Hereditary gastric cancer (HDGC) is associated with mutations in E-cadherin (CDH1), but there are some families that display the clinical characteristics of HDGC without carrying germline CDH1 mutations. Hansford et al performed extended mutational screening on 183 individuals meeting the criteria for HDGC. They found a diversity of CDH1 mutations, as well as mutations in other related genes. These data substantially expand our ability to identify families with a genetic predisposition to gastric cancer. Ford provides an Editorial.
Editorial and Continuing Medical Education
Author Audio Interview
Are medical costs driven by patients’ demands for unnecessary testing? Gogineni and colleagues’ survey of 5050 patient-clinician encounters demonstrated that only a small proportion of interactions resulted in a patient-initiated request for a medical test or intervention, and few of these were deemed inappropriate by the clinician. Clinicians were not likely to respond to the inappropriate demands. The myth of the “demanding patient” should be debunked. Back provides an Editorial.
The diagnosis of carcinoma of unknown primary (CUP) should not focus on discerning the tissue of origin but rather on determining whether there are “druggable” pathways. Ross et al performed comprehensive genomic profiling on 200 CUP specimens. They found that most tumors had several genomic alterations, with almost all demonstrating at least 1 potentially targetable alteration. Alterations in the receptor tyrosine kinase (RTK)/Ras pathway were found in significantly more adenocarcinomas of unknown primary than nonadenocarcinomas, representing an important route for drug development in this disease. Varadhachary provides an Editorial.
Use of electric power morcellators to remove presumed benign leiomyomas has been associated with the dissemination of malignancy. Wright et al performed a nationwide database study to analyze the prevalence of underlying cancer in women who underwent myomectomy with and without electric power uterine morcellation; more than 40 000 women were studied. They identified uterine cancer in 0.2% of women who underwent surgical myomectomy and in 0.1% of women undergoing morcellation. Age was the strongest risk factor for uterine cancer. They concluded that electric power morcellation should be used with caution in older women undergoing myomectomy. Nezhat provides an Invited Commentary.
The BCR-ABL1–negative myeloproliferative neoplasms consist of the triad of polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). Tefferi and Pardanani reviewed the literature, noting that JAK2 mutations are commonly found in all, with the frequency being highest in PV. Although all are clinically indolent, survival is inferior to age-matched controls, and the major complication of leukemic or fibrotic transformation is usually lethal. Treatment includes prevention of thrombosis by phlebotomy or aspirin therapy, and cytoreductive therapy is required in some patients. Risk stratification allows the identification of patients with PMF who may benefit from stem cell transplantation.
Highlights. JAMA Oncol. 2015;1(1):3. doi:10.1001/jamaoncol.2015.0650