ONCOLOGY Vol 10 No 3 | Oncology

Trends in Cancer Screening-United States, 1987 and 1992

March 01, 1996

Screening methods and programs are critical strategies for the early detection and timely treatment of some cancers. Established methods for early detection of cancer include mammography, clinical breast examination (CBE), the Papanicolaou (Pap) test, proctosigmoidoscopy, fecal occult blood test (FOBT), and digital rectal examination (DRE). To examine changes in the reported use of selected cancer screening tests, the National Cancer Institute analyzed data from CDC's National Health Interview Survey (NHIS) for 1987 and 1992 to calculate rates of use and compared these rates with the national health objectives for the year 2000. This analysis suggests that, although the use of these tests increased, substantial progress is needed to meet the objectives.

Economic Savings and Costs of Periodic Mammographic Screening in the Workplace

March 01, 1996

This paper is a very interesting economic analysis of workplace mammography screening programs. Especially important is the discussion of the effect of disease prevalence on the cost-effectiveness of workplace screening programs.

Book Review: Dr. Susan Love's Breast Book, 2nd Edition

March 01, 1996

Since the initial publication of Dr. Susan Love's Breast Book 5 years ago, every oncologist has seen this guide in the arms of many patients. When I read the cover to the second edition, stating that the book was "fully revised," I could not imagine how the universally excellent first edition could have been improved. The original text, in fact, remains essentially unchanged in the second edition. What has changed is the addition of some 138 pages addressing recent developments or expanding on various issues.

Trends in Smoking Initiation Among Adolescents and Young Adults-United States, 1980-1989

March 01, 1996

The evaluation of efforts to prevent tobacco use among adolescents requires accurate surveillance of both smoking prevalence and smoking initiation rates. Although several surveillance systems provide timely data about adolescent smoking prevalence, data characterizing rates of smoking initiation among adolescents have been limited. To improve characterization of trends in smoking initiation among young persons, data from the Tobacco Use Supplement of the 1992 and 1993 Current Population Surveys (CPS) were used to estimate smoking initiation rates for persons who were adolescents (age 14 to 17 years) or young adults (age 18 to 21 years) during 1980 to 1989. This report summarizes the results of that analysis.

Pilot Study Points to Possibly Improved NSCLC Survival With Simultaneous Chemo/RT

March 01, 1996

The delivery of chemotherapy simultaneously with radiotherapy may be the optimal way to improve survival in patients with non-small-cell lung cancer (NSCLC). The median survival time of the 79 patients in a nonrandomized pilot trial (RTOG 91-06) was 19 months.

DaunoXome Shows Promise as Breast Cancer Treatment

March 01, 1996

Data presented at the 18th Annual San Antonio Breast Cancer Symposium in Boulder, Colorado, shows that moderate-dose DaunoXome, NeXstar Pharmaceuticals' liposomal formulation of daunorubicin, is well-tolerated and has promising efficacy in treating advanced breast cancer. Moreover, the limited toxicity observed in this trial, particularly the absence of cardiotoxicity, suggests that DaunoXome may be useful in ameliorating the side effects that accompany high-dose anthracycline-based chemotherapy for metastatic breast cancer. The data, generated in a phase II study funded by NeXstar, were presented by P.S. Hupperets, MD, of the Akademisch Ziekenhuis, in Maastricht, The Netherlands.

New Agent Blocks HIV Integrase, Another Target for Anti-AIDS Therapy

March 01, 1996

Researchers at Aronex Pharmaceuticals, the Katholieke Universiteit Leuven, the National Cancer Institute, the University of California at San Francisco, and the Southern Research Institute reported laboratory results indicating that AR-177, a new anti-HIV drug, inhibits viral production through a pathway distinct from other established and experimental approaches. The studies were reported in the November 1995 issue of Antimicrobial Agents and Chemotherapy.

Topotecan Demonstrates Significant Activity in Small-Cell Lung Cancer

March 01, 1996

Topotecan HCl, an investigational anticancer drug, has demonstrated significant antitumor activity in previously treated small-cell lung cancer (SCLC) patients, according to European Organization for Research and Treatment of Cancer (EORTC) researchers, who presented phase II trial data at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

Xerostomia as a Complication of Cancer Treatment

March 01, 1996

Cancer is a devastating, life-altering disease. As our technology and knowledge base for the treatment of carcinomas expand, however, more and more patients' lives are being spared or prolonged. Unfortunately, the quality of life for many of these

Irinotecan Shown to Be Effective Against Colorectal Cancer

March 01, 1996

Irinotecan {Campo} a new anticancer agent developed by Rhone -Poulenc Rorer Inc, demonstrates significant activity in the treatment of advanced colorectal cancer, according to research presented at the Eighth Annual European Cancer Conference (ECCO-8) in Paris.

Docetaxel Said to Be Highly Effective and and Well Tolerated in Advanced Head and Neck cancer.

March 01, 1996

Docetaxel {Taxotere) demonstrated significant activity and was well tolerated in the treatment of advanced head and neck cancer, according to preliminary results of a phase II clinical trial presented at the Eighth Annual European Congress for Clinical Oncology (ECCO-8) in Paris.

Trial of Topotecan as First - Line Treatment for Ovarian Cancer Announced

March 01, 1996

SmithKline Beecham plans to launch a study of topotecan HCl, an investigational anticancer drug, in combination with cisplatin (Platinol) for the first-line treatment of ovarian cancer. The development of this protocol was announced at the Eighth European Conference on Clinical Oncology, Cancer Research and Cancer Nursing (ECCO-8) in Paris.

Isolation of New Transmissible Herpesvirus Suggests Additional Therapeutic Approaches for KS

March 01, 1996

A study demonstrating the existence of a new transmissible herpesvirus may lead to additional therapeutic approaches for Kaposi's sarcoma (KS), a cancer that remains one of the major AIDS-associated malignancies. The study findings were reported at The American Society of Hematology's 37th Annual Meeting in Seattle.

Does Neck Stage Predict Local Control After Irradiation for Head and Neck Cancer?

March 01, 1996

The review by Mendenhall et al presents selected papers pertinent to the effect of metastatic nodes on local control in patients with head and neck cancer. These data are retrospective and, as the authors point out, do not resolve the matter.

Should We Recommend Screening Mammography for Women Aged 40 to 49?

March 01, 1996

Esserman and Kerlikowske have done an excellent job in reviewing the factual information on screening mammography for women age 40 to 49 years. Their review builds on some previously published work by Kerlikowske and colleagues, particularly their meta-analysis [1]. This meta-analysis was important, in that it addressed the issue of timing in relation to mammography screening in women 40 to 49 years old, as compared with those 50 to 69 years of age. The combined data of eight randomized trials clearly demonstrated that there was absolutely no benefit of mammography for women age 40 to 49 at 7 to 9 years after the initiation of screening. In contrast, for women age 50 to 69, there was a substantial and statistically significant reduction in breast cancer mortality.

Treatment of Pancreatic Cancer: Current Limitations, Future Possibilities

March 01, 1996

Drs. Blackstock, Cox, and Tepper have outlined some salient aspects of the management of pancreatic cancer. I agree with most of their comments, and will address some issues from my own perspective, colored largely by a symposium on cancer of the pancreas held in Newport, Rhode Island, in July 1994. This gathering of a large nucleus of investigators with a major interest in pancreatic cancer provided some additional insights that I will explore in my commentary and that largely complement the points made by Blackstock et al. Among other issues, my remarks will focus on: (1) the use of molecular markers for diagnosis and treatment, (2) preoperative chemoradiation, and (3) some surgical considerations that still generate controversy; ie, the extent of resection.

Treatment of Pancreatic Cancer: Current Limitations, Future Possibilities

March 01, 1996

Blackstock and colleagues present a well-written, comprehensive review of the current state of management of both resectable and unresectable pancreatic carcinoma, as well as ongoing research and future strategies. Unfortunately, in the majority of patients, the disease is locally advanced at diagnosis, with or without regional and distant metastases. Unlike recent advances in screening for both prostate and breast cancer, no reliable and/or cost-effective method for identifying patients at risk for pancreatic cancer is available. Also, there is currently no reliable hematologic marker that can identify patients whose cancers are in the earliest developmental stage. Blackstock et al do emphasize that recent advances in laparoscopic techniques have led to better selection of patients for subsequent exploration and surgical resection. Given the reduction in operative mortality during the last 10 years, survival rates have improved.

Xerostomia: Diagnosis and Management

March 01, 1996

Xerostomia, or dry mouth, is a common complaint that may be caused by several conditions, which include side effects of a wide variety of drugs, such as antidepressants, therapeutic radiation to the head and neck,

Pathogenesis of AIDS-Related Kaposi's Sarcoma

March 01, 1996

Our arsenals for fighting off bacteria are so powerful, and involve so many different defense mechanisms, that we are in more danger from them than the invaders. We live in the midst of explosive devices; we are mined.

Pathogenesis of AIDS-Related Kaposi's Sarcoma

March 01, 1996

Emmanoulides, Miles, and Mitsuyasu have written an excellent review summarizing our current understanding of the pathogenesis of AIDS-related Kaposi's sarcoma (AIDS/KS). The authors cover what is currently well established and also provide their viewpoint on future developments in AIDS/KS. My commentary will highlight some of the major questions related to this complex disease.

Should We Recommend Screening Mammography for Women Aged 40 to 49?

March 01, 1996

Although there is general agreement that screening women over age 50 years with mammography reduces mortality from breast cancer, there has been controversy over the effectiveness of mammography in women 40 to 49 years old. Until 1993, the most widely accepted recommendation for screening mammography included baseline mammography between ages 35 and 40, mammography every 1 to 2 years between ages 40 and 50, and annual mammograms after age 50.

Biologic Basis for Radiation Oncology

March 01, 1996

Drs. Coleman and Stevenson have done a superb job in covering diverse aspects of biology relevant to clinical radiotherapy. They note that recent advances in understanding DNA repair may lead to practical applications in radiotherapy. For example, a dual benefit of unraveling DNA repair mechanisms may be to identify which tumors are the most likely to respond to therapeutic radiation and which patients are most likely to develop radiation-induced tumors. The authors point out that gene induction observed in vitro following large radiation doses may not necessarily be relevant to doses employed clinically. Coleman and Stevenson highlight the importance of defining the sequence of genes induced by radiation in clinically relevant doses.

Does Neck Stage Predict Local Control After Irradiation for Head and Neck Cancer?

March 01, 1996

The article by Mendenhall et al represents a comprehensive review of their own experience, as well as other large experiences in the literature, aimed at addressing the controversy of whether neck stage predicts local control after irradiation of head and neck cancer. The authors systematically explore this controversy in the setting of both definitive and postoperative therapy. Based on this review, and our own experience, we conclude that there are no significant data showing a correlation between neck stage and local control at the primary tumor site following irradiation of head and neck carcinoma.

Does Neck Stage Predict Local Control After Irradiation for Head and Neck Cancer?

March 01, 1996

The impact of neck stage (N stage) on local control after treatment for head and neck cancer is controversial. This article reviews the pertinent literature. Based on this review, the authors conclude that although N stage

Should We Recommend Screening Mammography for Women Aged 40 to 49?

March 01, 1996

In clinical trials, screening mammography has been shown to reduce mortality from breast cancer by about 25% to 30% among women aged 50 years and older after only 5 to 6 years from the initiation of screening. Among women 40 to 49 years old, the evidence supporting the efficacy of screening mammography is less convincing.

Pathogenesis of AIDS-Related Kaposi's Sarcoma

March 01, 1996

The occurrence of Kaposi's sarcoma (KS) in patients with HIV infection is more than 7,000 times higher than in the non-HIV infected population. The reason for this association is unclear but may involve decreased immune surveillance as a result of the profound cellular immune deficiency caused by HIV, a sexually transmitted KS-inducing virus, whose KS-transforming capabilities may be enhanced by HIV, or a direct or indirect effect of HIV itself in susceptible individuals.

A Nursing Perspective on Radiation-Induced Xerostomia

March 01, 1996

Xerostomia during and following a course of head and neck irradiation profoundly impacts the quality of life of many patients. Xerostomia not only affects mucous membranes and teeth but also interferes with patient comfort,

Biologic Basis for Radiation Oncology

March 01, 1996

Improved understanding of the underlying biologic mechanisms that pertain to radiation oncology is providing an explanation for the cellular and tissue responses to ionizing radiation and is leading to the potential for novel

Treatment of Pancreatic Cancer: Current Limitations, Future Possibilities

March 01, 1996

In an attempt to improve the grave prognosis associated with the diagnosis of pancreatic cancer, researchers have explored a number of novel therapies. These include hormonal therapy, immunotherapy, radiopharmaceuticals, and novel chemotherapeutic agents.

Does Neck Stage Predict Local Control After Irradiation for Head and Neck Cancer?

March 01, 1996

The paper by Mendenhall et al addresses a very debatable issue, ie, the influence of nodal stage on local control for head and neck carcinomas treated by radiotherapy. The paper is well written and appropriately referenced, and the authors fairly conclude that, based on currently available data, nodal stage has no clear impact on the probability of primary local control after radiotherapy.

Hormone Treatment May Help Some Cases of Pancreatic Cancer

March 01, 1996

The hormone somatostatin may be effective in treating some patients with pancreatic cancer, new research suggests. Studies conducted in mice and in laboratory samples found that pancreatic tumors responded to somatostatin only if the tumor cells had receptors for the hormone.