Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. To examine the link between infections and cancer, researchers performed a systematic analysis of the proportion of cancer cases attributable to infection in 2008. They used data on cancer incidence from the GLOBOCAN project along with epidemiological data regarding the causal effects of infection on cancer. The data included information on 27 types of cancer from 182 countries.

They found that of the 12.7 million new cancer cases that occurred worldwide in 2008, 16 percent—or roughly two million—were attributable to infections. The rate of infection-related cancer was about three times higher in developing countries. For example, 3.3 percent of cancers in Australia and New Zealand were infection related, whereas 32.7 percent of cancers in sub-Saharan Africa were attributable to infections. The four main infections associated with cancer were human papillomavirus, hepatitis C, hepatitis B, and Helicobacter pylori. These infections were responsible for approximately 1.9 million cancer cases in 2008, mainly gastric, liver, and cervical cancers.

Cervical cancer accounted for about half of the infection-related cancers in women. Liver and gastric cancers accounted for more than 80 percent of the infection-related cancers in men.  About 30 percent of infection-related cancers occurred in people younger than 50 years. It’s important to note that it takes decades of chronic infection before an infection progresses to cancer.

Based on the statistics, the researchers noted that approximately two million cancer cases each year might be preventable with better public health methods for preventing infection. In an accompanying editorial, Dr. Goodarz Danaei, an assistant professor of global health at Harvard School of Public Medicine in Boston, noted that vaccines for HPV and hepatitis B are effective and that increasing their availability should be a priority for higher risk countries.[2] He suggests that increasing vaccine coverage could reduce the global burden of cancer.

References:

How does cancer treatment affect fertility in men?

Chemotherapy: Chemotherapy can temporarily—and in some cases, permanently—stop sperm production by the testes.[1] The extent to which chemotherapy affects sperm production depends on several factors, including the type and dose of chemotherapy.

Radiation: Radiation to the abdomen or pelvis can also reduce or eliminate sperm production by the testes.

Surgery: Surgery that involves the removal of both testicles (an option for some men with prostate cancer) eliminates sperm production, but other types of surgery can also affect a man’s fertility. Some types of pelvic surgery, for example, can change or eliminate ejaculation.

Options for preserving fertility in men

Although many men are able to conceive naturally after cancer treatment, others are not.

If possible, men should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

Sperm banking is the most well-established method of preserving fertility in men.[2] It involves the collection and storage of sperm, ideally before cancer treatment begins. The samples are kept frozen at a lab or sperm bank until they are needed. Sperm can be stored in this way for many years. After being thawed, the sperm can be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). During IUI, sperm are placed directly into a woman’s uterus. During IVF, mature eggs are removed from a woman’s ovary and mixed with the sperm in the lab. Embryos that result from IVF can then be placed in a woman’s uterus or frozen for later use.

If a sample contains very few viable sperm (or if a man has already undergone cancer treatment and has a low sperm count), another approach may be used to fertilize an egg. Intracytoplasmic sperm injection (ICSI) requires only a small number of healthy sperm, along with mature eggs that have been collected from a woman’s ovary. A single sperm is injected directly into each egg. The embryos that develop can then be placed in a woman’s uterus or frozen for later use.

If it is not possible to collect sperm from ejaculate, it may in some cases be possible to collect sperm directly from the testicles. This approach is still investigational.

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. During radiation therapy, for example, it may be possible to shield the testes in order to preserve sperm production.

Pregnancy after cancer

In the event that your fertility is not affected by cancer treatment (or recovers quickly or unexpectedly), you and your partner should use birth control if you do not wish to have a child. If you are trying to conceive a child naturally, your doctor may advise you to wait for several months after treatment; this allows for the elimination of sperm that may have been damaged during treatment.

In general, the risk of birth defects in children born to cancer survivors appears to be similar to the risk in the general population.[3] If your cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), your children may inherit the gene mutation responsible for your family’s increased risk of cancer. Talking with a genetic counselor may be helpful.

Other options for parenthood

Not all men have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all men will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for men who want to father a child but cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, you may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Donor Sperm: Donor sperm is readily available from sperm banks and can be used for either intrauterine insemination or in vitro fertilization.

Individual decisions within a larger community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.  To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More information?

Discuss with others…. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

How does cancer treatment affect fertility in women?

Chemotherapy: Many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Radiation: Radiation to the pelvis can also destroy oocytes. Radiation to the pelvis can also affect uterine growth and blood flow, particularly if received before puberty.[1] A poorly developed uterus may make a woman more likely to have a miscarriage, or more likely to have a preterm or low-birthweight infant.

Surgery: Some cancers require surgical removal of the uterus, the ovaries, or both.

The effects of cancer treatment on fertility can vary substantially by age. Younger women, who have a larger pool of oocytes when they start cancer treatment, are more likely than older women to be able to get pregnant after treatment.[2]

Options for preserving fertility in women

If possible, women should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

One of the most established approaches for preserving fertility among female cancer patients is embryo freezing.[3] Before starting cancer treatment, a woman would be given hormones to stimulate the development of eggs in her ovaries. Mature eggs would be removed and fertilized with the sperm of her husband, partner or a sperm donor. The embryos that result from these fertilized eggs would be frozen for later use.

Although embryo freezing is an established approach to helping women become pregnant after cancer, there are downsides. A woman may not currently have a male partner and may be unwilling to use an anonymous sperm donor. It’s also important to be aware that embryo freezing takes approximately two weeks after the start of a woman’s period. If a woman needs to begin cancer treatment immediately, she may not be able to go through this process. Finally, this approach is only an option for women of childbearing age; stimulating the ovaries to produce mature eggs is not an option for girls who develop cancer during childhood.

Several other options are still in the experimental phase. One approach being explored is the freezing of unfertilized eggs.3 Once again, the ovaries would be stimulated to produce mature eggs before cancer treatment begins. The eggs would then be frozen without being fertilized by sperm. Currently, freezing unfertilized eggs is less likely to result in pregnancy than freezing embryos, largely because unfertilized eggs are less likely than embryos to survive the process of freezing and thawing. Nevertheless, it may be an option for women who do not have a male partner at the time of their cancer diagnosis, and it avoids the difficult issue of what to do with unused embryos.

Another promising but still experimental approach is to freeze all or a part of an ovary before cancer treatment.[4] After treatment, the ovarian tissue is implanted either back in the woman’s pelvis or in another location (such as under her skin). If this process is successful, the ovarian tissue will begin producing eggs. A safety concern with this approach is the possibility of reintroducing cancer cells along with the ovarian tissue, and the tissue will need to be carefully screened for cancer before it is transplanted.4

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. For example, shielding the ovaries during radiation, or moving the ovaries out of the radiation field, may protect them from the effects of radiation. Scientists are also exploring whether using drugs to suppress the activity of the ovaries during chemotherapy will make the ovaries less susceptible to damage by chemotherapy.[5] For women with certain types of cervical or ovarian cancer, fertility-preserving surgery may also be an option.[6] It’s important to understand that only specific subsets of patients will be candidates for these approaches, and that some of the methods are still in the early stages of evaluation.

Pregnancy after cancer

In addition to having concerns about their ability to get pregnant, women may have concerns about whether pregnancy after cancer treatment will be safe for themselves and their children. While there is a limited amount of information about these topics, the news is generally good.

The risk of cancer recurrence during or after pregnancy has been most studied in women with breast cancer, and these studies generally have reported that pregnancy does not increase the risk of breast cancer recurrence. [7] Many doctors, however, suggest waiting for a period of time after treatment before becoming pregnant. [8]

If chemotherapy or radiation therapy has damaged her heart or lungs, a woman may also have concerns about the strain that pregnancy will put on her body. Studies of breast cancer survivors suggest that long-term heart problems are uncommon after chemotherapy or radiation therapy, [9] but a woman may wish to talk with her doctor about her current health status and the likely effects of pregnancy.

Children born after their mother’s cancer treatment do not appear to be more likely than other children to have birth defects or cancer.[10] If a woman’s cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), her child may inherit the gene mutation responsible for her family’s increased risk of cancer. Talking with a genetic counselor may help clarify the child’s risk.

When planning for pregnancy, be aware that some cancer treatments may cause you to have an early menopause even if your periods resume after treatment. Also be aware that you may be capable of conceiving even if your periods do not resume; continue to use birth control if you do not wish to become pregnant.

Other Options for Parenthood

Not all women have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all women will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for women who want to become pregnant and cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, women may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Egg Donation: Women who still have a uterus may be able to become pregnant using an egg donated by another woman. Through in vitro fertilization, the donated egg would be fertilized by the cancer survivor’s male partner or a sperm donor, and implanted in her uterus. Alternatively, another couple may donate a frozen embryo that could be implanted in her uterus.

Gestational Carrier or Surrogate: Women who do not have a uterus, or who are otherwise unable to sustain a pregnancy, may be able to have another woman carry a pregnancy for them. If the cancer survivor has functioning ovaries, her own egg can be fertilized by her male partner’s sperm and transferred to the uterus of another woman. In this case, the woman who carries the pregnancy is known as a gestational carrier. If the cancer survivor does not have functioning ovaries, another woman can both donate an egg and carry the pregnancy. This is the arrangement traditionally known as surrogacy.

Individual Decisions Within a Larger Community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.

To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More Information?

Discuss with others….. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

Meningiomas are very common brain tumors that occur in the membranes that cover and protect the brain and spinal cord (the meninges). Meningiomas usually grow slowly and tend to affect more women than men. Most meningiomas are considered to be benign tumors; however, even benign brain tumors can cause disability and may sometimes be life-threatening.

The primary environmental risk factor for meningioma is ionizing radiation—and the most common artificial source of exposure to such radiation in the U.S. is dental x-rays. In order to examine the link between dental x-rays and meningioma, researches studied data from 1,433 patients (ages 20 to 79) who were diagnosed with the disease between May 2006 and April 2011. They compared these patients to a control group of 1,350 individuals who were similar in age, gender, and state of residence, but had no diagnosis of the disease.

The study examined the frequency of three different types of dental x-rays: bitewing, which is a focused image of one area taken with an x-ray film held in place by a tab between the teeth; panorex, which is taken outside the mouth and shows a panoramic view of the entire mouth; and full-mouth, which includes a number of images of the full mouth.

The results indicated that patients with meningioma were more than twice as likely as controls to report having ever had a bitewing exam. Individuals who reported undergoing yearly (or more frequent) bitewing exams were 1.4 to 1.9 times as likely to develop meningioma as controls. The risk varied depending on the age at the time of the bitewing exam.

Panorex exams were also linked to an increased risk of meningioma. Individuals who underwent panorex exams when they were younger than age 10 had a 4.9 times increased risk of developing the disease. Depending on their age, those who underwent panorex exams on a yearly or more frequent basis were 2.7 to 3.0 times as likely to develop meningioma compared to controls.

The researchers noted that the data was based on individuals who were likely exposed to dental x-rays that contained higher levels of radiation than most dental x-rays today. Still, the results indicate that moderation is important. While many dental x-rays are necessary, it’s important to use careful consideration to determine when and how to use them. The American Dental Association provides guidelines for the use of dental x-rays in healthy individuals: they suggest that children receive 1 x-ray every 1-2 years, teens receive 1 x-ray every 1.5-3 years, and adults receive 1 x-ray every 2-3 years.

As with anything, it’s important to weigh the risks and benefits of dental x-rays on an individual basis. While the results of this study do not prove that the radiation from the x-rays caused the brain tumors, they do suggest that there is a correlation between dental x-rays and meningioma incidence. This could be a modifiable risk factor that many individuals could avoid.

Reference:

A growing body of evidence suggests that aspirin may reduce the risk of several types of cancer, with particularly strong evidence for colorectal cancer. Not all studies have found a benefit, however, and any potential benefits of aspirin must be weighed against risks such as bleeding.

To further explore the relationships between daily aspirin and cancer, researchers conducted a combined analysis of 51 previous randomized trials.[1] The trials were originally designed to evaluate the effect of daily aspirin on outcomes such as heart disease, but information about cancer was also available.

• Daily aspirin reduced cancer deaths. After five years, aspirin users had a 37 percent reduction in risk of cancer death.
• Aspirin also reduced the likelihood of developing cancer. From three years onward, aspirin users had a 24 percent reduction in the risk of being diagnosed with cancer.
• As expected, aspirin carried a risk of major bleeding, but this risk appeared to diminish over time.

Another study published in the same issue of The Lancet evaluated the effect of daily aspirin on cancer metastasis (the spread of cancer from its original site to other parts of the body). The study focused on 987 people who were diagnosed with cancer while participating in one of five trials of aspirin use. Those who were taking aspirin were less likely to have metastatic cancer than those who were not taking aspirin.[2]

These results suggest that regular aspirin use may reduce cancer incidence and mortality, but concerns remain about the risks of regular aspirin use in healthy individuals. People who are considering using aspirin on a regular basis are advised to discuss the risks and benefits with their physician.

References:

Oligodendrogliomas are uncommon tumors that form in the nerve tissue of the brain. They occur primarily in adults, with an average age at diagnosis of 35 years.

The role of chemotherapy in the treatment of aggressive oligodendrogliomas was evaluated in a Phase III clinical trial (RTOG 9402). Study participants were treated with radiation therapy alone or in combination with chemotherapy.

Results reported in 2006 indicated no overall benefit from the addition of chemotherapy. The researchers noted, however, that patients whose tumors had a specific chromosomal abnormality (deletion of 1p and 19q) appeared to have better survival.

Researchers recently conducted an updated analysis of this study that further explored the role of the 1p19q chromosomal abnormality. Study participants have now been followed for a median of 11 years.

• Overall survival was better among patients whose tumors had the chromosomal abnormality: survival was 8.7 years among patients with the abnormality and 2.7 years among patients without the abnormality.
• The chromosomal abnormality also predicted a benefit from chemotherapy: among patients whose tumor had the abnormality, overall survival was 14.7 years among those who received both chemotherapy and radiation therapy, compared with 7.3 years among those who received radiation therapy alone. Among patients without the chromosomal abnormality, the addition of chemotherapy did not improve survival.

These results indicate that the 1p19q chromosomal abnormality is linked with both prognosis and response to treatment among patients with oligodendroglioma. This information will allow for more individualized treatment of this condition.

The full results of this study are being submitted for presentation at the 2012 annual meeting of the American Society of Clinical Oncology.

References:

American College of Radiology press release. Abnormal chromosome indicator of treatment and outcome in patients with rare brain tumor. January 19, 2012.

National Cancer Institute press release. Genetic abnormality predicts benefit from treatment for a rare brain tumor. January 19, 2012.

Myotonic muscular dystrophy (MMD) is the most common form of adult-onset muscular dystrophy. The condition is characterized by progressive muscle wasting and weakness.

Some reports have suggested that people with MMD may have an increased risk of benign and malignant tumors. To further explore this issue, researchers conducted a study among more than 1,600 people who were diagnosed with MMD in Sweden or Denmark between 1977 and 2008. The cancer risk in the study participants was compared with the cancer risk in the general population of those countries.

• 104 MMD patients were diagnosed with cancer during follow-up. In a similar group of people from the general population, only 52 cases of cancer would be expected.
• Types of cancer that were significantly more common among the MMD patients than among the general population were endometrial cancer (cancer of the lining of the uterus), brain cancer, ovarian cancer, and colon cancer. Other types of cancer that may be more common among MMD patients include eye cancer, female genital cancer, thyroid cancer, and pancreatic cancer.

These results suggest that people with MMD may have an increased risk of several types of cancer. People with MMD may wish to talk with their doctor about recommended cancer screening tests and other ways to manage their cancer risk.

Reference: Gadalla SM, Lund M, Pfeiffer RM et al. Cancer risk among patients with myotonic muscular dystrophy. JAMA. 2011;306(22):2480-2486.

Glioblastoma mutiforme is one of the most common and fatal types of primary brain cancer. It develops from the glial cells, which are the most abundant cells in the nervous system. Glial cells provide supportive functions that facilitate the work of neurons (cells that transmit impulses between the brain, spinal column, and nerves).

Treatment for GBM often involves surgery followed by radiation and chemotherapy with Temodar® (temozolomide). However, even with the most aggressive treatment available, many patients will survive less than one year after diagnosis. As such, researchers continue to evaluate new and innovative treatment strategies.

Rindopepimut is an investigational immunotherapeutic vaccine that targets a molecule known as epidermal growth factor receptor variant III, or EGFRvIII. This molecule—which is not present on normal cells—contributes to cancer growth. It is estimated that 25-30% of GBM patients have EGFRvIII-positive disease.

The ACT III trial evaluated rindopepimut in combination with radiation plus Temodar in patients with newly diagnosed GBM that expressed EGFRvIII. Sixty-five patients were enrolled in this Phase II study. Tumors had been surgically removed in all patients. For each participant, vaccination with rindopepimut began approximately three months after diagnosis.

Previous reports from this study suggested that rindopepimut improves progression-free survival (results were compared with historical information about patients who had not received rindopepimut). The current analysis provides information about overall survival.

• Median overall survival was 24.6 months. This is better than what would be expected without rindopepimut. In a similar group of patients who were treated outside of this study and without rindopepimut, overall survival was 15.2 months.
• Rindopepimut was well tolerated. The most common side effects were local reactions at the injection site.

These results continue to suggest that the addition of rindopepimut to standard GBM treatments may improve outcomes.

Reference: Lai R, Recht LD, Reardon DA et al. Long-term follow-up of ACT III: a phase II trial of rindopepimut (CDX-110) in newly diagnosed glioblastoma. Presented at the 2011 SNO Annual Scientific Meeting and Education Day. Orange County, California. November 17-20, 2011. Abstract IM-03.

Dr. Cassileth is a world-renowned authority in integrative medicine. She is a researcher, educator, and planner who has worked in complementary (integrative) medicine and the psychosocial aspects of cancer care for more than 25 years.  She has just released a new book, The Complete Guide to Complementary Therapies in Cancer Care. MSKCC’s Integrative Medicine Service’s Web site, www.MSKCC.org, offers evidence-based information about herbs, vitamins, and unproved cancer treatments at no charge to professionals and the public.

Integrative medicine combines modern scientific treatment with complementary therapies that can transform the physical, emotional, and spiritual lives of people living with chronic or life-threatening illness. Complementary therapies such as touch therapies, mind-body therapies, acupuncture, nutrition, and physical activity are not substitutes for mainstream medical care. But when used in concert with medical treatment, they alleviate stress; reduce pain, anxiety, and other physical and emotional symptoms; and enhance quality of life.

On Thursday, November 17, 2011 at 6:00 PM EST you’ll have the opportunity to hear a brief presentation and to ask the expert, Dr. Barrie Cassileth, about helpful, evidence-based complementary therapies. You’ll learn how to recognize bogus “treatments” you will want to avoid.

Click here to submit a question for the Q&A portion of the Web Chat or to register for the Web Chat. Please note, Dr. Cassileth will address as many questions as possible during the 30-minute live Q&A portion of the Web Chat. Thank you for your participation.