Keeping you up to date on recent developments in oncology.

After cancer diagnosis, women opt to remove healthy breast . . . A study appearing in Cancer has found that the number of women choosing surgery to remove a healthy breast after a cancer diagnosis in the other breast is rising, despite a lack of evidence that it improves survival. The study also found that despite extensive press coverage of women who choose to have both breasts removed because of a strong family history of cancer, the rate of this surgery remains relatively low for the last decade. Prophylactic mastectomy, the removal of a noncancerous breast, is one method for reducing a woman's risk of developing breast cancer. But there is little information available on prevalence of this practice among high-risk women or on the prevalence of the surgery to prevent tumors in the healthy breast among women whose cancer is limited to one breast. Researchers led by Stephen Edge, MD, FACS, of the Roswell Park Cancer Institute (Buffalo, New York), examined the frequency of prophylactic mastectomies in New York State using hospital discharge data combined with data from the state cancer registry. They identified 6,275 females who underwent prophylactic mastectomies. Most (81%) had been diagnosed with cancer in one breast, while 19% had no personal history of breast cancer. The researchers found that the number of prophylactic mastectomies increased during the time period, particularly among women with cancer in one breast. Over the 11-year study period, the prevalence of these contralateral mastectomies more than doubled. The prevalence of bilateral prophylactic mastectomies among women with no personal history of breast cancer increased only slightly. The data demonstrate that prophylactic mastectomy is an uncommon procedure, performed mostly on women with a personal history of breast cancer.

Cryo-imaging identifies, locates cancer cells . . . Dave Wilson, a professor of biomedical engineering at Case Western Reserve University (Cleveland) can identify a single cancer cell in preclinical imaging studies and pinpoint exactly where the cell is located in a 3-D image. Called cryo-imaging, the system enables Wilson and collaborators to identify single molecules, count the number of cells in an organ, compare a normal heart to an abnormal heart and more. The cryo-imaging system disassembles real tissue layer by layer then reassembles the details into a cyber model. In a paper published in the Annals of Biomedical Engineering, Wilson and co-authors describe cryo-imaging and the extensive software they wrote to enable them to zero in on single cells. In this specific model, the software assembled images of the internal organs, showing the location of individual metastatic cancer cells in the adrenal gland. Wilson launched his research with a Third Frontier grant from the state of Ohio and subsequent grants from the National Institutes of Health. He has now founded a start-up company, called BioInVision (Mayfield Village, Ohio) to commercialize the imaging system.

Men may not be properly included in prostate cancer screening decisions . . . Men largely make decisions about prostate cancer screening based on conversations with their clinicians, but these discussions often don't include information about the risks of testing in addition to the benefits, according to a report in Archives of Internal Medicine. A second report in the same issue used statistical modeling to estimate the benefits and risks of prostate-specific antigen (PSA) screening in men of various ages and risk levels. The majority of American men older than 50 have been screened with the PSA blood test. But the practice is controversial because there is no convincing evidence that screening prevents deaths from the disease, and treating early stage cancers detected by screenings may lead to important complications. Study authors surveyed 3,010 adults age 40 and older. The sample included 375 men who had either undergone or discussed PSA testing with their clinicians in the previous two years. These men were asked what they knew about prostate cancer, what their discussions with clinicians were like and what factors and sources of information influenced their screening decisions. Overall, 69.9% of the men had discussed screening with their clinician before making a decision, including 14.4% who chose not to undergo testing. Most often, clinicians raised the idea of screening and 73.4% recommended it. Recommendation from a clinician was the only characteristic of the discussion associated with testing. The authors concluded that those discussions – when held – didn't meet criteria for shared decision making. The second study concluded that, before undergoing PSA screening, men should be aware of the possible benefits and harms and of their chances of these benefits and harms occurring because, even under optimistic assumptions, the net mortality benefit is small.

More news on the prostate cancer front – a new test . . . UK scientists have discovered a molecular flag that predicts survival from prostate cancer at diagnosis, according to a study in British Journal of Cancer. The research led by pathologists based at the University of Liverpool measured the levels of a protein called heat shock protein-27 (Hsp-27) in prostate tissue samples taken from 553 men at the time they were diagnosed with prostate cancer. During a 15-year follow-up, the research showed that those men who tested positive for Hsp-27 at diagnosis were almost twice as likely to die from prostate cancer, than men who did not have the protein. The findings suggest that Hsp-27 could be used as a potential test to distinguish men with the aggressive forms of the cancer that need immediate treatment from men with slow-growing forms of prostate cancer, and with which they can live with for many years. At the moment, there are no reliable tests to make this distinction.

Identification of radiosensitive patients may lead to side effect-free radiotherapy . . . An international group of scientists has taken the first step on the road to targeting radiotherapy dosage to individual patients by means of their genetic characteristics. Dirk de Ruysscher, from Maastricht University Medical Centre (Maastricht, the Netherlands) has reported that his team's work might provide the basis for personalized radiotherapy in which, with a simple blood test, doctors may be able to select the optimal radiation dose for a particular patient. The team of scientists from The Netherlands, Belgium, Germany, and Canada studied a group of patients with hypersensitivity to radiation therapy, drawn from the largest worldwide database available – the European Union-funded Genetic pathways for the prediction of the effect of irradiation (GENEPI) study, which integrates biological material with patient data and treatment specifications. The database included information from more than 8,000 European patients. A tissue bank from patients who were known to be hypersensitive to radiation was established in Europe and Canada. When compared with a control group, also drawn from the GENEPI study, the hypersensitive patients showed either severe side effects occurring at very low radiation levels, or severe side effects lasting for more than four weeks after the end of radiotherapy and/or requiring surgery, or severe late side effects occurring or persisting more than 90 days after the end of radiotherapy. The scientists identified 33 such patients, 10 males and 23 females, of whom 11 proved to be really hypersensitive to radiation, underlining the rarity of this condition. The finding that individuals, as well as tumors, react differently will enable doctors in the future to target doses even more carefully, taking into account not just the radiosensitivity of the tumor type but also the potential reaction of the particular patient to treatment.

– Compiled by Lynn Yoffee, MDD