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Preoperative imaging is used prior to breast surgery to assist in estimating the extent of the resection and the potential stage of disease. Preoperative magnetic resonance imaging (MRI) has recently become more common, replacing routine mammography. Arnaout and colleagues show that preoperative use of MRI has increased 8-fold in the past decade. Use of preoperative MRI increases the likelihood of other ancillary investigations and can increase the wait time to surgery. Rahbar and Lehman provide an Editorial.
Genetic testing for the BRCA gene mutation is becoming increasingly common for assessing a woman’s risk for breast cancer. A major component of the process of testing for genetic risk has been patient counseling, but it is not known whether counseling always occurs. Armstrong and colleagues evaluated the experiences of 3874 women who had undergone BRCA mutation screening. On analysis, a substantial proportion did not meet the testing criteria. Mutations were found in only 5%. Fewer than half received genetic counseling from a genetics clinician prior to evaluation. Lack of physician recommendation was the most common reason for the lack of counseling. Narod provides an Editorial.
Androgen deprivation therapy, a mainstay for prostate cancer treatment, causes adverse effects and affects quality of life. Different schedules of delivering androgen deprivation therapy have been studied in an attempt to balance clinical effect with toxicity. In this meta-analysis, Magnan and colleagues analyzed data from 6856 patients. There was no significant difference between the continuous and intermittent use of androgen deprivation therapy on overall, cancer-specific, or progression-free survival. However, intermittent therapy was associated with improvements in physical and sexual functioning in most trials. Sweeney provides an Invited Commentary.
Bladder cancer is associated with specific occupational exposures, and Cumberbatch and colleagues revisited which occupations are associated with the highest risk of developing bladder cancer. Bladder cancer is found mostly in men, and incidence is increasing, likely due to more efficient detection. Workers exposed to aromatic amines have the highest incidence, whereas exposure to heavy metals and polycyclic aromatic hydrocarbons imparts the highest mortality. Weiderpass and Vainio provide an Invited Commentary.
Continuing Medical Education
Demaria and colleagues reviewed the role of radiotherapy in enhancing immune-based therapies. Radiation exposure can induce a type of cell death, as well as shedding of immunogenic proteins that stimulate the immune system to action. Combination radiation and immune checkpoint inhibition therapy has shown synergy, resulting in sustained and durable responses in advanced-stage cancers. How best to use radiation therapy to prime the immune system, what doses of radiation are most immunogenic, and the potential toxicities of combination therapy are all areas of intense investigation and are detailed in the review.
Highlights. JAMA Oncol. 2015;1(9):1189. doi:10.1001/jamaoncol.2015.0730