Author Interviews, Brigham & Women's - Harvard, Cancer Research, Immunotherapy, NEJM / 05.11.2015 Interview with: Toni Choueiri, MD Clinical Director, Lank Center for Genitourinary Oncology Director, Kidney Cancer Center Senior Physician Dana Farber Cancer Institute Associate Professor of Medicine Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Choueiri: In the METEOR trial, we aimed to compare cabozantinib, a novel VEGFR, MET, AXL inhibitor to everolimus, a standard 2nd line option in advanced RCC. There is an unmet in this setting. Cabozantinib resulted in a median PFS of 7.4 months compared to 3.8 months with everolimus. Responses also were 4-times higher with cabozantinib-treated patients. At the interim OS analysis, there was a strong trend favoring cabozantinib.  (more…)
Author Interviews, Cancer Research, JAMA, MD Anderson / 05.11.2015 Interview with: William N. William Jr., MD Associate Professor Chief, Head and Neck Section Department of Thoracic / Head and Neck Medical Oncology The University of Texas M. D. Anderson Cancer Center Houston, TX Medical Research: What is the background for this study? What are the main findings? Dr. William: Oral pre-malignant lesions are often characterized as white and/or red patches in the mouth and are considered risk factors for oral cancer. This is why it might be best for people to go get oral cancer screening done if they suspect that there might be a problem. However, not all oral pre-malignant lesions will turn into cancer, but when this happens, surgery is usually recommended, many times leading to serious speech and swallowing dysfunction. Chemoprevention is the use of compounds to prevent cancers from happening before they occur. One of the greatest challenges in developing chemopreventive agents is to identify the population at highest cancer risk. The Erlotinib Prevention of Oral Cancer (EPOC) trial involved 379 patients at five sites across the country. All had premalignant lesions in their mouths. Following study enrollment, participants were evaluated for LOH, a chromosomal abnormality characterized by the loss of chromosomal regions, which include tumor suppressor genes. Patients who tested positive for LOH were considered to be at high risk for oral cancer and were randomized to receive either erlotinib (an EGFR inhibitor drug) or a placebo for one year. The study’s primary endpoint was to determine if fewer patients treated with erlotinib would develop oral cancer, compared to those that received placebo. The EPOC study demonstrated that LOH predicted a higher oral cancer risk. LOH-negative patients had a three-year cancer-free survival rate of 87 percent compared to 74 percent for the LOH-positive group. However, patients who took erlotinib showed no statistical difference in terms of cancer-free survival rates after three years: 74 percent for participants given erlotinib compared to 70 percent for those taking placebo. Patients with both LOH and EGFR copy number gains had the highest incidence of cancer, but still did not benefit from erlotinib. (more…)
Author Interviews, Cancer Research, Dermatology, JAMA / 05.11.2015 Interview with: Dr. Brad A. Bryan Ph.D Assistant Professor Biomedical Sciences Texas A&M University Health Science Center, Houston, TX Department of Biomedical Sciences Texas Tech University Health Sciences Center Medical Research: What is the background for this study? What are the main findings? Dr. Bryan: In 2008 it was serendipitously discovered that the beta blocker propranolol was effective in treating a common benign pediatric vascular tumor called infantile hemangioma.  Over the past few years, my lab has been working on elucidating the molecular mechanisms underlying this pediatric tumor and part of this research involved uncovering how propranolol selectively inhibited these tumors.  At the same time these studies were taking place, other members of my lab were working on pre-clinical drug development for a malignant vascular tumor called angiosarcoma.  Patients with angiosarcoma are faced with very few effective treatment options and abysmal survival rates, so we decided to see if the efficacy of beta blockade observed in infantile hemangiomas transferred to angiosarcomas.  Using preclinical in vitro and in vivo assays, we demonstrated that propranolol was very effective at inducing cell death, blocking migration, and inhibiting tumor growth in our angiosarcoma models.  This work was subsequently published in Plos One (Stiles et al., 2013).  I then collaborated with Dr. William Chow from San Francisco to test propranolol off-label (propranolol is FDA approved to treat high blood pressure, heart dysrhythmias, thyrotoxicosis, and essential tremors) in a patient suffering from a rapidly expanding angiosarcoma covering a large portion of his face.  In the window between diagnosis of the tumor and the start of chemotherapy, we placed the patient on oral propranolol.  The redness of the tumor very rapidly lessened and remarkably by only one week of treatment the tumor margins appeared to significantly shrink.  We examined biospies of the tumor before and after only one week of propranolol and found that the proliferation of the tumor cells was markedly decreased following beta blockade.  After a combination of propranolol, chemotherapy, and radiation that lasted several months, the patient had no detectable metabolically active tumor or distant metastases. We published these findings in JAMA Dermatology (Chow et al., 2015). (more…)
Author Interviews, Breast Cancer / 05.11.2015 Interview with: Shirley Mertz President of the US Metastatic Breast Cancer Network (Ms. Mertz has been living with metastatic breast cancer since 2003) Medical Research: What do you mean by the term, "Long Term Responders"? How is this different than "Survivor"? Shirley Mertz: For many years, especially in the month of October in the U.S., the media and breast cancer organizations have written stories and celebrated women who have received an early stage breast cancer diagnosis, gone through treatment and now see breast cancer in their "rear view mirror." For these women (Stage I, II or III disease), treatment has an end and they can get on with their lives. In contrast, for patients diagnosed with Stage IV disease, also called metastatic breast cancer, treatment never ends and they will ultimately succumb to the disease. Long term responders are those metastatic breast cancer patients who have responded well to a treatment--experiencing perhaps a complete remission (not a cure) or stable disease. While that treatment may continue to keep their disease under control for 5 or more years, such patients must continue with treatment. Ultimately, their disease will progress and they will die of the disease. This can be immensely traumatic for the patient and the family if they were failed to be diagnosed by a doctor. If the cancer was found sooner then there would be a better chance of survival. If this has ever happened to you then you may want to contact a failure to diagnose attorney. (more…)
Author Interviews, Breast Cancer, Diabetes / 05.11.2015 Interview with: Dr Nicoletta Provinciali, MD Oncologist from the E.O. Ospedali Galliera Genoa, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Provinciali: We know that higher insulin levels have been associated with a worse prognosis in early breast cancer patients. In this study we wanted to evaluate the impact of insulin resistance on metastatic breast cancer patients receiving first line chemotherapy. We found that insulin resistance status together with the endocrine status had an adverse prognostic effect. (more…)
Author Interviews, Chemotherapy, Lymphoma, NEJM / 04.11.2015

Jia Ruan, M.D., Ph.D. Associate Professor of Clinical Medicine Weill Cornell Medicine Lymphoma Program Division of Hematology & Medical Oncology New York, NY Interview with: Jia Ruan, M.D., Ph.D. Associate Professor of Clinical Medicine Weill Cornell Medicine Lymphoma Program Division of Hematology & Medical Oncology New York, NY 10021   Medical Research: What is the background for this study? What are the main findings? Dr. Ruan: Mantle cell lymphoma is an uncommon subtype of non-Hodgkin lymphoma that primarily affects elderly populations. Conventional chemotherapy regimens are generally not curative, and may not be tolerated by many patients, underscoring the need for treatment alternatives.  Previous experience with immunomodulatory compound lenalidomide has shown favorable activity and was well tolerated in patients with relapsedMantle cell lymphoma.  We evaluated the efficacy and safety of the biologic combination with lenalidomide plus rituximab as initial treatment for mantle-cell lymphoma (MCL). The main findings of the study showed that the combination was effective and generally well tolerated when given as induction and maintenance treatment. The overall response rate was 92%, with complete response rate of 64% in the 36 evaluable patients. Median duration of response has not been reached at a median follow up of 30 months.   Treatment was outpatient-based and quality-of-life was preserved for most patients. (more…)
Author Interviews, Cancer Research, Personalized Medicine / 04.11.2015

Timothy Humphrey DPhil. CRUK/MRC Oxford institute for Radiation Oncology University of Oxford, Interview with Timothy Humphrey DPhil. CRUK/MRC Oxford institute for Radiation Oncology University of Oxford, UK Medical Research: What is the background for this study? What are the main findings? Response: Multiple mutations resulting in loss of a particular histone mark (H3K36me3) are frequently found in a number of cancer types. These include mutations resulting in loss of the tumour suppressor SETD2 (which trimethylates H3K36) and over-expression of the oncogene KDM4A (which demethylates H3K36me3), which together are observed in more than 10% of a number of cancer types. Notably, loss of H3K36me3 has been reported in more than 50% of pediatric high-grade gliomas. While loss of this histone mark is associated with poor prognosis, there is no targeted therapy yet. Following observations made in fission yeast, we have found a new way to selectively target H3K36me3-deficient cancers using the WEE1 inhibitor, AZD1775. Surprisingly, treatment of H3K36me3-deficient cancer cells with the WEE1 inhibitor resulted in S-phase arrest. Further analysis revealed ribonucleotide reductase to be the target of this synthetic lethal interaction, thereby leading to dNTP starvation, replication fork collapse and cell death. (more…)
Author Interviews, Cancer Research, Microbiome / 04.11.2015 Interview with: Simba Gill Ph.D CEO, Evelo Therapeutics MedicalResearch: Evelo Therapeutics, a new company focuses on leveraging the power of the microbiome to develop novel therapies for cancer. Evelo is pioneering Oncobiotic™ therapeutics, a new modality in cancer therapy based on the cancer microbiome. Dr. Gill, CEO of  Evelo Therapeutics began his career at Celltech, focused on antibody research. Dr. Gill earned his Ph.D. from King’s College, London, and his MBA from INSEAD. Medical Research:  What is a microbiome? How do microbiomes play a role in health and disease? Dr. Gill: The microbiome is the collection of trillions of bacteria, funguses, viruses and other microbes that live on and within the human body. There are different clusters of microbes in different parts of the body, including the skin, mouth, large intestine, and vagina. Recently we have learned that our microbial populations shift depending on changes to an individual’s health and wellness. The makeup of one’s microbiome has a strong influence on one’s health, immune response, and metabolic state. (more…)
Author Interviews, Biomarkers, Brigham & Women's - Harvard, Cancer Research / 03.11.2015 Interview with: Bakhos A. Tannous, Ph.D Associate Professor of Neurology Harvard Medical School Director, Experimental Therapeutics and Molecular Imaging Lab Director, Interdepartmental Neuroscience Center Director, MGH Viral Vector Development Facility Massachusetts General Hospital Charlestown, MA 02129 Medical Research: What is the background for this study? What are the main findings? Dr. Tannous: In recent years, it has become apparent that, in addition to their role in promoting blood clotting, platelets take up protein and RNA molecules from tumors, possibly playing a role in tumor growth and metastasis. Working with our collaborators Dr. Thomas Wurdinger and Pieter Wesseling at the VU Medical Center, Amsterdam, the Netherlands, we found that the RNA profiles of tumor-educated platelets – those that have taken up molecules shed by tumors – can (1) distinguish healthy individuals and patients with six different types of cancer, (2) determine the location of the primary tumor and (3) identify tumors carrying mutations that can guide therapeutic decision making and personalized medicine. (more…)
Author Interviews, Cancer Research, Cognitive Issues, Journal Clinical Oncology, Memory / 03.11.2015 Interview with: Dr Janette Vardy  BMed (Hons), PhD, FRACP A.Prof of Cancer Medicine University of Sydney Medical Oncologist ,Concord Cancer Centre Concord Repatriation & General Hospital Concord, Australia  Medical Research: What is the background for this study? Dr. Vardy: Many patients complain that their memory and concentration is not as good after chemotherapy.  Most of the studies have been in younger women with breast cancer, and are often limited by small sample sizes and short term follow up.    This is the largest longitudinal cohort study assessing impacts of cancer and its treatment on cognitive function. We evaluated changes in cognitive function in 289 men and women with localized colorectal cancer (CRC), comparing those who received chemotherapy to those who did not require chemotherapy, 73 with metastatic disease, and a group of 72 healthy controls.?The localized CRC patients were assessed at baseline (soon after diagnosis and prior to any chemotherapy), 6, 12 and 24 months.  The healthy controls and metastatic group were assessed at baseline, 6 and 12 months.  We also examined underlying mechanisms. (more…)
Author Interviews, Colon Cancer, Genetic Research, Journal Clinical Oncology / 03.11.2015 Interview with: Hans F.A. Vasen, MD Department of Gastroenterology Leiden University Medical Center and Netherlands Foundation for the Detection of Hereditary Tumours Leiden, the Netherlands Medical Research: What is the background for this study? Dr. Vasen: People with familial colorectal cancer (CRC) have a 3-6 fold increased risk of colorectal cancer. It has been estimated that about 2% of the population have familial CRC (about 2.7 million people in the US). Previous studies showed that colonoscopic surveillance reduces the CRC-mortality by >80%. In people with hereditary CRC, i.e., Lynch syndrome (10 fold increased risk of CRC), an intensive screening program with colonoscopy 1x/1-2 years, is recommended. In familialcolorectal cancer, the optimal screening program  is unknown. Medical Research: What are the main findings? Dr. Vasen: In this randomized trial with 528 individuals at risk for familial CRC, we compared screening intervals of 3 and 6 years. We found that patients had significant more high-risk adenomas (precursor lesions of CRC) at 6-years-follow-up compared to at 3-years-follow-up. However, because of the relatively low rate of high-risk adenomas at 6 years (7%) and the absence of colorectal cancer in the 6-years group, we consider a 6-year-interval safe. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, Cognitive Issues / 03.11.2015 Interview with: Kelly N. H. Nudelman, Ph.D. Department of Radiology and Imaging Sciences Indiana University-Purdue University Indianapolis (IUPUI) Indianapolis, IN 46202 Medical Research: What is the background for this study? Dr. Nudelman: Varying levels of cognitive problems and related changes in brain structure and function have been reported in breast cancer patients treated with chemotherapy. Pain has also been associated with altered brain structure and function. However, the association of chemotherapy-induced peripheral neuropathy (CIPN), a side-effect of chemotherapy treatment characterized by nerve damage primarily in the extremities, has not been specifically investigated for association with cognitive symptoms in breast cancer. We used data from a prospective, longitudinal breast cancer cohort to investigate the relationship of CIPN and neuroimaging measures of cognitive dysfunction.  Medical Research: What are the main findings? Dr. Nudelman: We found that increased chemotherapy-induced peripheral neuropathy symptoms were associated with resting brain blood flow increase in regions known to be involved in pain processing. We also found that decreased frontal lobe gray matter density was correlated with these changes, suggesting a link between chemotherapy-induced peripheral neuropathy and cognitive dysfunction. (more…)
Author Interviews, Breast Cancer, Technology / 31.10.2015 Interview with: Anuradha Godavarty PhD and Dr. Sarah J Erickson-Bhatt PhD Dept of Biomedical Engineering, Florida International University Miami, FL Medical Research: What is the background for this study? What are the main findings? Response: It is well known that early detection and staging of breast cancer is crucial in order to save lives. While the current gold standard for breast cancer screening is x-ray mammography, this method still misses many cancers especially in younger women with denser tissue. Our group and others have explored diffuse optical tomography using near-infrared light to image breast tumors. We have developed a unique optical imager with a hand-held probe that can contour to breast curvature in order to image the tissue without painful compression and without ionizing radiation (like x-rays). This study demonstrated the ability of the device to detect lesions in breast cancer patients due to elevated levels of total hemoglobin concentration in tumor vasculature. The hand-held has a potential to not only image the breast contours, but the probe was flexible to image the surrounding chest wall regions, thus expanding its application to image lymphatic spread as well. (more…)
Author Interviews, Cancer Research, End of Life Care, Nursing / 30.10.2015 Interview with: Dr. Hsien Seow, PhD Associate Professor Department of Oncology Cancer Care Ontario Research Chair in Health Services Research Associate Member, Department of Clinical Epidemiology & Biostatistics McMaster University Canadian Institutes of Health Research Young Investigator Hamilton, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Seow: Despite being commonplace in healthcare systems, little research has described the effectiveness of publicly-provided generalist homecare nursing to reduce unnecessary acute care use at end-of-life, such as emergency department (ED) visits. It is also unclear how homecare nursing intent, which varies by standard care or end-of-life, affects this relationship. Our study examined a population-based cohort of cancer decedents in Ontario, Canada who used homecare nursing in their last six months of life. Specifically, we examined the relationship between homecare nursing rate in a given week on the ED visit rate in the subsequent week. In our cohort of 54,576 decedents, there was a temporal association between receiving end-of-life nursing in a given week during the last six months of life, and of more standard nursing in the last month of life, with a reduced ED rate in the subsequent week. Homecare nursing for those who are receving end of life care will find that it can provide immediate assistance when needed. (more…)
Author Interviews, Cancer, Cancer Research, JAMA / 29.10.2015

Jiemin Ma, PhD, MHS Director of Surveillance and Health Services Research American Cancer Interview with: Jiemin Ma, PhD, MHS Director of Surveillance and Health Services Research American Cancer Society Medical Research: What is the background for this study? What are the main findings? Dr. Ma: This study is an analysis of long-term trends in mortality for all causes combined and for 6 leading causes of death, including heart disease, cancer, stroke, chronic obstructive pulmonary disease (COPD), unintentional injuries, and diabetes, in the United States from 1969 through 2013. We found that death rates for all causes and for five of these 6 leading causes (except COPD) decreased during this time period, although the rate of decrease appears to have slowed for heart disease, stroke, and diabetes. COPD death rates doubled during this time period, although the rate began to decrease in men since 1999. (more…)
Author Interviews, Cancer Research, Education, JAMA / 29.10.2015 Interview with: Vinay Prasad, MD MPH Assistant Professor of Medicine Division of Hematology Oncology in the Knight Cancer Institute Department of Public Health and Preventive Medicine Senior Scholar in the Center for Health Care Ethics Oregon Health and Sciences University Portland, Oregon 97239   Medical Research: What is the background for this study? What are the main findings? Dr. Prasad: We wanted to get some information about when and which cancer drugs were called "game changer" or "breakthrough" or "revolutionary".  What we found was surprising.  The use of these grandiose terms, or superlatives, was common in news articles.  They occurred across many classes of medication, were used for approved and unapproved drugs, and some of the use was questionable. (more…)
Author Interviews, Breast Cancer / 28.10.2015 Interview with: Dr. Paolo Boffetta, MD, MPH Professor, Medicine, Hematology and Medical Oncology, Oncological Services, Preventive Medicine, Associate Director, Population Sciences Tish Cancer Institute, Chief, Division of Cancer Prevention and Control Icahn School of Medicine at Mount Sinai Medical Research: What is the background for this study? Dr. Boffetta: Evidence of a protective effect of breastfeeding on breast cancer risk is becoming stronger; hence the need for a systematic review and meta-analysis. Medical Research: What are the main findings? Dr. Boffetta: Breastfeeding appears to be protective against breast cancer, in particular the most aggressive forms (hormone receptor negative and in particular ‘triple negative’). (more…)
Author Interviews, Prostate Cancer, Radiation Therapy / 26.10.2015 Interview with: Luca Incrocci, MD, PhD Department of Radiation Oncology Erasmus MC-Daniel den Hoed Cancer Rotterdam, The Netherlands  Medical Research: What is the background for this study? What are the main findings? Dr.Incrocci: The trial was designed in 2005-2006. The rationale was to reduce the number of fractions and therefore increase patient's comfort. At that moment some preliminary data was available on the sensitivity of prostate cancer cells to a higher does per fraction. Our calculations brought us to choose this new fractionation schedule. The hypofractionation arm (19x3.4 Gy/3 times per week) has shown equivalence in outcome compared to the conventional treatment (39x2 Gy/5 times per week) at a follow-up of 5 yrs. Toxicity is comparable, with a slight increase in bowel complaints at 5yrs. Patients will be followed-up to 10yrs. (more…)
Author Interviews, Breast Cancer, NYU, Surgical Research / 26.10.2015

Mihye Choi, M.D., F.A.C.S. Associate Professor of Surgery NYU Plastic Surgery NYU Langone Medical Interview with: Mihye Choi, M.D., F.A.C.S. Associate Professor of Surgery NYU Plastic Surgery NYU Langone Medical Center Medical Research: Would you tell us a little about yourself and your interests in plastic surgery? Dr. Choi: I wanted to be a surgeon first, then I fell in love with plastic surgery after seeing a cleft lip repair as a medical student.  It was amazing to watch the ingenuity of the design and the skills needed to repair a baby's face.  I felt that it was the highest gift a doctor can bestow, so that a child can go forward with life in confidence and all the promise that life holds.  After finishing plastic surgery training, I developed expertise in breast reconstruction over the years.  I feel breast reconstruction combines the science and art of surgery. (more…)
Alcohol, Author Interviews, Brigham & Women's - Harvard, Cancer Research, Dermatology / 26.10.2015 Interview with: Shaowei WuMDPhD Department of Dermatology, Warren Alpert Medical School Brown University, Providence, Rhode Island Department of Dermatology Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Basal cell carcinoma (BCC) of the skin is the most prevalent cancer in the US, and is responsible for substantial morbidity and billions of dollars of health care expenditures. Knowledge on the modifiable risk factors of BCC is required for targeted prevention of cancer incidence. Alcohol consumption is a well-known risk factor for human cancer and has been linked to a number of cancers, including breast, prostate, pancreatic, and colon cancers. Interestingly, a large epidemiological study has reported a positive association between alcohol consumption and increased prevalence of severe sunburn, an established skin cancer risk factor. It is hypothesized that metabolites of alcohol (e.g., acetaldehyde) can serve as photosensitizers and promote skin carcinogenicity in the presence of UV radiation. However, epidemiological evidence for the association between alcohol consumption and BCC risk has been limited and a few previous studies on this topic have yielded conflicting results. Therefore we conducted a comprehensive prospective study to investigate this question using data from three large cohorts including the Nurses’ Health Study (1984-2010), Nurses’ Health Study II (1989-2011), and Health Professionals Follow-up Study (1986-2010). We documented a total of 28,951 incident Basal cell carcinoma cases over the study follow-up. We found that increasing alcohol intake was associated with an increased Basal cell carcinoma risk in both women and men. In the combined analysis with all 3 cohorts, those who consumed 30 grams or more alcohol per day had a 22% higher risk of developing BCC when compared to nondrinkers. This increased risk was consistent in people with different levels of sun exposure. We also found that BCC risk was associated with alcohol intake levels more than a decade ago, suggesting that alcohol may have a lagged effect that can persist for a long-term period. Among the individual alcoholic beverages, white wine and liquor were positively associated with Basal cell carcinoma risk whereas red wine and beer were not associated with BCC risk. This difference may be due to some other chemicals accompanying alcohol in the specific beverages. For example, red wine contains higher amounts of phenolic compounds compared to white wine, and these compounds have antioxidant activities which may be beneficial for counteracting the potential carcinogenic properties of alcohol and its metabolites. (more…)
Author Interviews, Cancer Research, CDC, Gender Differences, Race/Ethnic Diversity / 24.10.2015 Interview with: Dr. Simple Singh MD Epidemiologist Division of Cancer Prevention and Control CDC  Medical Research: What is the background for this study? Dr. Singh: This report provides official federal statistics on the occurrence of cancer for 2011 and trends for 1999–2011 as reported by CDC and the National Cancer Institute (NCI). Cancer incidence data are from population-based cancer registries that participate in CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2013. Cancer mortality data are from death certificate information reported to state vital statistics offices in 2013 and compiled into a national file for the entire United States by CDC’s National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS). This report is a part of the first-ever Summary of Notifiable Noninfectious Conditions and Disease Outbreaks — United States, which encompasses various surveillance years but is being published in 2015. Medical Research: What are the main findings? Dr. Singh: In 2011, approximately 1.5 million invasive cancers were diagnosed in the United States, an annual incidence rate of 451 cases per 100,000 persons. In the same year, approximately 576,000 persons died of cancer nationally, an annual death rate of 169 deaths per 100,000 persons. Cancer incidence and death rates increase with age. Overall, 54% of cancer cases and 69% of cancer deaths in 2011 occurred among persons aged ≥65 years. Among men in 2011, blacks had the highest cancer incidence and death rates in the United States, and American Indians/Alaska Natives and Asians/Pacific Islanders had the lowest cancer incidence and death rates. Among women in 2011, whites had the highest cancer incidence rates and blacks had the highest cancer death rates. American Indians/ Alaska Natives had the lowest cancer incidence rates, and Asians/Pacific Islanders had the lowest cancer death rates. By state, overall (all cancer sites combined) cancer incidence rates in 2011 ranged from 374 to 509 cases per 100,000 persons, and overall cancer death rates ranged from 126 to 201 deaths per 100,000 persons. Four cancer sites accounted for half of all cases diagnosed in 2011, including 209,292 prostate cancers, 220,097 female breast cancers, 207,339 lung and bronchus cancers (110,322 among men and 97,017 among women), and 135,260 colon and rectum cancers (70,099 among men and 65,161 among women). These four sites also accounted for half of cancer deaths in 2011, including 156,953 lung cancer deaths, 51,783 colon and rectum cancer deaths, 40,931 female breast cancer deaths, and 27,970 prostate cancer deaths. During 1999–2011, cancer incidence rates declined from 485 cancer cases per 100,000 population in 1999 to 444 cases in 2011. Although lung cancer incidence declined steadily among men from 1999 to 2011, it increased among women from 1999 to 2005 and has since declined from 2005 to 2011. Prostate cancer incidence declined from 170 cases per 100,000 men in 1999 to 128 cases in 2011. Colorectal cancer incidence declined from 57 cases per 100,000 persons in 1999 to 40 cases in 2011. Female breast cancer incidence declined from 135 cases per 100,000 women in 1999 to 121 cases in 2005, increased to 125 cases in 2009, and declined again to 122 cases in 2011. During 1999–2011, cancer death rates declined from 201 deaths per 100,000 persons in 1999 to 169 deaths in 2011; during the same period, death rates declined for each of the top four cancers. (more…)
Author Interviews, Dermatology, Melanoma, Primary Care / 24.10.2015 Interview with: Simone Ribero,  M.D., Ph.D.  University of Turin Department of Medical Sciences Italy & King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Ribero: The total body naevus count is the principal risk factor for melanoma. having more than 100 moles increases  6 times the risk of developping a melanoma. In our study we described a model to predict the total number naevus count with the count of one arm. (more…)
Author Interviews, FDA, Immunotherapy, Lung Cancer / 24.10.2015 Interview with: Dickran Kazandjian, MD Office of Hematology and Oncology Products Center for Drug Evaluation and Research US Food and Drug Administration Silver Spring, Maryland Medical Research: What is the background for this study? What are the main findings? Dr. Kazandjian: Nivolumab is the first approved immunotherapy, for the treatment of metastatic squamous non–small-cell lung cancer (NSCLC) after platinum-based chemotherapy.  FDA initiated an expedited review after obtaining the data monitoring committee report of a planned interim analysis of a second-line squamous NSCLC trial demonstrating a large overall survival benefit (CheckMate 017). Nivolumab efficacy in metastatic Squamous (SQ) NSCLC has been previously reported in two studies.  CheckMate 063 was a single-arm trial in 117 patients with metastatic SQ NSCLC who had progressed after previous treatment with 2 systemic regimens including platinum-based doublet chemotherapy (Rizvi et al)  CheckMate 017 was a randomized study of nivolumab compared to docetaxel in 272 patients with metastatic SQ NSCLC who had progressed after prior platinum-based doublet chemotherapy (Brahmer et al).  The median survival of patients randomized to nivolumab was 9.2 months vs 6.0 months for docetaxel (hazard ratio, 0.59; 95%CI, 0.44-0.79; P < .001) a 41% improvement in the risk of death. Approval was supported by the single-arm study which demonstrated an objective response rate of 15% and at the time of analysis, 10 of the 17 responding patients (59%) had response  durations of 6 months or longer. The FDA approved nivolumab on March 4, 2015, saving 6 months by not waiting for formal preparation of data by the sponsor and 2.5 months by expediting review. (more…)
Author Interviews, Cancer Research, MD Anderson, Nature / 23.10.2015 Interview with: Dihua Yu, M.D., Ph.D. Professor and Deputy Chair Dept.  of Molecular and Cellular Oncology Hubert L. and Olive Stringer Distinguished Chair in Basic Science University Distinguished Teaching Professor Co-Director, Center of Biological Pathways Univ. of TX MD Anderson Cancer Center Houston, TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Yu: Metastasis is the number one cause of cancer-related mortality. Despite the continuous advancement of modern medicine in better controlling primary cancer progress, brain metastasis incidence constantly and steadily increases. Major neoplastic diseases such as melanoma, lung, breast, and colon cancers have high incidences of brain metastases. One-year survival after diagnosis of brain metastasis is less than 20%. Cancer cells dynamically interacts with specific organ microenvironments to establish metastasis as depicted by the “seed and soil” hypothesis. Many research have focused on how tumor cells modulate the metastatic microenvironment, but the reciprocal effect of the organ microenvironment on tumor cells has been overlooked. The brain tissue is very distinct from primary tumor environment for metastatic cancer cells. Brain metastasis frequently manifests in the late stages of cancer, and a long period of dormancy often precedes relapse. This implies that additional regulations imposed by the brain microenvironment are essential for metastatic colonization and outgrowth. Yet it is unclear when and how disseminated tumor cells acquire the essential traits from the brain microenvironment that primes their subsequent metastatic outgrowth. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Race/Ethnic Diversity, Surgical Research / 23.10.2015 Interview with: Dr. Quoc-Dien Trinh MD Assistant Professor of Surgery Harvard Medical School  Brigham and Women's Hospital Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Trinh:  Blacks who undergo radical prostatectomy, e.g. surgical removal of the prostate for cancer, are more likely to experience complications, emergency room visits, readmissions compared to their non-hispanic White counterparts. As a result, the 1-year costs of care for Blacks is significantly higher than non-hispanic Whites. Interestingly, despite these quality of care concerns, the survival of elderly Blacks and Whites undergoing prostatectomy is the same. Medical Research: What should clinicians and patients take away from your report? Dr. Trinh: A possible interpretation of our findings is that the biological differences in tumor aggressiveness among Blacks  (e.g. Blacks have more aggressive prostate cancer than Whites) may have been exaggerated, and that the perceived gap in survival is a result of lack of access or cultural perceptions with regard to surgical care for prostate cancer or other factors that differentiate who makes it to the operating table. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Primary Care / 22.10.2015

Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA Interview with: Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105 Medical Research: What is the background for this study? What are the main findings? Dr. Broussard: I am a clinical assistant professor of gastroenterology and I practice and teach fellows and residents GI at a safety-net hospital in Seattle and I was seeing too many late stage colorectal cancer (CRC) in our patient population. CRC is preventable with screening, and I wanted to see how the primary care clinics were performing in getting patients screened. When I looked at the baseline percentages, I realized this was an opportunity for improvement. I teamed up with an internal medicine resident Kara Walter, and we did a deep dive into the process of screening. The results of the poster presentation are a product of this teamwork, with cooperation and input from the directors of the six primary care clinics at our hospital. The main findings are that performing the FIT test is complicated and tricky for some patients, that this process can be streamlined with providing a toilet hat, a prepaid postage envelope, and improved and visual instructions. After one year, we saw statistically significant increases in overall screening with FIT in our patient population. (more…)
Author Interviews, Radiation Therapy, Supplements / 21.10.2015 Interview with: Dr. Nicholas G. Zaorsky MD Resident Physician, Radiation Oncology Fox Chase Cancer Center Medical Research: What was the motivation for your studies? Dr. Zaorsky: Men often walk down grocery store aisles and see bottles of pills labeled “men’s health” or “prostate health.” We call these pills “men’s health supplements.” Our goal is to determine what effect (if any) these pills have on the cancer that men are most commonly diagnosed with – that is, prostate cancer. Medical Research: What is the significance of these findings in simple terms? What are the implications for human health? What would you hope a general audience might take away from these findings? Dr. Zaorsky:  Men with prostate cancer commonly use these pills because of the high incidence of prostate cancer (about 1 in 6 men will be diagnosed with the disease), the stress associated with the diagnosis, the desire to benefit from all potential treatments, and the limited regulation on marketing and sale of the supplements.  Many men believe the supplements will help their cancer or (at worst) do nothing – so what’s the harm?  We found that men’s health supplements have no effect on curing prostate cancer treated with radiation therapy (a common treatment option). Men who took these pills also had no difference in their side effects during or after treatment.  Although we did not see a change in side effects, there have been thousands of cases in the US where supplements have harmed patients. (more…)
Author Interviews, BMJ, Cancer Research, Occupational Health / 21.10.2015 Interview with:, David Richardson PhD Associate Professor Epidemiology Gillings School of Global Public Health UNC Medical Research: What is the background for this study? Dr. Richardson:  The International Nuclear Workers Study (INWORKS) combines three cohorts from France, the United Kingdom, and the United States of America. INWORKS follows on from an earlier 15-Country Study but focuses on the three countries that provided the majority of the most informative data on early nuclear workers (1940’s onward). The use of data from just 3 countries, instead of 15, reduces the organisational requirements – and therefore financial burden – associated with the greater number of countries but the cohort selection (of the three main contributing countries) means that the power of the INWORKS study is not a concern. INWORKS uses information from the French, UK and US cohorts that has been updated since the 15-Country study was published. The overall purpose of the study is to improve the understanding of health risks associated with protracted, low-level exposure to ionising radiation. (more…)
Author Interviews, Breast Cancer, JAMA, Mammograms, UC Davis / 21.10.2015 Interview with: Diana L. Miglioretti, PhD Dean's Professor in Biostatistics Department of Public Health Sciences UC Davis School of Medicine Davis, CA  95616 Medical Research: What is the background for this study? What are the main findings? Dr. Miglioretti: Screening mammography intervals remain under debate in the United States. The US Preventive Services Task Force recommends biennial (every other year) screening, whereas other organizations recommend annual screening. To help inform their updated screening guidelines, the American Cancer Society guideline development group requested that the US Breast Cancer Surveillance Consortium conduct a study comparing cancer outcomes among women screened annually vs. biennially. Prior studies conducted by the consortium used wide intervals for defining annual and biennial mammograms. We wanted to evaluate cancer outcomes for women who more closely adhere to screening intervals. Our goal was to determine if women diagnosed with cancer following biennial screening have tumors with less favorable prognostic characteristics compared to women diagnosed after annual screening. We evaluated outcomes separately by age and by menopausal status because evidence suggests that younger women and premenopausal women may have more aggressive tumors and thus may benefit from more frequent screening. We found from this study that premenopausal women diagnosed with invasive breast cancer following biennial versus annual screening mammography were more likely to have tumors with less-favorable prognostic characteristics (e.g., later stage, larger size). For example, women with an invasive breast cancer diagnosed after a biennial screen had a 28% increased risk of a stage IIB or higher tumor, a 21% increased risk of being diagnosed with a tumor >15 mm, and an 11% higher risk of being diagnosed with a tumor with any less-favorable prognostic characteristic compared women diagnosed with breast cancer following an annual mammogram. In contrast, we found postmenopausal women not using hormone therapy and women 50 years of age or older had similar proportions of tumors with less-favorable prognostic characteristics regardless of screening interval. Relative risk estimates were close to one with no significant differences between biennial and annual screeners. Among postmenopausal women using hormone therapy at the time of the mammogram and women age 40-49, results were less clear. Relative risk estimates for biennial versus annual screeners were consistently above one, but were not as large as for premenopausal women and were not statistically significant. (more…)