TARGETING TUMORS

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  According to a recently published study in the medical journal Gut, age is a risk factor for progression of colon polyps to colorectal cancer (CRC) in both men and women, based on analysis of German cancer registries of 840,149 screening colonoscopies. This suggests that clinicians should consider age and colon screening, such that higher age should require more frequent endoscopies, in addition to other risk factors including family history of the cancer. Also reported by Reuters.

  Published Online First: 25 June 2007. doi:10.1136/gut.2007.122739
  Gut 2007;56:1585-1589
  Copyright © 2007 BMJ Publishing Group Ltd & British Society of Gastroenterology
  Risk of progression of advanced adenomas to colorectal cancer by age and sex: estimates based on 840 149 screening colonoscopies
  Hermann Brenner1, Michael Hoffmeister1, Christa Stegmaier2, Gerhard Brenner3, Lutz Altenhofen3, Ulrike Haug1

  1 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  2 Saarland Cancer Registry, Saarbrücken, Germany
  3 Zentralinstitut für die kassenärztliche Versorgung in der Bundesrepublik Deutschland, Berlin, Germany

  Correspondence to: Hermann Brenner, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Bergheimer Str. 20, D-69115 Heidelberg, Germany; h.brenner@dkfz-heidelberg.de

  Objectives: To derive age and sex specific estimates of transition rates from advanced adenomas to colorectal cancer by combining data of a nationwide screening colonoscopy registry and national data on colorectal cancer (CRC) incidence.

  Design: Registry based study.

  Setting: National screening colonoscopy programme in Germany.

  Patients: Participants of screening colonoscopy in 2003 and 2004 (n = 840 149).

  Main outcome measures: Advanced adenoma prevalence, colorectal cancer incidence, annual and 10 year cumulative risk of developing CRC among carriers of advanced adenomas according to sex and age (range 55–80+ years)

  Results: The age gradient is much stronger for CRC incidence than for advanced adenoma prevalence. As a result, projected annual transition rates from advanced adenomas to CRC strongly increase with age (from 2.6% in age group 55–59 years to 5.6% in age group >=80 years among women, and from 2.6% in age group 55–59 years to 5.1% in age group >=80 years among men). Projections of 10 year cumulative risk increase from 25.4% at age 55 years to 42.9% at age 80 years in women, and from 25.2% at age 55 years to 39.7% at age 80 years in men.

  Conclusions: Advanced adenoma transition rates are similar in both sexes, but there is a strong age gradient for both sexes. Our estimates of transition rates in older age groups are in line with previous estimates derived from small case series in the pre-colonoscopy era independent of age. However, our projections for younger age groups are considerably lower. These findings may have important implications for the design of CRC screening programmes.

   

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  From ThoughtBubbles.org: “There is no media hoopla about lung cancer, even though lung cancer kills more people than breast, prostate, and colon cancer combined.” Yvonne is right; last month we saw a flurry of pink ribbons. How many people know the color of the “lung cancer awareness” ribbon? (answer: clear, to signify that lung cancer is an invisible cancer). Lung cancer is often invisible to patients because they do not experience symptoms until relatively late in the disease, which is one of the reasons why lung cancer can be so deadly. Lung cancer is often invisible to the public because (and I speculate) of at least two reasons: 1) a stigma that lung cancer is “a smoker’s disease” when in fact, lung cancer has killed many non-smokers, men and women alike, and 2) lung cancer does not boast as many “survivors” who can later become vocal advocates the way breast cancer does.

   

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  US Food and Drug Administration (FDA) has approved Ixempra (ixabepilone, manufactured by Bristol-Myers Squibb) for combination treatment with capecitabine (brand name Xeloda, manufactured by Roche) and single-agent monotherapy for treating metastatic or locally advanced breast cancer that has not responded to other chemotherapy (doxorubicin, epirubicin, paclitaxel, or docetaxel). Ixempra belongs to a class of chemical called epothilones and work by binding to cancer cell microtubules, which interferes with cell division. Since Ixempra is in a Cremophor vehicle (same used for Taxol), those allergic to Cremophor or related chemicals should not take Ixempra. Side effects include peripheral neuropathy (numbness, tingling or burning in the hands or feet), bone marrow suppression, constipation, nausea, vomiting, muscle paint, joint pain, fatigue and general weakness. Source: US FDA. Visit drug website.

   

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  One of the concern oncologists have when treating “older” patients ages 70 or above is whether these patients may tolerate the full range of side effects that accompany dose intensive chemotherapy, and some oncologists are more conservative when treating the elderly patient population. In a recent study published in the Cancer medical journal, Dr. Michelle Shayne and colleagues looked at 115 community oncology practices and 976 patients who had received chemotherapy between 2002 and 2005 for various types of cancers and tumors to look at how elderly patients experience side effects from the dosage of chemotherapy they received.

  The side effects in particular included severe neutropenia (abnormal decrease in the number of neutrophils in the blood) and febrile neutropenia (reduced white blood cells used to fight an infection). The researchers found that older patients tend to receive lower dose chemotherapy even though patients who received 85% or more of the relative dose intensity of chemotherapy did not show significant increase in neutropenia side effects. Thus this would suggest that older patients may tolerate the high dose chemotherapy they would need to improve their chances of fighting cancer, and oncologists should take this study into consideration when designing the cancer fighting regimen for an older patient. (More …)

   

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  Today the Economist magazine website cited an editorial from the latest issue of the medical journal, Lancet Oncology that cancer patients’ survival may depend on where they live. Based on almost 3 million new cases diagnosed between 1995-1999 in 23 countries, survival rates were the lowest in central Europe and highest in the Nordic except for Denmark. Additionally commentary may be found from this website.

   

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