Research Findings

CANSA Research Highlights – 18 May 2009

CANSA Research Highlights – 18 May 2009

CANSA Research Highlights   Issue 42    18 May 2009

Ginger Eases Nausea From Chemo

Spice produced 40% reduction in symptoms among breast cancer patients

Researchers have discovered the nausea-easing powers of ginger that many grandmothers are already familiar with, and report that the spice helped cancer patients who were undergoing chemotherapy.

“Ginger at a daily dose of 0.5-to-1 gram significantly aids in the reduction of chemotherapy-related nausea on the first day of chemotherapy, and reduced nausea will lead to improved quality of life in many cancer patients,” said study author Julie Ryan, an assistant professor of dermatology and radiation oncology at the James P. Wilmot Cancer Center at the University of Rochester, said during a teleconference highlighting research that will be presented later this month during the American Society of Clinical Oncology (ASCO)annual meeting in Florida.

That dose is the equivalent of 1/4 to 1/2 a teaspoon of ground ginger, she added.

The trial participants, mostly women and mostly breast cancer patients, were also taking conventional drugs to quell vomiting.

“A lot of patients ask us as oncologists, ‘Is there anything more I can do to deal with chemotherapy-induced nausea?’ ” said Dr. Douglas Blayney, president-elect of ASCO and medical director of the Comprehensive Cancer Center at the University of Michigan, in Ann Arbor.

The majority of patients undergoing chemotherapy do have nausea and vomiting. And nausea can persist even if actual vomiting is stopped. Some 70 percent of patients in chemo still have the symptoms even with common use of antiemetic, or anti-vomiting, drugs.

Ginger is a spice that has been widely used for decades to treat nausea and vomiting, Ryan stated.

These researchers, supported by the U.S. National Cancer Institute, enrolled 644 cancer patients who had already experienced nausea after chemotherapy. All participants had to still be facing at least three rounds of chemo.

The trial is the largest of its kind, according to the researchers.

Participants were randomized to receive either a placebo or one of three doses of ginger supplement: 0.5 grams, 1 gram or 1.5 grams for three days before the start of chemo and three days after for the next two cycles. All also received traditional antiemetic drugs on the first day of treatment.

Most patients report the most severe nausea and vomiting on the first day of chemo, Ryan said. If nausea can be reduced during this critical time period, subsequent nausea is also less likely.

While all doses of ginger helped with nausea, “The largest reduction in nausea occurred with 0.5 and 1 gram of ginger, which was about a 40 percent reduction in nausea,” Ryan reported. The effect tended to wear off over the next 24 hours.

It wasn’t clear if the same effects would be seen with ginger products, such as tea, ginger cookies and sushi, the researchers said.

Source:  Medline Plus

Wart virus makes for less deadly cancer: study

A wart virus best known for causing cervical cancer may make for a less-deadly kind of head and neck cancer, researchers reported.

People whose head and neck tumors carried the human papillomavirus virus, or HPV, were 59 percent less likely to die than people whose tumors were not caused by the virus, the researchers said.

“A patient who has this actually has a better prognosis than patients with HPV-negative tumors,” Dr. Richard Schilsky, president of the American Society of Clinical Oncology and a cancer specialist at the University of Chicago, said in an interview.

He said it may be clear now that there are two kinds of head and neck cancers — those caused by HPV and those linked to other causes, such as smoking and drinking.

Not only can patients be treated differently, perhaps waiting longer for toxic chemotherapy if they have an HPV-positive tumor, but there may be ways to prevent these tumors, Schilsky said.

Two vaccines — Cervarix, made by GlaxoSmithKline, and Gardasil, made by Merck & Co Inc — prevent HPV-16 infection.

“There is every reason to think that vaccination with the HPV vaccine will prevent these,” Schilsky said.

Dr. Maura Gillison and colleagues at Johns Hopkins University in Baltimore studied 317 head and neck cancer patients whose tumors could be tested for HPV. The phase III study confirms earlier work Gillison’s lab did linking HPV and these tumors.

They said 87 percent of patients with tumors that tested positive for HPV-16 were alive four years later, compared to 67 percent of those whose tumors did not contain the virus. All got standard treatments for their cancer.
HPV causes virtually all cases of cervical cancer, but it has been linked with other cancers including anal and penile cancer and 20 percent to 40 percent of cancers of the mouth and pharynx. It is a very common sexually transmitted disease.

Cervical cancer is the second most common cancer in women worldwide, with more than 500,000 cases diagnosed annually and 200,000 deaths.

About 400,000 cases of head and neck cancer are diagnosed globally each year, and more than half of patients die.

More details of the study will be released at ASCO’s annual meeting in Orlando later this month but a summary of the findings, called an abstract, was released ahead of the meeting.

Source:  Medline Plus

Where You Live May Affect Your Cancer Diagnosis

Risk of late-stage cancer greater in city dwellers than in rural residents, study shows

Living in the city could lead to certain common cancers being diagnosed at much later stages of their development, new research has found.

A study of residents of Illinois finds that city dwellers are more likely to have doctors spot breast, colorectal, lung or prostate cancer later in the disease’s progression than their peers residing in the suburbs or rural areas. The rates for these late-stage cancers were highest in Chicago, the most densely populated and urban of the areas in the analysis, and tapered off the more rural and sparse an area’s population became, according to the findings, which were based on a review of the 1998 to 2002 Illinois State Cancer Registry.

“The concentration of health disadvantage in highly urbanized places emphasizes the need for more extensive urban-based cancer screening and education programs, especially programs targeted to the most vulnerable urban populations and neighborhoods,” the study’s authors, Sara L. McLafferty of the University of Illinois andFahui Wang of Louisiana State University, wrote in their article, to be published in the June 15 print issue of the journal Cancer.

Age and race may account for much of the geographical difference in when colorectal and prostate cancers were diagnosed while they played a smaller role in the timing of breast cancer detection, the researchers noted. Urban blacks, for example, were much more likely to receive a late-stage diagnosis while older people living in rural areas were more likely to have their cancer diagnosed early because, it is speculated, this group is likely to visit doctors more often and receive age-related screenings for various diseases.

For lung cancer, the authors found that age and race did not explain the geographic disparities for stage of diagnosis, leading them to guess that other factors might be responsible.

SOURCEAmerican Cancer Society, news release, May 11, 2009

Smoking Packs a Tougher Wallop for Women

Research suggests greater female susceptibility to carcinogens

Women may be more vulnerable than men to cancer-causing ingredients in cigarettes, according to a new study.

In an examination of data on 683 people with lung cancer who had been referred to a lung cancer center between 2000 and 2005, Swiss researchers found that female patients tended to be younger when they developed the disease, even though they tended to smoke significantly fewer cigarettes than men.

“Our findings suggest that women may have an increased susceptibility to tobacco carcinogens,” wrote Dr. Martin Frueh and colleagues. The study was to be presented this week at the European Multidisciplinary Conference in Thoracic Oncology, in Lugano, Switzerland.

The results add to growing evidence that smoking poses greater health risks to women than men, according to the conference co-chair, Dr. Enriqueta Felip, of Vall d’Hebron University Hospital in Barcelona, Spain.

“In the early 1900s, lung cancer was reported to be rare in women, but since the 1960s, it has progressively reached epidemic proportions, becoming the leading cause of cancer deaths among women in the United States,” Felip said in a news release from theEuropean Society for Medical Oncology.

“Lung cancer is not only a man’s disease, but women tend to be much more aware of other cancers, such as breast cancer,” she noted. “Several case-control studies seem to suggest that women are more vulnerable to tobacco carcinogens than men.”

Another study presented at the conference found that women tend to do better than men after surgery to remove lung tumors. The study of 640 patients found that median survival after surgery to remove non-small-cell lung cancer was 4.7 years for women and 2.1 years for men.

CANSA comment:  Over 44 000 South Africans die from tobacco-related diseases annually and many more become ill from using tobacco products and inhaling second-hand smoke. Smoking is the main cause of lung cancer – which  has one of the lowest survival rates of all cancers

Source:  Medline Plus

Vitamin E, Selenium and Soy Won’t Prevent Prostate Cancer

Study found no effect among men with precancerous lesions

Despite earlier promise, three nutrients – vitamin E, selenium and soy – do not seem to prevent prostate cancer in men with precancerous prostate lesions, Canadian researchers report.

“There has been a collection of scientific data that has suggested that these agents could have a tremendous impact in preventing prostate cancer,” said lead researcher Dr. Neil E. Fleshner, a Clinical Studies Resource Centre Member at the Ontario Cancer Institute and Love Chair in Prostate Cancer Prevention at the University of Toronto.

“So there was great hope that this would be a magic bullet that would help prevent prostate cancer,” he said. “Unfortunately, it doesn’t appear to be so.”

The report was to be presented Sunday at the American Urological Association’s annual meeting, in Chicago.

For the study, Fleshner’s team randomly assigned 303 men with high-grade prostatic intraepithelial neoplasia (precancerous lesions) to receive soy protein, vitamin E and selenium, or a placebo. Over three years, the men had several biopsies to determine if they had developed prostate cancer.
Just over 26 percent of the men did develop invasive prostate cancer. However, the three nutrients did not seem to minimize that risk, the team found.

“To recommend soy and these supplement to men with high-grade prostatic intraepithelial neoplasia really doesn’t make much sense, if the reason you are giving it is to prevent your patient from developing invasive cancer,” Fleshner concluded.

He did leave the door open to using these supplements to prevent prostate cancer before precancerous lesions have formed. “In pre-cancer, the cells may already be so damaged that supplements can’t reverse the changes,” he reasoned. “Or maybe it just doesn’t work.”

The results confirm the findings of the two recent prospective trials, which also found that vitamin E, vitamin C and selenium do not prevent prostate cancer. The results of these trials were published in the Jan. 7 issue of the Journal of the American Medical Association. Other recent studies have suggested that vitamins, B, C, D, E, folic acid and calcium taken alone, or in various combinations, aren’t effective for cancer prevention.

“Single-agent interventions, even in combinations, may be an ineffective approach to primary prevention in average-risk populations,” wrote Dr. Peter Gann, author of an accompanying Journal of the American Medical Association editorial.

However, one expert believes that while vitamins E and C may not prevent prostate tumors, soy might still prove to be of benefit.

“There is some evidence from laboratory and population studies that soy protein or its components might reduce risk of prostate cancer,” said Eric Jacobs, strategic director for Pharmacoepidemiology at the American Cancer Society.

In this study, soy protein had no apparent effect on the development of prostate cancer among men who already had precursor lesions in the prostate, Jacobs noted. “However, it remains possible that soy could reduce risk of developing prostate cancer by inhibiting earlier stages of prostate cancer development, or that soy could reduce the risk of recurrence or disease spread in men with prostate cancer,” he said.

Douglas MacKay is vice president for Scientific & Regulatory Affairs at the Center for Responsible Nutrition, which represents the supplements industry. He believes the role of supplements is complex and trying to find a pill that will prevent cancer is a hopeless task. However, supplements and a healthy lifestyle can both play a role in helping patients prevent or fight cancer, MacKay said.

“Soy isoflavones and other dietary supplements may help prevent the development of cancer,” MacKay said. “Men should include these things as part of a healthy lifestyle and integrated approach to preventive medicine. However non-pharmacologic dietary preventions, whole foods, extracts and herbs’ influence on the development of cancer is complex and may not be appropriately tested using a randomized clinical trial.”

Source:  Medline Plus

Experts Back Away From Annual PSA Test

Men should have a ‘baseline’ prostate cancer screen at 40, but yearly PSA may not be necessary, guidelines say

New guidelines on prostate cancer screening suggest that annual PSA blood tests might not be necessary for many men, but the same guidelines call for a “baseline” PSA test at the age of 40, rather than 50.

A prostate-specific antigen (PSA) test to detect early signs of prostate cancer should be offered to “well-informed men aged 40 and older who have a life expectancy of 10 years,” state clinical guidelines issued by the American Urological Association at its annual meeting in Chicago.

Noting that the issue of PSA testing and how it should be used to guide treatment “is highly controversial,” the association still stated that the test, “when offered and interpreted appropriately, may provide important information for the diagnosis, pre-treatment staging or risk assessment or post-treatment monitoring of prostate cancer.”

But it’s important that “the risks and benefits of PSA screening be discussed with men before the test is done,” said Dr. Peter Carroll, chairman of the department of urology at theUniversity of California, San Francisco, who headed the committee that drew up the new guidelines.

Those risks can include impotence and incontinence caused by unnecessary surgery.

The recommendation that a first PSA test be offered to men at 40 should help doctors spot high-risk patients more readily, however. “PSA at that age is strongly predictive of the future risk of prostate cancer,” Carroll said. “Later detection in the 50s, when the cancer would be more advanced, could be avoided.”

The guidelines also recognize that many prostate cancers grow so slowly that they are of no risk, he said. Further steps after detection of an elevated level of PSA, a protein produced by the prostate, should require consideration of “other risk factors, such as family history and ethnicity,” Carroll said.

Another major change is that the guidelines set no specific PSA blood level as an indicator of danger, he said. The danger level for an individual man will depend on other risk factors.

And yearly PSA tests might not be needed for many men, the guidelines note. “Screening less frequently may be a less costly way to screen,” Carroll said. No specific timetable for less frequent screening is set in the guidelines, but they might be recommended as more information becomes available, he said.

The new guidelines did take into account two recent studies, one in Europe which found that regular PSA screening reduced prostate cancer deaths, and one in the United States which found no effect of screening, Carroll said. The U.S. study was flawed in several ways, he noted. For example, it permitted men who were not assigned to the group for screening to go have PSA tests on their own.

“Both studies do not suggest that PSA screening should not be undertaken,” Carroll said.

New information on PSA testing has been a major focus at this year’s AUA meeting. One study by urologists at the University of Colorado focused on the timing of PSA tests. The study, which followed more than 76,000 men for at least five years, found that the PSA levels of nearly 99 percent of men with very low readings on an initial test would remain low for at least five years.

That suggests that limiting tests to every five years for men at that low level, and to every two years for men with slightly higher readings, would lower the overall need for PSA tests by 70 percent, reducing testing costs by $1 billion a year, the researchers reported.

On the other hand, a Swedish study found that PSA readings at age 60 were strong indicators of increased prostate cancer death risk. But “60 -year-old men with PSA at or below 1 nanogram per milliliter [a low reading] can be told that although they harbor prostate cancer, it is very unlikely to become life-threatening,” the researchers wrote.

A third report at the meeting took issue with the recommendation of the U.S. Preventive Task Force that men aged 75 and older should not have PSA tests at all.

Dr. Judd W. Moul said that when he read that recommendation, he did a poll of 340 older men at the Duke University Prostate Center, which he heads. “My immediate reaction was that it was age discrimination,” he said.

The survey, done by Duke medical students, found that 78.2 percent of the men were upset by the recommendation, said Moul, an outspoken proponent of PSA testing.

Moul acknowledged that the report had been refused publication by a medical journal on the grounds that it was biased. But he said the advice to stop PSA testing after 75 “was supported neither by public opinion nor by our outcomes data.”

CANSA comment:  Men over the age of 50 need to go for simple screening tests each year to check if they might have prostate cancer, which is the most common cancer among men in South Africa and globally. Read more…

Source:  Medline Plus

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