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IVF and Risk of Breast Cancer
The body of evidence suggests that breast cancer risk is not increased after in vitro fertilization (IVF), but is limited by lack of long-term follow-up data. In a recent Dutch cohort study of over 19,000 women treated with IVF between 1983 and 1995 and followed for a median of 21 years, the risk of breast cancer was similar to that in subfertile women not treated with IVF and in the general population, adjusted for parity and age at first birth. These data are reassuring, but difficult to generalize to women undergoing contemporary IVF treatment since IVF drug regimens have changed over time and improved success rates have reduced the number of cycles women are exposed to these regimens. Additionally, only 14 percent of the cohort was age >60 years, so the risk of postmenopausal breast cancer was not well defined.
USPSTF Recommendations for Skin Cancer Screening
In July 2016, the United States Preventive Services Task Force (USPSTF) updated its statement on skin cancer screening and concluded that there is insufficient evidence to assess the balance of benefits and harms of screening for skin cancer in asymptomatic adults with a clinical visual skin examination. Although we agree with the USPSTF conclusion, we suggest that persons at higher risk for fatal melanoma (eg, white men 50 years of age and over), individuals with multiple moles or at least a few clinically atypical moles, and individuals with the “red hair phenotype” have a total body skin examination performed by a clinician who has had appropriate training in the identification of melanoma.
Initial Treatment for Localized, Low-Risk Prostate Cancer
There are many options for treating men with localized, low-risk prostate cancer. The most extensive data comparing these options come from the Prostate testing for cancer and Treatment (ProtecT) trial, in which 1653 patients with localized, low-risk prostate cancer were randomly assigned to active surveillance, radical prostatectomy, or radiation therapy (RT). At a median follow-up of 10 years, there was no difference in 10-year overall survival, which was approximately 99 percent for all three groups. However, the incidence of metastases was increased in patients randomized to active surveillance (6.3 per 1000 person-years versus 2.4 and 3.0 for those managed with radical prostatectomy or RT). Longer follow-up will be required to know whether the higher incidence of metastatic disease affects cancer-specific mortality, overall mortality, or quality of life. Decisions regarding the choice of treatment continue to be individualized based upon a consideration of patient age, comorbidity, and patient preferences.
Outcome of Myomectomy With Morcellation in Unsuspected Uterine Sarcoma
Uterine morcellation and myomectomy in women with unsuspected uterine cancer can potentially spread malignant cells, but few data are available about the frequency of tumor dissemination and prognosis. A retrospective cohort study of 59 women with a postoperative diagnosis of previously unsuspected uterine sarcoma compared outcomes of those who underwent myomectomy with morcellation (n = 30) with those who underwent total hysterectomy (n = 29). At five years, myomectomy with morcellation was associated with significantly lower overall survival rate (38 versus 43 percent) and a trend toward lower recurrence-free survival (24 versus 46 percent). These data illustrate the potential effects of myomectomy with morcellation in women with uterine sarcoma.
Pembrolizumab Approved for Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck
The management of advanced squamous cell carcinoma of the head and neck that is refractory to platinum-based chemotherapy is difficult. In a phase 1b study of patients who had progressed on or after treatment with platinum-based chemotherapy, 16 percent had an objective response, and 23 of 28 responses had a duration of six months or longer. Based upon these results, pembrolizumab was granted conditional approval by the US Food and Drug Administration (FDA) in August 2016, and is the preferred approach for second line therapy of squamous cell carcinoma of the head and neck. Additional trials with this and other checkpoint inhibitors are ongoing to better define the role of immunotherapy in advanced head and neck cancer.