Radon and Hematologic Cancer in Women

A new report from American Cancer Society researchers finds a statistically-significant, positive association between high levels of residential radon and the risk of hematologic cancer (lymphoma, myeloma, and leukemia) in women. The study is the first prospective, population-based study of residential radon exposure and hematologic cancer risk, leading the authors to caution that it requires replication to better understand the association and whether it truly differs by sex. It appears early online in Environmental Research.

Radon is a naturally occurring byproduct of the decay of radium, and is a known human lung carcinogen, the second-leading cause of lung cancer in the United States. Modeling studies show that radon delivers a non-negligible dose of alpha radiation to the bone marrow and therefore could be related to risk of hematologic cancers. Studies to date, however, have produced inconsistent results.

More than 171,000 new cases of hematologic cancer and more than 58,000 deaths are expected in the United States in 2016. Hematologic cancers are the most expensive cancers to treat per quality-adjusted life year gained.

Lauren R. Teras, PhD

Lauren R. Teras, PhD

For the current study, researchers led by Lauren Teras, Ph.D. of the American Cancer Society used data from the American Cancer Society Cancer Prevention Study-II Nutrition Cohort established in 1992, to examine the association between county-level residential radon exposure and risk of hematologic cancer. The analysis included 140,652 participants among whom there were 3,019 hematologic cancers during 19 years of follow-up.

They found women living in counties with the highest mean radon concentration had a statistically significant 63% higher risk of hematologic cancer compared to those living in counties with the lowest radon levels. They also found evidence of a dose-response relationship. There was no such association among men.

Radon levels by U.S.county

Radon levels by U.S. county

The authors say men may have a higher baseline risk, possibly because of more exposure to occupational or other risk factors for hematologic cancer, reducing the impact of any additional risk from residential radon. In women, who have a smaller baseline risk, residential radon exposure might be a larger contributor to overall risk. Another reason may be that the women of this generation spent more time in their homes, so had more residential exposure than men.

“The overall lifetime risk of hematological cancers in the United States is about 2%, so even a 60% relative increase would still mean a relatively small absolute risk,” said Dr. Teras. “Nonetheless, radon is already associated with lung cancer, and if other studies confirm the link to blood cancers, we think it would warrant strengthened public health efforts to mitigate residential radon risks.”

For more information, see: Radon on http://www.cancer.org

Article: Residential radon exposure and risk of incident hematologic malignancies in the Cancer Prevention Study-II Nutrition Cohort, Environmental Research, July 2016 doi:10.1016/j.envres.2016.03.002

 

 

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A lung cancer vaccine from Cuba

For the past several months, reports have popped up on an experimental treatment being used in Cuba to treat lung cancer. Most recently, HealthNewsReview took on a Phoenix-area news outlet and a cancer clinic for touting the drug before it has undergone careful clinical study.

Dr Len

Len Lichtenfeld, M.D.

We asked Len Lichtenfeld, M.D., deputy chief medical officer for his thoughts on the drug, and the news coverage it has generated, and he had some important words of caution.

“The Cuban anti-cancer vaccine has been under development and investigation for over 20 years. There have been reports published suggesting that it may help patients with advanced lung cancer. A major cancer center in the United States (Roswell Park Cancer Institute) has indicated it is prepared to conduct clinical trials of the vaccine.

“This vaccine is intended to react with a protein in the blood called ‘epithelial growth factor’ or EGF. This protein helps some types of cancers grow. The theory behind the vaccine is that by blocking the protein with the vaccine the cancer cells will not be able to function.

“Currently we do not have the information we need to have to know whether or not this vaccine could be useful in treating lung cancer or possibly be used to prevent cancer in patients at high risk of developing lung cancer. The studies that have been reported from Cuba are small, and have limitations that prevent us from knowing how the treatment could be applied to the typical patient with lung cancer. And, unfortunately, the history of vaccines in treating cancer has shown many, many more failures than successes. That makes the need to undertake well-designed clinical trials all the more important.

“In the meantime, there are new targeted therapies and other immunotherapy drugs that have proven successful in treating lung cancer, the most common cause of cancer deaths in the United States. Whether this particular vaccine will be helpful is something that we do not know now and will take several years to determine.”

 

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Exciting results in immunotherapy: What do we know?

A story on BBC News  this morning quotes researchers who say a therapy using the body’s own immune system led to more than 90% of terminally ill patients they treated going into remission. The report is based on comments made Sunday at a symposium at the American Association for the Advancement of Science (AAAS) meeting in Washington D.C. The story was then picked up by CNBC, which called the results “spectacular.”

The work involves chimeric antigen receptor (CAR-T) T-cell therapy, a very promising area of research, but one that’s still very much in its infancy. We asked Chief Medical Officer Otis W. Brawley, M.D. for some perspective.

“CAR-T is known to be an exciting lead in the treatment of a number of cancers. The media reports of successful treatment using CAR-T are certainly exciting, however there’s still much we don’t know.

“The news appears to be based on comments made during a presentation discussing advances in immunotherapy. As best we know, the data have not been published or independently reviewed.

Otis Brawley

Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society

“The most we can say based on the reported comments is that this treatment sounds promising but further investigation is needed. Long term data on a larger number of patients will determine the ultimate success and risks of this approach.

“While we support this work and believe strongly that immunotherapy is promising, it is important to use caution in raising the hopes of patients based on early data that may or may not come to fruition.”

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HPV vaccination: A public health priority

Today, National Cancer Institute-designated Cancer Centers across the country issued a consensus statement urging action to increase vaccination against human papillomavirus (HPV).

The American Cancer Society’s Debbie Saslow, Ph.D., director of cancer control intervention, HPV & women’s cancers, says the time is now to increase HPV vaccination in the United States.

“We have a cancer prevention vaccine. HPV vaccines have been available for 10 years. They are safe and they work. Yet in this country only about half of girls and boys who are vaccinated with the other vaccines recommended for preteens are getting vaccinated to protect them from cancer. The reasons are complicated, but one thing is for sure: this is a national public health priority.

“The American Cancer Society strongly supports today’s call to action from National Cancer Institute-designated Cancer Centers across the country.

“HPV vaccination is underutilized despite the overwhelming evidence for its safety and effectiveness. Vaccination will prevent most cervical, vaginal, vulvar, and anal cancers and are expected to prevent most penile and oropharyngeal (throat and tongue) cancers that are diagnosed in 27,000 men and women every year. Vaccines are among the few medical interventions capable of achieving almost complete eradication of a disease. It is not often that we have an opportunity to prevent cancer, or in this case multiple cancers, with a single tool. Concerted efforts are needed so that this opportunity is not lost.

“The American Cancer Society is proud to lead the National HPV Vaccination Roundtable, a national coalition of organizations working together to prevent HPV-associated cancers and pre-cancers by increasing and sustaining U.S. HPV vaccination. The NCI-designated Cancer Centers are one of over 75 member organizations. In addition the Society is working to increase HPV vaccination rates for adolescents across the nation through improved provider awareness and education and improved system-wide processes. Our Vaccinate Adolescents against Cancer (VACs) program works through Society hundreds of health systems staff nationwide who partner with community health centers and state-based institutions and coalitions.”

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The President’s Cancer Moonshot: An Opportunity to Save Lives

Otis Brawley, M.D., chief medical officer for the American Cancer Society, today responded to the President’s call for a national effort to fight cancer.

Photo by Saul Loeb, AFP/Getty Images

Photo by Saul Loeb, AFP/Getty Images

“The President’s commitment to a moonshot against cancer led by Vice President Biden is a galvanizing call for a renewed effort to find new tools to fight cancer. It is imperative that we continue to fund the brightest minds to explore the nature and biology of our nation’s number two killer. Done right, we can build on our past investment, and spur even more progress against the disease.

“Medical science has already made huge leaps in our understanding of the inner workings of the cancer cell, and there is much left to learn. But just as important as continuing to explore new science is a concerted

Otis Brawley

Otis W. Brawley, MD, Chief Medical Officer, American Cancer Society

effort to gather what we already know about cancer and find ways to apply these tools more effectively to save lives. If we applied what we already know about cancer prevention, early detection, and treatment, we could prevent a substantial proportion of the nearly 600,000 cancer deaths in the U.S. each year. These remarkable tools mean nothing if they sit unused, unavailable to those in need because of gaps in care caused by poverty and other factors.

“Cancer will not be cured this year. But we should do all we can to ensure 2016 is remembered as the year we came together in an effort to work smartly, and with all the resources we needed, to harness the power in our hands to reduce the devastating impact of cancer.”

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Four Society Researchers Make Annual List of Highly Cited Researchers

Four American Cancer Society scientists have been included on Thomson Reuters’ list of 2015 Highly Cited Researchers. The annual list recognizes leading researchers in the sciences and social sciences from around the world.The American Cancer Society researchers honored are:

Ahmedin Jemal, PhD, vice president, surveillance and health sciences research

Robert A. Smith, PhD, vice president, cancer screening prevention and early detection

Michael J. Thun, MD, retired, vice president emeritus of the American Cancer Society Surveillance and Epidemiology Research program​

Elizabeth Ward, PhD, senior vice president, intramural research​

About 3,000 researchers earned the distinction in 2015 by authoring reports officially designated by Essential Science Indicators as Highly Cited Papers — ranking among the top 1% most cited for their subject field and year of publication, earning them the mark of exceptional impact.

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Groundbreaking Trial Reports Positive Results on Screening for Ovarian Cancer

An eagerly anticipated clinical trial shows lifesaving potential for a method to screen for ovarian cancer using annual CA-125 tests and ultrasound. The algorithm used in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS), whose results are published in The Lancet, reduced the risk of death from ovarian cancer an estimated 20 percent.

Ovarian cancer accounts for 1 in 20 cancer deaths in U.S. women, and causes more deaths than any other gynecological malignancy. Although survival is good when ovarian cancer is detected early, most ovarian cancers are diagnosed at an advanced stage when prognosis is poor.

The conventional approach to detect ovarian cancer early has focused on testing with a serum cancer antigen 125 (CA-125) and transvaginal ultrasound, but results to date have been disappointing. No organization recommends ovarian cancer screening.

Now, promising new results from the new trial have renewed hope for a modified approach.

Dr. Ian Jacobs and colleagues studied approximately 200,000 women over more than a decade to determine whether multi-modal screening (MMS) with a “risk of ovarian cancer algorithm” (ROCA), a quantitative algorithm based on age, risk status and CA-125 levels over time, was effective in reducing ovarian cancer mortality compared with ultrasound alone or usual care.

After a median follow-up of 11 years, the authors observed a nonsignificant 15% fewer deaths in the MMS group, but when the cases diagnosed in the first screening round were taken out of the analysis, a statistically significant 20% reduction in ovarian cancer mortality was observed. Why the adjustment? They say many of the deaths from ovarian cancer in the study group were because the cancer was already advanced at the time of the first screening exam.

The authors caution that more study is needed to better understand the efficacy and cost effectiveness of ovarian cancer screening.

We asked Robert Smith, Ph.D., vice president of cancer screening, for his thoughts on this eagerly anticipated study.

“There has been great interest in screening for ovarian cancer for as long as I’ve been involved in cancer, but until now there has been no evidence that the conventional approach of using a fixed cutoff CA-125 level combined with ultrasound was an effective approach.

Rsmith2010jpg

Robert A. Smith, PhD VP, Cancer Screening

“The findings are incredibly encouraging. We have known for some time that the ROCA appeared to have better performance, but until now, we did not have data that it was effective in reducing ovarian cancer deaths.

“But it’s important to note that this approach to testing also was associated with a high rate of invasive procedures and complications associated with false positive findings.

“The investigators are appropriately cautious, and agree that these findings are not sufficient to begin recommending that postmenopausal women start screening.

“However, the findings do mean that there is renewed urgency to answer unanswered questions to determine if and when screening for ovarian cancer might be recommended.

“As part of its ongoing guidelines development process, the American Cancer Society will review this new evidence and closely monitor on-going evaluation of the UKCTOCS data.”

You can read more about ovarian cancer, including statistics, risk factors, treatment and more here.

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