Early-Stage Cervical Cancer: Open Surgery Is Better
What’s New: Women who have open surgery (not laparoscopic) for early-stage cervical cancer have lower rates of recurrence and death compared to women who undergo minimally invasive surgery, according to data published on June 11 in JAMA Oncology. Research Details: Researchers analyzed 15 studies that included almost 9,500 women. The combined risk of recurrence or death was 71 percent higher in those who had minimally invasive surgery compared with open surgery. The recurrence rates for minimally invasive surgery and robot-assisted minimally invasive surgery were similar — both were inferior to open surgery. Why It Matters: Prior to the early 1990s, women with early-stage cervical cancer routinely underwent open surgery to remove the uterus and some surrounding tissue. However, laparoscopic, or minimally invasive, surgery became popular in the ’90s because it is associated with a shorter recovery time and fewer complications, though the long-term cancer outcomes of the two approaches had not been directly compared. The new evidence “strongly suggests that the harm of minimally invasive surgery for cervical cancer outweighs the benefits,” said the study’s lead author, Alexander Melamed, MD, assistant professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons and a member of Columbia’s Herbert Irving Comprehensive Cancer Center. RELATED: American Cancer Society Releases New Cervical Cancer Screening Guidelines
Vitamin D May Prevent an Annoying Immunotherapy Side Effect
What’s New: Patients who took vitamin D supplements while undergoing immunotherapy treatment for melanoma had a reduced risk of developing colitis, a side effect from immunotherapy drugs, according to research published online on June 22 in the journal Cancer. Research Details: Researchers at Dana-Farber Cancer Institute and Harvard Medical School studied 213 patients with melanoma who received a type of drug known as an immune checkpoint inhibitor as part of their treatment. Among this group, 37 developed colitis. Before beginning treatment with immunotherapy, 66 patients in the study took vitamin D supplements. The study found that those who took vitamin D had a 65 percent lower risk of developing colitis. Why It Matters: Immunotherapy medications have revolutionized the treatment of some types of cancer, but the drugs can cause immune system–related side effects. Colitis, an inflammation of the colon, is one of the most common and severe side effects of immunotherapy, said the authors of the study. Colitis can cause some patients to stop the immunotherapy treatment. “Our findings of a link between vitamin D intake and reduced risk for colitis could potentially impact practice if validated in future prospective studies,” said Osama Rahma, MD, of the Dana-Farber Cancer Institute and Harvard Medical School in Boston. RELATED: Does Cancer Immunotherapy Worsen COVID-19 Outcomes?
Less Time Sitting May Lower Cancer Risk
What’s New: People who exercise more in middle and older age and spend less time engaging in sedentary behavior have a reduced risk of death due to cancer, according to a study published on June 18 in JAMA Oncology. Research Details: Researchers looked at 8,002 adults ages 45 and older who were enrolled in a stroke study. The study analyzed the participants’ sedentary time, light-intensity physical activity, and moderate-to-vigorous activity for seven days using an activity monitor. The participants were followed for more than five years. The study showed that replacing 30 minutes of sedentary time with light-intensity physical activity lowered the risk of cancer death by 8 percent. Replacing 30 minutes of sedentary time with moderate-to-vigorous physical activity was linked to a 31 percent reduced risk of cancer death. Why It Matters: Many studies have linked physical activity to a reduced risk of cancer incidence and death, the authors note. Public health messages should not only encourage exercise but also urge adults to sit less, they said. “These results provide data on the benefits of more modest levels of physical activity to improve cancer outcomes and underscore a public health message that movement in itself (for example, sit less and move more), irrespective of intensity, is beneficial,” the authors wrote. RELATED: The Best Fat-Burning Exercises for at Home and the Gym
Surgery and Radiation May Not Extend Lives of Women Newly Diagnosed With Metastatic Breast Cancer
What’s New: Surgery and radiation do not extend the survival of women who have just been diagnosed with metastatic, or late-stage, breast cancer, according to research presented May 29 at the American Society of Clinical Oncology (ASCO) virtual meeting. Research Details: The study involved 390 women with stage 4 breast cancer. All received systemic therapy, i.e., chemotherapy, which is the standard of care for this type of disease. Of the patients who responded to systemic therapy, 256 were randomized to either continue systemic therapy or to receive surgery and radiation to the breast and then continue with systemic therapy. The study showed the survival rates of the two groups was the same after 4 1/2 years. Why It Matters: About 1 in every 20 women with breast cancer is diagnosed when she has advanced or metastatic cancer. Women who are newly diagnosed with stage 4 (advanced) breast cancer may be offered surgery and radiation even though there has been no data showing evidence of the benefit of those therapies. The new study shows that the treatments do not extend survival. “Based on the results of our study, women who present with a new diagnosis of breast cancer already in stage 4 should not be offered surgery and radiation for the primary breast tumor with the expectation of a survival benefit,” said lead investigator Seema A Khan, MD, Professor of Cancer Research and Surgery at Northwestern University’s Feinberg School of Medicine. “When making these decisions, it is important to focus energy and resources on proven therapies that can prolong life.” RELATED: San Antonio Breast Cancer Symposium: New Therapies for Women With HER2-Positive Breast Cancer Highlighted on Day 1
E-cigarettes Increase Risk of Relapse for Former Smokers
What’s New: Former cigarette smokers who use electronic nicotine delivery systems (ENDS) have a significantly increased risk of cigarette smoking relapse compared with former smokers who don’t use e-nicotine products, according to a study published on June 5 in JAMA Network Open. Research Details: Researchers from the National Institute on Drug Abuse examined data from the Population Assessment of Tobacco and Health Study, an ongoing, nationally representative study of U.S. adults. The analysis included 2,273 former smokers. The study showed that use of electronic nicotine delivery systems was linked to a higher risk of smoking relapse, especially among smokers who had quit recently. Why It Matters: Smoking is a major cause of lung cancer worldwide and also raises the risk of developing other types of cancers, cardiovascular disease, and other conditions. Quitting smoking is difficult, the authors note, and relapse is common. The study establishes electronic nicotine delivery systems as a factor in relapse. “For the many clinicians treating former smokers who have successfully quit all nicotine products, the implications are that use of ENDS products should be discouraged, just as use of all other tobacco products is discouraged,” the authors wrote. RELATED: Vaping Increases Chances for Asthma and COPD, Study Finds
Benefits of PSA Screening for Prostate Cancer Underestimated, Experts Say
What’s New: The long-term benefits of prostate-specific antigen (PSA) screening for prostate cancer are likely greater than has been previously estimated in guidelines for PSA screening, according to the authors of a report published on June 18 in the New England Journal of Medicine. Research Details: The authors of the report examined data from a high-quality clinical trial to discern the reduction in number of deaths due to prostate cancer as a result of PSA screening over 16 to 25 years. The study showed the continued accrual of the benefits of PSA testing over time. Why It Matters: According to the authors, the PSA testing guidelines issued by the U.S. Preventive Services Task Force (USPSTF) and the American Academy of Family Physicians that cast doubt on the usefulness of widespread PSA screening are based on only two clinical trials. But when the data from an array of reliable trials was included in the analysis in the current study, the benefits of screening to reduce deaths became clear, they said. “Prostate cancer screening can lead to overdiagnosis, but screening trials did not provide a correct perception of the harms relative to benefits and underestimated the lives that could be saved over the long term,” said Ruth Etzioni, PhD, faculty member of the Public Health Sciences Division at the Fred Hutchinson Cancer Research Center. RELATED: Prostate Cancer Screening Recommendations Result in More Prostate Cancer Diagnosed Late, Fewer Cases Diagnosed Early
Study Casts Doubt on Value of Digital Mammography
What’s New: Digital mammography is not associated with improved health outcomes compared with traditional film mammography, according to a study published on June 23 in JNCI: Journal of the National Cancer Institute. Research Details: The paper involved a review of studies comparing digital to film mammography in women undergoing regular screening mammography for early detection of breast cancer. Researchers looked at data from 24 studies totaling more than 16.5 million exams. The difference in cancer detection rates after the transition to digital mammography showed an increase of 0.51 cancer cases detected per 1,000 screens. Recall rates (the rate of women called back for a second screen due to a suspicious finding) reflected an increase of 6.95 recalls per 1,000 women screened after the transition to digital mammography. Why It Matters: Digital mammography was approved by the Food and Drug Administration in 2000. Experts expressed hope that the technology would be more specific, finding more cancers and reducing the number of women recalled for unnecessary additional screening. While there may be advantages to using digital mammography (such as easier storage of images for medical facilities), the study indicates that digital mammography has not resulted in health benefits, the authors said. “While the transition from film to digital may have been beneficial for technological reasons and for efficiencies in service screening, our research shows the increase in cancer detection was largely attributable to more detection of DCIS (ductal carcinoma in situ), with little difference in invasive cancer detection,” said the study’s lead author, Rachel Farber, School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia. RELATED: Fewer Call Backs From Mammography Screening Centers Linked With More Missed Cases of Breast Cancer
