Should I take aspirin to reduce risks of cancer and heart diseases?

I often heard and read about the health benefits of aspirin.  A study summarizing nine randomized placebo-controlled trials with at least 1000 participants each evaluated the role of aspirinr on cardiovascular disease (CVD), nonvascular outcomes, or death.

The study, which involved over 100, 000 participants, showed that aspirin reduced total CVD events by 10%, driven primarily by reduction in nonfatal MI (heart attack). There was no significant reduction in CVD death or cancer death.  There was increased risk of nontrivial bleeding events

The study concluded that for most of us who are healthy and do not have heart diseases, aspirin prophylaxis may not help reducing death from CVD or cancer and may increase bleeding complications.   As most of things in medicine which hardly black or white, you should discuss risks and benefits with your doctors.

Reference:

Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Erqou S, Sattar N, Ray KK.  Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(3):209.

 

What is my risk of re-operation if I elect to preserve my ovaries during hysterectomy?

About 500,000 hysterectomies are performed annually in the US.   Many of these surgeries are done for benign (non cancer) reason such as bleeding, fibroid, etc.    Many of these patients, especially if they are young, are often offered to remove their uterus but preserve their ovaries.   They often ask what is the risk of needing surgery in the future because of some problems with their ovaries.

 

Casiano and her team published a study to answer such question. Using Rochester Epidemiology Project resources,  they compared the risk of oophorectomy (removal of ovaries), among 4,931 women, who underwent ovary-sparing hysterectomy for benign indications (case group)  with 4,931 age-matched women who did not undergo hysterectomy (referent group).  With 30 years follow up, 9.2% of women of elected to preserve their ovaries required another surgery to remove the ovaries.   This only 1.9 percentage points higher than the incidence of oophorectomy in referent women with intact reproductive organs.

The conclusion of the study is try to preserve your ovaries during hysterectomy if you are pre-menopausal and being operated for non-cancer diagnosis.  However, as always, your case may be unique and do discuss it with your surgeon.

Reference:

Casiano ER, Trabuco EC, Bharucha AE, Weaver AL, Schleck CD, Melton LJ 3rd, Gebhart JB. Risk of oophorectomy after hysterectomy. Obstet Gynecol. 2013 May;121(5):1069-74

Should I get prophylactic mastectomy if I have ovarian cancer and BRCA gene mutations?

About 10-15% of patients with ovarian cancers may have genetic mutation of BRCA1 and BRAC2 genes.  Mutations in these genes predispose women for breast cancer as well.  However, the most appropriate management of breast cancer risk in these patients has not been defined.     

A 2013 study evaluated164 patients had BRCA-ovarian cancer (115 with BRCA1; 49 with BRCA2). Of these 164 patients, 152 developed ovarian cancer prior to BRCA testing (median time to testing, 2.4 years [0.01-55 years]). There were 46 deaths, but none were due to breast cancer. The 5- and 10-year overall survival were 85% (95% confidence interval [CI]= 0.78, 0.90) and 68% (95% CI = 0.59, 0.76), respectively. There were 18 metachronous breast cancer diagnoses.

The conclusion of the study was for women with a BRCA-associated epithelial ovarian cancer, the greatest risk of death was from ovarian cancer and not breast cancer.  Thus,  breast cancer surveillance with mammography and breast-clinical exam are a reasonable alternative to prophylactic bilateral mastectomy.

Reference: Domchek SM, Jhaveri K, Patil S, Stopfer JE, Hudis C, Powers J, Stadler Z, Goldstein L, Kauff N, Khasraw M, Offit K, Nathanson KL, Robson M.  Risk of metachronous breast cancer after BRCA mutation-associated ovarian cancer.  Cancer. 2013 Apr;119(7):1344-8.

New update for recurrent cervical cancer - the role of bevacizumab (avastin)

About 15 to 60% of patients with cervical cancer develop recurrent of their cancer.  Patients with local/central (in the uterus, vagina) locations has potential curative chance with more radical surgery (pelvic exenteration).   Patients with multiple or distant metastases, unfortunately, are difficult to cure.

A recent study presented at the 2013 ASCO meeting (GOG 240) randomized 452 women with recurrent cervical cancer to chemotherapy with or without bevacizumab. Previous platinum-based therapy was administered with RT in 75 and 74 percent of patients, respectively.   Patients who received Bevacizumab (Avastin) has an improvement in overall survival compared to chemotherapy alone (median, 17 versus 13 months, respectively; hazard ration [HR] 0.71, 95% CI 0.54-0.94).

However, Bevacizumab also increases toxicities such as serious (grade 3/4) bleeding (5 versus 1 percent), venous thromboembolic disease (9 versus 2 percent), and the occurrence of gastrointestinal fistula (3 versus 0 percent). However, there was no difference between the study arms in quality of life up to nine months following the start of therapy. The conclusion of the study is bevacizumab has an important role in patients with recurrent cervical cancer.   

Reference: Tewari KS, Sill M, Long HJ, et al. Incorporation of bevacizumab in the treatment of recurrent and metastatic cervical cancer: A phase III randomized trial of the Gynecologic Oncology Group. J Clin Oncol 31, 2013 (suppl; abstr 3).