Cancer Newsletter
February 6, 2017
When we are no longer able to change a situation, we are challenged to change ourselves.
                                                            -- Viktor Frankl
In this Issue
• Many Breast Cancer Survivors Don't Get Life-Extending Therapy
• Too Few Current, Former Smokers Screened for Lung Cancer
• Hormonal Drug Boosts Survival After Prostate Cancer's Return: Study
• What You Don't Know About Cancer Can Kill You

Many Breast Cancer Survivors Don't Get Life-Extending Therapy

Study estimates nearly 15,000 lives saved over decade if all who needed hormone treatment got it

THURSDAY, Feb. 2, 2017 (HealthDay News) -- Hormonal therapies such as tamoxifen, or a class of drugs called aromatase inhibitors, can reduce the likelihood that women diagnosed with certain breast cancers will experience a recurrence of their disease.

However, a new study finds these treatments -- used in breast cancers that are responsive to hormones such as estrogen -- are too seldom utilized or often used incorrectly.

According to the research team, if all U.S. breast cancer survivors who needed them followed recommendations for hormone therapy, that could mean almost 15,000 lives saved over a decade.

Unfortunately, these drugs are "still underused, and in some cases, misused -- offered to patients who lack [estrogen] hormone receptors" on their tumor cells, explained study senior author Dr. Dezheng Huo. He's associate professor of public health sciences at the University of Chicago.

As the researchers explained, hormonal therapies are associated with a 29 percent lower risk of death for women with hormone receptor-positive breast cancer.

The treatment involves drugs such as tamoxifen or aromatase inhibitors that block hormones and prevent cancer from coming back. These drugs work by slowing or stopping the growth of tumors that feed on certain hormones. Patients are encouraged to take these pills daily for at least 10 years.

The study involved nearly one million women with hormone-sensitive breast cancers who were included in a nationwide cancer registry. Of these women, one out of six who should have had post-surgical hormonal treatments never received them.

The study authors estimated that 14,630 women who did not get the recommended hormone therapy went on to die from a recurrence of their cancer between 2004 and 2013. These deaths could have been prevented, Huo's team suggested.

There was some good news, however: During the study period, adherence to guidelines on the use of the drugs did improve, the investigators found.

Their use "slowly gained popularity over this time," Huo said in a university news release. "It improved after 2004, rising from 70 percent in 2004 to almost 84 percent in 2011. Then it declined slightly to 82 percent in 2013, when the study ended."

Still, 18 percent of women who could have benefited from this treatment were not receiving it by the end of the study, the researchers noted. Also, about 3 percent of women received the therapies inappropriately, where they might not have been indicated for their particular breast cancer type.

There are some downsides to hormonal treatments, the researchers noted. The drugs may cause unpleasant side effects, such as nausea or hot flashes, which may help explain why they are underused.

Other risks vary by the type of drug. For example, patients taking tamoxifen are at greater risk for stroke, while those on aromatase inhibitors are more likely to develop osteoporosis, Huo's group noted.

The researchers also stressed that the long-term survival benefits of hormonal therapy after breast surgery are tough for the average patient to recognize -- the benefits aren't immediate and noticeable. That might also influence women's decisions on whether to continue the therapy.

Some women are also more likely than others to adhere to the therapy, the study found. Those groups include women who underwent breast surgery, or those treated at a large hospital. Asian and white women were also more likely than black or Hispanic women to continue their therapy, the research showed.

The findings were published Feb. 2 in JAMA Oncology.

More information

The U.S. National Cancer Institute has more on hormone therapy and cancer.

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Too Few Current, Former Smokers Screened for Lung Cancer

Such testing could cut death rate by 20 percent, American Cancer Society says

THURSDAY, Feb. 2, 2017 (HealthDay News) -- Most current and former smokers in the United States don't get screened for lung cancer even though they're at increased risk for the deadly disease, a new study reveals.

The findings highlight the need to educate doctors and at-risk patients about lung cancer screening, according to the American Cancer Society researchers.

Their analysis of federal government data found that the proportion of eligible current and former smokers who underwent lung cancer screening in the past 12 months remained low -- 3.3 percent in 2010 to 3.9 percent in 2015.

The researchers calculated that of the 6.8 million current and former smokers eligible for lung cancer screening in 2015, only 262,700 received it.

"The reasons for the low uptake in screening are probably varied, and likely include lack of knowledge among both smokers and doctors as to screening recommendations, as well as access to high-quality screening," study leader Dr. Ahmedin Jemal said in a cancer society news release.

"Our previous study showed implementing quality screening broadly across the U.S. could prevent about 12,000 lung cancer deaths every year in the short term. But we cannot prevent those deaths until and unless we start educating eligible smokers as well as clinicians about the benefits and risks of screening, so patients can make an informed decision," he said.

The U.S. Preventive Services Task Force recommends annual lung cancer screening with low-dose computed tomography for people aged 55 to 80 with a "30-pack or more per year smoking history."

Research suggests this could reduce lung cancer deaths in this group of patients by 20 percent, the study authors said.

The findings were published online Feb. 2 in the journal JAMA Oncology.

More information

The U.S. Centers for Disease Control and Prevention has more on lung cancer screening.

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Hormonal Drug Boosts Survival After Prostate Cancer's Return: Study

But, newer and possibly more effective drugs now available and being studied

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- When prostate cancer recurs after surgery, treatment with both radiation and a testosterone-suppressing drug can extend some men's lives, a new clinical trial finds.

In a nearly 20-year study, researchers found that the combination therapy cut the risk of death from prostate cancer in half, compared to radiation alone.

And that translated into better overall survival, the researchers reported in the Feb. 2 New England Journal of Medicine.

After 12 years, just over 76 percent of men who'd received radiation and the hormonal drug bicalutamide (Casodex) were still alive. That compared with just over 71 percent of those who'd received radiation alone.

Not all patients benefited from extra treatment, though -- including those with "lower-risk" prostate cancer that, despite recurring, appeared less aggressive.

And the testosterone-blocking drug carried expected side effects, such as enlarged breasts.

But on balance, the findings should be "practice-changing," said senior researcher Dr. William Shipley, of Massachusetts General Hospital in Boston.

The trial was funded by the U.S. National Cancer Institute (NCI) and AstraZeneca, which makes Casodex.

Other prostate cancer experts said the results offer "important" information. But they also said it's unclear how the findings will affect current prostate cancer treatment.

Since this trial began in 1998, "the prostate cancer therapeutic landscape has changed," said Dr. Alexander Kutikov, an associate professor of urologic oncology at Fox Chase Cancer Center in Philadelphia.

For one, Kutikov said, bicalutamide has been largely replaced by newer hormonal medications. Known as gonadotropin-releasing hormone agonists, they include drugs such as leuprolide (Eligard, Lupron) and goserelin (Zoladex).

And the newer medications, along with radiation, are already offered to some men with recurrent prostate cancer, said Dr. Ashutosh Tewari. He's chair of urology at Mount Sinai's Icahn School of Medicine in New York City.

Other ongoing trials are looking at those therapies, researchers said. One tested the effects of adding goserelin to radiation therapy in men with early signs of prostate cancer recurrence.

So far, that study has found that the combination keeps more men progression-free over five years. And the duration of the hormone therapy was much shorter, versus the bicalutamide trial: three months, rather than two years.

Plus, Kutikov said, when today's hormonal drugs are used with radiation as an initial therapy -- not for a recurrence -- six months of hormonal treatment has "proven to be sufficient" for many men.

"As such," Kutikov said, "the study's findings will need to be reconciled with current clinical practice."

Still, the bicalutamide trial is the only one that has gone on long enough to show that adding hormonal therapy to radiation can actually extend the lives of some men with biochemical recurrences.

A biochemical recurrence means their levels of prostate-specific antigen (PSA) start to rise again -- an early sign that the cancer may be returning.

Prostate cancer usually progresses slowly, so it took more than a decade to see a survival advantage with bicalutamide, the researchers said.

According to Tewari, the study offers "proof-of-principle" that adding "something to radiation is better than radiation alone."

Roughly 181,000 U.S. men were diagnosed with prostate cancer in 2016, according to estimates from the NCI.

Because the disease is typically slow-growing, most men are diagnosed when the tumor is confined to the prostate gland, according to the NCI.

Many patients have the option of delaying treatment and going with "active surveillance" -- where doctors closely monitor the cancer for signs of progression.

But in the United States, studies show that most men choose treatment. That treatment typically involves surgery to remove the prostate. Of men who undergo surgery, more than 30 percent will have a biochemical recurrence, according to Shipley's team.

Shipley and his colleagues studied 760 men who'd undergone surgery for localized prostate cancer and later had a biochemical recurrence.

They randomly assigned the patients to take either bicalutamide or placebo pills every day for two years. All of the men underwent 6.5 weeks of radiation.

After 12 years, almost 6 percent of bicalutamide patients had died of prostate cancer, versus just over 13 percent of placebo patients.

The benefits were not uniform, though, Kutikov pointed out.

Hormonal therapy made no difference in the survival rates of men with relatively low PSA levels when they entered the trial (below 0.7). The same was true of men with "Gleason scores" below 7.

That score is based on what a tumor sample looks like under the microscope. A lower score means the cells look more "normal," and the cancer is less likely to progress.

That, Kutikov said, suggests that men with lower-risk cancer could be "overtreated" if they receive hormonal therapy.

Overtreatment is a worry because it needlessly exposes patients to the risk of side effects.

In the case of hormonal therapies in general, Kutikov said, the potential side effects include lost libido and erectile dysfunction.

More information

The American Cancer Society has a guide on prostate cancer treatment.

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What You Don't Know About Cancer Can Kill You

Too few Americans realize that obesity, alcohol and inactivity boost risk for disease, survey finds

WEDNESDAY, Feb. 1, 2017 (HealthDay News) -- Cancer isn't inevitable, but many Americans don't know that several lifestyle factors affect their risk of developing the disease, a new survey finds.

Only one in two Americans is aware that obesity can raise the risk of cancer. And fewer than half understand that alcohol, inactivity, processed meat, eating lots of red meat and low consumption of fruits and vegetables are linked to cancer risk, the researchers said.

"There is a clear crisis in cancer prevention awareness," said Alice Bender, head of nutrition programs at the American Institute for Cancer Research.

A larger percentage of Americans mistakenly believe that stress, fatty diets and other unproven factors are linked with cancer, according to the institute's 2017 Cancer Risk Awareness Survey.

"It's troubling that people don't recognize alcohol and processed meats increase cancer risk," Bender said in an institute news release. "This suggests the established factors that do affect cancer risk are getting muddled with headlines where the research is unclear or inconclusive."

Highlights of the survey findings include:

  • Fewer than 40 percent of Americans know that alcohol affects cancer risk.
  • Only 40 percent know that processed meats are also associated with cancer risk.
  • Fifty percent of Americans are aware that being overweight spurs cancer risk, up from 35 percent in 2001.

Nearly one-third of common cancers in the United States could be prevented through diet, weight management and physical activity. That increases to half when factors such as not smoking and avoiding sun damage are added, according to the institute.

Research has linked alcohol to at least six cancers, including colon, breast, liver and esophageal. Studies have also shown that bacon, hot dogs and other processed meats may raise the risk of colon and stomach cancers.

Only half of Americans know that obesity increases the risk of several cancers and that a healthy weight is the second most important way -- after not smoking -- to reduce cancer risk, the researchers said.

"We know a lot of healthy people do get cancer and sometimes it's easier to worry about genes or uncontrollable things rather than your everyday choices," said Bender.

"But the research says that being physically active, staying a healthy weight, and eating a plant-based diet has the potential to prevent hundreds of thousands of cancer cases each year," Bender aded. "It's a powerful message."

More information

The U.S. National Cancer Institute has more on cancer prevention.

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