© 2005 Oxford University Press
IN THIS ISSUE
Annual Report on Cancer in the United StatesIn the Annual Report to the Nation on the Status of Cancer, Edwards et al. (p. 1407) update statistics for the 15 most common cancers in the five major racial/ethnic populations in the United States and highlight population-based trends in cancer treatment. They report that incidence rates for all cancer sites combined were stable from 1995 through 2002 for men but increased by 0.3% annually from 1987 through 2002 for women. Death rates in men and women combined decreased by 1.1% annually from 1993 through 2002 for all cancer sites combined and also decreased for many of the 15 most common cancers. Among women, lung cancer death rates increased from 1995 through 2002, but lung cancer incidence rates stabilized from 1998 through 2002. Results of cancer treatment studies suggest that geographic, economic, racial/ethnic, and age-related disparities in treatment persist even though the dissemination of guideline-based treatment into the community has improved.
Absolute Breast Cancer Risk After Hodgkin Lymphoma
Because many women develop breast cancer after chest radiotherapy for Hodgkin lymphoma (HL) at a young age, Travis et al. (p. 1428) estimated this future risk of breast cancer. They found that cumulative absolute risks of breast cancer increased with age at end of follow-up, time since HL diagnosis, and chest radiation dose but were lower in women treated with alkylating agents. For example, an HL survivor treated at age 25 years with a chest radiation dose of at least 40 Gy without alkylating agents had an estimated cumulative absolute risk of breast cancer by age 55 years of 29%. The authors conclude that their projected breast cancer risks are applicable for HL survivors treated with regimens of the past but should be used with caution for HL patients treated with more recent approaches, including limited-field radiotherapy and ovary-sparing chemotherapy.
In an editorial, Longo (p. 1394) compares the 29% cumulative absolute risk of breast cancer at age 55 years for a 25-year-old woman who received typical radiation therapy for HL with the 3% risk for a 25-year-old woman in the general population. He notes that overall survival after combined radiation therapy and chemotherapy is not superior to that after chemotherapy alone. He concludes that radiation therapy for HL should not be used routinely.
Thymidylate Synthase–Directed Poly-Epitopic Peptide Vaccine
Chemotherapeutic agents such as 5-fluorouracil (5-FU) inhibit thymidylate synthase (TS) expression, which is often increased in cancer cells. However, tumor cells are known to become resistant to 5-FU. To determine whether this treatment limitation could be overcome using a peptide vaccine, Correale et al. (p. 1437) evaluated mice vaccinated with a multiepitope peptide, TS/PP, for TS-directed cytotoxic T-lymphocyte (CTL)-response and anti-tumor activity. They report that in mice vaccinated with TS/PP and subsequently inoculated with TS-expressing lymphoma cells, tumor formation was either delayed or prevented, especially when the mice were also treated with 5-FU. The authors conclude that TS/PP could induce a tumor-specific response in mice and suggest that such a vaccine could have clinical application in humans.
In an editorial, Allegra and Childs (p. 1396) note that the vaccine approach described by Correale et al. would be remarkable if translated into the management of human cancer. However, they caution that this approach requires additional preclinical study of potential barriers to clinical use in patients.
Breast Feeding in Infancy and Subsequent Adult Cancer Risk
Exposures to environmental factors in infancy may influence cancer risk later in life. For example, breast feeding is associated with height and IGF-1 levels in later childhood, and height and IGF-1 levels have been associated with the risk of some adult cancers. Martin et al. (p. 1446) report two sets of analyses of the possible association between breast-feeding and adult cancer risk. One is a 65-year follow-up of the Boyd Orr cohort, which was established in Britain in the late 1930s; the other is a meta-analysis of published studies (including Boyd Orr) of the association between breast cancer and having been breast-fed. Neither analysis showed an association between having been breast-fed and incidence of either all cancers or of cancer at specific sites, including breast cancer. The meta-analysis did show a reduced risk of premenopausal breast cancer in breast-fed women, but the authors caution that the observed reduction may have arisen by bias or chance.
Meat Intake and Pancreatic Cancer Risk
Few modifiable risk factors for pancreatic cancer have been identified. Several case–control studies have suggested that meat and other animal products may be associated with increased risk of pancreatic cancer, either through fat or cholesterol or through carcinogens produced as a byproduct of cooking meat, but the findings have been inconsistent. To examine the association between meat and fat intake and pancreatic cancer risk in more detail, Nöthlings (p. 1458) used prospective data from a large cohort study, the Multiethnic Cohort Study. During 7 years of follow-up, almost 500 members of the nearly 200,000-person cohort developed pancreatic cancer. The authors observed increases in pancreatic cancer risk with increasing intake of processed meat, pork, and total red meat. However, there were no associations with intake of poultry, fish, dairy products, eggs, total fat, saturated fat, or cholesterol. The authors note that the risk associated with meat intake is more likely to reflect meat preparation methods than fat intake.
Hematopoietic Cancer Family History and Lymphoma Risk
Because a family history of hematopoietic malignancy is associated with an increased risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma but the magnitude of the risk is unclear, Chang et al. (p. 1466) estimated the association between familial hematopoietic cancer and risk of lymphoma using validated family data from the Swedish Multi-Generation Register and Cancer Register. They found that a history of hematopoietic malignancy in any first-degree relative was associated with an approximately twofold increased risk of all NHL, common B-cell NHL subtypes, and Hodgkin lymphoma. No statistically significant heterogeneity in NHL risk was observed in association with environmental factors between individuals with and without familial hematopoietic malignancy. The authors conclude that their data confirm the association between a family history of hematopoietic malignancy and the most common types of lymphoma.
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