The American College of Physicians (ACP) today sent a letter to Senate leaders sharing the College’s views on key issues in H.R. 3590, the Patient Protection and Affordable Care Act.

“We commend the Senate for approving a motion to proceed to debate this legislation, which includes important and essential reforms that overall are consistent with ACP policy to expand coverage and reverse a shortage of primary care physicians,” Joseph W. Stubbs, MD, FACP, president of ACP, said in the letter. “Although there is much in this bill that is consistent with these goals and ACP policy, we also have significant concerns regarding several provisions and urge you to consider amending the legislation to address these issues prior to Senate passage of the bill.”

ACP highlighted its support for the bill’s provisions to expand coverage to almost all legal residents in the United States, calling this one of the organization’s “highest priorities.” ACP also expressed support for provisions to reform payments to support the value of care provided by primary care physicians, to accelerate testing of innovative payment and delivery models, and to increase the training of primary care physicians.

Specific ACP recommendations included:
Sustainable Growth Rate: Enactment of a permanent repeal of the flawed SGR formula and replace it with a new payment system that will provide positive and predictable payment updates for physicians and a higher growth target, and update, for primary care and preventive services.

Patient-Centered Medical Home: ACP expressed support for several provisions in the bill to support patient-centered care in a medical home, but asked the Senate to provide specific funding for a Medicare Medical Home pilot, instead of leaving it to a new Center on Innovation to decide if such a program would be funded.

Improved Payments for Primary Care Services: ACP supported the intent of a proposal to increase Medicare payments to primary care physicians but advised the Senate leadership that it was “essential” that the provision be modified so as to not exclude most primary care internists. The Senate bill, by narrowly defining primary care services as excluding hospital visits, would exclude most primary care internists, particularly those in rural areas, who provide care to their patients in both the office and hospital setting – a hallmark of comprehensive primary care. ACP proposed that the Senate add hospital visits to the designated primary care services and allow any primary care physician to qualify if 50 percent of their total Medicare billings were for office, hospital, nursing, and other visits. ACP also urged that the Senate make the primary care bonus “permanent” instead of allowing it to expire after five years. It also cautioned the Senate not to make changes, in response to concerns from other groups, which would have the effect of lowering or diluting the primary care bonus.

Also, the Senate bill, unlike the House legislation, does not have any provisions to increase payments to primary care physicians under the Medicaid program. ACP strongly urged inclusion of a provision in the final bill that increases Medicaid payments to primary care to no less than the Medicare rates. Such a provision is urgently needed to ensure that primary care physicians will be available for the more than 10 million persons with incomes up to 133 percent of the Federal Poverty Level who would now be covered by Medicaid.

Workforce: While expressing broad support for the many policies in the bill to train more primary care physicians, ACP urged the Senate to reinstate the 20/220 loan deferment program in the final Senate health reform bill. This provision, which allows for the deferment of interest and principal payments on educational loans during residency, is the economic hardship deferment criterion that 67 percent of the nation’s medical residents have relied upon to defer their student loan debts while completing residency training. ACP also asked the Senate to increase funding for GME positions in primary care training programs. And, it asked the Senate to create a new loan repayment program for physicians who go into general internal medicine, pediatrics, or family medicine and who practice in an area of the country or health care facility with a high need for such specialties.

In the letter, Dr. Stubbs expressed support for the concept of an Independent Medicare Advisory Board but stated that the version in the bill lacks sufficient safeguards and oversight over the Board’s actions. ACP made four specific recommendations:
Representation on the Board: The Senate health reform bill designates the commission to be composed of 15 members, and includes experts in fields related to health care finance, delivery, and management and specifically requires representation of consumers and the elderly. ACP recommended that modifications be made to include specified representation of physicians who deliver care in a community setting, and at least one designated seat for a primary care physician.

Congressional Authority: ACP expressed concern that the Senate legislation would only allow Congress to block implementation of Medicare Commission recommendations by passing alternative legislation that meets the required savings benchmarks. This legislation could be vetoed by the President and then only overturned by a super-majority vote of both the House and Senate. ACP recommended that Congress be able to block implementation of the Commission’s recommendations by a simple majority vote in both Houses through a fast-track joint resolution process. Under this approach, Congress would not have to develop an alternative and current law would remain in effect if the Board’s proposals are not approved by Congress.

Transparency: The Senate legislation states that the Board may hold hearings concerning their proposals if they consider these forums advisable. This places too much authority with the Board deciding when, or even if, to hold hearings on important Medicare payment issues. The Board could simply decide not to hold hearings, regardless of the reason, which would effectively prevent adequate stakeholder input. The College recommended that to ensure transparency in the Commission’s proceedings and adequate opportunity for stakeholder input, that the legislation mandates the Commission to hold a minimum number of hearings before proposals are finalized.

Exemption of Certain Providers: ACP recommended that IMAB be allowed to make recommendations that apply broadly to physicians, hospitals, home health, hospice, nursing home, and other providers.

“ACP is pleased that H.R. 3590 has many of the key policies needed to provide affordable coverage to all Americans, expands the primary care workforce, and improves payment and delivery systems,” Dr. Stubbs noted. “We remain firmly committed to the goal of getting legislation passed this year by the Senate that delivers on these essential policies and goals.”

“We offer our recommendations for improving on the areas of concern in the spirit of achieving a final bill that would ensure that the policies intended to support primary care are sufficient to the need,” Dr. Stubbs emphasized. “We seek to accelerate pilot-testing of innovative delivery models and payment reforms with appropriate congressional oversight, to ensure that the Patient-Centered Medical Home will be among the models to be tested on an accelerated and expanded basis, and to eliminate the cycle of endless Medicare physician payment cuts that threaten access to care.”

“We look forward to continuing to work with you to achieve these objectives,” the letter concluded.

Source: David Kinsman

American College of Physicians

Abbott today announced that the U.S. Food and Drug Administration (FDA) approved the supplemental New Drug Application (sNDA) for CREON® (pancrelipase) Delayed-Release Capsules that now includes dosing guidance in the prescribing information specific to patients with limited production of enzymes in the pancreas (exocrine pancreatic insufficiency) due to chronic pancreatitis (CP) or removal of the pancreas (pancreatectomy). Prior to this FDA approval, dosing guidance for medications such as CREON was based on patients with cystic fibrosis.

Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. Patients with chronic pancreatitis or those who have had their pancreas removed (to manage conditions of the pancreas such as CP, pancreatic cancer or pancreatic tumors) often develop EPI. This insufficiency reduces the production or secretion of enzymes that are necessary to digest nutrients in food and can result in a type of oily diarrhea known as steatorrhea, malabsorption of nutrients, weight loss and even chronic malnutrition if left untreated.

With this FDA approval, CREON is the first medication in its class to have this guidance and information in its prescribing information for use in treating EPI due to CP and pancreatectomy.

“Without proper dosing guidance, some patients have previously attempted to control EPI symptoms by modifying their diets and limiting fat intake,” said Orelle Jackson, executive director of the National Pancreas Foundation. “However, this approach has yielded limited treatment success.”

The sNDA approval was based on results of a double-blind, randomized, placebo-controlled, two-arm, parallel-group study which enrolled 54 adults with EPI due to CP or pancreatectomy. The primary efficacy endpoint was a clinical measurement of how much fat consumed by a patient is absorbed by the body rather than excreted.

“Until now, patients who have had their pancreas removed or those with chronic pancreatitis have too often received inadequate doses of pancreatic enzymes to address their symptoms,” said David C. Whitcomb, M.D., Ph.D., University of Pittsburgh Medical Center. “The availability of new data for CREON is a benefit to prescribers by providing appropriate dosing information that can impact the treatment of these patients.”

About Pancreatic Enzyme Replacement Therapy

In April 2009, CREON became the first Pancreatic Enzyme Replacement Therapy (PERT) to receive approval under the FDA’s new guidelines for the class for the treatment of EPI due to cystic fibrosis or other conditions and has been available to patients in its FDA-approved formulation since July 2009. PERTs work in patients with EPI by delivering pancreatic enzymes to the small intestine to help break down fats, proteins and carbohydrates in food, thereby acting as a replacement for digestive enzymes physiologically secreted by the pancreas. EPI can occur as a complication of a variety of diseases or conditions, such as cystic fibrosis, chronic pancreatitis, pancreatic cancer and gastrointestinal surgery.

The original products in the PERT class pre-date the modern FDA regulatory requirements. Over the past two decades, products in this class have been allowed to be marketed as prescription drugs without formal New Drug Application (NDA) approval. In 2004, the FDA required manufacturers to submit NDAs for all PERTs in order to remain on the market. By the end of April 2010, all PERTs were required to have approved NDAs and be manufactured under the new guidelines.

About CREON

Uses

CREON (pancrelipase) Delayed-Release Capsules is a prescription pancreatic enzyme medicine used to improve food digestion in people who cannot digest food properly because they have exocrine pancreatic insufficiency.

Important Safety Information

CREON may increase the chance of having a serious bowel disorder called fibrosing colonopathy. The risk of having this condition may be reduced by following the dosing instructions.

CREON capsules or the contents of the capsules should not be crushed or chewed because this may cause mouth irritation. CREON should be taken during a meal or a snack and followed with sufficient fluid. CREON can cause allergic reactions such as unusual or severe stomach pain, worsening of gout, or painful, swollen joints, trouble with breathing, skin rashes or swollen lips. The most common side effects include: gassiness (flatulence), headaches, stomach area (abdominal) pain and dizziness.

Full Prescribing Information, including the Medication Guide, is available at CREON.

Source
Abbott

Breast cancer screening guidelines generally recommend mammography begin at age 40. However, based on prior national research, an estimated 34 percent of non-Hispanic black women, 30 percent of non-Hispanic white women and 22 percent of Hispanic women aged 30 to 39 have reported having a mammogram.

“Our goals are to better understand who these women are that are getting mammograms at such a young age and their outcomes,” said Julie M. Kapp, Ph.D., M.P.H., assistant professor at the University of Missouri-Columbia and lead author of the study, who presented the data at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, Dec. 6-9 in Houston.

Through the NCI Breast Cancer Surveillance Consortium, the researchers examined the first mammograms of women aged 18 to 39 with no prior history of breast cancer. The sample included 99,615 mammograms.

Even though the risk of developing breast cancer before age 40 is lower than 1 percent, research showed that the majority of first mammograms in this study were for screening purposes, rather than evaluation of a breast problem. Screening mammograms ranged from 69 percent among black women to 81 percent among Asian women.

“Women younger than 40 at low or average risk who receive screening mammography may be exposed to unnecessary negative harms, such as false positive results, additional radiation and invasive procedures,” said Kapp.

False positives from screening mammograms varied only slightly between ethnic groups, ranging from 10.4 percent to 14.1 percent. However, false positive rates from diagnostic mammograms showed wider disparity, from 8.7 percent for white women to 18.2 percent for Asian women.

Kapp and colleagues are concerned that the impact of false positives on women of various racial/ethnic groups may vary and deter future mammography screening for some. For instance, previous studies have shown black women have greater odds than white women of having multiple mammograms before the age of 40, but black women older than 40 years are less likely to receive mammography screening.

Future research should address why, and what impact early screenings at a young age could have on future mammography use in women older than 40 years, when the risk of breast cancer is higher, according to Kapp.

This work was supported by a grant from the National Cancer Institute [grant number R03CA134196 to JMK]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Data collection for this work was supported by a National Cancer Institute-funded Breast Cancer Surveillance Consortium co-operative agreement.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

As little as 15 minutes of exercise a day can reduce overall mortality rates in patients with prostate cancer, according to findings presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, held here, Dec. 6-9, 2009.

“We saw benefits at very attainable levels of activity,” said Stacey A. Kenfield, Sc.D., epidemiology research associate at the Harvard School of Public Health and lead author of the study. “The results suggest that men with prostate cancer should do some physical activity for their overall health.”

Researchers assessed physical activity levels for 2,686 patients enrolled in the Health Professionals Follow-up Study, both before and after diagnosis (men with metastases at diagnosis were excluded).

Men who engaged in three or more hours of Metabolic Equivalent Tasks (MET) a week equivalent to jogging, biking, swimming or playing tennis for about a half-hour per week had a 35 percent lower risk of overall mortality.

Specific to walking, the researchers found that men who walked four or more hours a week had a 23 percent lower risk of all-cause mortality compared to men who walked less than 20 minutes per week. Men who walked 90 or more minutes at a normal to brisk pace had a 51 percent lower risk of death from any cause than men who walked less than 90 minutes at an easy walking pace.

Walking didn’t show any effect on prostate cancer specific mortality, but more strenuous exercising did. Men who engaged in five or more hours of vigorous physical activity a week were at a decreased risk of dying from their prostate cancer.

“This is the first large population study to examine exercise in relation to mortality in prostate cancer survivors,” said Kenfield. Previous studies focused on how exercise affects risk of developing prostate cancer.

Kenfield said that researchers aren’t sure of the exact molecular effects exercise has on prostate cancer, but exercise is known to influence a number of hormones hypothesized to stimulate prostate cancer, boost immune function and reduce inflammation.

“How these factors may work together to affect prostate cancer biologically is still being studied,” she said. “For now, our data indicate that for prostate cancer survivors, a moderate amount of regular exercise may improve overall survival, while five or more hours per week of vigorous exercise may decrease the death rate due to prostate cancer specifically.”

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

Between 2002 and 2003, American women experienced a 7 percent decline in breast cancer incidence, which scientists attribute to the publicity surrounding results of the Women’s Health Initiative (WHI).

However, researchers led by Brian Sprague, Ph.D. have conducted a reevaluation of the post-WHI landscape that suggests otherwise.

“We found that the change in hormone therapy use only accounted for a decline of about 3 percent, so there’s another 4 percent that is being caused by something we do not yet know,” said Sprague, a postdoctoral fellow at the University of Wisconsin.

Results of this study were presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, held Dec. 6-9 in Houston.

In 1991, the National Institutes of Health established the WHI to address the most common causes of death, disability and deterred quality of life among 15,730 postmenopausal women cancer, cardiovascular disease and osteoporosis.

Results of the WHI demonstrated in 2002 that hormone therapy is linked with an increased risk of breast cancer. Other studies have confirmed this relationship, and many women have stopped taking hormone therapy due to concerns about the potential risk of cancer. At the same time, the incidence of breast cancer has declined, which researchers attribute to the decrease in hormone therapy use.

After conducting a thorough literature review of the decline in hormone use and the decline in breast cancer incidence, Sprague and colleagues estimated that 42 percent of the decline in incidence of breast cancer was linked to the cessation of hormone therapy use.

Sprague said that additional studies are needed to determine the source of the remaining decline in breast cancer cases.

“This does not mean that women should start taking hormones again, but there appear to be additional factors that have contributed to the decline in breast cancer,” he said.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

Long-chain omega-3 fatty acids, primarily found in fish and seafood, may have a role in colorectal cancer prevention, according to results presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, held Dec. 6 – 9, 2009, in Houston.

“Experimental data have shown benefits of long-chain omega-3 fatty acids in colorectal carcinogenesis, ranging from reduced tumor growth, suppression of angiogenesis and inhibition of metastasis,” said Sangmi Kim, Ph.D., a postdoctoral fellow at the National Institute of Environmental Health Sciences, Research Triangle Park, N.C. “Our finding of inverse association between dietary intakes of long-chain omega-3 fatty acids and distal large bowel cancer in white participants adds additional support to the hypothesis.”

Although experimental and clinical data suggest that long-chain omega-3 fatty acids possess anti-neoplastic properties in the colon, epidemiologic data to date has been inconclusive.

Kim and colleagues studied the link between polyunsaturated fatty acid intake and distal large bowel cancer using data from a population-based control study. They recruited 1,509 white participants (716 cancer cases and 787 controls) and 369 black participants (213 cancer cases and 156 controls) using the State Cancer Registry and Division of Motor Vehicles records.

Nineteen polyunsaturated fatty acids were assessed using a validated food frequency questionnaire, which included 124 questions on food items. The researchers used the questionnaire to collect information on the frequency and amount of foods typically consumed in the past 12 months.

Patients who consumed more long-chain omega-3 fatty acids had a reduced risk of distal large bowel cancer. Compared to the lowest quartile, fat intake in the highest quartile was linked with a 39 percent reduced risk of cancer.

The researchers detected these associations in white participants, but not in black participants.

“We were surprised that the association was not also observed among blacks,” Kim said. “We considered several possible explanations but were not able to account for this difference with the data we had. This finding warrants future study, but we should be careful about drawing conclusions about potential racial differences in the benefit from long-chain omega-3 fatty acids from this study.”

“An increase in dietary intake of long-chain omega-3 fatty acids, which mainly come from fish and seafood, may be beneficial in the prevention of distal large bowel cancer,” Kim said.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

While it is too early for physicians to start advising their male patients to take up the habit of regular coffee drinking, data presented at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference revealed a strong inverse association between coffee consumption and the risk of lethal and advanced prostate cancers.

“Coffee has effects on insulin and glucose metabolism as well as sex hormone levels, all of which play a role in prostate cancer. It was plausible that there may be an association between coffee and prostate cancer,” said Kathryn M. Wilson, Ph.D., a postdoctoral fellow at the Channing Laboratory, Harvard Medical School and the Harvard School of Public Health.

In a prospective investigation, Wilson and colleagues found that men who drank the most coffee had a 60 percent lower risk of aggressive prostate cancer than men who did not drink any coffee. This is the first study of its kind to look at both overall risk of prostate cancer and risk of localized, advanced and lethal disease.

“Few studies have looked prospectively at this association, and none have looked at coffee and specific prostate cancer outcomes,” said Wilson. “We specifically looked at different types of prostate cancer, such as advanced vs. localized cancers or high-grade vs. low-grade cancers.”

Caffeine is actually not the key factor in this association, according to Wilson. The researchers are unsure which components of the beverage are most important, as coffee contains many biologically active compounds like antioxidants and minerals.

Using the Health Professionals’ Follow-Up Study, the researchers documented the regular and decaffeinated coffee intake of nearly 50,000 men every four years from 1986 to 2006; 4,975 of these men developed prostate cancer over that time. They also examined the cross-sectional association between coffee consumption and levels of circulating hormones in blood samples collected from a subset of men in the cohort.

“Very few lifestyle factors have been consistently associated with prostate cancer risk, especially with risk of aggressive disease, so it would be very exciting if this association is confirmed in other studies,” said Wilson. “Our results do suggest there is no reason to stop drinking coffee out of any concern about prostate cancer.”

This association might also help understand the biology of prostate cancer and possible chemoprevention measures.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

Supplementation with a selenium-based antioxidant compound decreased the risk of developing new polyps of the large bowel called colorectal metachronous adenomas in people who previously had colorectal polyps removed.

“Our study is the first intervention trial specifically designed to evaluate the efficacy of the selenium-based antioxidant compound on the risk of developing metachronous adenomas,” said Luigina Bonelli, M.D., head of the unit of secondary prevention and screening at the National Institute for Cancer Research, in Genoa, Italy.

Bonelli presented these findings at the American Association for Cancer Research Frontiers in Cancer Prevention Research Conference, held in Houston, Dec. 6-9, 2009.

Adenomatous polyps (or adenoma) are benign lesions of the large bowel that, in time, could progress to cancer. Even though only a small proportion of adenomas will develop into cancer, almost 70 percent to 80 percent of colorectal cancer stems from an adenoma.

Adenomas are common in people aged 60 years or older; one in four people will have at least one adenoma.

Participants in this study were aged 25 to 75 years and had already had one or more colorectal adenomas removed, but did not have any other diagnosis of colorectal diseases, cancer or life-threatening illnesses and did not use vitamins or calcium supplementations. The researchers randomized 411 participants to the placebo group or to receive an antioxidant compound specifically selenomethionnine 200 Ојg, zinc 30 mg, vitamin A 6,000 IU, vitamin C 180 mg and vitamin E 30 mg.

“Our results indicated that individuals who consumed antioxidants had a 40 percent reduction in the incidence of metachronous adenomas of the large bowel,” Bonelli said. “It is noteworthy that the benefit observed after the conclusion of the trial persisted through 13 years of follow up.”

The researchers are currently conducting a study to evaluate the role of genetic alterations as predictors of metachronous adenomas in participants received the antioxidant compound compared with those in a placebo group.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 30,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 16,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.

Source: American Association for Cancer Research

Good news in the fight against cancer! A new report from leading health and cancer organizations shows national cancer rates continue to decline.

Rates of new cases and deaths from all cancers decreased significantly from 1999 to 2006 for men and women and for most racial and ethnic populations in the United States.

Doctor Edward J. Benz Junior is president of the Dana-Farber Cancer Institute in Boston. He says the news is encouraging. “I think the bottom line of this report is that it’s a bit of good news, but it shows how long a way we have to go.”

The report is published online in the journal Cancer. The findings show new diagnoses for all types of cancer were down almost one percent and cancer deaths decreased one point six percent per year from 2001 to 2006. The type of cancers reporting the largest declines for men are lung, prostate and colorectal. In women, the drops are in breast and colorectal cancer.

Dr. Benz says the research shows we’re moving in the right direction, but the hard work needs to continue.”You look at what forms of cancer are experiencing those declines and what the reasons are, it really shows the need for a comprehensive approach. Because it’s prevention, it’s early detection and screening and it’s better treatments, so we need to keep moving on all those fronts.”

The report is by researchers from the National Cancer Institute, part of the National Institutes of Health, the Centers for Disease Control and Prevention, the American Cancer Society and the North American Association of Central Cancer Registries.

Source: Dana-Farber Cancer Institute

Researchers from the Indiana University School of Medicine and colleagues at the University of Texas Southwestern and Case Western University have determined how the protein Mdm2, which is elevated in late-stage cancers, disables genes that suppress the growth of tumors. The finding may lead to the development of new drugs for late stage breast cancer and other difficult to treat malignancies.
The investigators have identified a critical pathway that stimulates the production of Mdm2 causing an increase in the level of protein that bind to p53, the most common tumor suppressor, as well as other tumor suppressors, and extinguishes tumor suppression activity. The study appears in the January 2010 issue of the Journal of Clinical Investigation.

Principal investigator Lindsey Mayo, Ph.D., assistant professor of pediatrics at the Herman B Wells Center for Pediatric Research at the IU School of Medicine and an Indiana University Melvin and Bren Simon Cancer Center member, says that keeping Mdm2 inactive and preventing the destruction of the tumor suppressor that Mdm2 targets, is critical to preventing cancer from spreading within the body.

To explain the role of Mdm2 and how the newly identified pathways function, Dr. Mayo uses the analogy of a florescent ceiling fixture in which Mdm2 is the fluorescent bulb. “Initially, it was only known that the light was on, not how it was turned on. We discovered the wall switch and wires that connect to the light fixture to turn on the fluorescent light.”

“This work provides new evidence about an important mechanism that tumor cells use to promote metastasis. While it has long been known that the loss of tumor suppressor activity triggers cancer, knowledge of how these cancer inhibitors are turned on and off has eluded researchers. Understanding the signaling pathways that elevate Mdm2 is critical to preventing cancer from spreading within the body and key to attacking many late stage cancers,” said Dr. Mayo, a molecular biochemist who studies the mechanisms that control tumor suppressors.

While it is too early to speculate on which chemical compounds may yield successful drugs, Dr. Mayo says this new insight into Mdm2 and its pathways provides a useful roadmap to stimulate development of new compounds which could bind to Mdm2 to inhibit the protein and stop its attacks on tumor suppressors.

In addition to Dr. Mayo, co-authors of the study, which was funded by the National Cancer Institute, are medical student Jacob A. Eitel, graduate student Christopher N. Batuello, Khadijeh Bijangi-Vishehsaraei, Ph.D. and Karen E. Pollok, Ph.D. of the IU School of Medicine, Shinako Araki, Ph.D., Xian-Jin Xie Ph.D., and David A. Boothman, Ph.D. of the University of Texas Southwestern Medical Center; and David Danielpour, Ph.D. of Case Western Reserve University.

The Wells Center is the research arm of the IU School of Medicine Department of Pediatrics and Riley Hospital for Children. The IU School of Medicine, the Wells Center, Riley Hospital and the IU Simon Cancer Center are located on the campus of Indiana University-Purdue University Indianapolis.

Source
Journal of Clinical Investigation.