Cannabis for cancer symptoms: Perceived or real benefit?

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Megan Brooks

 

TOPLINE:

Adults receiving cancer treatment who use cannabis perceived benefits regarding pain, sleep, nausea, and other factors but also reported worse physical and psychological symptoms.

METHODOLOGY:

  • Participants included 267 adults (mean age, 58 years; 70% women; 88% White) undergoing treatment for cancer, most commonly breast (47%) and ovarian (29%).
  • Participants completed online surveys to characterize cannabis use, reasons for using it, perceived benefits and harms, and physical/psychological symptoms.
  • Participants who had used cannabis for more than 1 day during the previous 30 days were compared with those who had not.

TAKEAWAY:

  • Overall, 26% of respondents reported cannabis use in the past 30 days, most often edibles (65%) or smoked cannabis (51%).
  • Cannabis users were more likely to be younger, male, Black, to have lower income, worse physical/psychological symptoms, and to be disabled or unable to work in comparison with nonusers.
  • Cannabis was used to treat pain, cancer, sleep problems, anxiety, nausea, and poor appetite; perceived benefits were greatest with respect to sleep, nausea, pain, muscle spasms, and anxiety.
  • Despite perceived benefits, cannabis users reported worse overall distress, anxiety, sleep disturbances, appetite, nausea, fatigue, and pain.

IN PRACTICE:

“The study findings indicate that patients with cancer perceived benefits to using cannabis for many symptoms” but also revealed that “those who used cannabis in the past 30 days had significantly worse symptom profiles overall than those who did not use cannabis,” the authors wrote.

SOURCE:

The study, led by Desiree R. Azizoddin, PsyD, University of Oklahoma Health Science Center, Oklahoma City, was published online in Cancer.

LIMITATIONS:

It’s not known whether adults who used cannabis had significantly worse symptoms at the outset, which may have prompted cannabis use, or whether cannabis use may have exacerbated their symptoms.

DISCLOSURES:

Funding for the study was provided by grants from the National Cancer Institute and the Oklahoma Tobacco Settlement Endowment Trust. Nine of the 10 authors have disclosed no relevant conflicts of interest. One author has relationships with various pharmaceutical companies involved in oncology.

A version of this article first appeared on Medscape.com.

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Megan Brooks
Author(s)
Megan Brooks

 

TOPLINE:

Adults receiving cancer treatment who use cannabis perceived benefits regarding pain, sleep, nausea, and other factors but also reported worse physical and psychological symptoms.

METHODOLOGY:

  • Participants included 267 adults (mean age, 58 years; 70% women; 88% White) undergoing treatment for cancer, most commonly breast (47%) and ovarian (29%).
  • Participants completed online surveys to characterize cannabis use, reasons for using it, perceived benefits and harms, and physical/psychological symptoms.
  • Participants who had used cannabis for more than 1 day during the previous 30 days were compared with those who had not.

TAKEAWAY:

  • Overall, 26% of respondents reported cannabis use in the past 30 days, most often edibles (65%) or smoked cannabis (51%).
  • Cannabis users were more likely to be younger, male, Black, to have lower income, worse physical/psychological symptoms, and to be disabled or unable to work in comparison with nonusers.
  • Cannabis was used to treat pain, cancer, sleep problems, anxiety, nausea, and poor appetite; perceived benefits were greatest with respect to sleep, nausea, pain, muscle spasms, and anxiety.
  • Despite perceived benefits, cannabis users reported worse overall distress, anxiety, sleep disturbances, appetite, nausea, fatigue, and pain.

IN PRACTICE:

“The study findings indicate that patients with cancer perceived benefits to using cannabis for many symptoms” but also revealed that “those who used cannabis in the past 30 days had significantly worse symptom profiles overall than those who did not use cannabis,” the authors wrote.

SOURCE:

The study, led by Desiree R. Azizoddin, PsyD, University of Oklahoma Health Science Center, Oklahoma City, was published online in Cancer.

LIMITATIONS:

It’s not known whether adults who used cannabis had significantly worse symptoms at the outset, which may have prompted cannabis use, or whether cannabis use may have exacerbated their symptoms.

DISCLOSURES:

Funding for the study was provided by grants from the National Cancer Institute and the Oklahoma Tobacco Settlement Endowment Trust. Nine of the 10 authors have disclosed no relevant conflicts of interest. One author has relationships with various pharmaceutical companies involved in oncology.

A version of this article first appeared on Medscape.com.

 

TOPLINE:

Adults receiving cancer treatment who use cannabis perceived benefits regarding pain, sleep, nausea, and other factors but also reported worse physical and psychological symptoms.

METHODOLOGY:

  • Participants included 267 adults (mean age, 58 years; 70% women; 88% White) undergoing treatment for cancer, most commonly breast (47%) and ovarian (29%).
  • Participants completed online surveys to characterize cannabis use, reasons for using it, perceived benefits and harms, and physical/psychological symptoms.
  • Participants who had used cannabis for more than 1 day during the previous 30 days were compared with those who had not.

TAKEAWAY:

  • Overall, 26% of respondents reported cannabis use in the past 30 days, most often edibles (65%) or smoked cannabis (51%).
  • Cannabis users were more likely to be younger, male, Black, to have lower income, worse physical/psychological symptoms, and to be disabled or unable to work in comparison with nonusers.
  • Cannabis was used to treat pain, cancer, sleep problems, anxiety, nausea, and poor appetite; perceived benefits were greatest with respect to sleep, nausea, pain, muscle spasms, and anxiety.
  • Despite perceived benefits, cannabis users reported worse overall distress, anxiety, sleep disturbances, appetite, nausea, fatigue, and pain.

IN PRACTICE:

“The study findings indicate that patients with cancer perceived benefits to using cannabis for many symptoms” but also revealed that “those who used cannabis in the past 30 days had significantly worse symptom profiles overall than those who did not use cannabis,” the authors wrote.

SOURCE:

The study, led by Desiree R. Azizoddin, PsyD, University of Oklahoma Health Science Center, Oklahoma City, was published online in Cancer.

LIMITATIONS:

It’s not known whether adults who used cannabis had significantly worse symptoms at the outset, which may have prompted cannabis use, or whether cannabis use may have exacerbated their symptoms.

DISCLOSURES:

Funding for the study was provided by grants from the National Cancer Institute and the Oklahoma Tobacco Settlement Endowment Trust. Nine of the 10 authors have disclosed no relevant conflicts of interest. One author has relationships with various pharmaceutical companies involved in oncology.

A version of this article first appeared on Medscape.com.

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Necessary Updates to Skin Cancer Risk Stratification

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Necessary Updates to Skin Cancer Risk Stratification
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Willis 'Hugh' Lyford, MD, FAAD

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References

1. Powers JG, Patel NA, Powers EA, Mayer JE, Stricklin GP, Geller AC. Skin cancer
risk factors and preventative behaviors among United States military veterans deployed to Iraq and Afghanistan. J Invest Dermatol. 2015;135:2871-2873.
2. Balci S, Ayaz L, Gorur A, Yildirim Yaroglu H, Akbayir S, Dogruer Unal N, Bulut B,
Tursen U, Tamer L. microRNA profiling for early detection of nonmelanoma skin cancer. Clin Exp Dermatol. 2016;41(4):346-51. doi:10.1111/ced.12736
3. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708
4. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.
5. Chou SE, Gaysynsky A, Trivedi N, Vanderpool R. Using social media for health: national data from HINTS 2019. Journ of Health Comm. 2019;26(3):184-193. doi:10.1080/10810730.2021.1903627
6. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-82.
7. Dennis LK, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Annals of Epidem. 2008;18(8):614-627. doi:10.1016/j.annepidem.2008.04.006
8. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev. 2014;23(6):1080-1089.
9. 2020 Demographics Profile of the military community. US Department of Defense. 2020:iv. Accessed November 15, 2022. 2020 Demographics Profile of the Military Community (militaryonesource.mil)
10. Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7:1-6.
11. Basch CH, Hillyer GC. Skin cancer on Instagram: implications for adolescents and young adults. Int J Adolesc Med Health. 2022;34(3). doi:10.1515/ijamh-2019-0218

Author and Disclosure Information

Willis ‘Hugh’ Lyford, MD, FAAD
Staff Dermatologist, Naval Medical Center
Assistant Professor of Dermatology,
Uniformed Services University of the Health Sciences
San Diego, CA

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Staff Dermatologist, Naval Medical Center
Assistant Professor of Dermatology,
Uniformed Services University of the Health Sciences
San Diego, CA

Author and Disclosure Information

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Staff Dermatologist, Naval Medical Center
Assistant Professor of Dermatology,
Uniformed Services University of the Health Sciences
San Diego, CA

Click here to view more from Cancer Data Trends 2023.

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References

1. Powers JG, Patel NA, Powers EA, Mayer JE, Stricklin GP, Geller AC. Skin cancer
risk factors and preventative behaviors among United States military veterans deployed to Iraq and Afghanistan. J Invest Dermatol. 2015;135:2871-2873.
2. Balci S, Ayaz L, Gorur A, Yildirim Yaroglu H, Akbayir S, Dogruer Unal N, Bulut B,
Tursen U, Tamer L. microRNA profiling for early detection of nonmelanoma skin cancer. Clin Exp Dermatol. 2016;41(4):346-51. doi:10.1111/ced.12736
3. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708
4. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.
5. Chou SE, Gaysynsky A, Trivedi N, Vanderpool R. Using social media for health: national data from HINTS 2019. Journ of Health Comm. 2019;26(3):184-193. doi:10.1080/10810730.2021.1903627
6. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-82.
7. Dennis LK, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Annals of Epidem. 2008;18(8):614-627. doi:10.1016/j.annepidem.2008.04.006
8. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev. 2014;23(6):1080-1089.
9. 2020 Demographics Profile of the military community. US Department of Defense. 2020:iv. Accessed November 15, 2022. 2020 Demographics Profile of the Military Community (militaryonesource.mil)
10. Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7:1-6.
11. Basch CH, Hillyer GC. Skin cancer on Instagram: implications for adolescents and young adults. Int J Adolesc Med Health. 2022;34(3). doi:10.1515/ijamh-2019-0218

References

1. Powers JG, Patel NA, Powers EA, Mayer JE, Stricklin GP, Geller AC. Skin cancer
risk factors and preventative behaviors among United States military veterans deployed to Iraq and Afghanistan. J Invest Dermatol. 2015;135:2871-2873.
2. Balci S, Ayaz L, Gorur A, Yildirim Yaroglu H, Akbayir S, Dogruer Unal N, Bulut B,
Tursen U, Tamer L. microRNA profiling for early detection of nonmelanoma skin cancer. Clin Exp Dermatol. 2016;41(4):346-51. doi:10.1111/ced.12736
3. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72(1):7-33. doi:10.3322/caac.21708
4. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748-62.
5. Chou SE, Gaysynsky A, Trivedi N, Vanderpool R. Using social media for health: national data from HINTS 2019. Journ of Health Comm. 2019;26(3):184-193. doi:10.1080/10810730.2021.1903627
6. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279-82.
7. Dennis LK, et al. Sunburns and risk of cutaneous melanoma: does age matter? A comprehensive meta-analysis. Annals of Epidem. 2008;18(8):614-627. doi:10.1016/j.annepidem.2008.04.006
8. Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev. 2014;23(6):1080-1089.
9. 2020 Demographics Profile of the military community. US Department of Defense. 2020:iv. Accessed November 15, 2022. 2020 Demographics Profile of the Military Community (militaryonesource.mil)
10. Apalla Z, Lallas A, Sotiriou E, Lazaridou E, Ioannides D. Epidemiological trends in skin cancer. Dermatol Pract Concept. 2017;7:1-6.
11. Basch CH, Hillyer GC. Skin cancer on Instagram: implications for adolescents and young adults. Int J Adolesc Med Health. 2022;34(3). doi:10.1515/ijamh-2019-0218

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It is becoming increasingly evident that members of the US military and veterans have higher risk factors for melanoma and nonmelanoma skin cancers due to occupational sun exposure. They may not have access to protection (ie, topical sunscreens, wide-brimmed hats, or ultraviolet-repellent clothing) and may lack awareness of the risks associated with certain military occupations that require prolonged sun exposure. Soldiers have reported low sunscreen usage, and few veterans recall the US military providing education on skin cancer risks during their service.1 

When detected and treated early, common forms of nonmelanoma skin cancer can have a survival rate higher than 95%.2 In some basal and squamous cell carcinoma cases, the cancer can be completely removed with the initial biopsy procedure alone. Skin cancer can affect anyone, regardless of skin color or ethnic background. The skin cancer diagnosis rate among non-Hispanic White individuals is roughly 30 times higher than that of people who are Hispanic, Black, Asian, or Pacific Islander.3 Unfortunately, skin cancer in patients with darker skin tones is usually diagnosed in a later stage, when it is more difficult to treat and outcomes are worse.3,4 Thus, people with darker skin tones are less likely than people with lighter skin tones to survive melanoma.3 

Two potentially underused resources that could assist with timelier awareness, diagnosis, and treatment of skin cancer for veterans and active-duty personnel include the use of artificial intelligence (AI) technology and social media platforms. 

Technology-enhanced detection of skin cancer through AI can assist dermatologists in clinical diagnosis and treatment of skin cancer, and also promote greater access to high-quality skin assessments for patients.3 Dermatologists can help provide access to a repository of diverse sets of data and images that are necessary for building these AI models; therefore, dermatologists can play a valuable role in the development and deployment of AI capabilities that can be applied to skin cancer diagnosis.

The use of social media to spread awareness of skin cancer risks and prevention is critical, especially among active-duty military members who are occupationally exposed to the sun. In 2019, the Health Information National Trends Survey (HINTS) showed that approximately 86% of internet users reported participating in at least 1 social media activity.5 Given the increasing use and influence of social media and its effects on human behavior, this resource can be used as a powerful tool to promote awareness and education and encourage sun protection and regular dermatological screenings, by targeting groups that identify as either active-duty military members or veterans for campaigns to raise awareness.

Veterans and active-duty military members alike need to be informed about skin cancer risks and prevention methods like self-skin evaluations. Using a combination of AI and social media, we can better educate and diagnose our active-duty and veteran patients now and in the future.
 

The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

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Gender Disparity in Breast Cancer Among US Veterans

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Gender Disparity in Breast Cancer Among US Veterans
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Anita Aggarwal, DO, PhD

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References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d                                                                              10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

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Chief, Hematology-Oncology Section, DC VA Medical Center
Professor of Medicine, George Washington University
Adjunct Professor, USUHS
Adjunct Clinical Professor of Medicine, Georgetown University
Washington, DC

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Professor of Medicine, George Washington University
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Washington, DC

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Anita Aggarwal, DO, PhD
Chief, Hematology-Oncology Section, DC VA Medical Center
Professor of Medicine, George Washington University
Adjunct Professor, USUHS
Adjunct Clinical Professor of Medicine, Georgetown University
Washington, DC

Click here to view more from Cancer Data Trends 2023.

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References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d                                                                              10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

References

1. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN. Breast carcinoma in men: a population-based study. Cancer. 2004;101(1):51-57. doi:10.1002/cncr.20312
2. Key statistics for breast cancer in men. American Cancer Society. Updated January 12, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/about/key-statistics.html
3. Aggarwal A, Adepoju B, Yacur M, Maron D, Sharma MH. Gender disparity in breast cancer: a veteran population-based comparison. Clin Breast Cancer. 2021;21(4):e471-e478. doi:10.1016/j.clbc.2021.01.013
4. Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998;34(9):1341-1347. doi:10.1016/s0959-8049(98)00028-8
5. Giordano SH. A review of diagnosis and management of male breast cancer. Oncologist. 2005;10(7):471-479. doi:10.1634/theoncologist.10-7-471
6. Midding E, Halbach SM, Kowalski C, Weber R, Würstlein R, Ernstmann N. Men with a “woman's disease”: stigmatization of male breast cancer patients—a mixed methods analysis. Am J Mens Health. 2018;12(6):2194-2207. doi:10.1177/1557988318799025
7. Key statistics for breast cancer. American Cancer Society. Updated October 6, 2022. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer/about/how-common-is-breast-cancer.html
8. Male breast cancer incidence and mortality, United States—2013-2017. Centers for Disease Control and Prevention. Updated October 1, 2020. Accessed December 14, 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no19-male-breast-cancer-incidence-mortality-UnitedStates-2013-2017.htm
9. Anderson WF, Althuis MD, Brinton LA, Devesa SS. Is male breast cancer similar or different than female breast cancer? Breast Cancer Res Treat. 2004;83(1):77-86. doi:10.1023/B:BREA.0000010701.08825.2d                                                                              10. Pritzlaff M, Summerour P, McFarland R, et al. Male breast cancer in a multi-gene panel testing cohort: insights and unexpected results. Breast Cancer Res Treat. 2017;161(3):575-586. doi:10.1007/s10549-016-4085-4
11. Ottini L, Capalbo C, Rizzolo P, et al. HER2-positive male breast cancer: an update. Breast Cancer (Dove Med Press). 2010;2:45-58. doi:10.2147/BCTT.S6519
12. Risk factors for breast cancer in men. American Cancer Society. Updated April 27, 2018. Accessed December 14, 2022. https://www.cancer.org/cancer/breast-cancer-in-men/causes-risks-prevention/risk-factors.html
13. Palli D, Masala G, Mariani-Constantini R, et al. A gene–environment interaction between occupation and BRCA1/BRCA2 mutations in male breast cancer? Eur J Cancer. 2004;40(16):2472-2479. doi:10.1016/j.ejca.2004.07.012
14. Hansen J. Elevated risk for male breast cancer after occupational exposure to gasoline and vehicular combustion products. Am J Ind Med. 2000;37(4):349-352. doi:10.1002/(sici)1097-0274(200004)37:4<349::aid-ajim4>3.0.co;2-l
15. Sung H, DeSantis C, Jemal A. Subtype-specific breast cancer incidence rates in Black versus White men in the United States. JNCI Cancer Spectr. 2020;4(1):pkz091. doi:10.1093/jncics/pkz091
16. Breast cancer, male: statistics. Cancer.net. January 2022. Accessed December 14, 2022. https://www.cancer.net/cancer-types/breast-cancer-male/statistics

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While breast cancer is the number one diagnosed cancer in women, it is one of the rarest forms of cancer in men (accounting for 1% of all breast cancers diagnosed); however, the incidence of breast cancer in men is increasing.1,2 Risk of breast cancer in males persists for at least 20 years after the diagnosis and depends on clinical features of the cancer. Currently, screening recommendations for men are lacking and there is a need for more awareness of the disease in men. Breast cancer develops in male veterans more often from toxic exposures during their deployment, such as Agent Orange and burn pits.3 

Male and female breast cancer characteristics share some similarities but differ notably. Symptoms of male breast cancer dif fer from those seen in females. Males with breast cancer typically present with gynecomastia, mass under the nipple, or pain in the breast, whereas breast cancer in females is usually diagnosed by either a screening mammogram or self-palpated breast mass. Although infiltrating ductal carcinoma is the most common tumor type in both male and female patients, male breast cancer has clinicopathologic differences. Male breast cancer is positive for hormone receptors (estrogen receptor-positive [ER+]/progesterone receptor-positive [PR+], human epidermal growth factor receptor 2 [HER2]-negative) in 84% of cases compared to 50% to 60% of female breast cancer cases. Males are usually older at the time of diagnosis and present with a higher stage of breast cancer; therefore, their survival rate is lower than that of females.3-5 Men are diagnosed with later-stage disease most likely because of the lack of screening mammograms.3 

Treatment remains the same in males and females, stage by stage. Because of the small amount of breast tissue, males need mastectomy as their surgical treatment, whereas females can have a lumpectomy or mastectomy. Most males with breast cancer refuse to take tamoxifen because of the side effect of hot flashes, and because male breast cancer patients can feel stigmatized.6 Aromatase inhibitors have not been studied in males.

 There is most certainly a gender disparity in breast cancer awareness and a need for screening recommendations for males. A better understanding of the biology of male breast cancer is also needed to develop markers for earlier diagnosis and therapeutic intervention—which may help reduce mortality and increase overall survival rates of males presenting with breast cancer.3

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References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
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Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
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Veterans Health Administration
Durham, NC

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Michael Kelley, MD
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Veterans Health Administration
Durham, NC

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References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
References
  1. US Department of Veterans Affairs. National Precision Oncology Program (NPOP). June 10, 2019. Accessed December 8, 2022. https://www.cancer.va.gov/CANCER/NPOP.asp
  2. US Department of Veterans Affairs, Office of Research and Development. VA National Precision Oncology Program brings tailored cancer treatment to veterans. October 3, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/1019-VA-National-Precision-Oncology-Program-brings-tailored-cancer-treatment-to-Veterans.cfm
  3. Kelley M, Ahmed S. National Precision Oncology Program (NPOP): right treatment for the right patient at the right time. 2022. Unpublished data.
  4. Vashistha V et al. PLoS One. 2020;15(7):e0235861. doi:10.1371/journal.pone.0235861
  5. Dong OM et al. Value Health. 2022;25(4):582-594. doi:10.1016/j.jval.2021.09.017
  6. Sadik H et al. JCO Precis Oncol. 2022;6:e2200246. doi:10.1200/PO.22.00246
  7. Petrillo LA et al. J Pain Symptom Manage. 2021;62(3):e65-e74. doi:10.1016/j.jpainsymman.2021.02.010
  8. Waks AG, Winer EP. JAMA. 2019;321(3):288-300. doi:10.1001/jama.2018.19323
  9. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  10. Debela DT et al. SAGE Open Med. 2021;9:20503121211034366. doi:10.1177/20503121211034366
  11. Gambardella V et al. Cancers (Basel). 2020;12(4):1009. doi:10.3390/cancers12041009
  12. US Department of Veterans Affairs, Office of Research and Development. VA Lung Precision Oncology Program (LPOP). Updated January 27, 2022. Accessed January 23, 2023. https://www.research.va.gov/programs/pop/lpop.cfm
  13. Montgomery B et al. Fed Pract. 2020;37(suppl 4):S48-S53. doi:10.12788/fp.0021
  14. Kelley MJ. Fed Pract. 2020;37(suppl 4):S22-S27. doi:10.12788/fp.0037
  15. Poonnen PJ et al. JCO Precis Oncol. 2019;3:PO.19.00075. doi:10.1200/PO.19.00075
  16. Natera awarded national MRD testing contract by the U.S. Department of Veterans Affairs [press release]. Natera. November 2, 2022. Accessed January 23, 2023. https://www.natera.com/company/news/natera-awarded-national-mrd-testing-contract-by-the-u-s-department-of-veterans-affairs/ 
  17. Katsoulakis E et al. JCO Precis Oncol. 2020;4:PO.19.00118. doi:10.1200/PO.19.00118
  18. Skoulidis F et al. N Engl J Med. 2021;384(25):2371-2381. doi:10.1056/NEJMoa2103695
  19. To KKW et al. Front Oncol. 2021;11:635007. doi:10.3389/fonc.2021.635007
  20. Price MJ et al. JCO Precis Oncol. 2022;6(1):e2100461. doi:10.1200/PO.21.00461
  21. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  22. Stivala S, Meyer SC. Cancers (Basel). 2021;13(20):5035. doi:10.3390/cancers13205035
  23. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
  24. OncoKB™ - MSK's precision oncology knowledge base. OncoKB. Accessed December 22, 2022. https://www.oncokb.org/actionableGenes
  25. National Library of Medicine, National Center for Biotechnology Information. PubChem compound database. Accessed December 22, 2022. https://pubchem.ncbi.nlm.nih.gov/
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Cancer treatment in the VA has been advancing for years, moving toward the use of targeted therapies and immunotherapies guided by comprehensive genomic profiling.1 Initiatives like NPOP, established in 2016, have contributed to these efforts, with more than 52,000 samples tested and 35,000 veterans having care guided by these molecular tests as of February 2023.2,3 NPOP has been generally well received by VA oncologists eager to provide personalized, cutting-edge cancer care for veterans.4 However, several challenges still need to be overcome to ensure the full adoption of precision medicine at the VA, no different from challenges faced in the private sector.5 For example, in advanced lung cancer, many patients may not have access to personalized treatment due to various clinical practice gaps that prevent the full integration of this technology into clinical care.6

In assessing cancer treatment innovation, it is important to consider the changes in treatment approaches based on a molecular understanding of individual patient tumors.5 The treatment process for many late-stage cancers now starts with, or at least includes, NGS to see if immunotherapies or other targeted therapies can be used in place of past methods such as chemotherapy.5 In lung cancer, for example, chemotherapy is still used, combined with immunotherapy or later in the process, but often after other treatments are ruled out.5 This innovation in the cancer treatment process has led to longer survival and better quality of life for patients with lung cancer and other advanced-stage cancers.5,7 NGS is used for many cancers, including lung, prostate, colorectal, hematologic, breast, brain, pancreatic, and bladder.3,8,9 Genetic sequencing and targeted therapies are changing the cancer treatment field dramatically, in both the general and veteran populations with programs like NPOP, the Lung Precision Oncology Program (LPOP), and Precision Oncology Program for Cancers of the Prostate/Genitourinary cancers (POPCaP/GU) making this possible.1,10-13

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References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
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References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
References
  1. Ng K et al. JAMA. 2021;325(19):1943-1945. doi:10.1001/jama.2021.4133
  2. Xie YH et al. Signal Transduct Target Ther. 2020;5(1):22. doi:10.1038/s41392-020-0116-z
  3. Muller C et al. Cells. 2021;10(5):1018. doi:10.3390/cells10051018
  4. Clebak KT et al. Am Fam Physician. 2022;105(2):198-200.
  5. May FP et al. Dig Dis Sci. 2017;62(8):1923-1932. doi:10.1007/s10620-017-4607-x
  6. May FP et al. Med Care. 2019;57(10):773-780. doi:10.1097/MLR.0000000000001186
  7. US Department of Veterans Affairs, National Oncology Program Office. National Precision Oncology Program (NPOP). Updated June 24, 2022. Accessed December 14, 2022. http://www.cancer.va.gov/CANCER/NPOP.asp
  8. André T et al; KEYNOTE-177 Investigators. N Engl J Med. 2020;383(23):2207-2218. doi:10.1056/NEJMoa2017699
  9. Naidoo M et al. Cancers (Basel). 2021;13(2):346. doi:10.3390/cancers13020346
  10. Kasi PM et al. BMJ Open. 2021;11(9):e047831. doi:10.1136/bmjopen-2020-047831
  11. Jin S et al. Proc Natl Acad Sci U S A. 2021;118(5):e2017421118. doi:10.1073/pnas.2017421118
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The screening and treatment landscape for colon cancer is changing rapidly.1,2 The recommended age for screening has been lowered to 45 from 50 years due to the increased incidence of colon cancer in younger people, especially among African American individuals.1,3 New screening recommendations also incorporate fecal immunochemical tests (FIT) and multitarget stool DNA tests, where abnormal results on stool-based screening should lead to timely colonoscopy.1,4 For veterans, colon cancer screening rates tend to vary based on VA health coverage, race, income, and mental health status but are higher than for the general public.5,6


The field of colon cancer treatment, along with the rest of oncology, is moving toward molecularly targeted therapies and immunotherapy. In the VA, NPOP provides tumor NGS that predicts response to molecularly targeted therapies.7 In addition, NGS can identify microsatellite instability (MSI)-high colon cancer. In MSI-high colon cancer, immunotherapy alone provides better PFS than older traditional chemotherapeutic regimens.8 Gene alterations of interest in colon cancer include NRAS, KRAS, BRAF, and HER2, which, along with MSI status and PD-L1 expression levels, guide the choice of therapy offered.2,8 The use of liquid biopsy panels that assess the quantity of circulating tumor DNA (ctDNA) is also being studied in veterans.9,10 Liquid biopsies can be used to assess treatment response, if minimal residual disease is present after surgical resection or if new mutations develop during treatment.9 All in all, screening guidelines are adapting as new data and tests become available, while the field of colon cancer treatment is evolving based on increased access to NGS and appropriate use of molecularly targeted therapy and immunotherapy.

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Cancer Data Trends 2023

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Federal Practitioner and the Association of VA Hematology/Oncology (AVAHO) present the 2023 edition of Cancer Data Trends (click to view the digital edition). This special issue provides updates on some of the top cancers and related concerns affecting veterans through original infographics and visual storytelling.

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Federal Practitioner and the Association of VA Hematology/Oncology (AVAHO) present the 2023 edition of Cancer Data Trends (click to view the digital edition). This special issue provides updates on some of the top cancers and related concerns affecting veterans through original infographics and visual storytelling.

In this issue:

Federal Practitioner and the Association of VA Hematology/Oncology (AVAHO) present the 2023 edition of Cancer Data Trends (click to view the digital edition). This special issue provides updates on some of the top cancers and related concerns affecting veterans through original infographics and visual storytelling.

In this issue:

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Promising New Approaches for Testicular and Prostate Cancer

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References
  1. Risk factors for testicular cancer. American Cancer Society. Updated May 17, 2018. Accessed December 15, 2022. https://www.cancer.org/cancer/testicular-cancer/causes-risks-prevention/risk-factors.html
  2. Chovanec M, Cheng L. BMJ. 2022;379:e070499. doi:10.1136/bmj-2022-070499
  3. Tavares NT et al. J Pathol. 2022. doi:10.1002/path.6037
  4. Bryant AK et al. JAMA Oncol. 2022;e224319. doi:10.1001/jamaoncol.2022.4319
  5. Kabasakal L et al. Nucl Med Commun. 2017;38(2):149-155. doi:10.1097/MNM.0000000000000617
  6. Sartor O et al; VISION Investigators. N Engl J Med. 2021;385(12):1091-1103. doi:10.1056/NEJMoa2107322
  7. Rowe SP et al. Annu Rev Med. 2019;70:461-477. doi:10.1146/annurev-med-062117-073027
  8. Pomykala KL et al. Eur Urol Oncol. 2022;S2588-9311(22)00177-8. doi:10.1016/j.euo.2022.10.007
  9. Keam SJ. Mol Diagn Ther. 2022;26(4):467-475. doi:10.1007/s40291-022-00594-2
  10. Lovejoy LA et al. Mil Med. 2022:usac297. doi:10.1093/milmed/usac297
  11. Smith ZL et al. Med Clin North Am. 2018;102(2):251-264. doi:10.1016/j.mcna.2017.10.003
  12. Hohnloser JH et al. Eur J Med Res.1996;1(11):509-514.
  13. Johns Hopkins Medicine website. Testicular Cancer tumor Markers. Accessed December 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/testicular-cancer-tumor-markers
  14. Webber BJ et al. J Occup Environ Med. 2022;64(1):71-78. doi:10.1097/JOM.0000000000002353
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University of Washington
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References
  1. Risk factors for testicular cancer. American Cancer Society. Updated May 17, 2018. Accessed December 15, 2022. https://www.cancer.org/cancer/testicular-cancer/causes-risks-prevention/risk-factors.html
  2. Chovanec M, Cheng L. BMJ. 2022;379:e070499. doi:10.1136/bmj-2022-070499
  3. Tavares NT et al. J Pathol. 2022. doi:10.1002/path.6037
  4. Bryant AK et al. JAMA Oncol. 2022;e224319. doi:10.1001/jamaoncol.2022.4319
  5. Kabasakal L et al. Nucl Med Commun. 2017;38(2):149-155. doi:10.1097/MNM.0000000000000617
  6. Sartor O et al; VISION Investigators. N Engl J Med. 2021;385(12):1091-1103. doi:10.1056/NEJMoa2107322
  7. Rowe SP et al. Annu Rev Med. 2019;70:461-477. doi:10.1146/annurev-med-062117-073027
  8. Pomykala KL et al. Eur Urol Oncol. 2022;S2588-9311(22)00177-8. doi:10.1016/j.euo.2022.10.007
  9. Keam SJ. Mol Diagn Ther. 2022;26(4):467-475. doi:10.1007/s40291-022-00594-2
  10. Lovejoy LA et al. Mil Med. 2022:usac297. doi:10.1093/milmed/usac297
  11. Smith ZL et al. Med Clin North Am. 2018;102(2):251-264. doi:10.1016/j.mcna.2017.10.003
  12. Hohnloser JH et al. Eur J Med Res.1996;1(11):509-514.
  13. Johns Hopkins Medicine website. Testicular Cancer tumor Markers. Accessed December 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/testicular-cancer-tumor-markers
  14. Webber BJ et al. J Occup Environ Med. 2022;64(1):71-78. doi:10.1097/JOM.0000000000002353
References
  1. Risk factors for testicular cancer. American Cancer Society. Updated May 17, 2018. Accessed December 15, 2022. https://www.cancer.org/cancer/testicular-cancer/causes-risks-prevention/risk-factors.html
  2. Chovanec M, Cheng L. BMJ. 2022;379:e070499. doi:10.1136/bmj-2022-070499
  3. Tavares NT et al. J Pathol. 2022. doi:10.1002/path.6037
  4. Bryant AK et al. JAMA Oncol. 2022;e224319. doi:10.1001/jamaoncol.2022.4319
  5. Kabasakal L et al. Nucl Med Commun. 2017;38(2):149-155. doi:10.1097/MNM.0000000000000617
  6. Sartor O et al; VISION Investigators. N Engl J Med. 2021;385(12):1091-1103. doi:10.1056/NEJMoa2107322
  7. Rowe SP et al. Annu Rev Med. 2019;70:461-477. doi:10.1146/annurev-med-062117-073027
  8. Pomykala KL et al. Eur Urol Oncol. 2022;S2588-9311(22)00177-8. doi:10.1016/j.euo.2022.10.007
  9. Keam SJ. Mol Diagn Ther. 2022;26(4):467-475. doi:10.1007/s40291-022-00594-2
  10. Lovejoy LA et al. Mil Med. 2022:usac297. doi:10.1093/milmed/usac297
  11. Smith ZL et al. Med Clin North Am. 2018;102(2):251-264. doi:10.1016/j.mcna.2017.10.003
  12. Hohnloser JH et al. Eur J Med Res.1996;1(11):509-514.
  13. Johns Hopkins Medicine website. Testicular Cancer tumor Markers. Accessed December 2022. https://www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/testicular-cancer-tumor-markers
  14. Webber BJ et al. J Occup Environ Med. 2022;64(1):71-78. doi:10.1097/JOM.0000000000002353
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Although testicular cancer is rare, it is most common in boys and men between 15 and 34 years of age—the age range of many active-duty military members. Risk factors include a personal history of an undescended testicle or prior testicular cancer, a family history of testicular cancer, HIV infection, having Klinefelter disease, age, and race.1

Treatment for testicular cancer can involve surgery, radiation, or chemotherapy. For patients with metastatic testicular cancer, the development of cisplatin-based chemotherapy has made this one of the most curable malignancies of any type.2,3 Advances in the treatment of men with testicular cancer continue to be made. A recently described serum biomarker,  miR-371a-3p, is more sensitive for detecting the presence of subclinical disease than those currently used and is poised to be in clinical use shortly.3 New approaches to treatment, including high-dose therapy and drugs targeting the epigenetic regulation of testicular cancer, continue to be explored. Prostate cancer, on the other hand, is the second most common cancer in men worldwide.4 The use of prostate-specific antigen (PSA) screening for the detection of prostate cancer has been controversial in the United States for years. Because the US Preventive Services Task Force recommended against PSA screening, PSA screening rates decreased in the VHA and across the United States from 2005 to 2019.

A recent study was conducted within the VHA to determine whether the lower PSA screening rates had an impact on the occurrence of metastatic prostate cancer in VHA patients. The results showed that facilities with higher PSA screening rates had lower rates of metastatic prostate cancer; conversely, higher long-term nonscreening rates were associated with higher metastatic prostate cancer diagnosis rates for patients within the VHA system.4

These results strongly suggest that PSA screening does aid in the early detection and reduction of the development of prostate cancer. New imaging and treatments for prostate cancer are also available and have shown promise for patients. Prostate-specific membrane antigen (PSMA) imaging can effectively detect prostate cancer that has spread at earlier time points and help with informed decision-making for treatment. Where available, PSMA positron emission tomography/computed tomography (PET/CT) is preferred over other forms of noninvasive diagnostic imaging for staging before local therapy and for detection of sites of recurrence after local therapy because of its greater sensitivity at low PSA levels.5
Lutetium Lu 177 vipivotide tetraxetan (Pluvicto), the newest FDA-approved drug for treating prostate cancer, is an IV radioligand therapy that delivers β-particle radiation to PSMA-expressing cells.6 It can target prostate cancer cells without affecting most normal tissues in patients with the use of imaging to confirm radionuclide binding.7 The use of Lutetium in men with advanced prostate cancer improved survival compared with the standard of care.6,7 Strategies for early detection of these 2 cancers affecting veterans should include testicular self-examination for the presence of any masses and the use of the PSA test should be considered for the early detection of prostate cancer in the appropriate patient.

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Lung Cancer Screening in Veterans

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Apar Kishor Ganti, MD, MS

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References
  1. Spalluto LB et al. J Am Coll Radiol. 2021;18(6):809-819. doi:10.1016/j.jacr.2020.12.010
  2. Lewis JA et al. JNCI Cancer Spectr. 2020;4(5):pkaa053. doi:10.1093/jncics/pkaa053
  3. Wallace C. Largest-ever lung cancer screening study reveals ways to increase screening outreach. Medical University of South Carolina. November 22, 2022. Accessed January 4, 202 https://hollingscancercenter.musc.edu/news/archive/2022/11/22/largest-ever-lung-cancer-screening-study-reveals-ways-to-increase-screening-outreach
  4. Screening facts & figures. Go2 For Lung Cancer. 2022. Accessed January 4, 2023. https://go2.org/risk-early-detection/screening-facts-figures/
  5. Dyer O. BMJ. 2021;372:n698. doi:10.1136/bmj.n698
  6. Boudreau JH et al. Chest. 2021;160(1):358-367. doi:10.1016/j.chest.2021.02.016
  7. Maurice NM, Tanner NT. Semin Oncol. 2022;S0093-7754(22)00041-0. doi:10.1053/j.seminoncol.2022.06.001
  8. Rusher TN et al. Fed Pract. 2022;39(suppl 2):S48-S51. doi:10.12788/fp.0269
  9. Núñez ER et al. JAMA Netw Open. 2021;4(7):e2116233. doi:10.1001/jamanetworkopen.2021.16233
  10. Lake M et al. BMC Cancer. 2020;20(1):561. doi:1186/s12885-020-06923-0
Author and Disclosure Information

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Doctor and Mrs. D. Leon UNMC Research
Fund Chair in Internal Medicine
Staff Physician, VA Nebraska-Western Iowa Health Care System
Professor of Medicine, Division of Oncology-Hematology
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Associate Director of Clinical Research, Fred & Pamela Buffett Cancer Center
University of Nebraska Medical Center
Omaha, NE

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Associate Director of Clinical Research, Fred & Pamela Buffett Cancer Center
University of Nebraska Medical Center
Omaha, NE

Click to view more from Cancer Data Trends 2023.

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References
  1. Spalluto LB et al. J Am Coll Radiol. 2021;18(6):809-819. doi:10.1016/j.jacr.2020.12.010
  2. Lewis JA et al. JNCI Cancer Spectr. 2020;4(5):pkaa053. doi:10.1093/jncics/pkaa053
  3. Wallace C. Largest-ever lung cancer screening study reveals ways to increase screening outreach. Medical University of South Carolina. November 22, 2022. Accessed January 4, 202 https://hollingscancercenter.musc.edu/news/archive/2022/11/22/largest-ever-lung-cancer-screening-study-reveals-ways-to-increase-screening-outreach
  4. Screening facts & figures. Go2 For Lung Cancer. 2022. Accessed January 4, 2023. https://go2.org/risk-early-detection/screening-facts-figures/
  5. Dyer O. BMJ. 2021;372:n698. doi:10.1136/bmj.n698
  6. Boudreau JH et al. Chest. 2021;160(1):358-367. doi:10.1016/j.chest.2021.02.016
  7. Maurice NM, Tanner NT. Semin Oncol. 2022;S0093-7754(22)00041-0. doi:10.1053/j.seminoncol.2022.06.001
  8. Rusher TN et al. Fed Pract. 2022;39(suppl 2):S48-S51. doi:10.12788/fp.0269
  9. Núñez ER et al. JAMA Netw Open. 2021;4(7):e2116233. doi:10.1001/jamanetworkopen.2021.16233
  10. Lake M et al. BMC Cancer. 2020;20(1):561. doi:1186/s12885-020-06923-0
References
  1. Spalluto LB et al. J Am Coll Radiol. 2021;18(6):809-819. doi:10.1016/j.jacr.2020.12.010
  2. Lewis JA et al. JNCI Cancer Spectr. 2020;4(5):pkaa053. doi:10.1093/jncics/pkaa053
  3. Wallace C. Largest-ever lung cancer screening study reveals ways to increase screening outreach. Medical University of South Carolina. November 22, 2022. Accessed January 4, 202 https://hollingscancercenter.musc.edu/news/archive/2022/11/22/largest-ever-lung-cancer-screening-study-reveals-ways-to-increase-screening-outreach
  4. Screening facts & figures. Go2 For Lung Cancer. 2022. Accessed January 4, 2023. https://go2.org/risk-early-detection/screening-facts-figures/
  5. Dyer O. BMJ. 2021;372:n698. doi:10.1136/bmj.n698
  6. Boudreau JH et al. Chest. 2021;160(1):358-367. doi:10.1016/j.chest.2021.02.016
  7. Maurice NM, Tanner NT. Semin Oncol. 2022;S0093-7754(22)00041-0. doi:10.1053/j.seminoncol.2022.06.001
  8. Rusher TN et al. Fed Pract. 2022;39(suppl 2):S48-S51. doi:10.12788/fp.0269
  9. Núñez ER et al. JAMA Netw Open. 2021;4(7):e2116233. doi:10.1001/jamanetworkopen.2021.16233
  10. Lake M et al. BMC Cancer. 2020;20(1):561. doi:1186/s12885-020-06923-0
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In the United States and among veterans, lung cancer has the highest rate of cancer-related mortality. Earlier detection and increased screening of high-risk individuals can improve the overall survival rate.1  With the broadening of the USPSTF lung cancer screening guidelines, in 2020 an estimated 15 million people in the United States—including at least 900,000 veterans—were eligible for lung cancer screening by CT.2,3 However, only 5% of those eligible were screened.4,5 One reason for this vast discrepancy is uneven access. Estimates in 2021 were that <20% of eligible veterans have undergone lung cancer screening because of problems accessing it in rural areas.6

Implementing the expanded USPSTF guidelines is key to maximizing screening among underserved populations, such as those in rural areas who may lack access to nearby health care, as well as racial and ethnic minorities.1  A study of one VAMCs standardization of screening practices found that radiologists were more likely to adapt to these changes than primary care clinicians, suggesting a need to better understand differences in health care professional practices and priorities to universally improve screening rates across the VA.1 

An important question will always be how many high-risk veterans are being screened for lung cancer?1  To ensure proper care, it is important to understand the characteristics of clinicians who provide screening based on setting and clinical areas of expertise. Where are they, who are they, and how do our most vulnerable populations gain access? Access is critical, particularly among clinicians who typically provide screening to those underserved populations.

Although lung cancer screening rates have increased over the years, overall, utilization remains low, even though data show a 20% reduction in lung cancer mortality with adherence to yearly CT screening.7  Looking at these rates helps us understand the need to intervene to increase lung cancer screening rates.8  Guidelines have been an essential component when it comes to outcomes related to screenings. Through programs implemented by the VHA, the goal is to improve the uptake and quality of lung cancer screening and optimize the practice and access for all veterans.9 For clinicians, future work should evaluate lung cancer screening programs with high vs low rates of adherence to identify and publicize best practices for timely, appropriate follow-up.9  Although adherence rates remain low regardless of race, further research, particularly among Black veterans, is encouraged to address delayed follow-up and to create culturally competent and inclusive lung cancer screening programs.10

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The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

  • More than $58 million has been awarded in research grants.
  • More than 1,000 scientists have been awarded grants.
  • Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

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The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

  • More than $58 million has been awarded in research grants.
  • More than 1,000 scientists have been awarded grants.
  • Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

The AGA Research Foundation plays an important role in medical research by providing grants to young scientists at a critical time in their careers. AGA’s flagship award is the Research Scholar Award (RSA), which provides career development support for young investigators in gastroenterology and hepatology research.

The AGA Research Awards program has a significant impact on digestive disease research.

  • More than $58 million has been awarded in research grants.
  • More than 1,000 scientists have been awarded grants.
  • Over the first 30 years of the Research Scholar Awards program, 57% of RSA recipients subsequently received at least one NIH R01 award, with 5 years on average between the RSA and first R01. Collectively, this group of investigators has secured 280 distinct R01 or equivalent awards.

Funded by the generosity of donors, the AGA Research Foundation’s research award program ensures that we are building a community of researchers whose work serves the greater community and benefits patients.

“In order to produce truly innovative work at the forefront of current discoveries, donations to research in GI are essential and cannot be replaced by other funding sources,” states Kathleen Curtius, PhD, MS, 2022 AGA Foundation Research Scholar Award recipient.

Join others in supporting the AGA Research Foundation. You will ensure that young researchers have opportunities to continue their lifesaving work. Your tax-deductible contribution supports the Foundation’s research award program, including the RSA, which ensures that studies are funded, discoveries are made, and patients are treated.

To learn more or to make a contribution, visit www.foundation.gastro.org.

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Exposure-Related Cancers: A Look at the PACT Act

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References
  1. US Department of Veterans Affairs. PACT Act. Updated November 4, 2022. Accessed January 4, 2023. https://www.publichealth.va.gov/exposures/benefits/PACT_Act.asp
  2. The White House. FACT SHEET: President Biden signs the PACT Act and delivers on his promise to America’s veterans. August 10, 202 Accessed January 10, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/10/fact-sheet-president-biden-signs-the-pact-act-and-delivers-on-his-promise-to-americas-veterans/
  3. US House of Representatives. Honoring our promise to address Comprehensive Toxics Act of 2021. Title I – Expansion of health care eligibility for toxic exposed veterans. House report 117-249. February 22, 2022. Accessed January 19, 202 https://www.govinfo.gov/content/pkg/CRPT-117hrpt249/html/CRPT-117hrpt249-pt1.htm
  4. VA News. Cancer Moonshot week of action sees VA deploying new clinical pathways. Updated December 7, 2022. Accessed January 19, 2023. https://news.va.gov/111925/cancer-moonshot-clinical-pathways/
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References
  1. US Department of Veterans Affairs. PACT Act. Updated November 4, 2022. Accessed January 4, 2023. https://www.publichealth.va.gov/exposures/benefits/PACT_Act.asp
  2. The White House. FACT SHEET: President Biden signs the PACT Act and delivers on his promise to America’s veterans. August 10, 202 Accessed January 10, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/10/fact-sheet-president-biden-signs-the-pact-act-and-delivers-on-his-promise-to-americas-veterans/
  3. US House of Representatives. Honoring our promise to address Comprehensive Toxics Act of 2021. Title I – Expansion of health care eligibility for toxic exposed veterans. House report 117-249. February 22, 2022. Accessed January 19, 202 https://www.govinfo.gov/content/pkg/CRPT-117hrpt249/html/CRPT-117hrpt249-pt1.htm
  4. VA News. Cancer Moonshot week of action sees VA deploying new clinical pathways. Updated December 7, 2022. Accessed January 19, 2023. https://news.va.gov/111925/cancer-moonshot-clinical-pathways/
References
  1. US Department of Veterans Affairs. PACT Act. Updated November 4, 2022. Accessed January 4, 2023. https://www.publichealth.va.gov/exposures/benefits/PACT_Act.asp
  2. The White House. FACT SHEET: President Biden signs the PACT Act and delivers on his promise to America’s veterans. August 10, 202 Accessed January 10, 2023. https://www.whitehouse.gov/briefing-room/statements-releases/2022/08/10/fact-sheet-president-biden-signs-the-pact-act-and-delivers-on-his-promise-to-americas-veterans/
  3. US House of Representatives. Honoring our promise to address Comprehensive Toxics Act of 2021. Title I – Expansion of health care eligibility for toxic exposed veterans. House report 117-249. February 22, 2022. Accessed January 19, 202 https://www.govinfo.gov/content/pkg/CRPT-117hrpt249/html/CRPT-117hrpt249-pt1.htm
  4. VA News. Cancer Moonshot week of action sees VA deploying new clinical pathways. Updated December 7, 2022. Accessed January 19, 2023. https://news.va.gov/111925/cancer-moonshot-clinical-pathways/
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Exposure-Related Cancers: A Look at the PACT Act
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Exposure-Related Cancers: A Look at the PACT Act
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In August 2022, Congress passed the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, known as the PACT Act. This new law signified the most expansive extension of VA health care and benefits in more than 30 years for veterans who were exposed to burn pits and other toxic substances during their service.1,2 In addition to striving for better care, the PACT Act also requires the VA to conduct new studies to better understand health trends in post-9/11 veterans and those who served in the Gulf War, and directs the Secretary of Veterans Affairs to develop a 5-year strategic plan on toxic exposure–related research.2

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