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Carriers of germline mutations in DNA mismatch repair (MMR) genes are at increased risk of several cancers including colorectal and gynecologic cancers (Lynch syndrome). There is no substantial evidence that these mutations are associated with an increased risk of cervical cancer. A total of 369 families with at least one carrier of a mutation in a MMR gene (133 MLH1, 174 MSH2, 35 MSH6 and 27 PMS2) were ascertained via population cancer registries or via family cancer clinics in Australia, New Zealand, Canada, and USA. Personal and family histories of cancer were obtained from participant interviews. Modified segregation analysis was used to estimate the hazard ratio (incidence rates for carriers relative to those for the general population), and age‐specific cumulative risks of cervical cancer for carriers. A total of 65 cases of cervical cancer were reported (including 10 verified by pathology reports). The estimated incidence was 5.6 fold (95% CI: 2.3–13.8; p = 0.001) higher for carriers than for the general population with a corresponding cumulative risk to 80 years of 4.5% (95% CI: 1.9–10.7%) compared with 0.8% for the general population. The mean age at diagnosis was 43.1 years (95% CI: 40.0–46.2), 3.9 years younger than the reported USA population mean of 47.0 years (p = 0.02). Women with MMR gene mutations were found to have an increased risk of cervical cancer. Due to limited pathology verification we cannot be certain that a proportion of these cases were not lower uterine segment endometrial cancers involving the endocervix, a recognized cancer of Lynch syndrome.

V-Go™ is a mechanical continuous insulin delivery device releasing a basal amount of rapid acting insulin that also allows the user the ability to deliver discrete meal time or correction doses. This analysis reviews available published literature on the technology, and discusses a recent article comparing the V-Go system with multiple daily insulin injection therapy. Finally, suggestions for future studies are provided.

Background: The burden associated with caregiving has been well documented. Caregivers have multiple responsibilities, and technology may be accessible as a potential burden-alleviating resource. Materials and Methods: We surveyed cancer caregivers regarding current technology use and willingness to use technology for easing burden or distress. Because age has been associated with technology use, responses were compared between geriatric (≥65 years old) and nongeriatric (18–64 years old) caregivers. Results: We had 112 respondents. Based on nonmissing responses, 66% ( n =71) were women, 95% ( n =106) were white, and 84% ( n =91) had post–high school education. Almost all caregivers reported having Internet (105 [94%]) and e-mail (102 [91%]) access. Nongeriatric caregivers indicated more willingness to access Internet-based tools that help caregivers (54 [93%] versus 41 [76%]; p =0.04) and were more frequent users of social media (37 [64%] versus 16 [30%]; p =0.01), smartphones (33 [57%] versus 16 [30%]; p =0.01), and other mobile wireless devices (42 [72%] versus 19 [35%]; p <0.001) than geriatric caregivers. They also more frequently expected technologies to improve their own quality of life ( p =0.009), increase their feelings of being effective as a caregiver ( p =0.02), and save time ( p =0.003). Regardless of age, a majority of caregivers (67 [62%]) endorsed the potential benefit of caregiving technologies in preventing burnout. Conclusions: Most caregivers have high access to and use of technology. Geriatric and nongeriatric caregivers were receptive to technology-based tools to help with their caregiving roles. Although nongeriatric caregivers expected to derive more benefit from such tools, both groups believed that caregiving technologies could reduce burden.

SummaryBackgroundCytotoxic T‐lymphocyte‐associated protein‐4 (CTLA‐4) has an important role in T‐cell regulation, proliferation and tolerance. Anti‐CTLA‐4 agents, such as ipilimumab and tremelimumab, have been shown to prolong overall survival in patients with metastatic melanoma, and their use is being investigated in the treatment of other malignancies. Their novel immunostimulatory mechanism, however, predisposes patients to immune‐related adverse effects, of which gastrointestinal effects such as diarrhoea and colitis are the most common.AimsTo discuss the existing literature and summarise the epidemiology, pathogenesis and clinical features of anti‐CTLA‐4‐associated colitis, and to present a management algorithm for it.MethodsWe searched PubMed for studies published through October 2014 using the terms ‘anti‐CTLA,’ ‘ipilimumab,’ ‘tremelimumab,’ ‘colitis,’ ‘gastrointestinal,’ ‘immune‐related adverse effect,’ ‘immunotherapy,’ ‘melanoma,’ and ‘diarrhoea.’ResultsWatery diarrhoea is commonly associated with anti‐CTLA‐4 therapy (27–54%), and symptoms occur within a few days to weeks of therapy. Diffuse acute and chronic colitis are the most common findings on endoscopy (8–22%). Concomitant infectious causes of diarrhoea must be evaluated. Most cases may be successfully managed with discontinuation of anti‐CTLA‐4 and conservative therapy. Those with persistent grade 2 and grade 3/4 diarrhoea should undergo endoscopic evaluation and require corticosteroid therapy. Corticosteroid‐resistant cases may respond to anti‐tumour necrosis factor‐alpha therapy such as infliximab. Surgery is reserved for patients with bowel perforation or failure of medical therapy.ConclusionGiven the increasing use of anti‐CTLA‐4 therapy, clinicians must be aware of related adverse events and their management.