© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 9, 639,
May 1, 2002
© 2002 Oxford University Press
IN THIS ISSUE |
In premenopausal women with breast cancer, it is unclear whether the phase of the menstrual cycle in which surgical treatment occurs influences the disease-free and overall survival. Love et al. (p. 662) investigated this question in a population of Chinese and Vietnamese women participating in a randomized clinical trial comparing mastectomy alone with mastectomy plus adjuvant oophorectomy and tamoxifen. The authors found that, for women who received mastectomy alone, the phase of the menstrual cycle did not affect disease-free and overall survival. However, women who received mastectomy and adjuvant oophorectomy and tamoxifen who had surgery during the luteal phase of the menstrual cycle phase had statistically significantly better disease-free and overall survival compared with women who had surgery during the follicular phase. The authors conclude that host factors associated with menstrual cycle phase may influence outcomes from simultaneous mastectomy and surgical oophorectomy.
In an accompanying editorial, Hortobagyi (p. 641) discusses the development and testing of hypotheses regarding the timing of surgical interventions for breast cancer in light of the controversies that surround this procedure relative to the phase of the menstrual cycle.
Interventions for Promoting Pap Testing Among Ethnic Minorities
Chinese women living in North America have higher rates of invasive cervical cancer compared with non-Latino white women. Studies suggest that cervical cancer screening rates are low in this ethnic group. To investigate an effective way of promoting Pap testing in Chinese-American women, Taylor et al. (p. 670), evaluated an outreach worker-based intervention and a direct mail intervention in a randomized controlled trial. Women either received a "home-visit" by an outreach worker and were given an instructional video and educational brochures and fact sheets or they received these materials in the mail. A control group received usual care only. At follow-up 6 months later, 39% of women in the outreach worker-based group reported that they had a Pap test in the previous 6 months, compared with 25% of women in the direct mail group and 15% of women in the control group. The authors conclude that culturally and linguistically appropriate interventions can improve Pap testing levels among Chinese women in North America.
Hodgkin’s Lymphoma and Infectious Mononucleosis
Young adults who have had infectious mononucleosis caused by Epstein-Barr virus (EBV) have an increased risk for Hodgkin’s lymphoma. To determine whether the association between these diseases is affected by high socioeconomic status, which is associated with both diseases, Hjalgrim et al. (p. 678) investigated whether first-degree relatives of patients with confirmed cases of EBV-related infectious mononucleosis were at increased risk for Hodgkin’s lymphoma. They found that these relatives were not at increased risk for Hodgkin’s lymphoma. The authors conclude that socioeconomic confounding is an unlikely explanation for the association between EBV-related infectious mononucleosis and Hodgkin’s lymphoma.
p53 Mutations, Lung Cancer Susceptibility, and Ethnicity
Mutations in the p53 tumor suppressor protein have been associated with inherited cancer susceptibility. Because there is a difference in the risk of lung cancer among different ethnic groups, Wu et al. (p. 681) examined associations between three p53 polymorphisms and the risk of lung cancer in Caucasians, African-Americans, and Mexican-Americans. The authors found that there was an association between the frequency of each polymorphism and ethnicity, with variant alleles present most often in African-Americans and least often in Mexican-Americans. Each polymorphism was associated with an increased risk of lung cancer. The authors also determined that presence of the polymorphisms was associated with alterations in p53 function. They conclude that p53 polymorphisms may be associated with increased lung cancer risk and may affect p53 function.
Host Circadian Clock and Control of Tumor Progression
The circadian timing system, controlled in the central nervous system by the suprachiasmatic nuclei (SCN) of the hypothalamus, regulates daily rhythms of motor activity and adrenocortical secretion. Alteration in these rhythms is associated with poor survival of patients with metastatic colorectal or breast cancer. Filipski et al. (p. 690) developed a mouse model to investigate the consequences of severe circadian dysfunction on tumor growth. The SCN of mice were destroyed and body activity, plasma corticosterone levels, and circulating lymphocyte counts were measured. Mice were inoculated with implants of one of two types of tumors. In mice with complete SCN destruction, the 24-hour activity cycle was ablated and the daily rhythms of serum corticosterone level and lymphocyte count were markedly altered. These mice also showed faster tumor growth and shorter survival than the control mice. The investigators conclude that the host circadian clock may play an important role in endogenous control of tumor progression.
Patient Adherence to Oral Drug Therapy
Many new anticancer drugs are orally administered, in contrast to more traditional chemotherapy drugs, most of which are delivered intravenously. Although orally administered drugs are more convenient for patients, the increasing use of such drugs raises the issue of patient adherence to prescribed drug regimens. Partridge et al. (p. 652) review current knowledge about patient adherence to oral medications in general, addressing factors that are associated with adherence and methods for measuring adherence. They also review published studies of adherence to antineoplastic drugs in both adult and pediatric populations. The authors conclude that future efforts should focus on ways to improve measurements and predictions of adherence and on developing interventions to improve adherence, both in clinical trials and in standard practice.
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