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A groundbreaking study analysing data from nearly 600,000 cancer patients in England has shed light on the increased risk of second cancers among breast cancer survivors. The research conducted by University of Cambridge in association with the Lancet Regional Health-Europe studied data from over 580,000 female and over 3,500 male breast cancer survivors diagnosed between 1995 and 2019 using the National Cancer Registration Dataset. The findings suggest that survivors of breast cancer, the most prevalent cancer in the UK, face a substantially higher risk of developing second primary cancers. According to the research, female survivors exhibited a twofold increase in the risk of contralateral breast cancer compared to the general population. The data highlighted an 87 per cent greater risk of endometrial cancer, a 58 per cent greater risk of myeloid leukemia, and a 25 per cent greater risk of ovarian cancer in female survivors.

Following the publication of a new study by the British Medical Journal (BMJ) that estimates the economic impact and prevelance of hazardous NSAID prescribing in England, the Royal Pharmaceutical Society (RPS) has underscored the pressing need for enhanced safety measures in medication management. The study, led by RPS Fellow Rachel Elliott, reveals significant health and financial costs associated with the high-risk prescribing of oral non-steroidal anti-inflammatory drugs (NSAIDs) among vulnerable populations. James Davies, Director for England at the RPS, emphasised the critical findings of the research. "Improving the safety of NSAID prescribing requires a multi-pronged approach, that educates and supports prescribers on the risk, as well as uses the skills of pharmacists in the primary care team to help identify higher risk patients and prescribing scenarios," Davies remarked. The study highlights that NSAIDs, while effective in managing pain and inflammation, are associated with serious adverse events, including gastrointestinal bleeding, renal dysfunction, and cardiovascular issues.

New research shows that lifelong excess weight almost doubles a woman's risk of developing womb cancer. The findings of the study were published in 'BMC Medicine'. The study from the University of Bristol is one of the first to find that for every fiver extra BMI units, a woman's risk of womb (endometrial) cancer is almost doubled (an increase of 88 per cent). This is higher than most previous studies have suggested and reflects lifelong weight status rather than a snapshot in time like most other studies. Five BMI units is the difference between the overweight category and the obese category, or of a 5'5 adult woman being two stones heavier. The international study looked at genetic samples from around 120,000 women from Australia, Belgium, Germany, Poland, Sweden, the UK, and the USA of which around 13,000 had womb cancer. This large statistical analysis is one of the first studies of its kind to look at the effect of lifelong greater BMI on womb cancer risk.

The Joint Committee on Vaccination and Immunisation (JCVI) has advised booster vaccination to be offered this autumn (2023) for those at higher risk of severe Covid-19 in its interim advice to government on the coronavirus (COVID-19) vaccination programme for 2023. The JCVI also advised that for a smaller group of people, such as those who are older and those who are immunosuppressed, an extra booster vaccine dose in the spring should also be planned for. Professor Wei Shen Lim, Chair of Covid-19 vaccination on the JCVI, said: "The Covid-19 vaccination programme continues to reduce severe disease across the population, while helping to protect the NHS. That is why we have advised planning for further booster vaccines for persons at higher risk of serious illness through an autumn booster programme later this year. We will very shortly also provide final advice on a spring booster programme for those at greatest risk."

The widely-held concept that levels of "good" cholesterol in the blood can indicate heart disease risk is not equally true for Blacks and whites, and the measure itself may be of less value than previously thought, according to a U.S. study published on Monday (November 21). Various types of cholesterol are thought to have either healthy or unhealthy effects. Low levels of so-called "good" high-density lipoprotein (HDL) cholesterol were linked with higher odds for developing cardiac problems in the long-term study - but only in white participants, the study published in the Journal of the American College of Cardiology found. In contradiction to what has generally been assumed, low HDL levels did not confer any higher risk of heart disease in Black people, researchers said. Among white people, however, those with HDL levels below 40 milligrams per deciliter had a 22% higher risk for coronary heart disease compared with those whose HDL levels were higher. High HDL levels (above 60 mg/dL), which are thought to be protective, were not linked with lower coronary heart disease risks in either race, researchers found.

The World Health Organization said on Sunday (May 29) that monkey pox constitutes a "moderate risk" to overall public health at global level after cases were reported in countries where the disease is not typically found. "The public health risk could become high if this virus exploits the opportunity to establish itself as a human pathogen and spreads to groups at higher risk of severe disease such as young children and immunosuppressed persons," WHO said. As of May 26, a total of 257 confirmed cases and 120 suspected cases have been reported from 23 member states that are not endemic for the virus, the health agency said in a statement. There has been no reported fatalities so far. WHO also said that the sudden appearance of monkeypox at once in several non-endemic countries suggests undetected transmission for some time and recent amplifying events. The agency added that it expects more cases to be reported as surveillance in endemic and non-endemic countries expands. Monkeypox is an infectious disease that is usually mild, and is endemic in parts of west and central Africa. It is spread by close contact, so it can be relatively easily contained through measures such as self-isolation and hygiene.

Recently launched generic version of Apixaban by Teva UK is said to bring savings to the NHS drug bill while making sure patients get the medicine they need. The generic apixaban is available for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA) and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. Previously there was only a 'branded' product available, but Castleford-based Teva UK succeeded in invalidating the apixaban patent and SPC (supplementary protection certificate) in the UK High Court and so is now able to launch its own 'generic' version - which will bring savings for the NHS while making sure patients get the medicine they need. "We've always said that we stand up for the patient", said Kim Innes, General Manager of Teva UK and Ireland. "The launch of generic apixaban emphasises Teva's commitment to doing the right thing by putting patients at the heart of everything we do by giving them and the NHS access to affordable treatments." Apixaban is an anticoagulant which directly inhibits factor X (factor Xa), inhibiting thrombin formation and the development of thrombi (blood clots). For at-risk patients, such as those with, or at risk for DVT, or NVAF, the risk of stroke related to blood clots forming in the body and traveling to the brain is a serious concern. Each year, DVT affects around 1 person in every 1,000 in the UK and if left untreated, about 1 in 10 people with a DVT will develop a PE.

UK regulator has approved a second oral antiviral for early treatment of Covid-19 in high-risk adults, after molnupiravir. The Medicines and Healthcare products Regulatory Agency (MHRA) gave its nod for a new treatment called Paxlovid (PF-07321332 and ritonavir), after finding it safe and effective at reducing the risk of hospitalisation and death in people diagnosed with mild Covid-19 infection. Developed by Pfizer, Paxlovid prevents the multiplying of virus, helping the body to overcome the infection. A clinical trial for the treatment in high risk individuals revealed that a five-days course of Paxlovid reduces the risk of hospitalisation and death by 89 per cent. It further revealed that Paxlovid is most effective when taken in the early stage of infection. Dr June Raine, MHRA chief executive, said: "We now have a further antiviral medicine for the treatment of Covid-19 that can be taken by mouth rather than administered intravenously. This means it can be administered outside a hospital setting, before Covid-19 has progressed to a severe stage."

The National Institute for Health and Care Excellence (NICE) has recommended icosapent ethyl also called Vazkepa manufactured by Amarin for adults who have cardiovascular disease with controlled LDL-C levels taking a statin. It's final draft guidance is expected to be available on the July 20. Nearly half a million people are expected to benefit from the first licensed treatment shown to reduce the risk of heart attacks and strokes in people with controlled low-density lipoprotein cholesterol (LDL-C - sometimes called "bad" cholesterol) who are taking a statin and who have raised levels of triglycerides. NICE said: "Clinical trial evidence suggests that for people with raised triglycerides who have LDL-C levels controlled by statins, and who have cardiovascular disease, icosapent ethyl reduces their risk of cardiovascular events by over a quarter compared with placebo. Helen Knight, interim director of medicines evaluation at NICE, said: "Icosapent ethyl is the first licensed treatment of its kind for people who are at risk of heart attacks and strokes despite well controlled LDL cholesterol because they have raised blood fats. And although lifestyle changes, including diet and exercise, can help to reduce their risk, these may not work for everyone.

Ninety-six per cent of community pharmacists surveyed in the Royal Pharmaceutical Society (RPS) Workforce Wellbeing survey said they were at 'risk of burnout'. A higher number of respondents working in community pharmacy (20%) reported not being offered breaks compared to all other sectors (8%) and were more likely to experience verbal or physical abuse from patients and the public (69% vs an average 44%). The annual Workforce Wellbeing survey also revealed that 88 per cent of pharmacists surveyed are at high risk of burnout due to winter pressure. Therefore, RPS is calling for workforce planning for pharmacy to address skill mix and staffing levels so that workloads can be effectively managed. Top factors causing poor mental health and wellbeing revealed by the survey include inadequate staffing (70%), lack of work/life balance (53%), lack of protected learning time (48%) and lack of colleague/senior support (47%). This is the fourth survey RPS has run in partnership with the charity Pharmacist Support on the state of mental health and wellbeing in pharmacy. The findings demonstrate continued pressure on pharmacists and trainees across the workforce, especially in community pharmacy where 96% of those surveyed said they were at risk of burnout.

The Medicine and Healthcare products Regulatory Agency (MHRA) has cautioned men on valproate to talk to their healthcare professional about their treatment, if they want to start a family in the next year. The warning came after a new study, commissioned by the European Medicines Agency, suggested that children fathered by men who took the anti-seizure medicine in the three months prior to conception may be at higher risk of developing neurodevelopmental disorders. Around five in 100 children born to fathers treated with valproate around conception were diagnosed with a neurodevelopmental disorder, compared to three in 100 children whose fathers were taking other antiseizure medicines (lamotrigine or levetiracetam). However, the risk is believed to be much smaller than the risk associated with valproate in pregnancy.

The Medicines and Healthcare products Regulatory Agency (MHRA) has advised the public to exercise caution when buying anti-choking devices online, ensuring these products are purchased from reputable sellers. As estimated by the regulator, more than 10,000 counterfeit or unbranded anti-choking devices have been purchased by the public within the last two years through listings on online marketplaces such as Amazon and eBay, as well as drop-shipping websites. People are cautioned that the use of such products poses a substantial risk of failure in clearing blockages and could exacerbate the situation by pushing obstructions further down into the airway passage. Dr Alison Cave, MHRA Chief Safety Officer, said: "Buying anti-choking devices that do not have a valid UKCA or CE mark increases the risk of receiving a product which does not include appropriate instructions and is either fake or does not meet the UK's regulatory requirements. "These products do not meet our strict quality standards and may put your health and safety at significant risk by failing to resolve or even worsening choking incidents."

Healthcare professionals in the UK are being advised to avoid prescribing the migraine and antiseizure medication topiramate, commonly known by the brand name Topamax, to women and girls unless they fulfil the requirements of a Pregnancy Prevention Programme. This guidance follows new safety measures introduced by the Medicines and Healthcare products Regulatory Agency (MHRA) following a major safety review, which highlighted a potential increased risk of neurodevelopmental disabilities in children exposed to topiramate during pregnancy. The Commission on Human Medicines (CHM) evaluated studies that examined the risks associated with using topiramate during pregnancy. These studies indicated that children born to mothers who took topiramate during pregnancy had an approximately 2 to 3 times higher risk of intellectual disability, autism spectrum disorders, and attention deficit hyperactivity disorder. Based on CHM's recommendations, the MHRA now advises that topiramate should not be prescribed for treating epilepsy during pregnancy unless there is no suitable alternative.

The National Institute for Health and Care Excellence (NICE) has recommended first new treatment - 'romosozumab' for osteoporosis for over a decade. Thousands of people in England and Wales with severe osteoporosis who are at high risk of fracture are set to benefit from a new treatment - romosozumab - after NICE published the final draft guidance. Over 20,000 people could be eligible for the treatment according to the company. Clinical trial evidence showed that romosozumab (also known as EVENITY and made by UCB) followed by alendronic acid is more effective at reducing the risk of fractures than alendronic acid alone. Osteoporosis is a disease that causes bones to become thin and fragile. Many people with osteoporosis show no symptoms, but they may be at increased risk of fracture. Osteoporosis leads to nearly 9 million fractures around the world each year, and over 300,000 people per year attend hospitals in the UK with fractures caused by osteoporosis.

In its first, the National Institute for Health and Care Excellence (NICE) has recommended the use of Pre Exposure Prophylaxis (PrEP) to treat people at the highest risk of catching HIV. The announcement comes along with a consultation on draft guideline by NICE on reducing sexually transmitted infections. NICE's recommendation is backed up by the government's HIV Action Plan to hit zero new transmissions of HIV by 2030. The pill prevents HIV by stopping the virus from crossing into the healthy cells and replicating. According to the UK PROUD study, PrEP reduced the risk of HIV infection by 86 per cent for men who have sex with men. However, people taking the pill must also get regular HIV testing and STI screening done every three months.

New data published by the UK Health Security Agency (UKHSA) has revealed that London is potentially at risk of a measles resurgence. UKHSA modelling suggests that, unless MMR vaccination rates improve, London could see a measles outbreak with tens of thousands of cases. "Those who have never received a measles vaccine (MMR) are at risk," said UKHSA. MMR is part of the NHS Routine Childhood Immunisation Programme. Parents whose infants missed out, or anyone of any age unvaccinated, are urged to come forward. Susceptibility is particularly high among 19 to 25 year olds, affected by unfounded stories in the early 2000s ('Wakefield cohorts') and some may still not be fully vaccinated. As part of continued efforts to protect people against getting measles, the NHS is launching a campaign encouraging people to check their vaccination status, with targeted outreach to groups in London.

Three batches of Mexiletine hydrochloride 50mg, 100mg and 200 mg hard capsules manufactured by Clinigen Healthcare has been recalled. Pharmacists are urged to quarantine the said batches and return it to the supplier by or before 12 August. Clinigen Healthcare Ltd has initiated a recall of three batches of Mexiletine hydrochloride hard capsules due to a potential risk of under dose or overdose, which could have consequences for the safety of patients. The manufacturer has confirmed that no alternative batches of Mexiletine hydrochloride 50mg, 100mg or 200mg hard capsules will be available until later in the year, therefore the recall of these batches from patients should only be considered where patients have access to appropriate alternative products. See below for more information on resupplying patients with alternative products. "Patients should be advised not to stop any treatments without consulting their relevant healthcare professional. The risks of suddenly stopping medication for ventricular arrhythmias is higher than the potential risk presented by too much or too little of the active ingredient in the capsule."

Within the last few weeks, at least six pharmacists have been subjected to interim order applications - either suspended or had significant restrictions placed upon their registration pending a full 'Fitness to Practise' hearing into serious allegations being made about their prescribing practices, the Pharmacists' Defence Association (PDA) has found. It said that there has been a "dramatic increase in action being taken by the pharmacy regulator (GPhC) against pharmacist prescribers associated with certain types of online prescribing services". It has warned pharmacist prescribers who work for online pharmacies about the specific risks associated with remote prescribing using a questionnaire-based model, typically with no direct prescriber/patient interaction. Common features that underpin the allegations include the following: Overreliance on a patient questionnaire to inform clinical decision making; No patient/prescriber interaction; Prescribing high risk medicines without adequate safeguards; Inadequate systems and processes leading to inappropriate prescribing; Very high volumes of prescriptions being authorised in short periods of time; and Prescribers/patient relationship established via an unregulated online portal.

Pharmacists are a vital member of the multidisciplinary team (MDT) supporting older people to manage their pain. The pharmacist is uniquely positioned to holistically review drug interactions and potential risks associated with each patient's medication and has the expertise to suggest alternative treatment options to reduce the risks associated with polypharmacy or unwanted side effects caused by other medications. Chronic pain The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. Although universally experienced by everyone, the perception of pain is a deeply personal experience influenced by biological, psychological, and social factors, and constitutes an essential behavioural feedback mechanism aimed at protecting us from harm. Pain may be perceived as either acute or chronic. Chronic pain, defined as pain that persists longer than the normal healing time, constitutes a substantial healthcare burden, affecting approximately 20 per cent of people worldwide and accounts for 15-20 per cent of physician consultations. Chronic pain is often associated with disrupted mood and sleep, substance misuse and other chronic conditions. Additionally, comorbidities of chronic pain may also lead to complex medication regimens that increase the risks of adverse drug interactions and unwanted side effects.

The Medicines and Healthcare Products Regulatory Agency (MHRA) confirmed that Ozempic has been found at two UK wholesalers on 18 October. The pre-filled falsely labelled pens have been purchased from legitimate suppliers in Austria and Germany. However, there has been no evidence that fake Ozempic has been supplied to UK patients. Dr Alison Cave, MHRA Chief Safety Officer spoke about closely with regulatory partners to ensure patients' safety. He said: "Buying semaglutide from illegally trading online suppliers significantly increases the risk of getting a product either falsified or not licensed for use in the UK. "Products purchased in this way will not meet our strict quality and safety standards, and taking such medicines may put your health at risk," he added.