John F. Forbes

Undergraduate education about cancer: a survey in Australian medical schools

The goals of undergraduate medical education are to provide a core of basic knowledge, and a framework to permit further development of that knowledge. The structure of teaching and experience in cancer medicine should reflect the increasing importance of cancer in the community. Undergraduate teaching of oncology and its scientific bases is currently fragmented, and in some cases may be deficient. Until now, there have few analyses of what is being taught about cancer at different medical schools. We have undertaken a survey of final year medical students or recently qualified doctors in Australia enquiring about their cancer education. The results indicated that substantial differences existed between the medical schools, and we therefore surveyed the teaching faculty in the schools to determine their view of the validity of the questions we used. Together these surveys showed that significant disparities existed between what the faculty felt should be taught and what students had actually experienced.

Analysis of HL-A antigens in patients with Hodgkin's disease and their families

The HL-A phenotypes of 127 patients with Hodgkins disease have been determined. A very significant association has been found between Hodgkins disease and two HL-A antigens, HL-A11 (P < 0.009), and W5 (P < < 0.0005). The families of 40 of these patients were genotyped for HL-A antigens. A normal mendelian segregation of the relevant antigen was found in all 12 families of HL-All positive patients and in 6 of 8 families of W5 positive patients. These findings suggest that certain Hodgkins patients have a genetically determined susceptibility to their disease. It is postulated that this susceptibility could be due to linkage between HL-A genes and genes controlling immune responsiveness. Analysis of subgroups of Hodgkins patients based on age, sex, and pathology suggests that these HL-A associations are most marked in certain subgroups.

Drug resistance in clinical practice: Patterns of treatment failure in patients receiving systemic therapy for advanced breast cancer

Strategies for overcoming the causes of drug resistance should take account of the patterns of treatment failure seen in clinical practice. We have analysed the patterns of disease progression in 267 patients with advanced breast cancer receiving systemic therapy. First disease progression on therapy most commonly occurred in tissues involved by tumour at the commencement of treatment. However in 40% of patients, first documentation of disease progression included a tissue not previously known to contain metastatic disease. In only 3% of patients was this new tissue the central nervous system. This pattern of disease progression was not influenced by treatment type (i.e. endocrine or cytotoxic), tumour response to treatment, oestrogen receptor status, prior adjuvant cytotoxic treatment, or disease free interval. These results question the wisdom of always ceasing existing therapy and substituting new treatment when progressive disease is first documented.