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Background Among sarcomas, which are rare cancers, many types are exceedingly rare; however, a definition of ultra-rare cancers has not been established. The problem of ultra-rare sarcomas is particularly relevant because they represent unique diseases, and their rarity poses major challenges for diagnosis, understanding disease biology, generating clinical evidence to support new drug development, and achieving formal authorization for novel therapies. Methods The Connective Tissue Oncology Society promoted a consensus effort in November 2019 to establish how to define ultra-rare sarcomas through expert consensus and epidemiologic data and to work out a comprehensive list of these diseases. The list of ultra-rare sarcomas was based on the 2020 World Health Organization classification, The incidence rates were estimated using the Information Network on Rare Cancers (RARECARENet) database and NETSARC (the French Sarcoma Network's clinical-pathologic registry). Incidence rates were further validated in collaboration with the Asian cancer registries of Japan, Korea, and Taiwan. Results It was agreed that the best criterion for a definition of ultra-rare sarcomas would be incidence. Ultra-rare sarcomas were defined as those with an incidence of approximately ≤1 per 1,000,000, to include those entities whose rarity renders them extremely difficult to conduct well powered, prospective clinical studies. On the basis of this threshold, a list of ultra-rare sarcomas was defined, which comprised 56 soft tissue sarcoma types and 21 bone sarcoma types. Conclusions Altogether, the incidence of ultra-rare sarcomas accounts for roughly 20% of all soft tissue and bone sarcomas. This confirms that the challenges inherent in ultra-rare sarcomas affect large numbers of patients.

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Bladder cancer is the fifth most common cancer in the United States and, on a per capita basis, is the most expensive cancer from diagnosis to death. Unfortunately, National Cancer Institute funding for bladder cancer is quite low when compared with other common malignancies. Limited funding has stifled research opportunities for new and established investigators, ultimately encouraging them to redirect research efforts to other organ sites. Waning interest of scientists has further fueled the cycle of modest funding for bladder cancer. One important consequence of this has been a lack of scientific advancement in the field. Patient advocates have decidedly advanced research efforts in many cancer sites. Breast, prostate, pancreatic, and ovarian cancer advocates have organized highly successful campaigns to lobby the federal government and the medical community to devote increased attention and funding to understudied malignancies and to conduct relevant studies to better understand the therapy, diagnosis, and prevention of these diseases. Bladder cancer survivors have lacked a coordinated advocacy voice until recently. A concerted effort to align bladder cancer advocates, clinicians, and urologic organizations is essential to define the greatest needs in bladder cancer and to develop related solutions. This position paper represents a collaborative discussion to define the most concerning trends and greatest needs in the field of bladder cancer as outlined by the Bladder Cancer Think Tank, the Bladder Cancer Advocacy Network, and the Society of Urologic Oncology.

BACKGROUND Carcinoembryonic antigen (CEA) is used as a serum marker to detect and monitor the status of various kinds of malignant tumors. To determine whether CEA might be detected in secretions collected topically from around the nipple area, and whether its secretion might differ in a cancerous versus a noncancerous breast, we developed a simple method for collecting and measuring CEA, using a small cellulose membrane disk and an enzyme immunoassay. METHODS We measured the amount of CEA excreted from the nipple area of 22 healthy control women and 32 women with unilateral breast carcinoma confirmed histologically. Secretions were collected from the nipple area by affixing a small (20 mm diameter) absorbent disk made of nitrocellulose membrane backed with filter paper to that area for 24 hours. Substances absorbed by the membrane were then subjected to an immunoassay for CEA using anti-CEA antibodies. RESULTS In the 22 healthy subjects, a small amount of CEA (0.6 +/- 0.9 units) was secreted from each nipple, which was equally low regardless of the phase of the menstrual cycle. In contrast, 30 of the 32 women with breast carcinoma secreted significantly greater amounts of CEA from the cancerous (16.1 +/- 8.2) than the noncancerous (2.0 +/- 2.2) breast. Such a difference (14.1 +/- 8.0) in CEA excretion was not observed in the healthy controls (0 +/- 0). CONCLUSIONS These findings suggest that such disks may provide a simple and noninvasive method of collecting trace molecules, including CEA, in skin secretions around the nipple to evaluate functional disorders of the mammary glands, particularly breast carcinoma. Additional studies are indicated in larger groups of women with various stages of breast carcinoma as well as with benign breast diseases.

Tyrosine hydroxylase (TH) activity has been determined in 22 neuroblastoma tumors from 15 patients, in 1 pheochromocytoma, 20 adrenal glands, 10 other tumors and organs, and 4 specimens of sera. The enzyme activity was found only in the neural crest tumors and adrenal glands, but the levels were too low to be detected in the other tumors and in normal liver and kidney tissues. The average specific activity (mean +/- SE) of TH in 23 neural crest tumors was 0.559 +/- 0.101; in 20 adrenal glands was 0.418 +/- 0.124 nmol/mg protein/minute. In 13 patients with neuroblastoma and 1 patient with pheochromocytoma, both TH levels in the primary tumors and urinary excretion of vanillylmandelic acid (VMA) and homovanillic acid (HVA) were studied. The urinary excretion of VMA by 10 of 13 neuroblastoma patients and by the patient with pheochromocytoma was significantly to markedly elevated above normal levels; excretion of HVA by 12 of 13 neuroblastoma patients was similarly elevated. These results indicate that tyrosine hydroxylase, an enzyme specifically located in the adrenal medulla and monoaminergic neurons, is also present in neuroblastoma, a malignant tumor of similar embryologic origin, and in pheochromocytoma. Not only can TH activity in these tumors be demonstrated in vitro, but the elevated urinary excretion of VMA and/or HVA by the majority of patients with these tumors also indicates TH activity of the tumors in vivo.

Some largely inconsistent associations between parental occupational dust exposure and childhood cancer have been reported, with maternal exposures inadequately studied. The authors examined whether maternal or paternal occupational exposure to animal, wood, textile, or paper dust around a child's birth was associated with an increased risk of childhood cancer, both overall and by type (leukemias, lymphomas, central nervous system tumors, and other cancers).In this nationwide, register-based, case-control study, children who were diagnosed with cancer from 1960 to 2015 were compared with up to 25 matched controls regarding maternal and paternal occupational dust exposure (9653 cases in maternal analyses and 12,521 cases in paternal analyses). Exposures were assessed using a job-exposure matrix and occupational information from census and register data. By using conditional logistic regression models, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated.Neither maternal nor paternal occupational exposure to animal, wood, textile, or paper dust was associated with childhood cancer overall, leukemias, or central nervous system tumors. Maternal, but not paternal, wood dust exposure was associated with an increased risk of lymphoma (OR, 1.42; 95% CI, 1.10-1.84), particularly non-Hodgkin lymphoma (OR, 2.03; 95% CI, 1.21-3.40).The current study did not confirm the associations reported previously but is the first to suggest a link between maternal occupational exposure to wood dust around pregnancy and lymphoma in the offspring.

Background Women of lower socioeconomic status (SES) with early‐stage breast cancer are more likely to report poorer physician‐patient communication, lower satisfaction with surgery, lower involvement in decision making, and higher decision regret compared to women of higher SES. The objective of this study was to understand how to support women across socioeconomic strata in making breast cancer surgery choices. Methods We conducted a 3‐arm (Option Grid, Picture Option Grid, and usual care), multisite, randomized controlled superiority trial with surgeon‐level randomization. The Option Grid (text only) and Picture Option Grid (pictures plus text) conversation aids were evidence‐based summaries of available breast cancer surgery options on paper. Decision quality (primary outcome), treatment choice, treatment intention, shared decision making (SDM), anxiety, quality of life, decision regret, and coordination of care were measured from T0 (pre‐consultation) to T5 (1‐year after surgery. Results Sixteen surgeons saw 571 of 622 consented patients. Patients in the Picture Option Grid arm (n = 248) had higher knowledge (immediately after the visit [T2] and 1 week after surgery or within 2 weeks of the first postoperative visit [T3]), an improved decision process (T2 and T3), lower decision regret (T3), and more SDM (observed and self‐reported) compared to usual care (n = 257). Patients in the Option Grid arm (n = 66) had higher decision process scores (T2 and T3), better coordination of care (12 weeks after surgery or within 2 weeks of the second postoperative visit [T4]), and more observed SDM (during the surgical visit [T1]) compared to usual care arm. Subgroup analyses suggested that the Picture Option Grid had more impact among women of lower SES and health literacy. Neither intervention affected concordance, treatment choice, or anxiety. Conclusions Paper‐based conversation aids improved key outcomes over usual care. The Picture Option Grid had more impact among disadvantaged patients. Lay Summary The objective of this study was to understand how to help women with lower incomes or less formal education to make breast cancer surgery choices.Compared with usual care, a conversation aid with pictures and text led to higher knowledge. It improved the decision process and shared decision making (SDM) and lowered decision regret. A text‐only conversation aid led to an improved decision process, more coordinated care, and higher SDM compared to usual care. The conversation aid with pictures was more helpful for women with lower income or less formal education.Conversation aids with pictures and text helped women make better breast cancer surgery choices., A paper‐based pictorial conversation aid (pictures plus text) is beneficial to all patients with early‐stage breast cancer and particularly to disadvantaged patients. Between‐surgeon variation suggests that the maximal impact of such interventions requires standardized physician training combined with these interventions.

Breast cancer associated morbidity issues for Native American patients have never been reported. To our knowledge, this paper is the first report of these experiences. Because this is the first of several papers on findings from the “Native American Cancer Education for Survivors” study, in-depth background information is provided about both the population and the study. Working with Native patients over the past few decades, the authors have generally encountered the message that ‘once you have cancer, you should begin to select a grave site.’ This paper documents a message of hope for Native American breast cancer survivors. According to the National Cancer Institute, approximately 63 percent of all American Indian (AI) and Alaska Native (AN) breast cancer patients are alive five years after diagnosis. This is the poorest five year relative survival of any ethnic and minority group in the US.1, 2, 3, 4, 5 In many geographic regions, no accurate survival data are available and quality of life (QOL) information specific to Native American cancer survivorship issues has not been reported,6, 7 thus the true impact of cancer in this population is unknown. The cancer burden continues to escalate among AIANs,8, 9 and importantly, Native Americans are not experiencing the decreases in cancer incidence that is occurring among other racial groups.10, 11 In November 2007, the federal government (specifically NIH, CDC, IHS) released a Report to the Nation8 that emphasized AIAN cancer incidence data. Breast cancer incidence is particularly elevated within Northern and Southern Plains tribal nations, with the highest rates in Alaska Natives. According to the 2008 Indian Health Service (IHS) mortality data (Figure 1), age-adjusted breast cancer deaths continue to be elevated for AIANs living in Alaska, the Northern Plains and the Southern Plains, in comparison to Natives living in other regions.12 Figure 1 IHS Age Adjusted Breast Cancer Mortality Rates, 1999–2003 Although age-adjusted rates are elevated among Alaska, Northern and Southern Plains AIANs, the actual number of cancer patients and the related cancer burden may be higher among those who live in the southwest and Southern Plains. According to the US Census 200038, the 48 contiguous states that are west of the Mississippi have 43% of all AIs in comparison with other regions of the US. The five states with the highest numbers of AIs are California, Oklahoma, Arizona, Texas and New Mexico, of which AZ and NM are within the Southwest and OK (Southern Plains). Of the ten most populated reservations and off-reservation trust lands, Navajo Nation (AZ, NM, UT with 175,228 AIs) is the largest and no other reservation is close to this elevated number of Native residents. Of the nine remaining largest reservations, Fort Apache, Gila River, Tohono O’odham, and San Carlos are all located in AZ/ the Southwest (respectively 11,854, 10,578, 9,794 and 9,065 AIs). In comparison, only two of the largest reservations are based in the Northern Plains: Pine Ridge and Rosebud (respectively 14,484 and 9,165 AIs living in SD/ Northern Plains). Osage (9,209 AIs living in OK) is within the ten largest reservations and is within the Southern Plains region. Many breast cancer survivors experience co-existing physical conditions, co-morbidities and side effects from treatment. However, there has not been any documentation of the prevalence of such conditions specifically within Native American breast cancer survivors. Likewise, there is a dearth of information about how co-existing conditions differ among newly diagnosed Native breast cancer (within one year), patients diagnosed one to four years ago, and those who are long-term survivors (five or more years from diagnosis). This paper provides the first descriptive summaries for such prevalence specific to Native breast survivors. NACR’s work with Native Cancer Patients leading to the Survivorship Program Native American Cancer Research (NACR) staff has worked with Native cancer survivors since the latter 1980s to help minimize the effects of cancer and cancer treatment and improve the Native patient’s quality of life (QOL). 7,13, 14, 15, 16, 17, 18, 19, 20, 21 In the 1990s, the “National Native American Cancer Survivors’ Support Network” was created and NACR initiated and continues to support gatherings specifically for Native cancer survivors. NACR also creates programs specifically designed to meet the needs of Native cancer survivors and makes cancer information available to survivors, families and healthcare providers free of charge from its website at http://NatAmCancer.org.

Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer that constitutes between 12% and 15% of breast cancers.1 Although the biological characteristics and treatment options of DCIS have been the subject of growing research over the past several decades, only a small number of studies have examined the psychosocial sequelae of a DCIS diagnosis.2–6 In addition, no research has been conducted to identify socioeconomic subgroups of women who might be vulnerable to psychological morbidity after a DCIS diagnosis. Research on the psychosocial sequelae of a DCIS diagnosis is warranted for several reasons. First of all, DCIS is generally not life-threatening. When treated with standard therapy, the majority of cases will not result in local or systemic recurrence.1,7 Yet, similar to invasive breast cancer, the primary treatment for DCIS is surgery, with 30% of women undergoing mastectomy and 60% undergoing a breast-conserving procedure.1 Consequently, women with DCIS may experience many of the same psychosocial issues as women who are treated for invasive breast cancer, such as anxiety,8–10 depression, sexual problems, and negative body image.9 In fact, the limited research that has directly compared women with DCIS to women with invasive breast cancer has found no difference in their levels of psychological symptoms (ie, difficulty sleeping, anxiety, and depression),2 quality of life, and overall well-being.3 However, women with DCIS may experience fewer physical symptoms, better general health, and a less negative impact on their sex life and interpersonal relationships than women with invasive breast cancer.3 The word carcinoma and the surgical treatments for DCIS suggest a level of disease severity, and the distinction between invasive and noninvasive cancer can be confusing for many patients.4,5 In addition, women report being frustrated by the lack of available information about their DCIS.4,5 A shortage of information may leave women with DCIS unaware of their true breast cancer risk. For example, research suggests that women with DCIS do not differ from women with invasive breast cancer in their perceived risk of local or distant recurrence or distant metastases2 or of dying from their disease.3 Furthermore, between 54% and 61% of women perceived at least a moderate risk for disease recurrence,6,11 and 39% perceived at least a moderate risk for invasive cancer in the next 5 years.6 These risk perceptions are inaccurate, as true risk for local recurrence in the form of DCIS or invasive breast cancer after modern therapy ranges approximately 1% to 7%.12–14 Prior work from our group suggests that distress may contribute to inaccurate risk perceptions. For example, women with elevated DCIS-related intrusive or avoidant thoughts were more likely to overestimate their risk of metastasis, whereas women with elevated anxiety were more likely to overestimate their risk of a DCIS or invasive breast cancer recurrence and of developing invasive breast cancer in their lifetime.6 To effectively address the psychosocial needs of women with DCIS, it is important to consider that the incidence and prevalence of distress after DCIS may not be equal across all women, but instead may vary by socioeconomic status (SES). SES is inversely associated with psychological morbidity after an invasive cancer diagnosis.15–22 In addition, SES dictates access to important resources such as money, knowledge, and social connections/support that could be used to minimize the impact of a major health crisis such as a cancer diagnosis.23–29 Women with low SES may not have the same financial and psychosocial resources to cope with their DCIS; thus, this population may be vulnerable to anxiety and depression after their diagnosis. The extent to which SES affects distress after a DCIS diagnosis has not been previously addressed. The authors conducted a prospective longitudinal observational study to examine the psychosocial impact of a DCIS diagnosis.6 The current paper analyzes a subset of these data to examine whether SES was associated with anxiety and depression in these women. Because social support is inversely associated with distress across populations,30,31 and social support is positively associated with SES,24–28 this paper also explores whether the association between SES and distress was explained by differences in social support (mediation) and whether social support buffered against distress among women with low SES (moderation). We hypothesized that 1) women’s distress (anxiety and depression) would be inversely associated with their SES (education and financial status) at baseline and at the 9-month follow-up; 2) SES would predict a change in distress from baseline to the 9-month follow-up; and 3) social support would mediate and moderate the association between SES and anxiety and depression.

The Third Cambridge Conference on Innovations and Challenges in Renal Cancer, a symposium held in Cambridge, Massachusetts, June 27-28, 2008, and chaired by Michael B. Atkins, was convened to discuss the current state of knowledge in the field, critique new data, stimulate communication among those involved in basic and clinical research, and offer recommendations for further study. Four main topics were discussed: genetics and molecular biology of renal cell cancer, staging and prognosis, systemic therapy, and correlative science and biomarkers in stage IV disease. The conference format combined brief presentations with extended periods of discussion. The conclusions and recommendations are summarized in this paper and presented in more detail in the individual papers that follow.

BACKGROUND Although narrative reviews have concluded that there is strong support for familial clustering of prostate carcinoma, the association has never systematically been quantified in reviews. The purpose of this meta–analysis was to summarize and quantify the recurrence risk ratio with emphasis on the degree of relation, the specific relationship of the family member, the number of affected family members, and the age at diagnosis. METHODS Publications were identified through computerized database searches for epidemiologic studies published up to December 2002. In addition, references cited in original and review papers were examined. Three blinded reviewers extracted both qualitative and quantitative information from each paper. Using random effects meta–regression analyses, the authors calculated summary recurrence risk ratios (Sλ). The reviewers also evaluated changes in Sλ according to differences in study methodology. RESULTS Thirty–three epidemiologic studies were included in the current review. Sλ was 2.53 (95% confidence interval, 2.24–2.85) for first–degree family members. Sλ appeared to be greater for men with an affected brother than for men with an affected father. Sλ for men who had second–degree relatives with prostate carcinoma was only slightly elevated. The nature of the familial clustering is such that Sλ increases with decreasing age of the patient and family members, with increasing genetic relatedness of the affected relative, and with increasing number of individuals affected within a family. CONCLUSIONS The studies that were reviewed consistently demonstrate that family history is a significant risk factor for development of prostate carcinoma. Cancer 2003;97:1894–903. © 2003 American Cancer Society. DOI 10.1002/cncr.11262

Empiric risk of prostate carcinoma for relatives of patients with prostate carcinoma: a meta-analysis. Zeegers MP, Jellema A, Ostrer H. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands. mpa.zeegers@epid.unimaas.nl BACKGROUND: Although narrative reviews have concluded that there is strong support for familial clustering of prostate carcinoma, the association has never systematically been quantified in reviews. The purpose of this meta-analysis was to summarize and quantify the recurrence risk ratio with emphasis on the degree of relation, the specific relationship of the family member, the number of affected family members, and the age at diagnosis. METHODS: Publications were identified through computerized database searches for epidemiologic studies published up to December 2002. In addition, references cited in original and review papers were examined. Three blinded reviewers extracted both qualitative and quantitative information from each paper. Using random effects meta-regression analyses, the authors calculated summary recurrence risk ratios (S(lambda)). The reviewers also evaluated changes in S(lambda) according to differences in study methodology. RESULTS: Thirty-three epidemiologic studies were included in the current review. S(lambda) was 2.53 (95% confidence interval, 2.24-2.85) for first-degree family members. S(lambda) appeared to be greater for men with an affected brother than for men with an affected father. S(lambda) for men who had second-degree relatives with prostate carcinoma was only slightly elevated. The nature of the familial clustering is such that S(lambda) increases with decreasing age of the patient and family members, with increasing genetic relatedness of the affected relative, and with increasing number of individuals affected within a family. CONCLUSIONS: The studies that were reviewed consistently demonstrate that family history is a significant risk factor for development of prostate carcinoma. Copyright 2003 American Cancer Society

Emerging data provide initial support for the concept that a single, minimally invasive liquid biopsy test, performed in conjunction with confirmatory radiologic or other diagnostic testing, when indicated, could be deployed on a broad scale to screen individuals for multiple types of cancer. Ideally, such a test could do this in a way that yields a clinically important percentage of true-positive indications of cancer while minimizing false-positive signals. Modern decision modeling approaches can and should be deployed to investigate the health and economic consequences of such multicancer early detection (MCED) testing within defined at-risk populations. In this paper, through small-scale analyses involving 3 hypothetical MCED-detectible cancers, the authors illustrate the potential for MCED testing to be cost-effective, along with the pivotal role of test-induced stage shift on results. The time is ripe for additional, prospective investigations of the clinical value of MCED testing, the benefits versus the risks for screened populations, and the overall projected impact on health outcomes and costs over time.

BACKGROUND Anemia is common in cancer patients, although the prevalence is influenced both by the type of malignancy and the choice of treatment. Individual studies have compared the survival of patients with and without anemia and have shown reduced survival times in patients with various malignancies, including carcinoma of the lung, cervix, head and neck, prostate, lymphoma, and multiple myeloma. The objective of this study was to systematically review, to summarize, and to obtain an overall estimate of the effect of anemia on survival in patients with malignant disease. METHODS A comprehensive literature review was carried out using the MEDLINE data base and reviewing the reference lists from published studies. Two hundred papers were identified. Of these, 60 papers that reported the survival of cancer patients according to either hemoglobin levels or the presence of anemia were included. Among these papers, 25% related to patients with lung carcinoma, 17% related to patients with head and neck carcinoma, 12% related to patients with multiple myeloma, 10% related to patients with prostate carcinoma, 8% related to patients with cervicouterine carcinoma, 7% related to patients with leukemia, 5% related to patients with lymphoma, and 16% related to patients with other types of malignancies. RESULTS The relative risk of death increased by 19% (95% confidence interval, 10–29%) in anemic patients with lung carcinoma, by 75% (37–123%) in anemic patients with head and neck carcinoma, by 47% (21–78%) in anemic patients with prostate carcinoma, and by 67% (30–113%) in anemic patients with lymphoma. The overall estimate increase in risk was 65% (54–77%). CONCLUSIONS Anemia is associated with shorter survival times for patients with lung carcinoma, cervicouterine carcinoma, head and neck carcinoma, prostate carcinoma, lymphoma, and multiple myeloma. Cancer 2001;91:2214–21. © 2001 American Cancer Society.

Uncontrolled chemotherapy-induced nausea and vomiting (CINV) can reduce patients’ quality of life and may result in premature discontinuation of chemotherapy. Although nausea and vomiting are commonly grouped together, research has shown that antiemetics are clinically effective against chemotherapy-induced vomiting (CIV) but less so against chemotherapy-induced nausea (CIN). Nausea remains a problem for up to 68% of patients who are prescribed guideline-consistent antiemetics. Despite the high prevalence of CIN, relatively little is known regarding its etiology independent of CIV. In this review paper, we summarize a metagenomics approach to the study and treatment of CIN with the goal of encouraging future research. Metagenomics focuses on genetic risk factors, encompassing both human (i.e., host) and gut microbial genetic variation. Little work to date has focused on metagenomics as a putative biological mechanism of CIN. Metagenomics has the potential to be a powerful tool in advancing scientific understanding of CIN by identifying new biological pathways and intervention targets. Investigation of metagenomics in the context of well-established demographic, clinical, and patient-reported risk factors may help to identify patients at risk and facilitate prevention and management of CIN.

Because pathologists differ widely in their definition and histologic classification of many types of cancer, progress has been impeded in determining the frequency, nature, and biological behavior of tumors, in elucidating their causes, and in evaluating treatment and prognosis. Histologic definitions and systems of classification that are accepted and utilized internationally are essential to advancement of our scientific information in many aspects of cancer. In order to make meaningful comparisons of data there must be reasonable uniformity in histologic definitions and classifications. Although the disparity in use of different and varying classifications for some tumors is generally recognized, recently more quantitative information has been published for lung cancer. Sobin11 reviewed 57 conveniently available English language papers on lung tumors between 1955 and 1970, and found 13 different classifications used. The 34 papers concerned with treatment and survival used 12 different classifications, and the 23 papers concerned with clinical diagnosis, cytology, epidemiology, genetics, occupation, and pathology used 7. Few papers defined the criteria used for placing cases in different histologic classes. Even greater variation in classification would be expected if papers written in different languages had been included.

Anticoagulants have been demonstrated to reduce tumor growth in certain experimental animal systems. Inhibition of clot formation interferes with tumor growth and spread while enhancement of coagulation promotes tumor growth and spread. The fact that the coagulation mechanism is commonly activated in human malignancy together with preliminary reports of therapeutic efficacy of anticoagulants suggests that the coagulation mechanism may be of pathophysiologic significance also in the growth of human tumors. A VA Cooperative Study has been established to test the hypothesis that warfarin anticoagulation will modify the course of malignancy in man. The purpose of this paper is to present the rationale and experimental design for this study with emphasis on management of anticoagulant administration in cancer patients. This paper serves as the basis for forthcoming reports of toxicity and therapeutic efficacy of warfarin in human malignancy.

This paper presents a preliminary report of 66 patients who underwent en bloc resection for osteogenic sarcoma of the femur (34 patients), tibia (12 patients), shoulder girdle (19 patients), and fibula (1 patient). Presentation of a limb, without sacrificing the principles of cancer surgery, is a desirable goal in people with osteogenic sarcoma. Up to the present time, amputation has been regarded by most authorities as the only well-established typical curative treatment for this malignancy. Usually when a tumor is close to a joint, amputation includes excision of a part of the adjacent joint as well as a wide removal of the involved bone to encompass both area of potential capsular-joint local skip and possible intraosseous skip areas of tumor. The former has been observed more than the latter. In an effort to improve survival rates, the distal femur lesion (having the lowest extremity cure rate in our opinion) requires removal of the whole bone. The following study was undertaken to determine whether en bloc resection in association with intensive chemotherapy is a realistic alternative to radical amputation and chemotherapy. We believe our definition of osteogenic sarcoma, unlike some, excludes the good prognostic medullary invading juxtacortical osteogenics, chondrosarcomas (making bone), and includes telangiectatic osteogenic sarcomas. Therefore, our cure rate, with amputation under the age of 21 was 17% with no evidence of disease. Any paper not analyzing the age of the patient (under 21 years old) cannot in itself be comparable. Cure rates of older patients can be as high as 35% according to Dr. Andrew Huvos at our hospital.

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a standard of care for patients with Philadelphia chromosome (Ph)–positive acute lymphoblastic leukemia (ALL). The introduction of tyrosine kinase inhibitors (TKIs) to first-line therapy has improved overall outcomes; however, a significant proportion of patients still relapse after alloHSCT. Posttransplant TKI maintenance was demonstrated to reduce the risk of relapse in a large retrospective study and, therefore, should be considered a valuable option. This consensus paper, written on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation, presents an overview of clinical studies on the use of TKIs after alloHSCT and proposes practical recommendations regarding the choice of TKI, treatment timing, and dosage. It is hoped that these recommendations will become the state of art in this field and, more importantly, lead to a reduction of Ph-positive ALL relapse after alloHSCT. Cancer 2016;122:2941-2951. © 2016 American Cancer Society.

BACKGROUND: There is considerable uncertainty regarding the acceptability of routine distress screening. METHODS: In an unfunded implementation study, the authors asked 50 clinicians (chemotherapy nurses and treatment radiographers/radiation technologists) to implement a screening program for distress as part of routine care and to record their feedback after each clinical encounter. In total, 379 patients were screened using a simple paper-and-pencil versions of distress thermometer and the emotion thermometer (ET). RESULTS: Across all screening applications, clinicians believed that screening was useful during 43% of assessments and was not useful during 35.9% of assessments, and they were unsure or neutral in 21.1% of assessments. The application of the screening program assisted staff in changing their clinical opinion after 41.9% of assessments, and clinicians believed that the screening program helped with communication in >50% of assessments. However, 37.5% believed that screening was impractical for routine use, and more chemotherapy nurses than radiographers rated the screening program as “not useful.” On multivariate analysis, 3 variables were associated with high staff satisfaction with screening, namely, receipt of prior training, talking with the patient about psychosocial issues, and improved detection of psychological problems. A favorable perception of screening also was linked to a change in clinical opinion. CONCLUSIONS: Opinions of cancer clinicians regarding routine distress screening were mixed: Approximately 33% considered screening not useful/impractical, whereas >50%n believed promoted good communication and/or helped with recognition. Clinicians who were more positive about screening gained greater benefits from screening in terms of communication and recognition. Cancer 2012. © 2012 American Cancer Society.

Cancer is an emerging public health problem in Africa. About 715,000 new cancer cases and 542,000 cancer deaths occurred in 2008 on the continent, with these numbers expected to double in the next 20 years simply because of the aging and growth of the population. Furthermore, cancers such as lung, female breast, and prostate cancers are diagnosed at much higher frequencies than in the past because of changes in lifestyle factors and detection practices associated with urbanization and economic development. Breast cancer in women and prostate cancer in men have now become the most commonly diagnosed cancers in many Sub-Saharan African countries, replacing cervical and liver cancers. In most African countries, cancer control programs and the provision of early detection and treatment services are limited despite this increasing burden. This paper reviews the current patterns of cancer in Africa and the opportunities for reducing the burden through the application of resource level interventions, including implementation of vaccinations for liver and cervical cancers, tobacco control policies for smoking-related cancers, and low-tech early detection methods for cervical cancer, as well as pain relief at the palliative stage of cancer.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and is often acquired soon after onset of sexual activity.1 HPV types 16 and 18 are causally linked to approximately 70% of cervical cancer cases2; HPV 6 and 11 cause 90% of anogenital warts. The quadrivalent human papillomavirus vaccine protects against infection from HPV types 6, 11, 16 and 18.3 It was recommended by the Advisory Committee on Immunization Practices (ACIP) in June 2006 for routine 3-dose vaccination of girls aged 11–12.4 The vaccination series can be initiated by girls beginning at age 9; catch-up vaccination is recommended for girls and young women aged 13–26 who have not been previously vaccinated or who have not completed the full series. In 2009, the ACIP made similar recommendations for the bivalent HPV vaccine, which protects against infection from HPV types 16 and 18.5 The target age for HPV vaccination is 11–12 years to ensure protection at an earlier age, prior to sexual debut.4 Monitoring HPV vaccine uptake allows public health practitioners to identify unvaccinated populations and to develop targeted interventions to increase vaccine coverage. Depending on uptake patterns, HPV vaccine has the potential to reduce existing disparities in cervical cancer, including a higher incidence and mortality among blacks, Hispanics, women of limited income, and women who do not access cervical cancer screening.6–8 Although several analyses have examined HPV vaccine coverage in the United States, most are limited surveys9–18, with few that are national in scope.15, 19, 20 In this study, we use the National Health Interview Survey (NHIS) to (1) examine quadrivalent HPV vaccine uptake 1–2 years after vaccine licensure among preadolescent and adolescent girls in the United States, (2) identify sociodemographic factors and preventive health behaviors associated with vaccine uptake, and (3) describe parental reasons for not intending to have their daughter vaccinated. We hypothesize that older girls are more likely to be vaccinated against HPV than younger girls. Our study along with the accompanying paper by Anhang Price, et al provides a comprehensive examination of national HPV vaccine uptake for females 9 to 26 years old, the full age range for which the vaccine is recommended.21

Age comparisons for incidence, histology, disease stage at initial diagnosis, and mortality of more than 20,000 ovarian cancer patients diagnosed between 1973-1987 are the focus of this descriptive epidemiologic study. This paper highlights key issues and concerns regarding ovarian cancer in women 65 years and older as a frame of reference for the proceedings of the working conference, "Perspectives on Ovarian Cancer in Older-Aged Women," co-sponsored by the National Institute on Aging, National Cancer Institute, and American Cancer Society held at the National Institutes of Health, November, 1991.Data are from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics. The SEER Program database represents approximately 9.6% of the U.S. population.Ovarian cancer affects women in the age group 65 years and older more frequently than younger women. More than 48% of all ovarian cancers occur in women in this age group. Age-adjusted rates increase as age advances, peaking at 54.0 per 100,000 in the age group 75-79 years. Time trends also indicate increases in age-specific incidence rates. This malignancy takes its toll in mortality in women 65 years and older with 64% of all deaths due to this neoplasm (in 1989). Moreover, older women are more likely to be initially diagnosed with advanced disease.Important questions about ovarian cancer in older-aged women need urgent attention from the research community. New strategies for diagnostic leads have to be developed for older women.

BACKGROUND: This paper examines the prevalence of cancer screening use as reported in 2005 among US adults, focusing on differences among historically underserved subgroups. We also examine trends from 1992 through 2005 to determine whether differences in screening use are increasing, staying the same, or decreasing. METHODS: Data from the National Health Interview Surveys between 1992 and 2005 were analyzed to describe patterns and trends in cancer screening practices, including Papanicolaou test, mammography, prostate-specific antigen, and colorectal screening. Logistic regression was used to report 2005 data for population subgroups defined by several demographic and socioeconomic characteristics. RESULTS: Rates of use for cancer tests are rising only for colorectal cancer, due largely to the increase in colorectal endoscopy screening. Use of all the modalities was strongly influenced by contact with a physician and by having health insurance coverage. CONCLUSIONS: There remain large gaps in use for all screening modalities by education, income, usual source of care, health insurance, and recent physician contact. These specific populations would benefit from interventions to overcome these barriers to screening. Cancer 2010. Published 2010 by the American Cancer Society.

The collection of papers in this Supplement combines cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program, enhanced by record linkages and geographic factors, to provide a comprehensive description of the cancer burden in the American Indian/Alaska Native population in the United States. Cancer incidence rates among this population varied widely, sometimes more than 5-fold, by geographic region.

African-Americans remain severely underrepresented in cancer control program delivery and research. Community-based organizational leaders and minority junior investigators have received little attention as representatives of target populations, or as agents to deliver and evaluate efforts to eliminate cancer health disparities. This paper describes activities of the National Black Leadership Initiative on Cancer II: Network Project, which has sought to address these issues. Community leaders and junior investigators received technical assistance (TA) and mentoring to develop applications for cancer education and community-based participatory research (CBPR) projects. TA was provided to 35 community leaders and 32 junior investigators. Twenty-nine community leaders won funding through the Community Partners for Cancer Education Program. Three pilot research applications were funded. Technical assistance may improve minority recruitment/retention in CBPR cancer control research and enhance understanding and elimination of cancer health disparities among African-Americans. Cancer 2006. (c) American Cancer Society.

BACKGROUND Nitric oxide (NO) is produced by a group of synthase enzymes (NOS). By means of different pathways, NO exerts several functions in benign and malignant human bladder tissues. The current paper describes the NO/guanylate cyclase (sGC)/cyclic guanosine monophosphate (cGMP) and the NO/oxidative pathways in human bladder tissues. METHODS Bladder carcinoma tissues were collected from 18 patients by transurethral resection procedures. Normal benign vesical tissue specimens from a further eight patients with benign diseases served as controls. Immunohistochemistry was conducted for localization of sGC, cGMP, and nitrotyrosine in benign and malignant vesical tissues, evaluating two–three tissue sections per patient. RESULTS Positive immunolabeling for sGC and cGMP was detected in vascular endothelial cells of normal and malignant vesical tissues. Those signals were most intense in bladder carcinoma tissues. Immunolabeling for sGC and cGMP was also detected in normal urothelial cells. In bladder carcinoma cells, a heterogeneous immunolabeling for sGC and cGMP was seen, with a wide spectrum of signal intensity. Positive immunostaining for sGC and cGMP was also observed in stromal round cells in benign and malignant bladder tissues. Immunolabeling for nitrotyrosine was mainly observed in endothelial cells, with a much stronger immunolabeling in bladder carcinoma tissues compared to normal benign controls. A weak immunolabeling for nitrotyrosine was also observed in bladder carcinoma cells. Normal urothelial cells did not show such nitrotyrosine expression. CONCLUSIONS The current report provides evidences that NO play several roles through different pathways in benign and malignant vesical tissues. The influences generated by NO molecules can be divided into cGMP-mediated effects (those resulting from the NO/sGC/cGMP pathway) and non-cGMP-mediated effects (those resulting from the NO/oxidative pathway). Increased angiogenesis is a cGMP-mediated effect, while nitrotyrosine production is a non cGMP-mediated oxidative effect. Such an NO/oxidative pathway is observed more often in bladder carcinoma. Cancer 2002;95:2293–301. © 2002 American Cancer Society. DOI 10.1002/cncr.10942

BACKGROUND. Upper limb edema remains the most frequent complication after treatments for breast carcinoma. Various imaging techniques can be used to prevent these complications, to manage them, and to diagnose the possible lymphonodal evolution that may underlie these events. In the present paper, these techniques are reviewed. METHODS. Based on clinical experience as well as on the data from the literature, these imaging techniques are presented, and their contributions are analyzed. RESULTS. The pre- and post-operative imaging and research techniques of the so-called sentinel nodes (using blue dye, and/or lymphoscintigraphy, and/or gamma probe) appear to be very promising for defining patients in whom axillary node clearance either might be avoided or is indicated. Lymphoscintigraphic investigations also can be used after surgery and/or radiation therapy to define patients who either are at risk to develop upper limb edema or present with latent edema. In patients with clinically obvious edema, even if it is limited, lymphoscintigraphic techniques can provide a morphologic and functional definition of the condition. Venous echo Doppler can be used when abnormalities of the venous return are suspected. In diagnosing the lymphonodal evolution of the disease, techniques like immunoscintigraphy, positron emission tomography (using 18- fluoro-2-deoxy-D-glucose), X-ray computed tomography, and nuclear magnetic resonance imaging can contribute. CONCLUSIONS. Various imaging techniques can be used to prevent and/or to manage the upper limb edema that may complicate the treatment(s) of the patients with breast carcinoma.

Age-adjusted mortality from cancer is steadily increasing among Native Americans, raising concern about environmental causes. Toxic waste dumps, mining activities, paper mills, military activities, agricultural chemicals, and urban pollution are common sources of carcinogen exposure on reservations and among the urban poor. Despite documented hazards, we do not see a pattern of cancer excess that might result if Native Americans were exposed to these carcinogens more than other Americans. Abuse of tobacco can be shown to be the most important contributor to cancer mortality among Native Americans. Although there are good reasons for environmental regulation and clean-up, the most cost-effective method of cancer prevention is tobacco control.

BACKGROUND Several studies have proven the usefulness of microvessel quantification as a prognostic factor for patients with various malignant tumors. The aim of this paper was to clarify the relationship between microvessel density (MVD) as a parameter of tumor angiogenesis and liver metastasis in colorectal cancer. METHODS A total of 175 patients with advanced colorectal cancer were evaluated (58 with concurrent liver metastasis). Microvessel quantification was performed immunohistochemically, using monoclonal antibodies against endothelial protein Factor VIII-related antigen (F8RA) and against endothelial surface marker CD34. Finally, the relationship between MVD and liver metastasis was analyzed. RESULTS A significant correlation was observed between MVD for F8RA and MVD for CD34 (n = 175, r = 0.9560, P = 0.0001). MVD in the tumors stained for F8RA ranged from 15.2 to 78.6 microvessels per × 200 field (mean 32.8 ± 11.7), while the tumors stained for CD34 varied between 21.6 and 118.8 microvessels per × 200 field (means 56.1 ± 20.5). A significantly higher MVD was observed in the tumors with liver metastatic disease compared with the tumors without liver metastasis (F8RA: mean 36.1 ± 11.3 vs. 31.2 ± 11.5, P = 0.0090; CD34: mean 64.4 ± 20.4 vs. 52.0 ± 19.4, P = 0.0010). CONCLUSIONS Microvessel quantification within a colorectal tumor using immunohistochemical staining methods has shown a significant correlation between MVD and liver metastasis. Tumors with a greater MVD may thus have a greater hematogenous metastatic propensity. Cancer 1996;77:1722-8.

Background. Retrospective studies have suggested that DNA tumor content (ploidy) has a significant effect on survival. This group has reported, prospectively, that among patients who had colorectal resections for carcinoma, the 2-year tumor recurrence rate was significantly greater for patients with aneuploid tumor than for those with diploid tumors. This paper reports the 5-year survival rates of this cohort of patients. Methods. Three hundred sixty-three patients who had colorectal resections for cancer between November, 1982, and March, 1988, were studied prospectively. The DNA tumor ploidy was measured from fresh and paraffin embedded tissues. These patients were followed regularly in a dedicated colorectal clinic for a minimum of 5 years or until death. Of the 363 patients studied, 2 were lost to follow-up. Results. Forty percent of the tumors were diploid, the remainder aneuploid. The 5-year survival for patients who had curative resections was 76% for those with diploid tumors compared with 64% for aneuploid tumors (P = 0.05 ; Mantel-Cox, 3.7). On further analysis, the survival benefit conferred by a diploid tumor appeared to be confined to those with Stage B tumors. There was no relation between ploidy and sex, age of patient, stage, histologic grade, or site of tumor. Conclusions. Ploidy is a useful objective measurement of the aggressiveness of Stage B tumors. Patients with aneuploid Stage B tumors have a poor prognosis ; this group may benefit from adjuvant therapy

Background. Confounding biologic factors, including histologic grade, may influence the outcome of adult patients with malignant gliomas more than may modifications in therapeutic approach. Any clinical trial design for malignant gliomas in adults must account for such biologic factors, including the accurate identification of the two histologic subgroups astrocytoma with anaplastic foci (AAF) or glioblastoma multiforme (GBM), which are associated with distinctly different survival outcomes. This paper examines the need for a central pathology review before entry of patients in cooperative group clinical trials stratified by histologic grade. Methods. Pathology slides from Radiation Therapy Oncology Group (RTOG) trial 83-02, a randomized Phase II study of hyperfractionated and accelerated hyperfractionated radiation therapy and carmustine for malignant gliomas, provided 747 analyzable cases, with 680 (91%) available for central pathology review. This review was performed by a single pathologist according to RTOG/Eastern Cooperative Oncology Group histopathologic criteria. The kappa statistic was used to measure agreement between the institutional and central classification of AAF and GBM. The influence of misclassification was examined using computer simulation of varying clinical trial sizes (n = 25, 50, or 200). The effect on the statistical power of trials (n = 200) with varying mixtures of AAF and GBM tumors was investigated using computer simulations. Results. Of 159 tumors classified as AAF by institutional pathology review, only 66% (105) were classified as AAF (AAF/AAF) by central review, and 54 of these cases (34%) were classified as GBM (GBM/AAF), whereas 96% (501) of 521 institutionally classified as GBM (GBM/GBM) were similarly classified by central review. Computer simulations demonstrated a 59% underestimation in the median survival (1.82 vs. 4.49 years) for trials of patients with institutionally defined AAF compared to patients with centrally defined AAF in studies of 200 patients, resulting from the addition of poor prognosis of GBM in the trial. Misclassification can also substantially reduce the statistical power of a clinical trial. In one of the simulation studies, statistical power was reduced from 65% to 14% if 50% of the patients were to receive an inaccurate histologic classification. Even greater losses in power are possible in many plausible clinical settings. Conclusions. This examination of a central versus an institutional pathology review demonstrates a low level of agreement on AAF classification and a high level of concordance on GBM classification. The results indicate the need to adjust sample size for trials of both AAF and GBM tumors to have adequate statistical power. A central pathology review remains essential for trial entry for patients with AAF and could be omitted for trials enrolling patients with GBM only

Background. High dose interleukin-2 (IL-2) has been found to produce durable antitumor responses in some patients, benefiting most greatly those patients with melanoma and renal cell carcinoma. In this paper, the hematologic toxicity and changes resulting from high dose IL-2 alone administered by intravenous bolus are discussed. Methods. One hundred ninety-nine consecutive patients treated with high dose IL-2 alone from January 1, 1988 to December 31, 1992 were included in this study. All patients had a diagnosis of metastatic melanoma or metastatic renal cell carcinoma and were treated at the National Cancer Institute (Bethesda, MD). Results. Anemia, requiring erythrocyte transfusions, occurred in 14% of all treatment courses, with a median of two units of erythrocytes transfused. Severe leukopenia (

Epithelial ovarian cancer, once categorizing all epithelial cancers of the ovary and fallopian tube, is now recognized to be an umbrella term. We are recognizing two categories of ovarian cancer, with the “type 1” cancers containing further types, including low grade serous cancers, mucinous, clear cell, and low grade endometrioid. These types are genetically and histologically as different as is their outcome. The paper accompanying this editorial further dissects low grade serous cancers to show that those carrying oncogenic KRAS or BRAF mutations have an unexpectedly excellent clinical outcome. We discuss this newest unexpected behavior of ovarian cancer.

The purpose of this paper is to review the incidence of upper-body morbidity (arm and breast symptoms, impairments, and lymphedema), methods for diagnosis, and prevention and treatment strategies. It was also the purpose to highlight the evidence base for integration of prospective surveillance for upper-body morbidity within standard clinical care of women with breast cancer. Between 10% and 64% of women report upper-body symptoms between 6 months and 3 years after breast cancer, and approximately 20% develop lymphedema. Symptoms remain common into longer-term survivorship, and although lymphedema may be transient for some, those who present with mild lymphedema are at increased risk of developing moderate to severe lymphedema. The etiology of morbidity seems to be multifactorial, with the most consistent risk factors being those associated with extent of treatment. However, known risk factors cannot reliably distinguish between those who will and will not develop upper-body morbidity. Upper-body morbidity may be treatable with physical therapy. There is also evidence in support of integrating regular surveillance for upper-body morbidity into the routine care provided to women with breast cancer, with early diagnosis potentially contributing to more effective management and prevention of progression of these conditions.

Quality-of-life evaluation has gained increasing attention within the oncology community over the past 2 decades. The breadth of quality-of-life research in women with breast cancer has expanded substantially during this time. This paper reviews the status of quality-of-life research in women with breast cancer and explores several areas in which quality-of-life research can be of value. Descriptive quality-of-life studies in patients undergoing active treatment can identify the impact breast cancer treatment has on a patient's life. For patients who have completed treatment, research can detect areas of persistent distress. Quality-of-life assessment now is incorporated in many clinical trials. These data can provide a patient-rated assessment of treatment and complement the traditional endpoints in clinical trials. Examples of selected quality-of-life studies in patients with breast cancer are presented.

Breast reconstruction has undergone a steady evolution since the introduction of the silicone gel prosthesis in the early 1960s. Current restrictions of the use of breast implants have increased the reliance on autologous tissue reconstruction. The improvement in the quality of breast reconstruction can be attributed in part to a refinement in mastectomy technique. There is an increasing emphasis on skin preservation, which makes it easier to match the remaining breast. In this paper, various methods, including tissue expansion, the latissimus dorsi flap, the transverse rectus abdominis musculocutaneous flap, and free flaps, are described. The indications as well as potential complications for each methods also are discussed. Local recurrence after breast conservation generally necessitates a total mastectomy. Radiation fibrosis and endarteritis interfere with skin blood supply and impair wound healing. Reconstruction in this setting has a potential for increased operative morbidity. Treatment options, including techniques to reduce potential complications, are presented.

BACKGROUND: Disclosure of conflicts of interest in biomedical research is receiving increased attention. The authors sought to define current disclosure policies and how they relate to disclosure statements provided by authors in major oncology journals. METHODS: The authors identified all oncology journals listed in the Thomson Institute for Scientific Information and sought their policies on conflict-of-interest disclosure. For a subset of journals with an Impact Factor >2.0, they catalogued the number and type of articles and the details of the published disclosures in all papers from the 2 most recent issues. RESULTS: Disclosure policies were provided by 112 of 131 journals (85%); 99 (88%) of these requested that authors disclose conflicts of interest (mean Impact Factor for these journals: 4.6), whereas the remaining 13 (12%) did not (mean Impact Factor: 2.9). Ninety-three journals (94%) required financial disclosure, and 42 (42%) also sought nonfinancial disclosures. For a subset of 52 higher-impact journals (Impact Factor >2.0), we reviewed 1734 articles and identified published disclosures in 51 journals (98%). Many of these journals (31 of 51, 61%) included some disclosure statement in >90% of their articles. Among 27 journals that published editorials/commentaries, only 14 (52%) included disclosures with such articles. There was no publication of any nonfinancial conflicts of interest in any article reviewed. CONCLUSIONS: Disclosure policies and the very definition of conflict of interest varied considerably among journals. Although most journals had some policy in this area, a substantial proportion did not publish disclosure statements consistently, with deficiencies particularly among editorials and commentaries. Cancer 2012;. © 2011 American Cancer Society.

Human papillomavirus (HPV) is an emerging causative factor for squamous carcinoma of the oropharynx and perhaps other head and neck cancers. There is a great deal of uncertainty regarding the clinical significance and implications of HPV status in this patient population. As a result, there is no established protocol for informing patients of the potential link between viral infection and their cancer. This paper discusses some of the ethical issues involved with informing head and neck cancer patients of their HPV status, recognizing the dilemma posed by unresolved clinical questions and the need to respect the autonomy of patients by disclosing relevant information.

In 1984, the American Cancer Society (ACS) determined that a substantial proportion of new cancer cases could be avoided if seven dietary guidelines were followed. Education programs were developed for the general public, young people, and the mass media. In 1989, a Working Group of the Society reviewed the guidelines and found them to be valid, the only change being to combine two of them. This paper summarizes recent dietary recommendations of other health authorities, describes progress in meeting ACS dietary recommendations, analyzes the barriers to and opportunities for dietary improvement, and proposes new leadership opportunities for the Society. Concern is expressed that the current guidelines lack the clarity and specificity needed for public education, and that they are inconsistent with recent dietary recommendations of other authorities such as the US Department of Health and Human Services and the National Academy of Sciences. Revisions to the ACS Dietary Recommendations and implications for ACS programs are proposed.

Effective assessment of treatment outcome and the development of successful rehabilitation for head and neck cancer patients demand an evaluation of the relevant parameters of functional status. This paper reports the development and testing of a new Performance Status Scale for Head and Neck Cancer Patients designed to assess the unique areas of dysfunction experienced by this population. The instrument is a simple, practical, clinician-rated assessment tool consisting of three subscales: (1) Understandability of Speech, (2) Normalcy of Diet, and (3) Eating in Public. The scale was administered to a group of 181 head and neck patients and a comparison group of 30 breast cancer patients. Results indicate that the scale is reliable across raters and sensitive to functional differences across a broad spectrum of head and neck cancer.

As similar cancer health disparities have been documented for African American (AA) women and Latinas, it would be important to determine whether comparable interventions could be used to increase screening among these 2 culturally different populations. This paper reports research findings comparing cultural dimensions of breast and cervical cancer as they impact Latino and AA social networks and explore the feasibility of creating outreach models that may serve both groups. An existing intervention that integrates the social roles and relationships of AA women, The Witness Project(R), is used as a framework for tailoring an intervention for Latino communities. Findings and data from focus groups and key informant interviews were collected from more than 120 Latinos in Arkansas and New York City. These findings are analyzed using the Pen-3 Model, categorized, and compared with previous social role and network information from AA women as reflected in the Witness Project(R) intervention model. The findings from this study demonstrated variations between AA women and Latinas with regard to roles and gender relationships while demonstrating similarities with regard to spiritual beliefs and attitudes toward cancer. We applied our results to culturally tailor and develop a breast and cervical cancer intervention, Esperanza y Vidatrade mark (Hope and Life), that incorporates Latino values and social relationships. This study demonstrates that a proven education and outreach model for AA women may provide a framework for creating a culturally appropriate intervention for Latinas. Further research is needed to study the efficacy of the new model. Cancer 2007. (c) 2006 American Cancer Society.

This paper describes the development of the American Indian Oncology Program (AIOP) and presents the accomplishments of a participatory research approach that involved an integrated network for cancer care and research. AIOP used a participatory process to develop infrastructure, identify research questions, develop methodologies, write supplemental grants, and evaluate accomplishments based on community defined measures of success. Partnerships between University and Indian Health Service, private, and state institutions led to improved collaboration. Health services delivery improved by increasing provider involvement at multiple institutions via a Tumor Board. Community awareness improved through workshops addressing community-specific cancer concerns. Collectively, these resulted in an environment receptive to the development of research activities. The AIOP team, through a participatory process, developed infrastructure at each institution that facilitated interaction, community-based education, and improved patient care; identified new partners; raised community-level knowledge and awareness about cancer; encouraged a research-friendly environment and building research capacity; and increased the cultural competency of researchers wishing to work in American Indian communities and created a cadre of future American Indian cancer researchers. As evidenced by successful pilot project development and formation of ongoing research and funding applications, the authors created a research-receptive environment and promoted potentially sustainable research capacity in the community. Much of their success is the result of utilizing a participatory model for capacity building that included not only communities but institutions. Cancer 2006. Published 2006 by the American Cancer Society.

Diffuse large B-cell lymphoma (DLBCL) is a biologically heterogeneous disease for which the current approach to treatment is only successful for 50% of patients. The prognostic value of various clinical and biological factors in predicting treatment outcome is discussed in this paper. A review of the English literature was performed including original articles and relevant reviews from MEDLINE that addressed the topics of DLBCL biology and potential prognostic factors. The International Prognostic Index is, to date, the most successful clinical model for predicting outcome. In addition, a rapidly expanding list of molecules has been identified by conventional and newer diagnostic methods that may be of significant prognostic value. Gene expression profiling has led to the discovery of new biological subtypes of DLBCL based on patterns of gene expression, and a host of new genes that may play important roles in this disease. Various derangements in apoptosis, cell-cycle regulation, differentiation, and signal transduction have been noted, while the host environment and immune response also appear to modify clinical outcome. Although to our knowledge, the fundamental abnormalities underlying DLBCL remain elusive, progress is being continuously made to further the understanding of the biological heterogeneity of this disease and the use of various clinical and biological variables to predict treatment outcome. The goal is to be able to identify subgroups of patients at high risk of treatment failure and develop more effective treatment based on specific biological defects that may represent new rational therapeutic targets.

The effectiveness of prescreening and rescreening cervical cytology preparations—whether used as quality assurance measures or in the attempt to improve sensitivity—has engendered broad discussion within the cytology community. This paper forms an introduction to some of the issues surounding prescreening and rescreening in cervical cytology. Cancer (Cancer Cytopathol) 2004. Published 2004 by the American Cancer Society.

It comes as no surprise that radiation at high doses can cause lung cancer. Survivors of the atomic bomb explosions in patients given radiotherapy for ankylosing spondylitis3 or and underground miners exposed to radon' all have been reported to be at increased risk of lung cancer. There is growing evidence that adjuvant radiotherapy for breast cancer after radical mastectomy, a common treatment practice in previous decades, but less so today, also is associated with an increased risk of lung cancer 10 or more years later.'"" For medically exposed populations, it is important to understand the magnitude of possible treatment risks, the associated benefits, and the relevance to current practice. The joint effects of radiation and other environmental exposures, most notably cigarette smoking, also await clarification and are of scientific interest for what they may imply atout the mechanisms of lung carcinogenesis. The paper by Neugut and colleagues in this issueI2 addresses the combined effects of radiation therapy and smoking, with a view toward the possible clinical implications. The authors report a 3-fold relative risk (RR) associated with radiotherapy for breast cancer among 10-year survivors, a 14-fold RR associated with cigarette smoking, and a 33-fold risk among irradiated smokers. Each of these associations was more pronounced for lung cancers occurring in the lung on the same side of the body as the breast cancer (ipsilateral) than for those occurring on the opposite (contralateral) and less heavily irradiated side. The authors suggest that radiotherapy and smoking act multiplicatively and that smokers represent a subgroup in which the absolute risks associated with radiotherapy are much greater than for nonsmokers, large enough, perhaps, to be an important consideration in the design of breast cancer treatment for smokers.