Cate Douglass

Swedish researchers have discovered that becoming pregnant while experiencing remission of Hodgkin lymphoma does not increase the risk of relapse. Their report is currently the largest study that specifically examines the impacts of pregnancy as a potential trigger for relapse in Hodgkin lymphoma survivors.

, compiled data from 449 women, aged 18-40, from Swedish health care registries and medical records. The women studied in the case were diagnosed with Hodgkin lymphoma between 1992 and 2009. Their data was examined by researchers starting 6 months after their diagnosis.

The team of researchers defined a pregnancy-related relapse as one happening either during pregnancy or within 5 years of giving birth.

Of the 449 women examined in the study, 144 women became pregnant during the examination period, with 1 of those patients experiencing a relapse within the 5-year time frame. In the group of patient participants who did not become pregnant or give birth during the study&rsquo;s time period, 49 people experienced a relapse.

Researchers were able to conclude that women who became pregnant had a lower rate of relapse than women who did not, though they warned this difference was not statistically significant.

&ldquo;Based on these findings, we see no evidence that Hodgkin lymphoma survivors who become pregnant are at higher risk for relapse,&rdquo; said lead study author Caroline Weibull, MSc, a biostatistician and doctoral student, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Stockholm, Sweden, in a statement.

According to co-author Ingrid Glimelius, MD, PhD, oncologist, Akademiska Hospital in Uppsala, Sweden and researcher affiliated with Uppsala University&rsquo;s Department of Immunology, performing this study was important for many Hodgkin lymphoma survivors who are at the childbearing age.

&ldquo;We conducted this study because Hodgkin lymphoma survivors, as well as clinicians, have expressed worries that pregnancy may increase the risk of relapse, despite a lack of empirical evidence to support such concerns,&rdquo; said Dr Glimelius said in a statement.

&ldquo;This rigorous study should help put those fears to rest.&rdquo;

Hodgkin lymphoma is a type of cancer that is most commonly found in adolescents and young adults. The disease has demonstrated a relatively high survival rate, especially in women below the age of 45.

It&nbsp;most commonly affects lymph nodes in the neck, the area between the lungs or the back of the breastbone, and has been known to spread to the spleen, liver, bone marrow or bone.

The American Cancer Society predicted that Hodgkin&rsquo;s lymphoma would affect an estimated 9,050 people this year in the United States, of which 1,150 people are expected to die from the disease.

With its relatively high survival rate, researchers suggested that a certain selection-bias, known as the &ldquo;healthy mother effect,&rdquo; may be an influencing factor in the lack of relapses among women who gave birth during their remission time.

The effect asserts that women with less severe disease are more likely to become pregnant while also more likely to have a lower risk of relapse, though Weibull explained that this might not entirely be the case.

&ldquo;We saw no evidence of a &lsquo;healthy mother effect&rsquo; in our study,&rdquo; said Weibull in a statement.

&ldquo;After accounting for differences in age and disease severity, we found that the probability of becoming pregnant did not differ markedly between patients with advanced and early stage disease or between patients who had different types of chemotherapy.&rdquo;

Merry-Jennifer Markham, MD, ASCO expert in lymphoma, added that the study&rsquo;s results are promising for many women diagnosed with the disease.

&ldquo;This is welcome and reassuring news for women who are in remission from Hodgkin lymphoma and wish to become pregnant,&rdquo; said Dr Markham in a statement.

&ldquo;This study is also a reminder that fertility after cancer remains an important concern for many patients, and it&rsquo;s a topic that should be discussed more frequently between physicians and their patients.&rdquo;

Weibull C, Eloranta S, Smedby K et al. Pregnancy and the Risk of Relapse in Patients Diagnosed With Hodgkin Lymphoma. Journal of Clinical Oncology. 2015. doi:10.1200/jco.2015.63.3446.

ASCO.org. Pregnancy Does Not Increase Risk of Hodgkin Lymphoma Relapse. 2015. Available at: http://www.asco.org/press-center/pregnancy-does-not-increase-risk-hodgkin-lymphoma-relapse. Accessed December 16, 2015.

Cancer.Net. Lymphoma - Hodgkin - Overview. 2012. Available at: http://www.cancer.net/cancer-types/lymphoma-hodgkin/overview. Accessed December 16, 2015.

Articles

Researchers discovered that pregnancy while in remission of Hodgkin lymphoma does not increase the risk of cancer relapse, making this report the first largest study to specifically examine the impacts of pregnancy as a potential trigger for relapse in Hodgkin lymphoma survivors.

Pregnancy Disproved as Potential Trigger for Relapse in Hodgkin Lymphoma Survivors

A team of researchers with the University of Texas MD Anderson Cancer Center found that adjuvant chemotherapy has a significant impact on patient survival, especially in patients with triple-negative breast cancer (TNBC).

discovered that patients who began chemotherapy more than 90 days after surgery were 34% more likely to die within a 5-year time frame, and patients with TNBC faced a 53% increased risk of death than other patients with breast cancer.

No current guidelines specify the most optimal time to start adjuvant chemotherapy, which is typically given after primary surgery and has been demonstrated to reduce disease recurrence and death. According to Mariana Chavez-MacGregor, MD, lead study author and assistant professor, Health Services Research and Breast Medical Oncology, delaying the start of adjunct chemotherapy runs the risk of allowing small remnants of the tumor to either grow or become drug resistant.

Previous studies have suggested that delaying chemotherapy post surgery could cause adverse patient outcomes, but finding an optimal time frame to administer adjunct chemotherapy has not yet been identified. The Center for Medicare and Medicaid Services considers administration of the adjunct chemotherapy within 120 days of diagnosis for certain patients a quality metric.

In an effort to define a time frame, the MD Anderson team analyzed data from the California Cancer Registry and examined information from nearly 25,000 patients with stage I to III invasive breast cancer diagnosed between January 1, 2005 and December 31, 2010, who were treated with adjuvant chemotherapy.

&ldquo;Compared to patients starting chemotherapy in the first month after surgery, we observed that those who initiated chemotherapy between 30 and 90 days following surgery did not have adverse outcomes,&rdquo; said Chavez-MacGregor in a statement. &ldquo;However, starting chemotherapy more than 90 days after surgery was associated with a statistically significant increase in the risk of death and breast cancer-specific death.&rdquo;

More specifically, patients who started chemotherapy treatment 90-days post surgery were 34% more likely to die within 5 years and 27% more likely to die from breast cancer within the same time period compared with patients who started their adjunct treatment within 30 days of initial surgery.

The study also found that patients with TNBC displayed a 53% increase in risk of death if adjunct chemotherapy was not administered within 90 days. Though, researchers were not able to find significant effects in delays of post-surgery treatment in hormone-receptor-positive, or HER2-positive, breast cancers.

Additionally, the MD Anderson team discovered that factors such as socio-economic status, insurance coverage, and ethnicity play a role in delayed treatment.

Patients of African-American descent, lower SES, and those with Medicare and Medicaid coverage had lower overall survival. Increased age and reconstructive surgery were also factors that contributed to delayed treatment times.

Patients with later stage disease or TNBC were less likely to experience delays in adjuvant chemotherapy.

&ldquo;We need to identify the determinants of delays in treatment so we can act on them and potentially improve the delivery of care in vulnerable populations. In most clinical scenarios, administering chemotherapy within 3 months is more than feasible,&rdquo; said Chavez-MacGregor.

The MD Anderson team concluded that all patients with breast cancer should receive adjuvant chemotherapy either within 90 days of surgery or 120 days of diagnosis.

&ldquo;In those patients who want to delay their chemotherapy, I would share this data and let them know that a delay can dilute the benefits of treatment. If at all possible, we should not delay,&rdquo; Chavez-MacGregor added.

Mdanderson.org. Delaying chemotherapy in breast cancer patients reduces overall survival, especially for those with triple-negative breast cancer | MD Anderson Cancer Center. 2015. http://www.mdanderson.org/newsroom/news-releases/2015/delaying-chemotherapy-breast-patients-reduces-survival-triple-negative.html. Accessed December 13, 2015.

Chavez-MacGregor M, Clarke C, Lichtensztajn D, Giordano S. Delayed Initiation of Adjuvant Chemotherapy Among Patients With Breast Cancer.

. 2015:1. doi:10.1001/jamaoncol.2015.3856.

A team of researchers with the University of Texas MD Anderson Cancer Center found that adjuvant chemotherapy has a significant impact on patient survival, especially in patients with triple-negative breast cancer.

Breast Cancer Survival Increased by Earlier Adjuvant Chemotherapy

Implementation of the Affordable Care Act (ACA) may have helped increase the number of women whose cases of cervical cancers were found and treated early, according to a study

The study found that after the 2010 act, 79% of cervical cancer cases in women between the ages of 21 to 25 were found at stage I or II, whereas, before the initiative, 71% of cases were found through early detection.

Since the introduction of the ACA, the number of women eligible for coverage of treatments for cervical cancer has grown, rising from 26% before the initiative to about 39% after the coverage change.

&ldquo;When cervical cancer is caught early, doctors can treat it with relatively small surgeries that leave the uterus intact, so that women can still have children,&rdquo; said Xuesong Han, PhD, director of surveillance and health services research at the American Cancer Society, in a statement.

According to the American Cancer Society, 91% of women with early cervical cancer survive at least 5 years whereas only 16% of women with advanced cervical cancer live that long.

Kevin Ault, MD, FACOG, a professor at the University of Kansas Medical Center, said in a

that cervical cancer is nearly 100% preventable. "Regular screenings with a doctor to help detect and remove precancerous lesions, as well as the human papillomavirus vaccine gives women the opportunity to protect themselves from acquiring the disease," he said.

While The American College of Obstetricians and Gynecologists advises women to begin regular screenings with a physician by the age of 21, administering the vaccine begins much earlier in young women. The Centers for Disease Control and Prevention believes the HPV vaccine should be given to girls aged 11 through 12, because it is most effective before the individual becomes sexually active.

The use of early detection and preventive care has sharply decreased the number of cervical cancer cases over the past several decades. Ault said that the disease was the leading cause of cancer-related death in women during the 1930s and 1940s; however, the American Cancer Society reports now that 12,900 Americans are affected by the disease.

The study warned, however, that there is no true way to verify the cause and effect relationship between the implantation of the ACA and increase in early detection cases. However, when compared with the number of early cases found in women ages 26 to 34, who were not eligible for the 2010 insurance expansion, researchers found no significant change.

The study also asserted that women with coverage were simply more likely to find cases of cervical cancer early, where nearly 78% of women with private insurance found and treated the disease early. In comparison, only 67% of women without insurance and 65% of women with Medicaid coverage caught the cancer early.

1. Robbins, AS, Han, X, Ward, EM, et al. Association between the affordable care act dependent coverage expansion and cervical cancer stage and treatment in young women.

2.  Szabo L. Early detection of cervical cancer increased after ACA expanded coverage. USA TODAY. 2015. Available at: http://www.usatoday.com/story/news/2015/11/24/early-detection-cervical-cancer-increased-after-aca-expanded-coverage/76273190/. Accessed December 9, 2015.

Implementation of the Affordable Care Act (ACA) may have helped increase the number of women whose cases of cervical cancers were found and treated early, according to a study published in JAMA. 

Affordable Care Act May Have Contributed to Early Detection of Cervical Cancer

Living a healthier lifestyle could be a robust preventative measure against&nbsp;metastatic prostate cancer. A study

published by a team of researchers from both the University of California, San Francisco (UCSF) and Harvard discovered that exercise and other healthy lifestyle habits may decrease a man&rsquo;s chances of developing lethal prostate cancer by up to 68%.

The researchers analyzed data from two US studies to determine whether or not lifestyle changes produce life-saving benefits. They awarded a &ldquo;point&rdquo; for every affirmative response to lifestyle changes study participants incorporated into their daily life. For example, researchers assigned one point to a participant&nbsp;for every affirmative response to questions such as if they practiced&nbsp;regular, intense exercise, had a body mass index under 30, and were tobacco-free for a minimum of 10 years. These questions also included diet-related&nbsp;questions, such as if they had a high intake of fatty fish and tomatoes, and a low intake of processed meat.

The first collection of data originated from the Health Professionals Follow-Up Study, which tracked nearly 42,000 men between the ages of 40 and 75 during a 14-year period from 1986 to 2010. The second set of data, the Physicians&rsquo; Health Study, examined 20,000 men between the ages of 40 and 84 during an even longer time frame, from 1982 to 2010.

The team discovered that participants who accumulated 5 to 6 points in the Health Professionals survey had a 68% of decreased risk for lethal prostate cancer. Comparatively, 38% demonstrated a decreased risk in the Physician&rsquo;s group.

The research team identified 576 cases of lethal prostate cancer in patients observed throughout the Health Professionals study, and 337 cases participating in the Physicians study.

&ldquo;It&rsquo;s interesting that vigorous activity had the highest potential impact on prevention of lethal prostate cancer. We calculated the population-attributable risk for American men over 60 [years] and estimated that 34% of lethal prostate cancer would be reduced if all men exercised to the point of sweating for at least 3 hours a week,&rdquo; said lead author Stacey Kenfield, ScD, assistant professor,&nbsp;Department of Urology,&nbsp;UCSF Medical Center, in a statement.

Kenfield added that incorporating five or more of these health habits could help decrease the number of lethal prostate cancer cases by almost half in men over the age of 60.

Not all cases of prostate cancer metastasize and become life-threatening according to the study  only a minority of patients are diagnosed with the aggressive, fatal form of the disease. Regardless, prostate cancer has still become one of the most frequently diagnosed cancers in the United States. &nbsp;

Additionally, controlling one&rsquo;s diet alone showed its own benefits in decreasing risk for this lethal prostate cancer. For example, men observed in the Health Professionals study showed a 46% decreased risk of developing the disease if they scored 3 or more points in affirmative dietary choices.

&ldquo;This study underscores the ongoing need for more effective prevention measures and policies to increase exercise, improve diet quality, and reduce tobacco use in our population,&rdquo; said senior author June M. Chan, ScD, departments of Urology, Epidemiology, and Biostatistics,&nbsp;UCSF, in a statement.

&ldquo;It takes cooperation and effort from multiple areas, like insurance companies, employers, policy makers, and city planners, to figure out how to creatively support and encourage more exercise into most busy adults&rsquo; working day.&rdquo;

Patients observed in the studies had to be free of cancer at the start of the study. Researchers also imposed a 4-year lag period to rule out any participants who may have unknowingly developed the lethal prostate cancer, all as a means to reduce error over the nearly 20-year long studies.

University of California. Working up a sweat may protect against lethal prostate cancer. http://universityofcalifornia.edu/news/working-sweat-may-protect-against-lethal-prostate-cancer. Accessed December 3, 2015.

Living a healthier lifestyle could be a robust preventative measure against metastatic prostate cancer. One new study suggests that leading a healthy lifestyle could reduce a man's chances of developing the cancer by up to 68%.

Cate Douglass | Authors

Articles

Pregnancy Disproved as Potential Trigger for Relapse in Hodgkin Lymphoma Survivors

Breast Cancer Survival Increased by Earlier Adjuvant Chemotherapy

Affordable Care Act May Have Contributed to Early Detection of Cervical Cancer

Healthy Living May Reduce Risk of Severe Prostate Cancer By Over Half