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Radiation not necessary for patients with low-risk breast cancer

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HHS radiation oncologist Dr. Tim Whelan is lead author on a study that found that some women with early-stage, low-risk breast cancer may not need radiotherapy after breast conserving surgery.

HHS radiation oncologist Dr. Tim Whelan is the study’s lead author

Some women with early-stage, low-risk breast cancer may not need radiotherapy after breast conserving surgery, according to new research led by Hamilton Health Sciences, McMaster University, BC Cancer, and the University of British Columbia.

The research, published in The New England Journal of Medicine, shows women 55 or older with a specific subtype of Stage 1 breast cancer can be effectively treated with just surgery and endocrine therapy.

The findings, which were initially presented in June 2022 at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago, have since been peer-reviewed for publication in full detail.

“This is a major advance in our treatment approach for breast cancer.”

Women with early breast cancer who have breast conserving surgery typically receive radiation to the breast daily for several weeks to reduce the risk of cancer returning. However, radiation can be costly, inconvenient for the patient and associated with both short-term side effects such as tiredness and skin irritation; and long-term side effects like breast pain and thickening of the breast tissue, which can affect how the breast looks and a woman’s quality of life.

The subtype of breast cancer that researchers focused on – luminal A – represents up to 60 per cent of all breast cancers diagnosed annually and is associated with a lower risk of recurrence. With this new approach, a significant proportion of women can be spared of radiation after breast conserving surgery. Eliminating the need for this group to receive radiation will allow women to avoid the side effects of therapy and can add capacity back into the public health care system, permitting increased access for those who require radiation therapy more urgently.

“This is a major advance in our treatment approach for breast cancer,” says Dr. Tim Whelan, lead author of the study and a radiation oncologist at Hamilton Health Sciences (HHS). Whelan is also a professor in the Department of Oncology at McMaster University and the Canada Research Chair in Breast Cancer Research. “With a better understanding of the molecular biology of breast cancer we can now identify women who do not need radiation,” he adds.

The study was coordinated by the Ontario Clinical Oncology Group at HHS, and followed 500 women from across Canada who were 55 years of age or older, had undergone breast conserving surgery, and their tumors were smaller than two centimetres without cancer in the lymph nodes under the arm. The growth rate of a woman’s tumor was assessed with a simple, low-cost and made-in-B.C. version of a molecular test called Ki67, which provided a quantitative measure that the participant’s cancer was low-risk.

“I want to thank all the women who had the courage to sign up for this study.”

In the trial, the luminal A sub-type was determined by a low reading on the Ki67 test plus the tumor having both the estrogen and progesterone receptors. If determined to be low risk, women were enrolled in the trial where they received standard endocrine therapy but not radiation. Radiation therapy is standard practice, so participants were monitored through regular clinical exams and annual mammograms. When planning the study, the investigators predicted that the risk of developing recurrence in the breast would be very low at five years.

At five years post-surgery, researchers found the recurrence of cancer in the breast was only 2.3 per cent without radiotherapy. This was roughly comparable with a 1.9 per cent risk of developing a new breast cancer in the other, untreated breast.

“I want to thank all the women who had the courage to sign up for this study,” says Torsten Nielsen, clinician-scientist at BC Cancer and professor of pathology and Laboratory medicine at University of British Columbia. “Their courage has led to a chance to improve care for many other women who we now know confidently will not need to undergo radiation therapy.” Nielsen developed the version of the Ki67 molecular test used in this clinical trial.

The overall risk of cancer recurrence following breast-conserving surgery has decreased in recent years because of regular mammogram screening, improved surgical techniques and better systemic treatments, the authors say.

The study received funding from the Canadian Cancer Society and the Canadian Breast Cancer Foundation.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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Alberta to launch new primary care agency by next month in health overhaul

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CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.

Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.

Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.

LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.

The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.

Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.

This report by The Canadian Press was first published Oct. 15, 2024.

The Canadian Press. All rights reserved.

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