Researchers have developed an online statistical tool for estimating an individual's risk of developing prostate cancer. The risk calculator is designed to help certain men and their physicians evaluate the potential risks and benefits of being screened for prostate cancer. It is available at http://www.compass.fhcrc.org/edrnnci/bin/calculator/main.asp.
The calculator takes into account prostate-specific antigen (PSA) testing, family history, rectal examinations, and history of a prior negative prostate biopsy. Though PSA testing is widely used to assess prostate cancer risk, it does have limitations. Men with normal PSA levels can develop prostate cancer, while some men without prostate cancer can have abnormal levels.
"This risk calculator model uses variables that go beyond only PSA level to help patients and physicians decide whether a prostate biopsy should be performed," write Dr. Ian Thompson, of the University of Texas Health Science Center at San Antonio, and his colleagues in the April 19 Journal of the National Cancer Institute (JNCI).
The calculator was developed using data from 5,500 men in the placebo group of the Prostate Cancer Prevention Trial; it is appropriate for men age 55 or older who have had recent PSA testing and rectal exams but no history of prostate cancer. The researchers say that the calculator improves the accuracy of PSA testing, but the use of PSA testing alone in prostate cancer screening has yet to be shown to save lives.
"The hope is that the risk calculator helps us do a better job selecting patients for biopsy," says co-author Dr. Howard Parnes of NCI, adding, "We need to be careful about how we apply the test." He raises the possibility that the calculator could lead to a large increase in the overall number of biopsies. This, in turn, could increase the overdiagnosis and overtreatment of the disease by detecting and treating cancers that would never have come to clinical attention were it not for screening.
A JNCI editorial discusses the critical need for accurate biological markers associated with life-threatening prostate cancer. "Once we have the ability to assess multiple risk factors in populations for which the long-term outcomes are known," approaches like the risk calculator will help identify those men who will benefit from active treatment, writes Dr. H. Ballentine Carter of the Johns Hopkins School of Medicine.
Elderly cancer survivors face quality-of-life issues that currently are not well understood. A large population-based cohort study published in the April 19 JNCI sought to clarify the limitations in daily activities faced by older women who have undergone cancer treatment.
In 1986, the Iowa Women's Health Study originally accrued 37,233 postmenopausal cancer-free women who were then followed for cancer occurrence through a link to the regional Surveillance, Epidemiology, and End Results cancer registry. Through a follow-up questionnaire, limitations in daily activities such as walking, housework, or meal preparation were assessed in 1997 for both cancer survivors and women who never had cancer.
Cancer survivors were divided into three postdiagnosis categories for analysis: less than 2 years, between 2 and 5 years, and 5 or more years. Other factors known to be associated with functional limitations, such as smoking, body mass index, and some chronic medical conditions, were included in the analyses.
Women returning the questionnaire less than 2 years after a diagnosis of cancer were significantly more likely to report functional limitations than women who never had cancer. Between 2 and 5 years after diagnosis, women were significantly more likely to report some but not all of the limitations listed on the questionnaire than women who never had cancer. Women who had been diagnosed more than 5 years previously were significantly more likely to report limitations in activities requiring strength and mobility than women who never had cancer.
The investigators conclude that "these findings support the need for interventions to prevent and reverse functional decline among elderly long-term cancer survivors." In an accompanying editorial, Drs. Julia Rowland and Rosemary Yancik from NCI's Office of Cancer Survivorship stress the need for incorporation of quality-of-life interventions into all stages of cancer treatment. They note that, "…with growing numbers of cancer survivors living 5 or more years after their diagnosis, the scope of quality cancer care must broaden beyond the limited focus on cure to one that fosters health promotion and minimizes dysfunction or disability after illness."
"I thought that before…there was no cure from it; that you just died basically." That's what a 10-year-old girl said to British researchers about her mother's breast cancer diagnosis. After conducting the study about communication between children and a parent with cancer, the researchers concluded that parents diagnosed with cancer would likely benefit from support and assistance in talking with their children about their situation.
In the study, an early online release in the British Medical Journal, Dr. Alan Stein and colleagues from Oxford University also found that the children in the study - who ranged in age from 6 to 18 - often already suspected or knew something was wrong before their parents finally told them about the cancer, and many of the children over 12 wanted more information about it than they got from their parents.
The research team conducted home-based interviews about family communication with 37 women diagnosed with breast cancer being treated at a single cancer center. They then conducted interviews with the women's children (31 altogether) about their experiences with their mothers' illness.
Many children found it especially distressing to see the effects of chemotherapy on their mothers, the researchers found, and also had wildly different interpretations of what the different treatments their mothers were undergoing actually meant for their prognosis.
"Parents are often unaware how much their children know and, often reeling from the diagnosis themselves, may not be in the best position to decide what and how to tell them," the researchers wrote. Families "may need considerable help in dealing with communication…and determining how support could be provided for their children as well as themselves."