| ||||||||||||||||||||||||||||||||||||||||||||||||||||||
© Oxford University Press 2008.
IN THIS ISSUE
18F-FDG PET to Detect Cervical Node Metastases in HNSCCDiagnosing lymph node metastases of patients with head and neck squamous cell carcinoma (HNSCC) is especially critical to make treatment decisions for patients who have been clinically diagnosed as cervical lymph node negative (cN0). Positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG PET) is a method that has been proposed to improve diagnosis of these metastases. To determine how well 18F-FDG PET performs as a diagnostic tool in this situation and how it compares with other diagnostic methods, Kyzas et al. (p. 712) performed a meta-analysis of 32 studies that included 1236 patients. Across all patients, sensitivity of 18F-FDG PET was 79% and specificity was 86%. However, for patients who were clinically diagnosed as being cervical lymph node negative, the sensitivity of 18F-FDG PET was 50% and its specificity was 87%. In studies that compared the diagnostic performance of 18F-FDG PET with that of conventional diagnostic methods, sensitivity was 80% and 75%, respectively, and specificity was 86% and 79%, respectively. The authors conclude that 18F-FDG PET has good diagnostic performance overall but does not detect metastases in half of cN0 patients with metastases.
In an editorial, Schwartz et al. (p. 688) discuss findings fueling the debate regarding the improved accuracy of 18F -FDG PET to diagnose nodal metastases in HNSCC patients over other methods. They note that issues regarding consistency across institutions that use different instruments and protocols are being evaluated as part of a phase III trial by the Radiation Therapy Oncology Group and the American College Radiology Imaging Network.
Design of Clinical Trials in Hepatocellular Carcinoma
The incidence of hepatocellular carcinoma (HCC) is high and increasing. Nevertheleless, relatively few randomized trials of therapeutic interventions for this disease have been carried out. Trial design is complicated by the frequent presence of concurrent liver disease, which can make it difficult to assess clinical benefit. A lack of consensus regarding universal disease classification has also hindered comparisons between trials. Llovet et al. (p. 698) discuss design considerations that were addressed by an expert panel convened by the American Association for the Study of Liver Diseases. The guidelines produced by the expert panel address appropriate endpoints, study population, stratification, and control arms. The authors note that further research is needed to incorporate biomarkers and molecular imaging into HCC research.
The Risk Over Time to Sisters of Women with Breast Cancer
Women who have a sister diagnosed with breast cancer are known to be at increased risk for the disease, but it has been unclear how the risk changes both over time and according to the age of the sister at risk. Combining data on birth dates and parentage with cancer registry data from Sweden, Rebora et al. (p. 721) found that the increased risk of breast cancer associated with having a sister diagnosed with the disease was most pronounced in younger women. For all women, the increased risk was constant with time elapsed since the sister’s diagnosis. The authors conclude that sisters in affected families live with the burden of increased breast cancer risk for the rest of their lives.
Physical Activity and Risk of Premenopausal Breast Cancer
Physical activity has been reported to be associated with decreased risk of postmenopausal breast cancer, but there is less evidence regarding its relationship to premenopausal breast cancer. Maruti et al. (p. 728) collected data regarding leisure-time physical activity from age 12 to current age of more than 64,000 women in the Nurses’ Health Study II and determined their risk of premenopausal invasive breast cancer during 6 years of follow-up. Women who engaged in an average of 39 or more metabolic equivalent hours, equivalent to 3.25 hours of running or 13 hours of walking, per week during their lifetime had a 23% lower risk of premenopausal breast cancer than less active women. Women with the highest lifetime physical activity had an age-adjusted breast cancer incidence rate of 136 per 100,000 person-years, whereas the rate in women with the lowest total lifetime physical activity was 194 per 100,000. Activity during ages 12–22 contributed the most to the association. The authors conclude that in this cohort, leisure-time physical activity was associated with reduced risk of premenopausal breast cancer and that women who are highly physical active during adolescence and adulthood may benefit the most.
Treatment Disparities After Referral for Rectal Cancer
Black patients with rectal cancer are considerably less likely than white patients to receive adjuvant therapy. Morris et al. (p. 738) used Surveillance, Epidemiology, and End Results–Medicare data to examine whether this disparity is due to the underreferral of black patients to medical and radiation oncologists. There was no difference between the black patients and the white patients in the frequency of consultation with a medical or radiation oncologist. However, blacks were less likely than whites to consult with both a medical oncologist and a radiation oncologist. Among patients who saw an oncologist, black patients were less likely than white patients to receive chemotherapy, radiation therapy, or both. Patient and provider characteristics had minimal influence on the racial disparity in the use of adjuvant therapy. The authors conclude that a better understanding of patient preferences, patient–provider interactions, and potential influences on provider decision making is necessary to develop strategies to increase the appropriate use of adjuvant treatment for rectal cancer among black patients.
Endoscopic Sphincterotomy and Risk of Cholangiocarcinoma
Sphincterotomy of the ampulla of Vater is a common diagnostic and therapeutic procedure that is sometimes done during endoscopic retrograde cholangiography (ERC). Sphincterotomy allows reflux of intestinal content into the biliary tree. The resulting inflammation may contribute to malignant transformation of the biliary epithelium and therefore, at least in theory, increase the risk of cancer of the bile ducts (cholangiocarcinoma). Mortensen et al. (p. 745) used data from population-based Danish health-care registries to examine the incidence of cholangiocarcinoma among patients who had undergone ERC with or without sphincterotomy. The cholangiocarcinoma incidence rates for ERC patients with and without sphincterotomy were similar during the first year after ERC and gradually declined over time. The similar rates at the latest times after ERC suggest the lack of a causal association between sphincterotomy and cholangiocarcinoma.
Related Articles in JNCI
CiteULike 
Connotea 
Del.icio.us What's this?
J Natl Cancer Inst 2008 100: 745-750.
J Natl Cancer Inst 2008 100: 712-720.
J Natl Cancer Inst 2008 100: 698-711.
J Natl Cancer Inst 2008 100: 728-737.
J Natl Cancer Inst 2008 100: 738-744.
J Natl Cancer Inst 2008 100: 721-727.
J Natl Cancer Inst 2008 100: 688-689.
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||