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This Week in JAMA
JAMA. 1999;281:1565.
CANCER
A JAMA THEME ISSUE
Edited by Charles B. Clayman, MD
Progression of Prostate Cancer After Initial Treatment
Pound and colleagues report that 15 years after surgery, the actuarial metastasis-free survival of a cohort of 1997 men who underwent radical prostactectomy was 82%. Predictors of the time course to the development of metastatic disease included the time to prostate-specific antigen (PSA) level elevation, Gleason score, and PSA level doubling time. Among 1765 men treated with external beam radiation therapy alone, Shipley and coworkers found that the 5-year estimate of freedom from biochemical recurrence (a rising PSA level) was 65.8%. These investigators identified 4 distinct prognostic groupings based on pretreatment PSA level and Gleason score. In an editorial, Scher emphasizes the importance of continuous prognostic reevaluation of men with prostate cancer to guide treatment decisions.
(SEE ARTICLE) and (SEE ARTICLE) and editorial (SEE ARTICLE)
When a Cancer Screening Test Result Is Abnormal
The optimal next step after abnormal cancer screening test results is often uncertain. Findings of the study by Manos and colleagues and the editorial comments of Cox support human papillomavirus DNA testing of specimens obtained at the time of initial cervical cancer screening to identify women with equivocal screening test results who are at risk of having high-grade squamous intraepithelial lesions. Levin and colleagues base recommendations for screening and follow-up sigmoidoscopy and colonoscopy on their findings that villous features in a distal adenoma, age older than 65 years, having more than 1 distal adenoma, and a positive family history of colorectal cancer were significant predictors of advanced proximal colonic neoplasia. Meyer and coworkers suggest that large-core needle biopsy of nonpalpable breast lesions identified on screening mammography is a reliable diagnostic alternative to surgical excision.
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Villous adenoma of the colon showing multiple fingerlike projections covered by crowded epithelial cells with loss of mucin production (hematoxylin-eosin, original magnification x100).
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(SEE ARTICLE) and editorial (SEE ARTICLE) , and (SEE ARTICLE) and (SEE ARTICLE)
Genetic Testing of Persons at Risk of Hereditary Cancer
Of 208 members of 4 extended families with hereditary nonpolyposis colon cancer (HNPCC), only 90 chose to receive results of genetic testing for HNPCC-associated mutations. Lerman and colleagues found that higher educational level and prior participation in a genetic linkage study were associated with higher rates of receiving results of genetic testing, while symptoms of depression were associated with lower rates.
(SEE ARTICLE)
Combination Therapy and Esophageal Cancer Survival
Interim results of the Radiation Therapy Oncology Group trial showed that subjects with esophageal cancer treated with chemotherapy and radiation therapy were surviving significantly longer than subjects treated with radiation therapy alone. Cooper and colleagues report that the 5-year overall survival was 26% in the randomized combined-treatment group; 14% in the nonrandomized combined-treatment group assembled after the interim results; and 0% in the randomized radiation therapy group.
(SEE ARTICLE)
Rising Incidence of Renal Cell Carcinoma
Chow and coworkers report that the incidence of renal cell cancer has increased between 1975 and 1995 but not the incidence of renal pelvis cancer. The increased incidence has been greater among blacks than among whites and 5-year survival, which has improved among white patients, has not improved among black patients.
(SEE ARTICLE)
Breast Cancer Risk and Folate Intake
In this analysis of data from 16 years of follow-up of 88,818 women in the Nurses' Health Study, Zhang and colleagues found that low total folate intake was associated with increased breast cancer risk only among women who consumed 15 g/d or more of alcohol.
(SEE ARTICLE)
A Piece of My Mind
"Already as a small child I was aware that in the handling of money, my mother was more than simply thrifty; she was downright frugal." From "Messages."
(SEE ARTICLE)
Medical News & Perspectives
Reports on the latest discoveries and controversies in cancer detection and treatment.
(SEE ARTICLE)
MSJAMA
Health hazards in the environment and workplace: educational, clinical, and ethical issues.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Screening for cervical cancer with the Pap test.
(SEE ARTICLE)
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