CA recent issues

[NEWS & VIEWS] ORAL CONTRACEPTIVES AND OVARIAN CANCER RISK

2008-05-06

[NEWS & VIEWS] COPAYS DETER WOMEN FROM GETTING MAMMOGRAMS

2008-05-06

[ARTICLES] Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology

2008-05-06

In the United States, colorectal cancer (CRC) is the third most common cancer diagnosed among men and women and the second leading cause of death from cancer. CRC largely can be prevented by the detection and removal of adenomatous polyps, and survival is significantly better when CRC is diagnosed while still localized. In 2006 to 2007, the American Cancer Society, the US Multi Society Task Force on Colorectal Cancer, and the American College of Radiology came together to develop consensus guidelines for the detection of adenomatous polyps and CRC in asymptomatic average-risk adults. In this update of each organization's guidelines, screening tests are grouped into those that primarily detect cancer early and those that can detect cancer early and also can detect adenomatous polyps, thus providing a greater potential for prevention through polypectomy. When possible, clinicians should make patients aware of the full range of screening options, but at a minimum they should be prepared to offer patients a choice between a screening test that is effective at both early cancer detection and cancer prevention through the detection and removal of polyps and a screening test that primarily is effective at early cancer detection. It is the strong opinion of these 3 organizations that colon cancer prevention should be the primary goal of screening.

[ERRATA]

2008-05-06

[ARTICLES] Cancer Screening in the United States, 2008: A Review of Current American Cancer Society Guidelines and Cancer Screening Issues

Smith, R. A., Cokkinides, V., Brawley, O. W. — 2008-05-06

Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer screening rates and trends in US adults. In 2007, the ACS updated its colorectal cancer screening guidelines in a collaborative effort with the US Multi-Society Task Force and the American College of Radiology. In this issue of the journal, we summarize the current ACS guidelines, provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and address some issues related to access to care.

[ARTICLES] The Staging of Cancer: A Retrospective and Prospective Appraisal

Greene, F. L., Sobin, L. H. — 2008-05-06

The tumor-node-metastasis (TNM) classification describes the anatomic extent of cancer. The ability to separately classify the individual T, N, and M elements and then group them into stages differs from other cancer staging classifications, which are primarily concerned with summarized groups. The objectives of the TNM system are to aid clinicians and investigators in planning treatment, assessing prognosis, stratifying patients for therapeutic studies, evaluating the results of treatment, and facilitating communication. The most important challenge facing TNM is how to interface the current taxonomy with the numerous nonanatomic prognostic factors currently in use or under study. As nonanatomic prognostic factors become widely used, TNM will remain a solid foundation on which to build prognostic classifications. There is, however, a risk that this system will be corrupted by a variety of irrelevant prognostic data. An anatomic extent of disease classification is needed to provide a standard against which to measure the importance of nonanatomic factors. Methods are needed to express overall prognosis without losing the vital anatomic content of TNM. These methods should be able to integrate multiple prognostic factors, including TNM, yet permit TNM to remain intact and distinct.

[NEWS & VIEWS] INSTITUTE OF MEDICINE'S 10-POINT PLAN FOR MORE COMPREHENSIVE CANCER CARE

2008-03-05

[NEWS & VIEWS] PROSTATE CANCER PATIENTS PICK TREATMENTS THAT MAY WORSEN QUALITY OF LIFE

2008-03-05

[ARTICLES] Cancer Statistics, 2008

Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J., Murray, T., Thun, M. J. — 2008-03-05

Each year, the American Cancer Society estimates the number of new cancer cases and deaths expected in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival based on incidence data from the National Cancer Institute, Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. Incidence and death rates are age-standardized to the 2000 US standard million population. A total of 1,437,180 new cancer cases and 565,650 deaths from cancer are projected to occur in the United States in 2008. Notable trends in cancer incidence and mortality include stabilization of incidence rates for all cancer sites combined in men from 1995 through 2004 and in women from 1999 through 2004 and a continued decrease in the cancer death rate since 1990 in men and since 1991 in women. Overall cancer death rates in 2004 compared with 1990 in men and 1991 in women decreased by 18.4% and 10.5%, respectively, resulting in the avoidance of over a half million deaths from cancer during this time interval. This report also examines cancer incidence, mortality, and survival by site, sex, race/ethnicity, education, geographic area, and calendar year, as well as the proportionate contribution of selected sites to the overall trends. Although much progress has been made in reducing mortality rates, stabilizing incidence rates, and improving survival, cancer still accounts for more deaths than heart disease in persons under age 85 years. Further progress can be accelerated by supporting new discoveries and by applying existing cancer control knowledge across all segments of the population.

[ARTICLES] Application of Nanotechnology in Cancer Therapy and Imaging

Wang, X., Yang, L., Chen, Z., Shin, D. M. — 2008-03-05

Recent developments in nanotechnology have provided researchers with new tools for cancer imaging and treatment. This technology has enabled the development of nanoscale devices that can be conjugated with several functional molecules simultaneously, including tumor-specific ligands, antibodies, anticancer drugs, and imaging probes. Since these nanodevices are 100 to 1,000-fold smaller than cancer cells, they can be easily transferred through leaky blood vessels and interact with targeted tumor-specific proteins both on the surface of and inside cancer cells. Therefore, their application as cancer cell-specific delivery vehicles will be a significant addition to the currently available armory for cancer therapeutics and imaging.

[ARTICLES] Tumor-Node-Metastasis Staging of Pancreatic Adenocarcinoma

Katz, M. H. G., Hwang, R., Fleming, J. B., Evans, D. B. — 2008-03-05

Accurate disease staging of patients with pancreatic cancer is essential to divide patients into prognostic subgroups, to allow delivery of stage-specific therapies, and to facilitate meaningful discussions between physicians and patients regarding management and expected outcomes. The tumor-node-metastasis staging system of the American Joint Commission on Cancer has undergone significant revisions over the past 2 decades. In its current form, the system places an emphasis on preoperative clinical staging and facilitates division of patients with pancreatic cancer into 4 groups based on a determination of local resectability and the presence or absence of distant disease as determined on high-quality cross-sectional imaging. A modern understanding of local tumor factors that influence technical resectability is incorporated into the algorithm. In this review, we examine the American Joint Commission on Cancer staging system, describe the rationale for its use, and demonstrate how it is a clinically relevant tool for the staging and management of patients with pancreatic cancer.

[FROM THE EDITORS] From the Editors

Gansler, T., Brawley, O. W. — 2008-01-02

[FROM THE OUTGOING AND INCOMING EDITORS-IN-CHIEF] From the Outgoing and Incoming Editors-in-Chief

Eyre, H. J., Brawley, O. W. — 2008-01-02

[NEWS & VIEWS] HYPNOSIS MAY LOWER COSTS OF BREAST SURGERY

2008-01-02

[NEWS & VIEWS] SMOKELESS TOBACCO: HARM REDUCTION DEBATABLE

2008-01-02

[EDITORIALS] Editorial

Huerta, E. — 2008-01-02

[ARTICLES] Association of Insurance with Cancer Care Utilization and Outcomes

2008-01-02

Advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14% decrease in the death rates from all cancers combined from 1991 to 2004 in the overall US population, with remarkable declines in mortality for the top 3 causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in women (breast and colorectal cancer). However, not all segments of the population have benefited equally from this progress, and evidence suggests that some of these differences are related to lack of access to health care. Lack of adequate health insurance appears to be a critical barrier to receipt of appropriate health care services. This article provides an overview of systems of health insurance in the United States, demographic and socioeconomic characteristics associated with health insurance coverage, and economic burdens related to health care among individuals and families. This article also presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey and the National Cancer Data Base. Although this article focuses on associations between health insurance and cancer care utilization and outcomes, it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient-level, provider, and health system factors. Evidence presented in this paper suggests that addressing insurance and cost-related barriers to care is a critical component of efforts to ensure that all Americans are able to share in the progress that can be achieved by access to high-quality cancer prevention, early detection, and treatment services.

[ARTICLES] Expanding Role of the Medical Oncologist in the Management of Head and Neck Cancer

Choong, N., Vokes, E. — 2008-01-02

The multidisciplinary approach to treating squamous cell carcinoma of the head and neck is complex and evolving. This article aims to review some recent developments in squamous cell carcinoma of the head and neck, in particular the expanding role of chemotherapy in its management. Surgery and radiotherapy have remained the mainstay of therapy. Chemotherapy is increasingly being incorporated into the treatment of squamous cell carcinoma of the head and neck. Previously, radiotherapy following surgery was the standard approach to the treatment of locoregionally advanced resectable disease. Data from randomized trials have confirmed the benefits of concurrent chemoradiotherapy in the adjuvant setting. Chemoradiotherapy is also the recommended approach for unresectable disease. Induction chemotherapy has been useful in resectable disease where organ preservation is desirable, but this approach was inferior for the goal of larynx preservation, while leading to similar survival when compared with concomitant chemoradiotherapy. There is recent evidence that taxanes added to induction chemotherapy with cisplatin and fluorouracil result in improved survival outcomes. Novel targeted agents, such as epidermal growth factor receptor antagonists, are showing promise in the treatment of patients with both locoregionally advanced and recurrent/metastatic squamous cell carcinoma of the head and neck.

[ARTICLES] Utilizing the Tumor-Node-Metastasis Staging for Prostate Cancer: The Sixth Edition, 2002

Chang, S. S., Amin, M. B. — 2008-01-02

The Sixth Edition of the tumor-node-metastasis staging system for prostate cancer attempts to provide a helpful staging paradigm for clinicians. Accurate staging is critical not only for managing individual patients, but also for ascertaining trends in disease pattern in a large population of patients with prostate cancer. Several modifications have been made in an attempt to improve the cohesiveness and uniformity of patient evaluation and to aid in future meaningful clinical research. As data are accumulated and analysis continues, ongoing critical evaluation of this staging system will undoubtedly incorporate new evidence-based factors and bring about future refinements to prostate cancer staging.

[ARTICLES] Surviving Cancer or Other Serious Illness: A Review of Individual and Community Resources

Coughlin, S. S. — 2008-01-02

In order to provide appropriate individual and community support for cancer survivors, there is a great need to better understand how people who have survived cancer or other serious illness adapt positively to health challenges and to identify effective approaches for helping people cope with health challenges over their lifetime. Studies have identified a number of personal factors that are associated with resilience, increased quality of life, and positive adaptation to illness. Of particular interest is the ability of individuals to survive or even thrive despite an adverse event, as influenced by both individual factors such as resiliency and external factors like social support. The experience of having a potentially life-threatening illness can lead to positive adaptation and increased ability to thrive despite difficult circumstances. The cancer survivorship movement and the cancer community in general provide important resources for improving quality of life and alleviating human suffering and distress among patients and survivors and for adding personal meaning and hope to people's lives.