Study shows higher cancer risk among twins, siblings

MIAMI, Florida - Twins share the same genes, and when one gets cancer, the other faces a higher risk of getting sick too, according to a study Tuesday that included 200,000 people.

But just because one twin falls ill does not mean that the other is certain to get the same cancer, or any cancer at all, according the report in the Journal of the American Medical Association (JAMA).

In fact, the amount of increased risk of cancer was just 14 percent higher in identical pairs in which one twin was diagnosed with cancer.

Identical twins develop from the same egg and share the exact same genetic material.

Among fraternal twins, which develop from two eggs and are as genetically similar as typical biological siblings, the risk of cancer in a twin whose co-twin was infected was five percent higher.

The twins in the study hailed from Denmark, Finland, Sweden and Norway—all countries that maintain detailed health registries—and were followed between 1943 and 2010.

When researchers looked at the group as a whole, they found that about one in three individuals developed cancer (32 percent).

Therefore, the risk of cancer in an identical twin whose twin was diagnosed was calculated to be 46 percent.

In fraternal twins it amounted to a 37 percent risk of developing cancer if a co-twin was diagnosed.

The exact same cancer was diagnosed in 38 percent of identical twins and 26 percent of fraternal pairs.

The cancers that were most likely to be shared among twins were skin melanoma (58 percent), prostate (57 percent), non melanoma skin (43 percent), ovary (39 percent), kidney (38 percent), breast (31 percent), uterine cancer (27 percent).

"Because of this study's size and long follow-up, we can now see key genetic effects for many cancers," said Jacob Hjelmborg, from the University of Southern Denmark and co-lead author of the study.

Researchers said the findings may help patients and doctors understand more about the hereditary risks of cancer, a disease that kills eight million people around the world each year. — Agence France-Presse

source: gmanetwork.com

Knee replacement surgery works, but so can nonsurgical techniques

Total knee replacement can usually relieve pain and improve function, but a nonsurgical regimen can also be effective in some people without posing the complication risks that can plague people who choose surgery, according to a new study.

The test found that while 85 percent of patients who underwent surgery showed clinically-significant improvement after one year, so did 67 percent assigned to a combination of supervised exercise, use of insoles, pain medication, education and dietary advice.

"It won't do any harm trying the nonsurgical treatment," chief author, Dr. Soren Skou of the University of Southern Denmark in Odense, told Reuters Health. "I hope this will give a more balanced discussion of whether or not to have the surgery."

There's little debate that knee replacement helps many people, and the new test of 100 patients—the first randomized controlled trial ever done on the technique—confirms it. Surgery patients didn't show just some improvement. They registered far less pain and disability than those assigned to the non-surgery group.

Yet the study was needed because as many as 1 percent of surgery patients die within 90 days of their operation and about 1 in 5 have residual pain at least six months after the procedure, said Dr. Jeffrey Katz of Harvard Medical School in Cambridge, Massachusetts, in an accompanying editorial in the New England Journal of Medicine. "Until now, we have lacked rigorously controlled comparisons between total knee replacement and its alternatives."

"People need to understand and respect that knee replacement is not without complication. Knee replacement is a big surgical procedure and there are risks associated with it," Dr. Andrew Pollak, chairman of orthopedics at the University of Maryland School of Medicine in Baltimore, told Reuters Health.

The study "really emphasizes what we suspected all along—total knee replacement works. It will be obvious to many of us who take care of patients. But for patients with significant symptoms and evidence of arthritis, total knee replacement is a very effective way of improving quality of life," said Pollak, who was not associated with the research. "Therapy alone has a role. It does help certain patients. It can certainly prolong the time to when knee replacement is necessary."

More than 670,000 total knee replacements are done in the US each year at a cost of $36.1 billion.

All of the patients in the study had moderate-to-severe knee osteoarthritis. The team measured symptoms, pain and quality of life over a one year period.

Volunteers in the surgery group gained an average of 32.5 points versus 16.0 points for people who received nonsurgical therapy. All started off with a score of about 48 on a 101-point assessment scale.

Individual measures of pain, symptoms, activities of daily living, quality of life, and sports and recreation all showed significant improvement with surgery.

But while there were just six instances of serious adverse events in the 50 patients who didn't receive surgery, there were four times as many among the 50 assigned to have a knee replaced. One third of the problems involved the replaced knee, including three cases each of unacceptable stiffness and deep vein thrombosis requiring anticoagulation, and one case each of deep infection and leg fracture.

Thirteen of the 50 patients assigned to the no-surgery group ended up having their knee replaced anyway during the 12-month follow-up period.

"We've had some patients who had the surgery who did not improve in pain and, in some cases, had worse pain," Skou said. They may improve with longer followup, but, he said, "what struck me is, if you do not go through surgery, you could always have the surgery later." —Reuters