ONCOLOGY Vol 10 No 10

Using a new molecular test, investigators at The Johns Hopkins University School of Medicine have detected genetic mutations specific to cancer in blood samples of six patients with head and neck cancer. Their findings are reported in the September issue of Nature Medicine.

The premise of Steen's book is that nearly everyone is confused about cancer prevention. The public, for whom the book is written, is the most confused, but cannot be faulted. According to Steen, the responsibility for their confusion lies with scientists and the press. Scientists make mistakes by reporting preliminary data from inadequate and mostly "workmanlike, undistinguished" (page 3) studies. The press, in turn, repeats these mistakes, adds some of its own, and so oversimplifies a complex topic that the public, in the end, receives "unconnected facts, partial truths, and outright lies" (page 3).

Researchers at Duke University Comprehensive Cancer Center have found that a newly identified liver cancer gene is also defective in more aggressive breast tumors that may not respond to certain common types of chemotherapy.

Reducing the prevalence of cigarette smoking among adults to no more than 15% is one of the national health objectives for the year 2000 (objective 3.4). To assess progress toward meeting this objective, the CDC analyzed self-reported information about cigarette smoking among US adults contained in the Year 2000 Objectives Supplement of the 1994 National Health Interview Survey (NHIS-2000). This report summarizes the findings of this analysis, which indicate that, in 1994, 25.5% (48.0 million) of adults were current smokers and that the overall prevalence of current smoking and estimates for sociodemographic subgroups were unchanged from 1993 to 1994.

Scientists searching for molecular clues to cancer have produced a detailed picture showing how a key protein blocks a central promoter of cell growth involved in virtually all human cancers. The discovery sets the stage for developing drugs to mimic the protein, called p27, with the hope of halting the uncontrolled cell division that ultimately leads to the formation of tumors.

Young tobacco farmers, feeling the heat from tobacco imports, increased regulation, and public health concerns, are interested in diversifying their crops, according to a recently completed survey sponsored by The Robert Wood Johnson Foundation (RWJF).

The Moran article presents an excellent summary of the malignancies associated with HIV. The diagnosis of an HIV-related malignancy places additional stress on an already compromised immune system. Neoplasms arising in AIDS patients tend to be aggressive, and because of the immunocompromised state of these patients, they are unable to tolerate the side effects of the various modalities used in treatment.

A recent survey of 224 hospitals nationwide, conducted by health-care management consulting firm TriBrook/AM&G, revealed that the number of hospitals pursuing managed-care affiliations is growing quickly, outpacing the growth in mergers and acquisitions.

Researchers at the Howard Hughes Medical Institute at Duke University Medical Center have shown how drugs that stop organ transplant rejection also partially reverse drug resistance in certain cancer cells.

At the 4th International Conference of Head and Neck Cancer held in Toronto, Canada, Robert H. Maisel, md, an otolaryngologist at the University of Minnesota Cancer Center, advocated performing tracheoesophageal puncture (TEP) at the time of surgical removal of the voice box due to cancer. While the voice-rehabilitating surgical procedure has been part of the cancer operation since 1985, it has traditionally been performed several months after removal of the larynx.

Oncologists still have no screening test that reliably can detect ovarian cancer in its early stages, and recent genetic advances, while shedding new light on the disease, have further complicated the issue.

Medical College of Wisconsin researchers recently reported on a study linking Helicobacter pylori to precancerous lesions of the stomach. By infecting specially bred mice with H pylori and showing the resulting precancerous changes in their stomachs, the researchers have uncovered an important clue to the origins of stomach cancer. Their results are the closest evidence to date showing that H pylori causes stomach cancer in any animal model.

Cancer is a genetic disease wherein mutations of growth regulatory genes result in abnormal proliferative capacity, recognized clinically as the occurrence of a malignant tumor. Transcription factors govern the expression of genes, be they "housekeeping" or regulatory. These factors organize the first crucial step in establishing the function of the gene, namely, the transcription of information in DNA into messenger RNA (mRNA). Translation of mRNA results in the synthesis of the oncogenic protein. Hence, the design of therapeutic agents targeted at transcription factors regulating the initial flow of "bad" information from "damaged" genes should be the ultimate goal of efforts to develop new weapons in the therapeutic armamentarium of the oncologist and, indeed, the general internist.

elloff and colleagues have been key players in the recent development of chemoprevention strategies--as initiators of their own studies and minders of others. The succinct summary of their approach is of particular value to oncologists, both because it provides a great deal of data on the current state of chemoprevention research itself and because it draws some useful distinctions between chemoprevention and chemotherapy.

The article by Kelloff et al is a useful, comprehensive review of the current strategy underlying the development of clinically useful chemoprevention agents. One important topic that is not addressed in the article is the failure of micronutrients (selected on the basis of favorable epidemiologic finding) when tested as chemopreventive agents in clinical trials. Two examples of this are particularly noteworthy: In two large randomized trials involving heavy current or former smokers, b-carotene supplementation resulted in an increase in lung cancers compared to placebo.[1,2] Also, in two large randomized trials, folic acid supplementation had no effect on the natural history of cervical intraepithelial neoplasia.[3,4]

Dr. Paulino has written an excellent review of our present knowledge of Wilms' tumor. Not everyone would agree, however, that ultrasound has replaced the intravenous pyelogram (IVP). The National Wilms' Tumor Study Group (NWTSG) recommends IVP together with real-time ultrasonography as the preoperative imaging studies for the abdomen.[1] The former is used to establish the presence of a functioning opposite kidney and of any congenital abnormality. The latter identifies the presence and status of inferior vena cava thrombi.

Moran provides a comprehensive overview of the myriad nursing challenges posed by patients who have a dual diagnosis of HIV disease and cancer. At least two factors make it imperative for nurses to become increasingly proficient in the care of patients with HIV-related malignancies. First, it is now estimated that 1 in every 250 people in this country is infected with HIV, with the largest increases occurring in heterosexual men and women.[1] Second, patients with HIV disease are being seen in virtually all health-care settings, and many dedicated oncology and HIV/AIDS services are now being mainstreamed into general medical services. Thus, nurses who may have had little experience with this patient population in the past are now much more likely to encounter these patients.

This well-written article can benefit only from reinforcement of a few of its major points, some supplemental discussion about the important role of biologic models in understanding and managing breast cancer development, and a note about the critical need for research and perspectives from the social sciences concerning this subject. I say "only" because this article beautifully and clearly explores some of the language of epidemiology critical to the subject, language which is becoming increasingly important in routine medical practice. Practitioners and, increasingly, the public (medical "consumers") are concerned with risks and numbers.

Dr. Paulino provides an excellent summary of current knowledge about Wilms' tumor and its treatment. He stresses the need to improve treatment for those with aggressive tumors and possibly avoid adjuvant treatment in a subset of patients.

Paulino has thoughtfully reviewed the etiology, diagnosis, and management of Wilms' tumor. Investigators from the National Wilms' Tumor Study Group (NWTSG) first divided Wilms' tumors into two groups: those with a favorable histology and those with an unfavorable histology.[1]

Significant advances have been made in the treatment of children with Wilms' tumor. Whereas 50 years ago overall survival was less than 10%, current survival estimates approach 90%. This progress has been made

As many as 40% of individuals infected with HIV will be diagnosed with a malignancy during the course of their illness. Although neoplasms of all organ systems have been reported in infected patients, Kaposi's sarcoma (KS),

Strategies for chemopreventative drug development are based on the use of well-characterized agents, intermediate biomarkers correlating to cancer incidence, and suitable cohorts for efficacy studies. Since

Physicians screening African-American men for prostate cancer should use different cut-off points for a popular blood test because they will accurately detect 95% of cases in this high-risk group, according to a study published in the August 1 issue of The New England Journal of Medicine. The revised normal values for the prostate-specific antigen (PSA) test are based on a new diagnostic strategy and age-specific ranges for African-Americans, who have the world's highest prostate cancer rate.

In a study of Olestra, the fat substitute recently approved for human consumption by the FDA, researchers from Pennsylvania State University concluded that human taste buds apparently don't detect the difference between the low-calorie fat replacer and regular fat when used in potato chips.

The cost-effectiveness of needle-exchange and other HIV prevention programs will be studied at Stanford and several other research centers, funded by a 5-year grant from the National Institute on Drug Abuse.

Cells respond to external signals by either activating or inhibiting key regulatory proteins of gene expression called transcription factors (TFs). Abnormal expression of these factors plays a critical role in many human

Available data show that women tend to overestimate their risk of developing breast cancer. Available models allow for the rapid identification of women who are at increased risk for breast cancer, along with a quantitative