Shave biopsy is a safe and acceptable method for initial evaluation of melanoma, study suggests

ScienceDaily (May 23, 2011) — A shave biopsy is a reasonably safe and accurate method for the initial diagnosis of melanoma, according to a study published in the April issue of the Journal of the American College of Surgeons. In the past, some physicians have criticized shave biopsies for not providing accurate T (tumor) stage information, thereby complicating treatment planning.

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"We conducted this study to determine the impact of shave biopsies on the initial staging of melanoma and their impact on the final treatment planning for patients," explained Jonathan S. Zager, MD, FACS, associate professor at the Moffitt Cancer Center, Tampa, FL, and lead author of the study. "Shave biopsies are commonly used by dermatologists, primary care physicians, and surgeons as a less invasive and more efficient means of biopsying suspicious lesions for diagnosis."

In the largest study to date, researchers at Moffitt Cancer Center and the University of Florida Shands Cancer Center, Gainesville, retrospectively analyzed 600 consecutive patients who underwent a shave biopsy for suspicious skin lesions between 2006 and 2009. They found presumptive pre-shave diagnosis of melanoma was suspected in only 25 percent of these patients. After definitive surgical wide excision was performed, 133 (22 percent) had residual melanoma in the surgical excision specimen. However, the detection of residual melanoma in these patients only resulted in subsequent upstaging in T-stage in a small group of 18 (3 percent) patients, showing that T-stage and depth data obtained through shave biopsy were accurate in 97 percent of all patients.

"The diagnosis of melanoma can be extremely challenging, even for the most experienced health care professional," Dr. Zager said. "Although traditional excisional biopsy remains the gold standard for the diagnosis of suspicious skin lesions, where a rim of normal appearing skin can be excised with the specimen (especially when melanoma is suspected), our results show shave biopsies may be used as a first-line evaluation for skin lesions with minimal impact on T-staging and definitive treatment options."

While there are advantages and disadvantages to consider when comparing excisional, punch, and shave biopsies of skin lesions, the disadvantages of shave biopsies remain largely cosmetic. Because shave biopsies don't require sutures for closure, a depressed, hypopigmented or hyperpigmented scar may sometimes occur. Punch biopsies present physicians with limitations with regard to the size of the biopsy tools available to accommodate an accurate biopsy, as best practices generally recommend excision of some normal appearing skin at the edges of the skin lesion in question.

According to the American Cancer Society, skin cancer accounts for almost half of all cancers in the United States. Melanoma, the most severe form of skin cancer, affected about 68,130 people in 2010 alone.

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Acetaminophen linked to lower prostate cancer risk in new study

ScienceDaily (May 24, 2011) — A new study from American Cancer Society researchers finds use of 30 tablets a month or more of acetaminophen for five or more years was associated with an estimated 38% lower risk of prostate cancer. The study appears in Cancer Epidemiology, Biomarkers and Prevention and is one of only two studies of prostate cancer to date that have examined the association with acetaminophen use that was both long-term and regular.

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Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), particularly long-term use, has been associated with modestly reduced risk of prostate cancer in some previous epidemiologic studies. Acetaminophen, a commonly used pain-reliever, is not traditionally considered an NSAID but can have anti-inflammatory effects.

For the current study, researchers led by Eric Jacobs, Ph.D., American Cancer Society epidemiologist, examined the association between acetaminophen use and prostate cancer incidence among 78,485 men in the Cancer Prevention Study II Nutrition Cohort. Information on acetaminophen use was obtained from a questionnaire completed at study enrollment in 1992 and updated using follow-up questionnaires in 1997 and every two years thereafter.

During follow-up from 1992 through 2007, there were 8,092 incident prostate cancer cases identified. Current regular use of acetaminophen (> 30 pills per month) for 5 years or more was associated with lower risk of overall prostate cancer (RR

Brisk walking may help men with prostate cancer, study finds

ScienceDaily (May 24, 2011) — A study of 1,455 U.S. men diagnosed with early-stage prostate cancer has found a link between brisk walking and lowered risk of prostate cancer progression, according to scientists at the University of California, San Francisco and the Harvard School of Public Health.

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The scientists found that men who walked briskly -- at least three miles per hour -- for at least three hours per week after diagnosis were nearly 60 percent less likely to develop biochemical markers of cancer recurrence or need a second round of treatment for prostate cancer.

"The important point was the intensity of the activity -- the walking had to be brisk for men to experience a benefit," said Erin Richman, ScD, a postdoctoral fellow at UCSF who is the first author on the study, published in the journal Cancer Research. "Our results provide men with prostate cancer something they can do to improve their prognosis."

An earlier study, published earlier this year by UCSF's June Chan, ScD, and collaborators at the Harvard School of Public Health, showed that physical activity after diagnosis could reduce disease-related mortality in a distinct population of men with prostate cancer. The new study complements this finding, as it was the first to focus on the effect of physical activity after diagnosis on early indications of disease progression, such as a rise in prostate-specific antigen (PSA) blood levels.

"Our work suggests that vigorous physical activity or brisk walking can have a benefit at the earlier stages of the disease," said Chan, the Steven and Christine Burd-Safeway Distinguished Professor at UCSF and senior author of both studies.

Common Form Of Cancer Among Men

After skin cancer, prostate cancer is the most commonly diagnosed type of cancer among men in the United States, and more than 217,000 U.S. men are diagnosed with the disease every year according to the National Cancer Institute. Last year alone 32,050 men died from the disease.

Vigorous exercise and brisk walking have been consistently shown to have significant benefits on cardiovascular health, diabetes, and many other diseases. Previous studies have also shown the benefit of regular physical activity for disease outcomes in breast and colon cancer, but this is one of the first studies to demonstrate such a benefit for men with prostate cancer.

The participants in this study were selected were a subset of a larger group of 14,000 men with prostate cancer who are enrolled in a long-term, nationwide prostate cancer registry study known as the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE™), led by Peter Carroll, MD, MPH, who is the chair of the Urology Department at UCSF and an author of the study.

A particular strength of this study is the focus on early recurrence of prostate cancer, which occurs before men may experience painful symptoms of prostate cancer metastases, a frequent cause for men to decrease their usual physical activity. Additionally, the researchers reported that the benefit of physical activity was independent of the participants' age at diagnosis, type of treatment and clinical features of their disease at diagnosis.

Asked whether she would recommend walking for all men who are diagnosed with prostate cancer, Dr. Chan said yes -- but emphasized that the walking must be brisk.

"Our results suggest that it is important to engage in exercise that gets your heart rate up a little bit," she advised.

The article, "Physical activity after diagnosis and risk of prostate cancer progression: data from the Cancer of the Prostate Strategic Urologic Research Endeavor" is authored by Erin L. Richman, Stacey A. Kenfield, Meir J. Stampfer, Alan Paciorek, Peter R. Carroll and June M. Chan.

This work was funded by the Department of Defense, the Prostate Cancer Foundation, Abbott Labs, and through a National Institutes of Health training grant.

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Lipofilling may be safe during conservation treatment for breast cancer, study suggests

ScienceDaily (May 24, 2011) — A new study has gone some way to answering the question about whether or not a technique called lipofilling is safe for women who are having their breasts reconstructed after surgery for breast cancer.

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Lipofilling involves taking some fat from another area of a woman's body, such as her abdomen, and using it to fill in small defects or asymmetry that may occur during breast reconstruction. However, until now, there has been a lack of evidence as to whether or not the technique could trigger a recurrence of the original breast cancer, and so plastic surgeons have not been able to advise patients fully on the pros and cons of lipofilling, despite the fact that it has been used for over 30 years.

Now, a study published in the cancer journal Annals of Oncology suggests that lipofilling seems to be a safe procedure for breast cancer patients, although the authors say that longer follow-up and more research is required in order to confirm their findings.

The researchers analysed data on 321 women who had been operated on for primary breast cancer at the European Institute of Oncology (IEO) in Milan, Italy, between 1997 and 2008, and who had then had lipofilling as part of their breast reconstruction. These women were matched with double the number (642) of women who had also had surgery for primary breast cancer, but who did not undergo lipofilling.

The researchers followed up the women for an average of 56 months from the time of the primary surgery and 26 months from the lipofilling. They found that eight women in the lipofillling group and 19 women in the control group had a local recurrence of their cancer -- a difference that was not statistically significant. When they analysed the data to look specifically at recurrences in women with non-invasive cancer (in situ cancer) they found there were three cases of recurrence in the lipofilling group and none in the control group; this was statistically significant, but may have been affected by the very small numbers involved, the short follow-up and the fact that there were no recurrences in the control group despite previous research suggesting there should be an average recurrence rate of over two percent during this period of time. "This indicates there might have been some bias in the selection of the women with non-invasive breast cancer in the control group," explained one of the authors, Professor Jean Yves Petit.

Prof Petit, from the Division of Plastic Surgery at the IEO in Milan, said: "To date, only a few studies have focused on cancer recurrences after lipofilling, and this is the first case-control study to investigate the question and the first publication to show the safety of the procedure. Our overall results do not find any difference in recurrences between the women in the lipofilling and control groups. However, it is still too early in the follow-up to be able to draw any definitive conclusions. We urge other teams working in the same field to gather their own results concerning local recurrences after lipofilling in breast conservation treatment."

This study is important because other, experimental work in the laboratory has shown that fatty tissue is capable of producing growth factors that can trigger cancer cells to multiply. This raised the question of whether this might happen in humans.

"Work by other researchers has shown that secretions from transplanted fat tissues can stimulate angiogenesis

Vulnerability to nicotine addiction appears to have a genetic basis, study suggests

ScienceDaily (May 13, 2011) — A person's vulnerability to nicotine addiction appears to have a genetic basis, at least in part. A region in the midbrain called the habenula (from Latin: small reins) plays a key role in this process, as Dr. Inés Ibañez-Tallon and her team from the Max Delbrück Center for Molecular Medicine (MDC) Berlin-Buch, Germany, have now shown. They also shed light on the mechanism that underlies addiction to nicotine.

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According to the World Health Organization WHO in Geneva, it is estimated that tobacco use kills more than five million people each year worldwide. Many of them die of lung cancer. "Two years ago, studies indicated that genetic variations in a specific gene cluster are risk factors for nicotine dependence and lung cancer," Dr. Ibañez-Tallon pointed out. She and her team, together with researchers from the Pasteur Institute in Paris, France and the Russian Academy of Sciences in Moscow, have now elucidated the mechanism underlying this dependence.

They investigated a specific receptor for the neurotransmitter acetylcholine, which is activated by nicotine in smokers and is encoded by this specific gene cluster, consisting of three subunits, that is three genes. "Although this gene cluster is present in the DNA of every cell, the receptor is only expressed in a few restricted areas of the brain. One of them is the habenula in the midbrain," Dr. Ibañez-Tallon explained.

The MDC researchers investigated this receptor and its subunits in egg cells of the African clawed frog (Xenopus laevis) and in transgenic mice. One of the three genes of the cluster is alpha5. "An important percentage of heavy smokers carry a single mutation in this gene. They are more prone to become addicted to nicotine and to develop lung cancer than individuals without this mutation," Dr. Ibañez-Tallon said.

Strong Aversion to Nicotine

A second gene in the gene cluster encoding this receptor is beta4. The MDC researchers demonstrated that transgenic mice expressing high levels of the beta4 gene have increased sensitivity to nicotine. These mice have a strong aversion to drinking water containing nicotine.

However, when the researchers expressed the mutated variant of the alpha5 gene via a lentivirus in the habenular brain region of these mice, after only two weeks the mice showed a preference for nicotine. Dr. Ibañez-Tallon and her colleagues conclude that only a balanced activity of these two genes can rein in nicotine use.

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Unhealthy substance use a risk factor for not receiving some preventive health services, study finds

ScienceDaily (May 13, 2011) — Researchers from Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) have identified unhealthy substance use as a risk factor for not receiving all appropriate preventive health services. The findings, which currently appear in BMJ Open, identify unhealthy substance use as a barrier to completion of mammography screening and influenza vaccination.

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Cancer and influenza are among the leading causes of mortality in the United States. Influenza is preventable, in part, through vaccination, and mortality from cervical, breast and colorectal cancer can be reduced through routine screening. Nevertheless, many eligible U.S. adults do not receive these recommended preventive services, in particular, low-income persons, racial and ethnic minorities, the uninsured and the foreign-born.

Despite this knowledge, and the implementation of interventions targeting these groups, preventive services are still underused, which has led some to believe that high-risk "pockets" of the population may account for gaps in service receipt.

"Persons with unhealthy substance use (for alcohol, the spectrum that ranges from risky use to dependence; for drugs, the spectrum from any illicit drug use, including prescription drugs to dependence), represent one such "pocket," said lead author Karen Lasser, MD, MPH, a primary care physician at BMC as well as an associate professor of medicine at BUSM.

The researchers analyzed data from 4,804 women eligible for mammograms, 4,414 eligible for Papanicolou (Pap) smears, 7,008 persons eligible for colorectal cancer (CRC) screenings, and 7,017 persons eligible for influenza vaccination. All patients were screened for unhealthy substance use.

Among the nearly 10,000 patients eligible for one or more of the preventive services of interest, 10 percent screened positive for unhealthy substance use. Compared to women without unhealthy substance use, women with unhealthy substance use received mammograms less frequently (75.4 percent vs. 83.8 percent), but Pap smears no less frequently (77.9 percent vs. 78.1 percent). Persons with unhealthy substance use received CRC screenings no less frequently (61.7 percent vs. 63.4 percent), yet received influenza vaccination less frequently (44.7 percent vs. 50.4 percent). "We speculate that persons with unhealthy substance use who are not engaged in primary care at the high thresholds used in these analyses may have substantially lower receipt of preventive services," said Lasser.

According to the researchers future interventions to promote mammography screening might target women with unhealthy substance use, and those to promote influenza vaccination might target both men and women with unhealthy substance use. "Clinical interventions could embed mammography screening and influenza vaccination in other services delivered to individuals with substance use problems. In addition, training interventions could enhance skills and systems for health care personnel who screen for substance use disorders to include referrals for preventive health services," she added.

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Advanced-stage prostate cancer patients experience 20-year survival rates with surgery, study suggests

ScienceDaily (May 15, 2011) — Long-term survival rates for patients with advanced prostate cancer suggest they can be good candidates for surgery, Mayo Clinic researchers have found. Their study found a 20-year survival rate for 80 percent of patients diagnosed with cancer that has potentially spread beyond the prostate, known as cT3 prostate cancer, and treated with radical prostatectomy, or surgery to remove the prostate gland. Previously, patients found to have cT3 prostate cancer were offered radiation or hormone treatment, but not radical prostatectomy.

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The researchers presented their findings during the American Urological Association Annual Meeting in Washington.

"We are doing a much better job of identifying and expanding candidates for surgery, which results in better, longer outcomes for so many of our patients," says R. Jeffrey Karnes, M.D., of Mayo Clinic's Department of Urology. "We have confirmed that patients diagnosed with locally advanced prostate cancer can enjoy a long, cancer-free interval."

The 80 percent survival rate for cT3 diagnoses at 20 years compares to 90 percent for cT2, or cancer confined to the prostate. This long-term follow-up of patients who underwent surgery between 1987 and 1997 is an important advance in understanding the quality outcomes for cT3 patients. The study sample included patients diagnosed and operated on between 1987 and 1997. Ongoing research will examine contemporary data.

Other study investigators include Christopher Mitchell, M.D., Eric Umbreit, M.D., Rachel Carlson and Laureano Rangel, all of Mayo Clinic.

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Yoga improves quality of life in women with breast cancer undergoing radiation therapy, study finds

ScienceDaily (May 18, 2011) — For women with breast cancer undergoing radiation therapy, yoga offers unique benefits beyond fighting fatigue, according to new research from The University of Texas MD Anderson Cancer Center.

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While simple stretching exercises improved fatigue, patients who participated in yoga that incorporated yogic breathing, postures, meditation and relaxation techniques into their treatment plan experienced improved physical functioning, better general health and lower cortisol (stress hormone) levels. They also were better able to find meaning in their cancer experience.

The findings, to be presented next month in an oral session at the 47th annual meeting of the American Society of Clinical Oncology by Lorenzo Cohen, Ph.D., professor and director of the Integrative Medicine Program at MD Anderson, are the latest in an ongoing effort to scientifically validate the age-old belief that mind-body interventions have a beneficial impact on the health of cancer patients. The research was conducted in collaboration with India's largest yoga research institution, Swami Vivekananda Yoga Anusandhana Samsthana in Bangalore, India.

The study assessed, for the first time, yoga benefits to cancer patients by comparing their experience with patients in an active control group who integrated simple, generic stretching exercises into their lives. "The combination of mind and body practices that are part of yoga clearly have tremendous potential to help patients manage the psychosocial and physical distress associated with treatment and life after cancer, beyond the benefits of simple stretching," said Cohen.

To conduct the study, 163 women with breast cancer (stage 0-3) averaging 52 years of age were randomized to one of three groups: 1) yoga; 2) simple stretching; or 3) no instruction in yoga or stretching. Participants in the yoga and stretching groups attended sessions specifically tailored to breast cancer patients for one hour three days a week throughout their six weeks of radiation treatment.

Participants were asked to report on their quality of life, including fatigue, daily functioning, benefit finding, depression and spirituality. Saliva samples were collected and electrocardiogram tests were administered at baseline, end of treatment, and at one, three and six months post-treatment.

After completing radiation treatment, only the women in the yoga and stretching groups reported a reduction in fatigue. At one, three and six months after radiation therapy, women who practiced yoga during the treatment period reported greater benefits to physical functioning and general health. They were more likely to perceive positive life changes from their cancer experience than either other group.

Women who practiced yoga also had the steepest decline in their cortisol across the day, indicating that yoga had the ability to regulate this stress hormone. This is particularly important because higher stress hormone levels throughout the day, known as a blunted circadian cortisol rhythm, have been linked to worse outcomes in breast cancer.

According to Cohen, developing a yoga practice also helps patients after completing cancer treatment. "The transition from active therapy back to everyday life can be very stressful as patients no longer receive the same level of medical care and attention. Teaching patients a mind-body technique like yoga as a coping skill can make the transition less difficult."

Through a grant from the National Cancer Institute -- the largest ever awarded for the study of yoga in cancer -- Cohen and his team will next conduct a Phase III clinical trial in women with breast cancer to further determine the mechanisms of yoga that lead to improvement in physical functioning, quality of life, and biological outcomes during and after radiation treatment. A secondary aim of the trial, but one of great importance, stressed Cohen, is assessing cost efficiency analysis for the hospital, health care usage costs in general, and examining work productivity of patients.

MD Anderson recognizes the growing body of research indicating that relaxation-based interventions can contribute to the well-being of people with cancer. Through the Integrative Medicine Program, complementary therapies, such as yoga, are offered at MD Anderson's Integrative Medicine Center, and are used in concert with mainstream care to manage symptoms, relieve stress, enhance quality of life, and improve outcomes for patients and their caregivers. MD Anderson's Integrative Medicine faculty also conduct research in the biological and behavioral effects of mind-body based interventions; the anti-cancer potential of natural compounds; and, acupuncture to treat common cancer treatment-related side effects.

In addition to Cohen, other MD Anderson researchers contributing to this study include: Kavita Chandwani, M.D., former senior research coordinator and yoga teacher; Robin Haddad, M.P.H. , research coordinator, George Perkins, M.D. in the Department of Radiation Oncology; Amy Spelman, Ph.D., Kayla Johnson, B.S. and Adoneca Fortier, B.S., all staff in the Integrative Medicine Program; Banu Arun, M.D., in the Department of Breast Medical Oncology; and Qi Wei, M.S., Sr. Statistical Analyst. Clemens Kirschbaum, Ph.D. contributed from the Technical University of Dresden, Dresden, Germany. Collaborators from SVYASA include NV Raghuram, B.E.; R. Nagarathna, M.D., and HR Nagendra, Ph.D., founder.

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Curcumin compound improves effectiveness of head and neck cancer treatment, study finds

ScienceDaily (May 19, 2011) — A primary reason that head and neck cancer treatments fail is the tumor cells become resistant to chemotherapy drugs. Now, researchers at the University of Michigan Comprehensive Cancer Center have found that a compound derived from the Indian spice curcumin can help cells overcome that resistance.

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When researchers added a curcumin-based compound, called FLLL32, to head and neck cancer cell lines, they were able to cut the dose of the chemotherapy drug cisplatin by four while still killing tumor cells equally as well as the higher dose of cisplatin without FLLL32.

The study appears this week in the Archives of Otolaryngology -- Head and Neck Surgery.

"This work opens the possibility of using lower, less toxic doses of cisplatin to achieve an equivalent or enhanced tumor kill. Typically, when cells become resistant to cisplatin, we have to give increasingly higher doses. But this drug is so toxic that patients who survive treatment often experience long-term side effects from the treatment," says senior study author Thomas Carey, Ph.D., professor of otolaryngology and pharmacology at the U-M Medical School and co-director of the Head and Neck Oncology Program at the U-M Comprehensive Cancer Center.

That tumors become resistant to cisplatin is a major reason why head and neck cancer patients frequently see their cancer return or spread. It also plays a big role in why five-year survival for head and neck cancer has not improved in the past three decades.

FLLL32 is designed to sensitize cancer cells at a molecular level to the antitumor effects of cisplatin. It targets a key type of protein called STAT3 that is seen at high levels in about 82 percent of head and neck cancers. High levels of STAT3 are linked to problems with normal cell death processes, which allow cancer cells to survive chemotherapy treatment. STAT3 activation has been associated with cisplatin resistance in head and neck cancer.

Curcumin is known to inhibit STAT3 function, but it is not well-absorbed by the body. FLLL32 was developed by researchers at Ohio State University to be more amenable to use in people. The current study used the compound only in cell lines in the laboratory.

In the current study, researchers compared varying doses of cisplatin alone with varying doses of cisplatin plus FLLL32 against two sets of head and neck cancer cells: one line that was sensitive to cisplatin and one line that was resistant.

They found that FLLL32 decreased the activation levels of STAT3, sensitizing both resistant and sensitive tumor cells to cisplatin. Further, lower doses of cisplatin with FLLL32 were equally effective at killing cancer cells as the higher doses of cisplatin alone.

Separate studies suggest FLLL32 may not be well-absorbed by the body and researchers are developing a next generation compound that they hope improves on that. The U-M team plans to further study this newer compound for its potential as part of head and neck cancer treatment. Clinical trials using this compound are not currently available.

Additional authors include Waleed M. Abuzeid, M.B.B.S.; Samantha Davis, B.S., M.D.; Alice L. Tang, B.A., M.D.; Lindsay Saunders, B.S.; J. Chadwick Brenner, M.S.E.; Emily Light, M.S.; Carol R. Bradford, M.D.; and Mark E.P. Prince, M.D., all from U-M; Jiayuh Lin, Ph.D., from the Nationwide Children's Hospital, Columbus, Ohio; James R. Fuchs, Ph.D., from The Ohio State University.

Funding was provided by the National Institute of Dental and Craniofacial Research, Head and Neck Specialized Program of Research Excellence (SPORE) grant, National Cancer Institute, American Cancer Society

Head and neck cancer statistics: 36,540 Americans will be diagnosed with head and neck cancer this year and 7,880 will die from the disease, according to the American Cancer Society.

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