JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 19, 2006)
HISPANICS AND BLACKS WITH MELANOMA MORE LIKELY TO BE DIAGNOSED AT A LATER STAGE
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, June 19, 2006)
TARGETED LYMPH NODE EXAMINATION IMPROVES STAGING OF COLON CANCER
SEQUENCE OF THERAPIES IS NOT ASSOCIATED WITH IMPROVED SURVIVAL FOR PATIENTS WITH INFLAMMATORY BREAST CANCER
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), Monday, June 19, 2006
Media Advisory: To contact corresponding author Robert S. Kirsner, M.D., Ph.D., call Jeanne Antol Krull at 305-243-4853.
HISPANICS AND BLACKS WITH MELANOMA MORE LIKELY TO BE DIAGNOSED AT A LATER STAGE
CHICAGO—Hispanic and black patients in Florida's Miami-Dade County are more likely than white patients to have a more advanced stage of melanoma at the time of diagnosis of the disease, according to a report in the June issue of the Archives of Dermatology, one of the JAMA/Archives journals.
The skin cancer melanoma has become increasingly more common, with incidence rates increasing 2.4 percent annually in the United States over the past decade, according to background information in the article. Because light-skinned individuals are at higher risk for melanoma, much of the prevention and early detection efforts have targeted white populations; this may help explain improving survival rates (up to 92 percent from 68 percent in the 1970s) among whites. However, similar progress has not been seen among black and Hispanic populations.
Shasa Hu, M.D., University of Miami Miller School of Medicine, and colleagues reviewed 1,690 melanoma cases reported in Miami-Dade County between 1997 and 2002. Of those, 1,176 occurred in white patients, 485 in Hispanic patients and 29 in non-Hispanic black patients.
Hispanic and black patients were both more likely to have advanced-stage melanomas than white patients. Of the melanoma patients, 16 percent of Hispanics and 31 percent of blacks had cancer that had already metastasized (spread to other organs and tissues) at the time it was diagnosed, compared with 9 percent of whites. Black patients had the highest rate, 52 percent, of regional- or distant-stage melanoma, the two most severe stages that indicate the cancer has spread to other lymph nodes or organs; this compares to 26 percent for Hispanics and 16 percent for whites. White patients were more likely to be diagnosed with earlier stages of melanoma, including melanoma in situ, or cases in which the cancer cells are found only in the outer layer of skin, and local melanoma, in which cancer has spread to the lower layers of skin but not to the surrounding lymph nodes. Twenty-seven percent of white patients, 10 percent of black patients and 22 percent of Hispanic patients were diagnosed with melanoma in situ; 57 percent of white, 38 percent of black and 52 percent of Hispanic cases were diagnosed at the local stage.
This disparity in stage at diagnosis may contribute to lower survival rates among blacks and Hispanics, the authors write. According to previously published studies, the five-year survival rate for melanoma diagnosed in the local stage is 98 percent. The rate drops to 64 percent for regional stage melanoma and 16 percent for distant stage.
"Evidence suggests that secondary prevention efforts such as skin cancer examination are suboptimal in Hispanic and black populations," the authors conclude. "Although varying cultural values may account for some differences in health care use, public education regarding melanoma risk in black and Hispanic persons and delivery of skin cancer screening and examinations represent the main potential areas of intervention to improve the stage at diagnosis of melanoma in these populations. We hope that earlier diagnosis of melanoma at a more favorable stage will ultimately improve melanoma survival rates in minority populations."
(Arch Dermatol. 2006;142:704-708. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 19, 2006
Media Advisory: To contact Anton J. Bilchik, M.D., Ph.D., call Trace Longo at 714-600-9811.
TARGETED LYMPH NODE EXAMINATION IMPROVES STAGING OF COLON CANCER
CHICAGO—Examining the lymph nodes to which colorectal cancer is most likely to have spread may improve the accuracy of colon cancer staging and spare some patients the cost and toxicity of chemotherapy, according to a report in the June issue of the Archives of Surgery, one of the JAMA/Archives journals.
Colon cancer is the second most common cause of cancer death in the United States, according to background information in the article. To determine the stage to which the cancer has progressed as well as assess treatment options, physicians surgically remove and examine cancer patients' lymph nodes. Patients whose cancer has spread to the lymph nodes have been shown to benefit from chemotherapy in addition to surgery, while those whose cancer has not spread to the lymph nodes (referred to as node negative) may not see any benefit to combination treatments over surgery alone. "One-third of patients with tumor-free lymph nodes have recurrences, and therefore, adjuvant [supplemental] chemotherapy may be beneficial in these patients," the authors write. "However, if all node-negative patients are treated, 70 percent will be subjected to unnecessary chemotherapy because surgery alone is curative. A better understanding of high-risk, node-negative patients and improved methods of lymph node evaluation are therefore needed."
Anton J. Bilchik, M.D., Ph.D., John Wayne Cancer Institute and Saint Johns Health Center, Santa Monica, Calif., and colleagues studied 132 patients (63 men and 69 women, median age of 74 years) with stage I and II colon cancer who were recruited from four referral cancer centers between March 2001 and June 2005. In a process known as lymphatic mapping, blue dye was injected near the site of each participant's tumor. The dye stained the sentinel (first) lymph nodes down the lymph channel, the pathway through which lymph-a fluid containing lymphocytes and the bacteria, cancer cells and other organisms they have attacked-drains from the spaces between body tissues. The tumor, sentinel nodes and other lymph nodes in the region were then removed and examined. "The sentinel node paradigm is based on the premise that lymphatic drainage from a primary organ site occurs in an orderly and progressive fashion," the authors write. "The sentinel lymph node is the first node to receive lymphatic drainage from a primary anatomical site and is therefore the most likely node to harbor a metastasis."
Of the 132 participants, 33 (30 percent) had stage I cancer, 46 (41 percent) had stage II and 32 (29 percent) stage III. Twenty-eight patients (23.6 percent) were classified at a more severe stage based on the analysis of sentinel nodes. The sensitivity of the lymphatic mapping/sentinel node procedure was 88.2 percent, meaning that 45 of 51 patients whose cancer had spread to their lymph nodes had tumors in their sentinel nodes. False negatives, when an individual's cancer had spread to lymph nodes but was not detected in the sentinel node, occurred in six of 81 (7.4 percent) of patients who were determined to be node negative. Eighteen percent of the sentinel nodes had tumors, compared with 6 percent of the other lymph nodes.
The results "suggest that lymphatic mapping and sentinel lymph node techniques are feasible and accurate in colon cancer," the authors write. "The improved risk stratification afforded by standardization of both surgical and pathological techniques may improve the selection of patients for chemotherapy, thereby avoiding the unnecessary toxic effects and expense for those cured by surgery alone."
(Arch Surg. 2006;141:527-534. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported in part by a grant from the National Cancer Institute and by funding from the Rod Fasone Memorial Cancer Fund (Indianapolis), the Henry L. Guenther Foundation (Los Angeles), the William Randolph Hearst Foundation (San Francisco), the family of Jeanne and Eric Li, the Davidow Charitable Fund (Los Angeles) and the Harold J. McAlister Charitable Foundation (Los Angeles).
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 19, 2006
Media Advisory: To contact corresponding author David R. Farley, M.D., call Elizabeth Zimmermann at 507-266-0810.
SEQUENCE OF THERAPIES IS NOT ASSOCIATED WITH IMPROVED SURVIVAL FOR PATIENTS WITH INFLAMMATORY BREAST CANCER
CHICAGO—The order in which patients with inflammatory breast cancer undergo different types of treatment does not appear to be associated with improved survival rates, which remain poor, according to a report in the June issue of the Archives of Surgery, one of the JAMA/Archives journals.
Approximately 2.5 in 100,000 women develop inflammatory breast cancer, which is characterized by rapid tumor growth, early metastasis (cancer spreading to other parts of the body) and poor survival rates as compared with other forms of breast cancer, according to background information in the article. Combining surgery, chemotherapy, radiation therapy and endocrine therapy has improved survival rates and become the standard of care for patients with this disease. Some recent studies have suggested that performing surgery before beginning other types of treatment may improve survival rates.
Rory L. Smoot, M.D., and colleagues at Mayo Clinic College of Medicine, Rochester, Minn., reviewed data from the records of 156 consecutive patients (155 female, one male) who were treated there for inflammatory breast cancer between 1985 and 2003. Twenty-eight patients with cancer that had already metastasized at their first visit were excluded from the study. The remaining 128 patients had an average age of 53 years, and 57 percent of women were post-menopausal.
By 2003, 51 patients (40 percent) survived and 77 (60 percent) died; five-year survival rates were 42 percent with 21 percent surviving disease-free. Of the 128 patients without metastatic disease, 22 (17 percent) had surgery as their initial treatment and 106 (83 percent) underwent chemotherapy first. Although some analyses showed that patients who had surgery first lived longer than those who did not, the results were not significant when other factors were taken into account. In addition, certain aspects of each patients' prognosis likely influenced her and her physician's treatment decisions, making outcomes difficult to compare, the researchers write.
"The treatment strategy described herein (neoadjuvant chemotherapy, mastectomy, adjuvant chemotherapy and radiotherapy, followed by endocrine therapy if receptors are positive) has significantly increased overall survival compared with single-modality or dual-modality regimens, but overall survival remains low compared with that associated with noninflammatory breast cancer," the authors conclude. "Although the combined-modality regimen clearly provides the best outcome for patients with inflammatory breast cancer, further research is necessary to delineate subsets of patients who may benefit from alterations in the approach to improve survival from this aggressive disease."
(Arch Surg. 2006;141:567-573. Available pre-embargo to the media at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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