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.


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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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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