A JAMA THEME ISSUE
Edited by Charles B. Clayman, MD
Pound and colleaguesArticle report that 15 years after surgery, the actuarial
metastasis-free survival of a cohort of 1997 men who underwent radical
prostactectomy was 82%. Predictors of the time course to the development of metastatic disease included the time to prostate-specific antigen (PSA) level elevation, Gleason score, and PSA
level doubling time. Among 1765 men treated with external beam radiation therapy alone, Shipley and coworkersArticle found that the 5-year
estimate of freedom from biochemical recurrence (a rising PSA level)
was 65.8%. These investigators identified 4 distinct prognostic groupings based on pretreatment PSA level and Gleason score. In an
editorial, ScherArticle emphasizes the importance of continuous prognostic
reevaluation of men with prostate cancer to guide treatment decisions.
The optimal next step after abnormal cancer screening test results is
often uncertain. Findings of the study by Manos and colleaguesArticle and the
editorial comments of CoxArticle support human papillomavirus DNA testing of
specimens obtained at the time of initial cervical cancer screening to
identify women with equivocal screening test results who are at risk of
having high-grade squamous intraepithelial lesions. Levin and
colleaguesArticle base recommendations for screening and follow-up
sigmoidoscopy and colonoscopy on their findings that villous features
in a distal adenoma, age older than 65 years, having
more than 1 distal adenoma, and a positive family history of colorectal
cancer were significant predictors of advanced proximal colonic
neoplasia. Meyer and coworkersArticle suggest that large-core needle biopsy of
nonpalpable breast lesions identified on screening mammography is a
reliable diagnostic alternative to surgical excision.
Of 208 members of 4 extended families with hereditary nonpolyposis
colon cancer (HNPCC), only 90 chose to receive results of
genetic testing for HNPCC-associated mutations. Lerman and colleagues
found that higher educational level and prior participation in a
genetic linkage study were associated with higher rates of receiving
results of genetic testing, while symptoms of depression were
associated with lower rates.
Interim results of the Radiation Therapy Oncology Group trial showed
that subjects with esophageal cancer treated with chemotherapy and
radiation therapy were surviving significantly longer than subjects
treated with radiation therapy alone. Cooper and colleagues report that
the 5-year overall survival was 26% in the randomized
combined-treatment group; 14% in the nonrandomized combined-treatment
group assembled after the interim results; and 0% in the randomized
radiation therapy group.
Chow and coworkers report that the incidence of renal cell cancer has
increased between 1975 and 1995 but not the incidence of renal pelvis
cancer. The increased incidence has been greater among blacks than
among whites and 5-year survival, which has improved among white
patients, has not improved among black patients.
In this analysis of data from 16 years of follow-up of
88,818 women in the Nurses' Health Study, Zhang and colleagues
found that low total folate intake was associated with increased breast
cancer risk only among women who consumed 15 g/d or more of
"Already as a small child I was aware that in the handling of money,
my mother was more than simply thrifty; she was downright frugal."
Reports on the latest discoveries and controversies in cancer detection
Health hazards in the environment and workplace: educational, clinical,
and ethical issues.
For your patients: Screening for cervical cancer with the Pap test.
This Week in JAMA. JAMA. 1999;281(17):1565. doi:10.1001/jama.281.17.1565