BACKGROUND: High levels of physical activity are associated with reduced risk of the blood cancer multiple myeloma (MM). MM is preceded by the asymptomatic stages of monoclonal gammopathy of undetermined significance (MGUS) and smouldering multiple myeloma (SMM) which are clinically managed by watchful waiting. A case study (N = 1) of a former elite athlete aged 44 years previously indicated that a multi-modal exercise programme reversed SMM disease activity. To build from this prior case study, the present pilot study firstly examined if short-term exercise training was feasible and safe for a group of MGUS and SMM patients, and secondly investigated the effects on MGUS/SMM disease activity.
METHODS: In this single-arm pilot study, N = 20 participants diagnosed with MGUS or SMM were allocated to receive a 16-week progressive exercise programme. Primary outcome measures were feasibility and safety. Secondary outcomes were pre- to post-exercise training changes to blood biomarkers of MGUS and SMM disease activity- monoclonal (M)-protein and free light chains (FLC)- plus cardiorespiratory and functional fitness, body composition, quality of life, blood immunophenotype, and blood biomarkers of inflammation.
RESULTS: Fifteen (3 MGUS and 12 SMM) participants completed the exercise programme. Adherence was 91 ± 11%. Compliance was 75 ± 25% overall, with a notable decline in compliance at intensities > 70% V̇O2PEAK. There were no serious adverse events. There were no changes to M-protein (0.0 ± 1.0 g/L, P =.903), involved FLC (+ 1.8 ± 16.8 mg/L, P =.839), or FLC difference (+ 0.2 ± 15.6 mg/L, P =.946) from pre- to post-exercise training. There were pre- to post-exercise training improvements to diastolic blood pressure (- 3 ± 5 mmHg, P =.033), sit-to-stand test performance (+ 5 ± 5 repetitions, P =.002), and energy/fatigue scores (+ 10 ± 15%, P =.026). Other secondary outcomes were unchanged.
CONCLUSIONS: A 16-week progressive exercise programme was feasible and safe, but did not reverse MGUS/SMM disease activity, contrasting a prior case study showing that five years of exercise training reversed SMM in a 44-year-old former athlete. Longer exercise interventions should be explored in a group of MGUS/SMM patients, with measurements of disease biomarkers, along with rates of disease progression (i.e., MGUS/SMM to MM).
BACKGROUND: https://www.isrctn.com/ISRCTN65527208 (14/05/2018).

The objective of this review is to summarize recent research advances in the detection and prevention of ovarian cancer and discuss the experts\' opinions of future directions. The 12th Biennial Ovarian Cancer Research Symposium was held in Seattle, Washington, in September 2018. At this meeting, experts in ovarian cancer research gathered to present and discuss recent breakthroughs and their visions of future ovarian cancer research. Session 1 of the symposium focused on the detection and prevention of ovarian cancer. It included two invited oral presentations from Ranjit Manchanda, MD, PhD (Barts Cancer Institute) and Rosana Risques, PhD (University of Washington). Another eight oral presentations were selected from abstract submissions. Fifteen abstracts were presented in poster format. These presentations covered topics including cellular origin of high-grade serous cancer, risk factors for ovarian cancer, new methods for early detection of ovarian cancer, mechanisms underlying ovarian cancer development, and new therapeutic approaches for preventing ovarian cancer from forming or progressing. In conclusion, a clear understanding of the cellular origin and molecular mechanisms underlying the initiation of high-grade serous cancer is essential for developing effective means for early detection and prevention of this most devastating type of ovarian cancer. Recognizing the complexity of ovarian cancer and appreciating that ovarian cancer is not a single disease will help us to generate proper models, design rational experiments, and collect and analyze patient data in a meaningful way. A concerted effort in the field will help to bridge the basic science and clinical applications and lead to more precise and effective detection and treatment.

Over the last 2 decades the pathogenesis and natural history of cervi-cal cancer has become clearer. As a result, the cytologic and histologic terminol-ogy used to refer to cervical cancer precursors has needed to change. Today we recognize that almost all cervical cancers are due to infection with specific high-risk types of human papillomavirus (HPV). Most women become infected with these viruses within several years of initiating sexual intercourse and a productive HPV in-fection frequently results in characteristic morphologic changes within the infected cervical squamous cells. Cells demonstrating the morphologic changes associated with a productive HPV infection are referred to as low-grade squamous intraepi-thelial lesions (LSIL) when observed in cytologic specimens and low-grade cervical intraepithelial neoplasia (CIN 1) when observed in histologic specimens. In some women, HPV gene expression becomes unlinked to the state of differentiation of the infected epithelial cells and deregulated expression of the early region of the viral genome results in a dramatic increase in expression of two HPV oncoproteins (E6 and E7). This results in loss of normal cell cycle control of the epithelium and genetic instability. When this occurs the epithelium develops characteristic mor-phologic features, with immature \"basaloid-type\" squamous cells and mitotic fig-ures in the upper half of the cervical epithelium. Such lesions are felt to represent \"true\" neoplasia and are referred to as high-grade squamous intraepithelial lesions (HSIL) when observed in cytologic specimens and high-grade cervical intraepithelial neoplasia (CIN 2,3) when observed in histologic specimens.