Big Cigarette Tax Hikes Might Prevent 200 Million Deaths in a Century

Study authors suggest that nations triple tobacco taxes

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MicroRNA-31 might predict lung-cancer spread

Sep. 24, 2013 — Determining whether a patient's lung cancer has spread to nearby lymph nodes is critical for identifying the most effective therapy, but it usually requires surgery. A new study suggests, however, that measuring levels of a particular molecule in a sample of tumor tissue might accurately answer the question.

Researchers at The Ohio State University Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC -- James) have discovered that levels of microRNA-31 (miR-31) predict the spread of the most common form of lung cancer to nearby lymph nodes.

They found that high levels of miR-31 in primary tumor cells predicted lymph node metastasis and poor survival in patients with non-small cell lung cancer (NSCLC). Low expression levels were associated with the absence of metastases and excellent survival.

The findings are published in the journal Clinical Cancer Research.

"Our findings suggest that microRNA expression in the primary lung tumor can estimate whether the tumor has spread to the lymph nodes and can help direct patients to the most appropriate treatment," says principal investigator Tim Lautenschlaeger, MD, a researcher in Radiation Oncology and the OSUCCC -- James Experimental Therapeutics Program.

"Many patients undergo radiation therapy for NSCLC, and particularly those with early stage disease do not routinely undergo surgical staging," he explains. "Staging with positron emission tomography-computed tomography is very useful but not perfect. MiR-31 and other microRNAs can potentially improve our ability to correctly stage these patients.

"Additionally, if we can better estimate invasiveness of each patient's tumor, we could individualize treatment to include the invasive microscopic disease while sparing as much normal tissue as possible."

An estimated 228,190 cases of lung cancer are expected to occur in the United States in 2013, along with 159,500 deaths from the disease. NSCLC accounts for about 80 percent of all lung-cancer patients. Adenocarcinoma is the most common subtype, representing about 40 percent of all lung cancer cases.

MicroRNAs are a class of short, non-coding RNAs that regulate the translation or degradation of messenger RNA and therefore the proteins that cells make. Certain microRNAs are frequently dysregulated in cancer and are associated with tumor initiation and progression.

For this study, Lautenschlaeger and his colleagues examined samples of primary lung adenocarcinoma tissue from 43 patients. They analyzed 10 of these using genome-wide microRNA-sequencing; four of these cases had lymph node metastases and six were free of metastases.

Key technical findings included:

• MiR-31 expression was four times higher in patients with lymph node metastases compared with those without them.
• miR-31 increases cell migration, invasion and proliferation;
• High miR-31 expression predicted poor survival, while low expression was associated with excellent survival.

"Overall, our findings provide a rationale to further evaluate microRNAs as biomarkers to determine which early-stage NSCLC patients treated with radiation therapy might benefit from additional cancer therapy," Lautenschlaeger says.

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Protein Found in Blood Might Help Detect Lung Cancer Sooner: Report

Preliminary finding focused on non-small cell lung cancer, Chinese researchers say

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Protein Found in Blood Might Help Detect Lung Cancer Sooner: Report

TUESDAY, Sept. 17 (HealthDay News) -- A protein that can be detected using a noninvasive blood test might one day help aid in the early diagnosis of lung cancer, preliminary research suggests.

A study conducted by researchers in China found that people with lung cancer have high levels of the so-called "biomarker," isocitrate dehydrogenase (IDH1). The investigators pointed out that lung cancer is the leading cause of cancer deaths in both men and women in the United States and around the world, and diagnosing the disease sooner could help reduce its high mortality rate.

"This study is the first to report identification of IDH1 as a novel biomarker for the diagnosis of non-small cell lung cancers using a large number of clinical samples," Dr. Jie He, director of the laboratory of thoracic surgery at the Peking Union Medical College and Chinese Academy of Medical Sciences in Beijing, said in a news release from the American Association for Cancer Research.

"Lung cancer has a high mortality rate, mostly because of late diagnosis. With an increase in aging population, we are likely to see an increase in lung cancer incidence and a need for better biomarkers for early diagnosis. We have identified IDH1 as an effective plasma [blood] biomarker with high sensitivity and specificity in the diagnosis of [non-small cell lung cancer]," He continued, especially the type known as lung adenocarcinoma.

The study, published in the current issue of the journal Clinical Cancer Research, involved blood samples collected from 943 patients with non-small cell lung cancers and 479 people who did not have lung cancer (the "control" group). None of the patients was diagnosed or treated for cancer in the three years before the study began.

The study found that the median IDH1 levels in patients with lung adenocarcinoma were 2.7 times higher than the healthy participants. The levels of this protein were also 2.2 times higher in those with squamous cell carcinoma, compared to the control group.

He's team noted that IDH1 can be detected in the blood of lung cancer patients with 76 percent sensitivity and 77 percent specificity. That means 24 percent of the tests would miss lung cancer, and 23 percent would diagnose lung cancer when it wasn't there. The researchers noted that when combined with current markers used to diagnose lung cancer, the sensitivity increased to 86 percent.

"Based on the present data, IDH1 can be used to detect stage 1 lung cancer; however, it is also possible that IDH1 could be used to detect precancer but further studies are required to address that possibility," added He.

"Our research also suggests IDH1 may be involved in the development of lung cancer, and it may be a good target for the treatment of [non-small cell lung cancer]," said He. The research team is currently studying what causes the increase of IDH1 in lung cancer patients and what the findings mean for patients.

More information

The U.S. National Cancer Institute has more about lung cancer.

Copyright c 2013?HealthDay. All rights reserved.

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Blood Tests Might Help Guide Breast Cancer Care

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TUESDAY, June 5 (HealthDay News) -- A simple blood test may help gauge prognosis and tailor treatments for women who have been diagnosed with early stage breast cancer.

The test, described in the June 6 online edition of The Lancet Oncology, measures how many tumor cells are circulating in the blood. In the new study, if even one cell was detected in the bloodstream, a woman had a greater chance of her cancer recurring and of dying.

"This may help with prognosis and staging of the cancer and, in the future, with targets for breast cancer treatments," said study lead author Dr. Anthony Lucci, a professor of surgery at the University of Texas MD Anderson Cancer Center, in Houston.

Commenting on the findings, Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, said, "We are moving into a state where we're looking at a person's individual tumor and this is another way to do that, potentially leading to treatment."

Whether or not cancer has spread to the lymph nodes is currently the best way to predict survival in women with breast cancer. Even so, a substantial number of patients whose cancer has not spread to the lymph nodes will have a recurrence while some of those who do have lymph-node involvement won't relapse.

Blood tests similar to the one investigated in this study have been found to be useful to gauge how well patients who already have metastatic cancer will do.

For this study, researchers counted circulating tumor cells in 302 breast cancer patients who were about to undergo surgery but who hadn't yet received chemotherapy.

Circulating tumor cells were detectable in about one-quarter of the participants, the investigators found. Fifteen percent of these individuals had a relapse and 10 percent died during a five-year follow-up, compared with 3 percent and 2 percent, respectively, of patients who did not have circulating tumor cells.

The more tumor cells a woman had in her bloodstream, the higher the likelihood of relapsing or dying, according to the report.

Although the test may not be far off in terms of clinical practice, "we need additional studies," Lucci said.

One area for study is how well these circulating cells predict recurrence and death in patients who have already had chemotherapy.

Currently, the American Society of Clinical Oncology does not recommend that clinicians measure circulating tumor cells in patients.

And in an accompanying comment article, Justin Stebbing, a professor in the department of surgery and cancer at Imperial College in London, said that "despite increasing evidence supporting the use of [circulating tumor cells] as biomarkers, how this information can be integrated into present practice is uncertain."

According to Bernik, though, "it makes sense that women who have circulating tumor cells would potentially be at higher risk of distant disease at some later date."

The problem is that just having circulating tumor cells may not be enough information to foretell the future, she noted.

"The cells also need to have a propensity to grow elsewhere," she said. "Not every cancer cell becomes a metastatic cancer cell. Hopefully, gaining the ability to tell which cells are more likely to spread potentially could guide therapy," Bernik added.

According to Lucci, circulating tumor cells are also showing promise in predicting melanoma prognosis, so the method may be "effective in several different tumor systems."

More information

The U.S. National Cancer Institute has more on breast cancer.

Copyright c 2012?HealthDay. All rights reserved.

Child CT Scans Might Up Risk of Brain Cancer, Leukemia

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WEDNESDAY, June 6 (HealthDay News) -- Children who undergo CT scans of the head may raise their risk of developing brain cancer or leukemia later in life, a new study says.

Although multiple CT scans could triple the risk, the absolute risk remains small -- one case in 10,000 scans of the head, the researchers said.

"We have shown small increased risks associated with the radiation exposures from CT," said study co-author Louise Parker, from the Canadian Cancer Society and a professor of medicine and pediatrics at Dalhousie University in Halifax, Nova Scotia.

"As long as CT is used only where justified, then the benefits of CT, a potentially lifesaving modality, will almost certainly outweigh the risks," she said.

Lead study author Amy Berrington de Gonzalez, from the U.S. National Cancer Institute, said this study is the first to look at the actual cancer risk of radiation from CT scans.

"All the previous studies about the potential risk of CT scans have been theoretical studies using models from other radiation-exposed populations," she said. Specifically, they studied the results of radiation exposure after atom bombs were dropped on Japan during World War II.

For the new study, researchers collected data on almost 180,000 British patients under age 22 who had CT scans between 1985 and 2002. They looked at cases of leukemia, brain tumors, how many scans were done and radiation dose absorbed by the brain and bone marrow.

Seventy-four patients developed leukemia, and 135 developed brain cancer. The researchers calculated that the relative risk for leukemia increases 0.036 for every extra milli-Gray (mGy) used, and the risk for brain tumors, 0.023 per additional mGy.

Using these data, they further calculated that one head CT scan before age 10 would result in one excess case of leukemia and one excess brain tumor per 10,000 patients in the 10 years after first exposure.

Children are more sensitive to radiation than adults, said the authors, adding that there are steps that parents can take to help limit the risk if a doctor calls for a CT scan on a child.

"Parents should talk to their health care providers and ask for the reasons for the scan, if one is recommended," Berrington de Gonzalez said. "They can also check if CT scanners are set appropriately for the age and size of the child to ensure that the doses are optimized. If this is done, the benefits of the scan should outweigh the small cancer risk."

The study appears in the June 7 online edition of The Lancet.

Richard Morin, chair of the American College of Radiology's Dose Index Registry and chief medical physicist at the Mayo Clinic in Jacksonville, Fla., said this is an epidemiological study that shows an association, but not necessarily a cause-and-effect relationship.

However, "CT scans should be used wisely, and there should be a medical reason why the scan is being done and as long as there is a sufficient medical reason then the benefit far outweighs the risk with regard to radiation," he said. "It's not zero. However, it's a better approach than surgery with sedation and its possible complications."

Parents should ask their doctor if the procedure is necessary or whether there are different tests that can get the same information without radiation, such as ultrasound or an MRI, Morin said.

Parents should also keep track of the tests done and the radiation levels used so they can show doctors if their child is seen at different facilities, he said.

The American College of Radiology recommends that parents ask their child's pediatrician or other provider who orders a scan these other questions:

Recently, to make sure children are not exposed to more radiation than necessary when they get X-rays or CT scans, the U.S. Food and Drug Administration asked the makers of these devices to factor in the safety of pediatric patients when using existing machines and designing new ones.

If the manufacturers can't show their equipment is safe for children, the FDA wants labels on the machines that say so.

More information

For more about imaging tests, visit the U.S. National Library of Medicine.

Copyright c 2012?HealthDay. All rights reserved.