Keeping you up to date on recent developments in oncology

UT Southwestern snares grant for CRC screening . . . Physicians still see screening for colorectal cancer (CRC) as underutilized and the University of Texas Southwestern Medical Center (Dallas) announced recently that it has won a $6.3 million grant from the National Cancer Institute to improve CRC screenings. According to Southwestern's Oct. 10 statement, the five-year grant will be used to boost screening at Southwestern and at Parkland Health & Hospital System (Dallas), and the two entities intend to reach as many as 32,000 residents of Dallas County aged 50 and older via a program said to be unique "because its screening effort will focus on people who lack insurance or are under-insured." This effort is part of the NCI Population-based Research Optimizing Screening through Personal Regimens (PROSPR) program, which is established at sites in California and Washington as well. The Southwestern statement indicates that NCI seeks to establish as many as a dozen PROSPR sites around the U.S. "to examine and improve screening processes for colorectal, breast and cervical cancers." The effort in Dallas is led by a pair of investigators from Southwestern, Celette Sugg Skinner, MD, associate director of the Harold C. Simmons Cancer Center at Southwestern, and Ethan Halm, MD, chief of general internal medicine also at Southwestern. The statement notes that the goal stated by Skinner and Halm "is twofold: to optimize colon cancer screening among Dallas residents and to develop a model for screening that can be used by public hospitals nationwide." Skinner said in the statement, "the earlier we can detect cancers, the better we are able to treat them," adding, "there is no reason why people with less insurance should bear a disproportionate burden of cancer." The point of emphasis on the uninsured is tied to their socio-economic difficulties. While the statement notes that there are more than 140,000 new cases of CRC diagnosed each year in the U.S. each year – along with nearly 50,000 fatalities – the disease has higher rates of occurrence and mortality among low-income patients, often because they lack access to proper screening. On the other hand, data systems at Parkland will also play a role in this effort. Halm said a key factor in securing the NCI grant "was Parkland's comprehensive electronic medical records system and its Center for Clinical Innovation, which will serve as the information technology backbone of the collaboration with UT Southwestern." Southwestern will also use the grant to boost a couple of research efforts already underway, including the use of a touch-screen computer program used in clinics that can query patients in either English or Spanish about their risk factors and family history in an effort to "generate a personalized screening regimen for colon cancer for each patient," the statement notes. Another project is to compare outreach strategies for both cost and effectiveness, while the third program is designed to assess best practices in terms of promoting screening. Skinner observed, "we think the Parkland-UT Southwestern PROSPR Center will make an important dent in colorectal cancer in Dallas County."

AACR announces molecular therapeutics conference . . . The American Association for Cancer Research (AACR; Philadelphia) has announced it will co-host a conference addressing molecular targets associated with cancer therapies at the Moscone Center in San Francisco later this year. The Oct. 5 AACR statement indicates that the association is teaming up with the National Cancer Institute and the European Organization for the Research and Treatment of Cancer (Brussels, Belgium) to bring together researchers from across the globe in a conference that will be "the only conference of its kind to focus exclusively on issues of drug development as cancer researchers continue their quest to develop personalized medicine." Among the abstracts that will be presented is one addressing phase I data of a new epigenetic therapy in lung cancer, and another that will deal with newly discovered mutations to the KRAS gene and the role of this mutation in non-small cell lung cancer. The gathering will take place Nov. 12-16 at the spacious Moscone Center in downtown San Francisco. For further information, visit and click on "meetings and workshop" on the right side of the home page.

Liver cancer running contrary to expectations . . . Epidemiologists are typically equipped with the best mathematical models, but even they are sometimes surprised. According to an Oct. 6 statement by the American Cancer Society (ACS; Atlanta), epidemiologists are likely scratching their heads over data suggesting that the incidence of liver cancer is rising in countries thought to present a low level of risk whereas the incidence appears to be on the wane in nations thought to present a high degree of risk. Despite the reversals, the ACS statement indicates that the the figures for incidence in Asian countries "remain twice as high as those in Africa and more than four times as high as rates in North America," and these findings are scheduled for release in an upcoming hard copy edition of Cancer Epidemiology Biomarkers and Prevention. Relying on data drawn from the International Agency for Research on Cancer, two epidemiologists working with ACS, Melissa Center, and Ahmedin Jemal, PhD examined trends in liver cancer incidence rates from 1993 to 2002 as depicted in 32 cancer registries worldwide and also looked at data assessing male-to-female rate ratios from four additional registries, based on 1998 incidence data. Center and Jemal determined that incidence rates for both sexes increased from 1993 to 2002 in eight of the 32 registries included in the analysis. The data indicated that increases were for the most part confined to the relatively economically advanced nations in Western Europe, North America, and Oceania, a trend they hypothesize may be due to increased chronic HCV infection driven by un-screened blood transfusions and contaminated needles used for medical purposes and for illicit drug use. Male-to-female rate ratios varied from 0.9 in sub-Saharan African and South American registries to 5.0, or five men for every woman diagnosed, in France and Egypt. The authors suggest that additional study is needed to establish causation more clearly. Center said in the statement, "we hope our description of international liver cancer incidence trends may stimulate studies to further illustrate etiologic factors associated with these divergent liver cancer incidence trends worldwide."

Cancer survivors becoming older patients . . . The advances in treatments and cures for cancer and other diseases is having a decisive effect on the ages of those who have survived cancer, and the American Association for Cancer Research (AACR; Philadelphia) has projected that the number of cancer survivors past the age of 65 will rise by more than 40% in the years to come. The Oct. 6 AACR statement notes that the trend will push the resources of healthcare in the U.S. because of "some unique challenges" presented by these patients even as "the number of oncologists and geriatric specialists is decreasing" at the very time "the need for these specialists is increasing," the statement indicates. Julia Rowland, PhD, director of the Office of Cancer Survivorship at the National Cancer Institute remarked in the statement that cancer "is largely a disease of aging, so we're seeing yet another effect of the baby boom generation and we need to prepare for this increase." She also commented that healthcare professionals "can expect a dramatic increase in the number of older adults who are diagnosed with or carry a history of cancer." Rowland's report is will appear in a special focus on cancer survivorship in the October issue of Cancer Epidemiology, Biomarkers & Prevention, a journal of AACR. Rowland and her colleagues determined that cancer survivors numbered about 3 million in 1971, the year the National Cancer Act was signed, but that this number quadrupled to nearly 12 million in 2008, the last year for which data are available. In 2008, 60% of those survivors were at least 65 years of age, a number NCI anticipates will increase another 63% by the end of this decade. The statement points out that much of the increase is due to improved detection and screening. Rowland remarked, "we may be fortunate in that the aging population is healthier than in previous generations, and [that] new technologies could allow for better communication and follow-up."

– Compiled by Mark McCarty, MDD Washington Editor

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