Cancer Prevention and Control: A Role for Medical Assistants?

This study aimed to assess medical assistants' willingness to engage in patient education and counseling about cancer prevention and control. A questionnaire was mailed to 402 medical assistants living in Maryland in June 2006 to assess attitudes and practices about counseling and educating patients on cancer prevention and control topics. Findings reveal that medical assistants are engaging patients in discussions about cancer prevention, with diet/nutrition and exercise being most often discussed. Medical assistants are willing to counsel and educate patients on cancer prevention and control topics.     

Addressing the Future Burden of Cancer and Its Impact on the Oncology Workforce: Where Is Cancer Prevention and Control?

The need for cancer professionals has never been more urgent than it is today. Reports project serious shortages by 2020 of oncology health care providers. Although many plans have been proposed, no role for prevention has been described. In response, a 2-day symposium was held in 2009 at The University of Texas MD Anderson Cancer Center to capture the current status of the cancer prevention workforce and begin to identify gaps in the workforce. Five working groups were organized around the following topic areas: (a) health policy and advocacy; (b) translation to the community; (c) integrating cancer prevention into clinical practice; (d) health services infrastructure and economics; and (e) discovery, research, and technology. Along with specific recommendations on these topics, the working groups identified two additional major themes: the difficulty of defining areas within the field (including barriers to communication) and lack of sufficient funding. These interdependent issues synergistically impede progress in preventing cancer; they are explored in detail in this synthesis, and recommendations for actions to address them are presented. Progress in cancer prevention should be a major national and international goal. To achieve this goal, ensuring the health of the workforce in cancer prevention and control is imperative.     

Immunotherapy for Prostate Cancer: What's the Future?

Prostate cancer is the most common noncutaneous cancer and second leading cause of cancer death among US men. A greater understanding of basic immunologic principles has led to a variety of new techniques,which has led to advancements in prostate cancer vaccines. This article discusses the rationale for the development of antibody-based therapy and vaccines therapy, including whole tumor cells, dendritic cells, and pox viral vectors. A summary of selected clinical studies incorporating these strategies and new approaches incorporating a combination of immunotherapy with traditional treatments for prostate cancer is presented.     

Can the Irisin be a Biomarker for Prostate Cancer? A Case Control Study

Aim: There is much evidence of an association between cancer and irisin that is an adipokine. This study researched on the relationship between prostate cancer (PCa) and irisin levels, and whether irisin can be used as a biomarker in the diagnosis of PCa. Materials and Methods: For the study groups, 50 primary PCa patients and 30 healthy male subjects were included in the PCa and healthy control groups, respectively. All volunteers in the healthy control group were screened for prostate cancer and other malignancies and chronic diseases. Volunteers who were determine to be completely healthy were included for healthy control group. In the serum samples of the subjects were measured free PSA, total PSA and irisin levels. Irisin levels were compared separately in terms of the Gleason scores and T stage. In addition to intergroup comparisons, the ROC curve for the irisin was plotted and power analysis was performed. Results: Free and total PSA levels in the PCa group were significantly higher compared to the healthy control group (p<0.05). In addition, irisin levels in the PCa group were significantly lower  than in the healthy control group (p<0.05). There was no significant difference between irisin levels in the groups classified in terms of Gleason scores (p>0.05).  When the cut-off value was taken as 8.1, the sensitivity and specificity of irisin for PCa were as 80.5% and 90%, respectively. Conclusion: The results of this study indicate that the levels of irisin in the PCa group are considerably reduced and irisin may be used as a biomarker as well as free and total PSA.     

Whither Papillon? — Future Directions for Contact Radiotherapy in Rectal Cancer

Although contact radiotherapy was developed 70 years ago, and is highly effective with cure rates of over 90% for early rectal cancer, there are few centres that offer this treatment today. One reason is the lack of replacement of ageing contact X-ray machines, many of which are now over 30 years old. To address this problem, the International Contact Radiotherapy Evaluation (ICONE) group was formed at a meeting in Liverpool in 2005 with the aim of developing a new contact X-ray unit and to establish clinical protocols that would enable the new machine to safely engage in the treatment of rectal cancer. As a result of these efforts, a European company is starting production of the new Papillon RT-50 machine, which will be available shortly. In addition, the ICONE group is planning an observational study on contact X-ray and transanal endoscopic microsurgery (CONTEM) for curative treatment of rectal cancer. This protocol will ensure standardised diagnostic procedures, patient selection and treatment in centres across the world and the data will be collected prospectively for analysis and audit. It is hoped that the CONTEM trial will provide the scientific evidence that is needed to obtain a broader acceptance of local contact radiotherapy as a treatment option for selected cases with early stage rectal cancer.     

Karachi Cancer Registry Data – Implications for the National Cancer Control Program of Pakistan

Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of ‍cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the ‍cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries ‍starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer ‍Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi ‍South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and ‍religion. It also has the distinction of being the only district in the country with representation of all ethnic and socioeconomic ‍groups of the country. The primary recommended strategy for the ‘National Cancer Control Program’ (NCCP), ‍Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb ‍on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by ‍17.8% . WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the ‍form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological ‍agents and solar UV protection would help control of another half of the malignancies. ‍Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of ‍accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient ‍capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the ‍malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout ‍the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of ‍malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for ‍males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher ‍KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidencebased ‍strategies, however ,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable ‍to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, ‍dietary deficiencies and prevalence of oncogenic viruses. ‍Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control ‍Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national ‍cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established ‍today will be realized after 20–30 years. Otherwise the country should be prepared to face epidemic proportions of the ‍disease in the next decade or two. Prerequisite ‘qualification criteria’ or ‘sincerity of intent test’ for NCCP funding by ‍international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria.     

What is the Future for the Asian Pacific Journal of Cancer Prevention (and Control) and the Asian Pacific Organization for Cancer Prevention (and Control)?

The Asian Pacific Organization for Cancer Prevention was launched approximately 10 years ago withpublication of a booklet entitled ‘Introduction to Cancer Prevention in Tables and Figures’. This was followedby regular quarterly publication of the APJCP starting in the year 2000 - a new project for a new millenium -and a number of research meetings held across Asia. The journal is now in its 10th year, indexed on PubMed andScience Citation Index (Expanded) and relatively well known (not least for its yellow cover). However, its futureafter its tenth birthday remains uncertain, as there is no infrastructure in place to ensure continuation afterretirement of the present Chief/Managing Editor. The question of what might be the best way forward is thefocus for the present ‘Editorial Comment’. For financial as well as ecological reasons the APJCP is now anelectronic journal, printing and postage for issues of almost 200 pages being beyond the resources available.While the costs are therefore relatively low and primarily limited to staff salaries, they do need to be coveredand it cannot be simply assumed that the present support provided by the UICC Japanese National Committeewill continue long-term. Therefore comments and suggestions are invited from all interested individuals andinstitutions as to how the APJCP, and by extension the APOCP, should be organized and financed. Allcommunications received will be given space in the next few issues of the APJCP so that discussion can befostered and informed decisions made at the 5th APOCP General Assembly Conference in Istanbul, April 2010.     

Adoptive Cell Therapy for Colon Cancer: the Right Choice?

Despite significant advances in the treatment and prognosis of colorectal cancer (CRC), not all tumors respond to current treatment modalities and patients with advanced disease continue to have a poor prognosis. New treatment strategies are needed to improve long-term survival in colorectal cancer patients with metastatic disease. Adoptive cell therapy is a novel approach that uses one’s own immune cells to target tumor cells directly. For the last two decades, a wide variety of methods have been described. T-lymphocyte-based immunotherapy may be a promising alternative treatment capable of mediating durable regressions in patients with advanced colorectal cancer.     

Setting the stage for Cancer Advocacy in Africa: how?

Background

Oftentimes, cancer advocates in Africa look at the developed nations in North America and Europe for guidance on cancer advocacy. However, lessons learnt from developed nations do not necessarily apply to the situational context of Africa. Without a doubt, successful cancer advocates in Africa can best serve as learning sources and role models for advocacy in Africa. This paper describes the results of an environmental scan of advocacy organizations in Africa.

Methods

A cross-sectional study design was employed for this project. Using a structured survey data collection form, participants submitted their responses either by online submission (Google docs) or by electronic mail to admin@aortic-africa.org.

Results

A total of 39 African advocates representing 17 countries participated in the project. The majority of participants have been advocates for more than five years; and mostly advocate for both males and females and individuals between the ages of 30 and 39. The most common cancers focused on by the advocacy organizations include breast, prostate, liver, cervix, stomach, bladder, pediatric, colorectal and neck. The information provided by participants offer clear guidelines on establishing and maintaining an advocacy program in Africa despite the various challenges faced by these organizations.

Conclusion

Whilst this paper only highlights a subset of advocacy initiatives on the Continent, there is an opportunity for a more inclusive dialogue for advocates to share ideas with each other, connect with other advocates, learn about other innovative advocacy programs, and join the global war against cancer. To this end, the biennial International Workshop on Cancer Advocacy for African Countries ( CAAC ) during the next AORTIC International Cancer conference, offers an opportunity to further Africa’s cancer advocacy initiatives.

     

A Case Control Study on Risk Factors for Stomach Cancer in Urban Shanghai

Objective To examine the possible risk factors for stomach cancer among men and women in Shanghai, China. Methods In urban Shanghai, in-person interviews were completed for 311 cases newly diagnosed with stomach cancer of ages 30 -74. Data were collected from April 1999 to October 1999 and compared to 1579 population-based controls (controls in three cancer studies used together). Information on demographic variables, smoking, diet consumption and others was collected from all subjects. Unconditional logistic regression was used to adjust the possible factors. Results Stomach cancer risk in men rose with smoking, eating hot and fried foods, chronic gastritis and a family history of gastric cancer among men; the risk among women was associated with the consumption of preserved, pickled and fried foods, heavy drinking, chronic gastritis, a history of ulcer disease and a family history of gastric cancer. A dose-response relationship was found (trends test,P<0.01) among men smokers. In contrast, the consumption of fresh vegetables and fruits, beans (especially soybeans) and soy products, plant oil, and eggs and egg products, was inversely associated with stomach cancer risk. After adjustment of the potential confounding variables, these associations remained significant. Conclusions The present findings provide further evidence that smoking, eating salted foods (especially salted vegetables), oil-fried foods(including fried cereal, eggs, and peanuts), chronic gastritis, a family history of gastric cancer and so on increase the risk of stomach carcinoma in Shanghai. Fresh vegetables and fruits, beans and soybean products (even after adjusted for use of fresh vegetables and fruits), plant oil, and so on may have protective effects.     

Assessment of Awareness Level on Tobacco and Smoking Habits as Risk Factors for Cancer among Lung and Laryngeal Cancer Patients in Kolkata -A Case Control Study

The burden of tobacco related cancers is increasing alarmingly throughout the world; therefore tobacco control merits ‍the highest priority in the fight against cancer worldwide. The present report concerns a case control study of males with ‍cancers of lung and larynx, to assess tobacco use, level of exposure and the awareness of risk of tobacco as a main cause of ‍cancer. A total of 217 new patients with cancer of lung and larynx registered at Chittaranjan National Cancer Institute ‍were recruited for the study, along with 200 healthy male (age, religion and residential status matched ) visiting controls. ‍Information on socio-demographic parameters, details of the disease, tobacco use, and awareness about effects of tobacco ‍were obtained through a standardized questionnaire. Smokers were at a higher risk of disease than nonsmokers, with a ‍direct correlation between duration and number of smoking, monthly income, family size and education level. Adjusted ‍ORs observed for smokers for duration more than 40years of smoking and smoking more than 40beedi/ cigarettes per day ‍were 4.3 and 3.9, respectively. Awareness level towards tobacco chewing, active and passive smoking revealed poor ‍response among the subjects. Thus improved health education for antismoking and awareness generation of tobacco hazards ‍should be strongly recommended as a preventive measure.     

Does Awareness on Tobacco Control Legislations Pertaining to Tobacco Sellers Lead to Compliance? – A Study from Chennai,India

Background: Tobacco Sellers (TS) are key stake holders in tobacco control and their compliance with the legislation is crucial to achieve the intended outcome. The current study was conducted to assess the awareness of the Cigarette and Other Tobacco Products Act (COTPA) among TS and their response. Methodology: TS (N=527) were randomly chosen from ten zones of Chennai city. A structured self-administered questionnaire was used to assess awareness and compliance regarding sections 4, 5 and 6. Results: Awareness of COTPA sections-4, 5, 6a, 6b among the TS was 42.0%, 31.0%, 69.3% and 57.2%, respectively, and 65.4% were of the opinion that the tobacco menace can be controlled through legislation. One fourth of the sellers reported that they were contemplating stopping selling tobacco and 13.4% had been requested by various people to stop doing so. The overall profit from tobacco sales was less than 10% for 58.1% of the sellers. There was no change in the sale trends of tobacco products and the smoking form of tobacco was reported to be highly sold (56.2%). Only 54.6% had displayed signboards mentioning the prohibition of smoking in public places as directed under section 4, and 90% of the sellers continued to supply accessories to smoker. In contravention of section-5, 85.6% continued to advertise tobacco in some form and total non-compliance with section-6a and 6b was observed. Conclusion: Awareness on tobacco control legislations among TS was found to be moderate. Furthermore, compliance with the COTPA was minimal.     

Preoperative Radio(Chemo)Therapy in Breast Cancer: Time to Switch the Perspective?

Aim: Radiation therapy represents, together with surgery and systemic treatment, the triad on which the current management of patients with breast cancer is based, achieving high control and survival rates. In recent years we have witnessed a (r)evolution in the conception of breast cancer treatment. The classic scheme of surgery followed by systemic treatment and radiotherapy is being subverted and it is becoming more and more frequent to propose the primary administration of systemic treatment before surgery, seeking to maximize its effect and favoring not only the performance of more conservative surgeries but also, in selected cases, increasing the rates of disease-free survival and overall survival. Radiotherapy is also evolving toward a change in perspective: considering preoperative primary administration of radiotherapy may be useful in selected groups. Advances in radiobiological knowledge, together with technological improvements that are constantly being incorporated into clinical practice, support the administration of increasingly reliable, precise, and effective radiotherapy, as well as its safe combination with antitumor drugs or immunotherapy in the primary preoperative context. In this paper, we present a narrative review of the usefulness of preoperative radiotherapy for breast cancer patients and the possibilities for its combination with other therapies.     

Where Do We Stand on the Integration of PARP Inhibitors for the Treatment of Breast Cancer?

Purpose of Review

To provide an overview of the clinical development of poly(ADP-ribose) polymerase inhibitors (PARPi) in breast cancer to date and to review existing challenges and future research directions.

Recent Findings

We summarize the clinical development of PARPi in breast cancer from bench to bedside, and discuss the results of recent phase 3 trials in patients with metastatic breast cancer (MBC) and germline mutations in BRCA1/2 (gBRCAm). We will also provide an update regarding mechanisms of action and resistance to PARPi, and review clinical trials of PARPi as monotherapy or in combination regimens.

Summary

PARPi are a novel treatment approach in persons with gBRCA1/2m-associated MBC. Going forward, the clinical applicability of these compounds outside the gBRCAm setting will be studied in greater detail. The identification of accurate predictive biomarkers of response is a research priority.