Conferences point to growing concern about possible links between breast cancer,environment.

Evidence is growing that there may be a connection between certain chemicals in the environment and the rising incidence of breast cancer in North America. Two recent Canadian conferences have been held to disseminate information and another is planned for 1996. "We have a situation that is similar to global warming, " Devra Lee Davis, founder of the US Breast Cancer Prevention Collaborative Research Group, warned people attending a conference in Niagara Falls, Ont. "Breast cancer continues to increase. The increase is greatest among older women who have fewer of the known risk factors. It makes sense to try to limit exposure to things that could be promoting the disease."     

Cervical cancer screening programs: summary of the 1982. Canadian task force report.

The Canadian Task Force on Cervical Cancer Screening Programs, which produced its first report in 1976, was reconvened by the Department of National Health and Welfare in 1980 in response to concerns expressed about the significance of new data, changing sociosexual patterns and wide variations in the implementation of the 1976 recommendations. This article is a summary of the 1982 task force report. In addition to updates of the 1976 material new sections appear on groups at risk, mathematical models of screening, quality control in screening programs, cytologic screening coverage of the Canadian population and management of patients with abnormal smears. The 1982 recommendations deal with frequency of screening, laboratory quality control and follow-up mechanisms. The task force concludes that measures to improve the quality and sensitivity of screening programs and to include women who have never been screened will be more effective in reducing mortality from carcinoma of the cervix than will attempts to increase the frequency of screening. The task force views as unnecessary the annual screening of women over 35 years of age whose previous smears have been normal. Since younger women are sexually more active and tend to have more than one sexual partner they are at high risk. Therefore, the task force recommends annual screening for sexually active women aged 18 to 35 years. Physicians, health care professionals and government health agencies have a role to play in informing women about the recommended intervals for cervical smears and ensuring that screening programs of adequate quality are available. Although women are primarily responsible for entering and continuing in such a program, government-sponsored registries are essential if the full potential of cervical smear programs is to be realized.     

Accelerating the development of innovative cellular therapy products for the treatment of cancer

The field of cell therapy is rapidly emerging as a priority area for oncology research and drug development. Currently, two chimeric antigen receptor T-cell therapies are approved by the US Food and Drug Administration and other agencies worldwide for two types of hematologic cancers. To facilitate the development of these therapies for patients with life-threatening cancers with limited or no therapeutic options, science- and risk-based approaches will be critical to mitigating and balancing any potential risk associated with either early clinical research or more flexible manufacturing paradigms. Friends of Cancer Research and the Parker Institute for Cancer Immunotherapy convened an expert group of stakeholders to develop specific strategies and proposals for regulatory opportunities to accelerate the development of cell therapies as promising new therapeutics. This meeting took place in Washington, DC on May 17, 2019. As academia and industry expand research efforts and cellular product development pipelines, this report summarizes opportunities to accelerate entry into the clinic for exploratory studies and optimization of cell products through manufacturing improvements for these promising new therapies.     

Non‐verbal interaction of Anglo‐Canadian,Jewish‐Canadian,and French‐Canadian physicians with their young,middle‐aged,and elderly patients

This study investigates the role that non‐verbal communication plays in establishing and maintaining rapport among physicians and their young, middle‐aged, and elderly patients.

Eleven physicians with a variety of patients were studied in the project in Montreal. Five physicians were Anglo‐Canadian, three were respectively Jewish‐Canadian and French‐Canadian. Three additional physicians were part of a pilot project.

Patient‐doctor interviews were videotaped by means of a stationary camera fitted with a wide‐angle lens placed in the doctors’ offices. Physical examinations were not videotaped. After each session, patients filled out a questionnaire elucidating the success of the interview.     

A patient's guide to choosing unconventional therapies

Unconventional therapies (UTs) are therapies not usually provided by Canadian physicians or other conventionally trained health care providers. Examples of common UTs available in Canada are herbal preparations, reflexology, acupuncture and traditional Chinese medicine. UTs may be used along with conventional therapies (complementary) or instead of conventional therapies (alternative). Surveys have shown that many Canadians use UTs, usually as complementary therapies, for a wide range of diseases and conditions. Reliable information about UTs is often difficult to find. Your doctor may be unable to give you specific advice or recommendations, since UTs are often not in a physician''s area of expertise. However, he or she will usually be able to provide some general advice and help supervise your progress. For your own health and safety, it is important to keep your doctor informed of the choices you make. This document is intended to (a) provide you with questions to consider when making your treatment choices, (b) help you find information about UTs, (c) help you decide whether a specific UT is right for you, and (d) provide tips to help you evaluate the information you find.     

Focus groups confirm that MDs,public differ on role of private health care

Polls conducted by the CMA in 1995 indicated that most physicians favour more private funding for Canadian health care. However, new information gathered in a series of CMA-sponsored focus groups confirms earlier findings that the public does not yet share these views. In March, a polling expert told the Board of Directors that physicians must be cautious in advocating a position on the issue.     

Life cycle management: UNEP-workshop

On August 30, 2001, the first in a series of planned global workshops on Life Cycle Management was organized in Copenhagen by UNEP in cooperation with dk-TEKNIK. The workshop provided an international forum to share experiences on LCM. The specific purpose of the workshop was to define the focus of a possible UNEP programme on Life Cycle Management under the UNEP/SETAC Life Cycle Initiative. Life Cycle Management has been defined by the SETAC Europe Working Group on LCM as an integrated framework of concepts, techniques and procedures to address environmental, economic, technological and social aspects of products and organizations to achieve continuous environmental improvement from a life cycle perspective. Life Cycle Management has been requested as an additional component for the Life Cycle Initiative by business organizations as well as governments in order to provide practical approaches for management systems in this area. The breakout groups of the workshop focussed on the role of integrating environmental management practices, concepts and tools in a life cycle perspective, on the integration of socio-economic aspects of sustainability in life cycle approaches, including the definition of adequate indicators for these aspects, on the communication strategies to promote life cycle thinking, and on the demand side of LCA. The workshop closed with a consensus that the UNEP/ SETAC Life Cycle Initiative should really include a programme on Life Cycle Management with the proposed areas of work. UNEP in cooperation with SETAC should function as a global catalyser of knowledge transfer and cooperation on life cycle approaches. The key issue behind all activities would be the promotion of Life Cycle Thinking since all break-out groups mentioned the importance of well-prepared communication strategies. Another interesting outcome of the workshop is the clear interest of different stakeholders in the consideration of social and institutional effects of products, in addition to environmental and economic impacts, i.e. a sustainable development perspective.     

Preventive practice among primary care physicians in British Columbia: relation to recommendations of the Canadian Task Force on the Periodic Health Examination.

OBJECTIVES: To compare the current practice of preventive medicine in British Columbia with the recommendations of the Canadian Task Force on the Periodic Health Examination. Four common, preventable forms of cancer (cervical, breast, lung and colorectal) were used as sentinel conditions. DESIGN: Random sample mailed survey. SETTING: Private primary care practices in British Columbia. PARTICIPANTS: A sample of 300 primary care physicians in 1991; of 285 eligible physicians 185 (65%) responded. OUTCOME MEASURE: Compliance with preventive practices recommended by the task force. RESULTS: Preventive practice complied with the task force''s recommendations for breast examinations, mammography, cervical smears and initial counselling against smoking; over 90% of the physicians performed these manoeuvres in all or most cases. However, less than half performed two recommended manoeuvres for all or most patients who smoke: advice to follow a diet high in beta-carotene (reported by 10%) and scheduling of follow-up visits to reinforce antismoking counselling (by 46%). Most of the physicians stated that they perform preventive manoeuvres in the context of an annual general physical examination rather than integrating them into routine patient care. CONCLUSIONS: The task force''s carefully constructed recommendations are incompletely followed. Overall, there appears to be a high level of compliance with traditional and recommended manoeuvres but also widespread persistence in performing traditional manoeuvres no longer recommended and failure to adopt new recommendations.     

Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists

ObjectiveThyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This article describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspeciality physicians and others providing care for patients with this condition.MethodsThe development of these guidelines was commissioned by the American Thyroid Association in association with the American Association of Clinical Endocrinologists. The American Thyroid Association and American Association of Clinical Endocrinologists assembled a task force of expert clinicians who authored this report. The task force examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to develop the text and a series of specific recommendations. The strength of the recommendations and the quality of evidence supporting each was rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group.ResultsClinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves’ hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves’ disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves’ ophthalmopathy; and management of other miscellaneous causes of thyrotoxicosis.ConclusionsOne hundred evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.     

Primary culture and mRNA analysis of human ovarian cells

Established cell lines are invaluable for studying cell and molecular biological questions. A variety of human ovarian cancer (OC) cell lines exist, however, most have acquired significant genetic alterations from their cells of origin, including deletion of important cell cycle regulatory genes. In order to analyze signaling events related to cell cycle control in human OC, we have modified existing protocols for isolating and culturing OC cells from patient ascites fluid and normal ovarian surface epithelial (OSE) cells from benign ovarian tissue sections. These cells maintain an epithelial phenotype and can be manipulated experimentally for several passages before cellular senescence. An example using TGF1 treatment of OC cells to examine signaling and target gene activation is presented. This work is supported in part by the National Cancer Institute of Canada with funds from the Canadian Cancer Society (#13631), the Nova Scotia Health Research Foundation, and by Cancer Research and Education (CaRE) Nova Scotia with funding from the Faculty of Medicine, Dalhousie University. L.D.D. is supported by the Rossetti Studentship for Cancer Research with funds from the Dalhousie Medical Research Foundation, T.G.S. is supported by a CaRE Fellowship with funding from the Canadian Cancer Society, and M.W.N is a Canadian Institutes of Health Research Scholar. Published: October 28, 2002.     

Move into hospital sector another sign of complementary medicine's growing popularity

Growing demand has led some Canadian hospitals to offer alternative therapies to patients, even though many physicians still question their efficacy. Anita Elash visited Toronto''s Sunnybrook Health Science Centre, where staff physicians have been debating the issue. One physician said hospitals have no choice but to offer the treatments. "If you believe in the primacy of patients making their own decisions and you believe in the fundamental of informed consent, you cannot deny them access to this treatment."     

Staging practices and breast cancer stage among population-based registries in the MENA region

BackgroundAvailability of stage information by population-based cancer registries (PBCR) remains scarce for diverse reasons. Nevertheless, stage is critical cancer control information particularly for cancers amenable to early detection. In the framework of the Global Initiative for Cancer Registry Development (GICR), we present the status of stage data collection and dissemination among registries in the Middle East and Northern Africa (MENA) region as well as the stage distribution of breast cancer patients.MethodsA web-based survey exploring staging practices and breast cancer stage was developed and sent to 30 PBCR in 18 countries of the MENA region.ResultsAmong 23 respondent PBCR, 21 collected stage data, the majority (80%) for all cancers. Fourteen registries used a single classification (9 TNM and 5 SEER), 7 used both staging systems in parallel. Out of 12,888 breast cancer patients (seven registries) 27.7% had unknown TNM stage (11.1% in Oman, 46% in Annaba). When considering only cases with known stage, 65.3% were early cancers (TNM I+II), ranging from 57.9% in Oman to 83.3% in Batna (Algeria), and 9.9% were stage IV cancers. Among the nine registries providing SEER Summary stage for breast cancer cases, stage was unknown in 19% of the cases, (0 in Bahrain, 39% in Kuwait). Stage data were largely absent from the published registry reports.ConclusionDespite wide stage data collection by cancer registries, missing information and low dissemination clearly limit informing efforts on early detection. The use of two classification systems in parallel implies additional workload and might undermine completeness. The favourable results of early cancer (TNM I+II) in two thirds of breast cancer patients needs to be interpreted with caution and followed up in time. Although efforts to improve quality of stage data are needed, our findings are particularly relevant to the WHO Global Breast Cancer Initiative.     

General practitioner and specialist views on colonoscopic screening of first-degree relatives of colorectal cancer patients

Introduction: Barriers to targeted colonoscopic screening of first-degree relatives of colorectal cancer patients have been the subject of considerable literature, always as seen from the patient's viewpoint. In the specific context of screening individuals with a family history, physicians may also play a predominant role in motivating their colorectal cancer patients to pass on screening information to their relatives. The aim of this study was to examine the views of general practitioners and specialists regarding barriers and facilitators affecting participation of relatives in colonoscopic screening. Methods: A qualitative study was conducted to collect and analyse information from two focus groups of 4 general practitioners and 9 gastroenterologists respectively, and from semi-structured individual interviews with 10 general practitioners, 2 surgeons and 3 oncologists. An extended focus group of 36 gastroenterologists was organized to validate the results. Results: The main barriers to colonoscopic screening of FDRs were associated with lack of direct communication between physicians and FDRs. Physicians needed support in the task of informing index patients and persuading them to transfer information on screening to their FDRs. The general practitioners spoke of their expectations in terms of training in and motivation for promoting screening and the gastroenterologists expressed the wish for patient education material specific to colonoscopy and for systematic post-colonoscopy consultations to inform patients about their results, follow-up and screening their relatives. Conclusion: The findings, notably the need for specific education materials and for training to improve the motivation of physicians, will help to develop effective interventions intended to increase participation in screening.     

A survey of postgraduate training for family practice.

The results of a survey of Canadian primary care physicians for the Canadian Medical Association (CMA''s) Task Force on Education for the Provision of Primary Care Services are reported. Recent Canadian medical school graduates in primary care practice reported that the three major training routes (rotating and mixed internships and family medicine residencies) each prepared them differently for practice. The graduates of 2-year family medicine residencies were more satisfied with their preparation than were the graduates of the other major training routes. A 2- or 3-year family medicine residency was preferred by 50% of the respondents, although only 33% of them had actually taken one of these routes. There was considerable agreement in the respondents'' assessments of the types of postgraduate education needed for primary care practice. The results of this survey were consistent with the recommendations in the final report of the CMA''s task force.     

CMA membership survey: opinions on issues facing the medical profession

A sample survey of Canadian Medical Association (CMA) members, conducted in early summer 1985 and designed to provide information to help guide the association''s activities and policies, shows that most Canadian physicians support involvement in political activities both by CMA and by indivudual physicians. A majority wishes to maintain the concept of extra/balance billing, to pursue the position that the health care system is underfunded and favours medicare premiums and hospital user fees as the preferred methods for increasing revenue.Most respondents believe that the number of doctors in Canada is about right but would prefer any reduction to be achieved by cutting medical school admissions or reducing postgraduate training positions open to graduates of foreign medical schools.Most of those members who know of CMA policies on a number of health care issues agree with them and also find them useful, but a significant proportion are not aware of their content.There is support for compulsory payment of dues by all licensed physicians to both their provincial medical association and CMA. A majority would like more information on pharmaceutical products and additional membership surveys.     

Prevention should be the preferred insurance program for all physicians.

Recent fee increases announced to the Canadian Medical Protective Association (CMPA) and the Ontario government''s plan to stop its CMPA rebate program for the province''s physicians have put the spotlight on medical liability insurance. In this examination of the role played by the CMPA, Ottawa lawyer Karen Capen notes that quality service and attention to physician-patient communication will in most cases ensure a litigation-free professional life.     

Face à une suspicion de cancer ou de récidive de cancer : pratiques,communication et difficultés des médecins nucléaires français

Nuclear imaging techniques have been occupying an increasingly large place in the study of potentially cancerous morphological abnormalities. A National French survey was conducted among members of the French Society of Nuclear Medicine (Société française de médecine nucléaire) to study the usual practices of nuclear medicine physicians regarding information and communication during the “pre-announcement” stage of a cancer diagnosis. Sixty-six doctors (with an average of 44.7 years of age and 16.3 years of experience) working in mainland France responded to the online survey between November 2013 and February 2014. Most physicians said that they were uncomfortable in this kind of situation. Half of the doctors interviewed faced that situation at least 5 times a month. Communication habits were varied: 20% of them adopted a systematic approach (chose ‘always’ or ‘never’ to communicate information regardless of the patients’ demands) and 80% adapted their approach to the situations and to the patients (communication ‘on case by case basis’ and ‘upon request’). The survey also showed that professionals have contrasting views on the relevance, interest and risks of informing patients about the results of the tests in this kind of situation. Our study shows that it is necessary to discuss the position of nuclear medicine physicians in the pre-announcement procedure set out in the French Cancer Plan so as to reduce the challenges facing them while at the same time organizing and defining their roles.     

Proteome biology of stem cells

The notion that integration of cutting-edge technologies in stem cell research would be enhanced by proteomic analyses has emanated from rapid advances in proteome technology. These advances have increased the probability that basic properties of stem cells will be elucidated more effectively, leading to acceleration toward novel stem cell therapies. We have therefore sought to establish a world-wide alliance of proteomics and stem cell researchers, which has resulted in the foundation of an initiative supported by the Human Proteome Organisation (HUPO) and the International Society for Stem Cell Research (ISSCR) called the Proteome Biology of Stem Cells Initiative. Here we report on the rationale and goals of this initiative.     

1st NCI Annual Meeting on Clinical Proteomic Technologies for Cancer

The National Cancer Institute of the US National Institutes of Health established a Clinical Proteomic Technologies Initiative for Cancer (CPTI) in 2006. The first annual meeting organized by the CPTI program provided up-to-date information on the research activities and achievements at its first anniversary of this program. Presentations were made by leaders from the five centers nationwide of the Clinical Proteomic Technology Assessment for Cancer (CPTAC), and other principal investigators funded by the CPTI.