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Toner J.P.,Atlanta Center for Reproductive Medicine | Seifer D.B.,Genesis Centre | Seifer D.B.,New York University
Fertility and Sterility | Year: 2013

Antimüllerian hormone is the most informative serum marker of ovarian reserve currently available and should be considered an important part of any contemporary reproductive medicine practice. It is both more convenient and informative than basal FSH and can be assessed at any point in the cycle. It is the most useful serum method of determining ovarian reserve, which guides pretreatment counseling, choice of infertility treatment, and avoidance of ovarian hyperstimulation. The future role of basal FSH testing is in doubt. © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.


Harvie M.,Genesis Centre
American Society of Clinical Oncology educational book / ASCO. American Society of Clinical Oncology. Meeting | Year: 2014

Nutritional supplements are widely used among patients with cancer who perceive them to be anticancer and antitoxicity agents. Large-scale, randomized cancer prevention trials have mainly been negative, with some notable adverse and beneficial effects. For example, these trials showed that beta-carotene increases the risk of lung and stomach cancer, vitamin E increases prostate cancer and colorectal adenoma, and selenium reduces gastric and lung cancer in populations with low selenium levels but increase rates in those with higher levels. Both beta-carotene and vitamin E supplementation increase overall mortality. This article reviews phase II and III trials that examine the effects of multivitamins, antioxidants, vitamin D, and n-3 supplements on outcome and toxicity from cancer treatments. Although vitamin E and beta-carotene reduce toxicity from radiotherapy among patients with head and neck cancer, it has been found to increase recurrence, especially among smokers. Antioxidants have mixed effects on chemotherapy toxicity, but there are no data on outcome. Vitamin D deficiency is relatively common among patients with cancer, and ongoing phase III trials are studying the effect of vitamin D on outcome as well as optimum vitamin D and calcium intakes for bone health. Docosahexanoic and eicosopentanoic acid supplements have mixed effects on cachexia and are currently being tested as potential adjuncts to maximize response to chemotherapy. Nutritional supplementation tailored to an individual's background diet, genetics, tumor histology, and treatments may yield benefits in subsets of patients. Clinicians should have an open dialogue with patients about nutritional supplements. Supplement advice needs to be individualized and come from a credible source, and it is best communicated by the physician.


Makrakis E.,Embryo Art Unit | Pantos K.,Genesis Centre
Current Opinion in Obstetrics and Gynecology | Year: 2010

Purpose of Review: To update information on the findings of hysteroscopy in women with implantation failures after in-vitro fertilization (IVF) as well as on the effect of the procedure on subsequent pregnancy rates. Recent Findings: Information from three review publications indicates that the incidence of abnormal hysteroscopic findings in women with repeated implantation failures (RIFs) varies between 25 and 50%, whereas by pooling data from randomized studies, hysteroscopy significantly increases the clinical pregnancy rate (CPR) on the subsequent IVF cycle (pooled RR = 1.57, 95% CI: 1.29-1.92, P < 0.00001). Two recent clinical articles reported that the incidence of abnormal hysteroscopic findings in RIF patients was approximately 37%: the one study reported no differences in CPR between RIF patients with abnormal versus normal hysteroscopy; the second study reported significantly increased CPR in RIF patients with abnormal or treated hysteroscopic findings compared to those with a normal hysteroscopy, as well as in RIF patients having a hysteroscopy compared to controls not having the procedure. Summary: There is accumulated evidence that hysteroscopy is beneficial for women experiencing implantation failures after IVF. Not only the correction of hysteroscopic findings improves the pregnancy rates, at least when compared to controls not having a hysteroscopy, but also the procedure itself may have a positive prognostic value for achieving a subsequent pregnancy. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Donnelly L.S.,Genesis Centre
British Journal of Cancer | Year: 2016

Introduction:There are widespread moves to develop risk-stratified approaches to population-based breast screening. The public needs to favour receiving breast cancer risk information, which ideally should produce no detrimental effects. This study investigates risk perception, the proportion wishing to know their 10-year risk and whether subsequent screening attendance is affected.Methods:Fifty thousand women attending the NHS Breast Screening Programme completed a risk assessment questionnaire. Ten-year breast cancer risks were estimated using a validated algorithm (Tyrer-Cuzick) adjusted for visually assessed mammographic density. Women at high risk (⩾8%) and low risk (<1%) were invited for face-to-face or telephone risk feedback and counselling.Results:Of those invited to receive risk feedback, more high-risk women, 500 out of 673 (74.3%), opted to receive a consultation than low-risk women, 106 out of 193 (54.9%) (P<0.001). Women at high risk were significantly more likely to perceive their risk as high (P<0.001) and to attend their subsequent mammogram (94.4%) compared with low-risk women (84.2%; P=0.04) and all attendees (84.3%; ⩽0.0001).Conclusions:Population-based assessment of breast cancer risk is feasible. The majority of women wished to receive risk information. Perception of general population breast cancer risk is poor. There were no apparent adverse effects on screening attendance for high-risk women whose subsequent screening attendance was increased.British Journal of Cancer advance online publication 29 March 2016; doi:10.1038/bjc.2016.56 www.bjcancer.com. © 2016 Cancer Research UK


Cuzick J.,Queen Mary, University of London | Sestak I.,Queen Mary, University of London | Cawthorn S.,Breast Care Center | Hamed H.,Guys and St. Thomas Hospital | And 3 more authors.
The Lancet Oncology | Year: 2015

Background: Four previously published randomised clinical trials have shown that tamoxifen can reduce the risk of breast cancer in healthy women at increased risk of breast cancer in the first 10 years of follow-up. We report the long-term follow-up of the IBIS-I trial, in which the participants and investigators remain largely masked to treatment allocation. Methods: In the IBIS-I randomised controlled trial, premenopausal and postmenopausal women 35-70 years of age deemed to be at an increased risk of developing breast cancer were randomly assigned (1:1) to receive oral tamoxifen 20 mg daily or matching placebo for 5 years. Patients were randomly assigned to the two treatment groups by telephone or fax according to a block randomisation schedule (permuted block sizes of six or ten). Patients and investigators were masked to treatment assignment by use of central randomisation and coded drug supply. The primary endpoint was the occurrence of breast cancer (invasive breast cancer and ductal carcinoma in situ), analysed by intention to treat. Cox proportional hazard models were used to assess breast cancer occurrence and mortality. The trial is closed to recruitment and active treatment is completed, but long-term follow-up is ongoing. This trial is registered with controlledtrials.com, number ISRCTN91879928. Findings: Between April 14, 1992, and March 30, 2001, 7154 eligible women recruited from genetics clinics and breast care clinics in eight countries were enrolled into the IBIS-I trial and were randomly allocated to the two treatment groups: 3579 to tamoxifen and 3575 to placebo. After a median follow up of 16·0 years (IQR 14·1-17·6), 601 breast cancers have been reported (251 [7·0%] in 3579 patients in the tamoxifen group vs 350 [9·8%] in 3575 women in the placebo group; hazard ratio [HR] 0·71 [95% CI 0·60-0·83], p<0·0001). The risk of developing breast cancer was similar between years 0-10 (226 [6·3%] in 3575 women in the placebo group vs 163 [4·6%] in 3579 women in the tamoxifen group; hazard ratio [HR] 0·72 [95% CI 0·59-0·88], p=0·001) and after 10 years (124 [3·8%] in 3295 women vs 88 [2·6%] in 3343, respectively; HR 0·69 [0·53-0·91], p=0·009). The greatest reduction in risk was seen in invasive oestrogen receptor-positive breast cancer (HR 0·66 [95% CI 0·54-0·81], p<0·0001) and ductal carcinoma in situ (0·65 [0·43-1·00], p=0·05), but no effect was noted for invasive oestrogen receptor-negative breast cancer (HR 1·05 [95% CI 0·71-1·57], p=0·8). Interpretation: These results show that tamoxifen offers a very long period of protection after treatment cessation, and thus substantially improves the benefit-to-harm ratio of the drug for breast cancer prevention. © 2015 Cuzick et al. Open Access article distributed under the terms of CC BY.

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