Breast Size: Can It Predict
Cancer Risk?
Breast asymmetry
may help predict a woman's risk of breast cancer, according to a recent study
published in Breast Cancer Research (2006;8:R14).
Previous studies have shown
that breast asymmetry, as measured from mammograms, is associated with many
known risk factors for breast cancer. In addition, women diagnosed with breast
cancer have been found to have higher asymmetry than age-matched healthy
women. However, no research has yet confirmed asymmetry to be an independent
predictor for the disease.
In this retrospective
case-control study, the mammograms of 252 women during 1979 to 1986 who did
not have breast cancer but later developed the disease were compared to
mammograms of 252 age-matched healthy women who remained cancer-free during
the same period.
Results showed that breast
volume asymmetry was greater in the group that developed cancer (median of 63
mL), compared to the control group who did not (median of 53 mL). The relative
odds of breast cancer increased by 1.50 for a 100-mL increase in absolute
asymmetry. A 1% increase in relative asymmetry was linked to an increased risk
of 1.09. "Asymmetrical breasts could prove to be reliable indicators of future
breast disease in women, and this factor should be considered in a woman's
risk profile," the authors concluded. Other significant independent predictors
of breast cancer were family history of breast cancer, age at menarche, and
age at menopause.
Vitamins Proven
Ineffective Against Lung Cancer
Contrary to
popular hypothesis, antioxidants and other vitamins do not lower the risk of
lung cancer, as reported in the International Journal of Cancer
(2006;118:970-978).
Vitamins A, C, and E and
folate have been theorized by some to help reduce lung cancer risk. However,
existing research has involved only a small number of cases and is therefore
unreliable. To determine the validity of these hypothesized associations,
authors pooled data from eight prospective studies from North America and
Europe. In each study, baseline vitamin intake was examined using a food
frequency questionnaire. The entire analysis included 430,281 individuals who
were followed for up to 16 years. Of these participants, 3,206 developed lung
cancer.
After adjusting for smoking
and other risk factors for lung cancer, the authors found no evidence
indicating that vitamins A, C, E or folate were protective against lung
cancer. Comparing the highest to the lowest quintile of intake from food only,
the pooled multivariate relative risks were 0.96 for vitamin A, 0.80 for
vitamin C, 0.86 for vitamin E, and 0.88 for folate. In addition, vitamin
consumption from foods and supplements was not linked to a lower lung cancer
risk; multivitamins and specific vitamin supplements were also not
significantly associated with this risk.
Men Given Biased Advice
for Prostate Cancer
Men with
localized prostate cancer may be making inappropriate treatment decisions
because of biased information they receive from physicians and educational
materials. These findings are based on a review published online in March in
the journal Cancer.
Treatment options for
localized prostate cancer vary widely, since there is no clear consensus on
the optimal approach. It is unknown which patient values or other factors may
influence men's therapy choices. To analyze patients' decision-making process
for prostate cancer, the authors conducted a systematic review of relevant
literature from 1990 to 2004. Seventy original peer-reviewed articles were
included in the researchers' analysis. Some treatment methods addressed were
radical prostatectomy, external beam radiation therapy, brachytherapy, and
watchful waiting.
The primary goal of
treatment for nearly all patients in the review was to eradicate cancer. While
men stated that side effects are important, few considered them to be a major
influence in their treatment choice. Furthermore, patients did not
consistently base their decisions on scientific proof of a therapy's efficacy
in controlling cancer or prolonging survival. One study showed that only one
in four patients selected a treatment based on evidence of its effectiveness.
Variations in therapy
choices may be attributed to the information patients receive, the authors
noted, rather than reflecting patient preferences. One study found that most
patient education materials contain biases regarding active treatment and
lessen the significance of watchful waiting.
The researchers concluded,
"Considerable progress is needed in helping patients fully understand how to
balance the complex issues surrounding prostate cancer treatment decision
making."
NCCN's New Guidelines
Target DVT
The first
guidelines regarding the prevention and treatment of deep vein thrombosis
(DVT) in patients with cancer were presented at the 11th annual conference of
the National Comprehensive Cancer Network (NCCN) in March.
The guidelines, targeted for
hospitalized patients, recommend anticoagulation therapy for those patients
who meet the criteria for treatment. The NCCN suggests physicians choose an
anticoagulation agent based on cost-effectiveness and patient conditions.
However, the NCCNdid not advise specific choices of anticoagulation for
individual patients. The guidelines listed the following agents:
unfractionated heparin (5,000 units subcutaneously three times a day);
low-molecular-weight heparin (dosed according to standard operating procedures
of individual institutions), with either dalteparin, enoxaparin, or
tinzaparin; and pentasaccharide and fondaparinux (2.5 mg subcutaneous daily).
Recommendations included prophylaxis of venous thromboembolism in patients
with cancer or who are suspected of cancer, treatment for patients with DVT,
and treatment for patients who experience pulmonary embolism.
"We have known for more than
150 years that cancer is linked to venous thromboembolism," stated Michael
Streiff, MD, an assistant professor of medicine-hematology at Johns Hopkins.
"Cancer increased the risk of deep vein thrombosis by four to seven times over
people who do not have cancer." The NCCN, an alliance of 20 cancer centers,
has been developing guidelines for the treatment of cancer since 1996.
Life Expectancy Is Lower in Younger Women With Breast Cancer
Women younger than 45 diagnosed
with early breast cancer have a higher risk of dying than older patients,
according to study results reported at the 5th European Breast Cancer
Conference in Nice, France.
Although only a small
percentage of young women develop early breast cancer (between 2% and 5% of
all cases), they account for a disproportionate number of deaths. The poor
prognosis of young women with breast cancer has been believed to be due to
late diagnosis, with the consequence that younger women generally had more
advanced disease.
Researchers evaluated 47,590
available records from the U.S. Surveillance, Epidemiology, and End Results
database. Women involved in the study were diagnosed with histologically
confirmed unilateral stage I breast cancer between 1988 and 1997 who underwent
lumpectomy or mastectomy with axillary dissection.
Authors found a 5% increase
in relative risk of breast cancer death for each year younger than 45.
Expected 10-year survival decreased from 90% to 80% in both women younger than
35 and women older than 60. In women under age 45, disease-specific survival
resembled overall survival, indicating that the reduced life expectancy in
young women was largely the result of breast cancer. Risk factors for breast
cancer include a family history of breast cancer, early puberty, late
menopause, and genetic mutations.
Age, more than other
factors, affects the chance of survival in young women, the authors concluded.
They suspect that unknown genetic damage may increase the risk of early
disease development and contributes to the poor prognosis in younger women.
Delayed Bladder Cancer
Surgery Decreases Rates of Survival
Patients with
muscle-invasive bladder cancer who had surgery within three months of
diagnosis had a higher survival rate than those whose surgery was delayed more
than three months, as reported in the Journal of Urology
(2006;175:1262-1267).
It has been theorized that a
delayed cystectomy may lead to a higher pathological stage and could affect
survival in patients with bladder cancer. To evaluate the impact of timing
from T2 bladder cancer diagnosis to cystectomy, investigators followed a
contemporary cohort of 214 consecutive patients who presented with clinical T2
bladder cancer and who underwent radical cystectomy as primary treatment. The
review involved time to cystectomy, pathological stage, disease-specific
survival, and overall survival. In addition, the authors examined the factors
that influence survival and cause delay using univariate and multivariate
analyses.
The mean time to cystectomy
was 60 days, and mean follow-up was 40 months. A significant advantage was
seen in disease-specific survival (P = .05) and overall survival (P
= .02) in patients who had surgery within 93 days (3.1 months), compared to
patients whose surgery was delayed for more than 93 days.
Of the 26 patients who had
delayed cystectomies, the most common factor that contributed to the delay was
physician scheduling problems associated with clinical or research
appointments (12 patients, 46% of cases). Other factors included a patient
seeking multiple opinions, one patient with social reasons, a patient who was
misdiagnosed, and one patient who was hesitant in undergoing treatment.
Most of these delays could
have been prevented, the authors noted. "Despite the need for second opinions
and the impact of busy surgical schedules, clinicians must strive to schedule
patients efficiently and complete surgical treatment within this time frame."
--Jessica Jannicelli
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