© 2003 by Oxford University Press
© 2003 Oxford University Press
IN THIS ISSUE |
In the Annual Report to the Nation on the Status of Cancer, Weir et al. (p. 1276) update statistics on lung, female breast, prostate, and colorectal cancers and highlight the uses of selected surveillance data to assist development of state-based cancer control plans. The authors note that observed cancer incidence rates for all cancer sites combined increased from the mid-1970s through 1992, decreased from 1992 through 1995, and were essentially stable from 1995 through 2000. The delay-adjusted trend showed an increase that had borderline statistical significance. Death rates for all cancer sites combined decreased beginning in 1994 and stabilized from 1998 through 2000, resulting in part from recent revisions in cause-of-death codes. Analysis of state data for the leading cancers revealed mixed progress in achieving national objectives for improving cancer screening, risk factor reduction, and decreases in mortality.
In an editorial, Quinn (p. 1258) compares the U.S. incidence and mortality data for the four major cancers with those from Europe. He comments on the trends and potential future reductions in cancer mortality within the context of the points of the European Code Against Cancer.
Randomized Trial of Clodronate for Metastatic Prostate Cancer
Prostate cancer frequently metastasizes to bone. In patients with other diseases, bisphosphonate treatment is associated with a reduction in excessive bone turnover while preserving bone structure and mineralization. Dearnaley et al. (p. 1300) conducted a randomized, double-blind, placebo-controlled trial to determine whether the first-generation bisphosphonate sodium clodronate could improve bone progression–free survival (BPFS) among men with prostate cancer bone metastases. The authors found that, compared with the placebo control group, the sodium clodronate group had better symptomatic BPFS and overall survival, but those differences were not statistically significant. Although after treatment the clodronate group was less likely than the control group to have a poorer performance status, the clodronate group reported more adverse events. The authors conclude that further studies of the effect of newer generation bisphosphonates on BPFS in men with metastatic prostate cancer are warranted.
In an editorial, Saad (p. 1262) discusses the rationale for using bisphosphonates to improve BPFS and the factors that may affect the efficacy of clodronate in preventing bone progression in metastatic prostate cancer.
Oxidative Damage DNA Repair Activity and Lung Cancer Risk
Although smoking causes lung cancer, only a proportion of smokers develop lung cancer, suggesting a genetic predisposition in some individuals. Because tobacco smoking is associated with the increased formation of DNA lesions, including those induced from oxidative damage, Paz-Elizur et al. (p. 1312) investigated whether the activity of the DNA repair enzyme 8-oxoguanine DNA N-glycosylase (OGG) is associated with lung cancer. The authors found that OGG activity was lower in peripheral blood mononuclear cells from case patients than in those from control subjects. After adjustment for age and smoking status, individuals in the lowest tertile of OGG activity had an approximately fivefold increased risk of non–small-cell lung cancer compared with individuals in the highest tertile. The authors suggest that smoking cessation in individuals with reduced OGG activity might be an effective strategy in lung cancer prevention.
In an editorial, Caporaso (p. 1263) provides an overview of the categories of questions that can be asked in molecular epidemiology studies that evaluate the role of oxidative damage to DNA in cancer.
First-Line Therapy for Treatment of Ovarian Cancer
Despite improvement in the treatment of advanced ovarian cancer, the optimization of efficacy and tolerability of these treatments remains an important issue. Du Bois et al. (p. 1320) performed a randomized non-inferiority trial comparing cisplatin plus paclitaxel (PT) with carboplatin plus paclitaxel (TC) in 798 women with advanced ovarian cancer. They found that the proportion of patients without disease progression at 2 years was not statistically significantly different between the treatment arms. They also found that, although the TC regimen was associated with a higher frequency of hematologic toxicities, it was associated with a lower frequency of gastrointestinal and neurologic toxicities and better quality-of-life scores than the PT regimen. The authors conclude that the TC regimen achieved comparable efficacy to the PT regimen but was associated with better tolerability and quality of life and, hence, should be considered as an alternative for first-line therapy in ovarian cancer patients.
Transfusion-Associated Transmission of HHV-8
Although human herpesvirus 8 (HHV-8), the etiologic agent for Kaposi’s sarcoma, can be detected in peripheral blood, blood-borne transmission of the virus has not been demonstrated. Mbulaiteye et al. (p. 1330) studied the association between HHV-8 seropositivity and transfusion history among children with sickle-cell disease in Uganda, where HHV-8 infection is common in blood donors. The authors found that HHV-8 seropositivity was more frequent in children who had received transfusions than in those who never had transfusions, and that seropositivity increased with the number of reported transfusions. Overall, the estimated HHV-8 transmission risk was 2.6% per transfusion, whereas the annual risk of infection unrelated to transfusion was 2.7%. The authors conclude that the risk of HHV-8 transmission from blood transfusions is approximately equivalent to the 1-year cumulative risk of infection from community sources.
HPV Status and Cervical Lesion Development
Cervical cancer results from a series of reversible changes in the cervical tissue. A biomarker that could predict the duration of a cervical lesion or the speed of its progression or regression would be useful for identifying women whose lesions are likely to progress quickly to more advanced stages. In this issue, Schlecht et al. (p. 1336) report that the type of human papillomavirus (HPV) infecting the cervical tissue may serve as such a biomarker. Using data from a longitudinal study of HPV infection and cervical neoplasia in Brazil, the authors found that precursor lesions of the cervix persisted longer, progressed more rapidly, and regressed more slowly in women infected with an oncogenic HPV type than in women infected with a non-oncogenic HPV type or in women with no HPV infection. The authors suggest that HPV testing of women with abnormal Pap smears may help identify women who might benefit from chemopreventive treatment.
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