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2012 Annual Highlights

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Issue Highlights:

Annual Report to the Nation on the Status of Cancer Screening Guidelines for the Prevention and Early Detection of Cervical Cancer EGFR Gene Status in Cytological Samples of Nonsmall Cell Lung Carcinoma Now Available:

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American Cancer Society Journals… Support Your Important Work in the Battle against Cancer Cancer | Cancer Cytopathogy | CA: A Cancer Journal for Clinicians The American Cancer Society (ACS) estimates that approximately 1.6 Americans will be diagnosed with cancer and more than 577,000 Americans will die from cancer in 2012. While progress has been made on many fronts in the battle against cancer—from prevention to early detection to treatment—clearly there is still much work to be done. Whether you are in research, clinical practice, or public health, you can depend on ACS journals to support and advance your own work. Take a look for yourself: this selection of groundbreaking articles published in ACS journals presents some of the latest emerging therapeutic strategies, evidence-based care practices, screening and prevention tools, and trends and risk factors in cancer. In short, you’ll find the information you need to do your best work in the battle against cancer.

Did You Know That...? > ACS has issued interim guidelines for lung cancer screening. > The Bethesda System for Reporting Thyroid Cytopathology has been shown to lower the number of ambiguous diagnoses. > Longitudinal studies on metabolic surgery have revealed that sustained weight loss results in lower cancer rates. > Income is still a strong predictor of whether or not a woman undergoes mammography screening. > It is still unclear whether diabetes is an added risk factor for developing breast cancer among women with a BRCA1 or BRCA2 mutation

Read On to Discover More News and Breakthroughs in Cancer Research and Care! > > >

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April 25, 2012 Pages 71–142

Cancer

Volume 120/Issue 2

Contents

ancer C Cytopathology

Bench-to-Bedside

Metabolic surgery and cancer.......................................................................................................................................5

Breast Cancer

Diabetes and breast cancer among women with BRCA1 and BRCA2 mutations............................................................................5 Was the drop in mammography rates in 2005 associated with the drop in hormone therapy use?......................................................5 The evolving role of axillary lymph node fine-needle aspiration in the management of carcinoma of the breast......................................6

Clinical Trials

Clinical trials in the era of personalized oncology................................................................................................................6

Colorectal Cancer

Anal cancer and cervical cancer screening: Key differences...................................................................................................6

Disparities Research

Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival. ..............................................7

Endocrine Disorders

Clinical and molecular features of papillary thyroid cancer in adolescents and young adults. ...........................................................7 Fine-needle aspirations of papillary carcinoma with oncocytic features......................................................................................8 The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, risk of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions..............................................................8

Epidemiology

Cumulative incidence of cancer among individuals with AIDS in the United States........................................................................9 Update on mammography trends...................................................................................................................................9 Annual Report to the Nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity. ..........................................................................................................................10 Global cancer statistics. ...........................................................................................................................................10 Breast cancer statistics, 2011. ...................................................................................................................................10 Cancer statistics, 2012.............................................................................................................................................11

Gastrointestinal Tract

Risk of colorectal cancer in self-reported inflammatory bowel disease and modification of risk by statin and NSAID use. .......................11 Intensity-modulated radiation therapy versus conventional radiation therapy for squamous cell carcinoma of the anal canal. ..................11 Randomized phase III trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer....................................................................................................................................12 Improved survival in patients with lymph node-positive gastric cancer who received preoperative radiation........................................12 Endoscopic ultrasound-guided paracentesis of ascitic fluid..................................................................................................12

Genetics

Genetics, genomics, and cancer risk assessment. ............................................................................................................13 Researchers find discordance between standard HER2 testing and HER2 status reported on Oncotype DX. .......................................13 No risk of genetic disease in childhood cancer survivors’ offspring found.................................................................................13 Preservation of fine-needle aspiration specimens for future use in RNA based molecular testing.....................................................14

Genitourinary & Prostate Cancer

Recurrence-free survival in prostate cancer is related to increased stromal TRAIL expression.........................................................14 Digitized microscopy in the diagnosis of bladder cancer. ....................................................................................................14

Guidelines

Coding changes in the United States front and center........................................................................................................15 Nutrition and physical activity guidelines for cancer survivors...............................................................................................15 American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer...........................................................................15 American Cancer Society guidelines on nutrition and physical activity for cancer prevention..........................................................16

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Contents, con’t.

Gynecologic Cancer

Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia................................................16 Use of high-risk human papillomavirus testing patients with low-grade squamous intraepithelial lesions ...........................................17 Testing for human papillomavirus in cervical cancer screening..............................................................................................17

Head & Neck

Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy.....................17

Hematology

The utility of endobronchial ultrasound-guided transbronchial needle aspiration biopsy in the diagnosis of mediastinal lymphoproliferative disorders. .....................................................................................................................18 Cytopathology of “double hit” non-Hodgkin lymphoma.......................................................................................................18

Hepatobiliary Disease

Is resection of colorectal liver metastases after a second line chemotherapy regimen justified?......................................................18 Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma. .....................................................19

Lung Cancer

Prognostic influence of metformin as first-line chemotherapy on advanced nonsmall cell lung cancer in patients with type 2 diabetes. ......19 An E3 ubiquitin ligase: c-Cbl.......................................................................................................................................19 EGFR gene status in cytological samples of nonsmall cell lung carcinoma. ...............................................................................20 EGFR and KRAS mutations in lung carcinoma. .................................................................................................................20 Equivocal cytology in lung cancer diagnosis....................................................................................................................20 Comparison of the expression levels of napsin A, thyroid transcription factor-1 and p63 in nonsmall cell lung cancer using cytocentrifuged bronchial brushings...................................................................................................................... 21

Melanoma

Randomized, double-blind, placebo-controlled trial of Sulindac in individuals at risk for melanoma: Evaluation of potential chemopreventive activity. ............................................................................................................. 21

Neuro-Oncology

Presentation, patterns of care, and survival in patients with brain metastases...........................................................................22

Outcomes and Treatment

The implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on cancer care delivery.............................................................................................................................................22 From critical values to critical diagnoses........................................................................................................................22 Prediction models in cancer care.................................................................................................................................23

Pediatric Oncology

Twenty years of follow-up of survivors of childhood osteosarcoma.........................................................................................23 The met and unmet health care needs of adult survivors of childhood central nervous system tumors. .............................................24

Screening/Early Detection

Promoting cancer screening within the patient centered medical home...................................................................................24 Cancer screening in the United States, 2012...................................................................................................................25

Survivorship

Survivorship Care Plans in Research and Practice.............................................................................................................25

Symptom Control & Palliative Care

Fatigue, vitality, sleep and neurocognitive functioning in adult survivors of childhood cancer. ........................................................26 Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment . ....................................................................26 The management of cancer pain..................................................................................................................................27

Translational Research

Human papillomavirus vaccine uptake among 9- to 17-year-old girls.......................................................................................27

Meet the Editors...........................................................................................................................................28

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Bench-to-Bedside Cancer | Volume 117, Issue 9, pages 1788–1799, 1 May 2011

Metabolic surgery and cancer Hutan Ashrafian MRCS, Kamran Ahmed MRCS, Simon P. Rowland BSc(Hons), Vanash M. Patel MRCS, Nigel J. Gooderham PhD, Elaine Holmes PhD, Ara Darzi KBE, FMedSci, Thanos Athanasiou MD, PhD, FETCS

Worldwide, the incidence of both obesity and cancer is increasing. There is now epidemiological evidence to support a connection between obesity, weight gain, and some cancers. Read this important review to learn more about the effects and mechanisms of cancer prevention by metabolic surgery.

Although several treatment strategies have been developed to decrease obesity, including behavioral modification and pharmacotherapy, they have been only marginally successful, if at all. Surgical solutions, on the other hand, have resulted in long-term weight loss. In addition, they have achieved pronounced metabolic effects, including diabetes resolution in the majority of morbidly obese patients. Whereas weight gain can result in higher cancer rates, the converse finding of weight loss and lower cancer rates has not been easy to document as there were no successful weight-loss modalities. Recently, however, longitudinal studies on metabolic surgery have revealed that successful weight loss also results in lower cancer rates.

Breast Cancer Cancer | Volume 117, Issue 9, pages 1812–1818, 1 May 2011

Diabetes and breast cancer among women with BRCA1 and BRCA2 mutations Louise Bordeleau MD, Lorraine Lipscombe MD, Jan Lubinski MD, Parviz Ghadirian PhD, William D. Foulkes MD, Susan Neuhausen PhD, Peter Ainsworth MD, Michael Pollak MD, Ping Sun PhD, Steven A. Narod MD, the Hereditary Breast Cancer Clinical Study Group

In this study of women with BRCA1 and BRCA2 mutations, the authors observed a significant increase in the risk of developing diabetes after a breast cancer diagnosis. They also found that the risk was compounded by a high body mass index and the use of chemotherapy. Several studies have shown that women with breast cancer who receive adjuvant chemotherapy are more likely to gain weight after treatment than women who do not receive chemotherapy, which may contribute to the risk of diabetes associated with chemotherapy.

The results of this study do not suggest that diabetes is an added risk factor for developing breast cancer among women with a BRCA1 or BRCA2 mutation; however, other studies have shown that diabetes is associated with a small but significant increased risk of breast cancer in the general population. The lack of association in this particular study may reflect differences in the study populations.

Cancer | Volume 117, Issue 24, pages 5450–5460, 15 December 2011

Was the drop in mammography rates in 2005 associated with the drop in hormone therapy use? Nancy Breen PhD, Kathleen A. Cronin PhD, Jasmin A. Tiro PhD, Helen I. Meissner PhD, Timothy S. McNeel BA, Susan A. Sabatino MD, MPH, Florence K. Tangka PhD, Stephen H. Taplin MD, MPH

In 2002, the Journal of the American Medical Association published a report from the Women’s Health Initiative that hormone therapy use was associated with an increased risk of breast cancer. This widely publicized finding alerted physicians and women, leading to a dramatic decline in the use of hormone therapy. In 2005, US data indicated the first-ever drop in mammography rates since they were first monitored in 1987. The authors of this study set out to discover whether this was a link between the decline in hormone therapy use and the decline in mammography.

This study is the first to demonstrate that a drop in hormone use was associated with a drop in mammography use for women aged 50 to 64. The authors theorized that women who stopped hormone therapy use had fewer encounters with physicians who might have reminded or encouraged them to have a mammogram. There are several other factors, however, that need to be examined, including women’s evolving understanding of the benefits of mammography. Wiley-Blackwell

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Breast Cancer, con’t. Cancer Cytopathology | Volume 119, Issue 5, pages 328–334, 25 October 2011

The evolving role of axillary lymph node fine-needle aspiration in the management of carcinoma of the breast Martin C. Chang MD, PhD, Pavel Crystal MD, Terence J. Colgan MD

The authors of this study set out to evaluate and compare the performance of image-guided fine-needle aspiration of axillary lymph nodes in staging breast carcinoma to the performance of combined clinical palpation and radiologic examination. In addition, they wanted to find out whether image-guided fine-needle aspiration of axillary lymph nodes is only a determinant of surgical management or whether it in fact has a role in the overall management of breast carcinoma.

The study results do provide further support for the accuracy of axillary lymph node fine-needle aspiration with respect to final histopathologic lymph node status. In particular, fineneedle aspiration provided higher sensitivity and specificity compared with clinical or radiologic assessment alone. The authors also found that lymph node fine-needle aspiration can play a role both in avoiding or limiting sentinel lymph node biopsy and in triaging cases for systemic therapy.

Clinical Trials CA: A Cancer Journal for Clinicians | Volume 61, Issue 6, pages 365–381, November/December 2011

Clinical trials in the era of personalized oncology Michael L. Maitland MD, PhD, Richard L. Schilsky MD

Personalized oncology seeks to maximize the therapeutic index for treating or curing cancer in each individual patient. The key question is how can we move from population-based oncology to personalized oncology? Using the development of treatments for breast cancer as a model, the authors of this article review the evolution of clinical trials and how they must continue to evolve to meet the promise of personalized oncology.

During the transition from population-based to personalized oncology, cancer investigators are facing two, sometimes competing, challenges. They must conduct clinical trials of new, potentially more effective, therapeutic interventions more quickly than ever before. At the same time, they must transform the clinical trials’ infrastructure and design to fit the needs of personalized oncology. Read the full article to discover how (or if) we are meeting these challenges.

Colorectal Cancer Cancer Cytopathology | Volume 119, Issue 1, pages 5–19, 25 February 2011

Anal cancer and cervical cancer screening: Key differences Teresa M. Darragh MD, Barbara Winkler MD

Cervical cancer and anal cancer share many similarities, including causation by oncogenic human papillomaviruses. This timely review provides an overview of anal cancer screening, highlighting its differences from cervical cancer screening and making key recommendations for overcoming remaining obstacles and controversies in order to achieve implementation of a successful anal cancer screening program.

Although rare, the incidence of anal cancer continues to increase in high-risk populations, particularly men who have

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sex with men regardless of their HIV status. As the incidence of anal carcinoma increases in populations at risk, cytologic screening combined with early detection and treatment has been proposed as a method to reduce the morbidity and mortality from invasive anal squamous cell carcinoma. The success of cervical cancer screening—based on a triad of cytologic screening, colposcopic identification, and histologic confirmation—has led to its use as a starting-point template for developing an anal cancer screening protocol.

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Disparities Research Cancer | Volume 117, Issue 14, pages 3242–3251, 15 July 2011

Effects of individual-level socioeconomic factors on racial disparities in cancer treatment and survival Xianglin L. Du MD, PhD, Charles C. Lin PhD, Norman J. Johnson PhD, Sean Altekruse DVM, PhD

How does socioeconomic status influence racial disparities in cancer treatment and survival? This article is the first study to use the linked National Longitudinal Mortality Study and Surveillance, Epidemiology, and End Results data to determine the effects of individual-level socioeconomic factors such as health insurance, education, and income status on racial disparities in receiving cancer treatment and in survival. The study included 13,234 cancer patients. The results indicate that favorable survival is associated with higher

socioeconomic status. Moreover, racial disparities in survival have persisted for some types of cancer even when controlling for various socioeconomic factors. Specifically, black women are more likely to die from breast cancer and black men are more likely to die from prostate cancer compared with whites. These associations were not observed among other racial/ethnic groups. Future studies should assess the role of treatment and local area effects as well as other factors that may affect minority disparities in cancer survival.

Endocrine Disorders Cancer | Volume 117, Issue 2, pages 259–267, 15 January 2011

Clinical and molecular features of papillary thyroid cancer in adolescents and young adults Menno R. Vriens MD, PhD, Willieford Moses BS, Julie Weng BS, Miao Peng MD, Ann Griffin PhD, Archie Bleyer MD, Brad H Pollock MPH, PhD, Daniel J. Indelicato MD, Jimmy Hwang PhD, Electron Kebebew MD

The incidence of thyroid cancer has doubled over the last 30 years, most likely due to the increased detection of small, low-risk papillary thyroid cancer. Among adolescents and young adults, thyroid cancer is the fifth most common cancer; however, it remains under reported. In this important study, the authors compared the molecular and clinical features of papillary thyroid cancer among adolescents and young adults with the same features among older patients.

The authors examined demographic, clinical, and survival data among 1,011 patients subdivided into two age groups: patients between the ages of 15 and 39 years and patients age 40 years and older. The results of the study indicated that the extent of disease at presentation and the survival of patients with papillary thyroid cancer differed between the group of adolescents and young adults and the group of older patients. The current results suggest that these differences may be caused by several candidate genes and that these genes are expressed differently and may play an important role in tumor cell biology.

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Endocrine Disorders, con’t. Cancer Cytopathology | Volume 119, Issue 4, pages 247–253, 25 August 2011

Fine-needle aspirations of papillary carcinoma with oncocytic features Andrew A. Renshaw MD

There is a subset of papillary carcinomas that have relatively abundant granular cytoplasm, making them very difficult to distinguish from Hürthle cell lesions. Unfortunately, the literature on the cytology of these tumors is limited, consisting of 13 cases, all of which appear to have been typical variants of papillary carcinoma. In order to better understand the cytologic appearance of these tumors, the author identified and reviewed 18 additional cases (found among a series of 7,089 fine-needle aspirates) in which the original cytologic

and histologic diagnoses included the differential diagnosis of papillary carcinoma or Hürthle cell lesions.

The author concluded that a subset of papillary carcinomas of the thyroid were difficult to distinguish from Hürthle cell lesions or repair and/or cyst-lining cells due to the presence of abundant granular cytoplasm and a lack of nuclear crowding. These tumors were often follicular or cystic variants of papillary carcinoma.

Cancer Cytopathology | Volume 119, Issue 5, pages 315–321, 25 October 2011

The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, risk of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions Amanda Crowe MD, Ami Linder MD, Omar Hameed MBChB, Chura Salih BDS, Janie Roberson CT (ASCP), Jonathon Gidley CT (ASCP), MBA, Isam A. Eltoum MD, MBA

The Bethesda System for Reporting Thyroid Cytopathology, first implemented in January 2008, is designed to improve patient outcomes by improving communication between pathologists and clinicians. The question is has it fulfilled its promise?

Reviewing patients who underwent fine-needle aspiration of the thyroid over a three-year period from April 2006 to April 2009, the authors were able to assess the impact of the Bethesda System for Reporting Thyroid Cytopathology on

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various quality and outcome measures by comparing results before and after implementation.

The authors found that the Bethesda System for Reporting Thyroid Cytopathology does appear to improve the quality of reporting by lowering the number of ambiguous and implicit diagnoses and thereby decreasing overall surgery rates. It does not, however, appear to have any effect on the accuracy of fine-needle aspiration of the thyroid, false-positive rates, or the frequency of intraoperative consultations.

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Epidemiology Cancer | Volume 117, Issue 5, pages 1089–1096, 1 March 2011

Cumulative incidence of cancer among individuals with acquired immunodeficiency syndrome in the United States Edgar P. Simard PhD, MPH, Ruth M. Pfeiffer PhD, Eric A. Engels MD, MPH

Mortality among HIV-infected individuals declined dramatically in the United States beginning in 1996 when the use of highly active antiretroviral therapy became widespread. In this population-based, record-linkage study, the authors set out to discover how the decline in overall mortality affected the cumulative incidence of cancer among AIDS patients.

The authors identified cancers in 472,378 individuals with AIDS from 1980 to 2006. By using nonparametric competing-risk methods, the cumulative incidence of cancer was estimated across three calendar periods: AIDS onset

between 1980-1989, 1990-1995, and 1996-2006. The results showed dramatically declining cumulative incidence of Kaposi’s sarcoma and non-Hodgkin lymphoma, two major AIDS-defining cancers, most likely due to the use of highly active antiretroviral therapy. On the other hand, the authors observed increased cumulative incidence of some non-AIDS defining cancers, including cancers of the anus, liver, and lung. This study underscores that, as HIV/AIDS is increasingly managed as a chronic disease, greater attention must be focused on cancer screening and prevention.

Cancer | Volume 117, Issue 10, pages 2209–2218, 15 May 2011

Update on mammography trends Nancy Breen PhD, Jane F. Gentleman PhD, Jeannine S. Schiller MPH

The benefit of mammography for average-risk women in different age groups has been the focus of ongoing discussion for decades. Based on the current best scientific evidence, the US Preventive Services Task Force guidelines have consistently recommended routine screening for women aged 50 to 69 years.

In this report, the authors have updated a previous analysis of mammography trends using newly available data from the National Health Interview Survey. By reading the full report, you’ll discover trends in mammography screening not only by age group, but also by education, income, access to insurance and health care, race and ethnicity, and immigration status.

Among the findings of this study, the authors noted that mammography use for women aged 40 to 49 years has been relatively stable since 1992 despite controversy in the literature about its effectiveness for this age group. The report also noted that mammography rates rose significantly among Asians and recent immigrants.

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Epidemiology, con’t. Cancer | Volume 118, Issue 9, pages 2338–2366, 1 May 2012

Annual Report to the Nation on the status of cancer, 1975-2008, featuring cancers associated with excess weight and lack of sufficient physical activity Christie Eheman PhD, S. Jane Henley MSPH, Rachel Ballard-Barbash MD, MPH, Eric J. Jacobs PhD, Maria J. Schymura PhD, Anne-Michelle Noone MS, Liping Pan MD, MPH, Robert N. Anderson PhD, Janet E. Fulton PhD, Betsy A. Kohler MPH, CTR, Ahmedin Jemal DVM, PhD, Elizabeth Ward PhD, Marcus Plescia MD, MPH, Lynn A. G. Ries MS, Brenda K. Edwards PhD

All cancer researchers and health care providers should turn to this latest Annual Report to the Nation for up-to-date information on cancer incidence and mortality. In particular, this report highlights several cancers associated with excess weight and insufficient physical activity. The report notes that the International Agency for Research on Cancer has concluded that one-quarter to one-third of common cancers in industrialized nations were caused by the joint effect of excess weight and lack of physical activity. Moreover, the report notes that excess weight and lack of

physical activity may also adversely affect cancer prognosis and quality of life among cancer survivors. For example, research indicates that excess weight is associated with poorer survival among patients with breast cancer and colorectal cancer.

This year’s Annual Report to the Nation continues the collaborative effort between the American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries.

CA: A Cancer Journal for Clinicians | Volume 61, Issue 2, pages 69–90, March/April 2011

Global cancer statistics Ahmedin Jemal DVM, PhD, Freddie Bray PhD, Melissa M. Center MPH, Jacques Ferlay ME, Elizabeth Ward PhD, David Forman PhD

Read this article for an overview of the global cancer burden, including the estimated number of new cancer cases and deaths in 2008 and the incidence and mortality rates by region for selected cancer sites. These statistics are based on GLOBOCAN 2008, the standard set of worldwide estimates of cancer incidence and mortality produced by the International Agency for Research on Cancer.

health campaigns promoting the benefits of physical activity and healthy diets. Reading this article, you’ll not only learn about current cancer trends, but also how you can participate in the fight against cancer.

As the authors note, a substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination for liver and cervical cancers, and early detection and treatment. In addition, there is a clear need for more widespread public

CA: A Cancer Journal for Clinicians | Volume 61, Issue 6, pages 408–418, November/December 2011

Breast cancer statistics, 2011 Carol DeSantis MPH, Rebecca Siegel MPH, Priti Bandi MS, Ahmedin Jemal DVM, PhD

Excluding skin cancers, breast cancer is the most common malignancy among women, accounting for nearly one in three cancers diagnosed among women in the United States. Moreover, it is the second leading cause of cancer death among women. This important review brings you up to date on the latest trends in incidence, mortality, and survival for female breast cancer in the United States. It also examines trends in mammography screening, survival, and mortality by

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socioeconomic status, as well as state variations in breast cancer incidence, mortality, and screening rates.

Among the many issues, the report notes that screening rates continue to be lower among poor women, despite overall progress in the use of mammography. In 2008, for example, 51% of poor women had undergone a screening mammogram in the past two years compared with 73% of non-poor women.

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Epidemiology, con’t. CA: A Cancer Journal for Clinicians | Volume 62, Issue 1, pages 10–29, January/February 2012

Cancer statistics, 2012 Rebecca Siegel MPH, Deepa Naishadham MA, MS, Ahmedin Jemal DVM, PhD

Discover the latest trends, statistics, and projections in cancer. This article estimates the number of new cancer cases and deaths in 2012 both nationally and by state. Moreover, it provides an excellent overview of current cancer trends using the most recent available data through 2008, including incidence, mortality, and survival rates. According to the ACS, a total of 1,638,910 new cancer cases

and 577,190 deaths from cancer are projected to occur in the United States in 2012. Reviewing historical data, the ACS found that death rates continue to decline for all four major cancer sites (lung, colorectum, breast, and prostate), with lung cancer accounting for almost 40% of the total decline in men and breast cancer accounting for 34% of the total decline in women. Most importantly, reading the full article will help you better understand and identify who is most at risk.

Gastrointestinal Tract Cancer | Volume 117, Issue 8, pages 1640–1648, 15 April 2011

Risk of colorectal cancer in self-reported inflammatory bowel disease and modification of risk by statin and NSAID use N. Jewel Samadder MD, Bhramar Mukherjee PhD, Shu-Chen Huang MS, Jaeil Ahn MS, Hedy S. Rennert MPH, Joel K. Greenson MD, Gad Rennert MD, Stephen B. Gruber MD, PhD

Statins and nonsteroidal anti-inflammatory drugs have been linked to a reduced risk of colorectal cancer in some studies. In this study, the authors investigated the relative risk of inflammatory bowel disease as a risk factor for colorectal cancer. Moreover, they examined whether this risk could be modified by long-term use of statins or nonsteroidal antiinflammatory drugs. Comparing 1,921 matched pairs of colorectal cancer cases and controls, the authors found that a self-reported history of inflammatory bowel disease was associated with a 1.9-fold

increased risk of colorectal cancer. On the other hand, longterm statin use was associated with a reduced risk of both inflammatory bowel disease-associated colorectal cancer and non-inflammatory bowel disease-associated colorectal cancer. The authors noted that additional evidence from population-based studies should help quantify the risk of colorectal cancer in inflammatory bowel disease patients, offer prognostic information, and determine appropriate surveillance algorithms based on risk level.

Cancer | Volume 117, Issue 15, pages 3342–3351, 1 August 2011

Intensity-modulated radiation therapy versus conventional radiation therapy for squamous cell carcinoma of the anal canal Jose G. Bazan MD, MS, Wendy Hara MD, Annie Hsu PhD, Pamela A. Kunz MD, James Ford MD, PhD, George A. Fisher MD, PhD, Mark L. Welton MD, Andrew Shelton MD, Daniel S. Kapp MD, Albert C. Koong MD, PhD, Karyn A. Goodman MD, Daniel T. Chang MD

The treatment of squamous cell carcinoma of the anal canal has evolved from the abdominoperineal resection to sphincterpreserving nonsurgical therapy with concurrent radiation therapy and chemotherapy. In addition to the primary tumor, the pelvic and perirectal lymph nodes also require treatment, leading to irradiation of bowel, bladder, and bone marrow as well as the external skin and genitalia. As a result, the risk of acute toxicity is high, often leading to interruptions in radiation and extending the overall treatment time. Intensity-modulated radiation therapy, using inverseplanning that varies beam intensities, allows radiation-dose Wiley-Blackwell

delivery while sparing adjacent normal tissues. In this study, the authors compared the toxicity and clinical outcome of patients with squamous cell carcinoma of the anal canal treated with intensity-modulated radiation therapy versus conventional radiotherapy. The results indicated that the use of intensity-modulated radiation therapy was associated with less toxicity, reduced need for treatment breaks, and excellent locoregional control and overall survival compared with conventional radiotherapy.

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Gastrointestinal Tract, con’t. Cancer | Volume 117, Issue 16, pages 3703–3712, 15 August 2011

Randomized phase 3 trial comparing preoperative and postoperative chemoradiotherapy with capecitabine for locally advanced rectal cancer Jin-hong Park MD, Sang Min Yoon MD, PhD, Chang Sik Yu MD, PhD, Jong Hoon Kim MD, PhD, Tae Won Kim MD, PhD, Jin Cheon Kim MD, PhD

Although many trials have shown the efficacy of preoperative chemoradiotherapy or postoperative chemoradiotherapy compared with surgery alone, the optimal sequence of radiotherapy and surgery has remained unclear. This single institution prospective randomized phase 3 trial focused on the treatment of advanced rectal cancer, comparing the outcomes of preoperative chemoradiotherapy with postoperative chemoradiotherapy.

To perform this study, 240 patients with locally advanced rectal cancer were randomly assigned to receive preoperative

or postoperative chemoradiotherapy. In addition, a total mesorectal excision was performed.

After a median follow-up of 52 months, the three- and fiveyear disease-free survival, overall survival, and cumulative incidence of local recurrence were similar for both patient groups. Acute and late complication rates were also similar in both groups. On the other hand, patients with low-lying tumors who received preoperative chemoradiotherapy had a higher rate of sphincter preservation.

Cancer | Volume 117, Issue 17, pages 3908–3916, 1 September 2011

Improved survival in patients with lymph node-positive gastric cancer who received preoperative radiation Ravi Shridhar MD, PhD, George W. Dombi PhD, Steven E. Finkelstein MD, Kenneth L. Meredith MD, Sarah E. Hoffe MD

Studies from the Surveillance, Epidemiology, and End Results database have investigated the survival impact of postoperative radiotherapy, but have not examined the impact of preoperative radiotherapy. The authors of this study theorized that preoperative radiotherapy offered advantages, including enhanced delivery of radiosensitizing chemotherapy and increased response due to the presence of aerated cells. To test this theory, the authors studied the overall survival rates of a group of patients who had nonmetastatic, resected

gastric cancer, comparing the outcomes of patients who had received preoperative radiotherapy, postoperative radiotherapy, and no radiotherapy at all.

In general, the authors found no survival benefit for patients who received preoperative or postoperative radiotherapy compared with patients who had not received any radiotherapy. They did, however, find an association between the receipt of preoperative radiotherapy and improved survival outcomes in patients with lymph nodepositive gastric cancer.

Cancer Cytopathology | Volume 119, Issue 1, pages 27–36, 25 February 2011

Endoscopic ultrasound-guided paracentesis of ascitic fluid Rooba Wardeh MD, John G. Lee MD, Mai Gu MD, PhD

Endoscopic ultrasound-guided fine needle aspiration has been proven to be highly sensitive and specific in the diagnosis of malignant neoplasms of the gastrointestinal tract, liver, pancreas, lymph nodes, and other non-gastrointestinal organs. In patients with these malignant neoplasms, the identification of malignant cells in the ascitic fluid signifies distant metastasis and advanced disease with poor prognosis, typically precluding surgical resection of the primary tumors. In this study, the authors sought to evaluate the accuracy and the cytologic features of endoscopic ultrasound-guided paracentesis for the diagnosis and staging of malignant neoplasms.

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In order to perform the study, the authors reviewed all 101 endoscopic ultrasound-guided paracenteses of ascitic fluid performed at the University of California Irvine Medical Center between January 2003 and February 2006. The results of the study indicated that endoscopic ultrasound-guided paracentesis is a valuable aid in the cytologic diagnosis of malignant ascites. Most notably, it is particularly useful when no abnormality is identified by prior computed tomography.

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Genetics CA: A Cancer Journal for Clinicians | Volume 61, Issue 5, pages 327–359, September/October 2011

Genetics, genomics, and cancer risk assessment Jeffrey N. Weitzel MD, Kathleen R. Blazer EdD, MS, CGC, Deborah J. MacDonald PhD, RN, APNG, Julie O. Culver MS, CGC, Kenneth Offit MD, MPH

This article reviews the evolution of scientific discovery in cancer genetics and genomics, describing current approaches, benefits, and barriers to translating scientific breakthroughs into the practice of preventive medicine. Given the experiences and lessons learned in the genetics era, the authors conclude that the multidisciplinary model of genetic cancer risk assessment and management will serve as a solid foundation to support the integration of personalized genomic information into the practice of cancer medicine.

By analyzing the lessons learned during the development of genetic cancer risk assessment and management, this article sets forth the challenges currently faced by practitioners seeking to integrate genomic technologies into medical practice. As the article states, “the future of personalized medicine is now.” Read the full article to see how decades of scientific discovery have impacted and will impact clinical practice.

CA: A Cancer Journal for Clinicians | Volume 62, Issue 2, pages 71–72, March/April 2012

Researchers find discordance between standard human epidermal growth factor receptor 2 (HER2) testing and HER2 status reported on Oncotype DX Mary Kay Barton MD

This is important information for all laboratory directors and clinicians who deal with breast cancer. Researchers at the University of Pittsburgh have conducted an assessment of concordance between human epidermal growth factor receptor 2 (HER2) status found by the Oncotype DX test and HER2 status as determined by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Their data suggest that the Oncotype DX test may be falsely negative for HER2 status in a substantial number of breast

cancer cases found to be positive by a guideline-specified combination of IHC and FISH assays.

According to the study’s authors, this is the first independent study of concordance between the HER2 status reported on the Oncotype DX RT-PCR assay and IHC/FISH testing in a high-volume laboratory. Read the full perspective for details on the study’s findings and what they may mean for breast cancer patient diagnosis and care.

CA: A Cancer Journal for Clinicians | Volume 62, Issue 3, pages 145-146, May/June 2012

No risk of genetic disease in childhood cancer survivors’ offspring found Mary Kay Barton MD

There is good news for childhood cancer survivors and their children. Two recent publications suggest that childhood exposure to potentially mutagenic radiation and chemotherapy agents does not significantly increase the risk of congenital anomalies or genetic disease in the offspring of those patients.

This article reviews both the Childhood Cancer Survivor Study, which included 4,699 children of 2,755 childhood cancer survivors, and the Danish Registry of Childhood Cancer Study, which surveyed 1,037 children of 472 childhood cancer survivors.

The two studies managed to overcome the major limitations of earlier studies by including larger cohorts and more detailed cancer treatment information such as gonadal radiation doses and drug treatments and dosage. Genetic counselors and clinicians working with childhood cancer survivors should read the full article for details.

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Genetics, con’t. Cancer Cytopathology | Volume 119, Issue 2, pages 103–110, 25 April 2011

Preservation of fine-needle aspiration specimens for future use in RNA-based molecular testing Amy C. Ladd PhD, Emerald O’Sullivan-Mejia MD, Tasha Lea MS, PA (ASCP), Jessica Perry MS, PA, Catherine I. Dumur PhD, Ema Dragoescu MD, Carleton T. Garrett MD, PhD, Celeste N. Powers MD, PhD

The application of ancillary molecular testing is becoming more important for the diagnosis and classification of disease. Moreover, the use of fine-needle aspiration biopsy as the means of sampling tumors in conjunction with molecular testing has the potential to be a powerful combination. This study evaluated cryopreservation of fine-needle aspiration specimens in order to maintain the cellular morphology and RNA integrity needed for effective molecular testing.

In order to perform the research, the authors collected fineneedle aspiration specimens from fresh tumor resections.

These specimens were then processed using a cryopreservation protocol and stored. Upon retrieval, samples were made into slides for morphological evaluation, with RNA extracted and assessed for integrity.

The authors found that fine-needle aspiration specimens can be stored in a manner that maintains the cellular morphology and RNA integrity necessary for studies of gene expression. In addition, the authors noted that cytology banks will be an invaluable resource for future molecular morphologic and diagnostic research studies.

Genitourinary & Prostate Cancer Cancer | Volume 117, Issue 6, pages 1172–1182, 15 March 2011

Recurrence-free survival in prostate cancer is related to increased stromal TRAIL expression Mariam Anees MPhil, Peter Horak MD, Ahmed El-Gazzar PhD, Martin Susani MD, Georg Heinze PhD, Paul Perco PhD, Massimo Loda MD, Rosina Lis MD, Michael Krainer MD, William K. Oh MD

TRAIL (tumor necrosis factor related apoptosis-inducing ligand) is involved in tumor immune surveillance and therefore may play a role in cancer therapy. In particular, TRAIL expression in the tumor microenvironment has been shown to impact cancer survival in multiple tumor types. In this important study, the authors studied TRAIL expression and outcomes in patients with prostate cancer.

To perform the study, tissue microarrays from 200 prostate cancer patients and from benign prostate tissue controls were used to assess the epithelial and stromal protein expression of TRAIL, death receptors, decoy receptors, and the FLICE

inhibitory protein. The authors then correlated these expression patterns with clinicopathological parameters to determine their impact on recurrence-free survival.

The authors found that expression of the components of the pro-apoptotic TRAIL pathway is altered in prostate cancer. Moreover, they determined that TRAIL expression in the tumor microenvironment may affect recurrence-free survival rate of prostate cancer patients. Coupled with additional research, these results may lead to the development of effective therapeutic strategies for prostate cancer.

Cancer Cytopathology | Volume 119, Issue 4, pages 279–289, 25 August 2011

Digitized microscopy in the diagnosis of bladder cancer William A. Marganski PhD, Vanessa El-Sirgany Costa BS, Michael W. Kilpatrick PhD, Triantafyllos Tafas PhD, Joon Yim MD, Michael Matthews MS

Because of the limitations of urine cytology and bladder cystoscopy, molecular biomarker techniques are often used as an adjunct in diagnosing urothelial carcinomas. This article describes the performance characteristics of the oncoFISH bladder Test System, based on the analysis of 3,200 slides containing urine specimens. First, the authors explain the system’s scanning process, then they describe the overall throughput and day-today scanning performance. Next, the scanning accuracy is 14 American Cancer Society Family of Journals

evaluated, providing clinically relevant data that eliminates the need for a manual slide review. Finally, the effects of the quality of the slide preparation are investigated.

This study demonstrates the value of an automated approach to the analysis of FISH slides, affording the benefit of highthroughput while providing cytologists with the necessary images and tools to quickly and accurately report a urothelial carcinoma. Wiley-Blackwell


Guidelines Cancer Cytopathology | Volume 119, Issue 5, pages 310–314, 25 October 2011

Coding changes in the United States front and center Diane Davis Davey MD, Margaret Havens Neal MD

Cytology Current Procedural Terminology (CPT) codes have been front and center within the past year, with changes to several key cytology codes now in effect. Cytologists and cytopathologists need to be aware of the recent changes to receive appropriate payments for services as quickly and efficiency as possible. In this commentary, the authors explain recent changes to cytology CPT codes, including how these changes affect both reimbursement and the services offered to patients and other providers.

On the positive side, the authors point to the new code 88177, which allows laboratories to at least partially account for the significant time and effort spent in radiologic and endoscopic procedures. On the other hand, the authors note that the new dedicated urine in situ hybridization codes will result in lower laboratory payments.

CA: A Cancer Journal for Clinicians | Volume 62, Issue 4, July/August 2012

Nutrition and physical activity guidelines for cancer survivors Cheryl L. Rock PhD, RD, Colleen Doyle MS, RD, Wendy Demark-Wahnefried PhD, RD, Jeffrey Meyerhardt MD, MPH, Kerry S. Courneya PhD, Anna L. Schwartz FNP, PhD, FAAN, Elisa V. Bandera MD, PhD, Kathryn K. Hamilton MA, RD, CSO, CDN, Barbara Grant MS, RD, CSO, LD, Marji McCullough ScD, RD, Tim Byers MD, MPH, Ted Gansler MD, MBA, MPH

Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplements to improve their treatment outcomes, quality of life, and overall survival.

To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer survivorship to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity.

The report discusses nutrition and physical activity guidelines during the continuum of cancer care, briefly highlighting important issues during cancer treatment and for patients with advanced cancer, but focusing largely on the needs of the population of individuals who are disease free or who have stable disease following their recovery from treatment. It also discusses select nutrition and physical activity issues such as body weight, food choices, food safety, and dietary supplements; issues related to selected cancer sites; and common questions about diet, physical activity, and cancer survivorship.

CA: A Cancer Journal for Clinicians | Volume 62, Issue 3, pages 147-172, May/June 2012

American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer Debbie Saslow PhD, Diane Solomon MD, Herschel W. Lawson MD, Maureen Killackey MD, Shalini L. Kulasingam PhD, Joanna Cain MD, Francisco A. R. Garcia MD, MPH, Ann T. Moriarty MD, Alan G. Waxman MD, MPH, David C. Wilbur MD, Nicolas Wentzensen MD, PhD, MS, Levi S. Downs Jr MD, Mark Spitzer MD, Anna-Barbara Moscicki MD, Eduardo L. Franco DrPH, Mark H. Stoler MD, Mark Schiffman MD, Philip E. Castle PhD, MPH1, Evan R. Myers MD, MPH, ACS-ASCCP-ASCP Cervical Cancer Guideline Committee

Screening works. Since the introduction of cervical cytology screening in the United States, cervical cancer, once the most frequent cause of cancer death in women, now ranks 14th for cancer deaths.

This update to the American Cancer Society’s guidelines for cervical cancer screening is based on a systematic evidence review, contributions from six working groups, and a symposium co-sponsored by the American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology. The new Wiley-Blackwell

screening recommendations address such factors as ageappropriate screening strategies, the use of cytology and HPV testing, and follow-up.

These screening recommendations reflect best evidencebased practices for the prevention of cervical cancer morbidity and mortality through currently available screening tests that maximize protection against cervical cancer while minimizing the potential harms associated with false-positive results and overtreatment. American Cancer Society Family of Journals 15


Guidelines, con’t. CA: A Cancer Journal for Clinicians | Volume 62, Issue 1, pages 30–67, January/February 2012

American Cancer Society guidelines on nutrition and physical activity for cancer prevention Lawrence H. Kushi ScD, Colleen Doyle MS, RD, Marji McCullough ScD, RD, Cheryl L. Rock PhD, RD, Wendy Demark-Wahnefried PhD, RD, Elisa V. Bandera MD, PhD, Susan Gapstur PhD, MPH, Alpa V. Patel PhD, Kimberly Andrews, Ted Gansler MD, MBA, MPH, The American Cancer Society 2010 Nutrition and Physical Activity Guidelines Advisory Committee

The American Cancer Society’s Nutrition and Physical Activity Guidelines, published approximately every 5 years, reflect the most current scientific evidence that connect diet and physical activity to cancer risk. The guidelines focus on four areas: • Achieving and maintaining healthy body weight • Adopting a physically active lifestyle

• Consuming a healthy, mostly plant-based diet • Limiting alcohol consumption

These guidelines are clearly written, making them easy to explain to patients. Moreover, the guidelines are accompanied by recommendations for community action and involvement, recognizing that a supportive environment is indispensable if individuals at all levels of society are to have genuine opportunities to understand and adopt healthy behaviors.

Gynecologic Cancer Cancer | Volume 117, Issue 7, pages 1438–1445, 1 April 2011

Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia Laurie Elit MD, Mark N. Levine MD, Jim A. Julian MMath, John W. Sellors MD, Alice Lytwyn MD, Sylvia Chong BSc, James B. Mahony PhD, ChuShu Gu MSc, Terri Finch BA, Luiz C. Zeferino PhD

Important information for the treatment of cervical cancer: currently, the optimal management strategy for women with low-grade biopsy-proven cervical intraepithelial neoplasia is not clear. In this study, the authors compared the effectiveness of regular colposcopic follow-up and treatment of progressive disease only versus immediate treatment. To perform the study, the authors collected data from 415 women with biopsy-proven grade 1 cervical intraepithelial neoplasia. Subjects were randomly assigned to either undergo immediate treatment with a loop electrical excision 16 American Cancer Society Family of Journals

procedure or receive regular colposcopic follow-up for 18 months. The authors found that the risk of progression to cervical intraepithelial neoplasia grade 2 or 3 or cancer over 18 months was similar in both treatment groups. They therefore concluded that follow-up for 18 months is a reasonable management strategy for women with persistent low-grade cytology. They did note that this strategy did increase inconvenience, anxiety, and noncompliance among some patients. Wiley-Blackwell


Gynecologic Cancer, con’t. Cancer Cytopathology | Volume 119, Issue 4, pages 228–234, 25 August 2011

Use of high-risk human papillomavirus testing in patients with low-grade squamous intraepithelial lesions Angelique W. Levi MD, Malini Harigopal MD, Pei Hui MD, PhD, Kevin Schofield CT (ASCP), David C. Chhieng MD, MBA

The role and value of testing for high-risk HPV when triaging women with a cytologic diagnosis of low-grade squamous intraepithelial lesions has not been well established. The authors of this study sought to correlate the status of highrisk HPV and the subsequent detection of high-grade dysplasia in women with low-grade squamous intraepithelial lesions. They also examined whether age stratification and high-risk HPV viral load quantification are clinically useful parameters when triaging women with low-grade squamous intraepithelial lesions.

High-risk HPV testing was performed using the Hybrid Capture 2 assay with 1 relative light unit/cutoff.

High-risk HPV testing was found to be highly sensitive for detecting CIN 2+ lesions in women with low-grade squamous intraepithelial lesions. Moreover, the colposcopy rate was significantly lower in women aged 30 years and older compared with women younger than 30. Triaging with high-risk HPV testing therefore may be indicated for women who are over 30.

To perform this study, a total of 1,046 women with lowgrade squamous intraepithelial lesions were identified. Cancer Cytopathology | Volume 119, Issue 4, pages 219–227, 25 August 2011

Testing for human papillomavirus in cervical cancer screening Ha Thanh Nishino MD, Rosemary H. Tambouret MD, David C. Wilbur MD

This important review explores current testing options for high-risk HPV as well as emerging options that have the potential to enhance cervical cancer screening. The authors note that although high-risk HPV testing is not presently recommended for primary screening by itself, preliminary studies have suggested that it may have superior sensitivity compared with cervical cytology for the detection of highgrade cervical intraepithelial neoplasia or cancer.

In addition to advances surrounding high-risk HPV DNA detection, the authors review molecular diagnostic assays for other disease-specific markers for cervical cancer. These markers have the potential to be more specific for highgrade lesions, as they test for targets that have been altered or expressed as the result of oncogenic mechanisms. Such markers could potentially be much more powerful than highrisk HPV testing alone because they identify a more discrete population of at-risk patients.

Head & Neck Cancer | Volume 117, Issue 19, pages 4439–4446, 1 October 2011

Rising incidence of second cancers in patients with low-risk (T1N0) thyroid cancer who receive radioactive iodine therapy N. Gopalakrishna Iyer MD, PhD, Luc G. T. Morris MD, R. Michael Tuttle MD, Ashok R. Shaha MD, Ian Ganly MD, PhD

The American Thyroid Association guidelines recommend the selective use of radioactive iodine therapy in patients with well differentiated thyroid cancer. Despite these guidelines, radioactive iodine therapy ablation is routinely used in all but the very lowest risk patients with thyroid cancer. In this study, the authors evaluated patterns of radioactive iodine therapy use in relation to the elevated risk of secondary primary malignancies in patients with low-risk well differentiated thyroid cancer.

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The authors examined data from 37,176 patients diagnosed with well differentiated thyroid cancer between 1973 and 2007. During the study period, the rate of radioactive iodine therapy use increased from 3.3% to 38.1%. Moreover, the authors found that there was an associated increased risk of a secondary primary malignancies in these patients. Given the lack of data demonstrating improved survival outcomes with adjuvant radioactive iodine therapy, the authors recommend careful rationing of radioactive iodine therapy for this patient population. American Cancer Society Family of Journals 17


Hematology Cancer Cytopathology | Volume 119, Issue 2, pages 118–126, 25 April 2011

The utility of endobronchial ultrasound-guided transbronchial needle aspiration biopsy in the diagnosis of mediastinal lymphoproliferative disorders Carrie B. Marshall MD, Betsy Jacob CT(ASCP), Shobhana Patel BS, CT(ASCP), Nour Sneige MD, Carlos A. Jimenez MD, Rudolph C. Morice MD, Nancy Caraway MD

Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is routinely used to stage lung cancer; however, its usefulness in diagnosing lymphoproliferative disorders has not been well established. A common belief is that it does not yield enough material for a full lymphoma workup even though studies have shown that many cases can be accurately diagnosed by fine-needle aspiration biopsy when the results are interpreted along with those of ancillary studies. In this retrospective study, the authors investigated the utility of endobronchial ultrasound-guided transbronchial

needle aspiration in evaluating mediastinal lymphadenopathy in patients with suspected lymphoproliferative disorders.

The study’s results indicate that endobronchial ultrasoundguided transbronchial needle aspiration is useful for evaluating mediastinal lymphadenopathy in patients with suspected lymphoproliferative disorders. Moreover, its use may offer the benefit of decreasing the need for invasive diagnostic procedures.

Cancer Cytopathology | Volume 119, Issue 4, pages 263–271, 25 August 2011

Cytopathology of “double-hit” non-Hodgkin lymphoma Camille T. Elkins MD, Paul E. Wakely Jr MD

Double-hit lymphomas (i.e., B-cell lymphomas with concurrent IGH-BCL2 and c-MYC rearrangements) fall into a rare, recently described category in the 2008 World Health Organization classification of hematopoietic neoplasms. Unfortunately, survival outcomes are poor. In this study, the authors reviewed files of cytogenetically documented double-hit lymphoma to determine whether there were any identifiable cytologic features that would facilitate its recognition. A total of 12 fine-needle aspirates, 2 pleural

fluids, and 1 touch imprint of cytogenetically proven doublehit lymphoma were examined.

The authors found that no specific cytomorphologic features were found to reliably identify double-hit lymphoma using either fine-needle aspiration or exfoliative cytology. Furthermore, because no distinctive cytomorphologic features led to a specific diagnosis, they recommend that a combination of bcl-2 and Ki-67 staining would be helpful in guiding further testing.

Hepatobiliary Disease Cancer | Volume 117, Issue 19, pages 4484–4492, 1 October 2011

Is resection of colorectal liver metastases after a second-line chemotherapy regimen justified? Antoine Brouquet MD, Michael J. Overman MD, Scott Kopetz MD, PhD, Dipen M. Maru MD, PhD, Evelyne M. Loyer MD, Andreas Andreou MD, Amanda Cooper MS, Steven A. Curley MD, Christopher R. Garrett MD, Eddie K. Abdalla MD, Jean-Nicolas Vauthey MD

The results of this study show that hepatectomy after a second-line chemotherapy regimen is feasible and associated with a modest survival benefit in patients who have colorectal liver metastases and who also have had a suboptimal response to systemic therapy. Although oncologic outcomes are not as good as previously reported following resection of colorectal liver metastases after first-line chemotherapy, resection of colorectal liver metastases after a second-line chemotherapy regimen can be associated with prolonged survival and a chemotherapy-free interval. 18 American Cancer Society Family of Journals

To the authors’ knowledge, this study is the largest one that evaluates outcomes of patients undergoing resection of colorectal liver metastases after a second-line chemotherapy regimen. Based on the results of the study, the authors believe that resection of colorectal liver metastases after a secondline chemotherapy regimen is an alternative to maintenance chemotherapy in patients with advanced disease, offering some survival benefit.

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Hepatobiliary Disease, con’t. Cancer | Volume 117, Issue 21, pages 4890–4904, 1 November 2011

Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma Shohei Komatsu MD, Takumi Fukumoto MD, PhD, Yusuke Demizu MD, PhD, Daisuke Miyawaki MD, PhD, Kazuki Terashima MD, Ryohei Sasaki MD, PhD, Yuichi Hori MD, PhD, Yoshio Hishikawa MD, PhD, Yonson Ku MD, PhD, Masao Murakami MD, PhD

Hepatocellular carcinoma is the fifth leading cause of cancer death worldwide, with the majority of patients in Asian countries. The authors of this study set out to evaluate and compare the clinical outcome of proton therapy and carbon ion therapy for hepatocellular carcinoma patients. Compared to radiotherapy, proton and carbon ion beams have the ability to deliver tumor doses without increasing toxicity to the surrounding noncancerous tissues and organs.

While there have been studies of proton therapy, few studies have reported results of carbon ion therapy for hepatocellular

carcinoma. Moreover, this is the first published study to compare the results of both types of therapy.

In order to conduct the study, the authors evaluated 343 patients: 242 who received proton therapy and 101 who received carbon ion therapy. The authors found that proton and carbon ion therapies for hepatocellular carcinoma were comparable in terms of both local control and overall survival rates. These therapies therefore may represent better alternatives to conventional local therapies.

Lung Cancer Cancer | Volume 117, Issue 22, pages 5103–5111, 15 November 2011

Prognostic influence of metformin as first-line chemotherapy for advanced nonsmall cell lung cancer in patients with type 2 diabetes Ben-Xu Tan MD, Wen-Xiu Yao MD, Jun Ge MD, Xing-Chen Peng MD, Xiao-Bo Du MD, Ru Zhang MD, Bin Yao MD, Ke Xie MD, Long-Hao Li MD, Hang Dong MD, Feng Gao MD, Feng Zhao MD, Jian-Mei Hou MD, Jing-Mei Su MD, Ji-Yan Liu MD

Studies have indicated that antidiabetic drugs affect the risk of cancer and the prognosis of cancer patients with diabetes, but few studies have demonstrated the influence of individual antidiabetic drugs on outcomes following anticancer therapy. In this study, the authors set out to evaluate the effect of the antidiabetic drugs metformin and insulin on the prognosis of patients with both advanced nonsmall cell lung cancer and type 2 diabetes who had received first-line chemotherapy. To perform the study, the authors analyzed data collected from five hospitals in China on 99 patients. The results

indicated that chemotherapy plus metformin produced superior results compared with chemotherapy plus insulin in terms of both progression-free survival and overall survival. It also produced superior results compared with chemotherapy plus drugs other than metformin or insulin. Moreover, no significant difference in survival was observed between patients receiving chemotherapy and insulin versus patients receiving chemotherapy and drugs other than metformin or insulin.

Cancer | Volume 117, Issue 23, pages 5344–5350, 1 December 2011

An E3 ubiquitin ligase: c-Cbl Fang-Yi Lo MS, Yi-Hung Carol Tan PhD, Hung-Chi Cheng PhD, Ravi Salgia MD, Yi-Ching Wang PhD

Casitas B-lineage lymphoma (Cbl) is an E3 ubiquitin ligase of many tyrosine kinase receptors. The authors of this study had previously detected c-Cbl mutation and low protein expression in nonsmall cell lung cancer. They therefore hypothesized that overexpression of wild-type c-Cbl exhibits tumor growth inhibition. To perform this study, wound healing and transwell assays were conducted to examine cell motility following wild-type c-Cbl transfection of nonsmall cell lung cancer cell lines. The cell cycle was investigated by flow cytometry. A549 and Wiley-Blackwell

H1299-Luc wild-type c-Cbl-transfected xenografts and experimental metastasis models were then performed to investigate tumor growth and metastasis inhibition. This study is the first to demonstrate that wild-type c-Cbl protein overexpression inhibits tumor metastasis and tumor growth in lung cancer xenograft models. Most importantly, the results provide evidence that ectopic expression of wildtype c-Cbl protein can be potentially applied as targeted therapy for the effective treatment of lung cancer.

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Lung Cancer, con’t. Cancer Cytopathology | Volume 119, Issue 2, pages 80–91, 25 April 2011

EGFR gene status in cytological samples of nonsmall cell lung carcinoma Gilda da Cunha Santos PhD, MD, FRCPC, Mauro Ajaj Saieg MD, PhD, William Geddie MD, FRCPC, Natasha Leighl MD, FRCPC

Read this review to gain a state-of-the-science understanding of the use of cytological specimens for EGFR testing in lung cancer. In order to develop a thorough review, the authors performed a systematic computerized search that identified 30 original research articles reporting the use of cytological samples for determining EGFR status in nonsmall cell lung cancer. An additional 19 reviews, consensus statements, and editorials were also selected. Examining the literature, the authors found strong evidence that cytological material is suitable for detecting EGFR status

using several different methodologies and preparations. The use of cytology specimens for molecular testing is both a challenge and an opportunity for pathologists to enhance patient care. The challenge lies in providing a mechanism by which adequate material can reproducibly be obtained for these important molecular studies. The authors commented that this could be achieved by having pathologists immediately evaluate specimens for adequacy and by using novel specimen-preservation techniques.

Cancer Cytopathology | Volume 119, Issue 2, pages 111–117, 25 April 2011

EGFR and KRAS mutations in lung carcinoma Shahreen Billah MD, John Stewart MD, Gregg Staerkel MD, Su Chen MD, Yun Gong MD, Ming Guo MD

Although attempts have been made to use routinely collected cytology specimens for molecular testing, including fineneedle aspiration biopsy and body fluids, most published studies have relied on cytology materials specifically collected and stored for molecular testing. If routine cytology specimens could be used, more invasive procedures needed to obtain sufficient tumor tissue for molecular testing could be reduced or avoided. To evaluate the clinical validity of using cytology specimens for molecular testing, the authors of this study worked with

cytology specimens (mainly smears and cell-block material) in lung cancer patients to detect EGFR and KRAS mutations with the use of molecular testing. Their findings—based on the analysis of 209 cytology specimens—do support clinical utilization of routinely prepared cytology specimens. This includes endobronchial ultrasound- and computed tomography-guided fine needle aspiration as well as body fluid specimens.

Cancer Cytopathology | Volume 119, Issue 3, pages 177–192, 25 June 2011

Equivocal cytology in lung cancer diagnosis Martin Schramm MD, Christian Wrobel, Ingmar Born, Marietta Kazimirek, Natalia Pomjanski MD, Marina William MD, Rainer Kappes MD, Claus Dieter Gerharz MD, PhD, Stefan Biesterfeld MD, PhD, Alfred Böcking MD, PhD

The results of this study may lead to earlier diagnosis of lung cancer and thus a better prognosis for lung cancer patients. Cytological lung cancer diagnosis is challenging because equivocal diagnoses are common. To enhance diagnostic accuracy, FISH, DNA-image cytometry, and quantitative promoter hypermethylation analysis have been proposed as adjuncts.

diagnostic accuracy at comparable rates. They also found that adjuvant quantitative methylation-specific polymerase chain reaction in cytologically negative cases with persistent suspicion of lung cancer enhanced sensitivity.

This prospective cohort study compared the potential benefit for improving diagnostic accuracy of routine pulmonary cytological diagnosis using LAVysion multicolor FISH, DNA-image cytometry, and quantitative methylationspecific polymerase chain reaction. The authors found that adjuvant FISH or DNA-image cytometry in cytologically equivocal diagnoses improves 20 American Cancer Society Family of Journals

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Lung Cancer, con’t. Cancer Cytopathology | Volume 119, Issue 5, pages 335–345, 25 October 2011

Comparison of the expression levels of napsin A, thyroid transcription factor-1, and p63 in nonsmall cell lung cancer using cytocentrifuged bronchial brushings Emiko Aikawa CT, Akihiko Kawahara PhD, Satoshi Hattori PhD, Tomohiko Yamaguchi CT, Hideyuki Abe CT, Tomoki Taira CT, Koichi Azuma MD, PhD, Masayoshi Kage MD, PhD

Newly developed target therapies call for nonsmall cell lung cancer patients to undergo different clinical treatments depending on whether or not they have an epidermal growth factor receptor mutation. As a result, histologic typing of nonsmall cell lung cancer has become critical. This study evaluates the expression levels of Napsin A, thyroid transcription factor-1, and p63 by immunostaining using CytoRich Red preserved cytocentrifuged bronchial brushings. Notably, this study represents the first attempt to use cytospin processing with CytoRich Red preserved cytocentrifuged bronchial brushings in respiratory cytology.

The authors found that immunostaining of bronchial brushings fixed with CytoRich Red was useful in determining histologic types in nonsmall cell lung cancer. In particular, they noted that the panels of Napsin A, thyroid transcription factor-1, and p63 were all effective in identifying histologic types. Moreover, they recommended that a combination of either Napsin A and p63 or thyroid transcription factor-1 and p63 should be chosen, depending on morphology.

Melanoma Cancer | Online Early View

Randomized, double-blind, placebo-controlled trial of Sulindac in individuals at risk for melanoma: evaluation of potential chemopreventive activity Clara Curiel-Lewandrowski MD, Susan M. Swetter MD, Janine G. Einspahr PhD, Chiu-Hsieh Hsu PhD, Ray Nagle MD, PhD, Paul Sagerman MD, Joseph Tangrea MPH, PhD, Howard Parnes MD, David S. Alberts MD, Hsiao-Hui Chow PhD

Melanoma is the fifth most common cancer in men and the seventh in women in the United States, with 70,230 newly diagnosed cases and 8,790 deaths anticipated in 2011. The increasing incidence of melanoma and its poor prognosis in advanced stages mandate the investigation of novel primary prevention approaches such as chemoprevention. To date, limited intervention trials have been conducted to evaluate potential chemopreventive agents for melanoma prevention. Individuals with atypical or dysplastic nevi have been targeted for chemoprevention efforts, because dysplastic nevi are the most important clinical marker of increased melanoma risk and can also serve as potential precursor lesions. This eight-week, randomized, double-blind, placebocontrolled trial of sulindac intervention resulted in high concentrations of sulindac sulfone, a proapoptotic metabolite, in BN but did not effectively modulate VEGFA and cleaved caspase-3 expression.

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Neuro-Oncology Cancer | Volume 117, Issue 11, pages 2505–2512, 1 June 2011

Presentation, patterns of care, and survival in patients with brain metastases Carsten Nieder MD, Oddvar Spanne PhD, Minesh P. Mehta MD, Anca L. Grosu MD, Hans Geinitz MD

In the past several years, new oncologic treatment options have become available for patients with brain metastases, but have they actually improved survival rates? The authors of this study performed a multi-institutional, time-staggered analysis to address this question. Two cohorts of patients were analyzed: one treated between 2005 and 2009 and the other between 1983 and 1989. The study shows that patterns of care for patients with brain metastases have changed significantly. The more recent cohort of patients received focal treatments such as

stereotactic radiosurgery and surgical resection far more frequently. Furthermore, systemic treatment was used more often in more recent patients, both before and after diagnosis of brain metastasis. Most importantly, improved survival was observed in the more recent cohort, with the one-year survival rate increasing from 15% to 34%. This improvement, however, was largely driven by patients with favorable prognostic features. As the authors note, “progress has been made, but the overall outcome needs to be improved further.”

Outcomes and Treatment Cancer | Volume 117, Issue 8, pages 1564–1574, 15 April 2011

The implications of the 2010 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act on cancer care delivery Heidi W. Albright MHA, Mark Moreno, Thomas W. Feeley MD, Ronald Walters MD, MBA, MHA, MS, Marc Samuels MPH, JD, Alissa Pereira MPH, Thomas W. Burke MD

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. Be sure to read this important review in order to better understand the law itself and its projected impact on cancer care providers and cancer patients and their families. In particular, the authors point to several provisions that remain unclear or have not been fully defined, including public reporting of quality measures, costs, and outcomes. Although healthcare reform is intended to improve quality of care through the development and implementation

of measures, reporting, and testing of different delivery systems and reimbursement models, the authors believe that the cancer care community must undertake a more in-depth analysis of practice variation, guideline measurement, volume providers, and inappropriate care across providers. They believe that it is crucial that examination of the act’s proposed programs and mandates continue so that the goal of increased quality, efficiency, and safety of care is reached.

Cancer Cytopathology | Volume 119, Issue 3, pages 148–157, 25 June 2011

From critical values to critical diagnoses Christopher N. Chapman MD, Christopher N. Otis MD

Identifying an important piece of information and telling someone who is in a position to act on this information seems simple; it happens every day. However, the impact of the success or failure of the process of identifying and communicating critical values in patient care is profound. In particular, this seemingly simple process becomes complex as a host of factors and variables are woven into the daily practice of clinical pathology, surgical pathology, and cytopathology. 22 American Cancer Society Family of Journals

This review, exploring the 40-year evolution of the concept of critical values, concludes with suggestions to enhance the operational success of critical value and diagnosis policies in cytopathology. These suggestions may also be applicable to anatomic pathology as a whole, leading to improved patient care and a reduction in medical errors. Most importantly, the authors note that “cooperation between key pathology and clinical organizations is essential for improvement in the critical value process.” Wiley-Blackwell


Outcomes and Treatment, cont’d. CA: A Cancer Journal for Clinicians | Volume 61, Issue 5, pages 315–326, September/October 2011

Prediction models in cancer care Andrew J. Vickers PhD

Discover the latest issues and controversies in cancer prediction models. Several prediction models are now widely used in clinical practice. With their ability to incorporate novel predictors such as genomic data, prediction models generally have greater accuracy than stage or risk groupings and are more useful for informing treatment decisions. This article begins with an overview of prediction modeling in cancer care, detailing its purported advantages. Next, the author discusses the evaluation of prediction models, describing some well-known examples, including the Prostate Cancer Prevention Trial risk calculator, Gail Model, Kattan nomogram, Adjuvant! Online, and ACCENT model. The author notes that the “literature is almost completely devoid of studies investigating the clinical implications of models,” so clearly research is needed to ensure that all cancer prediction models fulfill their promise.

Pediatric Oncology Cancer | Volume 117, Issue 3, pages 625–634, 1 February 2011

Twenty years of follow-up of survivors of childhood osteosarcoma Rajaram Nagarajan MD, MS, Anmmd Kamruzzaman MSc, Kirsten K. Ness PhD, PT, Victoria G. Marchese PhD, PT, Charles Sklar MD, Ann Mertens PhD, Yutaka Yasui PhD, Leslie L. Robison PhD, Neyssa Marina MD

In this study, the authors assessed the long-term outcomes of 733 five-year survivors of childhood osteosarcoma in order to provide a comprehensive evaluation of medical and psychosocial outcomes for survivors. The results showed that the overall survival of children diagnosed with osteosarcoma who had survived five years at 20 years from original diagnosis was 88.6%. Overall, 86.9% of osteosarcoma survivors experienced at least one chronic medical condition, with more than 50% experiencing two or more chronic medical conditions. Compared with survivors of other cancers, osteosarcoma survivors were more likely to report an adverse

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health status in at least one domain, with activity limitation being the most common.

Given that childhood cancer is relatively rare, and young adult survivors do not always return to their treatment center for long-term follow-up, a single institution typically does not have sufficient patients to draw firm conclusions about long-term outcomes. This multi-institutional study of individuals surviving five or more years after treatment for childhood cancer provided a unique opportunity to assess the outcomes of long-term survivors of pediatric osteosarcoma.

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Pediatric Oncology, cont’d. Cancer | Volume 117, Issue 18, pages 4294–4303, 15 September 2011

The met and unmet health care needs of adult survivors of childhood central nervous system tumors Emma Hovén PhD, Birgitta Lannering MD, PhD, Göran Gustafsson MD, PhD, Krister K. Boman PhD

Are we meeting the needs of childhood cancer survivors? Survivors of childhood cancer typically require more follow-up health care compared to general populations because of their heightened susceptibility to late effects, some of which may only become apparent several years after the end of treatment. The authors of this study sought to discover whether the health care needs of adult survivors of childhood cancer were being met, focusing on a group of survivors of childhood central nervous system tumors. Surveying 526 survivors and 550 parents, the authors used a questionnaire to assess four core areas of health care needs: medical care, care coordination and communication, illness education, and psychosocial services. The results of the survey indicated that approximately 40% of survivors felt that their health care needs exceeded the general population’s needs. Moreover, 41% had a current health care need that was unmet. The most common unmet need was a lack of psychosocial services, followed by a lack of illness education.

Screening/Early Detection CA: A Cancer Journal for Clinicians | Volume 61, Issue 6, pages 397–408, November/December 2011

Promoting cancer screening within the patient centered medical home Mona Sarfaty MD, MPH, Richard Wender MD, Robert Smith PhD

The Patient Centered Medical Home seeks to reinvent primary care practice. It sets forth a comprehensive approach to primary care, a personal relationship with a physicianled team that has collective responsibility for the patient’s needs in a manner that is coordinated and enhanced with supporting systems. Moreover, it sets forth a reimbursement approach that pays the cost of these systems.

integration of cancer screening and other preventive services. The authors explore such issues as the need for improved patient access and communication, health risk assessments, periodic preventive health exams, and use of registries that store cancer risk information and screening histories. Moreover, they stress the need for payment models that reward cancer screening.

This article explores capacities that are needed in the Patient Centered Medical Home model in order to facilitate the

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Screening/Early Detection, cont’d. CA: A Cancer Journal for Clinicians | Volume 62, Issue 2, pages 129–142, March/April 2012

Cancer screening in the United States, 2012 Robert A. Smith PhD, Vilma Cokkinides PhD, Otis W. Brawley MD

Screening is at the frontlines of cancer care, enabling clinicians to detect many cancers early when they are most treatable. Each year, the American Cancer Society publishes a summary of its cancer screening guidelines, helping you identify who will benefit from screening based on the latest clinical evidence. According to this report, national guidelines for average-risk adults endorse regular screenings for breast cancer, cervical cancer, and colorectal cancer based on clear evidence that screening reduces morbidity and mortality. At this time, informed and/or shared decision-making is recommended for adults considering prostate cancer screening based on the uncertainty of the balance of benefits and harms. Lung cancer screening guidelines are presently under development; however, the ACS has issued interim guidance for the general public and health care professionals.

Survivorship CA: A Cancer Journal for Clinicians | Volume 62, Issue 2, pages 101–117, March/April 2012

Survivorship care plans in research and practice Talya Salz PhD, Kevin C. Oeffinger MD, Mary S. McCabe RN, MA, Tracy M. Layne MPH, Peter B. Bach MD, MAPP

The Institute of Medicine recommends the use of survivorship care plans to ease the challenges of cancer survivorship. These survivorship care plans are personalized documents provided by the coordinating oncology clinician that summarize the patient’s diagnosis and treatment and describe possible late effects. Moreover, they recommend ongoing care and offer resources for addressing practical issues in survivorship care.

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The use of survivorship care plans was proposed in 2005. Since then, important questions have been raised. Do survivorship care plans address known deficiencies in the care of cancer survivors? Do they promote comprehensive care? How widely are they offered? Can they be developed in busy clinics? Are they being used once provided? This important review, which includes the results of a comprehensive survey of NCI-designated cancer centers, addresses these questions and much more.

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Symptom Control & Palliative Care Cancer | Volume 117, Issue 11, pages 2559–2568, 1 June 2011

Fatigue, vitality, sleep, and neurocognitive functioning in adult survivors of childhood cancer Nancy R. Clanton PhD, James L. Klosky PhD, Chenghong Li PhD, Neelam Jain PhD, Deo Kumar Srivastava PhD, Daniel Mulrooney MD, Lonnie Zeltzer MD, Marilyn Stovall PhD, Leslie L. Robison PhD, Kevin R. Krull PhD

Long-term survivors of childhood cancer are at risk for fatigue, sleep problems, and neurocognitive impairment; however, little is known of the association between fatigue or sleep quality and neurocognitive outcomes within this group. The authors of this study therefore set out to better understand this association. The results of their study suggest that neurocognitive function in long-term survivors of childhood cancer is particularly vulnerable to the effects of fatigue and sleep disruption. These findings indicate that sleep hygiene should be emphasized, as it may provide an additional mechanism to improve neurocognitive outcomes.

The authors also observed that decreased vitality and increased fatigue were strongly associated with neurocognitive impairment, even when controlling for sleep quality. Although fatigue and low vitality may result from poor sleep quality, physical and mental fatigue is also associated with metabolic or neuroendocrine dysfunction as well as cardiovascular disease. Because survivors of childhood cancer are at increased risk for symptoms related to these medical conditions, the role they play in neurocognitive outcomes should be further examined.

CA: A Cancer Journal for Clinicians | Volume 61, Issue 5, pages 287–314, September/October 2011

Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment Mark A. Lewis MD, Andrea Wahner Hendrickson MD, PhD, Timothy J. Moynihan MD

Oncologic emergencies can and do occur at any time during the course of a malignancy, from the presenting symptom to end-stage disease. Although some oncologic emergencies are related to and occur during active treatment, these emergencies can and do occur years after active treatment has ceased as well. Clinicians therefore need to be aware of a patient’s cancer history and its possible complications. This review will bring you up to date on the pathophysiology, presentation, diagnosis, and current best treatment

26 American Cancer Society Family of Journals

of commonly encountered emergencies in oncology. Emergencies are categorized as metabolic, cardiovascular, infectious, neurologic, hematologic, or respiratory to highlight their lack of disease specificity and facilitate their recognition during system-by-system assessment. For providers administering chemotherapy, the authors also address extravasation and anaphylactic reactions.

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Symptom Control & Palliative Care, cont’d. CA: A Cancer Journal for Clinicians | Volume 61, Issue 3, pages 157–182, May/June 2011

The management of cancer pain Judith A. Paice PhD, RN, Betty Ferrell PhD, RN

The experience of pain in cancer is a major threat to quality of life, and therefore the relief of pain has emerged as a priority in oncology care. Pain is associated with both the disease as well as treatment, making pain management essential from the onset of early disease through long-term survivorship or end-of-life care.

This review examines the current optimal practice of pain management, beginning with a discussion of the prevalence of cancer pain, its global impact, and barriers to effective

relief. It then discusses cancer pain syndromes, followed by comprehensive pain assessment.

The treatment of cancer pain has advanced greatly, with a wide spectrum of new pharmacologic and complementary therapies available. Read this article to learn about available treatment approaches that take into consideration the needs of individual patients as well as special populations, including the elderly, substance abusers, and end-of-life patients.

Translational Research

Cancer | Volume 117, Issue 24, pages 5612-5620, 15 December 2011

Human papillomavirus vaccine uptake among 9- to 17-year-old girls Charlene A. Wong MD, Zahava Berkowitz MSPH, MSc, Christina G. Dorell MD, MPH, Rebecca Anhang Price PhD, Jennifer Lee RN, Mona Saraiya MD, MPH

Eleven- and twelve-year-old girls are the target population for HPV vaccination since it is most effective when administered before initiating sexual activity. Because the benefits and cost-effectiveness of HPV vaccination decline with age, there is some debate regarding the value of catch-up vaccination among young adult women.

In response to the current debate regarding catch-up vaccination of young adult women, this study examined whether 18- to 26-year-old women most likely to benefit

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from catch-up vaccination were aware of the HPV vaccine and whether they had initiated the three-dose vaccine series. The results of the study show that HPV vaccine coverage among young adult women was low, particularly among uninsured. Overall, 68.5% of women aged 18-26 years reported ever having heard of the HPV vaccine. In particular, white women were significantly more likely than black, Hispanic, or Asian women to have heard of the vaccine.

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Meet the Editors

Otis Webb Brawley, MD Recognized by Castle Connelly Medical, Ltd. as one of America’s Top Doctors for Cancer, Otis Webb Brawley is the Chief Medical Officer and Executive Vice President of the American Cancer Society. He is also Editor-in-Chief of CA: A Cancer Journal for Clinicians. He is responsible for promoting cancer prevention, early detection, and quality treatment through cancer research and education, championing a variety of efforts, including initiatives to decrease smoking, improve diet, and enhance the ACS’s advocacy programs. Moreover, he is a leader in the Society’s efforts to eliminate disparities in access to quality cancer care. Dr. Brawley also serves as Professor of Hematology, Oncology, Medicine, and Epidemiology at Emory University.

Ted Gansler, MD, MBA, MPH As Director of Medical Content at the American Cancer Society, Ted Gansler heads the ACS Continuing Professional Education program, providing medical and scientific review of new cancer findings for patients and the general public. He is also Editor of CA: A Cancer Journal for Clinicians. Most recently, Dr. Gansler’s research has explored the evaluation of patient education interventions, cancer-related health literacy and attitudes, and the use of complementary therapies by cancer survivors. Prior to joining the ACS, Dr. Gansler directed the Cytopathology Laboratory and Cytopathology Fellowship Program at Emory University, where he is currently an Adjunct Associate Professor of Pathology.

Fadlo R. Khuri, MD Internationally respected for his groundbreaking research into lung, head, and neck cancers, Dr. Fadlo R. Khuri is Deputy Director of the Winship Cancer Institute and Chairman of the Department of Hematology and Medical Oncology at Emory University. A Georgia Cancer Coalition Distinguished Scholar, Dr. Khuri is also Editor-in-Chief of Cancer. His research focuses on the development of molecular, prognostic, therapeutic, and chemopreventive approaches to improve the standard of care for patients with tobacco-related cancers. His research has been supported by peer-reviewed grants from the National Cancer Institute, Department of Defense, and American Cancer Society. Dr. Khuri is the recipient of numerous awards, including the 2006 Naji Sahyoun Memorial Award from the Middle East Medical Assembly. He was inducted into the American Society for Clinical Investigation and is listed among America’s Top Doctors and the Marquis Who’s Who in the World. In addition, Dr. Khuri holds the Roberto C. Goizueta Distinguished Chair for Cancer Research and is Professor of Otolaryngology, Medicine, and Pharmacology. Feel free to submit to the journal at mc.manuscriptcentral.com/cancer

Celeste N. Powers, MD, PhD Well known throughout the international cytopathology community, Celeste N. Powers is Editor-in-Chief of Cancer Cytopathology, dedicated to advancing cytopathology research for early cancer diagnosis and prevention. Dr. Powers is also the Director of the Division of Anatomic Pathology at Virginia Commonwealth University Medical Center. She has served as Vice President and President of the American Society of Cytopathology, in addition to serving on the Society’s Executive Board and numerous committees. In recognition of her dedication to the field of cytopathology, Dr. Powers was presented with the Papanicolaou Award in 2008, the highest award given by the American Society of Cytopathology. Feel free to submit to the journal at mc.manuscriptcentral.com/cancercyto

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The American Cancer Society The American Cancer Society (ACS) is the nationwide, community-based, voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives, and diminishing suffering from cancer, through research, education, advocacy, and service. For further information on the American Cancer Society, please visit cancer.org.

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Announcement

New Continuing Education Website Launch We are pleased to announce that we will offer continuing education activities for physicians and nurses based on articles in CA: A Cancer Journal for Clinicians through the Wiley Health Learning website. All journal-based CE activities offered in CA are FREE of charge and will award 1 AMA PRA Category 1 Credit™ or ANCC contact hours upon successful completion of the quiz. You can follow a CE link from selected CA articles to our CE website, or you can visit the CE website directly. Registration is required for first-time users of the new CE website. Questions about the program can be sent to ce@cancer.org. Please visit our CE website acsjournals.com/ce for our current quiz and more information on the program.

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American Cancer Society Best of 2012