Oral contraceptive use and ovarian cancer risk among carriers of BRCA1 or BRCA2 mutations

Women with mutations of the genes BRCA1 or BRCA2 are at increased risk of ovarian cancer. Oral contraceptives protect against ovarian cancer in general, but it is not known whether they protect against the disease in carriers of these mutations. We obtained self-reported lifetime histories of oral contraceptive use from 451 women who carried mutations of BRCA1 or BRCA2. We used conditional logistic regression to estimate the odds ratios associated with oral contraceptive use, comparing the histories of 147 women with ovarian cancer (cases) to those of 304 women without ovarian cancer (controls) who were matched to cases on year of birth, country of residence and gene (BRCA1 vs BRCA2). Reference ages for controls had to exceed the ages at diagnosis of their matched cases. After adjusting for parity, the odds-ratio for ovarian cancer associated with use of oral contraceptives for at least 1 year was 0.85 (95 percent confidence interval, 0.53-1.36). The risk decreased by 5% (1-9%) with each year of use (P for trend=0.01). Use for 6 or more years was associated with an odds-ratio of 0.62 (0.35-1.09). These data support the hypothesis that long-term oral contraceptive use reduces the risk of ovarian cancer among women who carry mutations of BRCA1 or BRCA2

From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve

We analysed the introduction of the robot-assisted laparoscopic radical hysterectomy in patients with early-stage cervical cancer with respect to patient benefits and surgeon-related aspects of a surgical learning curve. A retrospective review of the first 14 robot-assisted laparoscopic radical hysterectomies and the last 14 open radical hysterectomies in a similar clinical setting with the same surgical team was conducted. Patients were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and open radical hysterectomy (RH) before August 2006 and were candidates for a laparoscopic sentinel node procedure, pelvic lymph node dissection and robot-assisted laparoscopic radical hysterectomy (RALRH) after August 2006. Overall, blood loss in the open cases was significantly more compared with the robot cases. Median hospital stay after RALRH was 5 days less than after RH. The median theatre time in the learning period for the robot procedure was reduced from 9 h to less that 4 h and compared well to the 3 h and 45 min for an open procedure. Three complications occurred in the open group and one in the robot group. RALRH is feasible and of benefit to the patient with early stage cervical cancer by a reduction of blood loss and reduced hospital stay. Introduction of this new technique requires a learning curve of less than 15 cases that will reduce the operating time to a level comparable to open surgery

Ovarian cancer

Ovarian cancer is not a single disease and can be subdivided into at least five different histological subtypes that have different identifiable risk factors, cells of origin, molecular compositions, clinical features and treatments. Ovarian cancer is a global problem, is typically diagnosed at a late stage and has no effective screening strategy. Standard treatments for newly diagnosed cancer consist of cytoreductive surgery and platinum-based chemotherapy. In recurrent cancer, chemotherapy, anti-angiogenic agents and poly(ADP-ribose) polymerase inhibitors are used, and immunological therapies are currently being tested. High-grade serous carcinoma (HGSC) is the most commonly diagnosed form of ovarian cancer and at diagnosis is typically very responsive to platinum-based chemotherapy. However, in addition to the other histologies, HGSCs frequently relapse and become increasingly resistant to chemotherapy. Consequently, understanding the mechanisms underlying platinum resistance and finding ways to overcome them are active areas of study in ovarian cancer. Substantial progress has been made in identifying genes that are associated with a high risk of ovarian cancer (such as BRCA1 and BRCA2), as well as a precursor lesion of HGSC called serous tubal intraepithelial carcinoma, which holds promise for identifying individuals at high risk of developing the disease and for developing prevention strategies

Using Theater to Increase Empathy Training in Medical Students

Abstract: Developing and nurturing empathy in medical trainees has been recognized as an essential element of medical education. Theater may be a unique instructional modality to increase empathy training.Methods: A multi-disciplinary team developed a theater workshop for first year medical students.  Through the use of theater games, art images and reflective writing, the workshop was designed to enable students to: 1) consider the concept of empathy within the context of theater; 2) experience art, theater and narrative as reflective tools to build empathy /self-reflection. The workshop was evaluated by students through a written questionnaire. It was evaluated by faculty and actors though narrative dialogue. The faculty and actors shared their perceptions about 1) students’ ability to demonstrate empathy through a written narrative based on an art image;  2) students’ use of reflection as part of empathy awareness; 3) students’ ability to demonstrate awareness of body language and emotion as diagnostic and clinical tools. The student questionnaire surveyed the 1) overall quality of the session; 2) ability of the session to help students understand the importance of body language in the doctor-patient relationship; 3) the effectiveness of actors in stimulating discussion about empathy, body language and communication in the doctor-patient relationship.Results: A description of the workshop’s content is described at length. Medical faculty and actors’ narrative comments reflect their positive perceptions of the workshop’s ability to promote empathy through the use of theater /narrative. Medical students evaluated, with less enthusiasm, the effectiveness of the actors in stimulating discussion on the role of empathy, body language and communication.Discussion: The workshop provided an innovative method to foster empathy in medical students.  Faculty and actors’ narrative comments were positive overall, as they commented on the importance of helping learners build skills in self-reflection and empathic communication. Mixed student feedback indicates the challenges in teaching clinical empathy and the diversity of students’ personalities and learning styles. Inadequate faculty development and the number of activities included in the session may have contributed to the discrepancy between faculty and student perceptions of the workshop.