Leukemia Risk? Dr. Malcolm Moore
Sousa, Ph.D., cloned the gene for GCSF by inserting it into bacteria. This produced the large quantities of G-CSF needed for clinical research.
Future Uses Moore speculated that in the future G-CSF may prove useful for other patients with impaired ability to produce white blood cells. Potential candidates are AIDS patients, postsurgjcal patients, diabetics, the elderly, newborns with septicemia, and severe burn patients. Although G-CSF and GM-CSF have been approved, questions about their potential uses and risks remain unanswered, said Janice Gabrilove, M.D., of Memorial Sloan-Kettering Cancer Center. The approval "will allow people to do more studies because they will have the drug and won't need a Vol. 83, No. 7, April 3, 1991
Some researchers speculate that the ability of colonystimulating factors to encourage white cell growth may induce leukemia in some patients 10 or 20 years later. Crawford said clinical trials with colony-stimulating factors have not shown any long-term adverse effects, but, in theory, they could hasten the onset of leukemia in patients who are already predisposed. He also pointed out that chemotherapy itself has been known for some time to slightly increase certain patients' risk for leukemia. This area is being investigated further, he said. Nevertheless, oncologists agree that the risk is slight and well worth taking. In a recent Gallup survey, 62% of oncologists said that colony-stimulating factors will have significant impact on cancer care in the near future (see previous article). —By Linda Schwab
AAAS Pannd Discosses Caimceir Annd Aginig ^^
c^
o
Americans 65 years and older get most of the cancer in this country, but they may not be getting the most optimal cancer care, according to researchers who met last month to discuss cancer and aging. Ageism may be a contributing factor, along with a relative lack of research on cancer in older populations, panelists said. The symposium, entitled "The Aging and Cancer Interface: Multidimensional Research Perspectives," was part of the annual meeting of the American Association for the Advancement of Science in Washington, D.C. In a survey of Wisconsin women aged 20-75 with colorectal or breast cancers, 43% of patients under age 65 reported having postsurgical chemotherapy, compared to 17% of those 65 or older. And while 20% of the younger group said they were not referred to medical or radiation oncologists for further treatment, 33% of their elders gave similar responses. Paul Carbone, M JD., director of the University of Wisconsin Clinical Cancer Center, said there is no reason why many older people should not be given chemotherapy or radiation, yet physicians often hesitate to recommend adjuvant treatment. "Studies show the elderly tolerate chemotherapy and radiotherapy as well as younger people," said Carbone, who carried out the study along with Polly Newcomb, Ph.D., of the Wisconsin center. "Physiology, not age, should determine extent of therapy." Some have suggested that physicians may be practicing informal health care rationing by offering less extensive treatment to elderly patients. National NEWS
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
drug company or the FDA's approval to obtain it," she said. G-CSF and GM-CSF currently are considered "essentially interchangeable," said Bruce Cheson, M.D., head of the medicine section of NCI's Clinical Investigations Branch, "although this concept will change as further trials are conducted." The FDA approved the drugs for different indications based on the clinical trials the drug companies presented, he said. While both drugs have low toxicity, FDA's Snider said, GM-CSF appears to be more toxic, causing diarrhea, skin rash, and weakness in some patients.
471
News News
Institute on Aging Director T. Franklin Williams, MX)., agreed that "we need to take steps to see that older people are not neglected, when they can be treated as effectively and successfully as anyone else." Rosemary Yancik, PhD., of NIA, said the aging of the country's population alone will cause an increase in cancer cases. The number of Americans living with cancer, estimated at 7 million in 1991, could double by the year 2030, she said. Yancik also discussed what she called "age-stage" relationships in cancer. "As persons advance in age, not only do they become at higher risk for cancer, but for some tumors, they are more likely to be initially diagnosed in advanced stages," she explained.
Secondary Prevention Harvey Cohen, M.D., director of Duke University's Center for the Study of Aging and Human Development, 472
"Studies have shown very nicely that in younger women, breast cancer screening with mammography and physical exam has produced improved survival," Cohen said. "But none have been done in women over the age of 74, and there is relatively little data for women between 65 and 74. So making recommendations becomes rather difficult." While different screening frequencies may work better in older groups, Cohen also raised the possibility that some types of screening that are not currently used in the general population, such as x rays or sputum cytology for lung cancer, may be useful in older subgroups known to be at high risk.
Cellular Changes Vincent Cristofalo, Ph.D., director of the Center for Gerontological Research at the Medical College of Pennsylvania, is searching for links between cancer and aging at another level: the genetic and biochemical events controlling the cycle of cell reproduction.
Comprehensive Model To avoid missing diseases that could be treated early, Cohen proposed a comprehensive geriatric model of assessment. "Any new symptom or sign in an older person needs to be thought of as potentially investigable," he said. "We want to assure ourselves that all the bases are touched." Cancer screening in the older population also deserves more research, Cohen said. Most studies of screening effectiveness have included few if any subjects over 65, he said, resulting in guidelines that may be optimal for younger populations but less so for older groups.
Dr. Vincent Cristofalo Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
Dr. Paul Carbon*
said the nature of age-stage relationships is still unclear, though differences in immune response and other biological factors probably play a role. But a lack of attention in the geriatric field to "secondary prevention," or early detection of cancer, is likely involved as well, he said. "If s easy to assume that prevention shouldn't be an issue when we're talking about older people, because after all, how much time have they got left anyway?" Cohen said. "But the facts are that a 70-year old woman has about 15 years of remaining life expectancy, and a man about 11." Diagnosis in older patients may be hampered by what \ Cohen called "cancer symptom confusion," that is, signs and symptoms of cancer may be discounted as simply the effects of normal aging For example, he said, a physician might misread early signs of melanoma as "age spots," or dismiss urinary or bowel abnormalities that could warn of prostate or colon cancers.
"Even though we still get cancers, these multiple mechanisms may have delayed their appearance for a long time," Cristofalo said. "In fact, one speculation is that P 1 ?""" 1 "" 1 lifespan may depend, in part, on the number and effectiveness of antineoplasia mechanisms."
Paying the Price Some of these same mechanisms, however, may eventually cause our
NBA Action
bodies to age. "The price paid for the multiple bastions of resistance to the uncontrolled growth characteristic of neoplasia is what we call the phenotype of senescence," Cristofalo said. Jerome Yates, MX)., of the Roswell Park Cancer Institute, said knowledge gained through research such as Cristofalo's may lead to more effective treatments for melanoma, breast cancer and other cancers, that may appear quiescent for years before reappearing as metastatic disease. Williams said NIA and the National Cancer Institute have embarked on a joint mission. "We are working toward encouraging and supporting more research around this interface of cancer and aging, at the basic biological level as well as in clinical challenges," he said. —By Tom Reynolds
Awards, Appointments, Announcements
The wives and friends of the Washington Bullets basketball team have begun a campaign to educate women about the importance of breast cancer screening. Some recently visited NIH to speak with breast cancer specialists and take a tour of the NIH Clinical Center. Shown here with NCI Director Samuel Broder, M.D., are (top row) Susan Moreland, Kathy Blair, Connie Unseld, Judy Holland, NCI's Claudia Baquet, M.D.; (bottom row) Nina Bzdelik, Theresa Butler, lisa Walker, and Beverly Grant. They distributed materials and staffed an NCI mammography exhibit at two Bullets games in March. The campaign is the brainchild of Irene Pollin, National Cancer Advisory Board member, shown at right with husband Abe Pollin, owner of the Bullets. Irene Pollin hopes this initiative will serve as a blueprint for similiar activities by the 27 NBA teams around the country. Vol. 83, No. 7, April 3, 1991
John D. Minna, M.D., has been named director of the new Harold C. Simmons Cancer Center at the University of Texas Southwestern Medical Center, Dallas. He was also named holder of the Lisa K. Simmons Distinguished Chair in Comprehensive Oncology. Minna has been at the National Cancer Institute since 1975, most recently serving as chief of the National Cancer Institute-Navy Medical Oncology Branch. "We are confident, given [Minna's] talent and experience, that under his leadership, U.T. Southwestern and the Simmons Comprehensive Cancer Center will rapidly attain a position of international leadership in cancer research and therapy," said Kern Wlldenthal, M.D., Ph.D., president of U.T. Southwestern.
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
The cellular malfunctions that cause cancer may actually represent a failure of the signaling process that tells cells to slow down, and finally stop, their DNA replication, Cristofalo said. On the cellular level, he said, senescence and neoplasia may be thought of as "opposite sides of the same coin." Through evolution, he explained, organisms have developed a series of genetic checks on unrestrained cell growth, without which cancer would run rampant.
NEWS 473
Sousa, Ph.D., cloned the gene for GCSF by inserting it into bacteria. This produced the large quantities of G-CSF needed for clinical research.
Future Uses Moore speculated that in the future G-CSF may prove useful for other patients with impaired ability to produce white blood cells. Potential candidates are AIDS patients, postsurgjcal patients, diabetics, the elderly, newborns with septicemia, and severe burn patients. Although G-CSF and GM-CSF have been approved, questions about their potential uses and risks remain unanswered, said Janice Gabrilove, M.D., of Memorial Sloan-Kettering Cancer Center. The approval "will allow people to do more studies because they will have the drug and won't need a Vol. 83, No. 7, April 3, 1991
Some researchers speculate that the ability of colonystimulating factors to encourage white cell growth may induce leukemia in some patients 10 or 20 years later. Crawford said clinical trials with colony-stimulating factors have not shown any long-term adverse effects, but, in theory, they could hasten the onset of leukemia in patients who are already predisposed. He also pointed out that chemotherapy itself has been known for some time to slightly increase certain patients' risk for leukemia. This area is being investigated further, he said. Nevertheless, oncologists agree that the risk is slight and well worth taking. In a recent Gallup survey, 62% of oncologists said that colony-stimulating factors will have significant impact on cancer care in the near future (see previous article). —By Linda Schwab
AAAS Pannd Discosses Caimceir Annd Aginig ^^
c^
o
Americans 65 years and older get most of the cancer in this country, but they may not be getting the most optimal cancer care, according to researchers who met last month to discuss cancer and aging. Ageism may be a contributing factor, along with a relative lack of research on cancer in older populations, panelists said. The symposium, entitled "The Aging and Cancer Interface: Multidimensional Research Perspectives," was part of the annual meeting of the American Association for the Advancement of Science in Washington, D.C. In a survey of Wisconsin women aged 20-75 with colorectal or breast cancers, 43% of patients under age 65 reported having postsurgical chemotherapy, compared to 17% of those 65 or older. And while 20% of the younger group said they were not referred to medical or radiation oncologists for further treatment, 33% of their elders gave similar responses. Paul Carbone, M JD., director of the University of Wisconsin Clinical Cancer Center, said there is no reason why many older people should not be given chemotherapy or radiation, yet physicians often hesitate to recommend adjuvant treatment. "Studies show the elderly tolerate chemotherapy and radiotherapy as well as younger people," said Carbone, who carried out the study along with Polly Newcomb, Ph.D., of the Wisconsin center. "Physiology, not age, should determine extent of therapy." Some have suggested that physicians may be practicing informal health care rationing by offering less extensive treatment to elderly patients. National NEWS
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
drug company or the FDA's approval to obtain it," she said. G-CSF and GM-CSF currently are considered "essentially interchangeable," said Bruce Cheson, M.D., head of the medicine section of NCI's Clinical Investigations Branch, "although this concept will change as further trials are conducted." The FDA approved the drugs for different indications based on the clinical trials the drug companies presented, he said. While both drugs have low toxicity, FDA's Snider said, GM-CSF appears to be more toxic, causing diarrhea, skin rash, and weakness in some patients.
471
News News
Institute on Aging Director T. Franklin Williams, MX)., agreed that "we need to take steps to see that older people are not neglected, when they can be treated as effectively and successfully as anyone else." Rosemary Yancik, PhD., of NIA, said the aging of the country's population alone will cause an increase in cancer cases. The number of Americans living with cancer, estimated at 7 million in 1991, could double by the year 2030, she said. Yancik also discussed what she called "age-stage" relationships in cancer. "As persons advance in age, not only do they become at higher risk for cancer, but for some tumors, they are more likely to be initially diagnosed in advanced stages," she explained.
Secondary Prevention Harvey Cohen, M.D., director of Duke University's Center for the Study of Aging and Human Development, 472
"Studies have shown very nicely that in younger women, breast cancer screening with mammography and physical exam has produced improved survival," Cohen said. "But none have been done in women over the age of 74, and there is relatively little data for women between 65 and 74. So making recommendations becomes rather difficult." While different screening frequencies may work better in older groups, Cohen also raised the possibility that some types of screening that are not currently used in the general population, such as x rays or sputum cytology for lung cancer, may be useful in older subgroups known to be at high risk.
Cellular Changes Vincent Cristofalo, Ph.D., director of the Center for Gerontological Research at the Medical College of Pennsylvania, is searching for links between cancer and aging at another level: the genetic and biochemical events controlling the cycle of cell reproduction.
Comprehensive Model To avoid missing diseases that could be treated early, Cohen proposed a comprehensive geriatric model of assessment. "Any new symptom or sign in an older person needs to be thought of as potentially investigable," he said. "We want to assure ourselves that all the bases are touched." Cancer screening in the older population also deserves more research, Cohen said. Most studies of screening effectiveness have included few if any subjects over 65, he said, resulting in guidelines that may be optimal for younger populations but less so for older groups.
Dr. Vincent Cristofalo Journal of the National Cancer Institute
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
Dr. Paul Carbon*
said the nature of age-stage relationships is still unclear, though differences in immune response and other biological factors probably play a role. But a lack of attention in the geriatric field to "secondary prevention," or early detection of cancer, is likely involved as well, he said. "If s easy to assume that prevention shouldn't be an issue when we're talking about older people, because after all, how much time have they got left anyway?" Cohen said. "But the facts are that a 70-year old woman has about 15 years of remaining life expectancy, and a man about 11." Diagnosis in older patients may be hampered by what \ Cohen called "cancer symptom confusion," that is, signs and symptoms of cancer may be discounted as simply the effects of normal aging For example, he said, a physician might misread early signs of melanoma as "age spots," or dismiss urinary or bowel abnormalities that could warn of prostate or colon cancers.
"Even though we still get cancers, these multiple mechanisms may have delayed their appearance for a long time," Cristofalo said. "In fact, one speculation is that P 1 ?""" 1 "" 1 lifespan may depend, in part, on the number and effectiveness of antineoplasia mechanisms."
Paying the Price Some of these same mechanisms, however, may eventually cause our
NBA Action
bodies to age. "The price paid for the multiple bastions of resistance to the uncontrolled growth characteristic of neoplasia is what we call the phenotype of senescence," Cristofalo said. Jerome Yates, MX)., of the Roswell Park Cancer Institute, said knowledge gained through research such as Cristofalo's may lead to more effective treatments for melanoma, breast cancer and other cancers, that may appear quiescent for years before reappearing as metastatic disease. Williams said NIA and the National Cancer Institute have embarked on a joint mission. "We are working toward encouraging and supporting more research around this interface of cancer and aging, at the basic biological level as well as in clinical challenges," he said. —By Tom Reynolds
Awards, Appointments, Announcements
The wives and friends of the Washington Bullets basketball team have begun a campaign to educate women about the importance of breast cancer screening. Some recently visited NIH to speak with breast cancer specialists and take a tour of the NIH Clinical Center. Shown here with NCI Director Samuel Broder, M.D., are (top row) Susan Moreland, Kathy Blair, Connie Unseld, Judy Holland, NCI's Claudia Baquet, M.D.; (bottom row) Nina Bzdelik, Theresa Butler, lisa Walker, and Beverly Grant. They distributed materials and staffed an NCI mammography exhibit at two Bullets games in March. The campaign is the brainchild of Irene Pollin, National Cancer Advisory Board member, shown at right with husband Abe Pollin, owner of the Bullets. Irene Pollin hopes this initiative will serve as a blueprint for similiar activities by the 27 NBA teams around the country. Vol. 83, No. 7, April 3, 1991
John D. Minna, M.D., has been named director of the new Harold C. Simmons Cancer Center at the University of Texas Southwestern Medical Center, Dallas. He was also named holder of the Lisa K. Simmons Distinguished Chair in Comprehensive Oncology. Minna has been at the National Cancer Institute since 1975, most recently serving as chief of the National Cancer Institute-Navy Medical Oncology Branch. "We are confident, given [Minna's] talent and experience, that under his leadership, U.T. Southwestern and the Simmons Comprehensive Cancer Center will rapidly attain a position of international leadership in cancer research and therapy," said Kern Wlldenthal, M.D., Ph.D., president of U.T. Southwestern.
Downloaded from http://jnci.oxfordjournals.org/ at New York University on June 21, 2015
The cellular malfunctions that cause cancer may actually represent a failure of the signaling process that tells cells to slow down, and finally stop, their DNA replication, Cristofalo said. On the cellular level, he said, senescence and neoplasia may be thought of as "opposite sides of the same coin." Through evolution, he explained, organisms have developed a series of genetic checks on unrestrained cell growth, without which cancer would run rampant.
NEWS 473
