Many women with early breast cancer must decide whether to have mastectomy or breast-conserving surgery (BCS). In the August 20 Journal of Clinical Oncology, researchers reported that women who let their surgeons make the decision were more likely to get BCS than were women who decided either on their own or jointly with their surgeon.
Researchers prospectively surveyed 1,844 women in Detroit and Los Angeles identified in NCI's Surveillance, Epidemiology and End Results (SEER) database; most were diagnosed with ductal carcinoma in situ and were candidates for BCS. The women's mean age was 60.1 years; 70.2 percent were white, 18 percent were African American, and 11.8 percent were of other ethnic groups. Despite the medical consensus that most women were good candidates for BCS, 30 percent received mastectomy. This cannot be explained by the influence of surgeons, since only 5.3 percent of patients who let the surgeon decide had mastectomy, compared with 16.8 percent who shared the decision, and 27 percent who decided on their own.
The findings "suggest that most women perceived that they had control over the decision-making process, and [that] many of these women seemed to have preferred and received mastectomy," wrote Dr. Steven J. Katz of the University of Michigan, and colleagues. African American women, however, had a different experience. They visited surgeons more often before deciding, were more likely to wait until after their first visit to decide, and - when their surgeon made the choice for them - were more likely to undergo mastectomy.
Researchers with the Multiethnic Cohort Study, which examines the relationship between lifestyle factors and disease outcomes among people in Hawaii and Los Angeles, have published new findings on the dietary risk factors for pancreatic cancer - specifically, red and processed meat, fat and saturated fat, dairy products, and food preparation. Their results appear in the October 5 Journal of the National Cancer Institute.
Some previous studies have shown a link between the disease and foods such as meat, eggs, and dairy products; the link to cancer being attributed to fat, cholesterol, and carcinogen-producing food preparation. But most of this research was conducted with small cohorts using retrospective dietary questionnaires, often completed by proxy after a participant's death. As a result, the findings from different studies were not consistent.
Multiethnic Cohort Study researchers gathered 7 years of prospective dietary data from 190,545 participants using questionnaires; they also double-checked the integrity of the data with a telephone survey of a random sample of 1,606 participants.
Study results show that eating large amounts of red meat - particularly processed meat - was linked to pancreatic cancer, while no link was found between the disease and consumption of poultry, fish, dairy products, or eggs. The data also showed that there was no association with total fat or cholesterol intake. The researchers noted that preparation techniques, however, including grilling, frying, and curing may play a role in cancer risk.
About 8.6 percent of patients diagnosed with melanoma will develop a second skin tumor, most within a year, according to a study in the October 5 Journal of the American Medical Association. Those with a family history of melanoma and a personal history of atypical moles called dysplastic nevi are at highest risk for multiple melanomas, wrote the researchers from Memorial Sloan-Kettering Cancer Center.
The study included 4,484 patients diagnosed with a first primary melanoma between 1996 and 2002. The researchers found that 385 patients (8.6 percent) were later diagnosed with a second primary melanoma. Although the researchers found patients with up to seven primary melanomas, the average among those with more than one tumor was 2.3. For most patients (74 percent), the initial melanoma was the thickest - and therefore the most dangerous. Fifty-nine percent presented with their second primary tumor within 1 year of their original diagnosis.
Twenty-one percent of multiple melanoma patients had a positive family history of melanoma, compared with 12 percent of patients with a single primary melanoma. Thirty-eight percent of multiple melanoma patients had dysplastic nevi, compared with 18 percent of single melanoma patients.
"Patients with a positive family history or a history of [dysplastic nevi] are at significantly greater risk of developing [multiple melanomas] and should be enrolled in more intensive dermatologic surveillance programs. This high-risk subset of patients should also be further characterized genetically to further elucidate the biology and etiology of melanoma," the authors concluded.
Some men suffer a biochemical recurrence of prostate cancer after radical prostatectomy. Researchers at the University of Texas M.D. Anderson Cancer Center reported a greater risk of aggressive cancers in men who were obese when originally diagnosed, especially when they had gained more than 3 pounds a year since age 25. Men in the study averaged 60 years old when diagnosed.
Dr. Sara Strom and colleagues divided 526 prostatectomy patients into normal, overweight, and obese groups based on standard body mass index (BMI) categories. The men self-reported their weight and height histories over an average of 54 months. Eighteen percent of patients developed serum prostate-specific antigen levels amounting to biochemical recurrence. The overweight group did not show meaningful trends, but when obese men were compared with nonobese men (BMI more and less than 30 kg/m²), significant differences emerged.
Men who were obese at age 25, at age 40, or who had gained more than 3.3 pounds a year all showed a risk increase of more than 130 percent. Among patients whose cancer recurred, those who had gained more than 3.3 pounds a year went 16.7 months before recurrence, compared with 23.7 months for those gaining less weight, and 39 months for those who gained little or no weight.
"These results suggest that body mass could be a better predictor of aggressiveness and more likely implicated" in the progression of prostate cancer than in its incidence, wrote the authors in the October 1 Clinical Cancer Research.
Overexpression of the gene Rsf-1 appears to be linked to aggressive ovarian cancer, researchers from the Johns Hopkins University School of Medicine have reported. After initially identifying Rsf-1 as being overexpressed in several cell lines, they then analyzed tumor samples from 107 ovarian cancer patients with aggressive disease. They found that the 16 patients with Rsf-1 overexpression had statistically significant shorter survival than those without Rsf-1 overexpression: 29 months versus 36 months.
"The mechanism of how Rsf-1 amplification contributes to shorter survival is not known," Dr. Tian-Li Wang and colleagues wrote in the September 27 Proceedings of the National Academy of Sciences. "However, because the mortality of ovarian cancer patients is directly related to … recurrent disease after chemotherapy, it is conceivable that Rsf-1 amplification may confer drug resistance and/or enhance cell proliferation in the chemoresistant recurrent tumors."
The research team used a genome-scanning technology developed at Hopkins called digital karyotyping to narrow down a region on chromosome 11 marked by significant gene amplification, and used other analyses to identify Rsf-1 as the amplification's primary source. The research team also tested whether reducing Rsf-1 expression using short-interfering RNAs in ovarian cancer cell lines would influence the survival of cancer cells. Cell growth was inhibited in the two of the three cell lines in which Rsf-1 amplification and/or overexpression was seen.