Northwest Georgia Oncology Centers

Stay on Top of Your Family History of Cancer

Fri, 15 Jul 2011 00:01:19 +0000

People who are at high risk of cancer as a result of their family history may be advised to undergo earlier or more intensive cancer screening. Because family history of cancer can change over time, it’s important to update this information periodically with your healthcare provider. This was the conclusion of a study published in the Journal of the American Medical Association.

Cancer screening involves the use of tests to detect cancer at an early stage in people with no symptoms of the disease. Commonly used screening tests include mammography for breast cancer, colonoscopy for colorectal cancer, and the prostate-specific antigen (PSA) blood test for prostate cancer.

People who are at high risk of a particular cancer as a result of their personal or family medical history may be advised to undergo earlier or more frequent cancer screening, or to be screened with more sensitive tests. Women who have a high risk of breast cancer, for example, are often advised to begin screening at an earlier age than other women, and to be screened with both mammography and magnetic resonance imaging (MRI).

Family history of cancer can change over time, and changes in family history may affect which screening tests and schedules are recommended. To explore how often this occurs, researchers collected information from a large database of US adults with a personal and/or family history of cancer.

The number of people who were candidates for high-risk colorectal cancer screening as a result of family history increased from 2.1% at age 30 to 7.1% at age 50.
The number of people who were candidates for high-risk breast cancer screening as a result of family history increased from 7.2% at age 30 to 11.4% at age 50.
The numbers for prostate cancer were smaller, but increased from 0.9% at age 30 to 2.0% at age 50.

These results suggest that family history of cancer (and the screening recommendations that may stem from family history) can change significantly during adulthood. The researchers recommend that healthcare providers collect updated family history information from patients at least every five to ten years.

Reference: Ziogas A, Horick NK, Kinney AY et al. Clinically relevant changes in family history of cancer over time. Journal of the American Medical Association. 2011; 306:172-178.

Adding Afinitor to Herceptin May Provide Breast Cancer Benefit

Thu, 14 Jul 2011 02:23:27 +0000

For women with HER2-positive breast cancer that worsens in spite of treatment with Herceptin® (trastuzumab), treatment with a combination of Herceptin and Afinitor® (everolimus) may provide a benefit. These results were published in the Journal of Clinical Oncology.

Approximately 20-25% of breast cancers overexpress (make too much of) the HER2 protein. HER2-targeted therapies such as Herceptin have dramatically improved outcomes for women with HER2-positive breast cancer, but researchers continue to explore new approaches to treatment. One important focus of research is the treatment of cancer that has progressed after prior HER2-targeted therapy.

Afinitor is an oral medication that works by inhibiting a protein known as mTOR. The mTOR protein plays an important role in regulating cancer cell division and blood vessel growth. Currently, Afinitor is used for the treatment of selected patients with kidney cancer, pancreatic neuroendocrine tumors, and subependymal giant cell astrocytoma (SEGA).

To evaluate the combination of Herceptin and Afinitor, researchers combined information from two clinical trials that were conducted concurrently. Information was available for 47 women with HER2-positive metastatic breast cancer that had progressed during treatment with Herceptin. Study participants received Herceptin every three weeks in combination with daily Afinitor.

Seven patients (15%) had a partial response to treatment (a reduction in detectable cancer).
An additional nine patients (19%) experienced stable disease for six months or longer.
Median duration of survival without cancer progression was 4.1 months.
Side effects included fatigue, infection, and mouth sores (mucositis).

These results suggest that the combination of Afinitor and Herceptin may benefit women with HER2-positive, advanced breast cancer that has worsened in spite of Herceptin treatment. Afinitor has been approved by the US Food and Drug Administration for other purposes, but has not yet been approved for breast cancer. Additional, ongoing studies are evaluating the combination of Herceptin, Afinitor, and chemotherapy in the first- and second-line treatment of metastatic breast cancer.

Reference: Khanh Morrow P, Wulf GM, Ensor J et al. Phase I/II study of trastuzumab in combination with everolimus (RAD001) in patients with HER2-overexpressing metastatic breast cancer who progressed on trastuzumab-based therapy. Journal of Clinical Oncology. Early online publication July 5, 2011.

Lung CT Scans Produce Variable Results

Wed, 13 Jul 2011 00:01:37 +0000

Estimates of lung tumor size based on computed tomography (CT) scans can vary from scan to scan even when the actual size of the tumor remains the same. These results were published in the Journal of Clinical Oncology.

CT scans are used for imaging body tissues and organs. X-ray transmissions are converted to detailed images using a computer to synthesize X-ray data. The images are displayed as a cross-section of the body at any level from the head to the feet. Repeated CT scans may be used to assess response to cancer treatment and to monitor patients for cancer progression.

Although cancer imaging tools have become increasingly precise, it’s possible for two back-to-back scans to produce slightly different results. Several factors may contribute to this variability, including how the machine captures the images and how the radiologist performs the measurements.

Understanding the extent of this variability is important when interpreting the results of a repeat CT scan. For example, if the results of a repeat scan indicate that the tumor is 2 millimeters larger than it was previously, could this be due to variability in measurement or is it likely that the cancer actually grew?

To explore variability across CT scans, researchers conducted a study among 30 patients with non-small cell lung cancer that measured at least one centimeter in diameter. Patients underwent two separate CT scans within a period of about 15 minutes (a period during which the actual size of the cancer would not have changed). The images for each patient were viewed side-by-side by three experienced radiologists. The radiologists were not told how much time had elapsed between the two scans.

For more than half the patients, the estimates of tumor size produced by the two scans varied by more than 1 mm. For one-third of patients, the estimates of tumor size varied by more than 2 mm.
The differences between the two scans ranged from a 23% reduction in tumor size to a 31% increase in tumor size.
For a majority of patients (84%), the second measurement differed from the first by 10% or less.

The results of this study suggest that small changes in lung tumor size on repeat CT scans should be interpreted with caution. The change may be due to variability in the CT scanning process rather a change in the tumor itself.

Reference: Oxnard GR, Zhao B, Sima CS et al. Variability of lung tumor measurements on repeat computed tomography scans taken within 15 minutes. Journal of Clinical Oncology. Early online publication July 5, 2011.

More Personalized Breast Cancer Screening May Provide Benefits

Tue, 12 Jul 2011 00:01:35 +0000

Rather than applying a single set of breast cancer screening guidelines to most women, a more individualized approach that considers risk factors such as breast density may help to balance the benefits and costs of screening. These results were published in the Annals of Internal Medicine.

A mammogram is an X-ray of the breast. A screening mammogram is a mammogram that is performed in a woman without breast symptoms. The goal of screening mammography is to detect breast cancer at an early stage when it is most easily treated.

Different groups of experts have reached different conclusions about when mammographic screening should begin and how often it should be performed. The U.S. Preventive Services Task Force recommends that routine screening of average-risk women begin at age 50 and be performed every two years. The American Cancer Society recommends annual screening beginning at age 40.

An alternative approach to screening is to make more individualized decisions based on a woman’s risk of breast cancer and her own beliefs about the risks and benefits of screening. This has already happened for women who are at very high risk of breast cancer (as a result of BRCA1 or BRCA2 gene mutations, for example), but the broader population of women may benefit as well.

One factor that has consistently been linked with risk of breast cancer is breast density. Breast density can be assessed by mammography and refers to the extent of glandular and connective tissue in the breast. Breasts with more glandular and connective tissue—and less fat—are denser. Women with high breast density are at increased risk of developing breast cancer.

To explore how factors such age, breast density, history of breast biopsy, family history of breast cancer, and screening interval influence the cost-effectiveness of breast cancer screening, researchers developed a statistical model. The following are some of the key findings of their research:

Having a mammogram every year was not cost-effective for any group of women.
Having a baseline mammogram at age 40 can help guide subsequent screening decisions. Women who are at increased risk of breast cancer as a result of high breast density or other factors may benefit from regular (every two years) screening in their 40s. Other women may be able to wait until age 50 for additional screening.
A three-to-four year interval between screening mammograms may be an option for some low-risk older women.

These results do not apply to women with gene mutations that put them at high risk of breast cancer. For the broader population of women, however, it appears that a more individualized approach to breast cancer screening may be warranted. The approach suggested by this study has not yet been incorporated into widely used screening guidelines such as those from the American Cancer Society and the U.S. Preventive Services Task Force. Screening guidelines will continue to evolve, however, as new evidence becomes available.

Women who have questions about the screening approach that’s right for them are advised to talk with their healthcare providers.

Reference: Schousboe JT, Kerlikowske K, Low A, Cummings SR. Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Annals of Internal Medicine. 2011;155:10-20.

Survivors of Childhood Cancer Face Risk of More Cancer

Mon, 11 Jul 2011 00:01:14 +0000

Children who survive cancer have an increased risk of developing cancer later in life. These findings were recently reported in the Journal of Clinical Oncology.

The good news about childhood cancer is that increasingly more children are surviving. These improved outcomes, however, present new concerns, as long-term health of these individuals may be compromised due to cancer and its treatment. One particular concern is the risk of developing subsequent cancer later in life.

To better define the risk of additional cancer diagnoses for survivors of childhood cancer, researchers recently evaluated 14,358 individuals who had been diagnosed with cancer during childhood. Participants had been diagnosed between 1970 and 1986 and had survived for at least five years.

1,382 of survivors studied (about 9.6%) developed a subsequent cancer. Non-melanoma skin cancer was the most common type of subsequent cancer.
Of those with a subsequent cancer, 386 (about 28%) developed a second subsequent cancer. The likelihood of developing two or more subsequent cancers was higher among people who had been treated with radiation therapy as children.

Individuals who have survived a childhood cancer diagnosis are at risk for more diagnoses later in life. Given this increased risk, survivors of childhood cancer should talk with their doctor about recommended cancer screening tests.

Reference: Armstrong GT, Liu W, Leisenring W, et al. Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology [early online publication]. June 27, 2011.

Barrett’s Esophagus May Carry Lower Risk of Esophageal Cancer Than Previously Reported

Fri, 08 Jul 2011 00:01:10 +0000

Barrett’s esophagus—a condition characterized by abnormal cells in the lower part of the esophagus—may carry a lower risk of esophageal cancer than previously reported. These results were published in the Journal of the National Cancer Institute.

The esophagus is the tube that carries food and liquids from the mouth to the stomach. Barrett’s esophagus affects an estimated 1% of U.S. adults, and is characterized by the development of abnormal cells in the lining of the lower part of the esophagus. The condition does not produce symptoms. Regular exposure to stomach acid is thought to be an important contributing factor, and Barrett’s esophagus is commonly found in people with gastroesophageal reflux disease (GERD).[1]

Barrett’s esophagus is known to be linked with an increased risk of esophageal cancer, but estimates regarding the frequency of cancer in people with Barrett’s esophagus have varied widely.

To get a better estimate of the risk of esophageal cancer, researchers in Northern Ireland evaluated information from one of the largest registries of Barrett’s esophagus in the world.[2] The registry included more than 8,500 patients.

During roughly seven years of follow-up, 79 people were diagnosed with esophageal cancer, 16 people were diagnosed with cancer of the gastric cardia (the upper part of the stomach), and 36 people were diagnosed with precancerous changes known as high-grade dysplasia.
The rate of these three conditions combined was 0.22% per year. Previous estimates have generally ranged from 0.58% per year to 3% per year.
The risk of cancer or high-grade dysplasia was higher among men, among people between the ages of 60-69, and among those who had low-grade dysplasia or specialized intestinal metaplasia at the time of their initial biopsy.

These results suggest that esophageal cancer may be less common among people with Barrett’s esophagus than has been previously reported. Cancer risk varies by several factors, however, including gender, age, and biopsy findings. Accurate estimates of risk are an important part of developing effective strategies for managing Barrett’s esophagus.

References:

[1] National Digestive Diseases Information Clearinghouse (NDDIC). Barrett’s esophagus. Accessed July 5, 2011.
[2] Bhat S, Coleman HG, Yousef F et al. Risk of malignant progression in Barrett’s esophagus patients: results from a large population-based study. Journal of the National Cancer Institute. Early online publication June 16, 2011.

Screening with Spiral CT Reduces Lung Cancer Deaths

Thu, 07 Jul 2011 00:01:09 +0000

Among people with a history of heavy smoking, screening with low-dose helical computed tomography (spiral CT) scans reduced lung cancer mortality by 20%. These results were published in the New England Journal of Medicine.

Lung cancer is the leading cause of cancer death among both men and women in the United States. Each year, an estimated 86,000 men and 71,000 women die of the disease. Other common cancers—such as prostate cancer and breast cancer—kill far fewer people: each year there are roughly 32,000 prostate cancer deaths and 40,000 breast cancer deaths in the U.S.

Avoidance of tobacco smoke offers the best hope for reducing lung cancer mortality. Early detection of lung cancer among people at high risk of the disease is also important, but previous studies of potential screening tests such as chest X-rays found no benefit from screening.

Spiral CT scans use X-rays to obtain a multiple-image scan of the entire chest. To compare screening with spiral CT to screening with standard chest X-ray, researchers conducted a study among more than 53,000 current and former heavy smokers between the ages of 55 and 74.[1] Study participants received three annual screens with either spiral CT or chest X-ray.

Preliminary results from this study were released by the National Cancer Institute in November, 2010, but the current publication provides more detailed findings.

There were 20% fewer lung cancer deaths among people screened with CT than among people screened with chest X-ray: the number of lung cancer deaths per 100,000 people per year was 247 in the spiral CT group and 309 in the chest X-ray group.
All-cause mortality (death from any cause, including lung cancer) was reduced by 7% among patients who underwent CT screening.
False-positive results were more common in the CT group than in the chest X-ray group. A false-positive result suggests that cancer is present when the person is actually cancer-free. Complications from the workup of positive tests, however, were uncommon. False-positive results were typically confirmed by additional imaging rather than by invasive tests such as bronchoscopy or needle biopsy.

These results suggest that among people at high risk of lung cancer as a result of long-term and/or heavy smoking, screening with spiral CT can reduce the number of lung cancer deaths. Groups such as the American Society of Clinical Oncology are now considering what screening guidelines might be warranted based on these results.[2]

References:

[1] The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine. Early online publication June 29, 2011.

[2] American Society of Clinical Oncology news release. ASCO statement on publication of the National Lung Screening Trial results. June 29, 2011.

Medicare Will Cover Provenge for Prostate Cancer

Wed, 06 Jul 2011 00:01:31 +0000

The Centers for Medicare and Medicaid Services has announced that Medicare will cover Provenge® (sipuleucel-T) for the uses approved by the U.S. Food and Drug Administration (FDA): the treatment of metastatic, hormone-refractory prostate cancer that is producing few or no symptoms.

Prostate cancer is a hormonally sensitive disease that can often be controlled for long periods with androgen-deprivation therapy. When prostate cancer stops responding to this treatment, it is referred to as hormone-refractory prostate cancer. Metastatic hormone-refractory prostate cancer is cancer that has stopped responding to standard hormone therapy and has spread to other parts of the body.

Provenge is an immunotherapy that prompts the body’s immune system to respond against the cancer. A Phase III clinical trial that contributed to the FDA’s approval of Provenge was a study known as IMPACT (IMmunotherapy for Prostate AdenoCarcinoma Treatment). Study participants had metastatic, hormone-refractory prostate cancer, and were treated with either Provenge or a placebo. Median overall survival was 25.8 months in the Provenge group compared with 21.7 months in the placebo group, a 4.1-month improvement. Side effects that were more common in the Provenge group included chills, fever, and headache.

Provenge was approved by the FDA in April, 2010 for the treatment of asymptomatic or minimally symptomatic, metastatic, hormone-refractory prostate cancer. The decision about Medicare coverage is effective immediately.

Reference: Centers for Medicare and Medicaid Services. Press release: Medicare expands treatment options for patients with advanced prostate cancer. June 30, 2011.

Prostate Cancer Outcomes Worse for Smokers

Tue, 05 Jul 2011 00:01:18 +0000

Men who smoke at the time they’re diagnosed with prostate cancer have an increased risk of recurrence and death compared with never smokers. Odds for men who quit smoking at least 10 years previously, on the other hand, are similar to those of never smokers. These findings were recently reported in JAMA.

Evidence continues to mount of an association between lifestyle factors and health. Smoking is a commonly investigated behavior for its association with several forms of cancer as well as other disease and illnesses.

To date, studies evaluating a link between smoking and prostate cancer and recurrence have been limited, with even less research focusing on prostate cancer-specific outcomes.

To better investigate whether smoking affects outcomes for patients with prostate cancer, researchers with Harvard School of Public Health and University of California, San Francisco, evaluated 5,366 men diagnosed with prostate cancer between 1986 and 2006. The outcomes they measured included overall mortality, prostate cancer-specific mortality, death from cardiovascular disease, and biochemical recurrence (as indicated by a rise in PSA level).

There were 1,630 overall deaths; 524 (32%) deaths were due to prostate cancer; 416 (26%) deaths to cardiovascular disease; and there were 878 biochemical recurrences.
Men who currently smoked had an increased risk for all-cause mortality, prostate cancer mortality, death from cardiovascular disease, and biochemical recurrence compared with never smokers.
Smokers who had quit for 10 years or more or who had quit for less than 10 years but were lighter smokers (less than 20 pack-years) had a similar risk of prostate cancer death as never smokers.

Though findings of an increased risk among current smokers of death from all causes, prostate cancer, and cardiovascular disease as well as increased risk of biochemical recurrence are bad news for smokers, these data also provide good incentive to quit. It appears that men who have quit smoking for at least 10 years prior to prostate cancer diagnosis have risks similar to those of men who have never smoked.

Reference: Kenfield SA, Stampfer MJ, Chan JM, et al. Smoking and prostate cancer survival and recurrence. JAMA. 2011;305(24):2548-2555. doi: 10.1001/jama.2011.879.

Longer Life for Brain Cancer Patients Who Exercise

Fri, 01 Jul 2011 00:01:45 +0000

Exercise is linked with longer survival for patients with advanced glioma, a form of brain cancer. These findings were recently reported in the Journal of Clinical Oncology.

Gliomas are brain tumors that arise from glial cells (cells that provide a supportive function in the brain). Depending on their characteristics, gliomas may be classified as low-grade (less aggressive) or high-grade (more aggressive).

Exercise and its relationship to patient quality of life, cancer prevention, and impact on treatment and recurrence have been studied extensively in several types of cancer. Regular physical activity may help improve overall health and well-being as well as treatment outcomes.

Researchers with the Duke Cancer Institute recently conducted a study designed to identify key indicators of prognosis among patients with malignant recurrent glioma. The study included 243 patients with this form of brain cancer. Participants reported their levels of physical activity. At a median follow-up of just over 27 months, 149 patients (61% of participants) had died.

Survival was extended significantly among patients who reported regular, brisk exercise. These patients lived a median of almost 22 months compared with about 13 months for sedentary patients.
Exercise was linked with survival independently of other prognostic factors (such as age, gender, and disease history).

The researchers conclude that information about a patient’s exercise habits can help doctors predict long-term outcome for patients with advanced glioma. They explain that accurate prognoses can help doctors create more-appropriate treatment plans.

Reference: Ruden E, Reardon DA, Coan AD, et al. Exercise, behavior, functional capacity, and survival in adults with recurrent malignant glioma. Journal of Clinical Oncology [early online publication]. June 20, 2011.