Other highlights in the Dec. 11 JNCI

December 11, 2007

Drug May Reduce Breast Cancer Recurrence

The drug anastrozole reduced the risk of breast cancer recurrence among postmenopausal women who took it for three years following treatment with tamoxifen.

A previous clinical trial showed that breast cancer patients who were still disease-free after taking tamoxifen for five years had their risk of recurrence further reduced if they received five additional years of treatment with the drug letrozole. Both anastrozole and letrozole are in the same class of drugs, known as aromatase inhibitors.

Raimund Jakesz, M.D., of Vienna Medical University and colleagues conducted a similar trial--the Austrian Breast and Colorectal Cancer Study Group trial--by randomly assigning breast cancer patients who had taken five years of tamoxifen to receive either three years of anastrozole or no further treatment.

After more than five years of follow-up, women who received anastrozole had a 38 percent reduction in the risk of recurrence compared with women who received no further treatment, but there was no difference in overall survival between the two groups. No unexpected side effects occurred in these women.

"The more manageable side effect profile of anastrozole compared with tamoxifen may allow the duration of adjuvant treatment to extend beyond the 5-year period recommended for tamoxifen," the authors write.

In an accompanying editorial, Tatiana Prowell, M.D., and Vered Stearns, M.D., of Johns Hopkins University School of Medicine in Baltimore compare this trial with similar breast cancer trials of aromatase inhibitors and discuss the factors that are important for deciding which drugs to give patients and for how long.

"Results from both completed and ongoing studies should not only help to identify women who can safely forego adjuvant therapy as well as those who are best treated with short-term and long-term adjuvant hormone therapy but also provide a rationale for the selection of the most appropriate drug or drugs to incorporate in adjuvant therapy," the editorialists write.


Patients More Likely to be Diagnosed with Cancer Soon after Blood Transfusions

Blood transfusion recipients have a slightly increased risk of cancer in the months immediately after the transfusion, but this may be due to the need for blood transfusions in patients with undiagnosed cancer.

Some researchers have speculated that blood transfusions could increase the recipient's risk of cancer through transmission of biologic agents or effects on the immune system. To investigate this, Henrik Hjalgrim, M.D., Ph.D., of Statens Serum Institut in Copenhagen and colleagues identified nearly 890,000 individuals who were cancer-free when they received blood transfusions after 1968 in Sweden and Denmark. The researchers tracked the patients to determine whether they were at increased risk of subsequent cancer.

Among this group, 80,990 cancers were diagnosed, whereas only 55,788 cancers were expected. During the first six months after a transfusion, patients had more than a fivefold increase in overall cancer risk compared with the general population, but after this period, the risk declined rapidly to levels approaching those of the general population .

"There has been speculation that blood transfusions promote tumor growth and this could precipitate incipient cancers. However, we speculate that other mechanisms unrelated to blood transfusion could account for the observed increased incidence of cancer at early times after blood transfusion," the authors write.

Contact: Mads Melbye, co-author, mme@ssi.dk, +45 3268 3164

PSA Testing Is Associated with More Prostate Cancer Diagnoses

The increase in prostate cancer cases in Nordic countries in recent years is consistent with the increased use of PSA testing over the same period.

Previous studies examining the relationship between the use of prostate-specific antigen (PSA) testing and prostate cancer mortality have been inconsistent.

Rune Kvåle, M.D., of the Cancer Registry of Norway in Oslo and colleagues studied trends in prostate cancer incidence and mortality in Scandinavian countries from 1980 to 2004. Based on their analysis of the trends, the researchers concluded that the increase in prostate cancer incidence during the 1990s coincided with the introduction of the PSA test. Mortality rates, on the other hand, have stabilized since the late 1980s.

"The recent stabilization or declines in prostate cancer mortality rates observed in four of the five Nordic countries are consistent with an effect of increased curative treatment of early diagnosed prostate cancer and improved treatment of more advanced disease," the authors write.

Contact: Rune Kvåle, rune.kvale@kreftregisteret.no, +4722451300

Greater Cancer Risk in NBN Mutation Carriers

A mutation in the NBN gene is associated with an increased risk of cancer in carriers of one copy of the mutation.

Nijmegen breakage syndrome (NBS) is disease that causes congenital microcephaly (a condition marked by abnormally small growth of the head), immunodeficiency, hypersensitivity to x-rays, and a predisposition to cancer, particularly cancers that affect the lymph nodes. The disease is caused by mutations in a gene known as NBN, and more than 90 percent of NBS patients have two copies of a certain mutation--657del5--in the NBN gene.

Eva Seemanová, D.Sc., of Charles University in Prague and colleagues identified 344 relatives of NBS patients and tested whether they carried a copy of the mutation. The researchers hypothesized, on the basis of the patients' genealogical data, that these carriers would be at a greater risk for developing cancer.

Thirteen of the relatives were diagnosed with cancer, and of those, 11 carried the NBN mutation. Only six cancers would be expected in the general population.

"The statistically significant excess of NBN 657del5 mutation carriers that we found among test cancer patients supports the hypothesis that [this genetic mutation predisposes] carriers to cancer," the authors write.

Contact: Eva Seemanová, eva.seemanova@lfmotol.cuni.cz, +4202/2443-3501
Also in December 11 JNCI: Note to Reporters:

We have started up an e-mail list to alert reporters when papers are available on the EurekAlert site. If you would be interested on being on this list, please let us know at jncimedia@oxfordjournals.org. The content will continue to be available through EurekAlert's e-mail system and our EurekAlert page.

The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jnci.oxfordjournals.org/.

Journal of the National Cancer Institute

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