False positives may provide clue to future breast cancer risk

A large new study out today finds women who had a false positive mammogram had an increased risk for developing breast cancer years later. The risk was independent of breast density and remained elevated for a decade after the false-positive test. The study appears in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

CH1231_smallSome other studies had previously shown false positives were associated with a higher risk of cancer, but not consistently. So this study’s size, with over 1.3 million women who underwent more than 2 million exams, makes it notable. It confirms that certain irregular findings in mammograms that are found not to be cancer appear to be associated with an increased risk of being diagnosed with breast cancer later.

But the most important number to keep in mind may be what this increased means in real life. While having a false alarm was associated with a relative increase of 40% (for those who underwent additional imaging) to 75% (for those who underwent a biopsy), the absolute risk over a 5 or 10 year period was not large. After five years, about 2% of women who had a false positive were diagnosed with cancer, compared to about 1% of women who had negative mammograms.

Still, there is some increased risk over the short term, and for up to 10 years of follow-up. Here’s what Robert A. Smith, PhD, vice president of cancer screening at the American Cancer Society, said about that study:

Robert A. Smith, PhD VP, Cancer Screening

Robert A. Smith, PhD
VP, Cancer Screening

“The most important takeaway from this and other studies of false positives and subsequent risk of breast cancer is that this information adds to the ability to estimate risk, and may help women and their doctors make decisions about screening moving forward. A prior false positive finding should be included in the factors considered as a woman decides on the frequency and types of screening she has as she ages.”

Recently updated recommendations from the American Cancer Society say starting at age 40, a woman should discuss with her doctor when to start screening, as long as she starts by age 45. The guideline points out that while the risk of breast cancer is lower in women between the ages of 40 to 44, some women will choose to accept the greater chance of a false positive as a reasonable trade-off for the benefits of screening.

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WHO Review Links Red and Processed Meats to Cancer

The International Agency for Research on Cancer (IARC), a part of the World Health Organization, has classified processed meat as a cancer causing agent (carcinogen), and red meat as a probable carcinogen. This conclusion was based on evaluation of the world’s scientific research on the carcinogenic role of red and processed meat consumption by an expert panel of scientists convened as part of IARC’s Monograph Program which seeks to identify the causes of human cancer. Of note, Marjorie McCullough, ScD, RD, American Cancer Society Strategic Director of Nutritional Epidemiology, attended the IARC evaluation as an observer.

Below is a comment from Susan Gapstur, MPH, PhD, Vice President of Epidemiology  on the news:

“The conclusion that processed meat (e.g., hot dogs, bacon, sausage, deli meats, etc.) causes cancer and that red meat (e.g., beef, pork, lamb) is a probable cause of cancer may come as a surprise to a public that for years has relied heavily on red and processed meats as a part of its diet.

“The conclusions for both red and processed meats are based primarily on evidence showing an increased risk of colorectal cancer, the third most commonly diagnosed cancer among men and among women in the U.S. For red meat, there was also evidence of increased risk of pancreatic and prostate cancer.

“In general, the IARC conclusion is consistent with the World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Continuous Update Project which found the evidence ‘convincing’ that diets high in red meat  and processed meat are associated with increased risk of colorectal cancer.

“In fact, classifying processed meat as carcinogenic and red meat as probably carcinogenic to humans is not unexpected. Indeed, based on earlier scientific studies, including findings from the American Cancer Society’s Cancer Prevention Study II, the American Cancer Society has recommended limiting consumption of red and processed meat specifically since 2002. Our most recent Guidelines on Nutrition and Physical Activity for Cancer Prevention, which were published in 2012 (CA Cancer J Clin 2012;62:30-67), emphasize the importance of choosing fish, poultry, or beans as alternatives to processed and red meat, and for those who choose to eat red meat, selecting lean cuts and eating smaller portions is important.

“The American Cancer Society Guidelines on Nutrition and Physical Activity also recommend preparing meat, poultry and fish by baking, broiling or poaching, rather than frying or charbroiling to reduce the formation of carcinogens during the cooking process.

“The IARC conclusion also provides support for the United States 2015 Dietary Guidelines for Americans Advisory Committee’s recommendation to consume a healthful dietary pattern that is ‘lower in red and processed meat.’ 

This is an important step in helping individuals make healthier dietary choices to reduce their risk of colorectal cancer in particular.”

Posted in Behavior, Colorectal, Lifestyle, Nutrition | 5 Comments

Study: Reducing Nicotine Leads to Less Smoking

A new study appearing in the New England Journal of Medicine finds lowering nicotine levels in cigarettes led smokers to smoke fewer cigarettes. The study was short, just six weeks,  so the authors say it should be viewed as preliminary. But they do say it does support the approach of lowering nicotine levels to help smokers quit.

We asked Cliff Douglas, vice president of tobacco control, about the study, and he shared these thoughts.

“This is a quality study from well-respected researchers, who address the significant research question of how reductions in nicotine in cigarettes could affect addiction and tobacco use.

Cliff Douglas, VP Tobacco Control

Cliff Douglas, VP Tobacco Control

“The study adds to earlier findings that reductions of nicotine in cigarettes could reduce the number of cigarettes smoked and nicotine dependence.

“The tobacco industry has itself recognized for decades that, as a leading Phillip Morris scientist stated in 1972, ‘Without nicotine… there would be no smoking.’ Tobacco manufacturers recognized that the elimination of tobacco addiction would fundamentally undercut their business and transform the tobacco epidemic.

“The study lends support for additional scientific review of the effects of reducing nicotine in tobacco products on nicotine addiction, tobacco product use, and tobacco-related diseases and death. It underscores the need to take a comprehensive approach to nicotine addiction, including all kinds of tobacco products given the market variety and potential for compensatory behaviors, to reduce widespread addiction to lethal tobacco products, ensure the protection of consumers, and avoid unintended public health consequences.”

If you’re a smoker trying to quit, see this new article by senior news editor Stacy Simon:  How to Quit Smoking.

 

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President Carter, a New Drug, and the Long Road of Research

During his press conference today, President Carter showed us all what dignity and grace looks like, dressed in blue jeans and a blazer.

President Carter addresses the news media Thursday morning (Photo: Erik S. Lesser, European Pressphoto Agency)

Mr. Carter laid out what is known about his cancer, his plans moving forward, and most remarkably shared his own personal approach, saying, “I’m perfectly at ease with whatever comes.”

During the press conference, he noted that he had taken a new drug that harnesses the power of the immune system to fight melanoma. That fact led Len Lichtenfeld, M.D., deputy chief medical officer and resident blogger, to make an important observation about cancer research.

“One remarkable aspect of this is the fact that President Carter is benefiting, quite directly, from investments the United States government made to cancer research during his administration.

“A strong research infrastructure is now coming to fruition to tackle the immune system to treat melanoma and a number of other cancers. It started decades ago, and I remember clearly the promise I felt as a young physician doing research in immunotherapy.

“Without that investment decades ago, we would not be where we are now, being able to understand and harness our own immune systems to treat cancer. That understanding in turn led to drugs whose benefits were first reported only in the last five years or so.

“In fact, the  drug the President is receiving, Pembrolizumab, has just been approved by the FDA, and has offered new hope for patients with melanoma. Until 2010, we were still using some of the same drugs we were using in the early 1970’s. No truly effective new treatments were available, and too many people suffered as a result.

“Our research efforts have taken time, but have made this progress possible—and the journey started in the early 1970’s. It’s remarkable and gratifying that President Carter would be able to benefit all these years later from research conducted during his administration. That’s what ‘investing in research’ is all about.”

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President Carter Announces He Has Cancer

Former U.S. President Jimmy Carter has released a brief statement saying he has been diagnosed with cancer that has spread to other parts of his body.

AP Photo/Elise Amendola

AP Photo/Elise Amendola

“Recent liver surgery revealed that I have cancer that now is in other parts of my body. I will be rearranging my schedule as necessary so I can undergo treatment by physicians at Emory Healthcare. A more complete public statement will be made when facts are known, possibly next week.”

Deputy Chief Medical Officer J. Leonard Lichtenfeld, M.D., had the following comments in response to the news.

Len Lichtenfeld, M.D.

Len Lichtenfeld, M.D.

“Currently, the American Cancer Society has limited information about President Carter’s cancer diagnosis. It is the decision of former President Carter and his family as to how much information they wish to share. We should not speculate on a diagnosis or treatment until we learn more details.

“It is not firm at this time whether the cancer started in the liver or spread from another part of the body. The likelihood is that this is a cancer from outside the liver, but we don’t know for certain.

“In similar situations a patient undergoes a series of tests to uncover the cancer’s origin, and sometimes that still doesn’t indicate where it came from. Doctors can also perform genetic analysis, which may help the care team make further treatment decisions.

“The President has a family history of pancreatic cancer. We cannot say whether that history has any bearing on his current circumstances.  Going forward, the President and his family will weigh their medical decisions on what treatments to pursue.

“Our thoughts and prayers are with them as they begin their journey that has been shared with so many others facing cancer.”

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Free time spent sitting linked to higher risk of some cancers in women

For several years now, research, including groundbreaking work done at the American Cancer Society, has sounded the alarm about cancer risk associated with time spent sitting. Now a new study co-authored by Alpa Patel, PhD, who also led earlier work on the link, digs deeper to find spending more leisure time sitting is associated not only with a higher risk of total cancer risk in women, but also with several cancers in particular: multiple myeloma, breast, and ovarian cancer.

Alpa Patel, PhDThe study, appearing in Cancer Epidemiology, Biomarkers, and Prevention, is the first to take a comprehensive look at site-specific cancers associated with sitting time. The higher risk was present even after taking into account BMI, physical activity, and other factors.

And for reasons that are as yet unclear, the study found no such association for men.

boy5The link between physical activity and cancer prevention is well-established. But emerging evidence has focused specifically on the link between time spent sitting and cancer. That includes time spent sitting at work, and also leisure time. In both cases, time spent sitting has increased due to several factors, including technological advancements, like computers and video games, and changes in transportation; we walk/bike less, and drive/ride more.

For the current study, investigators compared leisure time sitting to cancer risk among more than 146,000 men and women (69,260 men and 77,462 women) who were cancer-free and enrolled in the American Cancer Society Cancer Prevention Study II Nutrition Cohort. During the time of the study, (1992 – 2009), 18,555 men and 12,236 women were diagnosed with cancer.

The investigators found more leisure-time spent sitting was associated with a 10 percent higher risk of cancer overall in women after adjustment for physical activity, BMI and other factors..

In women, sitting time was associated with a 65 percent increased risk of multiple myeloma, a ten percent increase in risk of invasive breast cancer, and a 43 percent increase in risk of ovarian cancer. In men, just as with cancer overall, there was no association between overall or site-specific cancers and sitting time.

American Cancer Society guidelines for cancer prevention recommend reducing sitting time when possible. The authors say given the high rate of time spent sitting in the U.S., even a modest positive association with cancer can have broad public health implications.

“Our bodies were built to move, but our lifestyles today sometimes make that difficult to do,” said Dr. Patel. “Making simple changes like folding laundry while watching TV, or parking farther away from the entrance to a store can cut down on time you are sitting. Ultimately, these little changes can have a big impact on your health.”

Dr. Patel adds that further research is warranted to better understand the differences in associations between men and women, and that work could shed light on the reasons for link.

Article: Leisure-time spent sitting and site-specific cancer incidence in a large US cohort; Cancer Epidemiol Biomarkers Prev. [Epub ahead of print] Published Online First June 30, 2015; doi: 10.1158/1055-9965.EPI-15-0237

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Colon Cancer Hotspots: More Similar to Romania and Russia than to Rest of the U.S.

The large drop in colorectal cancer death rates in the United States is one of the real success stories in cancer. But while the risk of death from colorectal cancer is at a historical low for most Americans, progress has lagged among residents of the Lower Mississippi Delta and other rural areas; areas identified by American Cancer Society researchers as ‘hotspots’ that warrant intervention.

For their study, Rebecca Siegel, MPH and colleagues looked at colorectal cancer death rates from 1970 through 2011 for all counties in the United States using data from the National Center for Health Statistics.

They found the age-standardized colorectal cancer death rate decreased from 29.2 per 100,000 Americans in 1970 to 15.1 per 100,000 in 2011. Before 1990, colorectal cancer death rates were highest in the northeast and mid-central United States and lowest in the South. However, by the 2000s, rates were generally homogeneous across the country with the exception of three distinct spatial clusters, or hotspots.pullquote

These hotspots were located in the Lower Mississippi Delta, west central Appalachia, and eastern North Carolina/Virginia. They comprised 238 counties in 12 states. “The patterns in colorectal cancer death rates in these high-risk areas are more similar to those in economically transitioning countries with limited health care resources, such as Romania, Russia, and Mexico, than to those in the United States,” the researchers write.

3spot_smooth

Spatial mapping identified three distinct hotspots in the United States where colorectal cancer death rates were elevated.

The authors point to several factors likely to be playing a role in fueling these hotspots: lower rates of screening, which has played a major role in reducing colorectal cancer mortality; economically disadvantaged areas are known to have higher colorectal cancer death rates due to both higher incidence rates and poorer disease outcomes; higher rates of obesity; an unhealthy diet high in soft drinks, red meat, and salty snacks; and lack of physical activity, which protects against colorectal cancer.

In concluding, the researchers point to the state of Delaware, which “effectively eliminated colorectal cancer disparities in less than a decade by implementing comprehensive statewide colorectal cancer screening. The rapid introduction of coordinated, targeted, community-based screening programs in these high-risk areas could be similarly successful.”

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