Smoking habits before and after breast cancer

A large study of breast cancer survivors has found that those who quit smoking after their diagnosis had a 33 percent lower risk of death as a result of breast cancer than those who continued to smoke.

The study involved more than 20,600 women with breast cancer, and is one of the largest studies of survival outcomes according to smoking habits in women with a history of breast cancer, and the first study to assess smoking habits both before and after diagnosis.

Full reference: Passarelli, M. et al. Cigarette Smoking Before and After Breast Cancer Diagnosis: Mortality From Breast Cancer and Smoking-Related Diseases. Journal of Clinical Oncology, 2016

New tool to determine the risk of prostate cancer death

European Urology 2015; DOI: 10.1016/j.eururo.2015.10.053

Researchers at the University of Copenhagen have identified a new prognostic biomarker: the neuropeptide pro-NPY, which may help determine the risk of dying from prostate cancer. This particular type of protein is very specific to prostate cancer cells and could help identify whether newly diagnosed patients require radical prostatectomy surgery or if it is safe to delay surgery.

The research has been published in the journal, European Urology.

Full reference:  Iglesias-Gato, D et al. The Proteome of Primary Prostate Cancer. European Urology, 2015.

Latest research around e-cigarettes

  1. Electronic Cigarette and Nicotine Toxicity – Quan, D. & Kuehnle, S. Primary Care Reports. Published online: 26th January 2016.

Executive Summary:

  • E-cigarettes are not regulated in the United States and can therefore be legally sold and used by minors. They aerosolize nicotine and other flavorings, and can be used to deliver other drugs of abuse.
  • Nicotine causes increased mental alertness, as well as mood enhancement and mild euphoria. It is also an appetite suppressant.
  • Ingestion of nicotine in large amounts often leads to nausea and vomiting, thereby limiting toxicity.
  • Nicotine toxicity includes bronchorrhea, wheezing, seizures, and rhabdomyolysis. Use of succinylcholine in patients with nicotine toxicity is not recommended.

View the article here

2. Longitudinal study of e-cigarette use and onset of cigarette smoking among high school students in Hawaii – Wills, T. et al. Tobacco Control. Published Online First: 25th January 2016

Conclusions: Adolescents who use e-cigarettes are more likely to start smoking cigarettes. This result together with other findings suggests that policies restricting adolescents’ access to e-cigarettes may have a rationale from a public health standpoint.

Read the full research article here

3. Expert reaction to study of e-cigarette use and cigarette smoking in children. Science Media Centre. 25th January 2016

Prof. Linda Bauld, Professor of Health Policy at the University of Stirling, Deputy Director of UK Centre for Tobacco and Alcohol Studies, and Chair in Behavioural Research for Cancer Prevention at Cancer Research UK, said:

“This is the third published study from the USA suggesting that young people who have tried e-cigarettes at baseline are more likely to have tried tobacco smoking at follow up (in this case one year later).

“However, if you look more closely at the paper any assumptions that one leads to the other are not supported, as is the case with previous studies. In particular in this paper, more frequent use (compared to experimentation) of both e-cigarettes and tobacco at baseline and follow up was low and did not significantly increase – around 8% for e-cigarettes and 4% for tobacco at both time points.

“This study does not provide evidence that e-cigarettes are a gateway to regular smoking in teenagers. It is important that ongoing research on this topic is conducted, including in the UK, where e-cigarette age of sale laws already exist and significant marketing restrictions will be introduced from May this year. Such measures are important to protect children, as electronic cigarettes are products for adult smokers who wish to cut down and stop smoking.”

Read the full analysis here

New precision medicine guidelines aimed at improving personalized cancer treatment plans

A committee of national experts, led by a Cleveland Clinic researcher, has established first-of-its-kind guidelines to promote more accurate and individualized cancer predictions, guiding more precise treatment and leading to improved patient survival rates and outcomes.

These new guidelines are changing the traditional approach of cancer staging methods for cancer treatment. The new risk calculators — which will complement the existing staging system — will enable physicians to more accurately and precisely determine the best treatment for individual patients.

Image source: simplyanon

The current cancer staging system (stages I-IV), otherwise known as TNM, has been used for decades and is a simple way to universally assess cancer progression in patients around the world. However, many believe that the system is outdated, lumping all cancer patients into 4 stages, which do not account for individual differences in risk factors–such as genetics, age, gender, and lifestyle. As a result, a patient who is, for example, a “bad” stage 3, might be undertreated for a cancer that is likely to metastasize. On the other hand, a “good” stage 3 patient might receive more aggressive treatment than is necessary, which can lead to toxic side effects on the heart, kidneys or other organs.

Now that the guidelines have been established, researchers across the world will be invited to submit their cancer risk formulas for review by AJCC, with the potential of changing the face of cancer treatment for millions of people worldwide.

Read the full commentary via ScienceDirect

Read the full article via CA: A Cancer Journal for Clinicians

NHS England widens access to docetaxel for prostate cancer


Patients first diagnosed with advanced prostate cancer will now get immediate access to a drug which studies have shown can extend their life by more than a year compared to current options, NHS England has announced.

Following a review of evidence from two trials published late last year, specialists will now be able to prescribe the chemotherapy drug docetaxel as soon as someone is diagnosed with incurable prostate cancer. Under previous guidelines, patients had to wait until it was clear that existing, hormone-based treatments had stopped having an effect.

The two randomised control trials published in 2015 found that, compared with androgen deprivation therapy (ADT) alone, docetaxel combined with ADT improved overall survival by up to 15 months.

Read the full news report via NHS England

New Table of Contents – International Journal of Cancer

IJCVolume 138, Issue 7, pages 1557–1562, 1 April 2016

Articles include:

  • Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer (pages 1619–1625)Theodora Maria Ripping, Rebecca A. Hubbard, Johannes D.M. Otten, Gerard J. den Heeten, André L.M. Verbeek and Mireille J.M. Broeders

    What’s new?

    Breast cancer screening is shifting away from a one-size-fits-all approach, where age determines mammography frequency, to personalized approaches, which balance the benefits and harms of mammographic screening. This study shows that women with a first-degree family history of breast cancer are more likely to have favorable and unfavorable screening outcomes than women without a family history of the disease. Women with a family history had a higher chance of small invasive cancers being detected but also were at increased risk of interval cancers and false-positives. The findings emphasize the need for careful benefit-harm assessment in mammographic screening.


  • Clinicopathological and molecular alterations in early gastric cancers with the microsatellite instability-high phenotype (pages 1689–1697)Ryo Sugimoto, Tamotsu Sugai, Wataru Habano, Masaki Endoh, Makoto Eizuka, Eiichiro Yamamoto, Noriyuki Uesugi, Kazuyuki Ishida, Tomonori Kawasaki, Takayuki Matsumoto and Hiromu Suzuki

    What’s new?

    The relevance of the clinicopathological and molecular features of early gastric cancers with the microsatellite instability (MSI)-high phenotype remains to be clarified in sporadic gastric carcinogenesis. This study shows that early gastric cancers with the MSI-high phenotype exhibit distinct histological features and accumulation of both genomic damage and MSI within the same tumors. In regions with genomic damage, the frequencies of 3p and 22q AI were significantly higher in the MSI-high phenotype than in the microsatellite stable phenotype. The treatment strategies for patients with gastric cancers having the MSI-high phenotype may thus need to differ from patients with colorectal cancer.


  • High hemoglobin A1c levels within the non-diabetic range are associated with the risk of all cancers (pages 1741–1753)Atsushi Goto, Mitsuhiko Noda, Norie Sawada, Masayuki Kato, Akihisa Hidaka, Tetsuya Mizoue, Taichi Shimazu, Taiki Yamaji, Motoki Iwasaki, Shizuka Sasazuki, Manami Inoue, Takashi Kadowaki, Shoichiro Tsugane and for the JPHC Study Group

    What’s new?

    Diabetes and cancer share a positive association, yet the relationship between cancer risk and the most reliable blood glucose marker, hemoglobin A1c (HbA1c), remains unclear. This large-scale prospective study with strictly standardized HbA1c values in a Japanese population, which was cancer-free at baseline, shows that elevated HbA1c levels are significantly associated with risk for all reported cancer sites in both sexes, independent of potential confounding factors. The findings support the idea that glycemic control is key to cancer prevention in both diabetic and nondiabetic individuals with high HbA1c levels.

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

Lo, C. et al. BMJ Supportive & Palliative Care. Published Online First: 19 January 2016

Background: Managing Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).

Aims: To test trial methodology and assess feasibility of a confirmatory RCT.

Design: A parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination. Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9). Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem, experiential avoidance, quality of life and post-traumatic growth. Bayesian conjugate analysis was used in this low-powered setting.

Setting/participants: 60 adult patients with advanced cancer from the Princess Margaret Cancer Centre.

Results: Rate of consent was 32%, randomisation 78%, attrition 25%, non-compliance 37% and contamination 17%. There was support for potential treatment effects on: PHQ-9, OR=1.48, 95% Credible Interval (CRI.95) (0.65, 3.38); MDD, OR=1.56, CRI.95 (0.50, 4.84); attachment anxiety, OR=1.72, CRI.95 (0.73, 4.03); and attachment avoidance, OR=1.58, CRI.95 (0.67, 3.71). There was no support for effects on the seven remaining secondary outcomes.

Conclusions: A phase 3 CALM RCT is feasible and should aim to detect effect sizes of d=0.40, with greater attention to issues of compliance and contamination.

Read the full article here

A randomised trial of the effect of postal reminders on attendance for breast screening

Allgood, P. et al. British Journal of Cancer (2016) 114, 171–176

Image source: Flickr

Background: Some women make an informed choice not to attend breast screening, whereas others may have forgotten about the appointment. We report on a randomised trial that investigates whether a reminder letter affects attendance.

Methods: Women scheduled for a breast screening appointment were randomised to either receive a reminder letter a few days before their breast screening appointment in addition to the standard invitation letter (intervention) or not (control). The primary outcome was attendance within 30 days of the first offered appointment. Secondary outcomes were attendance within 90 and 180 days.

Results: In all, 11383 (49.9%) women were randomised to the intervention and 11445 (50.1%) to the control. In the intervention arm, 7759 (68.2%) attended within 30 days of the first offered appointment compared with 7349 (64.2%) in the control arm. This difference was significant (P<0.001). The odds ratio (OR) (95% confidence interval) for the primary end point was 1.19 (1.13–1.26). This was not significantly affected by age, socioeconomic status or type of screen (prevalent or incident). Secondary endpoint analyses supported these results. Results did differ, however, between the different centres studied.

 Conclusions: This study found that postal reminders increase breast screening uptake, and could be practicable to implement in the NHS Breast Screening Programme.

View the full article here

Treatment of muscle-invasive bladder cancer: A systematic review

Chou, R. et al. Cancer: Article first published online 15th Jan 2016

There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer.

Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the Web site were performed. A total of 41 articles were selected for review.

Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques.More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency.Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.

View the article abstract here