A Look into the Economics behind Cancer Interventions and Drug Development

Cancer is an extraordinarily tough combatant and is quickly becoming the number one cause of death in the world. With the global economic cost of cancer accumulating to $1.16 trillion in 2010, something has to be done to decrease this financial and societal weight that’s suffocating humanity. Through cost-effective analysis, it was found that cervical cancer interventions were the most cost-effective given their inclusion of advantageous preventative strategies at low costs. By implementing preventative measures, using a step-wise approach to treatment as dictated by the expansion path, and intervening at the earliest stages of cancer provide the most cost-effective outcomes. With revenues for pharmaceutical companies exceeding their research and development costs by potentially ten-fold only adds fuel to the fire on the drug pricing debate. Through cost-effective treatment of cancer and increased competition amongst pharmaceutical firms developing oncologic drugs to lower prices and increase patient access, the burden of cancer can begin to shrink.

Primary Leiomyosarcoma of the Penis: A Review and Update of the Literature

Less than 50 cases of Primary Leiomyosarcomas of the Penis (PLOP) have been reported despite this PLOPs are the second most common sarcomas of the penis. The usual site for the development of PLOP is the shaft or base of the penis but the malignancy can affect any site of the penis. PLOPs are likely to be superficially located above the tunica albuginea in comparison with deep seated PLOPs. Superficial PLOPs may be asymptomatic or they may present as lumps, ulcers or nodules on the penis. Deep PLOPs may manifest with dysuria and difficulty with micturition when they compress the urethra. Diagnosis of PLOP is based upon the pathology examination features of specimens of the penile lesion that show interlacing fascicles of spindled-cells that have abundant eosinophilic cytoplasm, focal juxta-nuclear vacuoles and blunt ended nuclei and moderate to severe nuclear atypia, rarely atypical multi-nucleated giant cells and focal necrosis tend to be seen. There may be evidence of many mitoses. Immunohistochemistry studies of PLOP tend to show tumor cells that exhibit positive staining for desmin, muscle specific-actin, and alpha smooth muscle actin. Most often superficial PLOPs tend to be treated by wide complete excision of the tumor with tumor free and clear surgical resection margins. Deep seated PLOPs have also been treated by complete excision in various forms depending upon the site and size of the tumor and some of these have included Wide excision, partial penectomy and total penectomy alone and sometimes with adjuvant chemotherapy/radiotherapy. Some cases of deep PLOPs tend to be associated with the development of recurrences and metastases as well as death of the patient and hence deep PLOPs are aggressive tumors. Some people are of the opinion that chemotherapy and radiotherapy are not effective for the adjuvant treatment of PLOP. For this reason it would appear that there is need for the development of new chemotherapy medicaments that would effectively destroy PLOP tumor cells. There is need to undertake a global multi-center treatment trial of immunotherapy, chemotherapy and radiotherapy in order to streamline the treatment of PLOPs especially deep PLOPs.

Micronuclei (MN), an Important Cancer Biomarker

Micronuclei (MN) formation has been observed (cancer and pre-cancerous lesions) of the oral cavity among betel quid chewers. Micronuclei act as a cancer biomarker which is related with smokeless tobacco associated genetic mutations. Micronuclei are a sensitive indicator of genetic damage. These are small, extra nuclear bodies that are formed during mitosis from lagging chromosomes. The test is used as a tool for genotoxicity and easily detectable without affecting the cancer patients. The present review focuses on the various types of cancer of the human body with micronuclei study.

Imbuing the Supply Chain with the Customers Mind: Todays Reality, Tomorrows Opportunity

This paper introduces a new approach to understanding the mind of the customer with the goal of optimizing the supply chain by creating, marketing and then delivering what the customer(s) want. The underlying notion is that for every product one can discover groups of people with defined preferences for the product and defined messages which drive expected purchase. The approach divides into two parts, knowledge development through Mind Genomics experiments and mind-set sequencing through the PVI (Personal Viewpoint Identifier). The paper shows data for six flavored beverages, the creation of mind-sets and the creation of the PVI to drive the messaging and thus purchase of each product. The paper finishes with the prospects for the world of product design and marketing when one can rapidly discover these product-specific mind-sets and the messages which excite each mind-set.

Recurrence and Mortality Rates Among Receivers and Decliners of Conventional Adjuvant Breast Cancer Treatments

Objectives: This paper compared Recurrence and Morality rates among women with breast cancer who received all recommended treatment (Receivers) and who did not (Decliners). Methods: 427 women were recruited through integrative oncology clinics and the Cancer Surveillance System (CSS) registry in Western Washington State. Secondary data analysis were conducted using descriptive statistics, t-tests, X2 tests, and R. Self-reported data included household income and comorbidity; medical records included dates of diagnosis, recurrence and last visit with medical oncologist; and CSS registry data included demographic, disease characteristics, and records on recommended treatments and receiving/declining them, and date of death. Results: 9% of Receivers and 2% of Decliners experienced a Disease Free Survival (DFS) limiting event commonly a recurrence, while 3% of Receivers and 2% of Decliners died. After controlling for stage at diagnosis and cohort, no difference was found on the Adjusted Hazard ratio of recurrence or mortality between Receivers and Decliners. Adjusted Hazard ratio of Decliners relative to Receivers was 0.29 (95% CI; 0.04 – 2.22, p = 0.22) for DFS and 0.50 (95% CI: 0.04, 6.49, p = 0.59) for mortality. Conclusions: Better clinical predictors among Decliners may be related to no rate difference in recurrence and mortality between Decliners than Receivers.

Routine Colonoscopy after Diverticulitis Should not be Performed to Rule Out Colorectal Cancer

Introduction: Diverticulitis is a clinical diagnosis generally confirmed by a radiological examination. Guidelines recommend routine screening for colorectal cancer after the acute phase. Aim: Patients diagnosed with diverticulitis were studied in order to gain more information on presence of concomitant abnormalities. Material and methods: Inclusion criterion was the radiologic diagnosis of diverticulitis. All consecutive requests for ultrasound and/ or CT-scan of the abdomen in a three year period, with Diverticulitis mentioned in application were included. If diverticulitis was diagnosed, than this specific investigation was included in the present study. Hospital records were searched for the presence of endoscopic investigation. Results: In the three year period 1410 consecutive ultrasound investigation and/or CT-scans of the abdomen were performed. After exclusions 198 patients remained with the radiological confirmed diagnosis of diverticulitis. Of these patients 127 (64%) underwent an additional endoscopy. Seventy one patients (36%) did not undergo a colonoscopy. There was no difference in gender or in age between both groups. Colonoscopy showed additional abnormalities in 22 (17.3%) of the patients. These were hyperplastic polyp(s) in six, adenomatous polyp(s) in nine, polyps without histological confirmation in three and segmental colitis in three. Two male patients were diagnosed with sigmoid cancer. Both had non-subsiding diverticulitis with abscess formation at the location of the tumor. Conclusion: It is safe to omit colonoscopy after an episode of uncomplicated diverticulitis. Only in cases of complications or persistent complaints cancer should be part of the differential diagnosis and a subsequent colonoscopy should be performed.

Frozen Section Assessment of Bronchial Margins during Lung Carcinoma Surgeries: Report of the Experience at a Single Institution

Introduction Many thoracic surgeons consider frozen section analysis of bronchial margins during lobectomies “obligatory” although routine frozen section analysis of the bronchial margin rarely yields positive results and infrequently changes intra-operative management in patients undergoing Non-Small Cell Lung Carcinoma (NSCLC) resection. Materials and methods 234 cases of lobectomies with carcinoma were reviewed at our institution to assess bronchial margin involvement, correlation between frozen section and final bronchial margin status, gross distance between tumor and margin, and tumor type. Results Tumor distance to margin varied in the 234 cases from grossly involved to 10 cm away. 5 cases out of 234 (approximately 2.1%) had a positive bronchial margin in the final report. 3 out of the 5 cases were poorly differentiated squamous cell carcinoma grossly abutting the bronchial margin, two cases were of poorly differentiated adenocarcinoma located grossly 0.5 cm away from the bronchial margin. 4 out of 5 cases were called positive intra-operatively. In none of the 4 out of the 5 positive cases did frozen section exam of the bronchial margins change the intra-operative management of the case. Conclusion Our study supports selective use of intra-operative frozen section of bronchial margins during lobectomies for carcinoma. On the basis of our findings, a distance of approximately 1 cm or less is suggested as a threshold for intra-operative microscopic examination of the bronchial margins. However, routine examination of the bronchial margins, regardless of the location of the tumor upon gross examination, and in the absence of empirical evidence supporting this practice, is only time consuming intra-operatively, wasteful of resources and has no therapeutic or prognostic value.

Screening for Prostate Cancer: To Screen or Not To Screen? A Review of The State-of-The Art

Prostate cancer is a major public health concern, particularly in the welfare countries, for this reason, screening should be considered to reduce the number of deaths. Screening tests are available, i.e. digital rectal examination; trans-rectal ultrasonography and prostate specific antigen, nevertheless their sensitivity, specificity and positive predictive value are far from being perfect. Evidences from randomized screening trials are still indebted for conclusive evidence. The screening might cause more harm than good due to over diagnosis and over-treatment as a result of limited specificity of the screening tests. According to our point a view, opportunistic screening as part of diagnostics of patients having suspicion for uncertain symptoms of prostatic disorder is fully justified but mass screening of the population of average risk should not be introduced until supportive evidence from randomized controlled trials would be available.

Immunotherapy of Prostate Cancer Patients could Overexpress The Virulence Factor Genes of E.faecalis

Prostate cancer is the most prevalent and second cause of death from cancer in men worldwide. Immunotherapy is a new method for the treatment of several cancers that fights cancer cells by strengthening the immune system through some medications. While immunotherapy is a useful method for cancer treatment; its side effects still are not totally clarified. Numbers of prostate cancer patients which take immunotherapy are experiencing prostate inflammation and prostatitis after treatment period. Enterococcus faecalis is Gram-positive and catalase-negative cocci that are common in the intestines of humans and other animals and cause most enterococcal infections such as intestinal infections, prostatitis, gastroenteritis and endocarditic. Present study aimed to evaluate the mRNA level of virulence genes which are involved in Enterococcus faecalis pathogenesis in prostate cancer patients that treated by immunotherapy. Expression level of gelatinase E (gelE) and Enterococcal surface protein (esp) genes were examined by Real time PCR in three groups of 68 male subjects. Group A normal subjects, group B prostate cancer patients before start treatment and group C prostate cancer patients after six months immunotherapy period. Results were showed significant (P<0.05) over expression of both genes (gelE and esp ) in group C against the group B. According to the results, it is reasonable that immunotherapy may have side effects such as increasing the pathogenicity risk of microflora in patients. Maybe these side effects could cause further infections after ending the immunotherapy of cancer. Antibiotic usage after or at the same time of immunotherapy period could prevent possible infections of microflora including E. faecalis.

The Utility of Visual Inspection with Acetic Acid in Cervical Cancer Screening

Objective: Cervical cancer is potentially preventable but still remains a leading cause of cancer mortality in in developing countries like Nigeria. Cytology-based screening programmes are difficult to maintain in these countries. Developing a cheap and reliable alternative is an important public health measure in these regions. This study was carried out to compare the utility of VIA and Pap smear as Cervical cancer screening methods in HIV-infected and non HIV-infected women. Methodology: Between March, 2013 and March, 2014, 461 consenting women, comprising 231 HIV positive women (HPW) and 230 HIV negative women (HNW) were recruited and screened for cervical cancer using conventional Pap smear and VIA simultaneously in University of Uyo Teaching Hospital. The Pap smear findings were classified using the 2001 Bethesda system. Patients with a positive Pap smear or abnormal VIA findings were recalled for biopsy. The results of the two tests were compared using biopsy as the gold standard. Results: The overall sensitivity, specificity, positive predictive value and negative predictive value for VIA were 100%,80%,76.9%, and 100%, respectively compared to 80%, 100%, 100%, and 88.2% for conventional Pap smear. Visual inspection of the cervix with acetic acid for cervical cancer screening is not specific but has a high negative predictive value. Conclusion: This study does not support a “see-and-treat” approach in cervical cancer management using VIA only. In resource-challenged areas, VIA can be applied on a large scale basis in primary screening for cervical cancer so as to triage, women who will benefit from further evaluation before applying the appropriate treatment.