MedicalResearch.com Interview with: Judith Trotman MBChB, FRACP, FRCPA
Associate Professor Concord Hospital
University of Sydney, Australia
Medical Research: What are the main findings of the study?Dr. Trotman: That PET-CT (applying the cut-off of ≥4 on the now internationally recommended 5 Point Scale) is a more powerful predictor of both Progression Free and Overall Survival than conventional CT in patients responding to first line immunochemotherapy for advanced follicular lymphoma. It is also a much stronger predictor than the pre-treatment prognostic indices FLIPI and FLIP2. Patients who achieve PET-negative status have a median PFS over 6 years compared to only 17 months in those who remain PET-positive.
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MedicalResearch.com Interview with: Blake Cady MDProfessor of Surgery (emeritus) at Harvard Medical SchoolPartners HealthCare, Harvard Medical
School institutions, Boston
Medical Research: What are the main findings of this study?Dr. Cady: Our findings support mammography screening, and our data is consistent
with the randomized trials. Breast cancer screening with mammography is the most extensively researched screening method ever studied. Only one “randomized" trial failed to show reduced mortality, (Canadian NCSS studies), and there were major flaws in its design and execution that negate their results, as noted in multiple critical publications (volunteers, not geographic assignment, palpable masses detected at examination assigned to “screening” arm, large contamination bias (control group got screened anyway), and very poor quality of mammography). Yet it is this NCSS study that is cited by critics and the press. “Failure Analyses” look backward from death, rather than forward from assignment in randomized trials. The concept of failure studies is well established as noted in recent reports of air-bag failures in cars, and many industrial studies. Seat belt prevention of deaths was discovered by police recording injuries and deaths in crashes after the fact - a failure analysis - not by randomized clinical trials. In breast cancer, failure analyses have advantages of little cost, early results, simplicity, and convenience, compared to randomized trials. Since our results support findings from randomized clinical trials (RCT), they can be accepted as reliable and accurate.
Our findings show that about 71% of deaths from breast cancer occur in the approximately 20% of our patients not in regular screening programs, while only 29% of deaths occur in the 80% of women who were regularly screened by mammography. By extrapolation, women regularly screened have only about a 5% breast cancer mortality, but women not screened have close to a 50% mortality.
(This is my extrapolation from our data, not direct data from our “Failure Analysis”)
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MedicalResearch.com Interview with: Dr. Jun Li, MD, PhD, MPH
Epidemiology and Applied Research Branch
Division of Cancer Prevention and Control
National Center for Chronic Disease Prevention and Health Promotion
Medical Research: What are the main findings of the study?Dr. Li: Using the 2001 to 2009 National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) data, which represent 94.2% of the US population, we identified 120,137 pediatric cancer cases with an incidence rate of 171 cases per million children and adolescents.
Overall cancer incidence rates were stable from 2001-2009. However, we found rates were increasing significantly at 1.3% per year in African American children and adolescents. This increase might be partially attributed to the rise among renal tumors and thyroid cancer. We also found rising incidence in thyroid cancer and renal carcinoma among children and adolescents.
As has been previously established, pediatric cancer is more common in males, in white, in adolescents, and in the Northeast. Leukemia is the most common pediatric cancer, followed by central nervous system (CNS) neoplasms, and then lymphomas.
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MedicalResearch.com Interview with:Nienke de Glas, MD PhD-student
Leiden University Medical Center
Department of Surgery
Leiden The Netherlands
Medical Research: What are the main findings of the study?Dr. de Glas: It remains unclear whether mass breast cancer screening has a beneficial effect in older women. In the Netherlands, the upper age limit of the breast cancer screening program was extended from 69 to 75 years in 1998. If a screening program is effective, it can be expected that the incidence of early stage tumours increases, while the incidence of advanced stage tumours decreases. The aim of this study was to assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands. We showed that the extension of the upper age limit to 75 years has only led to a small decrease of advanced stage breast cancer, while the incidence of early stage tumours has strongly increased. For every advanced stage tumour that was prevented, 20 “extra” and early stage tumours were diagnosed.
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MedicalResearch.com Interview wth:Prof. dr. B.J. Slotman
VU University Medical Center Cancer Center
Amsterdam Netherlands
Medical Research: What are the main findings of this study?Prof. Slotman: This randomized trial showed that the use of thoracic radiotherapy in patients with extensive stage small cell lung cancer reduces the risk of intrathoracic progression by about 50% and improves 2 years survival from 3 to 13%.
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MedicalResearch.com Interview with:Dr. Charles Mullighan, M.D., MBBS(Hons), MSc
Department of Pathology
St. Jude Children's Research Hospital
Memphis, TN 38105
MedicalResearch: What are the most important take home points from this study for practicing clinicians and their patients?Dr. Mullighan:Acute lymphoblastic leukemia (ALL) remains a leading cause of cancer death in children, and the prognosis worsens with increasing age. Current therapies are inadequate for many patients. This study has defined the genetic basis of a recently described subtype of Acute lymphoblastic leukemia called Ph-like ALL. We show that the prevalence increases with rising age, and that in both children and young adults the disease is driven by a diverse range of genetic changes that activate kinase signaling, which fuels the growth of leukemia cells. Ph-like Acute lymphoblastic leukemia currently has a poor outcome. The activated kinases may be inhibited by currently approved tyrosine kinase inhibitors (TKIs). We have shown efficacy of these inhibitors in cell lines and experimental models, and in a series of patients with Ph-like Acute lymphoblastic leukemia treated with TKIs.
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MedicalResearch.com Interview with:Dr. Constance Brinckerhoff
Professor of Medicine
Professor of Biochemistry
Geisel School of Medicine at Dartmouth
Medical Research: What are the main findings of the study?Dr. Brinckerhoff: The genetic mutation BRAFV600E , frequently found in metastatic melanoma, not only secretes a protein that promotes the growth of melanoma tumor cells, but can also modify the network of normal cells around the tumor to support the disease’s progression. Targeting this mutation with Vemurafenib reduces this interaction, and suggests possible new treatment options for melanoma therapy.
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MedicalResearch.com Interview with: Renata Afi Rawlings-Goss, Ph.D.
Postdoctoral Fellow
Tishkoff Lab, University of Pennsylvania
Medical Research: What are the main findings of the study?Dr. Rawlings-Goss: We found genetic mutations in key gene regulators that have been linked to ethnic disparities in cancer. Our investigation identified more than 30 previously undescribed mutations in important regulatory molecules called microRNAs. Individual microRNA molecules can regulate large numbers of genes in some cases over 6000 genes at once. Therefore, mutations in these genes have been linked to numerous diseases. By and large, however, microRNA mutations have not been studied in people of diverse ethnic backgrounds.
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MedicalResearch.com Interview with: Dr. Giulia Scioscia
Coauthor of this study with the Prof. Carpagnano
University of Foggia.
Medical Research: What are the main findings of this study?Dr. Scioscia: The principal and newest findings of our study are:
Airways inflammation and neoangionesis are critical component of the lung cancer pathogenesis and they contribute to the regulation of airways temperature. They cause a regional hyperthermia in the lung lesion.
The exhaled Breath temperature has been proven to be the expression of the airways temperature and for this reason of their inflammation and neoangionesis.
For the first time we have measured this hyperthermia in lung cancer patients with the xhalo. The patient with diagnosis of tumor shows an higher temperature than in healthy ones and this values correlate with cigarette smoking and tumor progression.
MedicalResearch.com Interview with: Professor Yuli Huang
The First People's Hospital of Shunde, Daliang Town, China, and colleagues
Medical Research: What are the main findings of the study?Professor Huang: In this meta-analysis of 16 prospective cohort studies comprising more than 890,000 individuals, we found that the presence of prediabetes at baseline associated with a 15% increased risk of cancer overall. The results were consistent across cancer endpoint, age, duration of follow-up and ethnicity. There was no significant difference for the risk of cancer with different definitions of prediabetes (impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT]).
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MedicalResearch.com Interview with: Karin Jors MA
Department of Palliative Care, Comprehensive Cancer Center,
University Medical Center Freiburg, Freiburg, Germany
Medical Research: What are the main findings of the study?Answer: The findings of our study shed light on the current circumstances for dying in cancer centers. Physicians and nurses in our study reported that they rarely have enough time to care for dying patients. In addition, only a minority of staff members felt that they had been well-prepared during their training to care for dying patients and their families. Overall, only 56% of participants indicated that it is usually possible for patients to die in dignity on their ward. This is likely the result of various factors such as: inadequate rooms for dying patients and their families (i.e. shared rooms), poor communication with patients regarding burdensome treatments, an overuse of life-prolonging measures, etc. Striking differences were found between the responses of palliative care staff and staff from other wards (e.g. general care, oncology, intensive care). For example, palliative care staff reported that they usually have enough time to care for dying patients. In addition, 95% of palliative care staff indicated that it is usually possible for patients to die in dignity on their ward. Overall, nurses perceived the situation for dying patients more negatively than physicians. Whereas 72% of physicians reported that patients can usually die a dignified death on their ward, only 52% of nurses shared this opinion. Although only slightly more than half of participants believed that patients can usually die in dignity on their ward, this is a considerable improvement to the situation 25 years ago. In a similar study published in 1989, researchers found that 72% of physicians and nurses experienced the situation for patients dying on their hospital ward as undignified.
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MedicalResearch.com Interview with:Lu Chen, MPH
Researcher in the Public Health Sciences Division
Fred Hutchinson Cancer Research Center
Doctoral student in the Department of Epidemiology
University of Washington School of Public Health
Medical Research: What are the main findings of the study?Dr. Chen: We found no evidence that wearing a bra is associated with breast cancer risk. Further, breast cancer risk was not impacted by bra wearing frequency, wearing a bra with an underwire, or starting to wear a bra at a young age.
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MedicalResearch.com: Interview with: Isabelle Bedrosian, M.D., F.A.C.S.
Associate Professor, Department of Surgical Oncology, Division of Surgery
Medical Director, Nellie B. Connelly Breast Center
The University of Texas MD Anderson Cancer Center, Houston, TX
Medical Research: What are the main findings of the study?
Dr. Bedrosian:
• National BCT (breast conserving therapy) rates have increased during the last two decades.
• Disparities based on age, geographic facility location and type of cancer treatment facility have lessened over time.
• Insurance type and travel distance remain persistently associated with underutilization of breast conserving therapy.
• Annual income of less than $35K may be emerging as a new association with underutilization of breast conserving therapy.
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MedicalResearch.com Interview InvitationPaula Berstad, PhD, postdoc
Telemark Hospital
c/o Cancer Registry of Norway
Oslo, Norway
Medical Research: What are the main findings of the study?Dr. Berstad: In general population of age 50-55 years, both those invited to bowel cancer screening in year 2001 by flexible sigmoidoscopy and those not invited improved their lifestyle from year 2001 to 2012. Lifestyle was measured as adherence to public health guidelines; non-smoking, daily physical exercise, healthy diet and normal body weight. However, the 11-year improvement was smaller in those who were screened for bowel cancer compared to those not screened. Further, among those who attended the screening, the improvement was smaller in those with findings at screening (positive screening result) compared to those without findings (negative screening result). Our interpretation of the findings is that bowel cancer screening may have a small unwanted effect on lifestyle. Particularly, attention should be given to lifestyle among those testing positive at screening.
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MedicalResearch.com Interview with:
Dr. Gudrun Jonasdottir Bergman PhD
National Board of Health and Welfare
Sweden, Stockholm, Sweden
Medical Research: What are the main findings...
MedicalResearch.com Interview with: Ying Wang PhD
Epidemiology Post-Doc Fellow
American Cancer Society Inc
Atlanta, GA 30303
Medical Research: What are the main findings of the study?Dr. Wang: Previous studies suggest that higher intake of fruits and vegetables are associated with lower risk of breast cancer risk, especially estrogen receptor (ER) negative (ER-) tumors that are more aggressive and difficult to treat. We found that postmenopausal women who had higher intake of flavones, a subgroup of flavonoids that are widely distributed in fruits and vegetables, had lower risk of breast cancer. Furthermore, higher intake of flavan-3-ols which is high in non-herbal tea was associated with lower risk of ER- but not ER positive breast cancer.
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MedicalResearch.com Interview with: Vanessa Er PhD
School of Social and Community Medicine
University of Bristol and Bristol Nutrition BRU
Medical Research: What are the main findings of the study?Dr. Er: We found that men who had optimal intake of three nutrients- calcium, selenium and foods rich in lycopene- had a lower risk of prostate cancer. Mainly, men who ate over 10 servings/week of tomatoes and tomato-based products had 18% reduction in risk of developing prostate cancer. We also found that the risk of prostate cancer was lower in men who had high intake of fruits and vegetables.
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MedicalResearch.com Interview with: Elizabeth Goodman BA
Division of Oncology
The Children’s Hospital of Philadelphia
Philadelphia, Pennsylvania
Medical Research: What are the main findings of the study?Answer: Weekend hospital admission for pediatric patients newly diagnosed with leukemia was associated with a longer length of stay, slightly longer wait to start chemotherapy and higher risk for respiratory failure; however, weekend admissions were not linked to an increased risk for death.
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MedicalResearch.com Interview with:
Dr. Mangesh Thorat
MBBS, MS(Surgery), DNB(Surgery), MNAMS
Centre for Cancer Prevention
Wolfson Institute of Preventive Medicine
Barts & The London School of Medicine and Dentistry, London
Queen Mary University of Londonm Honorary Clinical Lecturer
Division of Surgery and Interventional Science Whittington Hospital, London
Medical Research: What are the main findings of the study?Dr. Thorat : Accumulating evidence supports an effect of aspirin in reducing cancer incidence and mortality. Our analyses show that for average-risk individuals aged 50-65y taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15 year period and an overall 4% relative reduction in all deaths over a 20 year period. The benefits of aspirin use would be most visible in the reduction in deaths due to cancer. If the findings of our study are applied to the UK general population aged 50-64 taking aspirin for next 10 years, on an average more than 6000 lives will be saved every year.
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MedicalResearch.com Interview with: Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands
Medical Research: What are the main findings of the study?Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
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MedicalResearch.com Interview with:Frank van Hees, MSc
Researcher, Department of Public Health, Erasmus MC
Rotterdam, The Netherlands
Medical Research: What are the main findings of the study?Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.
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MedicalResearch.com Interview with: Devanand Sarkar, M.B.B.S., Ph.D
Harrison Scholar at VCU Massey Cancer Center,
Blick Scholar and Associate Professor
Department of Human and Molecular Genetics
Member of the VCU Institute of Molecular Medicine
Virginia Commonweath School of Medicine
Medical Research: What are the main findings of the study?Dr. Sarkar: Retinoic acid (Vitamin A) is an anti-cancer drug for a number of cancers including liver cancer. However, all patients do not respond to retinoic acid. Astrocyte elevated gene-1 (AEG-1) is overexpressed in a large percentage of cancer patients and promotes development and progression of cancer. In this study we document that AEG-1 inhibits retinoic acid function. Combinatorial strategy involving AEG-1 inhibition and retinoic acid synergistically blocks growth of human liver cancer cells in animal models.
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MedicalResearch.com Interview with: Dr Krishnan Bhaskaran MSc PhD.
Senior Lecturer in Statistical Epidemiology &
National Institute for Health Research Postdoctoral Fellow
London School of Hygiene and Tropical Medicine
London WC1E 7HT
Medical Research: What are the main findings of the study?Dr. Bhaskaran: Body mass index was associated with the majority of cancer types studied, and for 10 cancers, including some of the most common like colon cancer and postmenopausal breast cancer, higher body mass index was clearly associated with higher risk.
The cancer type that was most strongly related to BMI was uterine cancer, the 4th most common cancer in women. For a woman of average height, each 2 stone (13kg) increase in weight increased risk by over 60%. Body mass index also had particularly large effects on risk of kidney and gallbladder cancers.
In total, we estimated that over 12,000 cases of the 10 affected cancers may be caused each year by excess weight, and that if average body mass index in the population continues to increase, there may be several thousand more cases of these cancers each year as a result.
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MedicalResearch.com Interview with:Øyvind Holme, MD
Department of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
Institute of Health and Society, University of Oslo, Oslo, Norway
Departments of Epidemiology and Biostatistics, Harvard School of Public Health,
Harvard-MIT Division of Health Sciences and Technology
Boston, Massachusetts
Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
Medical Research: What are the main findings of the study?Dr. Holme: In this population-based trial, we found that once-only flexible sigmoidoscopy screening in asymptomatic 50-64 year old individuals reduces colorectal cancer mortality by 27% and colorectal cancer incidence by 20% after 11 years of follow-up. We found that the incidence reduction is as great in 50-54 year old individuals as in 55-64 old individuals. Addition of a once-only fecal occult blood test to flexible sigmoidoscopy did not lead to a larger reduction in colorectal cancer incidence or mortality compared to flexible sigmoidoscopy screening alone.
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MedicalResearch.com Interview with: Dr Sylvie Mesrine, Gynecologist, MD
Inserm, CESP Centre for Research in Epidemiology and Population
Health, U1018, Nutrition, Hormones and Women's Health Team,
Villejuif, France.
Medical Research: What are the main findings of the study?Answer:We wanted to disentangle the effect of recent physical activity (within the
previous four years) from the effect of past physical activity (5-9 years
earlier) on postmenopausal breast cancer risk. Our most important finding
was that recreational/transport physical activity (including walking,
cycling and engaging in other sports), even of modest intensity, seemed to
have a rapid impact on breast cancer risk: it was quite rapidly associated
with a decrease in breast cancer risk, which was however attenuated when
activity stops. To our knowledge, our study is the first to independently
assess the association between breast cancer risk and recreational physical
activity both 5 to 9 years earlier and within the previous 4 years.
Furthermore, the association of recent recreational physical activity and
breast cancer risk decrease was observed whatever the recent levels of
gardening or do-it yourself activities.
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MedicalResearch.com Interview with Lynn Rosenberg, ScD
Slone Epidemiology Center at Boston University
1010 Commonwealth Avenue
Boston, MA 02215
Medical Research: What are the main findings of the study?Response: With prospective data from the Black Women’s Health Study, we assessed vigorous exercise and walking in relation to incidence of invasive breast cancer . We found that the overall incidence of breast cancer was lower among women who exercised vigorously or walked briskly than among women who were sedentary. The reduction was most apparent among women who exercised at least 5 hours per week. The association of exercise with breast cancer risk did not differ by estrogen receptor status of the breast tumor, but further study is needed to firmly establish this. Sitting for long periods at work or watching television was not significantly associated with breast cancer incidence.
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MedicalResearch.com Interview with: Dr. Judith Malmgren PhD
Affiliate Assistant Professor, Epidemiology
University of Washington
School of Public Health
Seattle, WA 98177
Medical Research: What are the main findings of the study?Dr. Malmgren: We found a significant shift to lower stage breast cancer at diagnosis with an observed increase in mammography detected breast cancer over time and a significant decrease in later stage cancers found by the patient or her doctor.
Mammography detected breast cancers were more often treated with lumpectomy and radiation and less likely to require mastectomy or adjuvant chemotherapy.
We also observed better 5 year invasive breast cancer specific survival among the mammography detected patients as opposed to the patient or physician detected breast cancer cases.
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MedicalResearch.com Interview with: Professor Fritz H Schröder
Department of Urology, Erasmus University Medical Center
Rotterdam, Netherlands
Medical Research: What are the main findings of the study?Professor Schröder: I consider as the main finding that we could report a continuing effect of PSA driven screening on prostate cancer mortality for men aged 55 – 69 years in the screen arm of our study after 13 years of follow-up. The absolute reduction in the risk of death from prostate cancer amounts to 1.28 per 1000 men randomized to the screening arm. This translated into numbers to be invited to screening and numbers needed to be diagnosed to save one prostate cancer death of 781 and 27. These figures show an increasing effect with increasing time of follow-up. The relative risk reduction related to the control arm has remained unchanged with respect to the 11 year follow-up period. For men who actually participated and were screened the relative risk reduction amounted to 27%, the figure most applicable to men who consider to be tested.
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MedicalResearch.com Interview with:Dr. Tetyana Kendzerska
Institute for Clinical Evaluative Science
Women's College Research Institute
Women's College Hospital
Department of Medicine
University of Toronto
Medical Research: What are the main findings of the study?Dr. Kendzerska: In a large cohort with varying degrees of obstructive sleep apnea (OSA), severity of obstructive sleep apnea was not found to be independently associated with either prevalent or incident cancer, except in one subgroup analysis in smoking-related cancer.
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MedicalResearch.com Interview with:Dr Marc Tischkowitz MD PhD
University Lecturer (Associate Professor) and
Honorary Consultant Physician in Medical Genetics
Department of Medical Genetics, University of Cambridge
Medical Research: What are the main findings of the study?Dr. Tischkowitz: The PALB2 gene was first identified in 2006 and linked to breast cancer in 2007 but until now we have not had good breast cancer risk estimates for women who have inherited PALB2 mutations. This study was started in 2009 by an group of research institutions (The PALB2 Interest Group) in Canada, US, Europe (UK, Belgium, Greece, Italy, Finland) and Australia. We studied 362 individuals with PALB2 mutations from 154 families. We found that awomen with a PALB2 mutation will on average have a 35% risk of developing breast cancer by the age of 70, rising to 58% if there is a strong family history. Our study will help clinicians to better advise and manage such women.
There are several new aspects.
It is by far the largest study to date and provides the most accurate risk estimates for PALB2 mutation carriers.
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MedicalResearch.com Interview with:
Judith Trotman MBChB, FRACP, FRCPA
Associate Professor Concord Hospital
University of Sydney, Australia
Medical Research: What are the main findings of the study?
Dr. Trotman: That PET-CT (applying the cut-off of ≥4 on the now internationally recommended 5 Point Scale) is a more powerful predictor of both Progression Free and Overall Survival than conventional CT in patients responding to first line immunochemotherapy for advanced follicular lymphoma. It is also a much stronger predictor than the pre-treatment prognostic indices FLIPI and FLIP2. Patients who achieve PET-negative status have a median PFS over 6 years compared to only 17 months in those who remain PET-positive.
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