Other highlights in the July 20 JNCI

07/14/05

Other highlights in the July 20 JNCI include a study identifying HPV types that may help manage cancer risk in women with cervical abnormalities, a study examining the risk of contralateral testicular cancer, a study that looks at the association between higher urinary melatonin levels and breast cancer risk, and a study examining how accurately Medicare claims data reflect chemotherapy use in elderly beneficiaries.

Identifying HPV Types May Help Manage Cancer Risk in Women With Cervical Abnormalities

Women whose Pap test results are equivocal or mildly abnormal and who are positive for human papillomavirus (HPV) type 16 have an increased risk of developing cervical precancer compared with women diagnosed with other HPV types, according to a new study. A second study concludes that distinguishing HPV type 16 and 18 during cervical cancer screening may identify women with normal cervical cytology at greatest risk of cervical precancer and permit less aggressive management of women with other types of HPV infections.

HPV type 16--the most common and oncogenic HPV type--and HPV18 account for 60% to 70% of cervical cancer cases worldwide. Other oncogenic types of HPV are responsible for virtually all remaining cases. A pooled test for 13 types of HPV is currently being used for triage of equivocal cervical cytology results in women of any age and as an adjunct screening test with cervical cytology for women ages 30 and older. However, it was not previously known whether detection of specific HPV types would be clinically helpful in management of cervical cancer risk in women.

To determine the risk of cervical precancer in women with HPV16, Philip E. Castle, Ph.D., M.P.H., of the National Cancer Institute, and colleagues tested 5,060 women enrolled in a study, the atypical squamous cells of undetermined significance (ASCUS) low-grade squamous intraepithelial lesions (LSIL) Triage Study (ALTS), for HPV16 and other oncogenic HPV types at baseline and followed them for 2 years. The authors found that, of the 542 women who developed cervical intraepithelial neoplasia grade 3 (CIN3) or cancer, the 2-year cumulative risk was 38 times higher for women who were HPV16 positive and seven times higher for women who were positive for other oncogenic HPV types than for women who were HPV-negative at their baseline measurement.

To determine whether identifying HPV type might identify women in general screening at high risk of cervical precancer or its precursor, a second group of researchers, including Castle, tested 20,810 women who were enrolled in the Kaiser Permanente health plan in Portland, Oregon, for 13 oncogenic HPV types and followed them for 10 years. This group of women included 13,229 women aged 30 and older who might be co-screened by cervical cytology and HPV testing according to current national guidelines. At enrollment, 98% of women aged 30 and older had normal cytology, and at the end of the follow-up period, 45 (0.3%) had developed CIN3 or cancer. The authors found that cumulative rates for developing CIN3 or cancer among women aged 30 and older with normal cytology were: 20.7% among women with HPV type 16, 17.7% among women with HPV type 18, 1.5% among women positive for one of the other 11 oncogenic HPV types, and 0.5% in HPV-negative women.

Based on the results of both studies, identifying HPV type 16 in women with normal, equivocal, or mildly abnormal cervical cytology and identifying HPV type 18 in women with normal cervical cytology may be relevant to determining management options for women, the authors conclude.

Contact: National Cancer Institute Press Office, 301-496-6641, NCIPressOfficers@mail.nih.gov

Study Examines Risk of Contralateral Testicular Cancer

A new study's finding that men who are diagnosed with testicular cancer have a low risk of developing cancer in the opposite testicle and a high rate of long term survival supports the current U.S. approach of not performing a biopsy on the contralateral testicle, according to the authors.

To determine the risk of contralateral testicular cancer--both synchronous (two cancers diagnosed at the same time) and metachronous (two cancers diagnosed separately)--and long-term survival rates among men diagnosed with the disease, Sophie D. Fosså, M.D., of the Norwegian Radium Hospital in Oslo, Norway, and colleagues examined data from more than 29,000 U.S. men diagnosed with testicular cancer between 1973 and 2001.

A total of 175 men were diagnosed with synchronous contralateral testicular cancer, and 287 were diagnosed with metachronous contralateral testicular cancer. The 15-year cumulative risk of developing a metachronous contralateral testicular cancer was 1.9%. The 10-year survival rates were 85% among men diagnosed with synchronous contralateral testicular cancer and 93% among men diagnosed with metachronous contralateral testicular cancer. The authors conclude that the low risk of metachronous contralateral testicular cancer and overall favorable survival rate do no support routine biopsy of the opposite testicle in men diagnosed with testicular cancer.

Contacts:

  • Pernille Lønne Mørkhagen, Public Relations, Radiumhospitalet, +47-22934000/5716, pernille.lonne.morkhagen@radiumhospitalet.no
  • National Cancer Institute Press Office, 301-496-6641, NCIPressOfficers@mail.nih.gov

    Higher Urinary Melatonin Levels May Be Associated With Lower Breast Cancer Risk

    A new study has found that higher levels of a melatonin metabolite are associated with a lower risk of breast cancer.

    The production of melatonin--a hormone that the body produces only during the dark phase of the light–dark cycle--is suppressed by exposure to light during the night. Studies of night-shift workers have found an association between night-shift work (a surrogate for light exposure at night) and an increased risk of breast cancer, but the association between melatonin levels and breast cancer risk has been uncertain.

    To examine the association between urinary melatonin levels and breast cancer risk, Eva S. Schernhammer, M.D., Dr.P.H., and Susan E. Hankinson, Sc.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, conducted a prospective case–control study nested within the Nurses' Health Study II cohort. They measured levels of a major melatonin metabolite in the urine of 147 women with invasive breast cancer and 291 matched control women.

    Women in the highest quartile of melatonin metabolite levels had a 40% lower risk of invasive breast cancer compared with those in the lowest quartile. The authors conclude that their data supports the hypothesis that higher melatonin levels are associated with a lower risk of breast cancer.

    Contact: Amy Dayton Smith, Public Affairs, Brigham and Women's Hospital, 617-534-1603, asmith28@partners.org

    Medicare Claims Data Accurately Reflect Chemotherapy Use in Elderly Beneficiaries, Study Finds

    A new study has found that Medicare claims accurately reflect chemotherapy use in elderly Medicare beneficiaries with breast or lung cancers.

    Because the elderly are underrepresented in clinical trials of treatments for cancer, the benefits and toxicities of chemotherapy in elderly patients may be different than in clinical trial participants. Medicare claims may be a source of observational data for studies of chemotherapy in the elderly because Medicare reimburses for intravenous administration of chemotherapy. However, this type of data needs to be validated before such studies can be completed.

    To determine the accuracy with which data from Medicare claims measure chemotherapy use in elderly Medicare beneficiaries with cancer, Elizabeth B. Lamont, M.D., of Massachusetts General Hospital in Boston, and colleagues performed a criterion validation study by comparing Medicare claim data with gold-standard clinical trial data for 175 elderly cancer patients treated on two clinical trials. They found that the crude sensitivity (proportion of true-positive results) for chemotherapy administration was 93% and that individual chemotherapy agents had similarly high sensitivities, from 81% for carboplatin to 91% for cyclophosphamide. The authors conclude that administrative Medicare claims data appear to be a valid source of information for chemotherapy administered to elderly Medicare beneficiaries with cancer and thus may be used for studies of chemotherapy use and outcome in the elderly.

    Contact: Emily Parker, Massachusetts General Hospital Public Affairs, 617-724-6425, eparker2@partners.org

    Also in the July 20 JNCI:

  • Study Questions Mortality Benefit of Breast Cancer Screening in Community Settings: http://www.eurekalert.org/emb_releases/2005-07/jotn-sqm071405.php
  • Biased Reporting Found in Cancer Prognostic Studies: http://www.eurekalert.org/emb_releases/2005-07/jotn-brf071405.php

    Source: Eurekalert & others

    Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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