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In This Issue of JAMA Oncology
October 2015


JAMA Oncol. 2015;1(7):861. doi:10.1001/jamaoncol.2015.0728


The management of ductal carcinoma in situ (DCIS) has been an area of debate because of the lack of information regarding a patient’s risk of developing invasive breast cancer following a diagnosis of DCIS. Narod and colleagues evaluated more than 100 000 women who had received a diagnosis of DCIS and found that young age and black ethnicity increased the risk of dying of breast cancer. Aggressive treatment of DCIS did not reduce breast cancer mortality. Esserman and Yau provide an Editorial.


Continuing Medical Education

Does dose-escalated external-beam radiation therapy improve overall survival in patients with nonmetastatic prostate cancer? Kalbasi and colleagues studied more than 40 000 patients with low-, intermediate-, or high-risk prostate cancer. The intermediate- and high-risk groups seemed to benefit from dose escalation, with improved survival compared with those who received standard radiation doses. There was no benefit to dose escalation for patients with low-risk disease. Gray and Zietman provide an Editorial.


Human papillomavirus (HPV)–positive oral cancers respond better to standard treatment than those not caused by HPV. However, 10% to 25% of cancers recur after treatment. Rettig and colleagues demonstrate that persistent shedding of HPV type 16 in oral rinses after successful treatment for HPV-related oropharyngeal carcinoma was predictive of recurrence. If further validated, this simple test (quantitative polymerase chain reaction) could potentially identify patients at high risk for disease recurrence and result in more successful salvage therapy. Bauman and Ferris provide an Invited Commentary.

Invited Commentary

Normal Accident Theory teaches that accidents are inevitable in any system, yet accidents can be prevented through good organizational design. Chera and colleagues, in a Special Communication, apply Normal Accident Theory to address safety concerns in oncology. Concrete examples and solutions are discussed, and application of the principles of Normal Accident Theory is detailed in a real-world clinical setting.

Genomic analysis of hematologic tumors has changed the way oncologists view these cancers in terms of prognosis and treatment. Nabhan et al reviewed genetic markers associated with the prognosis of chronic lymphocytic leukemia. Although alterations in CD38, ZAP-70, and unmutated immunoglobulin variable heavy chain are useful in classifying patients, the use of genomic alterations in treatment selection has not yet been defined. The authors provide a state-of-the-art overview of the clinical genetics of chronic lymphocytic leukemia.