Do diet and exercise play a role in breast cancer risk or survival? Jennifer Ligibel, MD, director of the Zakim Center for Integrative Therapies at Dana-Farber, discusses the benefits of a healthy lifestyle for young women with cancer.
This presentation was originally given on Oct. 16, 2015 at the Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Communities of Color and Participation in Breast Cancer Researchbkling
40 percent of Americans belong to a minority racial or ethnic group, yet only 2 percent of cancer clinical trials have studied enough minorities to provide useful information to these populations. In this webinar Dr. Susan Love, from the Dr. Susan Love Research Foundation, presents on the importance of including communities of color in breast cancer research, the barriers to diversifying research, and what can be done to address them.
Slides and audio for this presentation are available on YouTube: http://youtu.be/NJ0HTrH-uog
Nancy Lin, MD, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, talks about the differences between various types of breast cancer, and the new therapies that are being developed to treat the disease. This presentation was originally given at the Metastatic Breast Cancer Forum held at Dana-Farber on Oct. 5, 2013. The program was sponsored by EMBRACE (Ending Metastatic Breast Cancer for Everyone).
Navigating Nutrition During Cancer and COVID-19bkling
Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.
Gain a deeper understanding of uterine and endometrial cancer symptoms, diagnosis, treatment options, and current research trends with Dr. Jason D. Wright, Division Chief of Gynecologic Oncology at New York-Presbyterian/Columbia University Medical Center. This webinar is a collaboration with the Foundation for Women's Cancer.
Audio and slides for this presentation are available on YouTube: http://youtu.be/UVRYzgFqVGM
Dana-Farber Nutritionist Hillary Wright presents on how to fight cancer with your fork. She discusses the importance of healthy eating, and dispels some of the common myths about certain foods and cancer.
Do diet and exercise play a role in breast cancer risk or survival? Jennifer Ligibel, MD, director of the Zakim Center for Integrative Therapies at Dana-Farber, discusses the benefits of a healthy lifestyle for young women with cancer.
This presentation was originally given on Oct. 16, 2015 at the Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Communities of Color and Participation in Breast Cancer Researchbkling
40 percent of Americans belong to a minority racial or ethnic group, yet only 2 percent of cancer clinical trials have studied enough minorities to provide useful information to these populations. In this webinar Dr. Susan Love, from the Dr. Susan Love Research Foundation, presents on the importance of including communities of color in breast cancer research, the barriers to diversifying research, and what can be done to address them.
Slides and audio for this presentation are available on YouTube: http://youtu.be/NJ0HTrH-uog
Nancy Lin, MD, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, talks about the differences between various types of breast cancer, and the new therapies that are being developed to treat the disease. This presentation was originally given at the Metastatic Breast Cancer Forum held at Dana-Farber on Oct. 5, 2013. The program was sponsored by EMBRACE (Ending Metastatic Breast Cancer for Everyone).
Navigating Nutrition During Cancer and COVID-19bkling
Nutrition can be puzzling enough, but when you add a cancer diagnosis and a global pandemic, it’s even harder to make sense of it all. Julie Lanford, MPH, RD, CSO, LDN, "The Cancer Dietitian" for Cancer Services, will help put the pieces together so you’re equipped to navigate nutrition during cancer and COVID-19.
Gain a deeper understanding of uterine and endometrial cancer symptoms, diagnosis, treatment options, and current research trends with Dr. Jason D. Wright, Division Chief of Gynecologic Oncology at New York-Presbyterian/Columbia University Medical Center. This webinar is a collaboration with the Foundation for Women's Cancer.
Audio and slides for this presentation are available on YouTube: http://youtu.be/UVRYzgFqVGM
Dana-Farber Nutritionist Hillary Wright presents on how to fight cancer with your fork. She discusses the importance of healthy eating, and dispels some of the common myths about certain foods and cancer.
Report Back from ASCO on Metastatic Breast Cancerbkling
Dr. Anne Moore, Medical Director of the Weill Cornell Breast Center, shares her experiences from the American Society of Clinical Oncology's June 2017 Conference. She also updates us on the latest research from the conference as it relates to metastatic breast cancer.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
There are striking disparities in survival between black and white patients. Dr. Christine Ambrosone and Dr. Song Yao have led a team that has done extensive research to understand the causes of more aggressive cancer in black women. Results from their research may open the door to treatment intervention that could help eliminate these disparities, and the doctors will go over their research and discuss how we can work towards the elimination of racial gaps in breast cancer survival.
Report Back from SGO: What’s the Latest in Uterine Cancer?bkling
Dr. Jeannine Villella, Chief of Gynecologic Oncology at Lenox Hill Hospital, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Villella breaks down what the research presented at the conference means for you and discusses new developments.
Intermittent Fasting: How it Can Reduce the Risk of Breast Cancer Recurrencebkling
Breast cancer recurrence is the greatest fear for those with breast cancer. While many survivors know that being overweight can contribute to recurrence of their cancer, the thought of dieting and how to go about it can be overwhelming. Dr. Nicholas Webster, Professor of Medicine, Chief of the Division of Endocrinology and Metabolism, and Associate Director for Shared Resources, Moores Cancer Center discusses his study that suggests a path that is easy to follow and produces the type of results that can be a matter of life and death for some breast cancer patients.
Addressing your COVID-19 Breast Cancer Concerns bkling
Dr. Anne Moore, medical oncologist and Director of the Breast Cancer Survivorship Program at Weill Cornell and Dr. Leticia Varella, Assistant Professor of Medicine at Weill Cornell Medical College will go over changes in treatment and maintenance care for those with an early stage or metastatic breast cancer diagnosis. They will address your risk level as a cancer patient, provide strategies to minimize risk, discuss how to deal with anxiety, and answer your questions to help you through the COVID-19 pandemic.
Research increasingly shows that “energy balance” is important in breast cancer. Learn why exercise, weight, and diet are important for breast cancer patients.
Living with Advanced Breast Cancer: Challenges and Opportunitiesbkling
Musa Mayer -- breast cancer survivor, advocate, and author -- presents at SHARE in November 2011. To view a video about the First International Consensus on Metastatic Breast Cancer, visit www.sharecancersupport.org/mayer.
All in the Family: Hereditary Risk for Gynecologic Cancerbkling
Knowing and understanding your inherited genetics is important for ovarian and uterine cancer patients. Dr. Melissa Frey, gynecologic oncologist at Weill Cornell Medicine, discusses how genetic factors affect women with ovarian and uterine cancer and influence treatment decisions, with a particular focus on BRCA1 & 2 and Lynch Syndrome.
This webinar was being put on in partnership with FORCE.
Deborah Collyar, President, Patient Advocates In Research, discusses what new research is telling us about DCIS, both here and abroad. What is low risk DCIS? Is it okay to monitor your DCIS? Is Endocrine Therapy absolutely necessary? What does the future look like? Deborah addresses this and so much more.
Patients with ER+ breast cancer have many treatment options, and a better understanding of mechanisms of resistance to therapy is leading to new treatments.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
Invasive Lobular Carcinoma — Highlights from the First Ever ILC Symposium bkling
Steffi Osterreich, PhD, and Rachel Jankowitz, MD, of University of Pittsburgh Cancer Institute, join Heather Hillier, breast advocate and co-chair of the first international ILC Symposium, in offering an overview of Invasive Lobular Carcinoma and highlights from the conference, which took place in Pittsburgh in September 2016. The program was presented in collaboration with MBCN.
Report Back from ASCO on Metastatic Breast Cancerbkling
Dr. Anne Moore, Medical Director of the Weill Cornell Breast Center, shares her experiences from the American Society of Clinical Oncology's June 2017 Conference. She also updates us on the latest research from the conference as it relates to metastatic breast cancer.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
There are striking disparities in survival between black and white patients. Dr. Christine Ambrosone and Dr. Song Yao have led a team that has done extensive research to understand the causes of more aggressive cancer in black women. Results from their research may open the door to treatment intervention that could help eliminate these disparities, and the doctors will go over their research and discuss how we can work towards the elimination of racial gaps in breast cancer survival.
Report Back from SGO: What’s the Latest in Uterine Cancer?bkling
Dr. Jeannine Villella, Chief of Gynecologic Oncology at Lenox Hill Hospital, provides a comprehensive update from the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer. Dr. Villella breaks down what the research presented at the conference means for you and discusses new developments.
Intermittent Fasting: How it Can Reduce the Risk of Breast Cancer Recurrencebkling
Breast cancer recurrence is the greatest fear for those with breast cancer. While many survivors know that being overweight can contribute to recurrence of their cancer, the thought of dieting and how to go about it can be overwhelming. Dr. Nicholas Webster, Professor of Medicine, Chief of the Division of Endocrinology and Metabolism, and Associate Director for Shared Resources, Moores Cancer Center discusses his study that suggests a path that is easy to follow and produces the type of results that can be a matter of life and death for some breast cancer patients.
Addressing your COVID-19 Breast Cancer Concerns bkling
Dr. Anne Moore, medical oncologist and Director of the Breast Cancer Survivorship Program at Weill Cornell and Dr. Leticia Varella, Assistant Professor of Medicine at Weill Cornell Medical College will go over changes in treatment and maintenance care for those with an early stage or metastatic breast cancer diagnosis. They will address your risk level as a cancer patient, provide strategies to minimize risk, discuss how to deal with anxiety, and answer your questions to help you through the COVID-19 pandemic.
Research increasingly shows that “energy balance” is important in breast cancer. Learn why exercise, weight, and diet are important for breast cancer patients.
Living with Advanced Breast Cancer: Challenges and Opportunitiesbkling
Musa Mayer -- breast cancer survivor, advocate, and author -- presents at SHARE in November 2011. To view a video about the First International Consensus on Metastatic Breast Cancer, visit www.sharecancersupport.org/mayer.
All in the Family: Hereditary Risk for Gynecologic Cancerbkling
Knowing and understanding your inherited genetics is important for ovarian and uterine cancer patients. Dr. Melissa Frey, gynecologic oncologist at Weill Cornell Medicine, discusses how genetic factors affect women with ovarian and uterine cancer and influence treatment decisions, with a particular focus on BRCA1 & 2 and Lynch Syndrome.
This webinar was being put on in partnership with FORCE.
Deborah Collyar, President, Patient Advocates In Research, discusses what new research is telling us about DCIS, both here and abroad. What is low risk DCIS? Is it okay to monitor your DCIS? Is Endocrine Therapy absolutely necessary? What does the future look like? Deborah addresses this and so much more.
Patients with ER+ breast cancer have many treatment options, and a better understanding of mechanisms of resistance to therapy is leading to new treatments.
SHARE Presentation: New Developments in the Medical Treatment of Breast Cance...bkling
Dr. Cliff Hudis on the latest information on new breast cancer treatments. Dr. Hudis is Chief of Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
Invasive Lobular Carcinoma — Highlights from the First Ever ILC Symposium bkling
Steffi Osterreich, PhD, and Rachel Jankowitz, MD, of University of Pittsburgh Cancer Institute, join Heather Hillier, breast advocate and co-chair of the first international ILC Symposium, in offering an overview of Invasive Lobular Carcinoma and highlights from the conference, which took place in Pittsburgh in September 2016. The program was presented in collaboration with MBCN.
Breast surgery for Metastatic Breast Cancer : Cochrane Analysis Kundan Singh
Breast surgery plus systemic treatment may improve local PFS when compared to systemic treatment alone (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; I2 = 43%; low quality evidence)
The group receiving breast surgery plus systemic treatment probably had a shorter time
to distant PFS compared to the group receiving systemic treatment alone (HR 1.42, 95%CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence)
Adjuvant Endocrine Therapy For Postmenopausal Breast CancerEmad Shash
Questions Covered in the presentation:
• Should patients receive an AI or Tamoxifen?
• Should patients receive monotherapy (AI or Tamoxifen alone) or sequential
therapy using both?
• 5 vs 10 years of therapy?
• If More than 5 years of endocrine therapy, which class to be used
SOURCES
CDC Resources and Educational Tools - Educational Tools for Clinicians
DES Lecture Presentation and DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_clinicians.html
CDC Resources and Educational Tools - Educational Tools for Nurses
DES Case Studies > http://www.cdc.gov/des/hcp/resources/tools_nurses.html
CDC Resources and Educational Tools - Clinician Information
DES References > http://www.cdc.gov/des/hcp/bibliography/index.html
MORE DES DIETHYLSTILBESTROL RESOURCES
DES cases and lawsuits:
http://diethylstilbestrol.co.uk/studies/des-lawsuits/
DES studies on cancers and screening:
https://desdaughter.com/2013/09/08/diethylstilbestrol-resources-1/
DES studies on epigenetics and transgenerational effects:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-6/
DES studies on fertility:
http://diethylstilbestrol.co.uk/studies/des-and-fertility/
DES studies on gender identity and psychological health:
https://desdaughter.com/2015/12/04/diethylstilbestrol-resources-3/
DES studies on in-utero exposure to DES and side-effects:
https://desdaughter.com/2013/12/31/diethylstilbestrol-resources-4/
DES studies on pregnancy:
http://diethylstilbestrol.co.uk/studies/des-and-pregnancy/
DES studies on the genital tract:
https://desdaughter.com/2015/12/16/diethylstilbestrol-resources-7/
DES videos:
https://www.youtube.com/playlist?list=PL3D4F4A11812DAE00
What's the latest in breast cancer treatment and research? Erica Mayer, MD, MPH, a medical oncologist in the Susan F. Smith Center for Women's Cancers, shares the latest breast cancer news.
This presentation was originally given on Oct. 16, 2015, at the annual Young Women with Breast Cancer Forum, hosted by the Program for Young Women with Breast Cancer in the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, in Boston, Mass.
Learn more: http://www.susanfsmith.org
Diagnosed with breast cancer while on a family historyscreen.docxduketjoy27252
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
Diagnosed with breast cancer while on a family historyscreen.docxlynettearnold46882
Diagnosed with breast cancer while on a family history
screening programme: an exploratory qualitative study
A. CLEMENTS, bsc, senior research nurse, Cancer Research UK Primary Care Education Research Group,
University of Oxford, Department of Primary Health Care, Oxford, B.J. HENDERSON, phd, research psycholo-
gist, Institute of Medical & Social Care Research, Ardudwy, Normal Site, University of Wales, Bangor, Gwynedd,
S. TYNDEL, ba, research officer, Cancer Research UK Primary Care Education Research Group, University of
Oxford, Department of Primary Health Care, Oxford, G. EVANS, md frcp, consultant in medical genetics,
Department of Clinical Genetics, St Mary’s Hospital, Manchester, K. BRAIN, phd, senior research fellow,
Institute of Medical Genetics, University of Wales College of Medicine, Heath Park, Cardiff, J. AUSTOKER, phd,
director, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of
Primary Health Care, Oxford, & E. WATSON, phd, deputy director, Cancer Research UK Primary Care Educa-
tion Research Group, University of Oxford, Department of Primary Health Care, Oxford, UK for the PIMMS Study
Management Group*
CLEMENTS A., HENDERSON B.J., TYNDEL S., EVANS G., BRAIN K., AUSTOKER J. & WATSON E. FOR
THE PIMMS STUDY MANAGEMENT GROUP (2008) European Journal of Cancer Care 17, 245–252
Diagnosed with breast cancer while on a family history screening programme: an exploratory qualitative study
Mammographic screening is offered to many women under 50 in the UK who are at moderate or high risk of
developing breast cancer because of their family history of the disease. Little is understood about the impact
of screening on the emotional well-being of women with a family history of breast cancer. This qualitative
study explores the value that women at increased risk placed on screening, both pre- and post-cancer diagnosis
and the impact of the diagnosis. In-depth interviews were undertaken with 12 women, aged 35–50, diagnosed
with breast cancer while on an annual mammographic screening programme. Women described the strong
sense of reassurance gained from screening prior to diagnosis. This faith in screening was reinforced by early
detection of their cancer. Reactions to diagnosis ranged from devastation to relief at having finally developed
a long-expected condition. Despite their positive attitudes about screening, not all women wanted to continue
with surveillance. For some, prophylactic mastectomy was preferable, to reduce future cancer risk and to
alleviate anxieties about the detection of another cancer at each subsequent screen. This study illustrates the
positive yet diverse attitudes towards mammographic screening in this group of women with a family history
of breast cancer.
Keywords: breast cancer, early screening programme, family history, qualitative.
Correspondence address: Alison Clements, Cancer Research UK Primary Care Education Research Group, University of Oxford, Department of Pr.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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The Link Between Breast Cancer and Hormones_ Kristin Rojas MD
1. Kristin Rojas, MD
Breast Surgical Oncology and Gynecologic Surgery
Obstetrics and Gynecology Grand Rounds
January 25, 2019
Maimonides Medical Center
The link between hormones and
breast cancer: does staying young
forever come with a price?
4. Introduction: BC Basics
P-1 Trial
NSABP B-14
NSABP B-24
• Invasive breast cancer is a diverse family of tumor
subtypes
• Subtypes grouped into the following:
• Luminal A-like tumors: ER+/Her2-
• Luminal B-like tumors: ER+/Her2+
• Basal-like tumors: ER-/Her2-
• Her2-overexpressing: ER-/Her2+
• Presentation, treatment, and prognosis related to
subtype
• Older literature does not assess risk by subtype
• Convenient, but does not scratch surface of heterogeneity
• Genomic profiling, next-generation sequencing
Rojas K and Stuckey A. Clin Obstet Gynecol (2016)
5. Estrogen
• Estrogen discovered in 1929, receptor discovered
in 1958 by Elwood Jensen at University of Chicago
• 80% of invasive breast cancers express the estrogen
receptor
• Estrogen blockade reduces lifetime risk in special
populations, decreases risk of recurrence after
primary treatment
P-1 Trial
NSABP B-14
NSABP B-24
7. The link between breast cancer and
reproductive factors
First evidence of hormonal influence on cancer risk
8. BC Risk Due to Reproductive Factors
• 1969: Fraumeni observed that nuns had a higher-than-
average risk of breast cancer
• Many attempts to articulate the link between
reproductive factors (endogenous hormone exposure)
and breast cancer risk
• Similar concept later applied to exogenous hormone
exposure
Fraumeni, et al. J Natl Cancer Inst (1969)
9. Brief Statistics Primer
• Relative risk: Probability of event in group 1 v. probability in group 2
• RR 1 is neutral: chance of event occurring is same for both groups
• Value <1: Group 1 has less of a chance of event
• Value >1: Group 1 has more of a chance of event
• Sometimes expressed as %:
• RR 1.26 means group 1 has 26% higher chance of event occurring
• If 95% CI cross 1= the result is not significant
Fraumeni, et al. J Natl Cancer Inst (1969)
10. 9 studies using data from 1966-2005
Old Data
Ma H, et al. Breast Cancer Res (2006)
11. 9 studies using data from 1966-2005
Studies with
significant
resultsà
Old Data
Ma H, et al. Breast Cancer Res (2006)
12. Better Data
15 studies using data from 2007-2014
21,941 breast cancers and almost 900,000 controls
Lambertini M, et al. Cancer Treat Rev (2016)
13. Better Data
15 studies using data from 2007-2014
21,941 breast cancers and almost 900,000 controls
Conclusion:
• Parity decreases your risk of ER+
tumors (OR 0.75 95% CI 0.70-0.81)
• Does decreased age at delivery?
Lambertini M, et al. Cancer Treat Rev (2016)
14. Better Data
15 studies using data from 2007-2014
21,941 breast cancers and almost 900,000 controls
Conclusion:
• Parity decreases your risk of ER+
tumors (OR 0.75 95% CI 0.70-0.81)
• Does decreased age at delivery?
?
Lambertini M, et al. Cancer Treat Rev (2016)
15. Reproductive Risk Factors
• Parity results in 25% risk reduction in only luminal tumors (ER+, Her2-)
• Not Her2-overexpressing or HR negative1,2
• Long-term benefit is preceded by increase in risk the years following deliveryàmore
on this later3
• Recent population-based epidemiological data has failed to demonstrate a
consistent association between breast cancer and…
• Age at menarche4
• Age at first delivery- maybe related to HR+1
• Of note, breastfeeding consistently decreases lifetimes risk of breast cancer
in HR positive and negative groups1,2
• Maybe not Her2+, but not enough data1
1Lambertini, et al. Cancer Treat Rev (2016)
2Ma, et al. Breast Cancer Res (2006)
3Lyons, et al. Nat Med (2011)
4Li, et al. Am J Epidemiol (2013)
17. Emmenin (1935)
• First commercial preparation of estrogen
• Alcohol-soluble substance derived from human
placentas
• Marketed to treat dysmenorrhea
Watson M. Canadian Med Assoc Journal (1935)
18. Premarin (1942)
• From pregnant mares’ urine
• Dominated by estrone (50%)
• Equilin (22.5% to 32.5%) with less than 5% estradiol.
• Premarin® approved by the FDA in 1942 to treat
hot flashes
• By 1992, was the number one prescription in
the US, with sales exceeding $1 billion in 1997
19. Feminine Forever
• In 1966, Dr. Robert Wilson wrote that
by using estrogen, menopause was a
preventable event.
• With this therapy, a woman’s “breasts
and genital organs will not shrivel. She
will be much more pleasant to live
with and will not become dull and
unattractive.”
20. The Nurses’ Health Study
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
• Studies in 1980’s, 1990’s observed HRT may be cardioprotective
• Prospective cohort NHS, published in 1996 followed 60,000 women
through menopause
• Collected data from 1976-1992, found marked decrease in coronary
disease in those taking CEE with progestin (RR 0.39) or alone (RR
0.60) compared to women who did not use hormones
Grodstein F, et al. N Engl J Med (1996)
21. A Secondary Analysis of the NHS
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
Colditz, et al. NEJM (1995)
22. A Secondary Analysis of the NHS
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
Colditz, et al. NEJM (1995)
23. A Secondary Analysis of the NHS
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
Colditz, et al. NEJM (1995)
NS
24. A Secondary Analysis of the NHS
• Does not apply for those
taking E other than oral CEE
• Increase in risk does not
apply to those taking HRT
for <5 years
• Does not apply to past use
of any kind
• Confirmed in the UK’s Million
Women Study
• No increased risk of dying
from breast cancer
NS
NS
Colditz, et al. NEJM (1995)
Beral, et al. Lancet (2003)
25. Leading up to the WHI
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
• NHS (1996) found cardioprotective effect of HRT, but increased risk of
BC in current users >5 years taking CEE with or without progestin
• HERS study (1998) found that CEE + MPA did not decrease CV events
in women with baseline CAD
• Mean age 66.7 years
• Also found increased VTE risk, despite improving lipid profile
• Did not look at BC risk
Hulley S, et al. JAMA (1998)
26. Leading up to the WHI
HRT: hormone replacement therapy
CEE: conjugated equine estrogen
MPA: medroxyprogesterone acetate
• Designed after Public Health Service Task Force found that research
disproportionately focused on white men
• First randomized trial in healthy women, but still older (n=160,000 aged 50-
79)
• Majority of women were >10 years past menopause
• Designed to measure effect of nutrition and HRT on “global health index”
• Included CV disease, breast, endometrial, and colon cancer
• Sought to look at women >10 yrs post-menopause:
• Enrollment had been restricted so that <10% were between 50-54
• Two hormone trials:
• 1) RCT of women without a uterus given CEE 0.625mg v. placebo
• 2) RCT of women with a uterus given CEE + MPA 2.5mg v. placebo
• HT components stopped early (planned 9 year f/u) after 5.2 years in 2002
WHI (2002)
31. “Fear and sensationalism over science…
for maximum publicity” – Dr. Robert Langer
• Lead researcher states he was told the CEE + MPA arm was stopped
based on a “finding of likely futility”, not harm
• Small group of study executives wrote initial results paper, press release,
citing increase in breast cancer as main reason for termination
• Clinical site PIs given hours to read article and submit edits, but article already
in print
• USPSTF downgraded HRT from B to D
Langer R. Climacteric (2017)
32. • Methodology:
• Although designed as RCT- should interpret data as observational
• Women at liberty to decide if they continued assigned treatment, or whether they
should undergo diagnostic procedures
• Previous hormone use not accounted for “3-month washout period”
• Statistics:
• The original paper emphasized relative and not absolute risks
• Results not adjusted for pre-existing diseases, treatments besides hormones,
skewed by unusually low rate of breast cancer in the placebo group
• Aftermath:
• Results incorrectly generalized to women <60 (30% of participants age 50-59)
• 2003 WHI paper emerged with CEE alone group with RR of breast cancer <1
Clark J. Nucl Recept Signal (2006)
Langer R. Climacteric (2017)
“Fear and sensationalism over science…
for maximum publicity” – Dr. Robert Langer
WHI (2002)
33. • Methodology:
• Although designed as RCT- should interpret data as observational
• Women at liberty to decide if they continued assigned treatment, or whether they
should undergo diagnostic procedures
• Previous hormone use not accounted for “3-month washout period”
• Statistics:
• The original paper emphasized relative and not absolute risks
• Results not adjusted for pre-existing diseases, treatments besides hormones,
skewed by unusually low rate of breast cancer in the placebo group
• Aftermath:
• Results incorrectly generalized to women <60 (30% of participants age 50-59)
• 2003 WHI paper emerged with CEE alone group with RR of breast cancer <1
Clark J. Nucl Recept Signal (2006)
Langer R. Climacteric (2017)
“Fear and sensationalism over science…
for maximum publicity” – Dr. Robert Langer
IGNORED
WHI (2002)
34. Clark J. Nucl Recept Signal (2006)
Langer R. Climacteric (2017)
• 26% increase in relative risk
(although still not significant)
• Public interpreted this as “I have a
26% risk of breast cancer”
• Absolute risk is 8 additional
cancers per 10,000 patient-
years
Relative vs. Absolute Risk
36. Relative vs. Absolute Risk
Clark J. Nucl Recept Signal (2006)
• 3A: Risk ratios appear to
spike at year 4-5
• 3B: Note the placebo
group drop in rates at
year 4
• THIS led to the
NONSIGNIFICANT
increase in relative risk
37. Relative vs. Absolute Risk
Clark J. Nucl Recept Signal (2006)
• 5A: Women with prior
HRT use: CIs very large,
no real conclusions
here
• 5B: No prior HRT use:
all CI cross 1
Questions
38. A RR < 3 Probably Doesn’t Mean Much
Pesch, et al. Int J Cancer (2012)
• Male smokers with an average daily
dose of >30 cigarettes:
• RR of squamous cell lung ca: >100
39. Study after WHI confirms no increased BC risk
• Danish Osteoporosis Prevention Trial (DOPS) RCT of recently-
menopausal women to receive:
• Triphasic estradiol + norethisterone acetate (intact uterus) v.
placebo
• 2 mg of estradiol (prior hysterectomy) v. placebo
• Planned as a 20-year trial, terminated in 2002
• Significant reduction (10 year f/u):
• Breast cancer mortality (HR 0.54; 95% CI 0.32–0.91)
• CV mortality (HR 0.48; 95% CI 0.26–0.87)
Langer R. Climacteric (2017)
40. Study after WHI confirms no increased BC risk
• Danish Osteoporosis Prevention Trial (DOPS) RCT of recently-
menopausal women to receive:
• Triphasic estradiol + norethisterone acetate (intact uterus) v.
placebo
• 2 mg of estradiol (prior hysterectomy) v. placebo
• Planned as a 20-year trial, terminated in 2002
• Significant reduction (10 year f/u):
• Breast cancer mortality (HR 0.54; 95% CI 0.32–0.91)
• CV mortality (HR 0.48; 95% CI 0.26–0.87)
Langer R. Climacteric (2017)
IGNORED
41. You do the math…
• Theoretical initiation of malignant breast tumors by HRT and clinical
detection is at least 5 years, maybe longer than 10 years
• HRT cannot plausibly cause increased incidence in invasive breast
cancers in less than 6 years
• Similarly, time from starting HRT to diagnosis was actually 1.2 years in
Million Women Study
• Most HRT-BC risk studies based on short observation periods
Beral, et al. Lancet (2003)
Dietel M, et al. Human Reprod (2005)
42. So what is true about the WHI study?
• Women taking CEE alone did not have more BC events than placebo
• Using adjusted RR, CEE + MPA group did not have more BC than
placebo
• Only significant findings: decrease in fracture rate, increase in VTE
• Effects of HRT on most organ systems vary by age, time since last
exposure to hormones- newly menopausal women were not
represented in the WHI study
WHI (2002)
43. Decrease in BC after WHI published
• 2001-2004: 12% decrease in breast cancer incidence in women age 50-691
• Analysis of same SEER registry found that decline started prior to WHI
publication, when HRT was high (as early as 1998) and was present for all types
of cancer2
• Decline in MMG compliance started in 20031
• Women who stop HRT less willing to continue periodic screening, but decline in
incidence was also observed in those who continued screening3,4
• Decline not consistently seen in countries with high cessation rates of HRT
• Norwegian screening data (stable and long-term, with 50% of post-menopausal
women on HRT) found initial increase in diagnosis with initiation of screening
(1996) followed by a continued decrease in incidence, not altered by the
decrease in HRT use in 20025
1Ravdin, et al. N Engl J Med (2007)
2Jemal, et al. Breast Cancer Res (2007)
3Glass, et al. J Natl Cancer Inst (2007)
4Cann, et a. J Natl Cancer Inst (2008)
5Zahl and Maehlen. N Engl J Med (2007)
Questions
44. The mortality toll of estrogen avoidance
• Estrogen HRT in younger postmenopausal women associated with
reduction in all-cause mortality
• Bone health:
• Significant increase in hip fractures after WHI released
• Cardiac health:
• Increased risk of cardiac death in first year after stopping HRT
• Analysis of excess deaths among hysterectomized women 50-60 yrs
• Excess mortality after decline in E use between 2002 and 2011
• Over 10 years, approx. 40,000 postmenopausal women died
prematurely because of avoidance of estrogen therapy
Karim, et al. Menopause (2011)
Mikkola, et al. J Clin Endocrinol Metab (2015)
45. What about other routes of HRT?
• Transdermal systemic HRT skips first pass metabolism, has lower rate
of VTE
• No strong evidence of an association of route of estrogen and BC risk has
been found1,2
• Vaginal estrogen has been shown to be more effective than
polycarbaphil-based moisturizers in the treatment of vaginal atrophy
• Although some is absorbed, difficult to discern how much due to issues with
immunoassays and cross-reactivity with other steroid hormones3,4
• Has never been found to increase the risk of breast cancer5, nor increase the
risk of recurrence in women with a history of breast cancer6,7
• Endorsed by ACOG8
1Fournier, et al. Breast Cancer Res Treat (2008)
2Crandall, et al. Menopause (2017)
3Lee, et al. J Clin Endocrin Metab (2006)
4Kushnir, et al. Am J Clin Pathol (2008)
5 Cransdall, et al. Menopause (2018)
6Dew, et al. Climacteric (2003)
7Le Ray, et al. Breast Cancer Res Treat (2012)
8ACOG CO 659 (2016)
46. HRT Summary
• The WHI data does not demonstrate an increased risk of breast
cancer with CEE alone or CEE+MPA
• HRT started near menopause is probably cardioprotective and
definitely decreases risk of fractures
• Not plausible that HRT caused de novo breast cancers in WHI study
• Transdermal, vaginal E routes have not been shown to increase risk
• The effects of the “spin” of the WHI study may have attributed to a
large number of preventable deaths
OCP
47. The link between hormones and
breast cancer: does reproductive
freedom come with a price?
48. What about OCPs and breast
cancer risk?
More mediocre science.
49. • Research for the pill started when discovered
that Mexican women were eating a certain
wild yam
• 1960- Edovid approved by the FDA
• Edovid: 150mcg estrogen, 10,000 mcg of
progestin
• Today’s doses 20-50 mcg estrogen and 50-150
mcg progestin
Oral Contraception (OC)
Asbell (1995)
Grimes (2000)
“Cabeza de Negra” yam
50. • Reproductive liberation ensued, but tempered by religious,
societal norms AND published studies linking hormonal
contraception and malignancy
• 1996 pooled analysis of 54 epidemiological studies suggested
small increased risk with current or recent combined oral
contraceptive (COC) use:
• RRcurrent 1.24 (95% CI 1.15-1.33)
• RRrecent 1.16 (95% CI 1.08-1.23)
• Risk absent 10 yrs after cessation
Old Data
CGHFBC (1996)
51. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged
35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely to be nulliparous, have a family history, not have breastfed
• Risk only increased for ER negative, triple negative subtypes
Better Data
Marchbanks, et al. 2002
Hunter, et al. 2010
Beaber, et al. 2014
52. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged
35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely to be nulliparous, have a family history, not have breastfed
• Risk only increased for ER negative, triple negative subtypes
Better Data
Marchbanks, et al. 2002
Hunter, et al. 2010
Beaber, et al. 2014
53. Is it the contraception or the nulliparity
that led to the increased risk?
54. Better Data
15 studies using data from 2007-2014
21,941 breast cancers and almost 900,000 controls
Conclusion:
• Parity decreases your risk of ER+
tumors (OR 0.75 95% CI 0.70-0.81)
• But increase in risk seen in years
after delivery
Lambertini M, et al. Cancer Treat Rev (2016)
55. Better Data
15 studies using data from 2007-2014
21,941 breast cancers and almost 900,000 controls
Conclusion:
• Parity decreases your risk of ER+
tumors (OR 0.75 95% CI 0.70-0.81)
• But increase in risk seen in years
after delivery
Lambertini M, et al. Cancer Treat Rev (2016)
57. Breast Cancer Risk After Delivery
• 15 studies of 19,000 breast cancers in 9.6 million person-years
• Compared with nulliparous women younger than 55, parous women
were more likely to be diagnosed with breast cancer up to 24 years
after giving birth
• This risk higher with family history or multiple deliveries
• Breastfeeding does decrease risk, but does not modify risk < 55
• Oral contraceptive use not found to increase risk for breast cancer
Nichols H, et al. Ann Intern Med (2018)
58. Breast Cancer Risk After Delivery
• 15 studies of 19,000 breast cancers in 9.6 million person-years
• Compared with nulliparous women younger than 55, parous women
were more likely to be diagnosed with breast cancer up to 24 years
after giving birth
• This risk higher with family history or multiple deliveries
• Breastfeeding does decrease risk, but does not modify risk < 55
• Oral contraceptive use not found to increase risk for breast cancer
Nichols H, et al. Ann Intern Med (2018)
59.
60. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged
35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely to be nulliparous, have a family history, not have breastfeed
• Risk only increased for ER negative, triple negative subtypes
Better Data
Marchbanks, et al. 2002
Hunter, et al. 2010
Beaber, et al. 2014
61. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged 35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely than controls to be nulliparous, have a family history, not have
breastfeed
• Risk only increased for ER negative, triple negative subtypes
BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
CARE (Marchbanks, et al. 2002) Previous use: OR 0.9 (95% CI 0.8-1.0)
Current use: OR 1.0 (95% CI 0.8-1.3)
No
No
Lower
Lower
NHS II (Hunter, et al. 2010) Previous use: RR 1.12 (95% CI 0.9-1.3)
Current use: RR 1.33 (95% CI 1.03-1.7
No
Yes
Lower
Lower
Beaber, et al. (2014) Ever use: OR 1.0 (95% CI 0.8-1.3)
15 years of use: OR 1.5 (95% CI 1.1-2.2)
No
Yes
Lower
Lower
62. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged 35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely than controls to be nulliparous, have a family history, not have
breastfeed
• Risk only increased for ER negative, triple negative subtypes
BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
CARE (Marchbanks, et al. 2002) Previous use: OR 0.9 (95% CI 0.8-1.0)
Current use: OR 1.0 (95% CI 0.8-1.3)
No
No
Lower
Lower
NHS II (Hunter, et al. 2010) Previous use: RR 1.12 (95% CI 0.9-1.3)
Current use: RR 1.33 (95% CI 1.03-1.7
No
Yes
Lower
Lower
Beaber, et al. (2014) Ever use: OR 1.0 (95% CI 0.8-1.3)
15 years of use: OR 1.5 (95% CI 1.1-2.2)
No
Yes
Lower
Lower
63. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged 35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely than controls to be nulliparous, have a family history, not have
breastfeed
• Risk only increased for ER negative, triple negative subtypes
BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
CARE (Marchbanks, et al. 2002) Previous use: OR 0.9 (95% CI 0.8-1.0)
Current use: OR 1.0 (95% CI 0.8-1.3)
No
No
Lower
Lower
NHS II (Hunter, et al. 2010) Previous use: RR 1.12 (95% CI 0.9-1.3)
Current use: RR 1.33 (95% CI 1.03-1.7
No
Yes
Lower
Lower
Beaber, et al. (2014) Ever use: OR 1.0 (95% CI 0.8-1.3)
15 years of use: OR 1.5 (95% CI 1.1-2.2)
No
Yes
Lower
Lower
64. • Large multicenter case-control studies
• CARE (2002): No association between OC and BC risk found in women aged 35-64
• ORprevious use 0.9 (95% CI 0.6-1.0)
• ORcurrent use 1.0 (95% CI 0.8-1.3)
• Risk did not increase with longer duration of use, higher doses
• Nurses’ Health Study II (2010)
• RRprevious 1.12 (95% CI 0.95-1.33)
• RRcurrent 1.33 (95% CI 1.03-1.73)
• Beaber, et al (2014):
• ORever use 1.0 (95% CI 0.8-1.3)
• OR>15 years’ use 1.5 (95% CI 1.1-2.2) in women aged 40-44 only
• Cases more likely than controls to be nulliparous, have a family history, not have
breastfeed
• Risk only increased for ER negative, triple negative subtypes
BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
CARE (Marchbanks, et al. 2002) Previous use: OR 0.9 (95% CI 0.8-1.0)
Current use: OR 1.0 (95% CI 0.8-1.3)
No
No
Lower
Lower
NHS II (Hunter, et al. 2010) Previous use: RR 1.12 (95% CI 0.9-1.3)
Current use: RR 1.33 (95% CI 1.03-1.7
No
Yes
Lower
Lower
Beaber, et al. (2014) Ever use: OR 1.0 (95% CI 0.8-1.3)
15 years of use: OR 1.5 (95% CI 1.1-2.2)
No
Yes
Lower
Lower
65. BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
NHS II (Hunter, et al. 2010) Current use: RR 1.33 (95% CI 1.03-1.7 Yes Lower
Beaber, et al. (2014) 15 years of use: OR 1.5 (95% CI 1.1-2.2) Yes Lower
66. BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
NHS II (Hunter, et al. 2010) Current use: RR 1.33 (95% CI 1.03-1.7 Yes Lower
Beaber, et al. (2014) 15 years of use: OR 1.5 (95% CI 1.1-2.2) Yes Lower
67. BC Risk Compared: Recent Pregnancy, COC Use
Study Risk Increase Significant? Compared to
recent delivery
Pregnancy (Nichols, et al. 2018) Recent preg: HR 1.8* (95% CI 1.6-1.9)
Recent preg + fam hx: HR 3.53* (95% CI 2.9-4.3)
Yes
Yes
Reference
CGHFBC (1996) Recent use: RR 1.16 (95% CI 1.08-1.2)
Current use: RR 1.24 (95% 1.1-1.3)
Yes
Yes
Lower
Lower
NHS II (Hunter, et al. 2010) Current use: RR 1.33 (95% CI 1.03-1.7 Yes Lower
Beaber, et al. (2014) 15 years of use: OR 1.5 (95% CI 1.1-2.2) Yes Lower
68. BC Risk Compared: Recent Pregnancy, COC Use
OC Relative Risk
Pregnancy Relative Risk
69. BC Risk Compared: Recent Pregnancy, COC Use
OC Relative Risk
Pregnancy Relative Risk
70. Breast Cancer Risk After Delivery
• Older data found that current OC use à increased BC risk that
disappears after cessation.
• Increased incidence or increased surveillance?
• Newer data shows maybe increased risk with current use >15 years in
women 40-44
• Not a consistent correlation between ER+ BC and other subtypes
• Recent pregnancy increases your risk substantially more than
current OC use
71. Breast Cancer Risk After Delivery
• Older data found that current OC use à increased BC risk that
disappears after cessation.
• Increased incidence or increased surveillance?
• Newer data shows maybe increased risk with current use >15 years in
women 40-44
• Not a consistent correlation between ER+ BC and other subtypes
• Recent pregnancy increases your risk substantially more than
current OC use
72. Other Contraceptives
• Progestin-only pill: Prospective study of Swedish, Norwegian women
(n=103,027) 30-49 y found no increased BC risk, later confirmed by
matched case-control study1,2
• Injected or implanted progestin: Case-control CARE study (n=4575)
did not find increased BC risk in pre- or post-menopausal women who
had ever been exposed3
• What about the levonorgestrel IUD?
1Kumle, et al. Cancer Epidemiol Biomark Prev (2002)
2Marchbanks, et al. N Engl J Med (2002)
3Strom, et al. Contraception (2004)
73. Other Contraceptives
• Progestin-only pill: Prospective study of Swedish, Norwegian women
(n=103,027) 30-49 y found no increased BC risk, later confirmed by
matched case-control study1,2
• Injected or implanted progestin: Case-control CARE study (n=4575)
did not find increased BC risk in pre- or post-menopausal women who
had ever been exposed3
• What about the levonorgestrel IUD?
1Kumle, et al. Cancer Epidemiol Biomark Prev (2002)
2Marchbanks, et al. N Engl J Med (2002)
3Strom, et al. Contraception (2004)
NO increased risk
74. Other Contraceptives
• Progestin-only pill: Prospective study of Swedish, Norwegian women
(n=103,027) 30-49 y found no increased BC risk, later confirmed by
matched case-control study1,2
• Injected or implanted progestin: Case-control CARE study (n=4575)
did not find increased BC risk in pre- or post-menopausal women who
had ever been exposed3
• What about the levonorgestrel IUD?
1Kumle, et al. Cancer Epidemiol Biomark Prev (2002)
2Marchbanks, et al. N Engl J Med (2002)
3Strom, et al. Contraception (2004)
NO increased risk
NO increased risk
75. LNG-IUD
• Two large Finnish, German retrospective case-control studies did not
find an increased risk of BC with LNG-IUD1,2
• Another large case-control Finnish study found LNG-IUD users had
significantly lower risk of endometrial (HR 0.5), ovarian (HR 0.6),
pancreatic and lung cancer3
• Then, in 2017…
1Backman, et al. Obstet Gynecol (2005)
2Dinger, et al. Contraception (2011)
3Soini, et al. Obstet Gynecol (2014)LNG-IUD: levonorgestrel IUD
76. LNG-IUD
• LNG-IUD users had RR 1.21 (95% CI 1.11-1.33) compared to never users
• Risk did not increase with duration of use
• Risk with progestins with higher dose (injectables) à no increased risk
• Study did not account for breastfeeding, alcohol, physical activity
• In the US (2015), risk of maternal mortality is 26.4 deaths/100,000
• Double the risk of BC than those using contraception in the study
Morch, et al. NEJM (2017)
LNG-IUD: levonorgestrel IUD
77. More problems with NEJM paper
• Comparing LNG-IUD and Cu-IUD, no difference in risk of breast cancer
(OR 0.99, 95% CI 0.88-1.12)
• Both methods prolong nulliparity, decrease lifetime # of deliveries,
eliminating levonorgestrel as likely cause of increased BC risk seen in
NEJM study
Morch, et al. NEJM (2017)
Dinger, et al. Contraception (2011)
LNG-IUD: levonorgestrel IUD
78. More problems with NEJM paper
• Comparing LNG-IUD and Cu-IUD, no difference in risk of breast cancer
(OR 0.99, 95% CI 0.88-1.12)
• Both methods prolong nulliparity, decrease lifetime # of deliveries,
eliminating levonorgestrel as likely cause of increased BC risk seen in
NEJM study
Morch, et al. NEJM (2017)
Dinger, et al. Contraception (2011)
LNG-IUD: levonorgestrel IUD
LNG-IUD lowers hormonally-
sensitive cancer risk, probably
does not increase BC risk in
normal-risk women
80. Olufunmilayo I, et al. Clin Cancer Research (2008)
Genetic/Familial Factors
81. Olufunmilayo I, et al. Clin Cancer Research (2008)
Modifiable Risk Factors for Cancer
82. Picon-Ruiz, et al. Cancer J Clin (2017)
Lifestyle factors and BC risk
• OBESITY increases breast cancer risk
• Increased risk of aggressive subtypes in
premenopausal women
• Risk of BC greatest in postmenopausal obese
women
• Worsens treatment outcomes
• Weight loss, bariatric surgery associated
with decrease BC, other cancer risk
• Smoking, radiation, physical inactivity,
alcohol also linked to increase BC risk
83. Conclusion
• WHI data does not demonstrate an increased BC risk with CEE alone or CEE+MPA
• HRT started at menopause probably cardioprotective, decreases risk of fx
• “Spin” of WHI study may have attributed to large number of preventable deaths
• Local forms of estrogen are safe, even in women with a history of breast cancer
• Especially with advances in adjuvant treatment, improvement in outcomes
• Newer data shows maybe inc. BR risk in current OC use >15 yrs in women 40-44
• Increased incidence or increased surveillance?
• Recent pregnancy increases your risk substantially more than current OC use
• Risk of breast cancer is multifactorial
• Probably more related to genetic factors than we know
• Focus on other modifiable risk factors
• Hormones for everyone?
• All women need appropriate risk-adjusted screening regimens