Amy Karon

Psoriatic arthritis patients treated with brodalumab improved by approximately 20%, compared with those on placebo, achieving the primary endpoint in a phase II trial, investigators reported online June 11 in the New England Journal of Medicine.

Brodalumab is a human monoclonal antibody targeting the interleukin-17 receptor A (IL-17RA). At week 12 of the 40-week randomized trial, 37%-39% of brodalumab patients had improved by at least 20% based on the American College of Rheumatology response criteria (ACR 20), compared with only 18% of the placebo patients (P = .03 and .02, respectively), reported Dr. Philip J. Mease of the Swedish Medical Center and the University of Washington, both in Seattle, and his associates.

Rates of 50% improvement in response criteria, or ACR 50, also exceeded placebo in both treatment arms (14%, compared with 4% for placebo; P = .05).

The researchers randomized 168 adults with psoriatic arthritis, of whom 159 finished the double-blind phase and 134 completed 40 weeks of the open-label extension (N. Engl. J. Med. 2014;370:2295-306 [doi: 10.1056/NEJMoa1315231]). By week 24, ACR 20 response rates were 51% for the 140-mg group, 64% for the 280-mg group, and 44% in placebo patients who switched to open-label brodalumab, said the researchers. Patients improved similarly whether they were treatment naive or had received previous biologic therapy, the investigators added.

Adverse events were comparable between the treatment and placebo groups, with no opportunistic infections or deaths, the investigators reported. Two patients tested positive for antibodies to brodalumab. "No significant neutropenic events were reported – an important safety outcome, since interleukin-17 is involved in neutrophil homeostasis," the researchers said. They noted, however, that larger trials would be needed to detect rare adverse events.

Amgen, a maker of brodalumab, funded the study. Dr. Mease and his coauthors reported employment with or receiving grants from Amgen.

The study findings also were scheduled for presentation in a poster at EULAR 2014.

Psoriatic arthritis patients treated with brodalumab improved by approximately 20%, compared with those on placebo, achieving the primary endpoint in a phase II trial, investigators reported online June 11 in the New England Journal of Medicine.

Brodalumab is a human monoclonal antibody targeting the interleukin-17 receptor A (IL-17RA). At week 12 of the 40-week randomized trial, 37%-39% of brodalumab patients had improved by at least 20% based on the American College of Rheumatology response criteria (ACR 20), compared with only 18% of the placebo patients (P = .03 and .02, respectively), reported Dr. Philip J. Mease of the Swedish Medical Center and the University of Washington, both in Seattle, and his associates.

Rates of 50% improvement in response criteria, or ACR 50, also exceeded placebo in both treatment arms (14%, compared with 4% for placebo; P = .05).

The researchers randomized 168 adults with psoriatic arthritis, of whom 159 finished the double-blind phase and 134 completed 40 weeks of the open-label extension (N. Engl. J. Med. 2014;370:2295-306 [doi: 10.1056/NEJMoa1315231]). By week 24, ACR 20 response rates were 51% for the 140-mg group, 64% for the 280-mg group, and 44% in placebo patients who switched to open-label brodalumab, said the researchers. Patients improved similarly whether they were treatment naive or had received previous biologic therapy, the investigators added.

Adverse events were comparable between the treatment and placebo groups, with no opportunistic infections or deaths, the investigators reported. Two patients tested positive for antibodies to brodalumab. "No significant neutropenic events were reported – an important safety outcome, since interleukin-17 is involved in neutrophil homeostasis," the researchers said. They noted, however, that larger trials would be needed to detect rare adverse events.

Amgen, a maker of brodalumab, funded the study. Dr. Mease and his coauthors reported employment with or receiving grants from Amgen.

The study findings also were scheduled for presentation in a poster at EULAR 2014.

Psoriatic arthritis patients treated with brodalumab improved by approximately 20%, compared with those on placebo, achieving the primary endpoint in a phase II trial, investigators reported online June 11 in the New England Journal of Medicine.

Brodalumab is a human monoclonal antibody targeting the interleukin-17 receptor A (IL-17RA). At week 12 of the 40-week randomized trial, 37%-39% of brodalumab patients had improved by at least 20% based on the American College of Rheumatology response criteria (ACR 20), compared with only 18% of the placebo patients (P = .03 and .02, respectively), reported Dr. Philip J. Mease of the Swedish Medical Center and the University of Washington, both in Seattle, and his associates.

Rates of 50% improvement in response criteria, or ACR 50, also exceeded placebo in both treatment arms (14%, compared with 4% for placebo; P = .05).

The researchers randomized 168 adults with psoriatic arthritis, of whom 159 finished the double-blind phase and 134 completed 40 weeks of the open-label extension (N. Engl. J. Med. 2014;370:2295-306 [doi: 10.1056/NEJMoa1315231]). By week 24, ACR 20 response rates were 51% for the 140-mg group, 64% for the 280-mg group, and 44% in placebo patients who switched to open-label brodalumab, said the researchers. Patients improved similarly whether they were treatment naive or had received previous biologic therapy, the investigators added.

Adverse events were comparable between the treatment and placebo groups, with no opportunistic infections or deaths, the investigators reported. Two patients tested positive for antibodies to brodalumab. "No significant neutropenic events were reported – an important safety outcome, since interleukin-17 is involved in neutrophil homeostasis," the researchers said. They noted, however, that larger trials would be needed to detect rare adverse events.

Amgen, a maker of brodalumab, funded the study. Dr. Mease and his coauthors reported employment with or receiving grants from Amgen.

The study findings also were scheduled for presentation in a poster at EULAR 2014.

Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.

Adults in poor cardiovascular health were more likely to develop cognitive problems such as learning and memory impairment, compared with healthier peers, according to a large prospective study published online June 11 in the Journal of the American Heart Association.

But top scorers on the cardiovascular health (CVH) measure used in the study were not more protected against incident mental impairment than were intermediate scorers, reported Evan Thacker, Ph.D., of Brigham Young University in Provo, Utah, and his associates.

"This pattern suggests that even intermediate levels of CVH are preferable to low levels of CVH," the investigators said. "This is an encouraging message for population health promotion, because intermediate CVH is a more realistic target than ideal CVH for many individuals."

The investigators used the American Heart Association Life’s Simple 7 score to classify the cardiovascular health of 17,761 black and white adults in the United States aged 45 years and older (J. Am. Heart Assoc. 2014 June 11 [doi: 10.1161/JAHA.113.000635]). Individuals were participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. The Six-Item Screener was used assess baseline global cognitive status; and a three-test measure of verbal learning, memory, and fluency was used to assess mental function at subsequent 2-year intervals. In all, 56% of individuals resided in "stroke belt" states, including Arkansas, Alabama, Louisiana, Georgia, Mississippi, North and South Carolina, and Tennessee, the investigators said. All study participants had normal cognitive function and no stroke history at the outset.

After adjustment for age, sex, race, and education, 4.6% of individuals with the worst CVH scores developed cognitive impairment after baseline (95% confidence interval, 4.0%-5.2%), compared with only 2.7% of those with intermediate scores (95% CI, 2.3%-3.1%) and 2.6% of those with the best scores (95% CI, 2.1%-3.1%), Dr. Thacker and his associates reported. Therefore, the odds of incident cognitive impairment were 35%-37% lower in the intermediate- and high-CVH groups than in the low-CVH group, the researchers added (odds ratios, 0.65 and 0.63; 95% CIs, 0.52-0.81 and 0.51-0.79, respectively).

"Rather than a dose-response pattern across the range of Life’s Simple 7 scores, we observed that associations with [incident clinical impairment] were the same for the highest tertile of Life’s Simple 7 score and the middle tertile, relative to the lowest tertile," the researchers wrote. "Based on these findings, we hypothesize that the AHA’s strategic efforts to improve CVH from poor to intermediate or higher levels could lead to reductions in cognitive decline, and we believe further research addressing this hypothesis is warranted."

The National Institute of Neurological Disorders and Stroke funded the study. The authors reported no conflicts of interest.

To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here. 

Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.

Adults in poor cardiovascular health were more likely to develop cognitive problems such as learning and memory impairment, compared with healthier peers, according to a large prospective study published online June 11 in the Journal of the American Heart Association.

But top scorers on the cardiovascular health (CVH) measure used in the study were not more protected against incident mental impairment than were intermediate scorers, reported Evan Thacker, Ph.D., of Brigham Young University in Provo, Utah, and his associates.

"This pattern suggests that even intermediate levels of CVH are preferable to low levels of CVH," the investigators said. "This is an encouraging message for population health promotion, because intermediate CVH is a more realistic target than ideal CVH for many individuals."

The investigators used the American Heart Association Life’s Simple 7 score to classify the cardiovascular health of 17,761 black and white adults in the United States aged 45 years and older (J. Am. Heart Assoc. 2014 June 11 [doi: 10.1161/JAHA.113.000635]). Individuals were participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. The Six-Item Screener was used assess baseline global cognitive status; and a three-test measure of verbal learning, memory, and fluency was used to assess mental function at subsequent 2-year intervals. In all, 56% of individuals resided in "stroke belt" states, including Arkansas, Alabama, Louisiana, Georgia, Mississippi, North and South Carolina, and Tennessee, the investigators said. All study participants had normal cognitive function and no stroke history at the outset.

After adjustment for age, sex, race, and education, 4.6% of individuals with the worst CVH scores developed cognitive impairment after baseline (95% confidence interval, 4.0%-5.2%), compared with only 2.7% of those with intermediate scores (95% CI, 2.3%-3.1%) and 2.6% of those with the best scores (95% CI, 2.1%-3.1%), Dr. Thacker and his associates reported. Therefore, the odds of incident cognitive impairment were 35%-37% lower in the intermediate- and high-CVH groups than in the low-CVH group, the researchers added (odds ratios, 0.65 and 0.63; 95% CIs, 0.52-0.81 and 0.51-0.79, respectively).

"Rather than a dose-response pattern across the range of Life’s Simple 7 scores, we observed that associations with [incident clinical impairment] were the same for the highest tertile of Life’s Simple 7 score and the middle tertile, relative to the lowest tertile," the researchers wrote. "Based on these findings, we hypothesize that the AHA’s strategic efforts to improve CVH from poor to intermediate or higher levels could lead to reductions in cognitive decline, and we believe further research addressing this hypothesis is warranted."

The National Institute of Neurological Disorders and Stroke funded the study. The authors reported no conflicts of interest.

To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here. 

Earn 0.25 hours AMA PRA Category 1 credit: Read this article, and click the link at the end to take the posttest.

Adults in poor cardiovascular health were more likely to develop cognitive problems such as learning and memory impairment, compared with healthier peers, according to a large prospective study published online June 11 in the Journal of the American Heart Association.

But top scorers on the cardiovascular health (CVH) measure used in the study were not more protected against incident mental impairment than were intermediate scorers, reported Evan Thacker, Ph.D., of Brigham Young University in Provo, Utah, and his associates.

"This pattern suggests that even intermediate levels of CVH are preferable to low levels of CVH," the investigators said. "This is an encouraging message for population health promotion, because intermediate CVH is a more realistic target than ideal CVH for many individuals."

The investigators used the American Heart Association Life’s Simple 7 score to classify the cardiovascular health of 17,761 black and white adults in the United States aged 45 years and older (J. Am. Heart Assoc. 2014 June 11 [doi: 10.1161/JAHA.113.000635]). Individuals were participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. The Six-Item Screener was used assess baseline global cognitive status; and a three-test measure of verbal learning, memory, and fluency was used to assess mental function at subsequent 2-year intervals. In all, 56% of individuals resided in "stroke belt" states, including Arkansas, Alabama, Louisiana, Georgia, Mississippi, North and South Carolina, and Tennessee, the investigators said. All study participants had normal cognitive function and no stroke history at the outset.

After adjustment for age, sex, race, and education, 4.6% of individuals with the worst CVH scores developed cognitive impairment after baseline (95% confidence interval, 4.0%-5.2%), compared with only 2.7% of those with intermediate scores (95% CI, 2.3%-3.1%) and 2.6% of those with the best scores (95% CI, 2.1%-3.1%), Dr. Thacker and his associates reported. Therefore, the odds of incident cognitive impairment were 35%-37% lower in the intermediate- and high-CVH groups than in the low-CVH group, the researchers added (odds ratios, 0.65 and 0.63; 95% CIs, 0.52-0.81 and 0.51-0.79, respectively).

"Rather than a dose-response pattern across the range of Life’s Simple 7 scores, we observed that associations with [incident clinical impairment] were the same for the highest tertile of Life’s Simple 7 score and the middle tertile, relative to the lowest tertile," the researchers wrote. "Based on these findings, we hypothesize that the AHA’s strategic efforts to improve CVH from poor to intermediate or higher levels could lead to reductions in cognitive decline, and we believe further research addressing this hypothesis is warranted."

The National Institute of Neurological Disorders and Stroke funded the study. The authors reported no conflicts of interest.

To earn 0.25 hours AMA PRA Category 1 credit after reading this article, take the post-test here. 

Patients with epilepsy and partial-onset seizures stayed on treatment longer and had fewer hospitalizations and emergency department visits when they took concomitant antiepileptic drugs with dissimilar mechanisms of action, according to an analysis published online June 9 in JAMA Neurology.

The study, the first of its kind in patients with partial-onset seizures, suggests that prescribing antiepileptics with different mechanisms of action (MOA) might optimize treatment outcomes when patients need more than one drug for seizure control, said Jay M. Margolis, Pharm.D., of Truven Health Analytics, Bethesda, Md., and his associates.

The investigators analyzed prescription claims data from 8,615 adults with epilepsy and partial-onset seizures who used two oral antiepileptics concomitantly for at least 90 days between 2005 and 2010 (JAMA Neurol. 2014 June 9 [doi:10.1001/jamaneurol.2014.808]). Data were from the Truven Health MarketScan Commercial Claims Database. The researchers divided the prescriptions into four categories: sodium channel blockers, gamma-aminobutyric acid analogs, synaptic vesicle protein 2A binders, and drugs with multiple MOAs.

Persistence on treatment served as a proxy for tolerability and seizure control, according to the investigators. They added that patients taking two drugs with different MOAs stayed on treatment up to 97 days longer, on average, and were significantly less likely to stop treatment than were patients prescribed two antiepileptics in the same category.

Furthermore, patients who took an oral gamma-aminobutyric acid analog and another antiepileptic with a different MOA were at lower risk of inpatient admission (odds ratio, 0.716; 95% confidence interval, 0.54-0.95; P = .02), compared with patients who took two gamma-aminobutyric acid analogs, said the investigators. Likewise, patients who took a sodium channel blocker plus another antiepileptic with a different MOA were at significantly lower risk of visiting an emergency department (OR, 0.85; 95% CI, 0.74-0.98; P = .03), compared with patients prescribed two sodium channel blockers. But the findings did not extend to all drug comparisons, possibly because the drug classes were not specific enough to detect differences between combinations, Dr. Margolis and his associates added. Future studies should explore factors that influence outcomes when patients take antiepileptics with different MOAs, they said,

Eisai Inc. funded the study. Truven Health Analytics employs two of the study’s coauthors and received research-related payments from Eisai Inc. The authors reported no other conflicts of interest.

Patients with epilepsy and partial-onset seizures stayed on treatment longer and had fewer hospitalizations and emergency department visits when they took concomitant antiepileptic drugs with dissimilar mechanisms of action, according to an analysis published online June 9 in JAMA Neurology.

The study, the first of its kind in patients with partial-onset seizures, suggests that prescribing antiepileptics with different mechanisms of action (MOA) might optimize treatment outcomes when patients need more than one drug for seizure control, said Jay M. Margolis, Pharm.D., of Truven Health Analytics, Bethesda, Md., and his associates.

The investigators analyzed prescription claims data from 8,615 adults with epilepsy and partial-onset seizures who used two oral antiepileptics concomitantly for at least 90 days between 2005 and 2010 (JAMA Neurol. 2014 June 9 [doi:10.1001/jamaneurol.2014.808]). Data were from the Truven Health MarketScan Commercial Claims Database. The researchers divided the prescriptions into four categories: sodium channel blockers, gamma-aminobutyric acid analogs, synaptic vesicle protein 2A binders, and drugs with multiple MOAs.

Persistence on treatment served as a proxy for tolerability and seizure control, according to the investigators. They added that patients taking two drugs with different MOAs stayed on treatment up to 97 days longer, on average, and were significantly less likely to stop treatment than were patients prescribed two antiepileptics in the same category.

Furthermore, patients who took an oral gamma-aminobutyric acid analog and another antiepileptic with a different MOA were at lower risk of inpatient admission (odds ratio, 0.716; 95% confidence interval, 0.54-0.95; P = .02), compared with patients who took two gamma-aminobutyric acid analogs, said the investigators. Likewise, patients who took a sodium channel blocker plus another antiepileptic with a different MOA were at significantly lower risk of visiting an emergency department (OR, 0.85; 95% CI, 0.74-0.98; P = .03), compared with patients prescribed two sodium channel blockers. But the findings did not extend to all drug comparisons, possibly because the drug classes were not specific enough to detect differences between combinations, Dr. Margolis and his associates added. Future studies should explore factors that influence outcomes when patients take antiepileptics with different MOAs, they said,

Eisai Inc. funded the study. Truven Health Analytics employs two of the study’s coauthors and received research-related payments from Eisai Inc. The authors reported no other conflicts of interest.

Patients with epilepsy and partial-onset seizures stayed on treatment longer and had fewer hospitalizations and emergency department visits when they took concomitant antiepileptic drugs with dissimilar mechanisms of action, according to an analysis published online June 9 in JAMA Neurology.

The study, the first of its kind in patients with partial-onset seizures, suggests that prescribing antiepileptics with different mechanisms of action (MOA) might optimize treatment outcomes when patients need more than one drug for seizure control, said Jay M. Margolis, Pharm.D., of Truven Health Analytics, Bethesda, Md., and his associates.

The investigators analyzed prescription claims data from 8,615 adults with epilepsy and partial-onset seizures who used two oral antiepileptics concomitantly for at least 90 days between 2005 and 2010 (JAMA Neurol. 2014 June 9 [doi:10.1001/jamaneurol.2014.808]). Data were from the Truven Health MarketScan Commercial Claims Database. The researchers divided the prescriptions into four categories: sodium channel blockers, gamma-aminobutyric acid analogs, synaptic vesicle protein 2A binders, and drugs with multiple MOAs.

Persistence on treatment served as a proxy for tolerability and seizure control, according to the investigators. They added that patients taking two drugs with different MOAs stayed on treatment up to 97 days longer, on average, and were significantly less likely to stop treatment than were patients prescribed two antiepileptics in the same category.

Furthermore, patients who took an oral gamma-aminobutyric acid analog and another antiepileptic with a different MOA were at lower risk of inpatient admission (odds ratio, 0.716; 95% confidence interval, 0.54-0.95; P = .02), compared with patients who took two gamma-aminobutyric acid analogs, said the investigators. Likewise, patients who took a sodium channel blocker plus another antiepileptic with a different MOA were at significantly lower risk of visiting an emergency department (OR, 0.85; 95% CI, 0.74-0.98; P = .03), compared with patients prescribed two sodium channel blockers. But the findings did not extend to all drug comparisons, possibly because the drug classes were not specific enough to detect differences between combinations, Dr. Margolis and his associates added. Future studies should explore factors that influence outcomes when patients take antiepileptics with different MOAs, they said,

Eisai Inc. funded the study. Truven Health Analytics employs two of the study’s coauthors and received research-related payments from Eisai Inc. The authors reported no other conflicts of interest.

Circumcision was linked to a 60% decrease in prostate cancer risk in black men, according to a large case-control study published online May 28 in BJU International.

"Very little evidence has accrued to date on the role of circumcision in prostate cancer risk among black men, known to have the highest rates of the disease. This clearly deserves further research," said Dr. Andrea Spence of the University of Quebec.

In the study, black men were less likely than were white men to be circumcised (30% versus 40% respectively), and were more likely to have had sexually transmitted infections (STIs) when they were uncircumcised (28%) than when they were circumcised (10%), noted Dr. Spence and her associates. "Such an STI pattern by circumcision status was not seen among white men," they added. "Although STI history was adjusted for within models, residual confounding may potentially explain the protective effect of circumcision in black men" (BJU Inter. 2014 May 28 [doi: 10.1111/bju.12741]).

Circumcision appeared to protect other study groups against prostate cancer, but associations did not reach statistical significance except in men circumcised at age 36 years or older, the researchers said. This was the first known report of such an association, and they did not know the reason, they added.

The population-based case-control study comprised 1,590 pathologically confirmed prostate cancer cases diagnosed in a Montreal hospital between 2005 and 2009, and 1,690 age-matched controls. Researchers interviewed cases and controls to measure demographic, lifestyle, and environmental factors. They used unconditional logistic regression to look at relationships between circumcision, age at circumcision, and prostate cancer risk while adjusting for age, ancestry, education, family history of prostate cancer, history of screening for prostate cancer, and history of STIs.

Circumcision was linked to an 11% decrease in prostate cancer risk in the overall study population, but the effect did not reach significance (odds ratio, 0.89; 95% confidence interval, 0.76-1.04) except in black men (OR, 0.40; 95% CI, 0.19-0.86; P = .02) and men circumcised at age 36 years and older (OR, 0.55; 95% CI, 0.30-0.98), reported Dr. Spence and her associates. In all, 2.6% of controls were circumcised at this older age, compared with 1.3% of cases, they added. The association in this subgroup remained significant even after the researchers controlled for factors linked to lower prostate cancer rates, such as type 2 diabetes, they said.

Circumcision status was self-reported and generally not verified by chart reviews.

The Canadian Cancer Society, Cancer Research Society, Fonds de la recherche du Québec – Santé (FRQS), FRQS-RRSE, the Minisétre du Développement Économique de l’Innovation et de l’Exportation du Québec, and the Canadian Institutes for Health Research funded the study. The authors disclosed no conflicts of interest.

Circumcision was linked to a 60% decrease in prostate cancer risk in black men, according to a large case-control study published online May 28 in BJU International.

"Very little evidence has accrued to date on the role of circumcision in prostate cancer risk among black men, known to have the highest rates of the disease. This clearly deserves further research," said Dr. Andrea Spence of the University of Quebec.

In the study, black men were less likely than were white men to be circumcised (30% versus 40% respectively), and were more likely to have had sexually transmitted infections (STIs) when they were uncircumcised (28%) than when they were circumcised (10%), noted Dr. Spence and her associates. "Such an STI pattern by circumcision status was not seen among white men," they added. "Although STI history was adjusted for within models, residual confounding may potentially explain the protective effect of circumcision in black men" (BJU Inter. 2014 May 28 [doi: 10.1111/bju.12741]).

Circumcision appeared to protect other study groups against prostate cancer, but associations did not reach statistical significance except in men circumcised at age 36 years or older, the researchers said. This was the first known report of such an association, and they did not know the reason, they added.

The population-based case-control study comprised 1,590 pathologically confirmed prostate cancer cases diagnosed in a Montreal hospital between 2005 and 2009, and 1,690 age-matched controls. Researchers interviewed cases and controls to measure demographic, lifestyle, and environmental factors. They used unconditional logistic regression to look at relationships between circumcision, age at circumcision, and prostate cancer risk while adjusting for age, ancestry, education, family history of prostate cancer, history of screening for prostate cancer, and history of STIs.

Circumcision was linked to an 11% decrease in prostate cancer risk in the overall study population, but the effect did not reach significance (odds ratio, 0.89; 95% confidence interval, 0.76-1.04) except in black men (OR, 0.40; 95% CI, 0.19-0.86; P = .02) and men circumcised at age 36 years and older (OR, 0.55; 95% CI, 0.30-0.98), reported Dr. Spence and her associates. In all, 2.6% of controls were circumcised at this older age, compared with 1.3% of cases, they added. The association in this subgroup remained significant even after the researchers controlled for factors linked to lower prostate cancer rates, such as type 2 diabetes, they said.

Circumcision status was self-reported and generally not verified by chart reviews.

The Canadian Cancer Society, Cancer Research Society, Fonds de la recherche du Québec – Santé (FRQS), FRQS-RRSE, the Minisétre du Développement Économique de l’Innovation et de l’Exportation du Québec, and the Canadian Institutes for Health Research funded the study. The authors disclosed no conflicts of interest.

Circumcision was linked to a 60% decrease in prostate cancer risk in black men, according to a large case-control study published online May 28 in BJU International.

"Very little evidence has accrued to date on the role of circumcision in prostate cancer risk among black men, known to have the highest rates of the disease. This clearly deserves further research," said Dr. Andrea Spence of the University of Quebec.

In the study, black men were less likely than were white men to be circumcised (30% versus 40% respectively), and were more likely to have had sexually transmitted infections (STIs) when they were uncircumcised (28%) than when they were circumcised (10%), noted Dr. Spence and her associates. "Such an STI pattern by circumcision status was not seen among white men," they added. "Although STI history was adjusted for within models, residual confounding may potentially explain the protective effect of circumcision in black men" (BJU Inter. 2014 May 28 [doi: 10.1111/bju.12741]).

Circumcision appeared to protect other study groups against prostate cancer, but associations did not reach statistical significance except in men circumcised at age 36 years or older, the researchers said. This was the first known report of such an association, and they did not know the reason, they added.

The population-based case-control study comprised 1,590 pathologically confirmed prostate cancer cases diagnosed in a Montreal hospital between 2005 and 2009, and 1,690 age-matched controls. Researchers interviewed cases and controls to measure demographic, lifestyle, and environmental factors. They used unconditional logistic regression to look at relationships between circumcision, age at circumcision, and prostate cancer risk while adjusting for age, ancestry, education, family history of prostate cancer, history of screening for prostate cancer, and history of STIs.

Circumcision was linked to an 11% decrease in prostate cancer risk in the overall study population, but the effect did not reach significance (odds ratio, 0.89; 95% confidence interval, 0.76-1.04) except in black men (OR, 0.40; 95% CI, 0.19-0.86; P = .02) and men circumcised at age 36 years and older (OR, 0.55; 95% CI, 0.30-0.98), reported Dr. Spence and her associates. In all, 2.6% of controls were circumcised at this older age, compared with 1.3% of cases, they added. The association in this subgroup remained significant even after the researchers controlled for factors linked to lower prostate cancer rates, such as type 2 diabetes, they said.

Circumcision status was self-reported and generally not verified by chart reviews.

The Canadian Cancer Society, Cancer Research Society, Fonds de la recherche du Québec – Santé (FRQS), FRQS-RRSE, the Minisétre du Développement Économique de l’Innovation et de l’Exportation du Québec, and the Canadian Institutes for Health Research funded the study. The authors disclosed no conflicts of interest.

Mothers did not transmit hepatitis B virus to their offspring when their viral load was less than 5 x 10⁷ IU/mL, even when the mothers tested positive for e antigen, researchers reported online May 26 in Annals of Internal Medicine.

"Prenatal treatments, such as oral antiviral agents, are unlikely to be of additional benefit in this population and may cause harm, even if used only for short periods, by inducing viral resistance or post-treatment hepatitis flares," said Ai Kubo, Ph.D., of the Kaiser Permanente division of research in Oakland, Calif., and her associates.

Betty Partin/CDC

Vertical transmission occurred in 3.61 of every 100 live births to mothers whose viral loads exceeded the 5 x 10⁷ IU/mL cutoff, the researchers reported (95% confidence interval, 0.75-10.56). "Future studies to evaluate the effectiveness of additional prophylaxis measures, such as late-pregnancy antiviral treatment, are warranted among these high-risk women," they said.

The observational study included 4,446 infants born to 3,253 hepatitis B virus (HBV)-positive mothers between 1997 and 2010. The mothers were members of the Kaiser Permanente Northern California integrated health services delivery organization, which has a centralized program of prenatal screening and neonatal immunoprophylaxis for HBV. The investigators searched electronic health data records to identify women who tested positive for HBV surface antigen and were due to deliver within 4 months, then tracked their infants to verify that they received HBV immunoglobulin and HBV vaccine (Ann. Int. Med. 2014 May 27 [doi: 10.7326/M13-2529]).

An estimated 0.75 infants were infected with HBV per 100 live births, the researchers reported (Poisson 95% confidence interval, 0.48-1.10). Infants born to e antigen–positive mothers had an infection rate of 3.37 per 100 live births (95% CI, 2.08-5.14), compared with 0.04 (95% CI, 0.001-0.24) for mothers who tested negative for e antigen. The lowest viral level associated with transmission was 6.32 x 10⁷ IU/mL, the investigators said.

The centralized program expanded over time, so by 2010 most mothers who tested positive for HBV surface antigen underwent prenatal testing for e antigen status and HBV viral load, the researchers also reported. In addition, almost all offspring of infected mothers received HBV immunoglobulin, a complete series of HBV vaccine within recommended time frames, and follow-up testing for HBV immune response and infection.

"Our results suggest that an organized program with high rates of prenatal screening, detection, and immunoprophylaxis can effectively prevent vertical transmission of hepatitis B," said Dr. Kubo and her associates. But they cautioned that "a centralized approach may be difficult to implement in many prenatal settings."

Kaiser Permanente Community Benefit and the National Institutes of Health funded the study. Dr. Kubo reported no conflicts of interest.

Mothers did not transmit hepatitis B virus to their offspring when their viral load was less than 5 x 10⁷ IU/mL, even when the mothers tested positive for e antigen, researchers reported online May 26 in Annals of Internal Medicine.

"Prenatal treatments, such as oral antiviral agents, are unlikely to be of additional benefit in this population and may cause harm, even if used only for short periods, by inducing viral resistance or post-treatment hepatitis flares," said Ai Kubo, Ph.D., of the Kaiser Permanente division of research in Oakland, Calif., and her associates.

Betty Partin/CDC

Vertical transmission occurred in 3.61 of every 100 live births to mothers whose viral loads exceeded the 5 x 10⁷ IU/mL cutoff, the researchers reported (95% confidence interval, 0.75-10.56). "Future studies to evaluate the effectiveness of additional prophylaxis measures, such as late-pregnancy antiviral treatment, are warranted among these high-risk women," they said.

The observational study included 4,446 infants born to 3,253 hepatitis B virus (HBV)-positive mothers between 1997 and 2010. The mothers were members of the Kaiser Permanente Northern California integrated health services delivery organization, which has a centralized program of prenatal screening and neonatal immunoprophylaxis for HBV. The investigators searched electronic health data records to identify women who tested positive for HBV surface antigen and were due to deliver within 4 months, then tracked their infants to verify that they received HBV immunoglobulin and HBV vaccine (Ann. Int. Med. 2014 May 27 [doi: 10.7326/M13-2529]).

An estimated 0.75 infants were infected with HBV per 100 live births, the researchers reported (Poisson 95% confidence interval, 0.48-1.10). Infants born to e antigen–positive mothers had an infection rate of 3.37 per 100 live births (95% CI, 2.08-5.14), compared with 0.04 (95% CI, 0.001-0.24) for mothers who tested negative for e antigen. The lowest viral level associated with transmission was 6.32 x 10⁷ IU/mL, the investigators said.

The centralized program expanded over time, so by 2010 most mothers who tested positive for HBV surface antigen underwent prenatal testing for e antigen status and HBV viral load, the researchers also reported. In addition, almost all offspring of infected mothers received HBV immunoglobulin, a complete series of HBV vaccine within recommended time frames, and follow-up testing for HBV immune response and infection.

"Our results suggest that an organized program with high rates of prenatal screening, detection, and immunoprophylaxis can effectively prevent vertical transmission of hepatitis B," said Dr. Kubo and her associates. But they cautioned that "a centralized approach may be difficult to implement in many prenatal settings."

Kaiser Permanente Community Benefit and the National Institutes of Health funded the study. Dr. Kubo reported no conflicts of interest.

Mothers did not transmit hepatitis B virus to their offspring when their viral load was less than 5 x 10⁷ IU/mL, even when the mothers tested positive for e antigen, researchers reported online May 26 in Annals of Internal Medicine.

"Prenatal treatments, such as oral antiviral agents, are unlikely to be of additional benefit in this population and may cause harm, even if used only for short periods, by inducing viral resistance or post-treatment hepatitis flares," said Ai Kubo, Ph.D., of the Kaiser Permanente division of research in Oakland, Calif., and her associates.

Betty Partin/CDC

Vertical transmission occurred in 3.61 of every 100 live births to mothers whose viral loads exceeded the 5 x 10⁷ IU/mL cutoff, the researchers reported (95% confidence interval, 0.75-10.56). "Future studies to evaluate the effectiveness of additional prophylaxis measures, such as late-pregnancy antiviral treatment, are warranted among these high-risk women," they said.

The observational study included 4,446 infants born to 3,253 hepatitis B virus (HBV)-positive mothers between 1997 and 2010. The mothers were members of the Kaiser Permanente Northern California integrated health services delivery organization, which has a centralized program of prenatal screening and neonatal immunoprophylaxis for HBV. The investigators searched electronic health data records to identify women who tested positive for HBV surface antigen and were due to deliver within 4 months, then tracked their infants to verify that they received HBV immunoglobulin and HBV vaccine (Ann. Int. Med. 2014 May 27 [doi: 10.7326/M13-2529]).

An estimated 0.75 infants were infected with HBV per 100 live births, the researchers reported (Poisson 95% confidence interval, 0.48-1.10). Infants born to e antigen–positive mothers had an infection rate of 3.37 per 100 live births (95% CI, 2.08-5.14), compared with 0.04 (95% CI, 0.001-0.24) for mothers who tested negative for e antigen. The lowest viral level associated with transmission was 6.32 x 10⁷ IU/mL, the investigators said.

The centralized program expanded over time, so by 2010 most mothers who tested positive for HBV surface antigen underwent prenatal testing for e antigen status and HBV viral load, the researchers also reported. In addition, almost all offspring of infected mothers received HBV immunoglobulin, a complete series of HBV vaccine within recommended time frames, and follow-up testing for HBV immune response and infection.

"Our results suggest that an organized program with high rates of prenatal screening, detection, and immunoprophylaxis can effectively prevent vertical transmission of hepatitis B," said Dr. Kubo and her associates. But they cautioned that "a centralized approach may be difficult to implement in many prenatal settings."

Kaiser Permanente Community Benefit and the National Institutes of Health funded the study. Dr. Kubo reported no conflicts of interest.

ALBUQUERQUE – Children and adults with atopic dermatitis had similar improvements in symptoms whether they received follow-up care through direct access to physicians online or in person, according to a 12-month randomized trial.

The mean decrease in scores on the patient-oriented eczema measure (POEM) was –5.1 for patients who received follow-up care from a dermatologist online, compared with –4.86 for those who received care in person, said Dr. April Armstrong.

"We’re looking at models that can essentially work for delivery of dermatology care anywhere, anytime," said Dr. Armstrong, vice chair of clinical research and associate professor of dermatology at the University of Colorado in Aurora. "From patients’ perspectives, they may be willing to pay out of pocket in return for expedited care without traveling, waiting, or missing work or school."

Dr. Armstrong presented the study findings at the annual meeting of the Society for Investigative Dermatology. Her interest in online care was sparked by patients’ lack of access to dermatologists and younger patients’ acceptance of and comfort with technology, she said.

She and her associates randomized 156 children (aged at least 4 years) and adults with atopic dermatitis to receive 12 months of follow-up care from dermatologists either in person or online. The online group took high-quality photographs of their skin lesions and sent the images and clinical data to dermatologists at the University of California, Davis, who provided asynchronous evaluations, made recommendations, and e-prescribed medications as needed. The second group received in-person care from the UC Davis dermatologists.

At 12 months, the difference in mean POEM scores between the two groups was 0.24, and the 95% confidence interval of –1.8-2.2 fell within the prespecified equivalence margin of 3, said Dr. Armstrong. Therefore, the results supported rejecting the null hypothesis that the care models had different effects, she said. The POEM assessment focuses primarily on symptom morbidity, and scores have been shown to correlate with the Eczema Area and Severity Index (EASI) and the SCORAD (scoring atopic dermatitis) Index, Dr. Armstrong said.

In addition, the researchers observed "clinically meaningful" improvements in both groups’ scores on the Dermatology Life Quality Index (DLQI) and the Children’s Dermatology Life Quality Index (CDLQI), with all mean improvements greater than 5, said Dr. Armstrong.

The groups did not differ significantly in terms of baseline characteristics, said Dr. Armstrong. There was a 10% dropout rate overall, with similar rates of loss to follow up between the two groups, she said. The groups also did not differ in terms of adverse effects from medications, she added.

The findings suggest that direct-access online follow-up care may be a reasonable option for children and adults with atopic dermatitis, Dr. Armstrong said. "The key questions are which diseases are suitable, which patients are suitable, and what the regulatory and consumer issues are," she added. "We want to tailor our delivery approach to our healthcare consumers."

The Agency for Healthcare Research and Quality funded the study. Dr. Armstrong reported no conflicts of interest.

ALBUQUERQUE – Children and adults with atopic dermatitis had similar improvements in symptoms whether they received follow-up care through direct access to physicians online or in person, according to a 12-month randomized trial.

The mean decrease in scores on the patient-oriented eczema measure (POEM) was –5.1 for patients who received follow-up care from a dermatologist online, compared with –4.86 for those who received care in person, said Dr. April Armstrong.

"We’re looking at models that can essentially work for delivery of dermatology care anywhere, anytime," said Dr. Armstrong, vice chair of clinical research and associate professor of dermatology at the University of Colorado in Aurora. "From patients’ perspectives, they may be willing to pay out of pocket in return for expedited care without traveling, waiting, or missing work or school."

Dr. Armstrong presented the study findings at the annual meeting of the Society for Investigative Dermatology. Her interest in online care was sparked by patients’ lack of access to dermatologists and younger patients’ acceptance of and comfort with technology, she said.

She and her associates randomized 156 children (aged at least 4 years) and adults with atopic dermatitis to receive 12 months of follow-up care from dermatologists either in person or online. The online group took high-quality photographs of their skin lesions and sent the images and clinical data to dermatologists at the University of California, Davis, who provided asynchronous evaluations, made recommendations, and e-prescribed medications as needed. The second group received in-person care from the UC Davis dermatologists.

At 12 months, the difference in mean POEM scores between the two groups was 0.24, and the 95% confidence interval of –1.8-2.2 fell within the prespecified equivalence margin of 3, said Dr. Armstrong. Therefore, the results supported rejecting the null hypothesis that the care models had different effects, she said. The POEM assessment focuses primarily on symptom morbidity, and scores have been shown to correlate with the Eczema Area and Severity Index (EASI) and the SCORAD (scoring atopic dermatitis) Index, Dr. Armstrong said.

In addition, the researchers observed "clinically meaningful" improvements in both groups’ scores on the Dermatology Life Quality Index (DLQI) and the Children’s Dermatology Life Quality Index (CDLQI), with all mean improvements greater than 5, said Dr. Armstrong.

The groups did not differ significantly in terms of baseline characteristics, said Dr. Armstrong. There was a 10% dropout rate overall, with similar rates of loss to follow up between the two groups, she said. The groups also did not differ in terms of adverse effects from medications, she added.

The findings suggest that direct-access online follow-up care may be a reasonable option for children and adults with atopic dermatitis, Dr. Armstrong said. "The key questions are which diseases are suitable, which patients are suitable, and what the regulatory and consumer issues are," she added. "We want to tailor our delivery approach to our healthcare consumers."

The Agency for Healthcare Research and Quality funded the study. Dr. Armstrong reported no conflicts of interest.

ALBUQUERQUE – Children and adults with atopic dermatitis had similar improvements in symptoms whether they received follow-up care through direct access to physicians online or in person, according to a 12-month randomized trial.

The mean decrease in scores on the patient-oriented eczema measure (POEM) was –5.1 for patients who received follow-up care from a dermatologist online, compared with –4.86 for those who received care in person, said Dr. April Armstrong.

"We’re looking at models that can essentially work for delivery of dermatology care anywhere, anytime," said Dr. Armstrong, vice chair of clinical research and associate professor of dermatology at the University of Colorado in Aurora. "From patients’ perspectives, they may be willing to pay out of pocket in return for expedited care without traveling, waiting, or missing work or school."

Dr. Armstrong presented the study findings at the annual meeting of the Society for Investigative Dermatology. Her interest in online care was sparked by patients’ lack of access to dermatologists and younger patients’ acceptance of and comfort with technology, she said.

She and her associates randomized 156 children (aged at least 4 years) and adults with atopic dermatitis to receive 12 months of follow-up care from dermatologists either in person or online. The online group took high-quality photographs of their skin lesions and sent the images and clinical data to dermatologists at the University of California, Davis, who provided asynchronous evaluations, made recommendations, and e-prescribed medications as needed. The second group received in-person care from the UC Davis dermatologists.

At 12 months, the difference in mean POEM scores between the two groups was 0.24, and the 95% confidence interval of –1.8-2.2 fell within the prespecified equivalence margin of 3, said Dr. Armstrong. Therefore, the results supported rejecting the null hypothesis that the care models had different effects, she said. The POEM assessment focuses primarily on symptom morbidity, and scores have been shown to correlate with the Eczema Area and Severity Index (EASI) and the SCORAD (scoring atopic dermatitis) Index, Dr. Armstrong said.

In addition, the researchers observed "clinically meaningful" improvements in both groups’ scores on the Dermatology Life Quality Index (DLQI) and the Children’s Dermatology Life Quality Index (CDLQI), with all mean improvements greater than 5, said Dr. Armstrong.

The groups did not differ significantly in terms of baseline characteristics, said Dr. Armstrong. There was a 10% dropout rate overall, with similar rates of loss to follow up between the two groups, she said. The groups also did not differ in terms of adverse effects from medications, she added.

The findings suggest that direct-access online follow-up care may be a reasonable option for children and adults with atopic dermatitis, Dr. Armstrong said. "The key questions are which diseases are suitable, which patients are suitable, and what the regulatory and consumer issues are," she added. "We want to tailor our delivery approach to our healthcare consumers."

The Agency for Healthcare Research and Quality funded the study. Dr. Armstrong reported no conflicts of interest.

In patients with colorectal cancer, laparoscopic resection reduced total hospital stay by a median of 2 days, compared with open surgery, researchers reported online May 5 in the Journal of Clinical Oncology.

However, laparoscopy did not significantly improve physical fatigue at 1 month, compared with open surgery, and it did not affect other secondary clinical outcomes, said Prof. Robin Kennedy of St. Mark’s Hospital, Harrow, England, and his associates.

The researchers conducted a multicenter, randomized trial of 204 patients with colorectal cancer, of whom 103 underwent laparoscopic resection and 101 had open surgery within a standardized enhanced recovery program (J. Clin. Oncol. 2014 May 5 [doi: 10.1200/JCO.2013.54.3694]).

Median total hospital stay was significantly shorter in the laparoscopy group (5 days; interquartile range, 4-9 days) vs. the open surgery group (7 days; IQR, 5-11 days; P = .033), the investigators reported. However, 1-month physical fatigue scores on the Multidimensional Fatigue Inventory 20 were similar between the two groups (mean for laparoscopy patients, 12.28; 95% confidence interval, 11.37-13.19; mean for open surgery patients, 12.05; 95% CI, 11.14-12.96; adjusted mean difference, –0.23; 95% CI, –1.52-1.07), the researchers reported. Other outcomes also were similar, including quality of the specimens based on central pathologic review, the researchers said.

The findings contradicted those of prior studies in which shorter duration of hospital stay correlated with less "pain, ileus, and other complications, leading to earlier mobilization, feeding, and recovery," the researchers noted. They recommended more studies to determine whether the similarities between other outcomes were due to a lack of power or truly indicated comparable short-term recoveries.

The research was funded by Cancer Research UK, the National Institute for Health Research, Ethicon Endo-Surgery Europe, the Medical Research Council ConDuCT Hub, and Yorkshire Cancer Research. The authors reported that they had no relevant conflicts of interest.

In patients with colorectal cancer, laparoscopic resection reduced total hospital stay by a median of 2 days, compared with open surgery, researchers reported online May 5 in the Journal of Clinical Oncology.

However, laparoscopy did not significantly improve physical fatigue at 1 month, compared with open surgery, and it did not affect other secondary clinical outcomes, said Prof. Robin Kennedy of St. Mark’s Hospital, Harrow, England, and his associates.

The researchers conducted a multicenter, randomized trial of 204 patients with colorectal cancer, of whom 103 underwent laparoscopic resection and 101 had open surgery within a standardized enhanced recovery program (J. Clin. Oncol. 2014 May 5 [doi: 10.1200/JCO.2013.54.3694]).

Median total hospital stay was significantly shorter in the laparoscopy group (5 days; interquartile range, 4-9 days) vs. the open surgery group (7 days; IQR, 5-11 days; P = .033), the investigators reported. However, 1-month physical fatigue scores on the Multidimensional Fatigue Inventory 20 were similar between the two groups (mean for laparoscopy patients, 12.28; 95% confidence interval, 11.37-13.19; mean for open surgery patients, 12.05; 95% CI, 11.14-12.96; adjusted mean difference, –0.23; 95% CI, –1.52-1.07), the researchers reported. Other outcomes also were similar, including quality of the specimens based on central pathologic review, the researchers said.

The findings contradicted those of prior studies in which shorter duration of hospital stay correlated with less "pain, ileus, and other complications, leading to earlier mobilization, feeding, and recovery," the researchers noted. They recommended more studies to determine whether the similarities between other outcomes were due to a lack of power or truly indicated comparable short-term recoveries.

The research was funded by Cancer Research UK, the National Institute for Health Research, Ethicon Endo-Surgery Europe, the Medical Research Council ConDuCT Hub, and Yorkshire Cancer Research. The authors reported that they had no relevant conflicts of interest.

In patients with colorectal cancer, laparoscopic resection reduced total hospital stay by a median of 2 days, compared with open surgery, researchers reported online May 5 in the Journal of Clinical Oncology.

However, laparoscopy did not significantly improve physical fatigue at 1 month, compared with open surgery, and it did not affect other secondary clinical outcomes, said Prof. Robin Kennedy of St. Mark’s Hospital, Harrow, England, and his associates.

The researchers conducted a multicenter, randomized trial of 204 patients with colorectal cancer, of whom 103 underwent laparoscopic resection and 101 had open surgery within a standardized enhanced recovery program (J. Clin. Oncol. 2014 May 5 [doi: 10.1200/JCO.2013.54.3694]).

Median total hospital stay was significantly shorter in the laparoscopy group (5 days; interquartile range, 4-9 days) vs. the open surgery group (7 days; IQR, 5-11 days; P = .033), the investigators reported. However, 1-month physical fatigue scores on the Multidimensional Fatigue Inventory 20 were similar between the two groups (mean for laparoscopy patients, 12.28; 95% confidence interval, 11.37-13.19; mean for open surgery patients, 12.05; 95% CI, 11.14-12.96; adjusted mean difference, –0.23; 95% CI, –1.52-1.07), the researchers reported. Other outcomes also were similar, including quality of the specimens based on central pathologic review, the researchers said.

The findings contradicted those of prior studies in which shorter duration of hospital stay correlated with less "pain, ileus, and other complications, leading to earlier mobilization, feeding, and recovery," the researchers noted. They recommended more studies to determine whether the similarities between other outcomes were due to a lack of power or truly indicated comparable short-term recoveries.

The research was funded by Cancer Research UK, the National Institute for Health Research, Ethicon Endo-Surgery Europe, the Medical Research Council ConDuCT Hub, and Yorkshire Cancer Research. The authors reported that they had no relevant conflicts of interest.

If current trends hold true, pancreatic and liver cancer will overtake breast and colorectal cancer to become the second- and third-most-common causes of cancer-related deaths in the United States by 2030, investigators reported May 19 in Cancer Research.

Lung cancer will remain the leading cause of cancer mortality, said Lynn Matrisian, Ph.D., M.B.A., vice president of scientific and medical affairs at the Pancreatic Cancer Action Network in Manhattan Beach, Calif., at a press briefing that coincided with publication of the paper in Cancer Research.

Courtesy AACR

The forecast for pancreatic cancer – including a projected increase in deaths from 36,888 in 2010 to 63,000 in 2030 – reflects demographic shifts in the United States and the relative lack of progress in screening and treatment for the disease, said Dr. Matrisian prior to a conference on pancreatic cancer held by the American Association for Cancer Research in New Orleans.

Based on the analyses, breast, prostate, and lung cancer will remain the three most commonly diagnosed cancers in the United States in 2030, but thyroid cancer will overtake colorectal cancer for fourth place, followed by melanoma and uterine cancer, the investigators reported (Cancer Res. 2014 May 19 [doi: 10.1158/0008-5472.CAN-14-0155]).

The "big four" cancers in the United States historically have been lung, breast, prostate, and colorectal cancer, which together have accounted for more than half of new cancer cases and cancer-related deaths (Annu. Rev. Public Health 2012; 33:137-56).

In the case of colorectal cancer, colonoscopy screening has led to earlier diagnosis and treatment and lower death rates, Dr. Matrisian noted.

In contrast, 5-year survival rates for patients with operable pancreatic cancer are 15%-20%, and most cases are inoperable because of distant metastases, leading to 5-year survival rates that of less than 5% (Ann. Surg. 2013;257:17-26).

Dr. Matrisian and her associates based the projections on average annual percentage changes in incidence and death rates in the United States from 2006 through 2010, as well as demographic changes predicted to occur in the country during the next two decades.

For 2014, the top causes of cancer deaths in men were expected to be lung, prostate, and colorectal cancers, the researchers reported. The rankings were the same for women, except that breast cancer took second place. But by 2030, the leading causes of cancer-related death for men and women were projected to be lung, pancreas, and liver, the researchers found. While total deaths for both men and women were projected to decrease for breast, colorectal, and prostate cancers, they were expected to increase for pancreas, liver, leukemia, and bladder cancers.

Increasing numbers of minorities and individuals aged 60 years and older explained the trends for pancreatic cancer, Dr. Matrisian said. "We’ve been so successful in preventing deaths from other major diseases – heart disease, infectious diseases – and so we’re living much longer in the United States, and one of the biggest risk factors for cancer is age," she added.

"This paper really was a call to action," Dr. Matrisian said. "We’ve been able to turn the tide on other cancers by investing in basic research and clinical research. It’s now time to realize that we need to turn the tide on pancreatic cancer."

The Pancreatic Cancer Action Network funded the study. Dr. Matrisian is an employee of PCAN and reported no conflicts of interest.

If current trends hold true, pancreatic and liver cancer will overtake breast and colorectal cancer to become the second- and third-most-common causes of cancer-related deaths in the United States by 2030, investigators reported May 19 in Cancer Research.

Lung cancer will remain the leading cause of cancer mortality, said Lynn Matrisian, Ph.D., M.B.A., vice president of scientific and medical affairs at the Pancreatic Cancer Action Network in Manhattan Beach, Calif., at a press briefing that coincided with publication of the paper in Cancer Research.

Courtesy AACR

The forecast for pancreatic cancer – including a projected increase in deaths from 36,888 in 2010 to 63,000 in 2030 – reflects demographic shifts in the United States and the relative lack of progress in screening and treatment for the disease, said Dr. Matrisian prior to a conference on pancreatic cancer held by the American Association for Cancer Research in New Orleans.

Based on the analyses, breast, prostate, and lung cancer will remain the three most commonly diagnosed cancers in the United States in 2030, but thyroid cancer will overtake colorectal cancer for fourth place, followed by melanoma and uterine cancer, the investigators reported (Cancer Res. 2014 May 19 [doi: 10.1158/0008-5472.CAN-14-0155]).

The "big four" cancers in the United States historically have been lung, breast, prostate, and colorectal cancer, which together have accounted for more than half of new cancer cases and cancer-related deaths (Annu. Rev. Public Health 2012; 33:137-56).

In the case of colorectal cancer, colonoscopy screening has led to earlier diagnosis and treatment and lower death rates, Dr. Matrisian noted.

In contrast, 5-year survival rates for patients with operable pancreatic cancer are 15%-20%, and most cases are inoperable because of distant metastases, leading to 5-year survival rates that of less than 5% (Ann. Surg. 2013;257:17-26).

Dr. Matrisian and her associates based the projections on average annual percentage changes in incidence and death rates in the United States from 2006 through 2010, as well as demographic changes predicted to occur in the country during the next two decades.

For 2014, the top causes of cancer deaths in men were expected to be lung, prostate, and colorectal cancers, the researchers reported. The rankings were the same for women, except that breast cancer took second place. But by 2030, the leading causes of cancer-related death for men and women were projected to be lung, pancreas, and liver, the researchers found. While total deaths for both men and women were projected to decrease for breast, colorectal, and prostate cancers, they were expected to increase for pancreas, liver, leukemia, and bladder cancers.

Increasing numbers of minorities and individuals aged 60 years and older explained the trends for pancreatic cancer, Dr. Matrisian said. "We’ve been so successful in preventing deaths from other major diseases – heart disease, infectious diseases – and so we’re living much longer in the United States, and one of the biggest risk factors for cancer is age," she added.

"This paper really was a call to action," Dr. Matrisian said. "We’ve been able to turn the tide on other cancers by investing in basic research and clinical research. It’s now time to realize that we need to turn the tide on pancreatic cancer."

The Pancreatic Cancer Action Network funded the study. Dr. Matrisian is an employee of PCAN and reported no conflicts of interest.

If current trends hold true, pancreatic and liver cancer will overtake breast and colorectal cancer to become the second- and third-most-common causes of cancer-related deaths in the United States by 2030, investigators reported May 19 in Cancer Research.

Lung cancer will remain the leading cause of cancer mortality, said Lynn Matrisian, Ph.D., M.B.A., vice president of scientific and medical affairs at the Pancreatic Cancer Action Network in Manhattan Beach, Calif., at a press briefing that coincided with publication of the paper in Cancer Research.

Courtesy AACR

The forecast for pancreatic cancer – including a projected increase in deaths from 36,888 in 2010 to 63,000 in 2030 – reflects demographic shifts in the United States and the relative lack of progress in screening and treatment for the disease, said Dr. Matrisian prior to a conference on pancreatic cancer held by the American Association for Cancer Research in New Orleans.

Based on the analyses, breast, prostate, and lung cancer will remain the three most commonly diagnosed cancers in the United States in 2030, but thyroid cancer will overtake colorectal cancer for fourth place, followed by melanoma and uterine cancer, the investigators reported (Cancer Res. 2014 May 19 [doi: 10.1158/0008-5472.CAN-14-0155]).

The "big four" cancers in the United States historically have been lung, breast, prostate, and colorectal cancer, which together have accounted for more than half of new cancer cases and cancer-related deaths (Annu. Rev. Public Health 2012; 33:137-56).

In the case of colorectal cancer, colonoscopy screening has led to earlier diagnosis and treatment and lower death rates, Dr. Matrisian noted.

In contrast, 5-year survival rates for patients with operable pancreatic cancer are 15%-20%, and most cases are inoperable because of distant metastases, leading to 5-year survival rates that of less than 5% (Ann. Surg. 2013;257:17-26).

Dr. Matrisian and her associates based the projections on average annual percentage changes in incidence and death rates in the United States from 2006 through 2010, as well as demographic changes predicted to occur in the country during the next two decades.

For 2014, the top causes of cancer deaths in men were expected to be lung, prostate, and colorectal cancers, the researchers reported. The rankings were the same for women, except that breast cancer took second place. But by 2030, the leading causes of cancer-related death for men and women were projected to be lung, pancreas, and liver, the researchers found. While total deaths for both men and women were projected to decrease for breast, colorectal, and prostate cancers, they were expected to increase for pancreas, liver, leukemia, and bladder cancers.

Increasing numbers of minorities and individuals aged 60 years and older explained the trends for pancreatic cancer, Dr. Matrisian said. "We’ve been so successful in preventing deaths from other major diseases – heart disease, infectious diseases – and so we’re living much longer in the United States, and one of the biggest risk factors for cancer is age," she added.

"This paper really was a call to action," Dr. Matrisian said. "We’ve been able to turn the tide on other cancers by investing in basic research and clinical research. It’s now time to realize that we need to turn the tide on pancreatic cancer."

The Pancreatic Cancer Action Network funded the study. Dr. Matrisian is an employee of PCAN and reported no conflicts of interest.

A biomarker panel distinguished individuals with pancreatic cancer from those who were healthy, had benign pancreatic cysts, or had chronic pancreatitis with about 90% accuracy, based on analyses of two cohorts.

The panel, which tests for the known pancreatic cancer biomarker CA 19-9 plus three new serum biomarkers, had a sensitivity of approximately 85%-92% and a specificity of 90%-94%, reported Dr. Ayumu Taguchi of the department of translational molecular pathology at the University of Texas M.D. Anderson Cancer Center in Houston.

After more testing, the panel might be useful for screening individuals who are known to be at high risk for pancreatic cancer on the basis of genetic studies, Dr. Taguchi said at a media briefing highlighting research to be presented at an American Association for Cancer Research meeting on pancreatic cancer research and treatment, held in New Orleans on May 19.

Imaging modalities such as endoscopic ultrasound and magnetic resonance cholangiopancreatography can detect early-stage pancreatic cancer or small pancreatic cysts, but "are not suitable for screening in terms of throughput, cost effectiveness, or invasiveness," Dr. Taguchi noted.

There is currently no approved screening panel for pancreatic cancer, which annually kills more than 39,000 individuals in the United States, according to the American Cancer Society. In a 2008 study (PLos Med. 2008;5:e123), an investigational biomarker panel differentiated healthy controls from pancreatic cancer cases when samples were obtained 7-13 months before patients developed cancer symptoms, Dr. Taguchi noted.

To further build on that research, investigators in the current study tested two independent cohorts – a training set of 138 pancreatic cancer patients, 52 healthy individuals, and 29 patients with chronic pancreatitis, and a test set consisting of 42 patients with early-stage pancreatic cancer, 50 healthy individuals, 29 patients with chronic pancreatitis, and 14 individuals with benign pancreatic cysts.

For the training set, the areas under the curve for the biomarker combination and for CA 19-9 alone were 0.80 (95% confidence interval, 0.71-0.89) and 0.76 (95% CI, 0.67-0.86), respectively (P = .014), Dr. Taguchi and his associates reported. For the test set, the AUCs were 0.91, 0.85, and 0.94 when patients with early-stage pancreatic cancer were compared with individuals who were healthy, had chronic pancreatitis, or had benign pancreatic cysts.

In addition, the biomarker panel substantially improved negative predictive values at 98% sensitivity when patients with early-stage pancreatic cancer were compared with healthy controls and patients with chronic pancreatitis, the investigators reported. The negative predictive values of the panel were 96%, 95%, and 88%, respectively, while those for CA19-9 alone ranged from 83% to 88%, they added.

"Our biomarker panel was much better at distinguishing patients with pancreatic cancer from those who were healthy, had chronic pancreatitis, or had pancreatic cysts, compared with CA 19-9 alone," Dr. Taguchi concluded. "This means that our panel has the potential to substantially reduce the number of patients who would have to undergo extremely invasive screening procedures."

The next step is to further validate the panel in larger numbers of samples collected before patients were diagnosed with early-stage pancreatic cancer, Dr. Taguchi said.

The National Cancer Institute Early Detection Network and the Lustgarten Foundation funded the research. Dr. Taguchi reported no conflicts of interest.

A biomarker panel distinguished individuals with pancreatic cancer from those who were healthy, had benign pancreatic cysts, or had chronic pancreatitis with about 90% accuracy, based on analyses of two cohorts.

The panel, which tests for the known pancreatic cancer biomarker CA 19-9 plus three new serum biomarkers, had a sensitivity of approximately 85%-92% and a specificity of 90%-94%, reported Dr. Ayumu Taguchi of the department of translational molecular pathology at the University of Texas M.D. Anderson Cancer Center in Houston.

After more testing, the panel might be useful for screening individuals who are known to be at high risk for pancreatic cancer on the basis of genetic studies, Dr. Taguchi said at a media briefing highlighting research to be presented at an American Association for Cancer Research meeting on pancreatic cancer research and treatment, held in New Orleans on May 19.

Imaging modalities such as endoscopic ultrasound and magnetic resonance cholangiopancreatography can detect early-stage pancreatic cancer or small pancreatic cysts, but "are not suitable for screening in terms of throughput, cost effectiveness, or invasiveness," Dr. Taguchi noted.

There is currently no approved screening panel for pancreatic cancer, which annually kills more than 39,000 individuals in the United States, according to the American Cancer Society. In a 2008 study (PLos Med. 2008;5:e123), an investigational biomarker panel differentiated healthy controls from pancreatic cancer cases when samples were obtained 7-13 months before patients developed cancer symptoms, Dr. Taguchi noted.

To further build on that research, investigators in the current study tested two independent cohorts – a training set of 138 pancreatic cancer patients, 52 healthy individuals, and 29 patients with chronic pancreatitis, and a test set consisting of 42 patients with early-stage pancreatic cancer, 50 healthy individuals, 29 patients with chronic pancreatitis, and 14 individuals with benign pancreatic cysts.

For the training set, the areas under the curve for the biomarker combination and for CA 19-9 alone were 0.80 (95% confidence interval, 0.71-0.89) and 0.76 (95% CI, 0.67-0.86), respectively (P = .014), Dr. Taguchi and his associates reported. For the test set, the AUCs were 0.91, 0.85, and 0.94 when patients with early-stage pancreatic cancer were compared with individuals who were healthy, had chronic pancreatitis, or had benign pancreatic cysts.

In addition, the biomarker panel substantially improved negative predictive values at 98% sensitivity when patients with early-stage pancreatic cancer were compared with healthy controls and patients with chronic pancreatitis, the investigators reported. The negative predictive values of the panel were 96%, 95%, and 88%, respectively, while those for CA19-9 alone ranged from 83% to 88%, they added.

"Our biomarker panel was much better at distinguishing patients with pancreatic cancer from those who were healthy, had chronic pancreatitis, or had pancreatic cysts, compared with CA 19-9 alone," Dr. Taguchi concluded. "This means that our panel has the potential to substantially reduce the number of patients who would have to undergo extremely invasive screening procedures."

The next step is to further validate the panel in larger numbers of samples collected before patients were diagnosed with early-stage pancreatic cancer, Dr. Taguchi said.

The National Cancer Institute Early Detection Network and the Lustgarten Foundation funded the research. Dr. Taguchi reported no conflicts of interest.

A biomarker panel distinguished individuals with pancreatic cancer from those who were healthy, had benign pancreatic cysts, or had chronic pancreatitis with about 90% accuracy, based on analyses of two cohorts.

The panel, which tests for the known pancreatic cancer biomarker CA 19-9 plus three new serum biomarkers, had a sensitivity of approximately 85%-92% and a specificity of 90%-94%, reported Dr. Ayumu Taguchi of the department of translational molecular pathology at the University of Texas M.D. Anderson Cancer Center in Houston.

After more testing, the panel might be useful for screening individuals who are known to be at high risk for pancreatic cancer on the basis of genetic studies, Dr. Taguchi said at a media briefing highlighting research to be presented at an American Association for Cancer Research meeting on pancreatic cancer research and treatment, held in New Orleans on May 19.

Imaging modalities such as endoscopic ultrasound and magnetic resonance cholangiopancreatography can detect early-stage pancreatic cancer or small pancreatic cysts, but "are not suitable for screening in terms of throughput, cost effectiveness, or invasiveness," Dr. Taguchi noted.

There is currently no approved screening panel for pancreatic cancer, which annually kills more than 39,000 individuals in the United States, according to the American Cancer Society. In a 2008 study (PLos Med. 2008;5:e123), an investigational biomarker panel differentiated healthy controls from pancreatic cancer cases when samples were obtained 7-13 months before patients developed cancer symptoms, Dr. Taguchi noted.

To further build on that research, investigators in the current study tested two independent cohorts – a training set of 138 pancreatic cancer patients, 52 healthy individuals, and 29 patients with chronic pancreatitis, and a test set consisting of 42 patients with early-stage pancreatic cancer, 50 healthy individuals, 29 patients with chronic pancreatitis, and 14 individuals with benign pancreatic cysts.

For the training set, the areas under the curve for the biomarker combination and for CA 19-9 alone were 0.80 (95% confidence interval, 0.71-0.89) and 0.76 (95% CI, 0.67-0.86), respectively (P = .014), Dr. Taguchi and his associates reported. For the test set, the AUCs were 0.91, 0.85, and 0.94 when patients with early-stage pancreatic cancer were compared with individuals who were healthy, had chronic pancreatitis, or had benign pancreatic cysts.

In addition, the biomarker panel substantially improved negative predictive values at 98% sensitivity when patients with early-stage pancreatic cancer were compared with healthy controls and patients with chronic pancreatitis, the investigators reported. The negative predictive values of the panel were 96%, 95%, and 88%, respectively, while those for CA19-9 alone ranged from 83% to 88%, they added.

"Our biomarker panel was much better at distinguishing patients with pancreatic cancer from those who were healthy, had chronic pancreatitis, or had pancreatic cysts, compared with CA 19-9 alone," Dr. Taguchi concluded. "This means that our panel has the potential to substantially reduce the number of patients who would have to undergo extremely invasive screening procedures."

The next step is to further validate the panel in larger numbers of samples collected before patients were diagnosed with early-stage pancreatic cancer, Dr. Taguchi said.

The National Cancer Institute Early Detection Network and the Lustgarten Foundation funded the research. Dr. Taguchi reported no conflicts of interest.