“Although quitting smoking is the most important preventive action in reducing lung cancer risk, consuming a mix of different types of fruit and vegetables may also reduce risk, independent of the amount, especially among smokers,” said H. Bas Bueno-de-Mesquita, M.D., M.P.H., Ph.D., senior scientist and project director of cancer epidemiology at The National Institute for Public Health and the Environment, The Netherlands.

Using information from the ongoing, multi-centered European Prospective Investigation into Cancer and Nutrition (EPIC) study, Bueno-de-Mesquita and colleagues evaluated 452,187 participants with complete information, 1,613 of whom were diagnosed with lung cancer.

Information was obtained on 14 commonly eaten fruits and 26 commonly eaten vegetables. The fruits and vegetables evaluated in the EPIC study consisted of a wide variety of fresh, canned, or dried products.

Previous results from the EPIC study showed that the quantity of vegetables and fruits may decrease risk of lung cancer; in particular the risk of one specific type of lung cancer, squamous cell carcinoma, decreased in current smokers.

Regardless of the amount, the researchers on the current study found that risk of lung cancer also decreased when a variety of vegetables were consumed. In addition, the risk of squamous cell carcinoma decreased substantially when a variety of fruits and vegetables were eaten. However, Bueno-de-Mesquita said that they “cannot exclude that these results can still be explained by smoking.”

“Fruits and vegetables contain many different bioactive compounds, and it makes sense to assume that it is important that you not only eat the recommended amounts, but also consume a rich mix of these bioactive compounds by consuming a large variety,” he said.

While previous research has shown the influence of the quantity of fruits and vegetables on cancer development, Stephen Hecht, Ph.D., editorial board member for Cancer Epidemiology, Biomarkers & Prevention, believes this study is one of the first to evaluate diversity of fruit and vegetable consumption, rather than quantity.

“The results are very interesting and demonstrate a protective effect in smokers. There are still over a billion smokers in the world, and many are addicted to nicotine and cannot stop in spite of their best efforts,” added Hecht, who is the Wallin Land Grant Professor of Cancer Prevention at the Masonic Cancer Center, University of Minnesota.

Tobacco smoke contains a complex mixture of cancer causing agents. Therefore, a mixture of protective agents is needed to have any beneficial effect in reducing one’s chance of lung cancer, Hecht said.

“Nevertheless, the public should be made aware and be reminded that the only proven way to reduce your risk for lung cancer is to avoid tobacco in all its forms,” he said.

American Association for Cancer Research.

In a paper published last week in the journal Science, Hongrong Liu, a UCLA postdoctoral researcher in microbiology, immunology and molecular genetics, and colleagues reveal an atomically accurate structure of the adenovirus that shows the interactions among its protein networks. The work provides critical structural information for researchers around the world attempting to modify the adenovirus for use in vaccine and gene-therapy treatments for cancer.

To modify a virus for gene therapy, researchers remove its disease-causing DNA, replace it with medications and use the virus shell, which has been optimized by millions of years of evolution, as a delivery vehicle.

Lily Wu, a UCLA professor of molecular and medical pharmacology and co-lead author of the study, and her group have been attempting to manipulate the adenovirus for use in gene therapy, but the lack of information about receptors on the virus’s surface had hampered their quest.

The structure of an adenovirus. By averaging thousands of noisy cryo-electron microscopy images (left bottom), researchers have determined the atomic structure of the human adenovirus (color). This structure reveals complex interactions among protein networks (center). Such interactions can be targeted to optimize an adenovirus for anti-cancer and gene therapy applications.

“We are engineering viruses to deliver gene therapy for prostate and breast cancers, but previous microscopy techniques were unable to visualize the adapted viruses,” Wu said. “This was like trying to a piece together the components of a car in the dark, where the only way to see if you did it correctly was to try and turn the car on.”

To better visualize the virus, Wu sought assistance from Hong Zhou, a UCLA professor of microbiology, immunology and molecular genetics and the study’s other lead author. Zhou uses cryo-electron microscopy (cryoEM) to produce atomically accurate three-dimensional models of biological samples such as viruses.

Wu, who is also a researcher at the California NanoSystems Institute (CNSI) at UCLA, learned of Zhou’s work after he was jointly recruited to UCLA from the University of Texas Medical School at Houston by the UCLA Department of Microbiology, Immunology and Molecular Genetics and UCLA’s CNSI.

About a year ago, once the transfer of Zhou’s lab was complete, Sok Boon Koh, one of Wu’s students, sought out Zhou’s group for their expertise and initiated the collaboration.

“This project exemplifies my excitement about being part of an institute as innovative as CNSI,” Zhou said. “Not only am I able to work with state-of-the-art equipment, but because CNSI is the hub for nanotechnology research and commercialization at UCLA, I have the opportunity to collaborate with colleagues across many disciplines.”

Working in the Electron Imaging Center for Nanomachines at the CNSI, a lab run by Zhou, the researchers used cryoEM to create a 3-D reconstruction of the human adenovirus from 31,815 individual particle images.

“Because the reconstruction reveals details up to a resolution of 3.6 angstroms, we are able to build an atomic model of the entire virus, showing precisely how the viral proteins all fit together and interact,” Zhou said. An angstrom is the distance between the two hydrogen atoms in a water molecule, and the entire adenovirus is about 920 angstroms in diameter.

Armed with this new understanding, Wu and her group are now moving forward with their engineered versions of adenovirus to use for gene therapy treatment of cancer.

“This breakthrough is a great leap forward, but there are still many obstacles to overcome,” Wu said. “If our work is successful, this therapy could be used to treat most forms of cancer, but our initial efforts have focused on prostate and breast cancers because those are the two most common forms of cancer in men and women, respectively.”

The group is working with the adenovirus because previous research has established it as a good candidate for gene therapy due to its efficiency in delivering genetic materials inside the body. The virus shell is also a safe delivery vehicle; tests have shown that the shell does not cause cancer, a problem encountered with some other virus shells. The adenovirus is relatively non-pathogenic naturally, causing only temporary respiratory illness in 5 to 10 percent of people.

CryoEM enables such a high-resolution reconstruction of biological structures because samples, in water, are imaged directly. In contrast, with X-ray crystallography (the conventional technique for atomic resolution models of biological structures), researchers grow crystal structures replicating the sample and then use diffraction to solve the crystal structure. This technique is limited because it is difficult to grow crystals for all proteins, samples for x-ray crystallography need to be very pure and uniform, and crystals of large complexes may not diffract to high resolution. These limitations resulted in critical areas of the adenovirus surface being unresolved using x-ray crystallography.

The study was funded by the National Cancer Institute and the U.S. Department of Defense.

Material adapted from UCLA.

Dr. Shapira showed in her study that a diet rich in antioxidants and omega-3 fatty acids, like the diet eaten in Mediterranean regions where melanoma rates are extremely low, can help protect us from skin cancer.

The sun’s rays damage both the skin and the immune system by penetrating the skin and causing photo-oxidation, she explains, affecting both the cells themselves and the body’s ability to repair any damage. Her prescription is to “go Greek” with foods such as olive oil, fish, yogurt, and colorful fruits and vegetables to fight the oxidizing effect of the sun, as well as regular applications of sunscreen and appropriate body coverings such as hats, beach coverups, and other sportswear.

Drinking to your health
Previous research demonstrated that the sun’s UV rays damage the skin by exciting its molecules and causing them to become oxidized, says Dr. Shapira. “My theory was that if you prepared the body with sufficient and relevant antioxidants, damage could be reduced.”

For a study at the Baltic Sea, Dr. Shapira and Prof. Bodo Kuklinski of Rostock University organized two groups. One group was provided a drink high in antioxidants, while the other enjoyed beverages such as sodas. Those who hydrated with the antioxidant-rich drink had fifty percent fewer oxidation products (i.e., MDA) in their blood at the end of the two-week period, which included five to six hours of exposure to the sun daily. Further studies proved that these antioxidants, especially carotenoids ― fruit and vegetable pigments like red from tomatoes and watermelons and orange from carrots and pumpkins that accumulate in the skin where they serve as a first line of protection ― had delayed the phenomenon of skin erythema, which indicates the initiation of tissue and DNA damage that can lead to skin cancer.

This information is invaluable, especially in light of climate change, notes Dr. Shapira. As temperature and humidity get stronger, which aggravates the damaging effect of solar UV rays, it is increasingly difficult for sunscreen alone to protect effectively. So while covering up, slathering on the sunscreen, and avoiding the sun during peak hours are still important to prevent a burn, consider dietary changes too, to promote skin health.

Go fish with a glass of red … and other colors
It might be tempting to load up on dietary supplements instead of changing the diet, but according to Dr. Shapira, supplements are simply not as effective. Foods provide nutrient “synergy,” she says. “In foods, many vitamins and various antioxidants and bioactive ingredients work to support one another and the body’s natural protective mechanisms. Synergies between the nutrients in your food, which make a significant contribution to health, may contrast with the relative isolation of a vitamin supplement.”

The research is getting attention: for the first time, the Israeli Cancer Association has included the nutritional information as part of their “Smart in the Sun” advisories.

It is not necessary to move to Greece, Israel, or Turkey to get the benefit of the diet. Most of the appropriate foods are stocked in American grocery stores. Olive oil, fresh fish, fruits and vegetables, red wine in moderation, whole grains, beans and lots of water should be at the top of the shopping list, Dr. Shapira advises.

And there are some foods to avoid, she points out. Go light on red meat, processed foods, and alcohol (red wine is preferable), and be wary of foods that contain the photosensitizing compound psoralen, such as parsley, celery, dill, cilantro and figs.

Material adapted from American Friends of Tel Aviv University.

A team led by Kathryn E. Weaver, Ph.D., M.P.H., an assistant professor in the Division of Public Health Sciences and lead author on the study, examined the prevalence of forgoing different types of health care due to financial concerns. Researchers sought to determine whether cancer history and race or ethnicity were associated with individuals’ likelihood to go without care.

The investigators analyzed information from the annual U.S. National Health Interview Survey (NHIS), an in-person, nationwide survey of 30,000 to 40,000 households in the civilian, non-institutionalized population that is used to track trends in illness and disability in the United States. Data from 6,602 adult cancer survivors and 104,364 individuals with no history of cancer, who were surveyed in the 2003 to 2006 NHIS, were included in the study.

The analysis showed that among cancer survivors, the prevalence of forgoing care in the past year due to concerns about cost was 7.8 percent for medical care, 9.9 percent for prescription medications, 11.3 percent for dental care, and 2.7 percent for mental health care. Cancer survivors under the age of 65 years were one and a half to two times more likely to delay or forgo all types of medical care than their same-age peers without a history of cancer. Hispanic and black cancer survivors were more likely to go without prescription medications and dental care than white survivors.

“Although the large number of survivors going without care was somewhat surprising, it has long been recognized that cancer can have a negative impact on the financial health of survivors,” Weaver said. “This is important because cancer survivors have many medical needs that persist for years after their diagnosis and treatment. The implications of this financial stress for their ongoing medical care are just beginning to be recognized.”

The analysis revealed that 18 percent of U.S. cancer survivors, which represents more than two million individuals, did not get one or more needed medical services because of financial concerns.

“Future research needs to examine the impact of forgoing care on survivors’ quality of life and survival,” the authors wrote. Weaver added that it was not clear from this study what specific types of medical care were not being received and whether the services were cancer-related. She also noted that it will be interesting to observe how recent health care reform efforts might impact access to care for cancer survivors in the coming years.

Material adapted from Wake Forest University Baptist Medical Center by CFisher.

Details of these analyses appear as a set of papers in the June 18, 2010, online issue of the American Journal of Epidemiology, and in print in the July 2010 issue.

“We did not see lower cancer risk in persons with high vitamin D blood concentrations compared to normal concentrations for any of these cancers,” said Demetrius Albanes, M.D., NCI, one of the study investigators. “And, at the other end of the vitamin D spectrum, we did not see higher cancer risk for participants with low levels.”

As part of a collaborative effort of the NCI Cohort Consortium, investigators from the Vitamin D Pooling Project of Rarer Cancers examined vitamin D levels in blood that had been collected from over 12,000 men and women participating in one of the studies. Some of those individuals went on to develop cancer. Vitamin D concentrations were measured using 25-hydroxyvitamin D (25(OH)D), which is the major form of this vitamin in the bloodstream.

Participants were followed for the development of cancer for up to 33 years, depending on the study. Investigators then compared cancer rates in participants whose levels of vitamin D in stored blood were high (above 75 nmol/L, or nanomoles per liter) or low (less than 25 nmol/L) with rates in participants whose levels of vitamin D were within the normal range (50 to 75 nmol/L).

For the small number of participants with vitamin D levels greater than 100 nmol/L, investigators observed elevated risk of pancreatic cancer, but not for the other cancers in these studies. They recommended further research to clarify this relationship.

Vitamin D is made naturally by the body when the skin is exposed to sunlight; it can also be obtained from a few foods in which it occurs naturally, from fortified foods, and from nutritional supplements. Vitamin D is essential for healthy bones, calcium absorption, and immune function.

Researchers and clinicians have looked to the possibility that vitamin D might be used for cancer prevention. Some evidence indicates that higher levels of vitamin D are associated with a lower risk of colorectal cancer, though the evidence is inconsistent.

Through the Vitamin D Pooling Project, researchers had access to a geographically and demographically diverse group of men and women, including participants from the United States, Finland, and China.

In this collection of groups of study participants, the proportion of the study population that was deficient in vitamin D varied from 3 percent to 36 percent, depending on geographical latitude, season during which the blood was collected, race, and other factors. The investigators had a wealth of other information on participants, including smoking history, lifestyle, and diet. As in other studies, individuals with higher 25(OH)D levels were more likely to be male, lean, and physically active. Those with higher levels also reported greater intake of multivitamins, calcium supplements, and foods rich in vitamin D.

“In this pooled analysis of cohort data, vitamin D was not associated with lower risk for these less common cancers, despite well-established benefits for bone health,” concluded Albanes.

Many people in the United States and around the world have low concentrations of 25(OH)D. The current recommended daily intake of vitamin D to maintain bone health and normal calcium metabolism, according to the Food and Nutrition Board of the Institute of Medicine, National Academy of Sciences, ranges from 200 IU (international units) to 600 IU, depending on age, with the highest dose recommendations being for the elderly. In addition, the 2005 Dietary Guidelines for Americans recommends that older adults, people with dark skin, and those exposed to insufficient sunlight consume extra vitamin D from vitamin D-fortified foods and/or supplements. Since there are very few foods which naturally contain vitamin D (fatty fish, fish liver oil, and eggs), most dietary vitamin D comes from fortified foods such as milk, juice, yogurt, bread and breakfast cereals.

Material adapted from National Institutes of Health by CFisher.

“This sort of dynamic runs contrary to what most people would expect, but economists often encounter this sort of thing,” says Joseph Newhouse, the John D. MacArthur Professor of Health Policy and Management at Harvard University and faculty member at Harvard Medical School, Harvard Kennedy School, Harvard School of Public Health, and the Faculty of Arts and Sciences, who carried out the study with colleagues Mireille Jacobson, now at RAND, Craig Earle, now at Sunnyside Medical Center, and Mary Price.

The study will be released on June 17 as a web first by Health Affairs, and will also appear in its July edition.

Unlike the process for prescribing and billing for typical drugs, in which physicians simply write prescriptions that patients must then fill, oncologists purchase chemotherapy agents directly from pharmaceutical companies and then bill the patient’s insurer. But they don’t necessarily bill for what they paid.

Like cars, these drugs have a “sticker price,” that is, a manufacturer’s suggested cost that may or may not reflect what doctors actually pay. Many doctors will often purchase the drugs at a price far below the suggested cost and then bill insurance for the suggested price, making upwards of a twenty percent profit.

In 2005, the Medicare Modernization Act established that Medicare would no longer automatically pay what physicians billed. Instead, the federal government calculated the average amount that doctors typically paid for each chemotherapy drug, and then decided to reimburse no more than six percent above this average cost.

Many critics, however, claimed that this would adversely affect the patient and that less monetary incentive would encourage less patient care.

In the first-ever study to test this critique, Newhouse and his team looked at Medicare claims for 222,478 beneficiaries who between 2003 and 2005 were diagnosed with lung cancer. The researchers found that on average, within one month of diagnosis, chemotherapy treatment increased 2.4 percent after the Medicare Modernization Act, from 16.5 percent to 18.9 percent. What’s more, use of more costly chemotherapy drugs increased, while use of less expensive drugs declined.

“Physicians don’t always respond to incentives the way most people expect,” says Mireille Jacobson of RAND, the study’s first author, “but in this case they do respond in a way that makes sense to economists. It seems logical on the one hand that when you pay less you get less. However, in this case, since a high proportion of an oncologist’s income depends on prescribing, paying less per drug results in more drugs.”

The authors state in the paper that they cannot extrapolate from these findings either the appropriateness of increased treatment or the effects on health outcomes. Additional studies will be necessary to examine these areas.

Material adapted from Harvard Medical School by CFisher.

In contrast, stress remained unabated and immunity significantly declined in the assessment-only group,” said lead researcher Barbara L. Andersen, Ph.D., professor in the department of psychology at the Ohio State University, Columbus, and a researcher at the Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute.

Psychological stress leads to disruptions in quality of life, health behaviors and immunity, all of which contribute to poorer health outcomes.

Barbara L. Andersen, Ph.D., is a professor in the department of psychology at the Ohio State University, Columbus.

Participants included 227 women with newly diagnosed Stage II or III breast cancer; they were randomized to receive a psychological intervention or assessment only. Psychological intervention included the following clinical objectives for patients: understand the nature of cancer stress; learn tangible ways to reduce stress and improve quality of life; maintain adherence and follow-up to cancer care; enhance communication with medical care providers; increase well-being during treatment, facilitate recovery and improve overall health.

During follow-up, 62 women were diagnosed with recurrent breast cancer. After recurrence, women who had earlier received the psychological intervention had a 59 percent reduction in the risk of dying of breast cancer.

According to Andersen, these results “show enduring benefits from the psychological intervention that were never previously considered or observed,” and suggest that the intervention’s mechanisms affected patients’ risks for recurrence and for breast cancer death.

“Survival advantages occurred above and beyond the improvements from state-of-the-science oncology treatments received at an NCI-designated comprehensive cancer center,” Andersen said. “An empirically supported psychological intervention for cancer patients can yield robust gains of enduring quality, and ones that may include important health benefits.”

Sarah Gehlert, Ph.D., is the E. Desmond Lee professor of racial and ethnic diversity at the Brown School, Washington University, St. Louis.

“We currently have few empirically supported psychosocial interventions for use with women who have been diagnosed with breast cancer,” she said. “An intervention that increased survival would be incredibly valuable. It represents a new tool for improving the lives of women with breast cancer.”

Gehlert, who is not affiliated with this study, believes this research will provide a template for future health services research in breast cancer.

“Dr. Andersen’s intervention provides a strong model for translation in breast cancer research,” she said. “These results are extremely heartening, because it shows that a psychological intervention can have long-term positive effects.”

Material adapted from American Association for Cancer Research by CFisher.

Schmitz, whose previous research reversed decades of cautionary exercise advice given to breast cancer patients with the painful arm-swelling condition lymphedema, led a 13-member American College of Sports Medicine expert panel that developed the new recommendations after reviewing and evaluating literature on the safety and efficacy of exercise training during and after cancer therapy.

“We have to get doctors past the ideas that exercise is harmful to their cancer patients.  There is a still a prevailing attitude out there that patients shouldn’t push themselves during treatment, but our message – avoid inactivity – is essential,” Schmitz says. “We now have a compelling body of high quality evidence that exercise during and after treatment is safe and beneficial for these patients, even those undergoing complex procedures such as stem cell transplants. If physicians want to avoid doing harm, they need to incorporate these guidelines into their clinical practice in a systematic way.”

Cancer patients and survivors should strive to get the same 150 minutes per week of moderate-intensity aerobic exercise that is recommended for the general public, the panel says. Though the evidence indicates that most types of physical activity – from swimming to yoga to strength training – are beneficial for cancer patients, clinicians should tailor exercise recommendations to individual patients, taking into account their general fitness level, specific diagnosis and factors about their disease that might influence exercise safety. Cancer patients with weakened ability to fight infection, for instance, may be advised to avoid exercise in public gyms.

One persistent area of concern for cancer patients is change in body mass – both weight gain and weight loss tied to disease symptoms and treatment side effects. Patients with hormone-based tumors, breast and prostate cancers, tend to gain weight during treatment and frequently have difficulty losing it. Other patients, especially those with gastrointestinal tumors, suffer from weight loss brought on by loss of appetite and changes in their ability to swallow and properly digest food. The new guidelines indicate that both groups can benefit from exercise. Studies show, for instance, that exercise for weight control and reduction in body mass may actually reduce the risk of recurrence for breast cancer patients, and ultimately decrease breast cancer mortality. For patients suffering from cancer-related weight loss, physical activity helps to maintain lean body mass, which can contribute to increased strength and well being.

Schmitz and her colleagues analyzed published studies related to five different adult cancer types (breast, during and after treatment, prostate, hematologic – with and without stem cell transplant – colon, and gynecologic), and reviewed the evidence for multiple health outcomes. The panel found that although there are specific risks associated with cancer treatment that need to be considered when patients exercise, there is consistent evidence that exercise training can lead to improvements in aerobic fitness, muscular strength, quality of life and fatigue in breast, prostate, and hematologic cancer patients and survivors. They found the data for colon and gynecologic cancers were too scant to draw firm conclusions, and identified several areas requiring further study. Age, for instance, is a critical variable, Schmitz says, since more must be learned about the effects of physical activity in cancer patients over age 65, to develop interventions that may help these patients continue to live and function independently.

The panel urges fitness professionals to enhance their capacity to serve the unique needs of cancer survivors. Schmitz noted that a “groundswell” of training programs now assist physical therapists and fitness trainers in deepening their knowledge of the effects of cancer diagnosis and treatment and improve their skills in this emerging area.

Schmitz also feels strongly that practicing oncologists need to be informed about the new guidelines and their importance, and says that patients can play a role in changing attitudes and clinical practice. Her hope is that patients will read the recommendations and discuss them with their doctors, creating the demand for change that will drive more cancer centers and oncology practices to create and offer cancer exercise rehabilitation services.

Material adapted from Penn Medicine by CFisher.

“Plus, exercise is a great alternative to patients combating fatigue and nausea who are considering using supplements which may interfere with medications and chemotherapy they’re taking during cancer treatment.”

Dr. Walker will present a poster with the study’s design and intervention methods June 7 at the 2010 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago. The abstract is now available online.

To study how exercise impacts cancer patients, Dr. Walker and her colleagues at Henry Ford’s Josephine Ford Cancer Center and the Henry Ford Heart & Vascular Institute developed a unique program called ExCITE (Exercise and Cancer Integrative Therapies and Education). ExCITE works with patients who are receiving cancer treatment to create individualized exercise programs. Some patients come into one of Henry Ford’s fitness centers to workout, while others have plans that allow them to exercise at home during various stages of their care.

The study group thus far includes 30 female breast cancer patients and 20 prostate cancer patients, all ranging in age from 35 to 80. All were newly diagnosed when they began ExCITE. The study followed the patients during treatment and for one-year following completion of cancer treatment.

Before beginning the exercise program, Henry Ford’s Preventative Cardiology Division measured the patients’ exercise capacity, skeletal muscle strength and endurance. General blood work, metabolic screens, bone density, and inflammatory biomarkers also were obtained at the start of the program.

Exercise and diet recommendation for each patient were based on their baseline exercise tolerances, weight, overall health, and type of cancer treatment they would receive. Acupuncture was used for patients who experienced hot flashes, pain, nausea/vomiting, insomnia and neuropathy as the result of cancer treatment.

Cheryl Fallen of Gross Pointe Park, Mich., was undergoing chemotherapy for breast cancer while she took part in the ExCITE program. Through a mix of exercise, acupuncture and good nutrition, she didn’t experiencing some of the more common side-effects from treatment – nausea, fatigue and trouble with memory.

“ExCITE offers cancer patients a way to holistically approach their cancer care by tailoring a specific exercise routine to fit the needs of the patient, whether it’s rehabilitation after surgery, or to enhance circulation or improve the immune system prior to chemotherapy or radiation,” says Fallen.

When her white blood cell count fell during chemotherapy, Fallen would work out at home using an exercise band or by walking outdoors. When she was well enough to return to the gym, her workouts consisted of using the exercise ball and treadmill, and doing other strength-training exercises.

“Overall, the program makes you feel better about yourself. It’s a positive support for cancer patients, and I really think it’s allowed me to be more productive during my treatment,” says Fallen.

Study of the ExCITE program is ongoing, with Dr. Walker and her colleagues continuing to investigate the potential benefits of exercise for cancer patients.

Material adapted from Henry Ford Health System by CFisher.

The researchers, who published their findings in the April issue of Cancer Cell, have identified a drug that targets an oncogene known as BCL6. BCL6 functions as a master regulatory protein. “It’s a protein that controls the production of thousands of other genes,” said Dr. Melnick, an associate professor of medicine at Weill Cornell Medical College in New York City. “Because of that, it has a very profound impact on cells and is required for lymphoma cells to survive and multiply.”

BCL6 causes the majority of diffuse large B cell lymphomas, the most common form of non-Hodgkin lymphoma. Currently, about 60 percent of diffuse large B cell lymphomas can be cured with chemo-immunotherapy, said Dr. Melnick. “The hope is that we can improve that to a higher percent, and in the long term reduce the need for chemotherapy,” he added.

Traditional cancer drugs target enzymes, which have small pockets on their surfaces that can be blocked with molecules. Until now, pharmaceutical companies have been reluctant to create drugs that target a protein like BCL6 because they function through a different mechanism involving interactions with cofactor proteins involving extensive protein surfaces. “And because the real estate covered by these interactions is so large, the drug companies have viewed these as being not druggable targets,” said Dr. Melnick.

He and his colleagues were able to identify a “hot spot” on BLC6 that they predicted would play a critical role in protein interactions. They showed that their BCL6 inhibitor drug was specific to BCL6, and did not block other master regulatory proteins. The drug had powerful lymphoma killing activity and yet was non-toxic to normal tissues. “This is the first time a drug of this nature has been designed and it shows that it’s not actually impossible to target factors like BCL6,” he said.

Emerging data from other investigators suggests that BCL6 is important in many other tumor types, including forms of leukemia.

“The Samuel Waxman Cancer Research Foundation has always supported the collaborative work of scientists, funding innovative cancer research grants,” said Samuel Waxman, M.D., the scientific director of the Foundation. “The Foundation has supported the work of Alexander MacKerell, Ari Melnick and Gilbert Privé for a number of years because we believe their work highlights the critical and important mission of our organization—that collaboration can lead to potential effective cures.”

Material adapted from Samuel Waxman Cancer Research Foundation by CFisher.

Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the information could be used to prioritize future resources for treating and preventing cancer.

Little information is available on how overall cancer costs have changed over time and who now bears the burden of financing the bulk of cancer-related expenses. To study recent trends in the medical costs of cancer and how these costs are paid for, Florence Tangka, Ph.D., a health economist at the Centers for Disease Control and Prevention (CDC) led a team of scientists from CDC, Emory University, and RTI International in analyzing data from the 2001 through 2005 Medical Expenditures Panel Survey and its predecessor, the National Medical Care Expenditure Survey, a one-time survey conducted in 1987. Both surveys are nationally representative of individuals across the United States and capture self-reported data on medical conditions and related expenditures.

The investigators found that in 1987 the total medical cost of cancer (in 2007 dollars) was $24.7 billion. Private insurance financed the largest share of the total (42 percent), followed by Medicare (33 percent). Out-of-pocket payments accounted for 17 percent of the costs, other public sources paid for 7 percent, and Medicaid paid for 1 percent. Between 1987 and the 2001-2005 period, the total medical cost of cancer increased to $48.1 billion due to new cases diagnosed among the aging population as well as an increase in the prevalence of cancer. In 2001-2005, private insurance paid for 50 percent of the costs, and Medicare paid for 34 percent. Out-of-pocket payments accounted for 8 percent of the costs, other public sources paid for 5 percent, and Medicaid paid for 3 percent.

The analysis also revealed that the share of total cancer costs incurred after inpatient hospital admissions fell from 64.4 percent in 1987 to 27.5 percent in 2001-2005. The decrease in cancer-related inpatient costs was accompanied by an increase in cancer-attributable outpatient expenditures.

“The information provided in this study enhances our understanding of the burden of cancer on specific payers and how this burden may change as a result of health reform measures or other changes to health care financing and delivery,” said Dr. Tangka. The authors noted that additional research will be needed to determine the impact of these changes on costs and quality of cancer care in the United States.

Material adapted from American Cancer Society by CFisher.

The study found that 589 survivors, or 9 percent, reported significant functional impairment and clinical distress as well as symptoms consistent with a full diagnosis of PTSD. In comparison, eight siblings, or 2 percent, reported impairment, distress and PTSD symptoms. The study is published in the May issue of the journal Pediatrics.

“Childhood cancer survivors, like others with PTSD, have been exposed to an event that made them feel very frightened or helpless or horrified,” said Dr. Margaret Stuber, a professor of psychiatry and biobehavioral sciences, a Jonsson Cancer Center researcher and first author of the study. “This study demonstrates that some of these survivors are suffering many years after successful treatment. Development of PTSD can be quite disabling for cancer survivors. This is treatable and not something they have to just live with.”

Affected survivors reported symptoms such as increased arousal, phobias, startling easily, being hyper vigilant, avoidance of reminders of their cancer diagnosis and treatment, being on edge and suffering extreme anxiety. They also reported that the symptoms kept them from functioning normally.

Other studies have looked for PTSD in childhood cancer survivors while they’re still children or adolescents, but the percentage reporting symptoms is far less, about 3 percent, Stuber said.

There could be several reasons for the discrepancy. Today’s treatment regimens employ less toxic treatments and rely far less on whole head radiation for brain tumors, causing far less trauma to the young patients. Additionally, the improved supportive care available today may result in fewer physical and cognitive late effects from treatment.

The survivors in Stuber’s study often underwent far harsher treatment regimens commonly used in the 1970s and early 1980s, and within the group studied, those that underwent the more toxic and damaging therapies reported more cases of PTSD.

Another possible reason that more of the young adults reported PTSD symptoms is because they’re facing the stressful situations typical for people at that age – finding a job, getting married, starting a family. That stress may exacerbate the PTSD, Stuber said.

“It may be that symptoms, clinical distress and functional impairment only emerge among the more vulnerable childhood cancer survivors as they contend with the developmental tasks of young adulthood and the added challenges of the late effects of treatment,” the study states. “The relative protection of the parental home is diminished as young adult survivors face the challenges of completing their education, finding a job, getting health insurance, establishing long-lasting intimate relationships and starting a family.”

And because many of the patients in the study underwent harsh therapies, they often suffer from significant late effects – infertility, cognitive impairment, stunted growth. This add to stress levels as well. Those that suffer from cognitive impairment may find it impossible to go to college or to land a good job that earns them an adequate income.

“These survivors may find that can’t get health insurance. They may be reluctant to put themselves on the marriage market because they’re sterile. Those that can have children may be afraid of passing their ‘bad genes’ onto their children. Some treatments affect growth, so some survivors may be shorter and heavier than their peers,” Stuber said. “They may feel like they’re damaged goods.”

Treatment options such as therapy and medication are available to help the survivors manage their symptoms. But addressing the issue will not be simple, Stuber said.

“People who had more intense treatment are more likely to have these symptoms because their treatment was more traumatic,” Stuber said. “And because more damage was done to their bodies, it makes it more difficult to have a good life later. It’s all interdigitating.”

Video
A link to a video interview with the researcher is here.

Material adapted from University of California – Los Angeles by CFisher.

The team looked at news stories about cancer that were reported in major news magazines and large city daily newspapers. Their findings showed:

• Although 32 percent of the articles focused on survival, only 8 percent covered death and dying; this despite the fact that half of all cancer patients will die of their illness.
• While most stories discussed aggressive cancer treatments, almost none (2 percent) discussed end-of-life, palliative or hospice care.
• 13 percent reported that aggressive cancer treatments can fail, and just 30 percent reported that aggressive treatments can result in adverse effects.

The study, its methodology and results are reported in the March 22 issue of the Archives of Internal Medicine. The research team was led by Penn Medicine’s Jessica Fishman, Ph.D.; Thomas Ten Have, Ph.D.; and David Casarett, MD, MA. The article “Cancer and the Media: How Does the News Report on Treatment and Outcomes?” noted “very few news reports about cancer discuss death and dying, and even those that do generally do not mention palliative and hospice care.”

The study notes that unrealistic optimism is presented in most stories about cancer treatment, when in reality half of all cancer patients do not survive, according to statistics from the American Cancer Society.

“The nation’s leading media institutions have set a low bar for routine coverage of the nation’s long-running war on cancer. Hype is the norm,” wrote medical author Merrill Goozner, MS, in a commentary accompanying the article. “The relationship between journalism and medical researchers has been called a complicit collaboration in which both benefit from sensationalized stories. Recent media cutbacks and the evolution of a hyper speed news cycle only made things worse.”

“The tendency of the news to report on aggressive cancer treatments and survival, but not on alternatives, is … noteworthy given that unrealistic information may mislead the public about the trade-offs between attempts at heroic cures and hospice care,” the authors of the study wrote.

The trio looked at a random sample of 436 articles from a total of 2, 228 stories that appeared in the news from 2005 to 2007. Using databases such as Lexis-Nexis, they examined cancer-related stories in Newsweek, Parade, People, Redbook, and Time magazines; the Chicago Sun-Times, Chicago Tribune, Daily Herald-Chicago, the New York Daily News, the New York Post, The New York Times, The Philadelphia Inquirer, and the Philadelphia Daily News. The selection of newspapers and magazines was based on previous research indicating that print publications were the most likely sources for this type of information.

“The absence of reporting about hospice and palliative care is significant given the numerous well-documented benefits for patients and family members,” the authors wrote. “For many patients with cancer, it is important to know (this) … because it can help them make decisions that realistically reflect their prognosis and the risks and potential benefits of treatment.”

Material adapted from Penn Medicine by CFisher.

Davis said the research findings provide additional evidence that walnuts, although high in fat, are healthful. “This study shows that when mice with prostate tumors consume an amount of walnuts that could easily be eaten by a man, tumor growth is controlled,” he said. “This leaves me very hopeful that it could be beneficial in patients.”

Prostate cancer affects one in six American men. It is one in which environmental factors, especially diet, play an important role. Numerous clinical studies have demonstrated that eating walnuts – rich in omega-3 polyunsaturated fats, antioxidants and other plant chemicals – decreases the risk of cardiovascular disease. These findings prompted the U.S. Food & Drug Administration in 2004 to approve, for the first time, a qualified health claim for reducing heart disease risk for a whole food.

Davis fed a diet with whole walnuts to mice that had been genetically programmed to get prostate cancer. After 18 weeks, they found that consuming the human equivalent of 2.4 ounces of walnuts per day resulted in significantly smaller, slower-growing prostate tumors compared to mice consuming the same diet with an equal amount of fat, but not from walnuts. They also found that not only was prostate cancer growth reduced by 30 to 40 percent, but that the mice had lower blood levels of a particular protein, insulin-like growth factor (IGF-1), which has been strongly associated with prostate cancer. Additionally, Davis and his research colleagues looked at the effect of walnuts on gene activity in the prostate tumors using whole mouse gene chip technology, and found beneficial effects on multiple genes related to controlling tumor growth and metabolism.

“This is another exciting study from UC Davis nutrition researchers, where truly promising results that have a molecular footprint are having beneficial effects against cancer,” said Ralph deVere White, UC Davis Cancer Center director and a prostate cancer researcher. “We have to find a way to get these kinds of studies on nutritional products funded so that we can truly evaluate their effects on cancer patients.”

Davis, whose research was funded by a grant to UC Davis from the California Walnut Board, said additional research is needed to further explore how walnuts reduce tumor cell growth.

“The bottom line is that what is good for the heart – walnuts – may be good for the prostate as well,” he said.

UC Davis Cancer Center is a National Cancer Institute-designated cancer center that cares for 9,000 adults and children with cancer each year from throughout the Central Valley and inland Northern California. Its Outreach Research and Education Program works to eliminate ethnic disparities in cancer region-wide.

Material adapted from UC Davis Health System by CFisher.

Temporal trends in death rates are the most reliable measure of progress against cancer, reflecting improvements in prevention, early detection, and treatment. Although age-standardized cancer death rates in the U.S. have been decreasing since the early 1990s, some reports have cited limited improvement in death rates as evidence that the “war on cancer”, which was initiated in 1971, has failed. Many of these analyses fail to account for the dominant and dramatic increase in cancer death rates due to tobacco-related cancers in the latter part of the 20th century.

To investigate further, researchers led by American Cancer Society epidemiologist Ahmedin Jemal, Ph.D., used nationwide cancer mortality data for the years 1970 through 2006 from the SEER*Stat database, which defines major cancer sites consistently over time in order to facilitate reporting of long term mortality trends. They found for all cancers combined, death rates (per 100,000) in men increased from 249.3 in 1970 to 279.8 in 1990, and then decreased to 221.1 in 2006, yielding a relative decline of 21% from 1990 (peak year) and a drop of 11% since 1970 (baseline year). Similarly, the death rate from all-cancers combined in women increased from 163.0 in 1970 to 175.3 in 1991, and then decreased to 153.7 in 2006, a relative decline of 12% and 6% from the 1991 (peak year) and 1970 rates, respectively.

The researchers also calculated years of potential life lost (YPLL) due to cancer before age 75 for 2006 as additional measure for the impact of declining cancer death rates on population health. They compared this to the YPLL that would have been expected had the 1970 age-specific cancer death rates continued to apply in 2006. For persons under age 75, the decrease in cancer death rates during the 36 years time interval (1970-2006) resulted in about 2.0 million years of potential life gained.

“Contrary to the pessimistic news from the popular media, overall cancer death rates have decreased substantially in both men and women whether measured against baseline rates in 1970/71 when the National Cancer Act was signed by President Nixon or when measured against the peak rates in 1990/91.,” write the authors. Despite those gains, the authors caution against complacency. “Continued and increased investment in cancer prevention and control, access to high quality health care, and research could accelerate this progress,” they conclude.

Material adapted from American Cancer Society by CFisher.

Introduction (continued)
Previous studies have reported that children with autism possess a higher number of genetic aberrations, including higher levels of chromosomal rearrangements [2] and copy number variations [3,4,5,6,7]. These studies raise the possibility that there may be correlations to cancer, a disease in which chromosomal aberrations are known to play a role. Here, researchers report a study in which the incidence of cancer is compared to the prevalence of autism.

Method
To determine if significant correlations exist between the prevalence of autism and the incidence of cancer, researchers obtained and analyzed state-wide data reported by age and gender throughout the United States. Autism data were obtained from the U.S. Department of Education via the Individuals with Disabilities Education Act (IDEA) (2000–2007, reported annually by age group) and cancer incidence data were obtained from the Centers for Disease Control and Prevention (CDC) (1999–2005). IDEA data were further subdivided depending on the method used to diagnose autism (DSM IV or the Code of Federal Regulations, using strict or expanded criteria).

Results
High correlations were found between autism rates and the incidence of in situ breast cancer using data from states that adhere strictly to the Code of Federal Regulations for diagnosing autism. By contrast, few significant correlations were observed between autism prevalence and the incidence of 23 other female and 22 male cancers. When a less conservative statistical method was applied (Simes’ procedure), correlations between autism and uterine cancer also emerged as consistently significant.

Conclusion
In conclusion, by using conservative statistical methods and a limited set of autism data from states using a uniform code of diagnosis, nominal statistical significance was observed in a few instances, notably for breast cancer and uterine cancer. In practice, it is not known whether the diagnosis of autism is truly uniform in individual school districts. Consequently, the results should be interpreted with caution, even if the p-values appear to be selective for these cancers and highly significant, as is the case here.

Nonetheless, it is of interest that the cumulative exposure to estrogen from endogenous and external sources is an established risk factor for both breast [20] and uterine [21] cancer, the two cancers that appear to be most consistently correlated with autism. Some analyses suggest that mothers are carriers of mutations that predispose children to autism [22], and there is literature implicating germline mutations in autism [23,24]. In this context, it is suggested that investigation of biomedical mechanisms to account for these epidemiological findings is warranted.

Citation/Download
Material adapted by CFisher from:

Kao H-T, Buka SL, Kelsey KT, Gruber DF, & Porton B (2010). The Correlation between Rates of Cancer and Autism: An Exploratory Ecological Investigation. PLoS ONE 5(2): e9372. doi:10.1371/journal.pone.0009372

References
Please see the freely available article for the extensive reference list. Numbered references in this current article match the references in the original article.

“When a patient is diagnosed with cancer many of them want to fully participate in their recovery, but don’t know where to begin. This program gives them control over their treatment,” said Julian Schink, MD, chief of Gynecologic Oncology at Northwestern Memorial and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

The integrative oncology services are part of a larger 360 Care Program that recently launched aimed to address cancer patients’ needs from every angle through treatment that extends beyond medical therapies, to include counseling, stress management and integrative medicine. Integrative oncology services include acupuncture, massage, energy healing and naturopathic medicine offered by Northwestern Memorial Physicians Group’s Center for Integrative Medicine and Wellness.

“Our goal is to treat the whole person, not just their illness,” said Melinda Ring, MD, medical director of the Center for Integrative Medicine and Wellness. “Research suggests that a holistic approach can alleviate stress and anxiety, as well as the physical pain and discomfort patients often experience while undergoing cancer treatments by activating the body’s innate healing process.”

While there is little research to explain exactly how integrative approaches like acupuncture work, researchers at the National Institute of Health state complementary therapy such as acupuncture do improve the body’s immune system. In an oncology setting, integrative approaches provide an effective way to manage symptoms, alleviate side effects, and help patients restore their sense of control and vitality.

“My body was hit hard with trauma. I was so tired, my joints hurt and my muscles were tense. I knew I needed more help. When I began massage therapy my muscles relaxed, and it helped me release my emotions. It reminded my body that it can relax in spite of what I am going through,” said Penny Kukovec, patient at Northwestern Memorial.

Common side effects of chemotherapy and radiation treatment for cancer include muscle tension, aches, pains nausea, vomiting and fatigue. The main role of complementary medicine is to provide supportive care and reduce adverse effects while helping the patient cope.

“Unfortunately, the side effects associated with conventional therapies often cause patients to end their treatments prematurely, or require that we take a less aggressive approach,” said Schink. “We’ve seen this occurrence decrease with the addition of integrative oncology services.”

“The medicine I was taking for my cancer caused nerve damage in my hands and feet. It was very uncomfortable. Acupuncture helped relieve the pain,” said Nancy Amicangelo, patient at Northwestern Memorial.

There is evidence that integrative approaches may also play a role in reducing the rate of depression among cancer patients. Services such as massage therapy are believed to have a short-term effect on reducing anxiety related to depression among patients.

“You’re sick, your hair falls out, and your family is stressed. When you are diagnosed it’s sometimes all that you can think about. The massages offer me a chance to escape,” said Kukovec.

While integrative medicine does not offer a cure for cancer, there is strong evidence that it positively affects the patient. Studies show 77 percent of cancer patients who incorporate complementary approaches believe it improves their quality of life, and 73 percent state it makes them feel hopeful. In addition, 71 percent say it helps to boost their immune system.

Material adapted from Northwestern Memorial Hospital by CFisher.

BRCA and PARP are two key players in DNA repair and have different but complementary functions in the cell. Loss of the BRCA protein still allows the cell to survive but greatly increases its chances of becoming cancerous through the accumulation of mutations. The loss of both proteins, however, kills the cell in a process called synthetic lethality.

This shows the mechanism of sensitivity to PARP inhibition in BRCA-deficient cells. Credit: Susan E Bates; F1000 Biology Reports

Researchers, by using drugs to block the activity of PARP in cells missing BRCA, such as those found in certain breast and ovarian cancers, can help spare healthy, non-cancerous cells because they have functional BRCA and are not affected by the loss of PARP. Thus, only cancer cells without functional BRCA protein are killed by drugs that inhibit PARP.

Recent clinical trials have shown that cancers caused by mutations that knock out BRCA activity can be controlled by blocking PARP activity with specific drugs. Patients were treated with traditional anticancer drugs alone or in combination with one of two new PARP inhibitors, olaparib or BSI-201.

Bates notes that patients on combination therapy had improved “[disease] progression-free survival, and overall survival” as compared to patients treated with traditional drugs alone.

Bates is optimistic about the promise of combining PARP inhibitors with existing cancer drugs. She says that the results of these clinical trials “have provided proof of principle in achieving synthetic lethality” with PARP-inhibiting drugs and that treatments combining novel PARP inhibitors with traditional chemotherapeutic drugs have the potential to vanquish BRCA-associated breast and ovarian cancers.

Material adapted from Faculty of 1000: Biology and Medicine by CFisher.

These findings are from a report authored by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). The report was published early online Dec. 7, 2009, in the journal Cancer.

Overall cancer rates continue to be higher for men than for women, but men experienced the greatest declines in incidence (new cases) and mortality (death) rates. For colorectal cancer, the third most frequently diagnosed cancer in both men and women, and the second leading cause of cancer deaths in the United States, overall rates are declining, but increasing incidence in men and women under 50 years of age is of concern, the report said.

In the Special Feature section, the authors used modeling projections of colorectal cancer rates to find that, with accelerated cancer control efforts to get more Americans to adopt more favorable health behaviors (such as quitting smoking) and higher use of screening (such as colonoscopy), as well as optimal treatment outcomes for colorectal cancer (such as more effective chemotherapy), there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

Other highlights from the report show that in men, incidence rates have declined for cancers of the prostate, lung, oral cavity, stomach, brain, colon and rectum, but continue to rise for kidney/renal, liver, and esophageal cancer, as well as for leukemia, myeloma and melanoma. In women, incidence rates decreased for breast, colorectal, uterine, ovarian, cervical and oral cavity cancers, but increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non-Hodgkin lymphoma, melanoma and leukemia.

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” said NCI Director John E. Niederhuber, M.D. “Yet we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

Among racial/ethnic groups, cancer death rates were highest in black men and women and lowest in Asian/Pacific Islander men and women. Although trends in death rates by race/ ethnicity were similar for most cancer sites, death rates from pancreatic cancer, the fourth most common cause of cancer death in the United States, increased among white men and women but decreased among black men and women.

The three leading causes of cancer death for all men, with the exception of Asian/Pacific Islanders, were lung, prostate and colorectal cancer. Lung, liver and colorectal cancers were the top three causes of cancer death in Asian/Pacific Islander men. For women, the three leading causes of cancer death were lung, breast and colorectal cancer for all racial/ethnic groups except Hispanic women, for whom breast cancer ranked first. The differences and fluctuations in death rates by racial/ethnic group, sex, and cancer site may reflect differences in risk behaviors, socioeconomic status, and access to and use of screening and treatment.

“The continued decline in incidence and death rates for all cancers combined is extremely encouraging, but progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of esophagus, liver and pancreas,” said Betsy Kohler, executive director of NAACCR.

The special section on colorectal cancer rates says that long-term incidence trends for colorectal cancer have been fairly consistent for men and women, with major declines from 1985 to1995, minor increases from 1995 to1998, and significant declines from 1998 to 2006. Since 1984, death rates have also declined for men and women with accelerated rates of decline since 2002 for men and 2001 for women. In the most recent decade for which there are data (1997-2006), rates of newly diagnosed colorectal cancer have decreased for men and women in all racial/ethnic groups examined except American Indian/Alaskan Native (AI/AN) women. Incidence rates declined most rapidly among men and women over 65 years of age and increased most rapidly in people under age 50 in most population groups.

“This report shows that we have begun to make progress reducing colorectal cancer. Yet, colorectal cancer still kills more people than any other cancer except lung cancer,” said CDC Director Thomas Frieden, M.D. “Reducing smoking further can bring lung and other cancer rates down, and improved colorectal cancer screening can prevent colorectal cancer. Through CDC’s Colorectal Cancer Control Program, we have tremendous potential to reduce the disparities that exist in colorectal cancer screening and to save lives.” The CDC program supports population-based screening efforts and provides colorectal cancer screening services to low-income men and women ages 50 to 64 years who are underinsured or uninsured for screening, when no other insurance is available.

Researchers used microsimulation modeling to analyze the historical impact of changes in risk factors, screening and treatment practices, and to project future mortality trends for colorectal cancer. The model, named MISCAN-Colon, which was developed by NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET) consortium, simulates the U.S. population from 1975 through 2020. The model includes factors that could increase risk for colorectal cancer (i.e., smoking, obesity, and red meat consumption), as well as factors that could decrease colorectal cancer risk (i.e., aspirin use, consumption of supplements such as folate and calcium, and physical activity). To calculate screening use, researchers used national data on the use of fecal occult blood testing (which looks for blood in stool samples), and endoscopy (including flexible sigmoidoscopy and colonoscopy, which allows doctors to examine the lower part of the colon or the entire large intestine, respectively). To assess the effects of treatment, researchers assessed data on use of, and disease-free survival rates associated with, four chemotherapy regimens used for advanced colorectal cancer during different historical time periods.

Using the model, the researchers were able to estimate the impact of historical changes in risk factors, screening practices, and treatment advances on past changes in incidence and mortality, as well as predict future trends through 2020.

From 1975 to 2000, colorectal cancer incidence fell 22 percent, half of which was most likely due to changes in risk factors, and half due to screening. Similarly, colorectal cancer deaths fell by 26 percent during that time period, with a 9 percent drop resulting from a change in risk factors, a 14 percent drop from screening, and a 3 percent drop from improved treatment.

The researchers created projections to look at how colorectal cancer mortality trends could change with varying levels of cancer control interventions. If there were no changes in risk factors, screening or treatment (stable since 2000), Americans could expect a 17 percent decline in colorectal cancer mortality from 2000 to 2020. However, if current trends persist, Americans could see a 36 percent decline in colorectal cancer mortality. With accelerated cancer control efforts, there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

“The extraordinary progress on colorectal cancer shows what can be achieved by coordinated and targeted efforts to apply existing knowledge to cancer control at the state and federal level,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. “Increases in colorectal cancer screening have been achieved through a variety of efforts, including education of the public and medical community and advocacy for health insurance coverage of the full range of colorectal cancer screening tests. The American Cancer Society is committed to continuing these efforts to get as close as we can to the potential 50 percent colorectal cancer mortality reduction that this report says is possible.”

Material adapted from National Institutes of Health by CFisher

Pomegranate is enriched in a series of compounds known as ellagitannins that, as shown in this study, appear to be responsible for the anti-proliferative effect of the pomegranate.

“Phytochemicals suppress estrogen production that prevents the proliferation of breast cancer cells and the growth of estrogen-responsive tumors,” said principal investigator Shiuan Chen, Ph.D., director of the Division of Tumor Cell Biology and co-leader of the Breast Cancer Research Program at City of Hope in Duarte, Calif.

Previous research has shown that pomegranate juice – punica granatum L – is high in antioxidant activity, which is generally attributed to the fruit’s high polyphenol content. Ellagic acid found in pomegranates inhibits aromatase, an enzyme that converts androgen to estrogen. Aromatase plays a key role in breast carcinogenesis; therefore, the growth of breast cancer is inhibited.

Chen, along with Lynn Adams, Ph.D., a research fellow at Beckman Research Institute of City of Hope, and colleagues, evaluated whether phytochemicals in pomegranates can suppress aromatase and ultimately inhibit cancer growth. After screening and examining a panel of 10 ellagitannin-derived compounds in pomegranates, the investigators found that those compounds have the potential to prevent estrogen-responsive breast cancers. Urolithin B, which is a metabolite produced from ellagic acid and related compounds, significantly inhibited cell growth. “We were surprised by our findings,” said Chen. “We previously found other fruits, such as grapes, to be capable of the inhibition of aromatase. But, phytochemicals in pomegranates and in grapes are different.”

According to Gary Stoner, Ph.D., professor in the Department of Internal Medicine at Ohio State University, additional studies will be needed to confirm the chemopreventive action of Urolithin B against hormone-dependent breast cancer. “This is an in vitro study in which relatively high levels of ellagitannin compounds were required to demonstrate an anti-proliferative effect on cultured breast cancer cells,” said Stoner, who is not associated with this study. “It’s not clear that these levels could be achieved in animals or in humans because the ellagitannins are not well absorbed into blood when provided in the diet.” Stoner believes these results are promising enough to suggest that more experiments with pomegranate in animals and humans are warranted.

Powel Brown, M.D., Ph.D., medical oncologist and chairman of the Clinical Cancer Prevention Department at the University of Texas M. D. Anderson Cancer Center, agreed with Stoner’s sentiments and said these results are intriguing. He recommended that future studies focus on testing pomegranate juice for its effect on estrogen levels, menopausal symptoms, breast density or even as a cancer preventive agent.

“More research on the individual components and the combination of chemicals is needed to understand the potential risks and benefits of using pomegranate juice or isolated compounds for a health benefit or for cancer prevention,” Brown said. “This study does suggest that studies of the ellagitannins from pomegranates should be continued.”

Until then, Stoner said people “might consider consuming more pomegranates to protect against cancer development in the breast and perhaps in other tissues and organs.”

Material adapted from American Association for Cancer Research by CFisher

A total of 26 group therapy sessions were conducted over the course of 1 year. Participants attended weekly group therapy sessions during months 1-4 and then moved to once per month sessions for remaining 8 months. The current study tracked participants for an average of 11 years (range of 7-13 years) after the completion of group therapy, and follow-ups were frequent and extensive and included clinical interviews, blood work to assess immune system functioning, mammograms, etc..

Overall, researchers reported that compared to the assessment only group, participants in the group therapy condition realized statistically significant reductions in the risk of breast cancer, breast cancer related death, and overall disease recurrence. In fact, these women had a reduced risk of death from all causes of mortality found in this study (i.e., other types of cancer, diseases, and illnesses).

More specifically, group therapy participants had:

1. Reduced likelihood of cancer recurrence, and an extra 6 months of cancer free living in those that went on to have cancer recurrence [45% reduced risk].
2. Reduced likelihood dying from cancer, and an extra 1 year or more of survival in those who died [56% reduced risk].

The authors discussed the body’s probable physical systems that react to stress and contribute to declining health, which included, for example, excessive activation of the autonomic nervous system and hypothalamic-pituitary-adrenal axis, suppression of the immune system, and increased release of hormones, such as adrenalin and cortisol.

These results are impressive and encouraging for women with breast cancer and provides further evidence that biopsychosocial based treatments may represent an important approach to health and wellness. The authors also discuss the urgent need to disseminate information about the role of stress in cancer treatment outcome to cancer patients and their doctors.

I plan to hunt down several articles cited in this research that discuss psychological interventions for cancer and may report on these in future posts in this Blog.

CFisher

Reference:

* Andersen, B., Yang, H.C., Farrar, W., Golden-Kreutz, D., Emery, C., Thornton, L., Young, D., & Carson, W. (2008). Psychologic intervention improves survival in breast cancer patients: A randomized clinical trial. Cancer, 113(12), 3450-3458.