Cancer

Cancer is an emerging public health problem in Africa because of the aging and growth of the population as well as increases in risk factors associated with urbanization and economic development. There are opportunities for implementing resource level interventions across all stages of the cancer control spectrum from prevention to early detection, treatment, and palliative care to reduce this burden.

Results from this study demonstrate that estrogen receptor status and multifocality after neoadjuvant chemotherapy (NAC) are independent predictors of ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy and that patients who develop IBTR after receiving NAC have significantly worse overall survival.

Because of lower disease incidence and a difference in the age profile of Chinese patients, resources allocated to policies advocating earlier mass screening by mammography for the early diagnosis of breast cancer, instead, could be allocated more effectively and efficiently to patients with breast cancer by funding other breast cancer care-related interventions among Chinese women.

When screening colonoscopy is performed by nongastroenterologist specialists, a relative 11% reduction in long-term colorectal cancer prevention rates may be expected compared with gastroenterologist endoscopists.

With a substantial proportion of patients at risk of disease progression (DP) following nephrectomy for localized renal cell carcinoma, there are 6 ongoing adjuvant trials assessing the efficacy of targeted agents: ARISER, ASSURE, EVEREST, PROTECT, SORCE, and S-TRAC. Although each trial has differing pathologic inclusion criteria, this study found relatively similar and high accuracy in predicting DP. Overall, the ongoing adjuvant trials would include patients who develop DP 43% to 59% of the time and exclude patients who develop DP 6% to 18% of the time during follow-up from this study's retrospective cohort at the Mayo Clinic (Rochester, Minnesota).

On average, old, sick, poor, and Medicare patients are less likely to be treated at high-volume hospitals for uro-oncologic surgery. Selective referral of individuals who are less likely to receive care at such institutions may represent a health care priority intended to optimize outcomes across all population strata.

The presence of oncogenic anaplastic lymphoma kinase fusions was demonstrated in a small subset of non–clear cell type renal cell carcinomas. This confirmed the potential of anaplastic lymphoma kinase inhibitor therapy for renal cell carcinoma.

Circumcision before first sexual intercourse is associated with a reduction in the relative risk of prostate cancer in this study population. The findings of this study are consistent with research supporting the infectious/inflammation pathway in prostate carcinogenesis.

The overall incidence of adenoid cystic cancer is declining. Females, patients with localized disease, and younger patients have significantly better survival across all time periods (all comparison-specific log-rank P values <.001).

Findings in particular tumor sites and stages may reflect the variability that still exists for the treatment of head and neck cancer. The use of taxanes and cetuximab will continue to increase based on new evidence of benefit.

Hypocellular myelodysplastic syndrome (MDS) is not well characterized. The authors present an analysis of the largest cohort so far analyzed of hypocellular MDS and propose a disease-specific prognostic score.

Clofarabine plus low-dose cytarabine induction achieves complete remission in 58% of patients, with an 8-week mortality of 7%. Alternating this combination with decitabine during consolidation produces a median overall survival of 12.7 months and is therefore a valuable option for newly diagnosed patients with acute myeloid leukemia.

The potential role of postoperative radiation therapy for patients with completely resected, stage III nonsmall cell lung cancer who have N2 disease remains controversial. By using several methods to control for selection bias, the results from this study indicate that postoperative radiotherapy is not associated with improved survival in elderly patients with N2 disease.

False cellular negatives explain <100% cellular positivity rates in lung cancer positive for ALK (anaplastic lymphoma kinase) as determined by fluorescence in situ hybridization (FISH). Neither percentage of positive cells nor signal copy number predict for benefit from ALK inhibition in ALK FISH–positive tumors.

By using the Surveillance, Epidemiology, and End Results database, the authors identify an association between Hispanic ethnicity and improved survival among patients with nonsmall cell lung cancer. Hispanic ethnicity also is associated with favorable histologic subtypes.

Patterns of metastatic spread were evaluated in patients with untreated nonsmall cell lung cancer following subclassification by ALK, EGFR, and KRAS. ALK gene rearrangements were associated with metastases to the pericardium, pleura, and liver.

The highest level of lymph node involvement can stratify the outcome of patients with nonsmall cell carcinoma who have pathologic N1 (pN1) lymph node status. Patients who have pN1 status with metastasis limited to segmental/subsegmental (level 13/14) lymph nodes have an intermediate 5-year disease-free survival rate between that of patients who have pN0 status and other patients with pN1 status.

This study of 2942 patients with stage IV melanoma indicates that, in addition to previously established clinical and pathologic factors, a history of multiple primary melanomas is an independent predictor of improved survival. A history of multiple primary melanomas should be incorporated into multivariate analyses of prognostic factors and treatment outcomes in patients with metastatic melanoma.

The authors report evidence of an increased risk of meningioma with exposure to dental x-rays, particularly for individuals who are exposed at a young age or with increased frequency. The results support the 2006 recommendations of the American Dental Association and highlight the finding that moderate use of this common and modifiable exposure may be of benefit to patients.

Patients with supratentorial World Health Organization grade IV glioblastoma in the Surveillance, Epidemiology, and End Results database from 1973 to 2006 are analyzed to determine the rate of radiation therapy utilization. The data show a decreasing utilization of radiation therapy in patients with glioblastoma over the past 16 years. Patients who are older, who are unmarried, and who have undergone biopsy only are less likely to receive radiation therapy.

O⁶-methylguanine-DNA methyltransferase (MGMT) promoter methylation status and low MGMT expression are predictors of improved prognosis in patients with newly diagnosed glioblastoma who undergo surgical resection and receive carmustine-releasing wafer implants followed by a protocol of adjuvant radiotherapy and concomitant oral temozolomide chemotherapy.

Carbon ion radiotherapy for 78 patients with unresectable osteosarcoma resulted in good local control and survival rates, especially for those with tumors <500 cm³. The treatment provided good long-term functional results without unacceptable morbidity.

The authors demonstrate that the cancer-testis antigen NY-ESO-1 is expressed in 100% of myxoid/round cell liposarcoma (MRCL) tumors tested and that MRCL cell lines can be recognized and specifically lysed by NY-ESO-1–specific effectors in vitro. These results establish NY-ESO-1 as an important target antigen for the treatment of patients with MRCL.

Measurements using recent conceptual advances indicate a high proportion of therapeutic misconception (TM) but reveal a complex view of risks and benefits. Continuing to improve understanding of key TM concepts, with attention to risks from nontherapeutic research procedures, is important.

Access to fertility counseling and fertility preservation has increased during the past decade for women in California who are survivors of reproductive age cancers. However, disparities with regard to age, education, ethnicity, gender identity, and parity may mark potential areas for improving access in the future.

This case-control study indicates that several factors play a role in acute myeloid leukemia (AML) predisposition to possible joint effects. The results suggest that AML is a heterogeneous disease with sex-specific and subtype-specific risk factors that need to be considered when developing risk-prediction models.

In children and young adults with osteosarcoma enrolled on North American cooperative group trials, age 18 to 30 years is associated with a statistically significant poorer outcome because of an increased rate of relapse. Poorer outcome in adolescent and young adult patients is not explained by tumor location, a higher incidence of poor histologic response, or metastatic disease at presentation.

The Female Sexual Function Index (FSFI) displays strong psychometric reliability and validity in this first validation of the instrument in cancer survivors. The results support its continued use for monitoring sexual function and cancer-related dysfunction among sexually active female cancer survivors.

We evaluated patient-reported health-related quality of life following proton therapy for prostate cancer in 262 men ≤60 years old. We found that these young men have excellent outcomes with respect to erectile dysfunction, urinary incontinence, and other health-related quality of life parameters during the first 2 years after treatment.

The 2009/H1N1 pandemic caused severe illness in immunocompromised patients with cancer who had solid tumors. The current study indicates that early initiation of antiviral therapy is crucial in this patient population to decrease morbidity and mortality.