11/08/2010 09:51 AM Posted by:

Screening Older Smokers, Ex-Smokers For Lung Cancer May Save Lives.

ABC World News (11/4, lead story, 3:25, Sawyer) covered a story yesterday that, according to the news outlet, "riveted the medical community." Calling the discovery "a holy grail of modern medicine," ABC's Chief Health and Medical Editor Richard Besser, MD, explained that the "largest study ever of lung cancer screening" indicates that it helps reduce the likelihood of death. The revelation brought "tears to the eyes of Dr. Claudia Henschke who has championed screening for more than 20 years," and who has, "over the course of" her "career...taken a lot of hits, a lot of shots for" her "statements about the use of CT."

        According to the CBS Evening News (11/4, lead story, 3:35, Couric), the "effectiveness of CT scanning for lung cancer has been debated for years," because the test can "pick up lung abnormalities like scars from past infections that are not cancer." Such irregularities "are common in heavy smokers and can result in costly anxiety producing tests." Radiation is also a concern, because a "CT scan -- even low dose -- delivers about 15 times more radiation than a chest x-ray."

        However, the authors of the latest study concluded "that a type of screening x-ray called a 'low-dose spiral CT scan' can actually help reduce the death rate from lung cancer," NBC Nightly News (11/4, story 2, 2:15, Williams) reported. In other words, clinicians "will be able to pick up early cancer, and if it's picked up, there is a chance you will survive this cancer."

        Until yesterday, "there has never been a reliable way to catch lung cancers early, when doctors can save about 70% of patients," USA Today (11/5, Szabo) reports. "Chest X-rays, an earlier form of screening tested repeatedly in the 1970s, have never been shown to save lives, says Ned Patz, a professor of radiology at Duke University Medical Center who helped design the trial." Consequently, "160,000 Americans a year die from lung cancer, the leading cause of cancer deaths in the world, according to the American Cancer Society."

        That mortality rate, Reuters (11/5, Fox) reports, could have been curtailed earlier, according to the author of a previous study. In 2006, Dr. Henschke, presently of the Mount Sinai School of Medicine, found that spiral CT scanning identified a large percentage of small lung tumors that could be surgically removed, but once it was discovered that a tobacco company underwrote some of her work, the study was dismissed by many. Dr. Henschke said she had wanted to provide more evidence that would support the call for the tobacco industry to pay for screens.

        Nevertheless, the National Cancer Institute's Christine Berg said that the current "eight-year study" conducted at 33 sites, "known as the National Lung Screening Trial (NLST), is the first to provide 'clear evidence' of a significant reduction in lung-cancer deaths with screening in a randomized controlled trial," Bloomberg News (11/5, Peterson) reports. Investigators began their work by looking at "53,000 current and former smokers ages 55 to 74, half of whom received annual CT scans for three years, while the others got X-rays instead, the National Institutes of Health said today in a statement."

        Researchers eventually noted "20 percent fewer deaths from lung cancer among those screened with spiral CTs than among those given chest X-rays," the AP (11/5, Neergaard) reports. "The actual difference: Of those who got a spiral CT, 354 died over the eight-year study period, compared with 442 deaths among those who got chest X-rays." Indeed, the difference may seem "modest," but it "could translate into big benefits."

        In fact, the results "were so conclusive that the study was terminated ahead of schedule last week and letters were sent to all the participants advising them of the results," the Los Angeles Times (11/5, Maugh) notes. "The study 'has important implications for public health,' added Dr. Harold Varmus, director of the National Cancer Institute, 'but no one should believe that it is safe to continue to smoke or to start smoking.'" Dr. Varmus "also noted that the researchers were not making any recommendations about whether routine screenings should be conducted in any group."

        The data must also undergo further analysis and be submitted for publication before the test can be recommended by groups like the United States Preventive Services Task Force and the American Cancer Society, according to the Wall Street Journal (11/5, Hobson, Dooren, subscription required). The test's price tag -- estimated to be several hundred dollars -- must also be considered in light of the nation's current struggle to rein in healthcare costs. One expert said that price could be reduced should the test be used for screening.

        Meanwhile, a front-page New York Times (11/5, A1, Harris) article points out that the "study's results could have both legal and political consequences," considering that "suits against tobacco companies have sought to force cigarette makers to pay for annual CT screens of former smokers." Even though "those claims have so far been rebuffed," Congress "diverted some research money to create pilot CT lung screening programs, diversions that may gain momentum now."

        Capturing the medical community's response, the Washington Post (11/5, Stein) reports that "findings were hailed by the American Cancer Society, the American Lung Association, and others."

        And, "on behalf of the American Society of Clinical Oncology, Bruce Johnson, MD, of the Dana-Farber/Harvard Cancer Center in Boston, gave a barometer reading for how cancer groups may interpret the findings when writing their guidelines," MedPage Today (11/4, Fiore) reported. "He said the findings show lung cancer screening in high-risk patients can 'save nearly as many lives as the number of people who die from breast cancer per year. We as a medical community now need to figure out how to do this in a way that the cost is acceptable to the public.'"

        In a separate but related article, USA Today (11/5, Szabo), discusses CT scans and screening in a Q & A segment. The Baltimore Sun (11/5, Cohn, Sun), the Boston Globe (11/4, Gil) "White Coat Notes" blog, the CNN (11/4) "The Chart" blog, the St. Paul Pioneer-Press (11/5, Snowbeck), the Detroit Free Press (11/4, Anstett), the Milwaukee Journal Sentinel (11/4, Fauber) "Heatlh & Science Today" blog, the Minneapolis Star Tribune (11/5), WebMD (11/4, Doheny), HealthDay (11/4, Gardner), and Medscape (11/4, Chustecka) also

Scientists Discover How Cancerous Cells Protect Themselves From Body's Immune System.


The UK's Telegraph (11/5, Alleyne) reports, "Researchers at Cambridge University have discovered how tumor cells protect themselves from the body's natural defenses." According to the paper in Science, "a protein known as FAP (fibroblast activation protein alpha) stops the body's immune system from attacking the rogue cancer cells." The protein is "found in stromal cells -- a kind of tissue cell that usually races to the scene of a wound to aid healing." Thus, the cancer can "trick the body into thinking it is an injury and instead of destroying the tumours it actually nurtures them," a deception that has thwarted the development "of vaccines and other treatments which rely on the body's immune system to work."

        The team made their breakthrough discovery after creating a "mouse in which FAP-producing cells could be eliminated," BBC News (11/5) reports. "When this happened in animals with well-established lung tumours, the cancer rapidly shrunk. Only 2% of the cells within these tumours actually produced FAP, so the scientists are convinced that they had a far wider role in protecting the tumour from the immune system."

Panel Of Autoantibodies May Successfully Detect Lung Cancer.


Medscape (11/4, Kling) reported, "A panel of autoantibodies successfully detects lung cancer, even in early stages of the disease," according to the co-founder of the product's developer, OncImmune. EarlyCDT-Lung, which "uses a panel of eight lung cancer-associated antibodies," was tested on 842 lung cancer patients. "For non–small cell lung cancer (NSCLC), the researchers found positivity rates of 28.0% (stage 1), 35.1% (stage 2), 30.6% (stage 3), and 34.4% (stage 4). In small cell lung cancer (SCLC), rates were 49.4% and 53.1% for limited and extensive disease, respectively."

SBRT Considered Viable Alternative For Older Patients With Operable Early-Stage NSCLC.

MedPage Today (11/4, Bankhead) reported, "Three out of four older patients with operable early-stage non-small cell lung cancer remained alive three years after treatment with stereotactic body radiation therapy (SBRT)," according to researchers in Japan. "More than half of the patients remained alive without progression, including almost 70% of those who had no evidence of locoregional progression." Lead investigator Yasushi Nagata, MD, pointed out that the "survival and progression rates compare favorably with outcomes following surgical treatment but with less morbidity."

Women Diagnosed With DCIS Before Age 45 May Face Increased Recurrence Risk.


WebMD (11/4, Laino) reported, "A study of nearly 600 younger women with a very early stage of breast cancer suggests that women under age 45 are at higher risk of recurrence." The patients with "ductal carcinoma in situ (DCIS)...were given the standard treatment of breast-conserving surgery followed by radiation," researchers in Toronto explained. But, "by an average of nearly eight years after treatment, cancer had come back in the affected breast of 18% of women under 45, compared with 11% of women aged 45 to 50."

Proportion Of Women Undergoing Prophylactic Mastectomy Increased More Than Ten-Fold Over 10-Year Period.


The Los Angeles Times (11/5, Maugh) "Booster Shots" blog reported, "The proportion of women having both breasts removed when breast cancer appears in one has increased more than ten-fold over a 10-year period, despite a limited amount of evidence showing a survival benefit for the procedure," according to a paper in the Annals of Surgical Oncology. Indeed, "removal of both breasts can reduce the risk of breast cancer by as much as 85% for women who have the BRCA1 or BRCA2 genes, which confer a high risk of contracting cancer, but less than 1% of the general population carries either of these genes," researchers at the NorthShore University HealthSystem explained. Notably, "women with private insurance were more than twice as likely to undergo prophylactic mastectomy as those who were uninsured or who had Medicare."

        Women May Be More Satisfied With Silicone Implants After Mastectomy. The CNN (11/8, Smith) "The Chart" blog reports, "Women who choose silicone implants after a mastectomy tend to be more satisfied with their breasts than women who get saline-filled implants," Memorial Sloan-Kettering Cancer Center researchers found after surveying 482 individuals. "Women in the study who received saline implants were also satisfied," according to the paper in Cancer. "It's just that those who chose silicone implants were slightly more satisfied." Yet, because of "silicone implants' somewhat checkered past," those who opt for the "implants post-mastectomy are advised by the FDA to get an MRI three years after implantation, and every two years after that."

Gold-Covered Nanoparticles May Help Eradicate Cancer Cells.

According to the Los Angeles Times (11/8, Dance), "drugs and radiation can beat back tumors, but some cancer cells usually survive the assault." Thus, Baylor College researchers "fortified their arsenal with gold-covered nanoparticles that embed themselves in tumors and bake them to temperatures of 108 degrees when activated with an infrared laser." According to their paper in Science Translational Medicine, "treating mice with heat plus standard radiation cleared breast cancer tumors better than either therapy alone."

Red Meat Consumption May Increase Risk For Certain Throat, Stomach Cancers.

Reuters (11/5, Norton) reported that, according to a study published Oct. 26 in the American Journal of Gastroenterology, individuals who consume large amounts of red meat are 79 percent more likely to develop esophageal squamous cell carcinoma than those who eat the lowest amounts. National Cancer Institute investigators also found that the risk for gastric cardia cancer also increased among those with the highest intake of one form of heterocyclic amine.


Scientists May Have Identified New Biomarkers For Very Early Prostate Cancer.


According to the UK's Telegraph (11/6, Adams), researchers at Bristol University "identified two proteins that are present in higher levels in men with prostate cancer" after looking at some 5,400 men. "The proteins are called 'growth factors'" and they "regulate normal growth and development in organs and tissue, especially in the womb and during childhood. Dr Mari-Anne Rowlands, a cancer epidemiologist and the lead author of the study, said: 'It's too early to be certain, but these results suggest that we may have identified potential new biomarkers for very early prostate cancer in men with no symptoms.'"

Radiation Treatment Plus Hormonal Therapy May Help Curb Deaths From High-Risk Prostate Cancer.

The UK's Press Association (11/8) reports, "Deaths from high-risk prostate cancer can be cut by giving men radiation treatment as well as hormonal therapy." In fact, a UK "trial involving 1,200 men with locally advanced cancers found that additional radiotherapy led to 43% fewer deaths after seven years." Specifically, "early results showed that 79% of men who had hormone therapy alone were alive seven years later, compared with 90% who received radiotherapy and hormone drugs." BBC News (11/8) also covers the study.

Proton Therapy May Prevent Impotency In Younger Men After Treatment For Prostate Cancer.

WebMD (11/5, Laino) reported, "A highly targeted form of radiation therapy may help younger men to avoid becoming impotent after treatment for prostate cancer, a preliminary study of nearly 100 men aged 55 and younger suggests." In fact, six "months after undergoing proton therapy, 90% of participants who had been sexually active before treatment remained sexually active." Researchers at the University of Florida Proton Therapy Institute also discovered that "by 12 and 18 months after the treatment, 95%, and 94% of treated men were sexually active."

Neoadjuvant Chemoradiation May Reduce Odds Of Five-Year Locoregional Recurrence In Locally Advanced Breast Cancer.

MedPage Today (11/5, Bankhead) reported, "Neoadjuvant chemoradiation reduced five-year locoregional recurrence to less than 5% in patients with locally advanced breast cancer," Vanderbilt researchers found after analyzing "data from three prospective clinical trials." The "preoperative regimen led to pathologic responses (complete or partial) in 36 patients (34%)," and "pathologic responses occurred more often in patients who were hormone receptor-negative (54% versus 18% of receptor-positive patients)." Yet, "only one of the five patients who subsequently developed recurrent disease had had a pathologic response to the chemoradiation regimen," and three "of the five recurrences involved receptor-negative patients."

Stereotactic Radiation Considered A Viable Option For Patients With Operable Early-Stage NSCLC.

Medscape (11/ 5, Nelson) reported, "Stereotactic radiation might be an option for patients with operable early-stage nonsmall-cell lung cancer (NSCLC)," researchers in Japan discovered. "The three-year overall survival, the primary end point of the study, was 76.0%," a rate that "is comparable to historic data of patients with similar stage I NSCLC who underwent surgery." However, the moderator of the "press briefing at which highlights of" this study "were presented, explained that surgery is the primary treatment in the United States for patients with early lung cancer. 'Stereotactic radiation is used in the United States,'" Yale's Lynn D. Wilson, MD, MPH, said, "but generally not as an alternative for a patient who has an operable tumor."

Anatomic Segmentectomy May Benefit Patients With Clinical Stage I NSCLC.

Medscape (11/5, Kling) reported, "In patients with clinical stage I nonsmall-cell lung cancer (NSCLC), anatomic segmentectomy has recurrence and survival rates similar to lobectomy, but reduced perioperative mortality," University of Pittsburgh researchers discovered after following up with patients some 30 months after treatment. "Locoregional recurrence was higher with wedge resection than with anatomic segmentectomy (14.6% vs. 8.9%)." What's more, "compared with lobectomy, anatomic segmentectomy was associated with reduced mortality (0.4% vs. 1.8%), similar locoregional recurrence, and similar recurrence-free survival."

Cancer Patients Urged To Remain Physically Active.

HealthDay (11/5, Thompson) reported that "a growing number of physicians and researchers" say that "people who remain physically active as best they can during treatment are more likely to beat cancer." In fact, the "positive evidence for exercise during and after cancer treatment has piled so high that an American College of Sports Medicine panel is revising the group's national guidelines regarding exercise recommended for cancer survivors. The panel's conclusion: Cancer patients and survivors should strive to get the same amount of exercise recommended for everyone else, about 150 minutes a week of moderate-intensity aerobic exercise. Resistance training and stretching also are recommended."

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