© 2000 by Oxford University Press
Journal of the National Cancer Institute, Vol. 92, No. 21, 1699,
November 1, 2000
© 2000 Oxford University Press
IN THIS ISSUE |
Metastatic prostate cancer is incurable, but hormonal and surgical intervention can relieve its symptoms and may prolong life. However, the costs of different treatment modalities for advanced prostate cancer vary widely. Bayoumi et al. (p. 1731), using decision analysis, computer models, and previously published data, evaluated and compared the cost-effectiveness of six androgen-suppression strategies. They estimated that diethylstilbestrol, the least expensive therapy, was also associated with the lowest quality-adjusted survival. Orchiectomy was the second least expensive but gave the highest estimated quality-adjusted survival of the six treatments. The other treatments—luteinizing hormone- releasing hormone agonists, nonsteroidal antiandrogens, and combined androgen blockade strategies—were substantially more expensive than orchiectomy and were associated with lower quality-adjusted survival. The authors conclude that, for men who find it acceptable, orchiectomy is likely to be the most cost-effective androgen-suppression treatment of prostate cancer.
In an editorial, Hillner and Roberts (p. 1704) urge readers to critically examine the source of clinical trial data, meta-analyses, and other factors that can influence cost-effectiveness analyses such as this one.
Fruit and Vegetables and Colorectal Cancer Incidence
Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. Michels et al. (p. 1740) investigated the relationship between fruit and vegetable consumption and subsequent incidence of colon and rectal cancer among women and men in two large cohorts: the Nurses’ Health Study (88,764 women) and the Health Professionals’ Follow-up Study (47,325 men). They found little association between the consumption of fruit, vegetables, or fruit and vegetables combined and the incidence of either colon cancer or rectal cancer. The associations were not modified by vitamin supplement use or smoking habits. The authors conclude that frequent consumption of fruit and vegetables does not appear to protect women or men from colon or rectal cancer.
In an accompanying editorial, Flood and Schatzkin (p. 1706) note that, although some doubt is now cast on the hypothesis that consumption of fruits and vegetables lowers the risk of colorectal cancer, the case is by no means closed. Citing opportunities for improving future studies, they note that, whatever the ultimate outcome regarding colorectal cancer, there are still substantial health advantages to eating a daily allotment of fruits and vegetables.
Risk of Esophageal and Gastric Cancers and Selenium
Many studies have shown that increased levels of serum selenium are associated with a reduced incidence of various cancers. A randomized nutritional intervention trial in Linxian, China, found that participants receiving selenium, ß-carotene, and vitamin E had lower mortality rates from esophageal and gastric cardia cancers than those who did not. In the current study, Mark et al. (p. 1753) examined the relationship between pretrial serum selenium levels in the trial participants and the subsequent risk of developing esophageal, gastric cardia, and gastric noncardia cancers after 5.25 years of follow-up. They found highly statistically significant inverse associations between serum selenium levels and the incidence of esophageal and gastric cardia cancers but not of gastric non-cardia cancers. The investigators conclude that the increased risk of esophageal and gastric cardia cancers associated with low selenium levels was evident regardless of whether the participants received supplemental selenium.
"In the United States, where intervention trials of selenium are in the planning stages, consideration should be given to including populations at high risk for squamous esophageal and [adenomatous] gastric cardia cancers."
—Mark et al.
DNA Repair Capacity and Susceptibility to Lung Cancer
Although tobacco smoke is known to cause lung cancer, only a fraction of smokers develop the disease. To determine whether differential susceptibility to lung cancer reflects differences in the capacity to repair DNA damage caused by carcinogens in tobacco smoke, Wei et al. (p. 1764) examined DNA repair capacity of blood cells in case patients with lung cancer and matched control subjects. The authors found that individuals vary widely in the ability to repair DNA but that repair capacity was statistically significantly lower in case patients overall than in control subjects. Moreover, the risk of lung cancer increased as the DNA repair capacity decreased: Individuals in the lowest quartile of DNA repair capacity had more than four times the risk of lung cancer than individuals in the highest quartile of DNA repair capacity. However, the authors note that, because of interassay variation, DNA repair capacity itself is probably not a sufficiently accurate predictor of lung cancer risk.
"Possible epigenetic influences on [DNA repair capacity] need to be further elucidated in future studies."
—Wei et al.
Making Beef Patties Safer
Concern over recent foodborne outbreaks of gastrointestinal illness in the United States, particularly those caused by a lethal strain of the bacteria Escherichia coli, have led to re-evaluation of methods of cooking meat. Although high-temperature cooking is preferred for inactivating bacteria in meat, high temperatures also tend to result in the production of heterocyclic amines, which appear to be associated with increased risk of cancer in humans. Salmon et al. (p. 1773) attempted to address this problem by cooking beef patties under various combinations of cooking times and temperatures. They found that cooking patties to an internal temperature of 70 °C (158 °F) and turning them frequently—once a minute—resulted in complete inactivation of E. coli, reduced the needed cooking time, and greatly lowered production of heterocyclic amines, especially compared with turning them just once.
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