Barbara Boughton

BRAF and CDKN2A mutations in secondary high-grade glioma.

The incidence of fractures in patients who have undergone hematopoietic stem-cell transplantation for malignant and non-malignant disorders is substantially increased, compared with the general US population, new research suggests. Xerxes Pundole (MD Anderson Cancer Center, Houston, TX, USA) and colleagues found that, with an increase in haematopoietic stem-cell transplantation in the past two decades, the number of people with the longterm adverse eff ects, such as bone loss leading to fractures, of the procedure (and its associated treatment) have also increased. The researchers did a retro spective study of 7620 patients (aged older than 18 years) who underwent haematopoietic stem-cell transplantation at the MD Anderson Cancer Center during 1997–2011. They aimed to compare the incidence and risk of fractures in the recipients of haematopoietic stem-cell transplantation to that in the general US population using data from the National Health Interview Survey (1994) and the National Hospital Discharge Survey (2004). After trans plantation, fractures were noted in 602 (8%) patients. The researchers also noted that the incidence of fractures was increased in patients older than 50 years, in patients with multiple myeloma and solid tumours, and in p.atients who underwent autologous transplantation. In women and men aged 45–64 years who underwent stem-cell transplantation, the esti mated relative risk of fracture was about eight and seven to nine times higher, respectively, than in the corresponding cohort in the general population. “There is a much higher risk of fractures in recipients of haematopoietic stem-cell trans plantation than the general public”, said investi gator Richard Champlin (MD Anderson Cancer Center, Houston, TX, USA). “Our results highlight that the risk of bone loss and fractures is a signifi cant problem during the survivorship period following hemato poietic stem-cell transplantation”, said investigator Huifang Lu (MD Anderson Cancer Center, Houston, TX, USA). However, according to Gary Schiller (UCLA Medical Center, Los Angeles, CA, USA), increased incidence of fractures in patients who have undergone haematopoietic stem-cell transplantation is not surprising, “considering the steroids that patients often require, the prolonged immobilisation, and vitamin D defi ciency”. “Osteoporosis is something that is typically evaluated in long-term survivors of [bone marrow transplantation]”, he said.

Exercise could improve colorectal-cancer survival

Exercise can signifi cantly improve survival and reduce cancer recurrence in patients with non-metastatic colorectal can cer, accordingly to two studies (J Clin Oncol 2006; 24: 3517–18 and 3527–34). “Higher levels of physical activity contributed to a 50% reduced risk of recurrence and mortality when com bined with standard therapies”, says lead author of both studies Jeff rey Meyerhardt (Dana-Farber Cancer Institute, Boston, MA, USA). “These studies provide consistent observational data that exercise may provide additive benefi t to patients diagnosed with colorectal cancer who have had surgery and chemotherapy”, he adds. In the CALGB 89803 study, all 832 patients diagnosed with stage III colon cancer completed questionnaires on lifestyle and exercise during and 6 months after adjuvant therapy. Compared with those who did less than three metabolic equivalent tasks (MET)-h per week of exercise, the adjusted hazard ratio for disease-free survival was 0·51 (95% CI 0·26–0·97) for those who did 18–26·9 MET-h of activity per week, and 0·55 (0·33– 0·91) for those who did 27 MET-h per week or more. In the Nurses’ Health Study, 573 women with stage I–III colorectal cancer who did at least 18 MET-h of activity had a hazard ratio of 0·39 (0·18–0·82) for cancer-specifi c mortality and 0·43 (0·25–0·74). for overall mortality, compared with those who did less than 3 MET-h per week. “These strong epidemiological studies give consistent data about the bene fi ts of exercise for cancer survivors. We can now say to patients: exercise is ass o ciated with reduced recurrence and mort ality in colorectal cancer”, says Wendy DemarkWahnefried (Duke University Medical Center, Durham, NC, USA), who wrote an accompanying editorial to the studies.

Decreasing treatment-related hearing loss

A study of intra-arterial cisplatin compared with intravenous cisplatin con comitantly administered with radiotherapy suggests the method of administration of cisplatin might aff ect treatment-induced hearing loss (J Clin Oncol 2007; 25: 3759-65). 158 patients were randomly assigned to treatment with cisplatin, given intra-arterially or intravenously, in a prospective analysis. Hearing thresholds at low and ultra-high frequencies were obtained for each patient before, during, and after treatment. Findings indicated that patients given intra-arterial cisplatin had 10% less hearing loss than those given intravenous cisplatin, and in the intra-arterial group, fewer patients qualifi ed for hearing aids.

Dietary folate protects against breast cancer in women who drink alcohol

th percentile) had a relative risk of breast cancer of 1.59, compared with women who did not drink and had the highest folate intake (above the 50 th percentile.). This translates to an increased risk of breast cancer of 59%, and an additional 205 cases of breast cancer per 100 000 person years. In 1986, women enrolled in the Iowa Women’s Health study completed a survey that assessed diet, vitamin use, and alcohol consumption, as well as other breast-cancer risk factors. During 1997, the researchers documented 1586 cases of breast cancer. Women with the lowest intake of folate, but not other B vitamins, were found to be at a slightly increased risk of the disease, but only if they also drank alcohol.

Cervical screening uptake in ethnic minority women

Pap smear screenings have increased greatly in the past 10 years, but not among many ethnic minority women. Asian, African-American, and Latina women still face barriers to obtaining regular screenings and early treatment for cervical cancer in the USA. A series of studies has documented the reasons why many ethnic minority women do not get Pap smears or return for follow-up screenings. The researchers have also proposed some unique solutions, including streamlined office visits, and the use of lay health workers, who work one-on-one with these patients. In an unpublished study of 376 Latina women and 66 non-Latinas at a community health clinic near Los Angeles, researchers from the University of California (Irvine, CA, USA) found that Latina women were much less likely to know what do after their doctor finds an abnormal Pap smear, much less likely to believe that cervical cancer was curable, and less likely to return for further treatment after an abnormal Pap smear. Nearly 40% of Latinas who had abnormal Pap smears did not return for treatment, according to the study, presented at the annual American Public Health Association Meeting (21–25 October 2001, Atlanta, GA, USA). The researchers proposed that the usual three to four consultations for Pap smear screening, follow-up, and treatment be compressed into one. Says lead researcher Alberto Manetta, Professor of Gynecologic Oncology at the University of California, “One visit would be much more acceptable and feasible for these women, and more likely to increase follow-up screenings”. In another recent study of cervical and breast cancer screening practices, researchers at the Northern California Cancer Center (Union City, CA, USA) surveyed 1600 Latina, Asian, AfricanAmerican, and white women in low income neighbourhoods in the San Francisco area from 1993 to 1996 (Prev Med 2001; 33: 190–203). They found that Pap smear screening rates were lowest among non-English speaking Latinas (72%) and non-English speaking Chinese women (24%). Many of the women were not aware of the importance of Pap smears, because of problems in communicating with doctors and the limited access to smear tests in their native country. In a second part of the study, the researchers assigned lay health workers to contact and follow-up on more than 2000 low income and ethnic minority women. Though the results have not yet been published, the researchers report that in the subset of women reached by the intervention, substantial increases in uptake of Pap smear screenings were found among the Chinese and Latina women. Says researcher Rena Pasick, Director of Prevention Sciences at the Northern California Cancer Center, “A woman to woman approach for educating women in their communities is critical in creating a commitment to lifelong screening”. Barbara Boughton