African Americans Face Higher Risk Of Lung Cancer Than Other Races, Study Says

African Americans who smoke face a higher risk of developing lung cancer than smokers of other races, indicating that genes “might help explain the racial differences long seen in the disease,” according to a study in Thursday’s New England Journal of Medicine, the AP/Detroit Free Press reports (Chang, AP/Detroit Free Press, 1/26). In the largest study on the topic to date, researchers from the University of Southern California and the University of Hawaii followed 183,000 study participants over an eight-year period beginning in 1993. Over the course of the study, 1,979 enrollees developed lung cancer. Among African-American men who smoked, there were 264 cases of lung cancer per 100,000 individuals, compared with 264 cases among native Hawaiian men, 158 cases among white men, 121 cases among Japanese-American men and 79 cases among Latino men. The study, which did not include other ethnic groups, found that women overall had lower incidences of lung cancer, but ethnic disparities generally “followed the same pattern,” the Wall Street Journal reports (Bulkeley, Wall Street Journal, 1/26). Overall, whites who smoked up to one pack of cigarettes daily had a 43% to 55% lower risk of developing lung cancer than blacks who smoked the same amount. Latinos and Japanese Americans were 60% to 80% less likely than blacks to develop lung cancer if they smoked up to a pack a day, according to the study (AP/Detroit Free Press, 1/26). The disparities — which persisted even after researchers considered factors such as diet, socioeconomic status and occupation — disappeared among participants who were the heaviest smokers, likely because the damage caused by smoking at that level overwhelmed other factors, according to lead author Christopher Haiman, an assistant professor at the Keck School of Medicine at USC.

Comments
Haiman said the study could not rule out the possibility that the findings resulted from unidentified environmental factors but noted that there could be “differences in how [African Americans] metabolize nicotine, which would influence smoking behaviors such as the depth and frequency of inhalation of tobacco smoke.” He added, “There could be genetic factors on how they metabolize tobacco smoke” (Stein, Washington Post, 1/26). In an editorial accompanying the study, Neil Risch, director of the Institute for Human Genetics at the University of California-San Francisco, said the results of the study “provide an example of how ethnicity can interact with environmental factors in terms of the risk of disease.” He added that the findings could help doctors diagnose and treat some illnesses (Wall Street Journal, 1/26).

Reaction
Esteban Gonzalez Burchard, an assistant professor at the UCSF School of Medicine, said, “If this happens with tobacco, what about other drugs? Tobacco is a drug. What about the drugs we give to patients, such as cancer medications or heart medications or lung medication? There could be important biologic differences that help to explain the differences we see in disease prevalence, severity and mortality, as well as response to therapies.” However, Jeffrey Kahn, a bioethicist at the University of Minnesota, said he is concerned that the findings could lead to discrimination, noting that “[t]he danger would be to sort of view lung cancer as a minority disease, and so something we don’t have to worry as much about.” Troy Duster, a professor of sociology at New York University, said, “This feeds into the 19th-century notion that these categories really separate people in terms of their physical and biological characteristics. The reason why black people may be getting cancer more has to do with a combination of forces, not just their biologic makeup.” M. Gregg Bloche, a health law and policy professor at Georgetown University, said the study should encourage more research into understanding the role of genetics in how different races react to medicines, adding, “The biggest danger here is ideology on both sides getting in the way of trying to understand this phenomenon” (Washington Post, 1/26).

The study is available online. The editorial is available online.

“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Smokers And Former Smokers Should Be Screened For Lung Cancer, Even If They Don’t Have Symptoms

Smokers and former smokers should be screened for lung cancer even if they don’t have symptoms, according to a new study led by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The findings, based on data from the largest clinical trial of lung-cancer computed tomography (CT) screening ever conducted, represent the first time tumor size and lung cancer stage have been linked in an asymptomatic population. Results of the study were published today in the Archives of Internal Medicine.

“The smaller the lung cancer is at diagnosis, the more likely it is to be stage 1 and curable,” says lead author Dr. Claudia Henschke, principal investigator of the International Early Lung Cancer Action Project (I-ELCAP); chief of the chest imaging division at NewYork-Presbyterian/Weill Cornell; and professor of radiology at Weill Cornell Medical College. “If small lung cancers are found, they may have a significantly improved chance of a cure.”

Dr. Henschke advises smokers to consider CT screening because they are at high risk of lung cancer. Former smokers remain at high risk for lung cancer for 20 or 30 years after they quit smoking and should consider annual CT screening. “CT screening has the potential to save lives in both of these groups,” she continues. “This new information should be most helpful in providing for an informed decision-making discussion between patients seeking CT screening for lung cancer and their physicians.”

Lung cancer remains the leading cause of cancer death in both men and women, killing more people than breast, prostate, and colon cancers combined, according to the American Cancer Society.

Stage 1 lung cancer has been shown to have better a cure rate than any other stage. When lung cancer is detected outside of screening, typically because of symptoms, it has often spread to the lymph nodes and beyond. At this point, the opportunity for curative resection or any effective treatment is greatly diminished.

The largest study ever undertaken to determine if annual screening by CT is effective, I-ELCAP screened 30,235 men and women at 38 institutions across the globe. The study released today evaluated 438 lung cancers identified in I-ELCAP and studied the relationship of cancer stage to tumor diameter in asymptomatic, latent lung cancers to determine if size is an indicator of prognosis. The researchers considered tumor diameter, consistency, and presence or absence of metastases at the time of diagnosis.

“This report confirms that small-sized lesions are a good indicator of early, curable cancer,” Dr. Henschke says. “Previously, concern regarding this relationship had led some to question the benefit of screening. This issue should no longer be of concern.”

The current lung cancer staging criteria considers tumors smaller than 30 millimeters (mm) without evidence of spread to be in stage 1A (National Cancer Institute-sponsored Surveillance, Epidemiology, and End Results — SEER — definitions, based on data from symptomatic cases). The study found more than 90 percent of the lesions that are smaller than 15 mm (about the size of a dime) are in stage 1A, and almost all of those are curable. The researchers found that 85 percent of 16 mm to 25 mm malignancies had no lymph node metastases and that 63 percent of the 26 mm to 35 mm had not metastasized. Because screening is useful for finding small, asymptomatic cancers, the researchers did not have many lesions larger than 35 mm to study.

“Screening allows us to find smaller lung cancers than what we typically find when patients are symptomatic,” says Dr. Henschke. “Clearly, the smaller the cancer the more curable it is, and stage 1 is the most hopeful. When found in later stages, the cure rate drops dramatically.”

“Therefore, our findings suggest that tumor diameter serves as a prognostic indicator for curability, perhaps even for micro-metastases not detectable by our current techniques,” she adds.

Since the early 1990s there have been remarkable advances in CT scanners, so that sub-millimeter “slicing” can now be applied to the entire chest in a single breath-hold; and as a result, lung cancer is being detected when it still is smaller than in cases diagnosable prior to 1986. While CT scans once yielded 30 images, current technology yields 900 images.

Dr. Henschke’s co-authors include Dr. Steven Markowitz (CBNS, City University of New York at Queens College, Queens, N.Y.), Dr. Shusuke Sone (Azumi Hospital, Nagano, Japan), Dr. Karl Klingler (LungenZentrum Hirslanden, Zurich, Switzerland), Dr. Melvyn Tockman (Lee Moffitt Cancer Center & Research Institute, Tampa, Fla.), Dr. Dorith Shaham (Hadassah Medical Center, Jerusalem, Israel), and the other I-ELCAP investigators. Also contributing to the study were NewYork-Presbyterian/Weill Cornell’s Dr. David F. Yankelevitz and Dr. Dorothy I. McCauley.

The original ELCAP study, which was led by Dr. Henschke and published in the July 1999 Lancet, determined that low-dose CT scans found more than 80 percent of the screening-detected cancers to be of stage I, the most curable stage of the cancer. An ELCAP study published in the August 2003 journal Chest, also led by Dr. Claudia Henschke, found that CT screening for lung cancer may not only improve a lung cancer patient’s chances for a cure, but is also likely to be cost-effective when compared with other widely accepted cancer screening methods.

The Radiological Society of North America (RSNA)

The Radiological Society of North America (RSNA) is an association of more than 37,000 radiologists, radiation oncologists, medical physicists, and related scientists committed to promoting excellence in radiology through education and by fostering research, with the ultimate goal of improving patient care. The Society is based in Oak Brook, Ill.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center

NewYork-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Weill Medical College of Cornell University. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory, and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education, and community service. NewYork-Presbyterian, which is among U.S. News & World Report’s top ten hospitals nationally, also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center and its academic affiliate, Columbia University College of Physicians and Surgeons.

NewYork-Presbyterian Hospital/Weill Cornell Medical Center
525 East 68th Street, Box 144
New York, NY 10021
www.med.cornell.edu
www.nyp.org

UK Smoking Ban – Macmillan Delighted At MPs’ Life Saving Action

Leading cancer care charity Macmillan Cancer Relief is delighted that MPs decided to save lives by voting for a full smoking ban in all pubs and clubs on Tuesday 14 February 2006.

Peter Cardy, Chief Executive, Macmillan Cancer Relief, said: “We are delighted that Parliament has seen sense and has taken the single most effective step it can to cut horrible, painful lung cancer deaths. As Macmillan Cancer Relief knows only too well, smoking and passive smoking cause nine out of 10 lung cancers. This move will, quite rightly, protect the health of staff working in pubs and membership clubs as well as their patrons.”

He was speaking after MPs voted for a full smoking ban, in both licensed premises and membership clubs, during the Health Bill Report Stage Debate.

Each year there are more than 37,000 new cases of lung cancer in the UK and many more people die from head, neck, throat and mouth cancers. A ban on smoking will be implemented in April in Scotland, where lung cancer deaths are particularly high, the Republic of Ireland introduced a ban in 2004, and a ban has also been announced for Northern Ireland.

Macmillan campaigned for a full ban on smoking in all workplaces and enclosed public places in England, including all pubs and clubs. The full ban was backed by the Health Select Committee, who described proposals for a partial ban as ‘unfair, unjust, inefficient and unworkable’. The Joint Committee on Human Rights also warned that exemptions for pubs and clubs could breach human rights legislation.

Public opinion was also in favour of comprehensive smokefree legislation. A major You Gov Poll in Dec 2005 found 71 per cent in favour of making all workplaces smokefree, including pubs and restaurants.

About Macmillan Cancer Relief

Macmillan Cancer Relief provides the expert care and emotional support that makes a real difference to people living with cancer. We offer a range of innovative cancer services and are at the heart of improving cancer care throughout the UK.

For cancer information and support, contact the Macmillan CancerLine (Monday – Friday, 9.00am – 6.00pm) by freephone: 0808 808 2020, textphone: 0808 808 0121 or email: cancerline@macmillan.org.uk; or log on to http://www.macmillan.org.uk.

Macmillan Cancer Relief is a member of The UK Lung Cancer Coalition (UKLCC). This powerful coalition of the UK’s leading lung cancer experts, senior NHS and Department of Health professionals, charities and healthcare companies is the UK’s largest multi-interest group in lung cancer. It is the first time that all the major charities with an interest in the disease have joined forces to fight lung cancer.

HELP STOP PEOPLE DYING NEEDLESSLY FROM LUNG CANCER

Lung cancer claims the lives of 92 people a day but more could be saved if only it was detected earlier say Macmillan Cancer Relief and The Roy Castle Lung Cancer Foundation. To find out more visit http://www.macmillan.org.uk/lungcancer

Lung Cancer: What Progress Are We Making Free Program At Rush University Medical Center, Saturday, February 25, 2006

Chicago, following the lead of other cities across the nation, recently passed an ordinance that bans smoking in virtually all public areas.

Efforts to stub out smoking are on the rise as more Americans die each year from lung cancer than from breast, prostate, and colorectal cancers combined, according to the American Cancer Society.

Chicago area residents have the opportunity to learn about lung cancer, the newest advancements in screening and the latest in research and treatment at a free seminar hosted by Rush University Medical Center.

“Lung Cancer: What Progress are We Making?” will be held from 10:00 to 11:30 a.m. on Saturday, February 25, at Rush University Medical Center, 600 S. Paulina Street, Armour Academic Center, Room 994.

Dr. Philip Bonomi, an oncologist specializing in lung cancer, will discuss improvements observed in long term lung cancer survival rates and changes in the way physicians are approaching treatment for lung cancer patients. Dr. James Mulshine, a lung cancer researcher, will discuss how fellow researchers are working to show the importance of screenings to find lung cancer in its earliest stages so that patients have a better chance of surviving.

Space is limited. To register for this free program, call (888) 352-RUSH. Free (validated) parking is available at the visitor/patient parking garage adjacent to Rush University Medical Center on Harrison Street just west of Ashland Avenue.

http://www.rush.edu

Inflammatory Biomarker Helps Identify Progressive Precancerous Lesions In The Lung

C-reactive protein (CRP), a biomarker for inflammation in the blood, can help to identify individuals whose abnormal precancerous lesions will advance closer to invasive lung cancer.

The results appear in the first issue for March 2005 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Stephen Lam, M.D., F.R.C.P.C., of the Lung Tumour Group, British Columbia Cancer Agency at the University of British Columbia in Vancouver, Canada, and three associates measured CRP, lung function and other inflammatory markers in 65 individuals. All participants had at least one abnormal cell site in their lungs (bronchial dysplasia) greater than 1.2 millimeters in size, which was biopsied at the start of the study and re-examined 6 months later.

Of the study cohort, 49 individuals (75 percent) were men, with 48 classified as current smokers. On average, study participants were 57 years old and had 52 pack-years of smoking history.

“Lung cancer is a worldwide epidemic,” said Dr. Lam. “More than 300 million people die of this disease annually. In the United States alone, 170,000 new cases of lung cancer are reported each year. Most of these are non-small cell lung cancer and the overall prognosis once diagnosed is dismal. The only reasonable chance of cure is surgical resection for early stage tumors. However, most patients with early lung cancer are asymptomatic. Symptoms usually develop after the tumors become invasive or disseminated and curative resection is infeasible.”

Consequently, researchers have been working to find novel non-invasive or semi-invasive methods of identifying individuals who harbor progressive precancerous lesions. If detected early, these lesions might be treated with a chemopreventive agent to impede progress to invasive carcinoma.

In the study, the level of CRP only differed between individuals who either did or did not develop progression in their bronchial lesions.

“The odds of developing progressive disease were 9.6 fold higher in the group that had CRP greater than 0.5 mg per liter compared with the group less than this threshold,” said Dr. Lam.

There were 32 subjects whose bronchial lesions had progressed to a more abnormal state when biopsied after 6 months.

“These data are consistent with the prevailing hypothesis that squamous cell carcinoma arises from preinvasive lesions in stepwise fashion, which is called the sequential theory of cancer development,” said Dr. Lam. “This hypothesis is supported by animal experiments mimicking human carcinogenesis.”

The authors believe that these results will be helpful in designing future chemopreventive and early detection studies by identifying high-risk subjects for non-small cell lung cancer.

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Contact: Stephen Lam, M.D., F.R.C.P.C., Lung Tumour Group, British Columbia Cancer Agency, University of British Columbia, 675 West
10th Avenue, Vancouver, BC, Canada V5Z 1L3
Phone: (604) 675-8094
E-mail: slam@bccancer.bc.ca

Contact: Suzy Martin
smartin@thoracic.org
American Thoracic Society

USA Today Examines ‘Tragic Truth’ That Lung Cancer Affects Nonsmokers

USA Today on Wednesday examined the “tragic truth” that lung cancer can affect individuals who never smoked. About 85% of non-smokers diagnosed with lung cancer are women, according to Jill Siegfried, a researcher at the University of Pittsburgh. One out of five women with lung cancer never smoked, compared with one out of 10 men with lung cancer, Siegfried said. It is unclear why most lung cancer patients who did not smoke are women, although estrogen and genetics might be factors. Joan Schiller, a lung cancer doctor at the University of Wisconsin-Madison and president of Women Against Lung Cancer, said about 40% of people with lung cancer are women, but “when many people, both doctors and nondoctors, think about lung cancer, the face they see is an older, smoking man” (Rubin, USA Today, 3/8).

“Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . В© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Cells In Mucus From Lungs Of High-Risk Patients Can Predict Tumor Development

In a group of high-risk patients, a test that examined DNA from cells expelled in sputum for evidence of “silenced” genes correctly identified the majority of patients who were later diagnosed with lung cancer, say researchers in a study published in the March 15 issue of Cancer Research.

As such, the sputum test potentially represents a unique, non-invasive, and cost-effective screening method that could lead to earlier treatment of lung cancer.

“Short of repeatedly X-raying a person’s lungs to look for emerging tumors, there is no way now to screen people at high risk for lung cancer, much less predict who will be diagnosed with the cancer at a later date,” said the study’s senior author, Steven Belinsky, Ph.D., director of the Lung Cancer Program at the Lovelace Respiratory Research Institute in Albuquerque, N.M.

“When perfected and validated, this kind of test holds great promise for identifying people with lung cancer early enough to successfully treat them,” he said.

The test was able to predict which patients would develop lung cancer up to 18 months later. Catching lung tumors within that short timeframe can change a patient’s outcome, Belinsky said, because these cells often proliferate rapidly after a long slow-growth period.

“Because most people are diagnosed when their cancer is advanced, they may not benefit from surgery, chemotherapy or radiation, which is why median survival from diagnosis is only 13 months,” he said. “But lung tumors that can be surgically removed are associated with a five year survival rate of more than 60 percent.”

The researchers are now working to perfect the test because it is not yet accurate enough for the clinic. It identified 65 percent of individuals who later developed symptoms of lung cancer, but also tagged 35 percent of cancer-free control participants.

“Our hope is that our continuing research will identify additional genes that will make a sputum test like this highly predictive,” Belinsky said.

The test is also unique because it examines cells sloughed off in sputum for evidence that genes have been “turned off,” in contrast to the more traditional “biomarker” assays that look for increased gene activity.

Belinsky and his research team developed the test by identifying genes known to be “hypermethylated” in lung cancer — that is, decorated with molecules known as methyl groups that function to turn a gene off. Stephen Baylin, M.D., and James Herman, M.D., from Johns Hopkins Kimmel Cancer Center, Baltimore, Md. — who are co-authors of this study — are recognized leaders in this area of research.

Addition of these methyl groups to the DNA base cytosine modifies histone proteins, which act like spools around which DNA winds itself. Histones play a role in gene regulation, and when altered, prevent genes from being transcribed into proteins, according to Belinsky.

These modifications to a gene’s promoter region offer scientists a biomarker to determine which genes have been hypermethylated, and a panel of such markers can form an assay, he said. This assay uses stretches of artificial DNA that can attach only to specific methylated genes.

In this study, Belinsky worked with researchers at University of Colorado Health Sciences Center, Denver, Colo., to develop a blinded and nested case-control study within their Sputum Screening Cohort Study, which has been ongoing since 1993. The Colorado researchers asked whether mucus that coats all parts of the lung can contain genetic evidence of cancer cells when expelled in sputum. Their study enrolled patients who all had a history of smoking and chronic obstructive pulmonary disease. Belinsky and the researchers examined sputum from 98 people who developed cancer, and compared these samples to 92 participants who did not.

They looked at silencing of 14 genes known to be inactivated at different stages of lung cancer development, and found that six of these genes served to predict who would develop lung cancer. These genes are P16, PAX5_, MGMT, DAPK, GATA5, RASSF1A. Then, they found that participants who had three or more of these methylated, silenced genes in sputum, collected within 18 months of diagnosis, had a 6.5-fold increase risk for lung cancer.

The test didn’t work well if the sputum was collected more than 18 months before lung cancer was diagnosed, Belinsky said. “The prevalence for methylation of gene promoters increased as the time to lung cancer diagnosis decreased,” he said.

A person who tests positive for the test would receive a follow-up diagnostic bronchoscopy or X-ray to determine if tumors exist, Belinsky said. If tumors are not evident, patients could be retested in several months.

He added that the test might also be used in the future to help guide drug therapy. A new class of therapeutic drugs is being developed that are designed to reduce methylation in genes and restore their function, Belinsky explained. “When a number of these agents come on the market, then an improved sputum test could be used to match these agents to genes individual patients have lost,” he said. “We can then use this kind of test diagnostically.”

In addition to Belinsky, Herman, and Baylin, study co-authors include Kieu Liechty and Frederick Gentry at the Lovelace Respiratory Research Institute; Holly Wolf, Justin Rogers, Kieu Vu, Jerry Haney, Tim Kennedy, Fred Hirsch, York Miller, Wilbur Franklin, Paul Bunn and Tim Byers at the University of Colorado Health Sciences Center; and James Herman, Johns Hopkins Kimmel Cancer Center.

The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. Our members include more than 24,000 basic, translational, and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 60 other countries. 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, and funding meritorious research projects. The AACR Annual Meeting attracts some 16,000 participants who share the latest discoveries and developments. Special Conferences throughout the year present novel information across a wide variety of cancer research and patient care topics. AACR publishes five major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; and Cancer Epidemiology, Biomarkers & Prevention, as well as CR, a magazine about people and progress in cancer.

http://www.aacr.org

Nicotine Prevents Chemotherapy From Working For Lung Cancer Patients

Researchers have found that nicotine stops chemotherapy drugs, such as gemcitabine, cisplatin and taxol, from destroying lung cancer cells. This finding was reported at the Annual Meeting of the American Association for Cancer Research.

The scientists added that patients who are on chemotherapy for lung cancer who gave up smoking, but are taking smoking cessation products which contain nicotine, may be seriously undermining their treatment.

Batches of cells were taken from lung cancer tumours of patients. If nicotine was found, the effectiveness of the chemotherapy was seriously reduced, said the researchers.

There are two proteins which nicotine boosts – these proteins also protect cancer cells.

Doctors have always known that a lung cancer patient will have more effective chemotherapy treatment if he/she gives up smoking before treatment begins. This study has shown that not only does the patient have to give up smoking, he/she has to make sure there is no nicotine in his/her system.

Written by: Christian Nordqvist
Editor: Medical News Today

Lung Cancer Risk Calculated Based On Medical History And Genetics

Physicians have little to help them predict development of lung cancer in their patients – even a history of heavy smoking doesn’t really help, since only a small fraction of lifetime smokers develops the cancer.

Now, however, researchers at The University of Texas M. D. Anderson Cancer Center are developing a risk assessment model that they hope will result in early detection of lung cancer in those smokers identified to be most at risk.

Using this prototype model, which is being discussed at the annual meeting of the American Association for Cancer Research (AACR), researchers already have calculated that a subset of heavy smokers who have emphysema and possess inefficient DNA repair capacity have as much as 11 times the risk of developing lung cancer.

“Our goal is to develop an instrument that can help physicians estimate risk for developing lung cancer, like the Gail model does for breast cancer, or the Framingham model used to predict heart disease,” says the study’s first author, Matthew Schabath, Ph.D., a postdoctoral researcher in the Department of Epidemiology.

The analysis is based on research that compared the medical history and DNA repair capacity profiles of 2,134 lung cancer patients treated at M. D. Anderson with the same data from 2,295 matched healthy individuals.

The prototype model is designed to first evaluate risk using only medical history, if that is all that is available, or a combination of medical history and genetic information related to molecular processes that either raise or reduce a person’s risk of developing cancer. In this study, the researchers used a laboratory test that calculates how efficiently subjects’ lymphocytes drawn into a test-tube repair damage from a tobacco carcinogen. In the future, more cost effective and simpler laboratory analyses need to be developed to represent the activity of genes involved in the repair processes.

Using the model, they have found, for example, that:

* Heavy smokers who have a previous history of emphysema (a chronic lung condition occurring in heavy smokers) exhibit nearly a four times increased risk of lung cancer than light smokers without emphysema.
* The risk of developing lung cancer increases to nearly 11-fold if a patient with the same medical history also has an inefficient DNA repair capacity.
* Clinical variables that appear to protect against lung cancer development are also being incorporated into the model, Schabath says. For example, they have estimated that:
* Individuals with a history of allergies (defined by a prior history of hay fever) have a 29 percent reduced risk of lung cancer.
* Such individuals, who also exhibit efficient DNA repair capacity, have a 56 percent reduced risk of developing lung cancer, compared with people who do not allergies with poor DNA repair genes.

Allergies are believed to stimulate an immune response in lungs that help fight initial tumor development, Schabath says.

The model is a work in progress, says senior author Margaret Spitz, M.D., professor and chair of the Department of Epidemiology. “It appears to be reasonably accurate in that we can correctly classify over 78 percent of lung cancer cases,” she says, adding that additional variables such as genetic variations in important pathways and more environmental risk factors will be added in the future.

“Early detection is key to successful treatment of any cancer, and this model is designed to help physicians identify and screen those patients most at risk for lung cancer,” Spitz adds.

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Contact: Julie A. Penne,
jpenne@mdanderson.org

Nancy Jensen
nwjensen@mdanderson.org

University of Texas M. D. Anderson Cancer Center

Non-smokers With Lung Cancer Respond Better To Treatment Than Smokers, Study Says

Smoking history contributes to poor outcomes in the treatment of lung cancer, according to a new study. Non-small cell lung cancer (NSCLC) lung cancer patients who have never smoked before in their life have better overall survival rates and respond better to chemotherapy than current or former smokers. Published in the June 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study also reveals that smoking status during treatment has no affect on clinical outcome.

Cigarette smoking is the most significant risk factor for developing lung cancer, one of most common and aggressive malignancies in the world. In 2005, over 170,000 Americans were diagnosed with lung cancer and over 160,000 patients died. The five-year survival rate from lung cancer is less than 20 percent at best. NSCLC causes the majority of lung cancers, and if cured, the survivor has up to a 4 percent annual risk of developing another tumor.

Despite the association of lung cancer with cigarettes, diagnosed patients continue to smoke. However, physicians remain unable to tell their patients how that will impact their cancer treatment. Previous studies have failed to agree on whether smoking status impacts the outcome of chemotherapy or chemotherapy and thoracic irradiation.

Led by Anne S. Tsao, M.D. of the University of Texas M. D. Anderson Cancer Center in Houston, researchers reviewed the medical records of 1370 patients with NSCLC who were treated with chemotherapy or chemo-radiation to determine an association between smoking and treatment response and survival.

The researchers found that patients who never smoked had a better response to the chemotherapy; developed less disease progression during therapy; and showed improved survival over former and current smokers. They say the finding may be due to non-smokers having less genetic damage compared to smokers, being less likely to have other ailments that would affect survival, and having better preserved lung function. The authors write that “Continued efforts at preventing smoking initiation are a critical public health issue and emphasize the need for chemoprevention for smokers and primary-prevention protocols to prevent smoking.”

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Article: “Smoking Affects Treatment Outcome in Patients with Advanced Nonsmall Cell Lung Cancer,” Anne S. Tsao, Diane Liu, J. Jack Lee, Margaret Spitz, Waun Ki Hong, CANCER; Published Online: April 2006 (DOI: 10.1002/cncr.218844); Print Issue Date: June 1, 2006.

Contact: Amy Molnar
John Wiley & Sons, Inc.