Saturday, April 28, 2012

My Diagnosis

Metastatic Renal Cell Carcinoma. Diagnosis rendered on 4/27.

My mission is clear.
  • Define the disease and the cause or precipitant of it.
  • Eliminate the hip as being some kind of initial precipitant (ongoing/this will take time)
    • Review the three test results I have taken (I will share those with you as soon as I have them.)
      • metal testing on the biopsied results
      • path tests on the diagnostics
      • the cytogenetics tests on the DNA changes.
  • Select a treatment program.
I will  publish  one part of the investigation for this blog since the subject matter of this blog is hip related and will continue this blog as long as the potential link between the hip and cancer is resolved one way or another.

Here are the 3 key large short term patient metal on metal  studies that will prompt me to move forward and serve as my inspiration that there are no answers at this point...only questions. I also will commit to attempt to get some studies funded to move this research forward.

Cancer risk after hip replacement with metal implants: a population-based cohort study in Sweden.

     J Natl Cancer Inst. 1995 Jan 4;87(1):28-33.

                  CONCLUSION:  (40K patients)

•     In this study, the largest study to date to evaluate hip replacement and subsequent cancer risk, the overall cancer risk appears to be negligible from a public health perspective, and our results have not produced any strong evidence against the continued use of these devices. Nevertheless, the small but statistically significant increases in kidney and prostate cancers and the decrease in gastric cancer deserve further study.

      Nationwide study of cancer risk among hip replacement patients in Sweden.

    J Natl Cancer Inst. 2001 Sep 19;93(18):1405-10.

      CONCLUSIONS:  (116K patients)

•     In this 2nd study, the largest study to date, hip implant patients had similar rates of most types of cancer to those in the general population. Although the excesses of melanoma, multiple myeloma, and prostate and bladder cancers may be due to chance, confounding, or detection bias and should be interpreted cautiously, they warrant further investigation because of the ever-increasing use of hip implants at younger ages

The third study was just published
British Medical Journal
BMJ 2012;344:e2383 doi:  10,1136/bmj.e2383 published 4/3/12
Risk of cancer in the first seven years after the MOM hip replacement ...

 Conclusions: (41K patients
  • The incidence of cancer was low after hip replacement  (1.25% at one year.)
  • There was no evidence that metal on metal bearings were associated with an increased risk of any cancer diagnosis after 7 years
  • There was no increase in the risk of malignant melanoma or haematological, prostrate and renal tract cancers. 
  • The 5 year incidence of all cancers for men aged 60 was approx 5%,  with resurfacing approx 6%,  with stemmed MOM 7%  and were lower with woman.
"These data are reassuring, but the findings are observations with short follow up,  The use of hospital episode statistics data might underestimate  cancer diagnoses and there is the possibility of confounding  by indication.  Furthermore, as some cancers have a long latency period , it is important that we study the longer term outcomes and continue to investigate the exposure to orthopedic metals.

[There are issues with all of this stuff.  How often do patients get hip operations that have been tested for Cancer?  Never? While the author does point this out,these studies need to be taken to the next step. For obvious reasons, they all underestimate the cancer risk but we don't really know that someone has cancer unless there is a reason to have discovered it.]

1 comment:

  1. Connie, you have now developed a significant cadre of readers who care about you as well as about the hip issues. Please plan to continue the blog as your situation unfolds, covering both the hip issues and whether related or not, your cancer treatment. Pam