide, pancreatic cancer incidence is about 8 per 100,000 and mortality is 7-8 per 100,000, making it the 8th most common cancer.
- In Chile, incidence and mortality are slightly higher than worldwide averages.
- About 60% of pancreatic cancers are metastatic at diagnosis, 30% are locally advanced, and only 10% are early-stage.
- KRAS mutations are present in approximately 95% of pancreatic cancers.
This document discusses and compares case-control and cohort studies in epidemiology. It defines epidemiology as the study of health-related states in populations and applying this to control health problems. Analytical epidemiology focuses on testing hypotheses about individuals within populations. Both case-control and cohort studies are described as types of analytical epidemiology. Case-control studies are retrospective while cohort studies are prospective. The key differences and advantages/disadvantages of each study type are outlined.
The document discusses various methods for predicting indolent or low-risk prostate cancer, including nomograms developed using retrospective data on tumor characteristics like PSA levels, Gleason scores, and biopsy results. Several nomograms are presented that provide probabilities of indolent disease or survival based on pre-treatment clinical factors. Compliance with treatment recommendations based on nomogram risk assessments is generally high for both patients and doctors. Improving the accuracy and specificity of nomograms will require incorporating additional biomarkers and longer-term validation studies.
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Research Report
1. Population Genetics May 12, 2015
Quantitative Risk Assessment for Breast Cancer in European American Women
By Amanda Jimcosky
Abstract
As a quantitative trait, breast cancer has many risk loci associated to it that currently
explain ~49% of the heritability of the disease (Fachal & Dunning, 2015). Through a
comprehensive list of SNPs collected from various published sources, partially known and
absolute risk scores can be assigned to theoretical individuals at highest, average, and lowest risk
as well as to any individual who has been genotyped through a service such as 23andme. The
calculated results show that my absolute risk of 34.58% is almost 3-fold higher than the average
European American, 12.68%. While my score is not particularly high-risk, such scores can
classify individuals’ risk and in turn could lead to preventative measures being more strictly
followed. The currently identified loci do not represent an individual’s true risk of developing
breast cancer because all risk loci have not been identified and the calculated risk scores do not
consider environmental, gene-environmental interactions, and non-additive genetic risk. With the
current knowledge, the high-risk classification that creates the largest divide between high and
low risk groups is approximately 12% of the population or the 88th percentile.
Introduction
Breast cancer is a quantitative trait that is impacted by many loci throughout the genome.
While genes such as BRCA1/2 have greater effect sizes (i.e. contribute more to overall risk),
many genes over the past ten years have been associated to the development of breast cancer.
While currently identified loci only represent approximately 49% of familial risk, the growing
knowledge of associated genes has led to a greater predictability of breast cancer development
than earlier predictions based primarily on high effect genes such as the BRCA genes (Fachal &
2. Population Genetics May 12, 2015
Dunning, 2015). In this study, I create a comprehensive list of loci that impact European
American women’s risk of developing breast cancer in order to calculate and compare an
individual’s risk to the average risk of the population and to assess whether I fall into a high or
low risk category for breast cancer.
Materials & Methods
The first step of this study was to compile a list of SNPs associated to breast cancer from
published sources, as well as the effect size or relative risk of each risk allele and the risk allele
frequency (Supplementary Table 1). Once the full list of SNPs associated with breast cancer was
complete, each was searched within my 23andme genotype data in order to determine if it was
available in the dataset and if so, to determine my genotype at the marker. The list of SNPs was
then narrowed down to those whose risk allele frequency, effect size, and genotype were all
available (Table 1). The most common genotype was determined assuming Hardy-Weinberg
equilibrium and using the risk allele frequency of each locus in order to create a comparison of
an individual with the overall most common genotype.
The statistical methods used in this study were based on the analysis completed by Sieh
et al. (2014) as follows. The partially known risk score was calculated first, using each variant’s
effect size, β, and number of risk alleles (0, 1, or 2), g:
s = b1g1 +...+bngn
The effect size β can be determined by taking the log of the relative risk of the effect allele. It
was found that many studies equated relative risk and odds ratio. Despite the general inaccuracy
of using these terms interchangeably, the reported values for either were used to determine the
effect size, following the trend seen in other literature. From the partially known risk score, the
absolute risk score was calculated using the following equation:
3. Population Genetics May 12, 2015
R =1-exp(-ces
),
where c is a positive constant determined by using the average absolute risk of the population,
12.68% , and the partially known risk score of an individual with the most common genotype, as
described above. Through these methods, the above equation for absolute risk was solved for c,
and c was calculated to be 0.0428 in this instance. The absolute risk score of the worst-case
scenario, an individual with two risk alleles at each locus, was calculated using this c value in
order to verify that the calculation was correct. Along with the risk scores for an individual with
the most common genotype and for an individual with highest risk, the risk scores for an
individual with no risk alleles was also calculated as a reference to my own risk scores.
Results
From nine different sources, 158 SNPs were reported as being linked to breast cancer
(Supplementary Table 1). However, five of these SNPs (rs1550623, rs1045485, rs11242675,
rs2380205, and rs12422552) were found insignificant by Michailidou et al. (2015), so they were
eliminated from the dataset. After narrowing the dataset to include only SNPs for whom the
effect size, risk allele frequency, and genotype data were available in the literature, 72 loci
remained for the analysis (Table 1).
Table 1. Summary of SNPs with all information (effect size, risk allele frequency, and genotype)
available. The calculated risk scores use only the information from the following loci.
Study Locus/SNP Gene Alleles1 RAF2 Relative Risk
Sieh et al. 1 rs11249433 NOTCH2/FCGR1B A/G 0.42 1.14
Sieh et al. 2 rs616488 PEX14 A/G 0.34 1.06
Sieh et al. 3 rs4849887 C/T 0.1 1.1
Sieh et al. 4 rs13387042 IGFBP2, IGBP5, TPN2 A/G 0.49 1.12
Sieh et al. 5 rs4973768 SLC4A7/NEK10 C/T 0.47 1.11
Sieh et al. 6 rs6762644 ITPR1/EGOT A/G 0.39 1.07
Sieh et al. 7 rs10941679 MRPS30/HCN1 A/G 0.25 1.19
Sieh et al. 8 rs889312 MAP3K1/MEIR3 A/C 0.28 1.13
Sieh et al. 9 rs1353747 PDE4D T/G 0.1 1.09
4. Population Genetics May 12, 2015
Sieh et al. 10 rs1432679 EBF1 T/C 0.43 1.07
Sieh et al. 11 rs204247 RANBP9 A/G 0.44 1.05
Sieh et al. 12 rs17530068 T/C 0.18 1.09
Sieh et al. 13 rs2046210 ESR1 G/A 0.35 1.13
Sieh et al. 14 rs3757318 ESR1 G/A 0.09 1.21
Sieh et al. 15 rs720475 ARHGEF5/NOBOX G/A 0.24 1.06
Sieh et al. 16 rs9693444 C/A 0.32 1.07
Sieh et al. 17 rs13281615 MYC A/G 0.41 1.08
Sieh et al. 18 rs1011970 CDKN2A/B G/T 0.17 1.09
Sieh et al. 19 rs7072776 MLLT10/DNAJC1 G/A 0.28 1.07
Sieh et al. 20 rs10995190 ZNF365 G/A 0.15 1.16
Sieh et al. 21 rs704010 ZMIZ1 C/T 0.39 1.07
Sieh et al. 22 rs7904519 TCF7L2 A/G 0.45 1.06
Sieh et al. 23 rs11199914 C/T 0.32 1.05
Sieh et al. 24 rs2981579 FGFR2 G/A 0.42 1.26
Sieh et al. 25 rs3817198 LSP1/H19 T/C 0.32 1.07
Sieh et al. 26 rs10771399 PTHLH A/G 0.11 1.19
Sieh et al. 27 rs17356907 NTN4 A/G 0.3 1.1
Sieh et al. 28 rs1292011 TBX3/MAPKAP5 A/G 0.42 1.1
Fachal & Dunning 29 rs11571833 BRCA2 A/T 0.004 1.26
Sieh et al. 30 rs999737 RAD51B C/T 0.23 1.09
Sieh et al. 31 rs3803662 TOX3/LOC643714 G/A 0.28 1.2
Sieh et al. 32 rs17817449 MIR1972-2-FTO T/G 0.4 1.08
Sieh et al. 33 rs13329835 CDYL2 A/G 0.22 1.08
Sieh et al. 34 rs6504950 STXBP4/COX11 G/A 0.28 1.05
Sieh et al. 35 rs1436904 CHST9 T/G 0.41 1.04
Sieh et al. 36 rs8170 MERIT40 G/A 0.19 1.25
Sieh et al. 37 rs3760982 KCNN4/ZNF283 G/A 0.47 1.06
Sieh et al. 38 rs2284378 RALY C/T 0.204 1.16
Sieh et al. 39 rs2823093 NRIP1 G/A 0.26 1.09
Michailidou et al 40 rs2012709 C/T 0.46 1.06
Michailidou et al 41 rs10069690 TERT C/T 0.26 1.13
Michailidou et al 42 rs2363956 ANKLE1 G/T 0.49 1.19
Pharoah et al. 43 rs1053485 CASP8 C/A 0.86 1.13
Pharoah et al. 44 rs2981582 FGFR2 G/A 0.4 1.26
Fachal & Dunning 45 rs1562430 CASC21, CASC8 T/C 0.32 1.17
Fachal & Dunning 46 rs909116 TNNT3 T/C 0.53 1.17
Fachal & Dunning 47 rs9383938 ESR1 G/T 0.154 1.18
Fachal & Dunning 48 rs9485372 TAB2 G/A 0.241 1.11
Fachal & Dunning 49 rs13393577 ERBB4 T/C 0.113 1.53
Fachal & Dunning 50 rs4951011 ZC3H11A A/G 0.195 1.09
Fachal & Dunning 51 rs6964587 AKAP9 G/T 0.372 1.05
Bogdanova et al. 52 rs34767364 NBN/NBS1 G/A 0.001 1.9
5. Population Genetics May 12, 2015
Using the effect size of each SNP’s risk allele and g=2, the partial and absolute risk
scores for an individual with two copies of each risk allele were calculated to be 9.754 and 1.00,
respectively. Likewise, the partial and absolute risk scores of an individual with no copies of any
of the risk alleles were calculated, using g=0, to be 0.00 and 0.0419, respectively. The partially
known risk score of an individual with the average lifetime risk of 12.68% and the most common
genotype at each locus was calculated to be 1.154. Lastly, my personal genotype data from
23andme was used to calculate my partial and absolute risk scores, which are 2.295 and 0.3458,
respectively. This information is summarized in Table 2.
Peng et al. 53 rs1219648 FGFR2 A/G 0.42 1.32
Peng et al. 54 rs2180341 RNF146 A/G 0.21 1.41
Peng et al. 55 rs16886165 MAP3K1 G/T 0.15 1.23
Peng et al. 56 rs981782 A/C 0.53 1.04
Rennert et al. 57 rs36053993 MUTYH C/T 0.002 1.86
Li et al. 58 rs12443621 TOX3 A/G 0.572 1.01
Li et al. 59 rs8051542 TOX3 C/T 0.181 1.12
Johnson et al. 60 rs1799950 BRCA1 T/C 0.054 1.72
Johnson et al. 61 rs4986850 BRCA1 C/A 0.074 1.07
Johnson et al. 62 rs16942 BRCA1 A/G 0.322 1.46
Johnson et al. 63 rs1799966 BRCA1 A/G 0.323 1.37
Johnson et al. 64 rs766173 BRCA2 T/G 0.031 1.16
Johnson et al. 65 rs144848 BRCA2 T/G 0.279 1.11
Johnson et al. 66 rs4987117 BRCA2 C/T 0.035 1.09
Johnson et al. 67 rs1799954 BRCA2 C/T 0.008 1.47
Johnson et al. 68 rs11571747 BRCA2 A/C 0.003 1.04
Johnson et al. 69 rs1800056 ATM T/C 0.011 1.52
Johnson et al. 70 rs1800058 ATM C/T 0.018 1.23
Johnson et al. 71 rs1801673 ATM A/T 0.005 1.41
Johnson et al. 72 rs1042522 TP53 C/G 0.262 1.02
1Reference/risk allele
2Risk allele frequency
[Note: Alleles, allele frequencies, and effect sizes were not always from the original source of the
identified SNP as listed in the left-hand column of the chart. These values were taken from the journal
articles listed on the reference page as well as refSNP, an NCBI SNP database.]
6. Population Genetics May 12, 2015
Table 2: Summary of Risk Assessment Results. The best-case, most common case, and
worst-case scenarios act as controls or comparisons for an individual’s risk scores. My data
yields an absolute risk score nearly three times higher than the average American woman.
Partially Known Risk Score Absolute Risk Score Lifetime Risk
Best-Case 0.00 0.0419 4.19%
Most Common 1.154 0.1268 12.68%
Worst-Case 9.754 1.0000 100.00%
Myself 2.295 0.3458 34.58%
Discussion
These calculated risk scores
can be used to categorize risk as either
high or low within the population
based on the average risk. Sieh et al.
(2014) evaluated various thresholds for
classifying someone as “high-risk”
(Figure 1). Roberts et al. (2012)
defined the high-risk category to
include individuals who exceeded the
90-95th percentile of risk. However,
the data reported by Sieh et al. (2014)
reveal that the greatest risk difference
between the high and low risk groups
occurs when the threshold for high-risk is set at approximately 12%, as indicated by the vertical
line on graph. This would set the cutoff at the 88th percentile, slightly lower than indicated by
Roberts et al (2012).
0
2
4
6
8
10
12
14
16
0 10 20 30 40 50 60 70 80 90 100
LifetimeRisk(%)
Percent of Population At High Risk
Low-Risk
High Risk
Figure 1: Comparison of risk groups for various thresholds of the high-risk
category. This data,taken from Sieh et al. (2014) shows that the greatest
difference in risk as currently understood occurs at a 12% cutoff, as indicated by
the vertical line. A lower cutoff increases the risk in both categories while a
higher cutoff decreases the risk in both categories. For optimal results,
individuals in the 88th percentile and higher should be classified as high-risk.
7. Population Genetics May 12, 2015
The calculations done in this study can relate to this designation of high and low risk
because a woman classified as high risk would benefit the most from implementing lifestyle
changes and medical interventions in order to avoid breast cancer or detect the disease early on.
In my case, my absolute risk is almost 3-fold higher than the average European American
woman. However, a risk of 34.58% is much lower than the typical classification of high-risk.
This information can guide me toward making healthier lifestyle choices, but it is also not strong
enough to, for example, encourage a medical provider or insurance company to recommend
rigorous preventative steps such as mastectomy or even early mammography. Understanding the
genetic underlying of breast cancer has the potential to aid individuals and doctors toward
personalized medicine based on overall risk. However, the full effectiveness of such testing
cannot be understood yet, as only approximately half of the heritability of breast cancer is
currently understood (Fachal & Dunning, 2015).
Another barrier to the interpretation of risk calculations is the exclusion of non-genetic
factors. It is well known that many environmental elements increase a person’s risk for various
forms of cancer, including breast cancer. However, in the analysis completed in this study,
environmental factors, gene-environment interaction, and non-additive genetic factors were
ignored. In the case that genetic testing was to be incorporated into routine medical care and the
risk of various diseases were to be evaluated, a more holist analysis would need to be developed
that would take all risk factors into consideration.
8. Population Genetics May 12, 2015
References
1. Bogdanova, N., Feshchenko, S., Schürmann, P., Waltes, R., Wieland, B., Hillemanns, P.,
… & Dörk, T. (2008). Nijmegen breakage syndrome mutations and risk of breast cancer.
International Journal of Cancer, 122, 802-806.
2. Fachal, L. & Dunning, A.M. (2015). From candidate gene studies to GWAS and post-
GWAS analyses in breast cancer. Current Opinion in Genetics and Development, 30, 32-
41.
3. Johnson, N., Fletcher, O., Palles, C., Rudd, M., Webb, E., Sellick, G., … & Peto, J.
(2007). Counting potentially functional variants in BRCA1, BRCA2, and ATM predicts
breast cancer susceptibility. Human Molecular Genetics, 16(9), 1051-1057.
4. Li, H., Beeghly-Fadiel, A., Wen, W., Lu, W., Gao, Y.T., Xiang, Y.B. … & Zheng, W.
(2013). Gene-environment interactions for breast cancer risk among Chinese women: a
report from the Shanghai breast cancer genetics study. American Journal of
Epidemiology, 177, 161-170.
5. Michailidou, K., Beesley, J., Lindstrom, S., Canisius, S., Dennis, J., Lush, M., … &
Easton, D. (2015). Genome-wide association analysis of more than 120,000 individuals
identifies 15 new susceptibility loci for breast cancer. Nature Genetics, 47(4), 373-380.
Retrieved April 9, 2015, from PubMed.
6. Michailidou, K., Hall, P., Gonzalez-Neira, A., Ghoussaini, M., Dennis, J., Milne, R.L., …
& Easton, D. (2013). Large-scale genotyping identifies 41 new loci associated with breast
cancer risk. Nature Genetics, 45, 353-361.
7. Pellatt, A.J., Wolff, R.K., Torres-Mejia, G., John, E.M., Herrick, J.S., Lundgreen, A., …
& Slattery, M.L. (2013). Telomere length, telomere-related genes, and breast cancer risk:
the breast cancer health disparities study. Genes Chromosomes Cancer, 52(7), 595-609.
Retrieved May 9, 2015, from PubMed.
8. Peng, S., Lu, B., Ruan, W., Zhu, Y., Sheng, H., & Lai, M. (2011). Genetic
polymorphisms and breast cancer risk: evidence from meta-analyses, pooled analyses,
and genome-wide association studies. Breast Cancer Research and Treatment, 127, 309-
324.
9. Pharoah, P., Antoniou, A., Bobrow, M., Zimmern, R., Easton, D., & Ponder, B. (2002).
Polygenic susceptibility to breast cancer and implications for prevention. Nature
Genetics, 31(1), 33-36. Retrieved April 9, 2015, from PubMed.
10. Pharoah, P., Antoniou, A., Easton, D., & Ponder, B. (2008). Polygenes, risk prediction,
and targeted prevention of breast cancer. The New England Journal of Medicine, 358(26),
2796-2803. Retrieved April 9, 2015, from PubMed.
11. Reference SNP (refSNP) Cluster Report. (n.d.) NCBI. Retrieved May 3, 2015.
12. Rennert, G., Lejbkowicz, F., Cohen, I., Pinchev, M., Rennert, H.S. & Barnett-Griness, O.
(2012). MUTYH mutation carriers have increased breast cancer risk. Cancer, 118, 1989-
1993.
13. Sieh, W., Rothstein, J., McGuire, V., & Whittemore, A. (2015). The role of genome
sequencing in personalized breast cancer prevention. Cancer Epidemiology, Biomarkers
& Prevention, 23(11), 2322-2327. Retrieved April 9, 2015, from PubMed.
9. Population Genetics May 12, 2015
Supplementary Material
Supplementary Table 1. Summary of SNPs associated with breast cancer risk. (Those highlighted in red were
found insignificant by Michailidou et al.)
Study Locus/SNP Gene Alleles1 RAF2 Relative Risk
Sieh et al. 1 rs11249433 NOTCH2/FCGR1B A/G 0.42 1.14
Sieh et al. 2 mult MUTYH - - 1.4-2.2
Sieh et al. 3 rs616488 PEX14 A/G 0.34 1.06
Sieh et al. 4 rs11552449 TPN22/BCL2L15 C/T 0.17 1.07
Sieh et al. 5 rs4245739 MDM4 A/C 0.27 1.14
Sieh et al. 6 rs4849887 C/T 0.1 1.1
Sieh et al. 7 mult MSH6 - - 4.9
Sieh et al. 8 mult MSH2 - - 2.4
Sieh et al. 9 rs12710696 C/T 0.36 1.11
Sieh et al. 10 rs2016394 METAP1D G/A 0.47 1.05
Sieh et al. 11 rs1550623 CDCA7 A/G 0.16 1.06
Sieh et al. 12 rs1045485 CASP8 G/C 0.13 1.03
Sieh et al.
13
rs13387042
IGFBP2, IGBP5,
TPN2 A/G 0.49 1.12
Sieh et al. 14 rs16857609 DIRC3 C/T 0.26 1.08
Sieh et al. 15 rs4973768 SLC4A7/NEK10 C/T 0.47 1.11
Sieh et al. 16 rs12493607 TGFBR2 G/C 0.35 1.06
Sieh et al. 17 rs6762644 ITPR1/EGOT A/G 0.39 1.07
Sieh et al. 18 rs9790517 TET2 C/T 0.22 1.05
Sieh et al. 19 rs6828523 ADAM29 C/A 0.12 1.11
Sieh et al. 20 rs10941679 MRPS30/HCN1 A/G 0.25 1.19
Sieh et al. 21 rs7734992 TERT C/T 0.43 1.05
Sieh et al. 22 rs889312 MAP3K1/MEIR3 A/C 0.28 1.13
Sieh et al. 23 rs10472076 RAB3C T/C 0.36 1.05
Sieh et al. 24 rs1353747 PDE4D T/G 0.1 1.09
Sieh et al. 25 rs1432679 EBF1 T/C 0.43 1.07
Sieh et al. 26 rs204247 RANBP9 A/G 0.44 1.05
Sieh et al. 27 rs17530068 T/C 0.18 1.09
Sieh et al. 28 rs2046210 ESR1 G/A 0.35 1.13
Sieh et al. 29 rs3757318 ESR1 G/A 0.09 1.21
Sieh et al. 30 rs11242675 FOXQ1 T/C 0.38 1.06
Sieh et al. 31 rs720475 ARHGEF5/NOBOX G/A 0.24 1.06
Sieh et al. 32 mult NBN - - 1.3-3.1
Sieh et al. 33 rs9693444 C/A 0.32 1.07
Sieh et al. 34 rs6472903 T/G 0.17 1.1
Sieh et al. 35 rs2943559 NGF4G A/G 0.07 1.13
Sieh et al. 36 rs13281615 MYC A/G 0.41 1.08
10. Population Genetics May 12, 2015
Sieh et al. 37 rs11780156 MIR1208 C/T 0.17 1.07
Sieh et al. 38 rs1011970 CDKN2A/B G/T 0.17 1.09
Sieh et al. 39 rs865686 KLF4/RAD23B T/G 0.37 1.12
Sieh et al. 40 rs10759243 C/A 0.27 1.06
Sieh et al. 41 rs2380205 ANKRD16 C/T 0.44 1.02
Sieh et al. 42 rs7072776 MLLT10/DNAJC1 G/A 0.28 1.07
Sieh et al. 43 rs11814448 DNAJC1 A/C 0.02 1.26
Sieh et al. 44 rs10995190 ZNF365 G/A 0.15 1.16
Sieh et al. 45 rs704010 ZMIZ1 C/T 0.39 1.07
Sieh et al. 46 mult PTEN - - 2.0-10.0
Sieh et al. 47 rs7904519 TCF7L2 A/G 0.45 1.06
Sieh et al. 48 rs11199914 C/T 0.32 1.05
Sieh et al. 49 rs2981579 FGFR2 G/A 0.42 1.26
Sieh et al. 50 rs3817198 LSP1/H19 T/C 0.32 1.07
Sieh et al. 51 rs3903072 OVOL1 G/T 0.47 1.05
Sieh et al. 52 rs614367 CCND1/FGFs C/T - 1.15
Sieh et al. 53 rs494406 CCND1 C/T 0.27 1.07
Sieh et al. 54 mult ATM - - 2.0-3.0
Sieh et al. 55 rs11820646 C/T 0.41 1.09
Sieh et al. 56 rs10771399 PTHLH A/G 0.11 1.19
Sieh et al. 57 rs12422552 G/C 0.26 1.05
Sieh et al. 58 rs17356907 NTN4 A/G 0.3 1.1
Sieh et al. 59 rs1292011 TBX3/MAPKAP5 A/G 0.42 1.1
Sieh et al. 60 mult BRCA2 - - 9.0-21.0
Fachal & Dunning 61 rs11571833 BRCA2 A/T .004 1.26
Sieh et al. 62 rs2236007 PAX9/SLC25A21 G/A 0.2 1.08
Sieh et al. 63 rs999737 RAD51B C/T 0.23 1.09
Sieh et al. 64 rs2588809 RAD51L1 C/T 0.15 1.08
Sieh et al. 65 rs941764 CCDC88C A/G 0.33 1.06
Sieh et al. 66 rs3803662 TOX3/LOC643714 G/A 0.28 1.2
Sieh et al. 67 rs17817449 MIR1972-2-FTO T/G 0.4 1.08
Sieh et al. 68 rs11075995 FTO T/A 0.23 1.1
Sieh et al. 69 mult CDH1 - - 2.0-10.0
Sieh et al. 70 mult PALB2 - - 2.0-4.0
Sieh et al. 71 rs13329835 CDYL2 A/G 0.22 1.08
Sieh et al. 72 mult BRCA1 - - 5.0-45.0
Sieh et al. 73 mult BRIP2 - - 2.0-3.0
Sieh et al. 74 mult TP53 - - 2.0-10.0
Sieh et al. 75 rs6504950 STXBP4/COX11 G/A 0.28 1.05
Sieh et al. 76 mult RAD51C - - 3.2-3.5
Sieh et al. 77 rs527616 G/C 0.37 1.05
Sieh et al. 78 rs1436904 CHST9 T/G 0.41 1.04
Sieh et al. 79 mult STK11 - - 2.0-10.0
11. Population Genetics May 12, 2015
Sieh et al. 80 rs8170 MERIT40 G/A 0.19 1.25
Sieh et al. 81 rs4808801 SSBP4/ISYNA1/ELL A/G 0.34 1.06
Sieh et al. 82 rs3760982 KCNN4/ZNF283 G/A 0.47 1.06
Sieh et al. 83 rs2284378 RALY C/T 0.204 1.16
Sieh et al. 84 rs2823093 NRIP1 G/A 0.26 1.09
Sieh et al. 85 mult CHEK2 - - 2.0-3.0
Michailidou et al 86 rs17879961 CHEK2 A/G 0.03 -
Sieh et al. 87 rs132390 EMID1/RHBDD3 T/C 0.03 1.12
Sieh et al. 88 rs6001930 MKL1 T/C 0.1 1.12
Michailidou et al 89 rs12405132 C/T - -
Michailidou et al 90 rs12048493 A/C 0.34 1.04
Michailidou et al 91 rs72755295 A/G 0.03 1.19
Michailidou et al 92 rs6796502 G/A 0.09 1.09
Michailidou et al 93 rs13162653 G/T 0.45 1.09
Michailidou et al 94 rs2012709 C/T 0.46 1.06
Michailidou et al 95 rs7707921 A/T 0.23 1.06
Michailidou et al 96 rs9257408 G/C 0.38 1.05
Michailidou et al 97 rs4593472 C/T 0.35 1.09
Michailidou et al 98 rs13365225 A/G 0.17 1.12
Michailidou et al 99 rs13267382 G/A 0.36 1.07
Michailidou et al 100 rs11627032 T/C 0.26 1.06
Michailidou et al 101 rs745570 A/G 0.50 1.06
Michailidou et al 102 rs6507583 A/G 0.07 1.10
Michailidou et al 103 rs6678914 LGR6 G/A 0.42 -
Michailidou et al 104 rs1053338 ATXN7 A/G 0.13 1.07
Michailidou et al 105 rs10069690 TERT C/T 0.26 1.13
Michailidou et al 106 rs2736108 TERT C/T 0.27
Michailidou et al 107 rs17529111 FAM46A T/C 0.21
Michailidou et al 108 rs12662670 ESR1 T/G 0.08
Michailidou et al 109 rs78540526 CCND1? C/T 0.08
Michailidou et al 110 rs554219 CCND1? C/G 0.13
Michailidou et al 111 rs75915166 CCND1? G/A 0.06
Michailidou et al 112 rs2363956 ANKLE1 G/T 0.49 1.19
Pharoah et al. 113 rs1053485 CASP8 C/A 0.86 1.13
Pharoah et al. 114 rs2981582 FGFR2 G/A 0.40 1.26
Fachal & Dunning 115 rs1562430 CASC21, CASC8 T/C 0.32 1.17
Fachal & Dunning 116 rs909116 TNNT3 T/C 0.53 1.17
Fachal & Dunning 117 rs9383938 ESR1 G/T 0.154 1.18
Fachal & Dunning 118 rs10822013 ZNF365 C/T 0.421 1.12
Fachal & Dunning 119 rs9485372 TAB2 G/A 0.241 1.11
Fachal & Dunning 120 rs13393577 ERBB4 T/C 0.113 1.53
Fachal & Dunning 121 rs2290854 MDM4 G/A 0.461
Fachal & Dunning 122 rs4951011 ZC3H11A A/G 0.195 1.09
12. Population Genetics May 12, 2015
Fachal & Dunning 123 rs10474352 C/T 0.343 1.09
Fachal & Dunning 124 rs2290203 PRC1 G/A 0.375 1.08
Fachal & Dunning 125 rs6964587 AKAP9 G/T 0.372 1.05
Bogdanova et al. 126 rs34767364 NBN/NBS1 G/A 0.001 1.90
Peng et al. 127 rs1219648 FGFR2 A/G 0.42 1.32
Peng et al. 128 rs2180341 RNF146 A/G 0.21 1.41
Peng et al. 129 rs4784227 TOX3 C/T 0.20 1.24
Peng et al. 130 rs16886165 MAP3K1 G/T 0.15 1.23
Peng et al. 131 rs981782 A/C 0.53 1.04
Rennert et al. 132 rs24612342 MUTYH T/C - 1.39
Rennert et al. 133 rs36053993 MUTYH C/T 0.002 1.86
Li et al. 134 rs12443621 TOX3 A/G 0.572 1.01
Li et al. 135 rs8051542 TOX3 C/T 0.181 1.12
Johnson et al. 136 rs1799950 BRCA1 T/C 0.054 1.72
Johnson et al. 137 rs4986850 BRCA1 C/A 0.074 1.07
Johnson et al. 138 rs2227945 BRCA1 A/G 0.0004 0
Johnson et al. 139 rs16942 BRCA1 A/G 0.322 1.46
Johnson et al. 140 rs1799966 BRCA1 A/G 0.323 1.37
Johnson et al. 141 rs766173 BRCA2 T/G 0.031 1.16
Johnson et al. 142 rs144848 BRCA2 T/G 0.279 1.11
Johnson et al. 143 rs4987117 BRCA2 C/T 0.035 1.09
Johnson et al. 144 rs1799954 BRCA2 C/T 0.008 1.47
Johnson et al. 145 rs11571746 BRCA2 T/C 0.0002 0
Johnson et al. 146 rs11571747 BRCA2 A/C 0.003 1.04
Johnson et al. 147 rs4987047 BRCA2 A/T 0.0002 0
Johnson et al. 148 rs1801426 BRCA2 A/G 0.0008 0
Johnson et al. 149 rs3218707 ATM G/C 0.0004 0
Johnson et al. 150 rs4987945 ATM C/G 0.0002 5.21
Johnson et al. 151 rs4986761 ATM T/C 0.013 1.02
Johnson et al. 152 rs3218695 ATM C/A 0.010
Johnson et al. 153 rs1800056 ATM T/C 0.011 1.52
Johnson et al. 154 rs1800057 ATM C/G 0.024 1.68
Johnson et al. 155 rs3092856 ATM C/T 0.0006 0
Johnson et al. 156 rs1800058 ATM C/T 0.018 1.23
Johnson et al. 157 rs1801673 ATM A/T 0.005 1.41
Johnson et al. 158 rs1042522 TP53 C/G 0.262 1.02
1Reference/risk allele
2Risk allele frequency
[Note: Alleles, allele frequencies, and effect sizes were not always from the original source of the identified
SNP as listed in the left-hand column of the chart. These values were taken from the journal articles listed on
the reference page as well as refSNP, an NCBI SNP database.]