Archive for the ‘cancer’ Category

Research, BMJ, doi:10.1136/bmj.39367.495995.AE (published 6 November 2007)

What is already known on this topic

  • Increased body mass index is known to increase the risk of adenocarcinoma of the oesophagus, endometrial cancer, kidney cancer, and postmenopausal breast cancer in women
  • Body mass index has also been associated with the risk of other, rarer, cancers, but the findings are not yet conclusive

What this study adds

  • High body mass index in women may increase the risk of multiple myeloma, leukaemia, pancreatic cancer, non-Hodgkin’s lymphoma, and ovarian cancer
  • Menopausal status seems to affect the relation between body mass index and risk of breast cancer, endometrial cancer, and colorectal cancer
  • Among postmenopausal women in the UK, 5% of all cancers (about 6000 annually) are attributable to women being overweight or obese
  • Around half of all cases of endometrial cancer and adenocarcinoma of the oesophagus in postmenopausal UK women are attributable to women being overweight or obese

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Editorials, BMJ  2007;335:897 (3 November).

The possible influence of diet on the risk of cancer is constantly topical. The subject is important because people can change their diets, and even a moderate effect on risk could prevent several thousand cancers each year in a country the size of the United Kingdom. However, apart from the confirmed adverse effects of alcohol and obesity on the risk for some types of cancer, progress in understanding has been slow and the evidence remains confusing.

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BMJ  2007;335:765-768 (13 October), by:

Patrick Petignat, consultant gynaecological oncologist, Michel Roy, professor and gynaecological oncologist.

  • Cervical cancer is the second most common cancer in women worldwide.
  • Cervical cancer is an important cause of early loss of life as it affects relatively young women. 
  • Cervical biopsy is the most important investigation in diagnosing cervical cancer

Surgery or chemoradiotherapy can cure 80-95% of women with early stage disease (stages I and II) and 60% with stage III disease.

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BMJ  2007;335:715-718 (6 October), by: Anne B Ballinger, consultant gastroenterologist.

Colorectal cancer is common, the presenting symptoms are non-specific, and the stage of disease at diagnosis is closely related to survival.

Summary points

  • The lifetime risk of developing colorectal cancer is about 5%
  • Increasing age and a family history of colorectal cancer are the greatest risk factors for the disease
  • Patients presenting with suspicious symptoms and signs should be referred and investigated urgently in a specialised unit
  • Colonoscopy and computed tomographic colonography are of equal sensitivity for detection of colorectal cancer
  • Colonoscopy allows biopsy of suspicious lesions and removal of polyps
  • Population screening by testing for faecal occult blood has begun in the United Kingdom

>>>>> CLICK here for more …..

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Mike Fitzpatrick, The meaning of cancer.

British Journal of General Practice, October 2007, p 847.

In the 19th-century the concept was, that disease can be challenged by will. This notion is always closely linked to the idea that disease is itself an expression of character.

The cultural critic Susan Sontag, who died from cancer in December 2004, observed that the view of disease as an expression of inner self appears less moralistic than that of disease as a punishment for sin. ‘But this view turns out to be just as, if not even more, moralistic and punitive’, she argued.

Contrasting the old myths about tuberculosis (TB) and modern myths about cancer, she noted that both proposed notions of individual responsibility. But, for her, the cancer imagery was ‘far more punishing’.

Whereas TB was regarded as a disease of passion or excess, cancer is a disease of repressed emotion, associated with depression (‘melancholy minus its charms’) and stress.

Whereas the tubercular character was once envied as an outlaw, a misfit, a bohemian, today’s cancer patient is a loser, with a shameful affliction, someone deserving of pity.

Sontag shrewdly observed that ‘theories that diseases are caused by mental states and can be cured by willpower are always an index of how much is not understood about the physical terrain of a disease’.

When the identification of the tubercle bacillus in the 1880s deprived TB of much of its mystery.

Cancer — a group of diseases that is still ill-understood and for which current treatments are often ineffectual— became the focus of modern fears and of notions that both its onset and its course could be influenced by emotional factors and psychological therapies.

Sontag S. Illness as metaphor: Aids and its metaphors. London: Penguin, 1991.

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BMJ 2007;335:267-268 (11 August)
Fast track referral for cancer
Has not improved patient outcomes in the UK
BY: Moyez Jiwa, professor of primary care, Christobel Saunders, professor of surgical oncology

The current cancer referral policy in the UK—whereby patients with a given set of symptoms are seen within two weeks—results in more patients who have cancer being seen on routine waiting lists than on the fast track list. This means diagnosis is delayed even further.

Introduction of the two week standard clinics has not improved the outcomes for patients in some of the commonest cancers.

Many factors affect the decision to refer for an expert opinion, including a patient’s help seeking behaviour, doctor-patient communication, eliciting and interpreting signs and symptoms, applying evidence to decision making, negotiation with the patient about the need for and most appropriate route of referral, and conveying the information in sufficient detail to allow the patient to be fully informed about the need for urgency or otherwise.

It has been calculated that if the practitioner successfully negotiates each of the above stages on 80% of occasions then only a small percentage of decisions will be evidence based.

A substantial proportion of patients with common cancers present as emergencies with advanced disease; in the case of colorectal cancer this has been estimated to be as high as 20%.

Furthermore, given that cancer is an uncommon diagnosis in general practice, practitioners are unlikely in most cases to opt to investigate symptomatic patients.

In practice, however, doctors will act on the basis of personal experience, respected local opinion, and anecdotal evidence rather than on high quality published research .

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EU postponed threathened restriction of using MRI scanners

Rory Watson, BMJ 2007;335:844-845

Medical specialists, patients’ groups, and European parliamentarians launched a campaign last week to ensure that new EU health and safety legislation will not restrict the use of magnetic resonance imaging (MRI).

The Alliance for MRI fears that new Europe-wide measures, which are
designed to protect employees , from short term exposure to electromagnetic fields, will inadvertently make it harder to use equipment to diagnose and treat illnesses from cancer and heart attacks to strokes and brain tumours.

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