© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 17, 1437,
September 1, 1999
© 1999 Oxford University Press
IN THIS ISSUE |
The incidence of Kaposi's sarcoma (KS) is increased several-fold in individuals infected with human immunodeficiency virus-1 (HIV). Human herpesvirus 8 (HHV8) has also been implicated in KS. Rezza et al. (p. 1468) have investigated several factors that may determine the onset of KS, in particular, HHV8 infection in individuals after they convert to HIV seropositivity. The authors studied 366 individuals belonging to different HIV-exposure categories (homosexual activity, intravenous drug use, and heterosexual contact) for whom a negative and then a positive HIV serologic test were available within a 2-year period. HHV8 antibody testing was performed on the first serum sample available after the first positive HIV test. Approximately one third of HIV/HHV8-co-infected individuals developed KS within 10 years after HIV seroconversion. According to the authors, progression to KS appeared to increase dramatically with time after HIV seroconversion and with increasing antibody titers to lytic HHV8 antigens.
In an editorial, Beral et al. (p. 1440) point out that HIV infection might encourage the persistence of HHV8 infection, which otherwise would be self-limiting; alternatively, HIV infection might lead to the reactivation of latent HHV8 infection. Other mechanisms, such as HIV-related immune dysregulation or the effect of HIV transactivation (Tat) protein on KS growth, may also be involved, they say. As yet, there is little direct evidence to explain the phenomenon. The editorial writers further state that a strong association between high anti-HHV8 antibody titers and KS risk suggests that increased expression of viral genes, perhaps through HHV8 viremia, may be relevant.
Surveying Cancer Survivors
To learn more about the growing population of cancer survivors, questions for this population were added as supplements to the 1992 National Health Interview Survey (NHIS). Hewitt et al. (p. 1480) report on the findings of these NHIS supplements and compare the prevalence of cancer reported by the survey subjects with cancer registry data. On the basis of the NHIS, there were an estimated 7.2 million adult survivors of cancer (excluding nonmelanoma skin cancer) in 1992, representing 3.9% of the U.S. adult population. However, comparisons with prevalence estimates from cancer registry data suggest that cancer was underreported by those surveyed. Nearly three fifths of cancer survivors had their disease detected during a visit to a doctor for a health problem and a majority had obtained a second opinion regarding their treatment. Nearly 11% of the survivors reported being denied insurance coverage and nearly a fifth reported having employment problems following their diagnosis because of their cancer.
Prophylactic Surgery to Reduce Breast Cancer Risk?
Women who inherit mutations in the BRCA1 gene are at increased risk of breast cancer. Bilateral oophorectomy (i.e., surgical removal of both ovaries) may reduce breast cancer risk by decreasing exposure of breast tissue to ovarian hormones (e.g., estrogen). Rebbeck et al. (p. 1475) have evaluated whether prophylactic bilateral oophorectomy might be associated with a reduction in breast cancer risk in a cohort of women with inherited BRCA1 mutations. They found an approximately 50% reduction in risk in women who had undergone the surgery compared with women who had not. They noted an even greater risk reduction in women followed 5-10 years or more since the surgery. The use of hormone replacement therapy did not negate the breast cancer risk reduction observed following surgery.
". . . [W]hile surgery may reduce cancer risk, it does not completely eliminate occurrence of breast cancer. Breast cancer screening and prevention options should continue after surgery."
— Rebbeck et al.
In an editorial, Helzlsouer (p. 1442) notes that the finding by Rebbeck et al. is a first step in determining the options regarding oophorectomy for women who carry BRCA1 mutations and needs to be interpreted with caution. Oophorectomy is associated with an array of side effects that can affect quality of life and overall mortality. Helzlsouer says that studies of the effectiveness of clinical management for the prevention of cancer in genetically susceptible individuals should not lose sight of maintaining the overall health of the individual.
Race, Health Care Access, Survival
African-American women with breast cancer have shorter survival than do similar American women of European descent. But is the difference due to socioeconomic factors or biologic differences between the two groups? A report by Ulcickas Yood et al. (p. 1487) suggests that the difference is probably not intrinsic. When the authors compared survival in 886 African-American and European-American women diagnosed with breast cancer over 10 years in the same health maintenance organization, the authors report that the African-American women were 1.6 times as likely to die within 5 years of diagnosis than the European-American women. However, after adjustment for sociodemographic factors (i.e., age, marital status, and mean household income) and tumor stage, the difference in survival essentially disappeared. The authors conclude that the effect on an intrinsic difference between the races in tumor biology, if any, must be small.
"In a population with uniform health care coverage, we found that the residual influence of race after adjustment is negligible."
—Ulcickas Yood et al.
Peer Education to Improve Fruit and Vegetable Intake
The National Cancer Institute and several health authorities recommend that Americans eat at least five daily servings of fruits and vegetables because these foods may help reduce the risk of cancer and other diseases. However, national efforts to increase fruit and vegetable consumption may not reach important subpopulations, such as minorities and lower socioeconomic groups. Buller et al. (p. 1491) conducted a randomized trial testing the effectiveness of education by co-workers at increasing fruit and vegetable intake among lower socioeconomic, multicultural labor and trades employees. Results showed an increase in fruit and vegetable consumption that persisted beyond the trial period but seemed to diminish with time.
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