YOUR DOSE OF MEDICINE By Charles C. Chante, MD Updated March 08, 2009 12:00 AM
Preoperative magnetic resonance imaging may be a factor in the rising rate of mastectomy among women with early-stage breast cancer, a retrospective study suggests.
Investigators reviewed 5,596 stage 0-11 breast cancers in 5,463 women who underwent surgery for the malignancy between 1997 and 2006 at the Mayo Clinic in Rochester, Minn. They found that mastectomy rates decreased from 45% in 1997 to 30% in 2003, but then increased to 43% in 2006.
The rebound occurred in tandem with a doubling in the percentage of women who underwent preoperative breast magnetic resonance imaging, one of the investigators noted in a preview of the findings presented during a press briefing at the annual meeting of the American Society of Clinical Oncology.
It was reported at the Mayo Clinic that 11% of the women who were studied in 2003 underwent preoperative breast MRI, but this had increased to 22% of women in 2006.
Patients who underwent preoperative breast MRI were significantly more likely to undergo preoperative breast MRI (52% vs. 38%).
A similar increase in mastectomy rates was seen, however, in those who did not undergo preoperative MRI, with rates in those patients increasing from 28% in 2003 to 41% in 2006.
After adjustment for age, stage, contralateral breast cancer, and density, pre-operative MRI was found to be an independent predictor of mastectomy (odds ratio 1.7, P less than .0001).
Surgical year was also found to be a predictor of mastectomy.
Compared with 2003, the odds ratios for mastectomy were 1.4 for 2004, 1.9 for 2005 and 1.7 for 2006 (P less than .0001).
It was noted that other factors might also play a role in the increasing number of women who are undergoing mastectomy.
It cited patient preference, some women choose mastectomy over lumpectomy to maximize their risk reduction and changes in medical procedures and technologies, such as improved breast reconstruction options and the introduction of genetic testing.
Chair of the ASCO Cancer Communications Committee and moderator of the press briefing, added that studies have shown that when breast MRI is performed at the time of early stage breast cancer diagnosis, more cancer is found in both the breast known to be affected and the contralateral breast than is found on mammography.
Doctor of the University of Washington and the Fried Hutchinson Cancer Research Center, both in Seattle said that it may be that these surgeries based on MRI are appropriate.
MRI referrals bias might also play a role in the increased mastectomy rates.
Additional study is required to further elucidate the influence of these various factors on surgical management, and to assess whether the changing trends in surgical management improve outcomes for women with breast cancer.
After garnering awards and citations both in the local and international medical scene, who would have not heard of the name Rolando dela Cruz.
Dela Cruz’ invention, a cream that treats and cures Basal Cell Carcinoma (BCC), is another milestone in his already fruitful career.
According to Dela Cruz, his discovery of DeBCC was after the insistence of one of his client who was suffering from skin cancer. The client pleaded that he use the cream to treat his condition. Although not sure at first, he told the client to come back and using a stronger formulation, the treatment proved to be successful.
However, Dela Cruz knows that further tests needs to be done to prove the efficacy of his new found treatment. It must have been devine providence that he met up with Dr. Eric S.M. Talens in one of Dela Cruz’ medial missions.
Tie-up with medical experts
A graduate of medicine in the University of the Philippines and Chief of the Division of Trauma, Department of Surgery at Philippine General Hospital (PGH), Dr. Talens shares that it was during a coffee break after the mission that Dela Cruz told him about the cream and that he tried it to treat skin cancer. Dela Cruz even showed him some pictures of the treatment process but being a man of science and being a natural skeptic, he told Dela Cruz to put science behind the indigenous treatment. “They (indigenous treatment) don’t come out in the practice of medicine because there is no science to it,” he says and further explains that for Dela Cruz to convince doctors, a study must be done.
“We started looking at patients and treating them, documenting it, measuring them with all the biopsies…we collated the data and it was very encouraging.” From then on, the 14 cases they documented was the start of the continuous awards and recognitions both local and international including the Best Scientific Exhibit, the world’s largest convention for surgeons held at New Orleans in Louisiana U.S.A. last 2007.
“Now we have 39 well-documented cases 16 of which are declared cured.” Dr. Talens explains that for a BCC condition to be declared cured, a period of 5 years after treatment showed no signs or evidence of disease.
He explains that most people who suffer from BCC are the elderly and the treatment before DeBCC came into being was to perform a surgery. And the process of surgery was to remove a portion of the skin surrounding the skin cancer and in some cases will totally deform those affected areas like the face, neck or shoulders (areas usually exposed to the sun). Although surgery proved to be efficient, Dr. Talens cited three major problems. First is when the BCC affected a large skin portion especially in the face, second the process of reconstruction, and lastly, the risk involved. He further relates that some of their patients are those who cannot and do not want to be handled by other institutions because of the above-mentioned considerations. With this, the use of the cream is the only non-surgical option left.
Currently, the clinical studies done by Dr. Talens and other medical experts like Drs. Daniel dela Paz, Orlando Ocampo, Porfirio Tica, and the late pharmacologist Horacio Estrada resulted to 36 case studies and 16 of it completed the 5-year follow-up period and were declared cured. “They (patients) came here na wala na silang option. Sila pa ang nagpupumilit na isama sila sa study.”
Dr. Talens further shares that a Randomized Controlled Trial is being done at University of the Philippines-PGH were a patient blindly selects the treatment (either DeBCC or surgery). “You’ll measure all the results, x-ray, kung may deformity, yung comfort ng patient, titignan namin lahat ng parameters na yun,” he says and so far, the trial accumulated 9 cases already.
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Q. Our 68-year-old neighbor died of liver cancer last week, less than six months after he was diagnosed with the disease. I understand that the outlook for liver cancer patients is very poor. Why is this so? Also, why is this form of cancer common in the Philippines when it is rare in the US? Is there a way to prevent this form of cancer?
Celso N., Cebu City
A. Liver cancer has a poor prognosis or outlook because it is often diagnosed very late in its course. It usually presents no symptoms until the tumor is already at least 10 cm in size, at which time the disease has typically already spread and is in the advanced stage.
Most liver cancer patients die within a year of diagnosis, and the five-year survival rate for the disease (if no treatment is undertaken) is less than five percent. Even with treatment, the five-year survival rate for liver cancer is still a low 35 percent.
Liver cancer is only the eighth most common cancer worldwide, and as you mentioned, it is relatively rare in the US (and for that matter, other developed countries). In the Philippines and other underdeveloped countries, however, the incidence of liver cancer is rather high. The latest DOH advisory shows that liver cancer is the third most common form of cancer among Filipinos—in men, it is the second most common, while in women, it is the ninth most common.
Liver cancer is relatively common in our country primarily because many Filipinos suffer from cirrhosis of the liver, a major risk factor for liver cancer. Cirrhosis of the liver precedes 80 percent of all liver cancers; thus, any condition that predisposes to cirrhosis indirectly causes liver cancer. The usual cause of liver cirrhosis among Filipinos is chronic hepatitis B, a major public health problem in the country. Chronic hepatitis B afflicts between 10 and 12 percent of all Filipinos (i.e., more than 8 million Filipinos). Other less significant causes of cirrhosis are hepatitis C infection and alcoholism.
Another risk factor for liver cancer that adds to the high incidence of the malignancy among Filipinos is aflatoxin. Aflatoxin is a poisonous substance that damages the liver and may cause liver cancer. It is produced by certain species of molds that grow in foodstuff such as peanuts, corn, rice, dried fruits, spices, crude vegetable oils, cocoa beans, and copra, as well as milk and milk products from cattle that have consumed contaminated feed. The high temperature and relative humidity that prevail in the Philippines and the often improper storing, processing, and handling of foodstuff are the reasons why the aflatoxin content of the above-mentioned food products is frequently above the acceptable level.
Other less common causes of liver cancer in the Philippines are certain chemicals such as vinyl chloride (used in certain industries), and estrogens and androgens—hormones that are present in oral contraceptives and anabolic steroids, respectively.
The outlook for liver cancer is poor, but the disease is preventable because the major risk factors for the disease have already been identified. Measures that can significantly reduce one’s risk for cancer of the liver include vaccination for hepatitis B, avoidance of alcohol, and proper storage of foodstuff.
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