Myles P. Cunningham

The national cancer data base report on race, age, and region variations in prostate cancer treatment

Patterns of care for prostate cancer patients in the United States have changed as early detection has improved. The National Cancer Data Base of the American College of Surgeons Commission on Cancer provides information about the treatment of patients in all age, race, and regional groups from institutions that represent cancer care at the community level as well as in medical centers.

Symptomatology as an indicator of recurrent or metastatic breast cancer

Eight‐seven patients with recurrent breast cancer after mastectomy were analyzed for patterns of recurrence and methods of detection. After an average disease‐free interval of 30 months, 38% developed osseous metastases, 16% recurred locally, 10% had local plus systemic disease, 10% showed pulmonary metastases and the remainder were distributed among liver, brain, and remaining breast disease. In 79 patients recurrence was heralded by symptoms. Physical examination in five asymptomatic patients revealed local or supraclavicular recurrence. In only three asymptomatic patients was recurrence documented by “routine” chest x‐rays (in two), or liver enzymes/liver scan (in one). No asymptomatic disease was found by bone scan. It is concluded that periodic history, physical examination, and chest x‐rays are the most important components in the follow‐up of breast cancer patients. Radioisotope scans and other radiographs are valuable in confirming symptomatic disease and detecting additional disease, but cannot be recommended routinely in the asymptomatic patient because of low yield and cost. Cancer 43:956–960, 1979.

Preoperative and follow‐up procedures on patients with breast cancer

From July 1, 1975 to June 30, 1979, 194 patients were enrolled in a program under a contract from the NCI to study chemoimmunotherapy in patients with Stage II and Stage III breast cancer. Patients were treated in six‐week cycles for one year and were later followed at six month intervals. Pretreatment evaluation included complete blood count, SMA‐12, xerogram, chest x‐ray, and bone scan. The blood count and SMA‐12 were repeated every six weeks before each course of treatment, and all of the preoperative tests were repeated at the completion of one year of treatment. After the year of treatment, testing was variable depending upon the stage of the disease, the patients symptoms, and the individual preferences of the responsible physician. Up to the present time, there have been 38 recurrences in the 194 patients entered into this protocol. Twenty‐nine of the recurrences were symptomatic at the time of discovery, four were asymptomatic and detected on physical examination, and five asymptomatic recurrences were detected by routine testing. Review of 60 patients who developed recurrence during approximately the same interval but who were not on the protocol shows that 43 were symptomatic and 14 were discovered on routine physical examination; 3 patients were asymptomatic. During this time, five new breast cancers were discovered in patients included in this report. Three were discovered by xerogram and two by physical examination. Further studies need to be made to provide sound data for optimal follow‐up procedures on previously treated breast cancer patients. Careful history, physical examination, and evaluation of symptoms will identify most recurrences at a relatively early stage and extensive routine testing may not be worthwhile.

Follow-up adjuvant chemotherapy and chemoimmunotherapy for stage II and III carcinoma of the breast

Patients with Stage II or III carcinoma of the breast were assigned to one of three adjuvant chemotherapy and chemoimmunotherapy treatment groups following radical or modified radical mastectomy. This study compares the efficacy of single drug treatment (melphalan) versus multiple drug regimens (CFP and CFP + BCG). In the initial phase of the project participants in the melphalan group showed a higher recurrence rate than those in the CFP and CFP + BCG groups. The recurrence rate of the melphalan group was 4.4 times higher than the recurrence rate of the combined polychemotherapy arms. However, after the initial phase, the recurrence rates for the polychemotherapy arms steadily increased and approached the dropping rate of the melphalan group. Currently (247 weeks after the beginning of the study and nine months after the last patient accrual), 194 patients have been treated (median follow‐up time of 101 weeks), and no significant differences can be detected between the three treatment arms using any of the following criteria: disease‐free interval, proportion of recurrence and recurrence rate. The only factors which are significant with respect to recurrence are the two prognostic factors: tumor size and degree of nodal involvement. The two chemotherapy groups, CFP and CFP + BCG, show no significant difference with respect to recurrence rate along the entire span of the study.

Medical/Legal issues in genetic testing†

Patrick Lynch, J.D., M.D. (Co-Chair) T Matthew Severin, J.D., Ph.D. (Co-Chair) he workgroup considered a number of medical-legal issues in genetic testing, including regulatory issues, legislative issues, Alan Mills (Rapporteur) and emerging standards of patient care that perhaps have, or will, Linda Bosserman, M.D.* represent a ‘‘duty’’ on the part of the physician. These issues Doreine Carson* share a degree of uncertainty as well as a lack of clear and shared Donald C. Chambers, M.D.* standards, and in some instances are driven by competing interMyles Cunningham, M.D.* ests. The workgroup participants agreed that there was a pressing May Sung, M.P.H.* Nicholas J. Vogelzang, M.D.* need to further define and explore these issues, especially among competing interests, and that there should be strong collaborative initiatives among appropriate organizations to establish guidelines to assist the public and providers on issues related to risk assessment and clinical decision making.