Women over the age of 65 who have lymph node-positive breast cancer but are otherwise in good health can benefit from adjuvant chemotherapy just as much as younger women, according to a study published in the March 2 Journal of the American Medical Association.
The research team reviewed data from 4 clinical trials that collectively enrolled more than 6,000 women. They found that women over age 65 had more lymph nodes positive for cancer and a higher rate of treatment-related mortality than did younger women, but that age had no relationship to the positive effects of chemotherapy and tamoxifen on disease-free and overall survival.
The authors stress that elderly cancer patients may experience age discrimination from health care providers and family members who fear that they are too frail for the toxic effects of chemotherapy. This is underscored by the fact that only 8 percent of patients enrolled in the 4 studies analyzed were aged 65 or older, though about half of new breast cancer diagnoses occur in women in this age group.
The authors caution that not all older patients are good candidates for chemotherapy, and cite www.adjuvantonline.com as a model for healthcare providers to use in estimating the benefit of adjuvant chemotherapy for these women.
Men with higher levels of vitamin E in their blood were found to have a lower risk of developing prostate cancer, according to a report in the March 2 Journal of the National Cancer Institute.
The study was led by Drs. Stephanie J. Weinstein and Demetrius Albanes of NCI’s Division of Cancer Epidemiology and Genetics. They conducted a case-control analysis of 300 men from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) trial of nearly 30,000 Finnish participants. The ATBC trial had previously shown that men who took vitamin E supplements had a 32 percent lower incidence of prostate cancer than those who did not.
For the current report, the scientists measured for the two principal forms of vitamin E - alpha-tocopherol and gamma-tocopherol - in the baseline serum before the men took vitamin E pills. Men with the highest baseline levels of alpha-tocopherol had a 53 percent reduction in risk and those with the highest levels of gamma-tocopherol had a 39 percent reduction in risk.
“These data reinforce the protective relationship seen in the ATBC trial for alpha-tocopherol,” said Dr. Weinstein. “They also suggest that the other major form of vitamin E - gamma-tocopherol - may also inhibit prostate carcinogenesis.”
Dr. Albanes noted that the findings “should be reassuring” for the SELECT trial, which is testing the effects of alpha-tocopherol and selenium supplements in prostate cancer prevention, because “we saw stronger inverse associations between prostate cancer and serum concentrations of both tocopherols in the men who were receiving the trial alpha-tocopherol supplements.”
A new study confirms previous reports that mutations in the EGFR (epidermal growth factor receptor) gene, which are associated with responsiveness to the lung cancer drug gefitinib (Iressa), occur preferentially in four subsets of patients: women, patients who have never smoked, Asians, and patients with adenocarcinoma.
The reason the mutations appear among these groups is not clear, but they can lead to the development of non-small-cell lung cancer, according to research in the March 2 Journal of the National Cancer Institute. In the largest such study to date, researchers profiled more than 600 lung tumors from patients in Japan, Taiwan, the United States, and Australia.
EGFR mutations were more common in females than males (42 percent vs. 14 percent), in never-smokers than in smokers (51 percent vs. 10 percent), in adenocarcinomas than in other types of lung cancer (40 percent vs. 3 percent), and in patients of East Asian ancestry than in other ethnicities (30 percent vs. 8 percent).
EGFR mutations are the first known to occur in nonsmokers with lung cancer, according to Dr. Adi F. Gazdar of the University of Texas Southwestern Medical Center at Dallas, who led the study. “We always believed that lung cancer in nonsmokers was due to exposure to second-hand smoke, but here we’re seeing very different changes at the molecular level in nonsmokers and smokers,” said Dr. Gazdar. “The implication is that there may well be factors that lead to cancer in nonsmokers other than second-hand smoke.”
The first physician-endorsed, low-intensity dietary intervention to target a rural, low-income population made up of poorly educated, minority individuals demonstrated the feasibility of effectively changing dietary behavior in rural residents. Results of the NCI-funded Rural Physician Cancer Prevention Project, published in the February American Journal of Preventive Medicine, demonstrate significant improvement in dietary fat and fiber consumption in this population.
Dr. Elizabeth Fries, of Virginia Commonwealth University, and her colleagues enrolled patients from three physician practices in rural Virginia and randomly assigned them to an intervention (tailored feedback on eating habits, brief counseling, and dietary self-help booklets) or control group. Intervention materials were written at or below a sixth-grade reading level and mailed along with letters from participants’ physicians. Investigators conducted follow-up phone interviews 1, 6, and 12 months after the intervention. Individuals in the intervention group significantly reduced their dietary fat intake, increased dietary fiber consumption, and expressed an intention to reduce dietary fat and eat more fiber, fruits, and vegetables.
Efforts to improve health in rural areas may be compromised due to reduced access to health care and lack of appropriate nutrition education. The authors note that rural primary care providers may be viewed by community members as the only legitimate source of health information; however, many are overburdened with a large patient load. This study shows that a low-intensity dietary intervention can net significant changes without increasing time constraints on physicians.