Surprising variability in melanoma diagnostic findings

Elmore et al. figure

In one case, 36 pathologists used 18 different diagnostic terms to define the same tissue section, shown here at two magnifications.

Although pathologists are likely to agree when evaluating skin biopsies that are benign or highly malignant, they often disagree when lesions fall into intermediate categories, new research finds. Pathologists’ diagnostic interpretations of melanoma in situ and early stage invasive melanoma – categories that are not well characterized – were neither reproducible nor accurate. And this may be creating the potential for both overdiagnosis and underdiagnosis of melanoma, according to the new study with two OHSU co-authors, Heidi D. Nelson, M.D., M.P.H., and Patricia Carney, Ph.D.

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New funding for a dire need: Pancreas cancer early detection

With a $250,000 award from the Pancreatic Cancer Action Network, researchers will seek to validate biomarkers able to detect pancreas cancer months or years before patients experience overt symptoms of the disease.

 

Brett Sheppard, M.D.

Brett Sheppard, M.D.

Pancreatic ductal adenocarcinoma is the deadliest of the major cancer types, with a five-year survival rate of less than 10 percent. Unlike the other major causes of cancer mortality, pancreatic cancer is increasing in both incidence and number of deaths each year.

Principal investigator Brett Sheppard, M.D., is a professor of surgery in the OHSU School of Medicine. Co-principal investigator Rosalie Sears, Ph.D., is a professor in the Department of Molecular and Medical Genetics. The two are co-directors of the Brenden-Colson Center for Pancreatic Care as well as members of the Knight Cancer Institute.

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Nerve damage from chemotherapy may persist for years, worsening risk of falls

neuropathy image(Getty Images)

In a study that kept in touch with more than 500 women cancer survivors for an average of six years, nearly half continued to experience chemotherapy-induced peripheral neuropathy and a heightened risk of falling.

The study, published in the Journal of Clinical Oncology, challenges the widely held assumption that chemotherapy-induced neuropathy will mostly cause no serious long-term effects.

“Many cancer survivors are told these chemo-related symptoms will eventually go away. Our study found that’s just not the case,” said first author Kerri Winters-Stone, Elnora E. Thompson Distinguished Professor in the OHSU School of Nursing and co-leader of the Knight Cancer Institute’s Cancer Prevention and Control Program.

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When cancer drug marketing sneaks into a soap opera plot

"General Hospital" character Anna Devane ponders her diagnosis.

“General Hospital” character Anna Devane ponders her diagnosis.

Polycythemia vera is an uncommon blood cancer that can be controlled with long-established treatments. So it seemed more than a little suspicious to Vinay Prasad, M.D., M.P.H., when the disease took center stage in an episode of “General Hospital” – the longest running daytime drama on American television.

“I felt there had to be some backstory,” Prasad, an OHSU Knight Cancer Institute hematologist-oncologist told listeners of  the public radio program Think Out Loud. “What we found was that a company called Incyte Corporation, which actually manufactures a very costly new drug for polycythemia vera, was in a partnership with ‘General Hospital’ and had helped craft this plot line in an effort to raise awareness for this condition.”

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Outsmarting treatment-resistant prostate cancers

Aggressive prostate tumors can rapidly evolve to resist PARP inhibitors, but it may be possible to detect resistance early enough to counteract.

 

Protein_PARP1_PDB_1uk0Two views of the structure of the DNA-repair protein PARP1

It was a surprising discovery that opened up a new avenue for treating prostate cancer. In recent years, studies have revealed that gene mutations long associated with breast and ovarian cancers – BRCA1 and BRCA2 – also play a significant role in driving aggressive prostate cancers

Men with these mutations (about 20 percent of prostate cancer patients with metastatic tumors) have shown very high response rates to a new class of drugs called PARP inhibitors, three of which have already gained FDA approval for use in ovarian cancer.

The bad news: Prostate cancers can rapidly evolve to resist PARP inhibitors.

The good news: It may be possible to detect the emergence of resistant cancer cells with just a blood test, researchers have now found, and that could provide earlier information about PARP inhibitor resistance and important clues about how to overcome resistance.

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Widely used prostate cancer treatment may worsen risk of falls

man falling

Men with prostate cancer became more vulnerable to falls if they used androgen deprivation therapy, and the heightened risk of falling persisted for more than a year after ending therapy, a study has revealed.

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Riveting survival stories from the early clinical trials of Gleevec

(Left to right) Judy Orem, 73, of Lake Oswego, Oregon, Doug Jenson, 83, of Canby, Oregon, and Dori Mortensen, 79, of Bend, Oregon, inside Multnomah Pavilion at Oregon Health & Science University in Portland, Oregon on Thursday April 20, 2017.

(Left to right) Judy Orem, Doug Jenson and Dori Mortensen were diagnosed with chronic myeloid leukemia in the 1990s, when few survived more than five years. They were among the earliest participants in clinical trials of Gleevec. (Stat News/Meg Roussos)

Medicine had never seen anything like it before, Brian Druker, M.D., recalled. “These are people who’d been told to get their affairs in order. And now their blood counts are normal,” the director of the OHSU Knight Cancer Institute told Stat News reporter Bob Tedeschi.

“But here’s the problem: When can you celebrate? I felt a little bit like walking on eggshells, because it’s like, OK, is this going to be a flash in the pan, or is this going to last? And there’s only one way to find out: wait and see.”

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Oregon’s precision medicine pioneer targets earlier cancer detection

OHSU Knight Cancer Institute Director Brian Druker talks with Medscape about breaking out of one-size-fits-all thinking in cancer screening and prevention

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Brian and Eric

Knight Cancer Institute Director Brian Druker, M.D., recorded an interview in La Jolla, California, with Medscape Editor-in-chief Eric Topol, M.D.

“We are now in the process of building an entire program on what I call precision early detection of cancer,” said Brian Druker, M.D., “We are trying to be more accurate in taking the same precepts of precision medicine for advanced cancer and using them earlier.”

If it works, Druker told Medscape’s editor-in-chief, Eric Topol, M.D., the early detection initiative at OHSU will find a way out of the big conundrum of cancer screening: technologies that too often fail to find dangerous cancers while at the same time raising too many alarms about essentially harmless tumors and driving overdiagnosis and unnecessary treatment.

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Oregon’s Death with Dignity Act, 20 years later

PAD trend

Number of prescriptions and assisted deaths under the Oregon Death with Dignity Act. (Blanke et al. from Oregon Health Authority data)

In 1997, Oregon became the first state to make it legal for terminally ill patients to self-administer a prescription to hasten death.

A review of 991 cases of lethal self-medication through 2015 shows that the law’s impact has remained largely predictable. Three-fourths of the people were dying of cancer, nearly all were white and around 70 percent had attended college. More than 90 percent had health insurance, were receiving hospice care and died at home.

Still, some findings surprised first author Charles Blanke, M.D., a professor of medicine in the OHSU Knight Cancer Institute and chair of the SWOG research consortium.

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A new way to guide cancer immune therapy

Scrutinizing the immune cells infiltrating a tumor may reveal the cancer’s vulnerability or resistance to immune-based therapies.

 

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Outsmarting treatment-resistant prostate cancers

Outsmarting treatment-resistant prostate cancers

Aggressive prostate tumors can rapidly evolve to resist the new class of drugs called PARP inhibitors. Knight Cancer Institute scientists have discovered how it may be possible to detect resistance early enough to counteract.