© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 13, 1025,
July 5, 2000
© 2000 Oxford University Press
IN THIS ISSUE |
Menopausal symptoms such as hot flashes, vaginal dryness, and urinary incontinence are common in breast cancer survivors and cannot be managed with standard estrogen replacement therapy. Ganz et al. (p. 1054) tested in a randomized study the efficacy of a comprehensive menopausal assessment intervention program in achieving relief of symptoms, improving quality of life, and improving sexual function in breast cancer survivors who had at least one severe target symptom. Psychosocial symptoms were assessed with the use of a self-report screening instrument. Compared with the usual-care group, patients receiving the intervention demonstrated statistically significant improvement in menopausal symptoms and sexual functioning but no significant change in vitality or quality of life. The authors conclude that a clinical assessment and intervention program for menopausal symptom management in breast cancer survivors is feasible and acceptable to patients.
In an editorial, Loprinzi and Barton (p. 1028) agree with the conclusions of Ganz et al. and discuss the strengths of the study. They also point out some limitations, which include the absence of a placebo control, the inability to sort out the individual effects of different components of the program, and the limitations of transferring the intervention to other clinical sites.
VEGF Transcription in Cancer Cells
Interactions between tumor cells are important in tumor growth and progression. Production of vascular endothelial growth factor (VEGF), an important factor in the growth of new blood vessels (angiogenesis) in tumors, can be induced by cell–cell contact, but less is known about the signaling pathways that mediate this process. Sheta et al. (p. 1065) studied the conditions under which VEGF is transcribed in normal and malignant prostate cells. They found that direct cell–cell contact was required for transcription of VEGF in malignant cells, but such contact did not induce VEGF in normal cells. Two other proteins, FRNK and Rap1, were key signaling molecules in this process. The authors conclude that these results shed light on some of the cellular processes required for tumor angiogenesis.
In an accompanying editorial, Ellis and Gallick (p. 1030) point out that redundant pathways leading to transcription of VEGF can help ensure the survival of tumors. The existence of multiple pathways, they note, complicates the task of finding effective therapies that are not toxic to the host.
Paclitaxel and Quality of Life in NSCLC
Non-small-cell lung cancer (NSCLC), the most common form of lung cancer, is often diagnosed at a late stage. Although the main focus of care at this stage is on relief of symptoms, some studies have shown that chemotherapy may modestly improve survival; however, these studies often have not addressed quality-of-life issues. Ranson et al. (p. 1074) compared NSCLC patients randomly assigned to receive either paclitaxel in addition to best supportive care with patients who received best supportive care alone. They found that the group treated with paclitaxel had modestly increased survival compared with the group receiving best supportive care only (median, 6.8 versus 4.8 months). Some aspects of quality of life were somewhat better in the paclitaxel group. The authors suggest that paclitaxel plus supportive care could be used as the control arm in future studies.
"This study provides important evidence that survival among patients with advanced NSCLC can be statistically significantly improved by the addition of single-agent paclitaxel to best supportive care."
—Ranson et al.
Breast Density and Interval Cancer
Screening mammography can reduce mortality from breast cancer, but some breast cancers cannot be detected by mammography. Mandelson et al. (p. 1081) investigated whether breast density is related to the risk of interval cancer (cancer diagnosed after a negative mammogram and prior to the next scheduled screening mammogram). The authors found that that mammographic sensitivity, or the ability of mammography to detect a cancer, was 80% among women with predominantly fatty breasts but just 30% among women with extremely dense breasts. They also found that, for women in the highest category of breast density, the odds of interval cancer were sixfold greater than those for women in the lowest density group. They conclude that breast density appears to be a major risk factor for interval cancer.
BRCA1 and p53 Mutations in Ovarian Cancer
Neither loss of heterozygosity for BRCA1 nor mutations of the p53 gene have been documented in preinvasive lesions of the ovary arising in women with germline BRCA1 mutations. Such documentation is difficult because lesions are rarely identified in ovarian epithelium. Werness et al. (p. 1088) looked for loss of heterozygosity in the regions of the BRCA1 and p53 tumor suppressor loci in an incidental carcinoma in situ of the ovary removed prophylactically from a woman with a germline BRCA1 mutation. Two markers linked to p53 as well as an intragenic BRCA1-linked marker showed loss of heterozygosity. Strong immunostaining for p53, indicating mutated p53, was seen confined to the atypical epithelium. On the basis of these findings, the authors conclude that a loss of function of these two tumor suppressor genes occurs early in ovarian carcinogenesis in BRCA1 mutation carriers.
Breast Cancer Screening and X-ray Scattering
Analysis of x-ray diffraction patterns of scalp and pubic hair has been previously reported as a possible novel screening method for breast cancer. However, follow-up studies have reported conflicting results. Meyer et al. (p. 1092) used a recently developed small-angle x-ray scattering system to determine whether they could detect different diffraction patterns from the pubic and scalp hair of women with breast cancer and the same hair types from healthy women. These authors report that they did not detect statistically significant differences in the diffraction patterns of these hair types between the two groups of women. They conclude that the x-ray diffraction pattern of these hair types is not an indication of either breast cancer or breast cancer susceptibility.
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