McHale Institute

Tamoxifen and Raloxifene Both Decrease Breast Cancer Risk

Tue, 04 May 2010 00:17:35 +0000

Among postmenopausal women at increased risk of breast cancer, use of either tamoxifen (Nolvadex®) or raloxifene (Evista®) can substantially reduce the risk of breast cancer. The reduction in risk was somewhat greater with tamoxifen (50% versus 38% with raloxifene), but women treated with tamoxifen were also more likely to experience certain serious side effects. These results were published in Cancer Prevention Research.

Drugs that block the effects of estrogen have been shown to reduce the risk of breast cancer in women at high risk of the disease. Two drugs that have been approved for breast cancer risk reduction in certain groups of women are tamoxifen and raloxifene. Tamoxifen is approved for breast cancer risk reduction in women who are at high risk of the disease (including high-risk premenopausal women). Raloxifene—originally approved for the prevention and treatment of osteoporosis—is approved for breast cancer risk reduction in postmenopausal women with osteoporosis or postmenopausal women at high risk of breast cancer.

To directly compare raloxifene to tamoxifen in the prevention of breast cancer in high-risk women, researchers conducted a clinical trial known to as the STAR trial (The NSABP Study of Tamoxifen and Raloxifene [STAR] P-2 Trial). The study enrolled more than 19,000 postmenopausal women at increased risk of breast cancer. Women were assigned to receive either tamoxifen or raloxifene daily for five years. Study participants have now been followed for a median of 6.8 years.

Initial results from the trial indicated that raloxifene and tamoxifen were similarly effective at reducing the risk of invasive breast cancer—both drugs reduced risk by roughly 50%. Raloxifene appeared to be somewhat less effective, however, at reducing the risk of noninvasive breast cancers such as ductal carcinoma in situ (DCIS).

More recent, longer-term results indicate that as women in the study completed five years of the drugs and stopped taking them, tamoxifen continued to reduce the risk of invasive and noninvasive breast cancer by roughly 50% compared with a roughly 38% reduction in risk with raloxifene.

Study participants who took raloxifene had fewer serious side effects than study participants who took tamoxifen, both initially and after longer-term follow-up. Side effects that were less common in women treated with raloxifene than women treated with tamoxifen included uterine cancers, blood clots, and cataracts.

The results of this study demonstrate that both tamoxifen and raloxifene reduce the risk of breast cancer in postmenopausal women at increased risk of the disease. Women at elevated risk of breast cancer as a result of family history or other characteristics may wish to talk with their doctor about the risks and benefits of using one of these drugs to reduce breast cancer risk.

Reference: Vogel VG, Costantino JP, Wickerham DL et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing Breast Cancer. Cancer Prevention Research [early online publication]. April 19, 2010.?

Provenge Approved for Advanced Prostate Cancer

Sat, 01 May 2010 00:35:10 +0000

Provenge® (sipuleucel-T), a type of immunotherapy, has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of asymptomatic or minimally symptomatic, metastatic, hormone-refractory prostate cancer.[1]

Prostate cancer is a hormonally sensitive disease that can be controlled for long periods with androgen-deprivation therapy (ADT). When prostate cancer stops responding to this treatment it is referred to as hormone-refractory. Metastatic, hormone-refractory prostate cancer is a challenging form of the disease to treat because the cancer has spread to distant sites in the body and does not respond to treatment with hormonal therapy.

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 approval of Provenge was a study known as IMPACT (IMmunotherapy for Prostate AdenoCarcinoma Treatment). The study enrolled 512 men with metastatic, hormone-refractory prostate cancer. Study participants 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.[2]

The most common side effects of Provenge are chills, fatigue, fever, back pain, nausea, joint ache, and headache.

Initially, Provenge is expected to be made available at approximately 50 centers, all of which were approved Provenge clinical trial sites.

References:

[1] FDA News Release. FDA Approves a Cellular Immunotherapy for Men with Advanced Prostate Cancer. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm210174.htm Accessed April 29, 2010.

[2] Kantoff P, Higano CS, Berger ER, et al. Updated survival results of the IMPACT trial of sipuleucel-T for metastatic castration-resistant prostate cancer (CRPC). Presented at the 2010 Genitourinary Cancers Symposium in San Francisco. March 5-7, 2010. Abstract #8.

Epidermal Growth Factor Receptor (EGFR) Levels Significantly Elevated in Women Who Developed Breast Cancer

Fri, 30 Apr 2010 23:40:40 +0000

Blood levels of epidermal growth factor receptor (EGFR) may be elevated in women up to 17 months prior to a diagnosis of breast cancer. These findings were recently presented at the American Association for Cancer Research 101^st Annual Meeting.[1]

In an attempt to improve survival by detecting breast cancer at an earlier stage, researchers are evaluating potential biomarkers of the disease. Levels of certain proteins in the blood, for example, may be higher in women with breast cancer than in women without breast cancer. If these markers reliably distinguish women with and without breast cancer, and if the markers can be identified early in cancer development (before the cancer would typically be diagnosed clinically), then they may contribute to the early detection of breast cancer.

In the current study, researchers first evaluated blood samples from 420 women with estrogen receptor-positive breast cancer and a set of matched controls (women without breast cancer). For the women with breast cancer, blood had been collected up to 17 months prior to cancer diagnosis. Biomarkers that appeared promising at this first stage (that appeared to distinguish women with and without breast cancer) were then further evaluated in a separate set of women with and without breast cancer.

EGFR levels were significantly elevated in women who developed breast cancer compared with controls.
Women with the highest levels of EGFR had a 2.9-fold increased risk of developing breast cancer compared with women with the lowest EGFR levels.
In women who used estrogen plus progestin hormone therapy, high EGFR levels were associated with a ninefold increased risk of developing breast cancer.

Although the results of this study did not indicate that EGFR levels were sufficient to be used as a sole predictor of breast cancer, the researchers were optimistic that “there may indeed be detectable changes of proteins in blood within two years of making a clinical breast cancer diagnosis.” This type of research continues to hold promise.

Reference:

[1] Pitteri SJ, Amon LM, Buson TB, et al. Elevated plasma levels of epidermal growth factor receptor prior to diagnosis of breast cancer in preclinical specimens from the Women’s Health Initiative Observational Study. Proceedings from the 101^st Annual Meeting of the American Association for Cancer Research. April 17-21, 2010. Abstract 4815.

Study Evaluates Long-term Efficacy of Peripheral Blood Stem Cell Transplant Versus Bone Marrow Transplant

Fri, 30 Apr 2010 00:45:51 +0000

For leukemia patients who undergo allogeneic stem cell transplantation, 10-year results indicate that bone-marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) produce similar rates of overall and leukemia-free survival. These results were recently published in the journal The Lancet Oncology.[1]

Following the delivery of high-dose chemotherapy to patients for the treatment of cancer, infusion of stem cells is necessary to ensure recovery of bone marrow function and production of red blood cells, white blood cells, and platelets. Historically, stem cells were harvested from bone marrow, but more recently, many cancer centers have adopted the practice of collecting stem cells from peripheral blood. Peripheral blood stem cell transplantation results in faster blood cell recovery than BMT, but information about long-term differences in outcomes between the two procedures has been limited.

In this study researchers evaluated the long-term safety and efficacy of PBSCT versus BMT. The study enrolled 329 leukemia patients who were assigned to receive either PBSCT or BMT from an HLA-identical sibling donor.

Ten-year overall survival was 49.1% for the PBSCT group versus 56.5% for the BMT group. Ten-year leukemia-free survival was 42.3% for the PBSCT group versus 45.5% for the BMT group. These differences between groups did not meet the criteria for statistical significance, suggesting that they could have occurred by chance alone.
Chronic graft-versus-host disease was more common after PBSCT than after BMT (73% versus 56%). Nevertheless, the two groups of patients had similar performance status and ability to return to work

The researchers conclude that after more than nine years of follow-up, overall and leukemia-free survival remain similar among patients treated with PBSCT and BMT. Possible differences in outcomes among patients with different types of leukemia may warrant additional investigation. Patients undergoing cancer treatment with a transplantation should discuss the risks and benefits of stem cell collection from bone marrow versus blood in order to make an informed decision.

Reference:

[1] Friedrichs B, Tichelli A, Bacigalupo A, et al. Long-term outcome and late effects in patients transplanted with mobilised blood or bone marrow: a randomised trial. Lancet Oncology. 2010:11;331-338.

Indoor Tanning May Be Addictive in Some Individuals

Fri, 30 Apr 2010 00:42:55 +0000

Researchers report that some individuals may meet criteria for addiction to indoor tanning and are more likely to exhibit other addictive behaviors and affective disturbance. These results were recently published in the journal Archives of Dermatology.[1]

Each year in the Unites States, an estimated 28 million people visit an indoor tanning facility, with a majority of visits made by women and teenage girls. In a survey of White adolescents (13 to 19 years old), 37% of the girls and 11% of the boys reported having used a tanning bed at least once. The bad news is that tanning beds—like the sun—expose the skin to ultraviolet radiation, and a growing body of research indicates that indoor tanners have an increased risk of skin cancer. Skin cancer prevention interventions include awareness of the link between indoor tanning and skin cancer risk. With the growing incidence of skin cancer, there is a great interest in promoting sun safety through educational interventions. Several studies have evaluated sun safety attitudes and behaviors in order to develop more effective prevention programs.

In this study 421 college students provided self-reported data on indoor tanning, substance use, anxiety, and depression. The researchers modified questionnaires used to screen for alcoholism and substance-related disorders to evaluate indoor tanning addiction. Standardized questionnaires were used to evaluate participant anxiety, depression, and substance use. Approximately 30% of the study participants were addicted to indoor tanning. In addition, participants who were addicted to indoor tanning experienced more anxiety symptoms as well as reported greater use of alcohol, marijuana, and other substances.

These researchers concluded that indoor tanning can be addicting for some individuals and these individuals may present with other addictive behaviors. This information may be useful in the development of more impactful skin cancer prevention programs that integrate education on indoor tanning addiction.

Reference:

[1] Mosher CE and Danoff-Burg S. Addiction to Indoor Tanning: Relation to Anxiety, Depression, and Substance Use. Archives of Dermatology. 2010;146:412-417.

High Rate of False-positive Results in Lung Cancer Screening with CT Scan

Thu, 29 Apr 2010 01:41:25 +0000

Screening for lung cancer using computed tomography (CT) scans can yield a high rate of false-positive results, according to a study published in the Annals of Internal Medicine. False-positive results are risky because they may lead to invasive follow-up testing, financial burden, and anxiety.

CT scanning is being studied as a screening tool for lung cancer. Several studies have indicated that screening with CT scan appears to provide improved long-term survival for patients with lung cancer; however, not all results from these studies demonstrate improved survival, which is why the medical community has not adopted CT scanning for standard screening for lung cancer.

In order for new screening methods to be adopted into routine clinical care, the measures must identify cancer early enough to improve outcomes, must be economically feasible, and must detect cancer with an acceptable degree of accuracy. As well, in order to encourage patient compliance, screening measures must not be too invasive, painful, or risky. To date no screening measures for lung cancer have been identified that provide a confirmed benefit.

To estimate the frequency of false-positive test results among patients undergoing screening for lung cancer using CT scans, researchers evaluated approximately 3,000 individuals. Study participants were current of former smokers who had never been diagnosed with lung cancer. They underwent screening with CT scan or chest X-ray at the beginning of the study and again one year later. Patients were then followed for 12 months to determine if positive screening results were valid or false-positive (meaning further diagnostic testing did not find lung cancer).

Following the first screening, patients undergoing CT scan had a 21% probability of a false-positive result compared with 9% for those undergoing chest X-ray.
After two rounds of screening, the CT group had a 33% probability of a false-positive versus 15% for the chest X-ray group.
7% of patients in the CT group receiving a false-positive result underwent a follow-up invasive diagnostic procedure compared with 4% in the chest X-ray group.

The researchers concluded that screening for lung cancer with CT scans carries a “substantial” risk for false-positive results. Because CT scans themselves may pose a risk to patients by exposing them to radiation (a potential risk for cancer), and false-positive results can lead to invasive procedures that are accompanied by economic and psychological burdens, further study of CT scans for lung cancer screening are needed before this method can be widely recommended.

Reference: Croswell JM, Kramer BS, Kreimer AR, et al. Cumulative incidence of false-positive results in repeated, multimodal cancer screening. Annals of Internal Medicine. 2009 May-Jun;7(3):212-22.

Acupuncture Relieves Pain, Improves Functioning After Neck Surgery

Thu, 29 Apr 2010 01:37:24 +0000

Acupuncture may reduce pain and improve functioning among patients with cancer who have undergone surgery to the neck, according to a study published in the Journal of Clinical Oncology.[1] As well, acupuncture may relieve xerostomia (dry mouth) among these patients.

Acupuncture is a form of traditional Chinese medicine that aims to improve health by stimulating specific points of the body.[2] Previous studies have found that acupuncture may effectively relieve certain side effects of cancer and its treatment.

To evaluate whether acupuncture can relieve pain and improve functioning among patients with a history of surgery to the neck, researchers studied 58 patients, 28 of whom received acupuncture and 30 who received “usual care” (physical therapy, anti-inflammatory drugs, or painkillers). Researchers also assessed whether acupuncture could improve dry mouth among these patients

After four weeks patients in the acupuncture group reported less pain and improved functioning—including daily tasks—compared with patients receiving usual care.
Patients receiving acupuncture experienced greater relief of dry mouth than those receiving usual care.

The researchers concluded that acupuncture may be an effective way to relieve pain, improve functioning, and control dry mouth among patients with a history of neck surgery for cancer. Although further study is needed, it appears that acupuncture may be an effective therapy among this patient population.

References:

[1] Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for Pain and Dysfunction After Neck Dissection: Results of a Randomized Controlled Trial. Journal of Clinical Oncology [early online publication]. April 20, 2010. [2] National Center for Complementary and Alternative Medicine. Acupuncture: An Introduction. Available at: http://nccam.nih.gov/health/acupuncture/introduction.htm. Accessed April 23, 2010.

Well-done Red Meat Increases Bladder Cancer Risk

Tue, 27 Apr 2010 23:25:15 +0000

Some individuals are more genetically susceptible to this risk.

High consumption of red meat and/or fried meats such as chicken or fish increase the risk of bladder cancer, especially among individuals who already carry a genetic risk, according to the results of a study presented at the annual meeting of the American Association for Cancer Research on April 20, 2010 in Washington, D.C.[1]

Bladder cancer is diagnosed in as many as 60,000 individuals annually in the United States. It is much more common in elderly individuals. Bladder cancer has high cure rates if detected and treated early; however, these cure rates fall dramatically once the cancer has spread to different sites in the body. As with all types of cancer, the best “treatment” of bladder cancer is to prevent its occurrence in the first place. Thus, researchers continue to evaluate potential risk factors for the disease.

High-temperature cooking methods—such as grilling, charring, frying, and barbecuing—have been found to generate heterocyclic amines (HCAs), which are carcinogenic compounds that increase cancer risk. Researchers from the M. D. Anderson Cancer Center conducted a study that included 884 patients with bladder cancer and 878 control subjects. After collecting dietary data from all subjects, the researchers found that individuals who reported eating a lot of beef, pork, bacon, fried chicken, and fried fish had a higher risk of developing bladder cancer. Red meats cooked at the medium level conferred 1.46 times the level of those cooked rare, while meats cooked to well-done levels conferred 1.94 times the risk.

The researchers also observed a “joint effect” when individuals with certain genetic variants in the pathways related to HCA metabolism consumed high quantities of red meat. Individuals who have these genetic variations are 4.74 times as likely to develop bladder cancer when they eat a lot of red meat.

The researchers concluded that red meat intake increases the risk of bladder cancer, especially when combined with other factors such as high-temperature cooking or genetic predisposition.

Reference:

[1] Lin J, Wang J, Grossman HB, et al. Red meat and heterocyclic amine intake, metabolic pathway genes, and bladder cancer risk. Presented at the Annual Meeting of the American Association for Cancer Research, April 17-21, 2001. Washington, D.C. Abstract #2825.

Weight Gain Increases Risk of Prostate Recurrence

Tue, 27 Apr 2010 23:22:33 +0000

Weight gain and obesity—especially among inactive men—may increase the risk of prostate cancer recurrence after a prostatectomy, according to the results of a study presented at the annual meeting of the American Association for Cancer Research on April 20, 2010 in Washington D.C[1]

The prostate is a male sex gland responsible for producing fluid that forms semen. It is located below the bladder, in front of the rectum, and surrounds the urethra. Prostate cancer occurs when the cells in the prostate gland grow out of control. Prostate cancer is the most common type of cancer (other than skin cancer) diagnosed in men in the United States.

Researchers from Johns Hopkins Bloomberg School of Public Health evaluated 1,337 men with localized prostate cancer who underwent prostatectomy between 1993 and 2006. The men were surveyed regarding dietary and lifestyle factors five years prior to surgery and one year after. By the end of the follow-up period, 102 men experienced prostate cancer recurrence. Men who recurred tended to be older, more likely to have tumors that had poor pathological characteristics, and less likely to have a family history than men who did not recur.

Five years prior to surgery, 54% of the men were overweight and 9% were obese. Men who gained five pounds or more from five years before surgery to one year after surgery were twice as likely to experience recurrence compared with those who maintained a stable weight. Men who were obese after surgery were 1.67 times more likely to recur compared with those with a normal weight. The risk of recurrence associated with obesity was even more pronounced among men who were considered sedentary or inactive.

The researchers concluded that weight gain and obesity may increase the risk of prostate cancer recurrence. Maintaining a healthy lifestyle is important both before and after cancer treatment.

Reference:

[1] Joshu CE, Mondul AM, Han M, et al. Weight gain is associated with an increased risk of prostate cancer recurrence in the PSA era. Presented at the Annual Meeting of the American Association for Cancer Research, April 17-21, 2001. Washington, D.C. Abstract #883.

More Than Half of Young Adults in New Relationships Infected with HPV

Mon, 26 Apr 2010 20:10:35 +0000

More than half of young adults in a new sexual relationship are infected with human papillomavirus (HPV), and of those 44% were infected with an HPV type that causes cancer, according to the results of a groundbreaking study called the HITCH Cohort Study (HPV Infection and Transmission in Couples through Heterosexual activity).[1]

Human papillomaviruses (HPV) consist of more than 100 different viruses. Some types of HPV cause warts on the hands or feet; others cause genital warts; and some have been linked with cancer, most notably cervical cancer. The types of HPV most commonly linked with cervical cancer are HPV 16 and HPV 18, but several other high-risk types contribute to cancer as well.

The types of HPV that cause cervical cancer or genital warts are transmitted sexually. HPV infection is extremely common and generally occurs soon after an individual becomes sexually active. Although most infections resolve on their own, some persist and can lead to precancerous or cancerous changes to the cervix, vulva, vagina, penis, and anus. HPV infections have also been linked with some head and neck cancers.

The HITCH Cohort Study is the first large-scale study of HPV infection among couples early in their sexual relationships when transmission is most likely. Participants are young women attending university in Montreal, Quebec, and their male partners. New couples are defined as those who have been together for less than six months.

Recruitment for the study is continuing, but thus far results indicate that 56% of young adults in new sexual relationships are infected with HPV and of those, 44% were infected with an HPV type that causes cancer. The researchers observed that, in 42% of couples, when one partner had HPV, the other partner also had the infection. HPV infection in one partner was the strongest predictor of finding the same HPV type in the other partner. If one partner was infected, the other partner was 50 times more likely to also be infected with the same HPV type.

The researchers concluded that HPV is easy to both contract and transmit. They suggest that this underscores the importance of screening for cervical cancer, as well as considering HPV vaccination.

Reference:

[1] Burchell AN, Tellier PP, Hanley J, et al. Human papillomavirus infections among couples in new sexual relationships. Epidemiology. 2010; 21: 31-37.