10 replies to this topic

[Tedsey]

My gynecologist told me in a grave voice that women who receive cancer treatment have a high risk of developing cervical cancer (while on treatment).  Since I have had an abnormal pap, I am thinking, "Oh great."  "Females with CML have to be on the drug for life."  So, even if my last pap comes back normal this time, she still wants to see me every six months to make sure nothing is developing.  She is also pushing for a yearly mammogram.  I had one last year and it was normal.  And I am still under the age that it is statistically worthwhile for.  But are my odds higher of getting breast cancer  too because of cancer treatment?

Anyway, back to cervical cancer, I could only guess that what she has read relates to women on standard chemotherapy.  I am pretty sure there is not much out there, if anything at all, about females with CML on TKIs getting cervical cancer at a higher rate (drugs probably too new).

It was very unsettling to hear this.  The way she relayed it to me, it seemed like it was inevitable.  She was very sure.  She is a good doctor and I am sure what she reads is credible.  But, I just cannot help thinking that the stats she reads have nothing to do with females on TKIs.  Like most, she has seemed to lump cancer sufferers into one category.  And the cancers she read most about probably deal with the breast and reproductive system near and around.  I know breast, and cervical cancer can be related.  So there seems to be some variables out there along with chemotherapy that may or may not really cause cervical cancer.  But I know very little of the subject.

Has anyone read anything about this subject?  Any thoughts?

Teds

P.S.  I am not sure of any significance, but could only guess that any cancer treatment for any kind of cancer could result in a secondary cancer.  The drugs are very cytotoxic.  I am also wondering if the odds for cerical cancer are any higher than for anyone to get a second cancer after (or while) receiving cancer treatment.  Pretty much as I understand it, if you have one cancer, the odds are increased that you will get another.  However, I think this has a lot to do with the kind of treatment you are receiving.  Hope I am not totally off base.  Like I said, I am not very knowledgeable.

[scuba]

Hi Teds,

Actually - your chances of getting cervical cancer are reduced while using Sprycel (and I suspect other Tyrosine Kinase Inhibitors, but especially Sprycel):

http://www.ncbi.nlm....pubmed/20532678

http://www.hindawi.c...jo/2010/530130/

Your doctor is probably just misinformed lumping general chemotherapy with SRC and TKI's.

Begs the question: Is your Sprycel "chemo"? Perhaps for the sake of clarification, the use of chemo to apply to our drugs leads only to confusion as to the reality of what TKI's really do. TKI's target specific functions of aberrant cells. General Chemo as your doctor properly understands is not specific to one cell and therefore the toxicity is much much worse. Good cells and bad cells are pretty much affected together.

Perhaps we should call our drugs chemo-lite? or chemo with a small "c". or better still, not call it chemo at all. Tell your doctor you don't take chemo - that you take an SRC inhibitor and research shows that SRC inhibitors also inhibit pathways important to Cervical cancer.

[CallMeLucky]

http://bloodjournal....18/16/4353.full

Malignancies occurring during therapy with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML) and other hematologic malignancies

Abstract

Success of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML) has given patients hope for a long disease-free-survival. A longer survival raises the question of late effects, including development of another malignancy. Records of 1445 patients with CML/myeloproliferative neoplasm or other hematologic malignancies treated with TKIs were reviewed to investigate frequency and characteristics of second malignancies (other than acute myeloid leukemia, acute lymphocytic leukemia, or myelodysplastic syndrome). The number of second cancers was compared with the number expected from the Surveillance, Epidemiology, and End Results database. After a median follow-up of 107 months (range, 13-362 months) after CML/myeloproliferative neoplasm diagnosis, 66 patients (4.6%) developed 80 second cancers, including skin (31%), prostate (15%), melanoma (13%), digestive system (10%), kidney (4%), thyroid (4%), breast (3%), chronic lymphocytic leukemia (3%), hepatobiliary (3%), and other cancers (14%). Excluding nonmelanoma skin cancers, 55 second cancers were seen in 51 (3.5%) of all patients treated. The risk of second cancer was lower than expected (observed-to-expected ratio, 0.6; 95% confidence interval, 0.44-0.81). Second cancers occur in a small percentage of patients receiving therapy with TKIs for hematologic malignancies, mostly CML. No evidence at the moment suggests that exposure to TKIs increases the risk of developing second cancers.

[Rissa]

It does sound to me like she hasn't done her research.  Regardless, an abnormal pap is an abnormal pap.  Hopefully the next one will come back clean.  If it does and she wants to see you back in 6 months, then I'd say go ahead.  Better safe than sorry, right?  Just don't allow her gloom and doom predictions to get to you.  She's a gynecologist, NOT a CML expert.  Doctors don't know everything.  If they did, we'd all be cured of whatever ails us.  Keep us posted.

Rissa

[Tedsey]

Thanks guys.  The first abstract talks about mice.  Hope it relates to humans.  Second study has a pretty good sample size.  I think my original thinking was right.  TKIs are in a class by themselves.  At a LLS conference this spring, I did hear a researcher reiterate that there is an increased chance of a second cancer with anyone diagnosed with a cancer, but it is "slight".  He didn't mention the kind of treatment patients were receiving, which, of course, would be a variable.  Like in life, you just gotta roll with the punches.  And sadly, some of us get beaten pretty hard.  I hope it is found that the TKIs protect us from more than just CML progressing, and, of course, harm in long-term use is next to nil. 

Take care,

Teds

[Happycat]

Hi, Teds,

I've had an HPV infection years ago, and HPV is what leads to cervical cancer.  My paps have been clean since I had laser surgery back in 1990.  I quizzed my hem-onc about TKIs affect on the immune system, would it reawaken any remaining HPV virus?  He said there isn't a huge correlation between the two, but the TKI could have a bit of an impact on the immune system. I think he said the NK-cells?  It's been awhile. Maybe T-cells. 

Anyway, I saw my OB-gyn last year, and I was in a panic because they had put me on a long pap cycle.  It had been 5 yrs since my last pap. (New test supposedly able to project risk out to 5 yrs.). Anyway, since she'd had a 70 yr old patient on gleevec (for GIST) pop up with an HPV infection, she figured it was prudent to put me back on a yearly pap schedule.  I agreed, I'd rather be proactive about it.

So, my take on it is if you've never had an HPV infection, you're probably fine (assuming you don't join a swingers club or something). In your case, with an abnormal pap, I'd stick to the 6 mo schedule.  It's the same schedule they put me on after my HPV infection, and seems reasonable to me. I started out with a slightly abnormal pap, they watched it for awhile, then decided that,,yep, there were too many changes and they had to laser those cells off there.   I think I went every 6 months for 2 yrs after my surgery before they let me go to,yearly paps.

For the mammo, I think I did them every 2 yrs starting at 35, then switched to yearly at 40. I have no family history, though.  I actually find it preferable to get the yearly mammos, so I don't stress about the what-ifs by waiting longer periods. Mind you, I hate the big squeeze, but my brain won't let the worry rest until I go get it done. And frankly, I've known too many women who lost their breast cancer battle, so I get it done with them in mind.

The other option is to get a second opinion from another gyn.  It sounds like your gyn is on the more risk averse side.  That's not always a bad thing. Prudence can be a virtue. Just don't let her unduly scare you. She's just looking out for you.

HTH,

Traci

[Susan61]

Hi :  I would not worry about it.  Most doctors do not even know what  TKI is.  I have been to doctors and have had to explain what Gleevec is.  They do not know that it is technically not a Chemo as they think of Chemo.  They feel your taking a oral chemo drug.  I would just repeat the Pap Test to be sure all is okay.  I have never had a abnormal Mammo. I just did one back in May to make my doctor happy.  Now I will not do another one for 3 years.  I have been doing them every 3 years for awhile now, but thats me.

      I have a dental appointment tomorrow morning for a toothache that I have had for a week already, and I  am sure when I list my  meds that he will ask about Gleevec.

Susan

[GerryL]

My last pap smear was low grade abnormal so I had a colcoscopy which came back clear. I said to my GP prior to the pap smear that I wouldn't be surprised if something showed up as Gleevec does some interesting things to my skin cells. When I went back to her about the results and asked what if this keeps happening, she told me I could have a hysterectomy, she made it sound so casual, like popping off to the shops.    I'm down for a yearly pap smear at the moment.

[Trey]

Those who believe that our TKI drugs are chemo should worry about getting secondary cancers.

Those who do not have nothing to worry about. 

Just sayin'

[Antilogical]

I like your thinking, Trey....

[Tedsey]

Thanks for your kind words Rissa.

Teds