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© Oxford University Press 2007.
IN THIS ISSUE
Screening Interval and Prostate Cancer IncidenceScreening asymptomatic men for prostate cancer has led to an increase in disease incidence. To determine whether the time between screening visits, the screening interval, has an effect on the rate of cancers detected between screening visits, Roobol et al. (p. 1296) analyzed data from two centers involved in the European Randomized Study of Screening for Prostate Cancer. As part of the study, 4,202 men in Gothenburg, Sweden, underwent screening at 2-year intervals, and 13,301 men in Rotterdam, the Netherlands, underwent screening at 4-year intervals. The 10-year cumulative incidence of prostate cancer was 13.14% in Gothenburg and 8.41% in Rotterdam. The cumulative number of prostate cancers diagnosed during the screening interval, or interval cancers, was 31 (0.74%) in Gothenburg and 57 (0.43%) in Rotterdam; of these, 5 (0.12%) and 15 (0.11%) were considered life-threatening. The authors conclude that although overall prostate cancer incidence was higher with the 2-year screening interval than the 4-year interval, the incidence of interval cancers and aggressive interval cancers was similar.
In an editorial, Crawford (p. 1279) discusses screening as one approach for the increasing prevalence of prostate cancer and notes that more data is needed to determine what type of screening program, if any, is best.
Breast Cancer, Hormone Use, and Mammography Screening
Breast cancer incidence in the United States has been declining in recent years, but the relative contributions of decreases in hormone therapy use and mammography screening to this decline has been unclear. Kerlikowske et al. (p. 1335) analyzed rates of invasive breast cancer and postmenopausal hormone therapy use in women aged 50–69 years who were receiving mammography screening. The data came from more than 600,000 mammography examinations reported to four registries from 1997 through 2003. Annual rates of hormone therapy use declined 7% between 2000 and 2002 and 34% between 2002 and 2003, and annual rates of invasive cancer declined 5% between 2000 and 2003; rates of ductal carcinoma in situ did not change. Annual rates of estrogen receptor–positive invasive cancer declined 13% between 2001 and 2003. Because the study was restricted to screened women, a decline in mammography use is unlikely to have contributed to the decline in invasive breast cancer. Instead, the authors conclude that the decline in hormone therapy use has probably contributed to the breast cancer decline.
Trial of Hypnosis for Surgical Side Effects in Breast Cancer Patients
Hypnosis has been found to reduce pain and anxiety in a number of surgical populations. Montgomery et al. (p. 1304) report that it appears to reduce surgical side effects in breast cancer patients receiving surgical breast biopsy or lumpectomy. In a randomized trial, 200 women received either a 15-minute presurgery hypnosis session or a non-directive listening session, both given by the same group of psychologists. Patients in the hypnosis group required statistically significantly less pain and sedative medication during surgery than control patients. They also reported less pain intensity, pain unpleasantness, nausea, fatigue, discomfort, and emotional upset than control patients; the differences were both statistically significant and clinically meaningful. Patients in the hypnosis group also spent less time in surgery than control patients, which contributed to a reduction in institutional costs.
In an editorial, Spiegel (p. 1280) asks why hypnosis is not more widely used given its benefits, which can include decreased pain, medication use, procedure time, and cost. He notes the ongoing skepticism of physicians, despite a number of plausible neurophysiologic mechanisms to explain how hypnosis reduces pain and pain perception.
UGT1A1*28 Genotype and Irinotecan-Induced Neutropenia
Studies of the association between the UGT1A1*28 genotype and the risk of irinotecan-induced severe neutropenia have been inconsistent. Hoskins et al. (p. 1290) conducted a meta-analysis of 10 sets of patients (821 total) and assessed irinotecan dose, risk of grade III–IV irinotecan-related hematologic toxic effects, and UGT1A1 genotype. For low doses (less than 150 mg/m2, which is in the therapeutic range), the risk was similar among UGT1A1*28/*28 patients and patients with one or two copies of the wild-type allele. However, the risk was greater among UGT1A1*28/*28 patients at medium doses (150–250 mg/m2) and greatest at high (more than 250 mg/m2) doses. The authors conclude that the risk of irinotecan-related hematologic effects for UGT1A1*28/*28 patients is dose related.
OGR1 Acts as a Metastasis Suppressor in Prostate Cancer
Metastasis is the main cause of death among cancer patients. Ovarian Cancer G Protein–Coupled Receptor 1 (OGR1) is expressed at lower levels in prostate tumor metastases than in the primary tumors. To investigate the effects of OGR1 on tumor growth and metastasis, Singh et al. (p. 1313) implanted metastatic human prostate cancer cells containing OGR1 or a control into the prostate lobes of immunocompromised mice. Only four of 32 mice injected with the OGR1 cells developed metastases, whereas all 26 of the mice injected with control cells did. OGR1 expression had no effect on primary tumor growth. The authors conclude that OGR1 is a new metastasis suppressor gene for prostate cancer.
H. pylori Genotype, Gastric Cancer, and Precancerous Gastric Lesions
Chronic Helicobacter pylori infection increases the risk of gastric cancer, but the association between the bacterium and precancerous lesions is less clear. Plummer et al. (p. 1328) genotyped H. pylori in gastric biopsy specimens to determine if they were positive for the cagA gene, a marker for a set of pathogenic H. pylori genes. Advanced precancerous lesions, including dysplasia, were strongly associated with cagA-positive but not cagA-negative H. pylori. The authors suggest that the proportion of gastric cancer attributable to H. pylori may have been previously underestimated due to lack of discrimination of H. pylori infection by cagA status.
Immune Supression and Squamous Cell Carcinoma of the Eye
Squamous cell carcinoma of the eye occurs at increased rates in individuals infected with HIV. Whether immune supression in the absence of HIV infection is associated with this cancer was not known. Vajdic et al. (p. 1340) compared data from Australian transplant and cancer registries and found a statistically significant increase in the incidence of squamous cell carcinoma of the eye among patients who received kidney transplants and had been treated with immunosuppressive drug regimens. The authors thus suggest that squamous cell carcinoma of the eye is an immune deficiency–associated cancer. Because transplant recipients who developed this rare cancer tended to reside in regions of high sun exposure and to have a history of skin cancer, the authors suggest that an interaction between sun exposure and immune suppression may play a role in the etiology of this rare disease.
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Connotea 
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J Natl Cancer Inst 2007 99: 1340-1342.
J Natl Cancer Inst 2007 99: 1296-1303.
J Natl Cancer Inst 2007 99: 1304-1312.
J Natl Cancer Inst 2007 99: 1313-1327.
J Natl Cancer Inst 2007 99: 1335-1339.
J Natl Cancer Inst 2007 99: 1290-1295.
J Natl Cancer Inst 2007 99: 1328-1334.
J Natl Cancer Inst 2007 99: 1279-1280.
J Natl Cancer Inst 2007 99: 1280-1281.
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