© 2005 Oxford University Press
IN THIS ISSUE
Cardiac Death After Adjuvant Radiotherapy for Breast CancerPreviously, it has been noted that breast cancer patients who receive adjuvant radiation have an increased risk of death from ischemic heart disease. In addition, patients with left-sided breast tumors receive a higher dose of radiation to the heart than patients with right-sided tumors. Because radiation techniques have changed in the last few decades, Giordano et al. (p. 419) investigated whether the risk of death from ischemic heart disease after adjuvant breast radiotherapy has decreased over time by comparing ischemic heart disease mortality among patients with left- versus right-sided breast tumors. They found that, for women diagnosed in 1973–1979, there was a difference in 15-year mortality from ischemic heart disease between patients with left-sided versus right-sided breast cancer; no such difference was found for women diagnosed after 1979. After 1979, the hazard of death from ischemic heart disease for women with left-sided versus those with right-sided disease declined by 6% per year.
In an editorial, Cuzick (p. 406) points out that, by comparing patients with left-sided tumors with patients with right-sided tumors, Giordano et al. were able to make a comparison that is rarely possible outside of a clinical trial and that involved a large population of women drawn from routine practice. He notes that the results support conclusions drawn from more recent clinical trials, which have not shown the excess cardiac mortality evident in earlier trials.
HAART, Behavior, and Cancer Risk in an HIV Cohort Study
The risk of cancer is higher in people infected with human immunodeficiency virus (HIV) than in the general population. Clifford et al. (p. 425) examined the effects of behavioral risk factors and highly active antiretroviral therapy (HAART) on cancer risk in 7,304 Swiss HIV-infected men and women. The population had higher risks for Kaposi sarcoma (KS); non-Hodgkin lymphoma; anal cancer; Hodgkin lymphoma; and cancers of the cervix, liver, lip, mouth, pharynx, trachea, lung, bronchus, and skin than the general population. In people treated with HAART, risk was lower for KS and non-Hodgkin lymphoma than in those not treated, and no cases of lung cancer were observed among nonsmokers. The authors conclude that, in people infected with HIV, HAART treatment may prevent most excess risk for KS and non-Hodgkin lymphoma but not that for Hodgkin lymphoma or other non–AIDS-defining cancers.
In an editorial, Engels and Goedert (p. 407) revisit the history of the AIDS epidemic and how the knowledge of cancer and immune diseases has grown since it began. They note that questions remain about the role of immunosuppression in the types of cancer for which infected persons in the United States and in Europe are at higher risk.
Initial Prostate Cancer Screening in the PLCO Trial
Although some medical organizations recommend screening for prostate cancer with serum prostate-specific antigen (PSA) testing and digital rectal examinations (DRE) and many men receive such tests, it is not known whether prostate cancer screening reduces mortality from prostate cancer. The prostate component of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial aims to determine the impact of annual PSA and DRE screening on prostate cancer mortality by comparing a screened arm with a control arm of men undergoing routine medical care. The mortality results will not be available for several years, but on p. 433 of this issue, Andriole et al. report that compliance, biopsy, and cancer detection rates in the PLCO trial all appear to be representative of contemporary practice patterns. Thus, the authors note, the trial is evaluating in a clinically robust manner the question of whether prostate cancer screening reduces mortality from the disease.
Ethnicity and Breast Cancer
Women of minority groups, including African Americans, have a lower incidence of breast cancer than white women, but African American women have higher breast cancer mortality than white women. To investigate whether differences in risk factor distribution explain these differences, Chlebowski et al. (p. 439) examined breast cancer risk factors and outcomes in more than 150,000 post-menopausal women followed prospectively in the Women's Health Initiative. The incidence of breast cancer was lower in all minority groups than in whites, but adjustment for breast cancer risk factors attenuated these differences for all groups except African Americans. Despite the lower incidence of breast cancer in African American women, breast cancers that developed in African Americans were more likely to have unfavorable characteristics (i.e., to be high grade and receptor negative) than those that developed in white women. The reasons for this difference are unknown, but it may explain the higher mortality in African American women.
The BCPT Symptom Scales
Stanton et al. (p. 448) used the Breast Cancer Prevention Trial (BCPT) Symptom Checklist to develop the BCPT Symptom Scales to assess side effects and examine correlates of the derived symptom dimensions among four groups of women participating in different research investigations. The authors identified eight factors corresponding to the physical symptoms associated with cancer treatment, chemoprevention, menopause, and normal aging: hot flashes, nausea, bladder control, vaginal problems, musculoskeletal pain, cognitive problems, weight problems, and arm problems. Demographic and cancer-related variables accounted for up to 15% of the inter-individual variance in how women responded to the symptom scales. The authors conclude that the BCPT Symptom Scales is a valuable tool to assess side effects associated with treatment and prevention of breast cancer.
Aspirin Use, Gene Interaction, and Colorectal Adenoma Risk
Two genetic variants in the uridine diphosphate glucuronosyltransferase 1A6 (UGT1A6) enzyme are associated with reduced aspirin metabolism compared with wild-type UGT1A6 enzymes. Chan et al. (p. 457) conducted a prospective, nested case–control study to determine whether UGT1A6 polymorphisms modified the risk of colorectal adenoma related to regular aspirin use. They found that, among women with variant genotypes, regular aspirin use was associated with a decreased risk of adenoma. In contrast, among women with wild-type UGT1A6 genotypes, regular aspirin use was not associated with a reduced risk of adenoma at any dose of aspirin examined. The authors conclude that women with functional UGT1A6 variants may obtain differential benefit from aspirin chemoprevention of adenoma.
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