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© Oxford University Press 2008.
IN THIS ISSUE
Recurrence Risk Perceptions of Women with DCISWomen who are diagnosed with ductal carcinoma in situ (DCIS) have a good prognosis, but many overestimate their risk of DCIS recurrence and invasive breast cancer. Little is known about the psychosocial outcomes of women who are recently diagnosed with DCIS and whether these outcomes are associated with their perceptions of DCIS recurrence and invasive breast cancer. Partridge et al. (p. 243) surveyed almost 500 women in eastern Massachusetts who had been diagnosed with DCIS within the past 6 months. At enrollment, 54% of women surveyed perceived at least a moderate risk of DCIS recurrence within 5 years, 68% in their lifetime. For invasive breast cancer, 39% perceived at least a moderate risk within 5 years, 53% in their lifetime. At 18 months, the perceived risks were similar to those at enrollment. The surveys showed that anxiety levels were strongly and consistently associated with the overestimated perceived risks.
In an editorial, Welch et al. (p. 228) discuss the issues that surround early detection and cancer screening, including overdiagnosis and overtreatment. The authors suggest clinical trials that test "watchful waiting" for DCIS and raise the possibility that biopies be reserved for breast tumors that can be palpated (i.e., > 1 cm).
Competing Causes of Death in Breast Cancer Patients by Age
Older patients with breast cancer experience higher rates of non–breast cancer–related death than younger patients. Chapman et al. (p. 252) examined factors associated with cause-specific death— from breast cancer, from other malignancies, and from other, non-cancer causes—in a large cohort of breast cancer patients who had been treated with extended adjuvant endocrine therapy. Non–breast cancer–related deaths were more common than breast cancer–related deaths, especially among older women. Pre-existing cardiovascular disease was associated with an increased risk of death from other causes, and pre-existing osteoporosis was associated with an increased risk of death from other malignancies. Age older than 70 years was associated with increased risk of death from all three causes. The authors conclude that medical attention to the potential for death from other causes is increasingly important in older breast cancer patients.
In an editorial, Giordano and Hortobagyi (p. 230) write that better tools are needed that assess the competing risks of death in breast cancer patients to assist in planning treatment, particularly for those who receive potentially cardiotoxic therapies and/or have cardiovascular disease or other illnesses. The authors conclude that such tools would greatly assist patients and oncologists in determining the risks and benefits of adjuvant therapies.
Head and Neck Squamous Cell Carcinoma Outcomes and HPV
Some data have suggested that patients with head and neck squamous cell carcinoma (HNSCC) whose tumors test positive for human papillomavirus (HPV) have a better prognosis than those whose tumors do not. To address this question, Fakhry et al. (p. 261) conducted a prospective study that controlled for potentially confounding factors, including age, tumor stage, and performance status. Among HNSCC patients who were treated with chemotherapy followed by radiation, those with HPV-positive tumors had better overall and progression-free survival than those with HPV-negative tumors. The authors suggest that the risks and benefits of current therapies may need to be assessed separately according to tumor HPV status.
Adverse Event Reporting and Targeted Therapies
Several versions of the Common Terminology Criteria for Adverse Events (CTCAE) have been developed by the National Cancer Institute’s Cancer Therapy Evaluation Program to provide standard language for reporting adverse events and toxic effects that occur in NCI–sponsored clinical trials. In a commentary, Edgerly and Fojo (p. 240) discuss why the current version of the CTCAE is not adequate to reflect the subacute adverse events that commonly occur with today's targeted therapies. They propose revising the CTCAE to better account for the adverse effects of targeted therapies whose administration is intended to be daily and prolonged.
DNA Repair Gene Variants and Meningioma Risk in Europeans
Meningioma is a type of brain tumor that is associated with exposure to ionizing radiation. Family members of meningioma patients have a threefold higher risk of developing the disease than the general population. To determine whether the risk of meningioma is associated with sequence variations in DNA repair genes, Bethke et al. (p. 270) analyzed 1,127 single-nucleotide polymorphisms (SNPs) from participants in five case–control studies performed in Europe. The SNP rs4968451, which is located in the gene for a protein that interacts with a breast cancer susceptibility gene, was associated with an increased risk of meningioma. The authors conclude that rs4968451 may have an important role in meningioma because approximately 28% of the European population carries a variant allele of this SNP that is associated with an increased risk of meningioma.
Muir-Torre Syndrome Frequency Among Lynch Syndrome Families
Some individuals with Lynch syndrome—an inherited predisposition to develop colorectal and other cancers—also have a tendency to develop certain skin tumors (i.e., Muir-Torre syndrome). Cancerous lesions associated with both syndromes are characterized by inherited mutations in DNA mismatch repair genes, including MSH2. South et al. (p. 277) determined the frequency of Muir-Torre syndrome among 50 Lynch syndrome families identified from a population of cancer patients who had been newly diagnosed with colorectal or endometrial carcinoma. Muir-Torre syndrome was observed in 28% of the 50 families and in 9.2% of the 152 individuals with Lynch syndrome. Muir-Torre syndrome was present among 75% of families who carried a specific deleterious mutation in the MSH2 gene but only 25% of families who carried other mutations in this gene. The authors recommend screening for Muir-Torre syndrome–associated skin lesions among patients with Lynch syndrome.
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Connotea 
Del.icio.us What's this?
J Natl Cancer Inst 2008 100: 277-281.
J Natl Cancer Inst 2008 100: 240-242.
J Natl Cancer Inst 2008 100: 270-276.
J Natl Cancer Inst 2008 100: 243-251.
J Natl Cancer Inst 2008 100: 261-269.
J Natl Cancer Inst 2008 100: 228-229.
J Natl Cancer Inst 2008 100: 252-260.
J Natl Cancer Inst 2008 100: 230-231.
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