Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Adjuvant endocrine therapy (ET) reduces the odds of distant recurrence and mortality by nearly one-half in women with hormone receptor (HR) positive early stage breast cancer. While the risk of recurrence is lower for HR positive than negative patients during the first 5-7 years, HR positive patients suffer ongoing recurrences between 0.5 and 2% year over subsequent years. Extended adjuvant ET further reduces recurrence during this late phase of follow-up. ET is associated with post-menopausal side effects (hot flashes, sexual dysfunction, mood changes, and weight gain), and occasional major toxicities (thrombosis and endometrial cancer with tamoxifen; bone mineral loss and possibly heart disease with AIs) persist throughout therapy. Accurate and reliable estimates of the risk of recurrence after five years of ET for women with prior HR positive breast cancer would permit appropriate extended ET decisions. The risk of long-term relapse is related to lymph node status and size of tumor, but these are relatively crude. Several groups have investigated whether multi-parameter tumor biomarker tests might identify those patients whose risk of recurrence is so low that extended ET is not justified. These assays include IHC4, the 21-gene "OncotypeDX", the 12-gene "Endopredict," the PAM50, and the 2-gene "Breast Cancer Index (BCI)" assays. The clinical validity of all these tests for this use context have been established, with at least one paper for each that shows a statistically significant difference in risk of distant recurrence during the 5-10 years after the initial five years of adjuvant endocrine therapy. However, the stakes are high, and although each of these represents a "prospective retrospective" study, they require further validation in subsequent datasets before they should be considered to have "clinical utility" and are used to withhold potentially life-saving treatment. Perhaps more importantly, the clinical breast cancer community, and especially the patient, need to determine how low the risk of late recurrence needs to be to forego the toxicities and side effects of extended adjuvant ET.
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PMID:Clinical utility of genetic signatures in selecting adjuvant treatment: Risk stratification for early vs. late recurrences. 2623 37

In addition to the common symptoms that occur after natural menopause, special considerations apply to women who have had their ovaries removed, particularly when oophorectomy occurs before age 45 years. Women with premenopausal oophorectomy have more severe and prolonged menopausal symptoms. Their risks of adverse mood, heart disease, excessive bone resorption, sexual dysfunction, and cognitive disorders are increased compared with the general population. Retention of the ovaries carries a survival benefit for women at low risk of ovarian malignancy. Women facing oophorectomy should understand the balance of risks and benefits in order to make an informed decision.
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PMID:Surgical Menopause. 2631 41

Sexual dysfunction occurs in men and women and the prevalence increases with age. Dysfunction can occur in one or more areas of the normal sexual response cycle: desire, arousal, or orgasm. It can also be due to pain. Family physicians should routinely screen all men and women for sexual dysfunction, given its high prevalence and high correlation with other conditions. Risk factors include use of prescription drugs (eg, selective serotonin reuptake inhibitors, diuretics, antihormonals), recreational drugs, alcohol, and/or nicotine; certain health and lifestyle issues; and many chronic medical conditions, such as heart disease and diabetes. Diagnosis is based on clinical features; therefore, a detailed sexual history and focused physical examination are critical. Laboratory testing, imaging, and management are tailored to the suspected condition. Although some therapies require referral, education of patients about the normal sexual response cycle, discontinuation or changing of drugs, screening for and management of comorbid conditions, and counseling and guidance about lifestyle changes or use of devices all can be addressed in the family medicine setting.
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PMID:Gender and Sexual Health: Sexual Dysfunction. 2773 68


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