Urine Test Might Help Predict Prostate Cancer Risk

WEDNESDAY, Aug. 3 (HealthDay News) -- A new urine test might help doctors detect prostate cancer and better evaluate a patient's treatment options, researchers say.

"This is a tool that men and their physician can use to help them decide whether it's appropriate to get a biopsy now or delay that decision," said lead researcher Dr. Scott Tomlins, a pathology resident at the University of Michigan Health System.

The test looks for two genetic markers associated with prostate cancer. The first, called TMPRSS2:ERG, is caused by two genes changing places and fusing together; it is thought to cause prostate cancer. Since the gene fusion is only seen in about half of cancer patients, the test also looks for another marker, called PCA3.

"We are exploiting some new bio-markers to try to refine the PSA [prostate-specific antigen] test," Tomlins said.

The PSA test can indicate prostate cancer, but it is unreliable, often producing false positives and false negatives, Tomlins said. "You can have low PSA and have cancer, or high PSA and not have cancer," he said.

The two genetic markers may be more reliable indicators of prostate cancer, he said. One of them, TMPRSS2:ERG, is only seen in cancer, he added.

Together, they can be used "to stratify men into saying, 'You have a high chance of having cancer, and you should get a biopsy now, or if you are in a lower risk group you have a much lower risk of cancer and perhaps you could delay the biopsy,'" Tomlins said.

However, Tomlins cautioned that the test is not perfect. "It's hard to recommend that someone not get a biopsy, because there is always a chance you are going to miss a cancer that doesn't have either of these two markers," he said.

For the study, published in the Aug. 3 issue of Science Translational Medicine, Tomlins' team studied urine samples from 1,312 men who had high PSA levels and had had a prostate biopsy or surgery to remove the prostate.

The researchers specifically looked for the two markers and used them to slot the men into high-, intermediate- or low-risk groups for prostate cancer. They then compared their results with the results from biopsies, which are done with a needle in a physician's office for detection of any cancer cells.

Based on the biopsies, cancer was found in 21 percent of the men in the low-risk group, in 43 percent of the intermediate-risk group and in 69 percent of the high-risk group.

The researchers said the findings of the urine tests correlated with tumor size and the cancer's aggressiveness. In the low-risk group, only 7 percent had aggressive cancer, compared with 40 percent of the men classified as high-risk, they found.

One limitation of the study is that most patients were Caucasian, so further studies are needed to see whether the findings extend to all men, the researchers noted.

Although not yet available to the public, the test soon will be offered at the University of Michigan, Tomlins said.

The test is licensed to Gen-Probe, a San Diego maker of genetically based diagnostic tests. Mike Watt, a company spokesman, said the test is still in the early stages of development and has not been submitted to the U.S. Food and Drug Administration for approval. The company has no firm idea of the test's cost should it be approved, Watt added.

Study funding was supported in part by Gen Probe, and the University of Michigan and Brigham and Womens Hospital have obtained a patent on the detection of ETS gene fusion in prostate cancer, in which four co-authors are listed as co-inventors.

A prostate cancer expert, Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said the test is "a step forward, but we still have a ways to go."

"On average the risk is higher in people with both markers and lowest in people who have neither, but that's on average," D'Amico said.

If a patient has indications of an aggressive prostate cancer, the test can add more to that diagnosis, D'Amico said. But for men who potentially have cancer, a low-risk determination based on this test shouldn't preclude biopsy, he said.

"It adds fuel to the fire when you suspect something bad, but I don't think it takes you out of the woods when these markers are not present," D'Amico said.

More information

For more information on prostate cancer, visit the American Cancer Society.

SOURCES: Scott Tomlins, M.D., Ph.D., pathology resident, University of Michigan Health System, Ann Arbor; Anthony D'Amico, M.D., Ph.D., chief, radiation oncology, Brigham and Women's Hospital, Boston; Mike Watt, spokesman, Gen-Probe, San Diego, Calif.; Aug. 3, 2011, Science Translational Medicine

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Growing Up Near Livestock Tied to Blood Cancers

THURSDAY, July 28 (HealthDay News) -- Children raised on livestock farms are at significantly greater risk of developing blood cancers -- such as leukemia, multiple myeloma and non-Hodgkin's lymphoma -- later in life, a new study contends.

The researchers pointed out that further studies will be needed before a definitive cause and effect can be established, but they suggested that exposure to particular viruses during childhood may modify the immune system response and result in a higher risk for blood cancer in adulthood.

In conducting the study, published in the July 28 online edition of Occupational and Environmental Medicine, researchers compiled information from 114,000 death certificates for people between 35 and 85 years of age who died between 1998 and 2003 in New Zealand.

The study found that over the five-year period, more than 3,000 deaths were attributed to blood cancers. Moreover, the researchers revealed that growing up on a livestock farm was linked to a higher risk. They noted, however, that people who were raised on farms with crops were not more likely to develop blood cancer.

Overall, the risk of developing a blood cancer was 22 percent higher for those who grew up on a livestock farm than those who did not, according to Andrea 't Mannetje, of the Centre for Public Health Research at Massey University in Wellington, New Zealand, and colleagues.

Being raised on a poultry farm carried the greatest risk, the researchers noted. Those who had spent their childhood living on a poultry farm were three times more likely to develop a blood cancer than others.

On the flip side, growing up on a crop farm came with a nearly 20 percent lower risk of developing blood cancer, the investigators found.

More information

The U.S. Centers for Disease Control and Prevention provides more information on blood cancers.

SOURCE: Occupational and Environmental Medicine, news release, July 27, 2011

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Study of Bone Cancer in Dogs May Improve Treatment in Kids

MONDAY, Aug. 8 (HealthDay News) -- The discovery of a gene pattern that distinguishes highly aggressive bone cancer in dogs from a less aggressive form may help improve treatment of bone cancer in children, according to researchers.

Other than humans, dogs are the only species that develops bone cancer spontaneously with any frequency. Dogs are more likely than humans to develop bone cancer, but human and dog forms of bone cancer are very similar, explained study team leader Dr. Jaime Modiano, a comparative medicine expert at the College of Veterinary Medicine and Masonic Cancer Center at the University of Minnesota.

The newly discovered gene pattern in dogs is an exact match with humans and may assist in treatment planning for children with bone cancer, according to the report in the September issue of the journal Bone.

"Our findings pave the way to develop laboratory tests that can predict the behavior of this tumor in dogs and children at the time of diagnosis," Modiano said in a university news release. "This allows us to tailor individualized therapy to meet the patient's needs. Patients with less aggressive disease could be treated conservatively, reducing the side effects and the risks associated with treatment, while patients with more aggressive disease could be treated with more intense therapy."

The course and aggressiveness of bone cancer can vary from patient to patient and is difficult to predict. Some patients respond well to conventional treatment and live for decades without recurrence, while others have a poor response and experience a rapid return of bone cancer, the release noted.

More information

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

SOURCE: University of Minnesota, news release, July 28, 2011

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Early Morning Smoking Riskier For Cancer

MONDAY, Aug. 8 (HealthDay News) -- Smokers who light up right after they wake up in the morning may be at greater risk for lung, head and neck cancers than those who wait longer before having their first cigarette of the day, a new study finds.

The study was released online Aug. 8 in advance of publication in an upcoming print issue of the journal Cancer.

"These smokers have higher levels of nicotine and possibly other tobacco toxins in their body, and they may be more addicted than smokers who refrain from smoking for a half hour or more," said Joshua Muscat, of Penn State College of Medicine in Hershey, in a journal news release. "It may be a combination of genetic and personal factors that cause a higher dependence to nicotine."

In the study, researchers compared 4,775 lung cancer patients with 2,835 smokers who didn't have cancer. They found that those who smoked 31 to 60 minutes after waking up were 1.3 times more likely to develop lung cancer than those who waited at least an hour before lighting up. Meanwhile, those who smoked within 30 minutes of waking up were 1.79 times more likely to develop lung cancer.

In a separate analysis, the investigators compared 1,055 smokers with head and neck cancer with 795 smokers without the disease. Those who smoked 31 to 60 minutes after waking up were 1.42 times more likely to develop cancer than those who waited more than 60 minutes to have a cigarette. Smokers who had their first cigarette within a half hour of waking up were 1.59 times more likely to develop head and neck cancer.

The findings suggest the desire to have a cigarette immediately after waking up may increase smokers' risk for cancer, the researchers concluded. As a result, these smokers would benefit from smoking cessation programs that specifically target this early morning behavior and the greater risks involved, they added.

More information

The U.S. Centers for Disease Control and Prevention provides more information on the health effects of smoking.

SOURCE: Cancer, news release, Aug. 8, 2011

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Drop in Breast Cancer Death Rates May Not Be Linked to Screening Rates

FRIDAY, July 29 (HealthDay News) -- Developed countries have seen a drop in breast cancer death rates in recent years, but a new international study suggests this trend is less about rising screening rates and more about the availability of increasingly effective treatments and improving health-care systems.

The finding stems from an analysis of World Health Organization (WHO) breast cancer data collected between 1980 and 2006, in which French, British and Norwegian researchers compared the screening and fatality rates of several Western European countries. The observations were presented online July 29 in the British Medical Journal.

"The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality," a team of researchers led by Philippe Autier, research director of the International Prevention Research Institute in Lyon, France, said in a journal news release.

To explore to what degree breast cancer screening rates appeared to be related to fatality rates, the authors chose six countries for points of comparison.

Northern Ireland was stacked up against the Republic of Ireland; the Netherlands was compared with Belgium/Flanders; and Sweden was examined alongside Norway.

The team noted that medical services and the prevalence of breast cancer death risk factors were comparable in each pairing. However, in the space of the study, the second country of each of the three groups was 10 to 15 years behind the first country in terms of their implementation of mammography screening protocols.

The results: Breast cancer death rates, which dropped across the board, were more or less similar in each country pairing, despite stark differences in screening histories.

For example, fatalities between 1989 and 2006 had plummeted by 29 percent in Northern Ireland, as compared with 26 percent in the Republic of Ireland.

The Netherlands registered a 25 percent drop, compared with a 20 percent to 25 percent drop in Belgium/Flanders, while the downward trend of 16 percent in Sweden compared with 24 percent in Norway.

In general terms, Autier's team also noted breast cancer death rates were not that different among women who had undergone almost no screening as compared with those who had been screened quite often.

And the biggest death rate drop seen overall was among women between the ages of 40 and 49, whether or not they had undergone screening.

Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital (affiliated with Northshore/LIJ) in New York City, cautioned that it's not clear that the current findings are easily generalizable to other nations.

"I'm not sure how well this finding would translate in comparison with the U.S.," she noted. "I suspect that we may be more aggressive in our screening protocols, and our health system is very different from the ones they looked at."

"And, in any case, I would certainly say that people should continue getting screened," Cassell stressed. "Because we still do know that catching any cancer at an earlier stage does translate into better outcomes and maybe less treatment. Because even if the end result is the same, and fatal, I certainly would like to have a cancer that could be treated with hormonal treatment and not chemotherapy, if possible."

More information

For more on breast cancer screening guidelines in the United States, visit the American Cancer Society.

SOURCE: BMJ, July 28, 2011, news release

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For Many, Risks of Lung Biopsy May Outweigh Benefits: Study

MONDAY, Aug. 1 (HealthDay News) -- For many patients, biopsies of lung nodules found during CT scans may be unnecessary and even dangerous, a new study finds.

"As we have been doing more CT scans, we are finding more of these nodules or spots in the lungs, which have unclear clinical significance," said lead researcher Dr. Renda Soylemez Wiener, an assistant professor of medicine at Boston University School of Medicine.

Nodules are spotted in as many as 25 percent of patients undergoing a chest CT scan, the study said. "When nodules show up, doctors and patients need to decide whether to biopsy that spot in the lung," she said. "There are risks to that [surgical] procedure, which may be more common than most people realize."

Lung collapse and bleeding are complications of the procedure, which involves removing and examining a sample of tissue.

Wiener, noting that 98 percent of the nodules turn out to be benign, said physicians perform too many unnecessary lung biopsies.

Too many CT scans are also done, Wiener said. "We find information we don't know what to do with. Like we find a spot in the lung and have to decide whether or not to expose a patient to the risk of biopsy," she said.

One factor driving lung biopsies is physician fear of being sued for not finding a cancer, Wiener said. Also, a recent U.S. National Cancer Institute report, which found that CT screening reduced lung cancer deaths compared with use of traditional chest X-rays, is expected to boost the use of scans for smokers and others at risk of lung cancer. But doctors need to tell patients about the risks, the study authors said.

"There are situations where it might not be worth it to do a biopsy," Wiener said. These include "people with either very low risk of cancer or people who have such a high risk of cancer that they are probably going to go to surgery no matter what a biopsy shows," she said.

Also, people so frail that they couldn't withstand lung cancer treatment should not have a biopsy, Wiener said.

For the study, published in the Aug. 2 issue of the Annals of Internal Medicine, Wiener's team reviewed data on 15,865 adults who underwent a lung biopsy.

Of the 1 percent who experienced bleeding as a result of the procedure, 17.8 percent needed a blood transfusion, they found.

Lung collapse, a condition called a pneumothorax, occurred in 15 percent of the patients.

Of that group, 6.6 percent needed a chest tube to expand the lung and a longer hospital stay. These patients were also more likely to develop respiratory failure that required mechanical ventilation, the researchers found.

Complications during biopsy were more common among older patients, smokers and people with chronic obstructive pulmonary disease, the researchers said.

Dr. Norman H. Edelman, a professor of preventive medicine, internal medicine, physiology and biophysics at Stony Brook University in New York and chief medical officer for the American Lung Association, said the "the findings are especially relevant" in light of the National Cancer Institute lung cancer screening trial.

"In all likelihood, the Institute's findings will result in the identification of many more pulmonary nodules, which physicians will have to evaluate," he said.

Typically, doctors must choose between careful watching with subsequent CT scans and early biopsy. "The current report should be helpful to physicians in making a 'real world' risk-versus-benefit analysis between the two approaches," Edelman said.

Edelman also said the regional variation in use of needle lung biopsy invites examination. (The data showed a rate of 14.7 per 100,000 adults in New York compared to 36.2 per 100,000 adults in Florida.)

"If we are to be rational about resource utilization, we must solve the question of whether some regions do too few procedures or other regions do too many," he said.

More information

For more information on lung cancer, visit the U.S. National Library of Medicine.

SOURCES: Renda Soylemez Wiener, M.D., M.P.H., assistant professor, medicine, Boston University School of Medicine; Norman H. Edelman, M.D., professor, preventive medicine, internal medicine, physiology and biophysics, Stony Brook University, N.Y., chief medical officer, American Lung Association; Aug. 2, 2011, Annals of Internal Medicine

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When Answers Lead to Action

Kari Bohlke, ScD

What characteristics have you inherited from your family? Specific features such as hair and eye color may come to mind, along with less tangible characteristics, like a quirky sense of humor.

Sometimes, however, it’s hard to predict which parts of our family history will play out in our own lives. Take cancer: your family history can provide clues about your own risk, but often doesn’t tell the whole story. Cancer can develop in someone with no family history of the disease, and may never develop in someone with a strong family history.

Fortunately, research into inherited susceptibility to cancer is helping to reduce this uncertainty for some families, allowing individuals to make informed choices about how to manage their cancer risk. In these families, certain members have a very high risk of cancer as a result of genetic mutations that are passed on from one generation to the next. These mutations tend to result in multiple family members developing cancer, often at a relatively young age.

As an example, mutations in two genes—BRCA1 and BRCA2—have been found to greatly increase the lifetime risk of developing breast and ovarian cancer. Mutations in these genes can be passed down through either the mother’s or the father’s side of the family. Similarly, inherited mutations in one of three genes—MLH1, MSH2, or MSH6—lead to a condition known as Lynch syndrome (also known as hereditary non-polyposis colorectal cancer, or HNPCC). People with Lynch syndrome have an increased risk of colorectal cancer, uterine cancer, and ovarian cancer, as well as other cancer types.

For these and other well-established hereditary cancer syndromes, genetic testing can determine which family members have inherited the mutation and which haven’t. People who find out that they have a mutation that places them at high risk of cancer can take steps to reduce their risk or to detect the cancer at the earliest stage possible.

“It’s the kind of information that really can drive patients or family members in terms of medical decision-making going forward,” says Donald Braun, PhD, Vice President of Clinical Research at Cancer Treatment Centers of America® (CTCA) in Zion, Illinois. “People who discover that they have these mutations are now in a much more informed position to make choices about how they will manage their health.”

In the case of BRCA1 or BRCA2 mutations, for example, options for risk reduction or early detection include prophylactic (preventive) surgery to remove the breasts or ovaries before cancer develops, chemoprevention (use of medication to reduce cancer risk), and earlier and more frequent screening.

Who Should be Tested?

Your doctor or a genetic nurse or genetic counselor can help you determine whether you are a candidate for testing. Genetic testing is not recommended for everyone; it’s targeted toward those who are most likely to have a certain mutation. Risk of having a mutation is based on your own medical history as well as your family’s medical history. Aspects of family history that are helpful to collect include which family members have cancer as well as which family members do not have cancer. If you are considering genetic testing, try to collect information about any family members who have been diagnosed with cancer, including age at diagnosis and site of cancer (breast, for example). In some cases, it’s also helpful to have information about your family’s ethnic origins; certain BRCA1 and BRCA2 mutations, for example, are particularly common in people of Ashkenazi Jewish descent.

What Are the Possible Test Results?

Understanding the results of a genetic test for cancer susceptibility can be complicated. “There are four possible results,” explains Marty Weinar, MS, RN, manager of Research and Genetics at CTCA in Philadelphia, Pennsylvania. A positive test is the most straightforward: it means that you have a gene mutation that is known to increase cancer risk. A positive test does not mean that you will definitely get cancer; rather, the positive test means that you are more likely to develop cancer than a person without the mutation.

Interpretation of a negative test will depend on whether or not a specific gene mutation has already been identified in your family by previous testing. If your family has a known mutation and you test negative, it’s a true negative: you have not inherited your family’s known cancer susceptibility gene. Keep in mind that a negative test does not mean that you are immune to cancer. It simply means that you don’t have the very elevated risk that your affected family members have.

If you test negative and there is no known gene mutation in your family, the result is referred to as a negative of limited significance. With this result, says Weinar, “we can’t say with absolute certainty that there is not a mutation; you just don’t have what we were able to test for.”

A final possibility is that the test will identify a genetic change that has an unknown effect. This is referred to as a variant of uncertain significance. Although this can be a disconcerting result to receive, “it happens less frequently than it used to,” says Weinar. “We tell these patients to stay tuned.” If the genetic change is later found to be harmless (or if it’s found to increase cancer risk) patients can be informed.

The Benefits of Working with a Genetics Professional

Health care providers with specialized training in genetics can help you navigate and understand all stages of the testing process. These providers include genetic counselors and nurses trained in genetics. “The role for the nurse or the counselor,” says Weinar, “is to identify which patients might be appropriate for testing, educate and counsel the patients, get all the paperwork filled out, and then, depending on the results, collaborate with the doctor to come up with a plan for managing the cancer risk.”

“Susceptibility testing should never be done without the counselors and the practitioners who can tell you what the results mean and what options are available to help you manage your risk,” emphasizes Dr. Braun. “The message should not be, ‘I have horrible news: you have the mutation and there’s nothing you can do about it,’ because that’s not true. If you have the mutation, you’re armed with some very powerful information. In the right setting, qualified practitioners and counselors can truly help you make decisions that can save your life.”

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