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Innovation in Cancer Treatment

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Sara Ahmed, PhD, and Michael Kelley, MD

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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 Unpublished data.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/
Author and Disclosure Information

Sara Ahmed, PhD
Director of Precision Oncology, National Oncology Program
Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
Executive Director, National Oncology Program
Veterans Health Administration
Durham, NC

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Sara Ahmed, PhD, and Michael Kelley, MD
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Sara Ahmed, PhD
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Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
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Veterans Health Administration
Durham, NC

Author and Disclosure Information

Sara Ahmed, PhD
Director of Precision Oncology, National Oncology Program
Veterans Health Administration
St. Louis, MO

Michael Kelley, MD
Executive Director, National Oncology Program
Veterans Health Administration
Durham, NC

Click to view more from Cancer Data Trends 2023.

Click to view more from Cancer Data Trends 2023.

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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Screening Guideline Updates and New Treatments in Colon Cancer

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Screening Guideline Updates and New Treatments in Colon Cancer
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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
Author and Disclosure Information

David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

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Cancer
Author(s)
David H. Wang, MD, PhD
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David H. Wang, MD, PhD
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David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

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David H. Wang, MD, PhD
Associate Professor of Internal Medicine
UT Southwestern Medical Center
VA North Texas Health Care System
Dallas, TX

Click to view more from Cancer Data Trends 2023.

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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.

In this issue:

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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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Bruce Montgomery, MD

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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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Bruce Montgomery, MD
Medicine and Oncology,
University of Washington
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Seattle, WA

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Prostate Cancer
Genitourinary Cancer
Cancer
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Bruce Montgomery, MD
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Bruce Montgomery, MD
Medicine and Oncology,
University of Washington
Fred Hutchinson Cancer Center
VA Puget Sound HCS
Seattle, WA

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Bruce Montgomery, MD
Medicine and Oncology,
University of Washington
Fred Hutchinson Cancer Center
VA Puget Sound HCS
Seattle, WA

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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
Publications
Federal Practitioner
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Federal Practitioner
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Prostate Cancer
Genitourinary Cancer
Cancer
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Promising New Approaches for Testicular and Prostate Cancer
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Promising New Approaches for Testicular and Prostate Cancer
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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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Lung Cancer Screening in Veterans
Author(s)
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

Apar Kishor Ganti, MD, MS
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
Professor (Courtesy) of Biochemistry and Molecular Biology
Associate Director of Clinical Research, Fred & Pamela Buffett Cancer Center
University of Nebraska Medical Center
Omaha, NE

Publications
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AVAHO
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Cancer
Lung Cancer
Author(s)
Apar Kishor Ganti, MD, MS
Author(s)
Apar Kishor Ganti, MD, MS
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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
Professor (Courtesy) of Biochemistry and Molecular Biology
Associate Director of Clinical Research, Fred & Pamela Buffett Cancer Center
University of Nebraska Medical Center
Omaha, NE

Author and Disclosure Information

Apar Kishor Ganti, MD, MS
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
Professor (Courtesy) of Biochemistry and Molecular Biology
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
Publications
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AVAHO
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AVAHO
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Lung Cancer
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Lung Cancer Screening in Veterans
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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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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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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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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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New Classifications and Emerging Treatments in Brain Cancer

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New Classifications and Emerging Treatments in Brain Cancer
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Margaret O. Johnson, MD, MPH

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References
  1. Sokolov AV et al. Pharmacol Rev. 2021;73(4):1-32. doi:10.1124/pharmrev.121.000317
  2. Louis DN et al. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093/neuonc/noab106
  3. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  4. Woo C et al. JCO Clin Cancer Inform. 2021;5:985-994. doi:10.1200/CCI.21.00052
  5. Study of vorasidenib (AG-881) in participants with residual or recurrent grade 2 glioma with an IDH1 or IDH2 mutation (INDIGO). ClinicalTrials.gov. Updated May 17, 2022. Accessed December 8, 2022. https://clinicaltrials.gov/ct2/show/NCT04164901
  6. Servier's pivotal phase 3 indigo trial investigating vorasidenib in IDH-mutant low-grade glioma meets primary endpoint of progression-free survival (PFS) and key secondary endpoint of time to next intervention (TTNI) (no date) Servier US. March 14, 2023. Accessed March 20, 2023. https://www.servier.us/serviers-pivotal-phase-3-indigo-trial-meets-primary-endpoint
  7. Nehra M et al. J Control Release. 2021;338:224-243. doi:10.1016/j.jconrel.2021.08.027
  8. Hersh AM et al. Cancers (Basel). 2022;14(19):4920. doi:10.3390/cancers14194920
  9. Shoaf ML, Desjardins A. Neurotherapeutics. 2022;19(6):1818-1831. doi:10.1007/s13311-022-01256-1
  10. Bagley SJ, O’Rourke DM. Pharmacol Ther. 2020;205:107419. doi:10.1016/j.pharmthera.2019.107419
  11. Batich KA et al. Clin Cancer Res. 2020;26(20):5297-5303. doi:10.1158/1078-0432.CCR-20-1082
  12. Lin J et al. Cancer. 2020;126(13):3053-3060. doi:10.1002/cncr.32884
  13. Barth SK et al. Cancer Epidemiol. 2017;50(pt A):22-29. doi:10.1016/j.canep.2017.07.012
  14. VA and partners hope APOLLO program will be leap forward for precision oncology. US Department of Veteran Affairs. May 1, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/0519-VA-and-partners-hope-APOLLO-program-will-be-leap-forward-for-precision-oncology.cfm
  15. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
Author and Disclosure Information

Margaret O. Johnson, MD, MPH
Neuro-oncologist, National TeleOncology and National Precision Oncology Program
Veterans Health Administration
Assistant Professor of Neurosurgery,
Preston Robert Tisch Brain Tumor Center,
Duke University School of Medicine
Durham, NC

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Margaret O. Johnson, MD, MPH
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Margaret O. Johnson, MD, MPH
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Neuro-oncologist, National TeleOncology and National Precision Oncology Program
Veterans Health Administration
Assistant Professor of Neurosurgery,
Preston Robert Tisch Brain Tumor Center,
Duke University School of Medicine
Durham, NC

Author and Disclosure Information

Margaret O. Johnson, MD, MPH
Neuro-oncologist, National TeleOncology and National Precision Oncology Program
Veterans Health Administration
Assistant Professor of Neurosurgery,
Preston Robert Tisch Brain Tumor Center,
Duke University School of Medicine
Durham, NC

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References
  1. Sokolov AV et al. Pharmacol Rev. 2021;73(4):1-32. doi:10.1124/pharmrev.121.000317
  2. Louis DN et al. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093/neuonc/noab106
  3. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  4. Woo C et al. JCO Clin Cancer Inform. 2021;5:985-994. doi:10.1200/CCI.21.00052
  5. Study of vorasidenib (AG-881) in participants with residual or recurrent grade 2 glioma with an IDH1 or IDH2 mutation (INDIGO). ClinicalTrials.gov. Updated May 17, 2022. Accessed December 8, 2022. https://clinicaltrials.gov/ct2/show/NCT04164901
  6. Servier's pivotal phase 3 indigo trial investigating vorasidenib in IDH-mutant low-grade glioma meets primary endpoint of progression-free survival (PFS) and key secondary endpoint of time to next intervention (TTNI) (no date) Servier US. March 14, 2023. Accessed March 20, 2023. https://www.servier.us/serviers-pivotal-phase-3-indigo-trial-meets-primary-endpoint
  7. Nehra M et al. J Control Release. 2021;338:224-243. doi:10.1016/j.jconrel.2021.08.027
  8. Hersh AM et al. Cancers (Basel). 2022;14(19):4920. doi:10.3390/cancers14194920
  9. Shoaf ML, Desjardins A. Neurotherapeutics. 2022;19(6):1818-1831. doi:10.1007/s13311-022-01256-1
  10. Bagley SJ, O’Rourke DM. Pharmacol Ther. 2020;205:107419. doi:10.1016/j.pharmthera.2019.107419
  11. Batich KA et al. Clin Cancer Res. 2020;26(20):5297-5303. doi:10.1158/1078-0432.CCR-20-1082
  12. Lin J et al. Cancer. 2020;126(13):3053-3060. doi:10.1002/cncr.32884
  13. Barth SK et al. Cancer Epidemiol. 2017;50(pt A):22-29. doi:10.1016/j.canep.2017.07.012
  14. VA and partners hope APOLLO program will be leap forward for precision oncology. US Department of Veteran Affairs. May 1, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/0519-VA-and-partners-hope-APOLLO-program-will-be-leap-forward-for-precision-oncology.cfm
  15. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
References
  1. Sokolov AV et al. Pharmacol Rev. 2021;73(4):1-32. doi:10.1124/pharmrev.121.000317
  2. Louis DN et al. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093/neuonc/noab106
  3. Mellinghoff IK et al. Clin Cancer Res. 2021;27(16):4491-4499. doi:10.1158/1078-0432.CCR-21-0611
  4. Woo C et al. JCO Clin Cancer Inform. 2021;5:985-994. doi:10.1200/CCI.21.00052
  5. Study of vorasidenib (AG-881) in participants with residual or recurrent grade 2 glioma with an IDH1 or IDH2 mutation (INDIGO). ClinicalTrials.gov. Updated May 17, 2022. Accessed December 8, 2022. https://clinicaltrials.gov/ct2/show/NCT04164901
  6. Servier's pivotal phase 3 indigo trial investigating vorasidenib in IDH-mutant low-grade glioma meets primary endpoint of progression-free survival (PFS) and key secondary endpoint of time to next intervention (TTNI) (no date) Servier US. March 14, 2023. Accessed March 20, 2023. https://www.servier.us/serviers-pivotal-phase-3-indigo-trial-meets-primary-endpoint
  7. Nehra M et al. J Control Release. 2021;338:224-243. doi:10.1016/j.jconrel.2021.08.027
  8. Hersh AM et al. Cancers (Basel). 2022;14(19):4920. doi:10.3390/cancers14194920
  9. Shoaf ML, Desjardins A. Neurotherapeutics. 2022;19(6):1818-1831. doi:10.1007/s13311-022-01256-1
  10. Bagley SJ, O’Rourke DM. Pharmacol Ther. 2020;205:107419. doi:10.1016/j.pharmthera.2019.107419
  11. Batich KA et al. Clin Cancer Res. 2020;26(20):5297-5303. doi:10.1158/1078-0432.CCR-20-1082
  12. Lin J et al. Cancer. 2020;126(13):3053-3060. doi:10.1002/cncr.32884
  13. Barth SK et al. Cancer Epidemiol. 2017;50(pt A):22-29. doi:10.1016/j.canep.2017.07.012
  14. VA and partners hope APOLLO program will be leap forward for precision oncology. US Department of Veteran Affairs. May 1, 2019. Accessed December 8, 2022. https://www.research.va.gov/currents/0519-VA-and-partners-hope-APOLLO-program-will-be-leap-forward-for-precision-oncology.cfm
  15. Konteatis Z et al. ACS Med Chem Lett. 2020;11(2):101-107. doi:10.1021/acsmedchemlett.9b00509
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New Classifications and Emerging Treatments in Brain Cancer
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Brain cancer remains a tremendous challenge in oncology, often with the worst prognosis and fewest approved treatment options.1 Classifying, treating, and identifying the causes in both the general population and in veterans have been challenging; but recently, there has been progress.2-4 In 2021, the World Health Organization (WHO) updated the classification system for primary brain and spinal cord tumors.2 Most importantly, the fifth edition of the WHO Classification of Tumors of the Central Nervous System (WHO CNS5) updates included the importance of molecular diagnostic techniques to ensure appropriate diagnoses.2 

Along with the progress in tumor classification, treatment advances are also showing promise with the use of new targeted therapies.3 A multi-site phase 3 clinical trial investigating an isocitrate dehydrogenase (IDH) inhibitor, vorasidenib, in patients with residual or recurrent IDH mutant low-grade glioma met its primary endpoint of PFS in March 2023.5,6 In addition to brain-penetrant targeted therapies, advances in drug administration and delivery have also emerged to circumvent the blood-brain barrier using nanotechnology, focused ultrasound, oncolytic viruses, vaccines, and CAR T-cell therapies.7-11

Many unanswered questions remain regarding the rates and outcomes for veterans with brain cancer. However, investigations and initiatives are ongoing to better understand the role of military service and exposures that may be associated with an increased risk of developing brain tumors.4,12,13 In addition, efforts are in place to improve molecular characterization and personalized treatments for brain cancer through the Applied Proteogenomics Organizational Learning and Outcomes (APOLLO) and NPOP.14 Despite the complexity of brain cancer, with its numerous challenges and unknowns, there have been recent advances in classification and potential treatments. Understanding the causes and improving treatments for brain cancer in the veteran population is paramount.

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COVID-19 Outcomes in Veterans With Hematologic Malignancies

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Click to view more from Cancer Data Trends 2023. 

References
  1. Parker S. Lancet Oncol. 2022;23(1):2 doi:10.1016/S1470-2045(21)00713-0
  2. Englum BR et al. Cancer. 2022;128(5):1048-1056. doi:10.1002/cncr.34011
  3. Leuva H et al. Semin Oncol. 2022:49(5):363-370. doi:10.1053/j.seminoncol.2022.07.005
  4. Wu JTY et al. JAMA Oncol. 2022;8(2):281-286. doi:10.1001/jamaoncol.2021.5771
  5. Fillmore NR et al. J Natl Cancer Inst. 2021;113(6):691-698. doi:10.1093/jnci/djaa159
  6. Morawska M. Eur J Haematol. 2022;108(2):91-98. doi:10.1111/ejh.13722
  7. Passamonti F et al. Hematol Oncol. 2023;41(1):3-15. doi:10.1002/hon.3086
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Durham, NC

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Assistant Professor of Medicine
Durham VA Medical Center
Duke University School of Medicine
Durham, NC

Click to view more from Cancer Data Trends 2023. 

Click to view more from Cancer Data Trends 2023. 

References
  1. Parker S. Lancet Oncol. 2022;23(1):2 doi:10.1016/S1470-2045(21)00713-0
  2. Englum BR et al. Cancer. 2022;128(5):1048-1056. doi:10.1002/cncr.34011
  3. Leuva H et al. Semin Oncol. 2022:49(5):363-370. doi:10.1053/j.seminoncol.2022.07.005
  4. Wu JTY et al. JAMA Oncol. 2022;8(2):281-286. doi:10.1001/jamaoncol.2021.5771
  5. Fillmore NR et al. J Natl Cancer Inst. 2021;113(6):691-698. doi:10.1093/jnci/djaa159
  6. Morawska M. Eur J Haematol. 2022;108(2):91-98. doi:10.1111/ejh.13722
  7. Passamonti F et al. Hematol Oncol. 2023;41(1):3-15. doi:10.1002/hon.3086
References
  1. Parker S. Lancet Oncol. 2022;23(1):2 doi:10.1016/S1470-2045(21)00713-0
  2. Englum BR et al. Cancer. 2022;128(5):1048-1056. doi:10.1002/cncr.34011
  3. Leuva H et al. Semin Oncol. 2022:49(5):363-370. doi:10.1053/j.seminoncol.2022.07.005
  4. Wu JTY et al. JAMA Oncol. 2022;8(2):281-286. doi:10.1001/jamaoncol.2021.5771
  5. Fillmore NR et al. J Natl Cancer Inst. 2021;113(6):691-698. doi:10.1093/jnci/djaa159
  6. Morawska M. Eur J Haematol. 2022;108(2):91-98. doi:10.1111/ejh.13722
  7. Passamonti F et al. Hematol Oncol. 2023;41(1):3-15. doi:10.1002/hon.3086
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The COVID–19 pandemic has forever changed the world, but the true extent of its lasting impact remains unclear. There were immediate diagnostic and treatment ramifications at the start of the pandemic. Stay-at-home ordinances, fear of infection, and decreased staffing availability made in-person health care appointments more challenging. A stark decline in diagnostic screening procedures and imaging was observed early during the pandemic.1,2 There was a paucity of information to help guide health care practitioners as they designed treatment strategies in anticipation of potential COVID–19 infections in their patients with cancer. The unknown relationship between cancer therapy and COVID–19 infection introduced uncertainty and confusion for patients and hindered ongoing surveillance efforts.

Several studies performed within the VA have highlighted the concern that although vaccination is effective in reducing infection and mortality rates in patients with cancer, such benefits are distributed unequally. Despite vaccination status, patients with hematologic malignancies appear more likely to contract COVID–19 and have worse COVID–19–related outcomes. Nevertheless, vaccinated patients fare better than their unvaccinated counterparts, demonstrating the ongoing importance of immunization.3-5 We now know that cancer treatment history also affects vaccine efficacy, which is critical to consider when deciding on potential chemotherapy and targeted agents for cancer treatment.6,7

We now have more robust data to help guide decision-making along with an expanding armamentarium of vaccines and therapeutics to lower the risk of COVID–19 infection. Vaccines, while less effective in patients with hematologic malignancies, continue to reduce severity of COVID–19. This knowledge has led to increased risk mitigation strategies for our patients with hematologic malignancies, particularly those receiving cancer therapy, such as recommendations for increased masking in social situations and administration of antiviral and monoclonal antibody therapy. Practitioners remain uniquely positioned to help guide their vulnerable patients through these turbulent times. This relationship undoubtedly saves lives.

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New cancer data spark outcry from patient advocates

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Newly released figures showing a rise in the number of men with advanced prostate cancer have laid bare long-simmering resentment among patient advocates who feel the nation’s leading cancer group has largely ignored their concerns for years.

The American Cancer Society on Jan. 13 revealed what it called “alarming” news about prostate cancer: After 2 decades of decline, the number of men diagnosed with the disease in the United States rose by 15% from 2014 to 2019.

“Most concerning,” according to the group’s CEO Karen Knudsen, PhD, MBA, is that the increase is being driven by diagnoses of advanced disease.

“Since 2011, the diagnosis of advanced-stage (regional- or distant-stage) prostate cancer has increased by 4%-5% annually and the proportion of men diagnosed with distant-stage disease has doubled,” said Dr. Knudsen at a press conference concerning the figures. “These findings underscore the importance of understanding and reducing this trend.”

The increase, which works out to be an additional 99,000 cases of prostate cancer, did not take the ACS by surprise; the group has been predicting a jump in diagnoses of the disease, which is the most common cancer in men after skin cancer, and the second most common cause of cancer death for that group.

The ACS announced a new action plan, “Improving Mortality from Prostate Cancer Together” – or IMPACT – to address the rise, especially in Black men, and to curb the increasing rate of advanced, difficult-to-treat cases.

“We must address these shifts in prostate cancer, especially in the Black community, since the incidence of prostate cancer in Black men is 70% higher than in White men and prostate cancer mortality rates in Black men are approximately two to four times higher than those in every other racial and ethnic group,” William Dahut, MD, PhD, chief scientific officer for the ACS, said at the press conference.

A study published in JAMA Network Open challenged that claim, finding that, after controlling for socioeconomic factors, race does not appear to be a significant predictor of mortality for prostate cancer.

Dr. Dahut said in an interview that IMPACT “is still [in the] early days for this initiative and more details will be coming out soon.”

Charles Ryan, MD, CEO of the Prostate Cancer Foundation, the world’s largest prostate cancer research charity, called IMPACT “extremely important work. Highlighting the disparities can only serve to benefit all men with prostate cancer, especially Black men.”
 

Bold action ... or passivity?

Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million deaths, according to ACS. But the story for prostate cancer is different.

The society and advocates had warned as recently as 2 years ago that prostate cancer was poised to rise again, especially advanced cases that may be too late to treat.

Leaders in the prostate cancer advocacy community praised the ACS plan for IMPACT, but some expressed frustration over what they said was ACS’ passivity in the face of long-anticipated increases in cases of the disease.

“I think prostate cancer was not high on their agenda,” said Rick Davis, founder of AnCan, which offers several support groups for patients with prostate cancer.  “It’s good to see ACS get back into the prostate cancer game.”

Mr. Davis and patient advocate Darryl Mitteldorf, LCSW, founder of Malecare, another prostate support organization, said ACS dropped patient services for prostate cancer patients a decade ago and has not been a vocal supporter of screening for levels of prostate-specific antigen (PSA) to detect prostate cancer early.

“Early detection is supposed to be their goal,” Mr. Davis said.

In 2012, the U.S. Preventive Services Task Force recommended against PSA screening, giving it a D-rating. The move prompted attacks on the task force from most advocates and many urologists.

Following this criticism, the task force recommended shared decision-making between patient and doctor, while giving PSA screening a C-rating. Now, the ACS recommends men in general at age 50 discuss prostate cancer screening with their doctor and that Black men do the same at age 45.

Mr. Mitteldorf said ACS “owes prostate cancer patients an explanation and analysis of its response to the USPTF’s downgrade of PSA testing and how that response might be related to death and instance rates.”

Mr. Mitteldorf added that male patients lost key support from ACS when the group dismantled its Man to Man group for prostate cancer patients and its Brother to Brother group for Blacks in particular.

Dr. Dahut said Man to Man “sunsetted” and was turned over to any local organization that chose to offer it. He said longtime staff didn’t have “a lot of information about [the demise of] Brother to Brother.”

For Mr. Davis, those smaller cuts add up to a much larger insult.

“Today, in 2023, ACS continues to poke a finger in the eyes of prostate cancer patients,” he said. “Since 2010, they have not given us any respect. ACS dumped its support.”

He pointed to the group’s funding priorities, noting that outlays for prostate cancer have consistently lagged behind those for breast cancer.

The ACS spent $25.3 million on breast cancer research and $6.7 million for prostate cancer in 2018, and in 2023 will designate $126.5 for breast cancer research and $43.9 million for prostate cancer.

ACS has earmarked $62 million this year for lung cancer programs and $61 million for colorectal cancer.

“Parity between breast cancer and prostate cancer would be a good start in sizing the IMPACT program,” Mr. Davis said. “After all, breast cancer and prostate cancer are hardly different in numbers today.”

Dr. Dahut denied any gender bias in research funding. He said the group makes funding decisions “based on finding the most impactful science regardless of tumor type. Our mission includes funding every cancer, every day; thus, we generally do not go into our funding cycle with any set-asides for a particular cancer.”

Mr. Davis also said the ACS data suggest the growing number of prostate cancer cases is even worse than the group has said. Although the society cites a 3% annual increase in prostate cancer diagnoses from 2014 to 2019, since 2019 the annual increase is a much more dramatic 16%. Meanwhile, the number of new cases of the disease is projected to rise from 175,000 per year in 2019 to 288,000 this year.

Dr. Dahut said the society used the 2014-2019 time frame for technical reasons, separating confirmed cases in the earlier period from estimated cases in recent years.

“We discourage comparing projected cases over time because these cases are model-based and subject to fluctuations,” Dr. Dahut said.

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

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Newly released figures showing a rise in the number of men with advanced prostate cancer have laid bare long-simmering resentment among patient advocates who feel the nation’s leading cancer group has largely ignored their concerns for years.

The American Cancer Society on Jan. 13 revealed what it called “alarming” news about prostate cancer: After 2 decades of decline, the number of men diagnosed with the disease in the United States rose by 15% from 2014 to 2019.

“Most concerning,” according to the group’s CEO Karen Knudsen, PhD, MBA, is that the increase is being driven by diagnoses of advanced disease.

“Since 2011, the diagnosis of advanced-stage (regional- or distant-stage) prostate cancer has increased by 4%-5% annually and the proportion of men diagnosed with distant-stage disease has doubled,” said Dr. Knudsen at a press conference concerning the figures. “These findings underscore the importance of understanding and reducing this trend.”

The increase, which works out to be an additional 99,000 cases of prostate cancer, did not take the ACS by surprise; the group has been predicting a jump in diagnoses of the disease, which is the most common cancer in men after skin cancer, and the second most common cause of cancer death for that group.

The ACS announced a new action plan, “Improving Mortality from Prostate Cancer Together” – or IMPACT – to address the rise, especially in Black men, and to curb the increasing rate of advanced, difficult-to-treat cases.

“We must address these shifts in prostate cancer, especially in the Black community, since the incidence of prostate cancer in Black men is 70% higher than in White men and prostate cancer mortality rates in Black men are approximately two to four times higher than those in every other racial and ethnic group,” William Dahut, MD, PhD, chief scientific officer for the ACS, said at the press conference.

A study published in JAMA Network Open challenged that claim, finding that, after controlling for socioeconomic factors, race does not appear to be a significant predictor of mortality for prostate cancer.

Dr. Dahut said in an interview that IMPACT “is still [in the] early days for this initiative and more details will be coming out soon.”

Charles Ryan, MD, CEO of the Prostate Cancer Foundation, the world’s largest prostate cancer research charity, called IMPACT “extremely important work. Highlighting the disparities can only serve to benefit all men with prostate cancer, especially Black men.”
 

Bold action ... or passivity?

Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million deaths, according to ACS. But the story for prostate cancer is different.

The society and advocates had warned as recently as 2 years ago that prostate cancer was poised to rise again, especially advanced cases that may be too late to treat.

Leaders in the prostate cancer advocacy community praised the ACS plan for IMPACT, but some expressed frustration over what they said was ACS’ passivity in the face of long-anticipated increases in cases of the disease.

“I think prostate cancer was not high on their agenda,” said Rick Davis, founder of AnCan, which offers several support groups for patients with prostate cancer.  “It’s good to see ACS get back into the prostate cancer game.”

Mr. Davis and patient advocate Darryl Mitteldorf, LCSW, founder of Malecare, another prostate support organization, said ACS dropped patient services for prostate cancer patients a decade ago and has not been a vocal supporter of screening for levels of prostate-specific antigen (PSA) to detect prostate cancer early.

“Early detection is supposed to be their goal,” Mr. Davis said.

In 2012, the U.S. Preventive Services Task Force recommended against PSA screening, giving it a D-rating. The move prompted attacks on the task force from most advocates and many urologists.

Following this criticism, the task force recommended shared decision-making between patient and doctor, while giving PSA screening a C-rating. Now, the ACS recommends men in general at age 50 discuss prostate cancer screening with their doctor and that Black men do the same at age 45.

Mr. Mitteldorf said ACS “owes prostate cancer patients an explanation and analysis of its response to the USPTF’s downgrade of PSA testing and how that response might be related to death and instance rates.”

Mr. Mitteldorf added that male patients lost key support from ACS when the group dismantled its Man to Man group for prostate cancer patients and its Brother to Brother group for Blacks in particular.

Dr. Dahut said Man to Man “sunsetted” and was turned over to any local organization that chose to offer it. He said longtime staff didn’t have “a lot of information about [the demise of] Brother to Brother.”

For Mr. Davis, those smaller cuts add up to a much larger insult.

“Today, in 2023, ACS continues to poke a finger in the eyes of prostate cancer patients,” he said. “Since 2010, they have not given us any respect. ACS dumped its support.”

He pointed to the group’s funding priorities, noting that outlays for prostate cancer have consistently lagged behind those for breast cancer.

The ACS spent $25.3 million on breast cancer research and $6.7 million for prostate cancer in 2018, and in 2023 will designate $126.5 for breast cancer research and $43.9 million for prostate cancer.

ACS has earmarked $62 million this year for lung cancer programs and $61 million for colorectal cancer.

“Parity between breast cancer and prostate cancer would be a good start in sizing the IMPACT program,” Mr. Davis said. “After all, breast cancer and prostate cancer are hardly different in numbers today.”

Dr. Dahut denied any gender bias in research funding. He said the group makes funding decisions “based on finding the most impactful science regardless of tumor type. Our mission includes funding every cancer, every day; thus, we generally do not go into our funding cycle with any set-asides for a particular cancer.”

Mr. Davis also said the ACS data suggest the growing number of prostate cancer cases is even worse than the group has said. Although the society cites a 3% annual increase in prostate cancer diagnoses from 2014 to 2019, since 2019 the annual increase is a much more dramatic 16%. Meanwhile, the number of new cases of the disease is projected to rise from 175,000 per year in 2019 to 288,000 this year.

Dr. Dahut said the society used the 2014-2019 time frame for technical reasons, separating confirmed cases in the earlier period from estimated cases in recent years.

“We discourage comparing projected cases over time because these cases are model-based and subject to fluctuations,” Dr. Dahut said.

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

Newly released figures showing a rise in the number of men with advanced prostate cancer have laid bare long-simmering resentment among patient advocates who feel the nation’s leading cancer group has largely ignored their concerns for years.

The American Cancer Society on Jan. 13 revealed what it called “alarming” news about prostate cancer: After 2 decades of decline, the number of men diagnosed with the disease in the United States rose by 15% from 2014 to 2019.

“Most concerning,” according to the group’s CEO Karen Knudsen, PhD, MBA, is that the increase is being driven by diagnoses of advanced disease.

“Since 2011, the diagnosis of advanced-stage (regional- or distant-stage) prostate cancer has increased by 4%-5% annually and the proportion of men diagnosed with distant-stage disease has doubled,” said Dr. Knudsen at a press conference concerning the figures. “These findings underscore the importance of understanding and reducing this trend.”

The increase, which works out to be an additional 99,000 cases of prostate cancer, did not take the ACS by surprise; the group has been predicting a jump in diagnoses of the disease, which is the most common cancer in men after skin cancer, and the second most common cause of cancer death for that group.

The ACS announced a new action plan, “Improving Mortality from Prostate Cancer Together” – or IMPACT – to address the rise, especially in Black men, and to curb the increasing rate of advanced, difficult-to-treat cases.

“We must address these shifts in prostate cancer, especially in the Black community, since the incidence of prostate cancer in Black men is 70% higher than in White men and prostate cancer mortality rates in Black men are approximately two to four times higher than those in every other racial and ethnic group,” William Dahut, MD, PhD, chief scientific officer for the ACS, said at the press conference.

A study published in JAMA Network Open challenged that claim, finding that, after controlling for socioeconomic factors, race does not appear to be a significant predictor of mortality for prostate cancer.

Dr. Dahut said in an interview that IMPACT “is still [in the] early days for this initiative and more details will be coming out soon.”

Charles Ryan, MD, CEO of the Prostate Cancer Foundation, the world’s largest prostate cancer research charity, called IMPACT “extremely important work. Highlighting the disparities can only serve to benefit all men with prostate cancer, especially Black men.”
 

Bold action ... or passivity?

Overall cancer mortality has dropped 33% since 1991, averting an estimated 3.8 million deaths, according to ACS. But the story for prostate cancer is different.

The society and advocates had warned as recently as 2 years ago that prostate cancer was poised to rise again, especially advanced cases that may be too late to treat.

Leaders in the prostate cancer advocacy community praised the ACS plan for IMPACT, but some expressed frustration over what they said was ACS’ passivity in the face of long-anticipated increases in cases of the disease.

“I think prostate cancer was not high on their agenda,” said Rick Davis, founder of AnCan, which offers several support groups for patients with prostate cancer.  “It’s good to see ACS get back into the prostate cancer game.”

Mr. Davis and patient advocate Darryl Mitteldorf, LCSW, founder of Malecare, another prostate support organization, said ACS dropped patient services for prostate cancer patients a decade ago and has not been a vocal supporter of screening for levels of prostate-specific antigen (PSA) to detect prostate cancer early.

“Early detection is supposed to be their goal,” Mr. Davis said.

In 2012, the U.S. Preventive Services Task Force recommended against PSA screening, giving it a D-rating. The move prompted attacks on the task force from most advocates and many urologists.

Following this criticism, the task force recommended shared decision-making between patient and doctor, while giving PSA screening a C-rating. Now, the ACS recommends men in general at age 50 discuss prostate cancer screening with their doctor and that Black men do the same at age 45.

Mr. Mitteldorf said ACS “owes prostate cancer patients an explanation and analysis of its response to the USPTF’s downgrade of PSA testing and how that response might be related to death and instance rates.”

Mr. Mitteldorf added that male patients lost key support from ACS when the group dismantled its Man to Man group for prostate cancer patients and its Brother to Brother group for Blacks in particular.

Dr. Dahut said Man to Man “sunsetted” and was turned over to any local organization that chose to offer it. He said longtime staff didn’t have “a lot of information about [the demise of] Brother to Brother.”

For Mr. Davis, those smaller cuts add up to a much larger insult.

“Today, in 2023, ACS continues to poke a finger in the eyes of prostate cancer patients,” he said. “Since 2010, they have not given us any respect. ACS dumped its support.”

He pointed to the group’s funding priorities, noting that outlays for prostate cancer have consistently lagged behind those for breast cancer.

The ACS spent $25.3 million on breast cancer research and $6.7 million for prostate cancer in 2018, and in 2023 will designate $126.5 for breast cancer research and $43.9 million for prostate cancer.

ACS has earmarked $62 million this year for lung cancer programs and $61 million for colorectal cancer.

“Parity between breast cancer and prostate cancer would be a good start in sizing the IMPACT program,” Mr. Davis said. “After all, breast cancer and prostate cancer are hardly different in numbers today.”

Dr. Dahut denied any gender bias in research funding. He said the group makes funding decisions “based on finding the most impactful science regardless of tumor type. Our mission includes funding every cancer, every day; thus, we generally do not go into our funding cycle with any set-asides for a particular cancer.”

Mr. Davis also said the ACS data suggest the growing number of prostate cancer cases is even worse than the group has said. Although the society cites a 3% annual increase in prostate cancer diagnoses from 2014 to 2019, since 2019 the annual increase is a much more dramatic 16%. Meanwhile, the number of new cases of the disease is projected to rise from 175,000 per year in 2019 to 288,000 this year.

Dr. Dahut said the society used the 2014-2019 time frame for technical reasons, separating confirmed cases in the earlier period from estimated cases in recent years.

“We discourage comparing projected cases over time because these cases are model-based and subject to fluctuations,” Dr. Dahut said.

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

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Lifestyle changes may reduce colorectal cancer risk

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Laird Harrison

Changes regarding smoking, drinking, body weight, and physical activity may alter the risk for colorectal cancer (CRC), the results of a study on a large European cohort suggest.

“This is a clear message that practicing clinicians and gastroenterologists could give to their patients and to CRC screening participants to improve CRC prevention,” write Edoardo Botteri, PhD, Cancer Registry of Norway, Oslo, and colleagues in an article published in the American Journal of Gastroenterology.

Previous studies have shown a correlation between cancer in general and unhealthy lifestyle factors. They have also shown an association between weight gain and an increased risk for CRC and a reduced risk with smoking cessation. But Dr. Botteri and colleagues could not find any published research on the association of other lifestyle factors and the risk for CRC specifically, they write.

To help fill this gap, they followed 295,865 people who participated in the European Prospective Investigation into Cancer (EPIC) for a median of 7.8 years. The participants were mostly aged from 35 to 70 years and lived in Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

The researchers calculated a healthy lifestyle index (HLI) score on the basis of smoking status, alcohol consumption, body mass index, and physical activity. The median time between baseline and the follow-up questionnaire was 5.7 years.

They awarded points as indicated in the following table.

 

Participants’ scores ranged from 0 to 16. At baseline, the mean HLI score was 10.04. It dipped slightly to 9.95 at follow-up.

Men had more favorable changes than women, and the associations between the HLI score and CRC risk were only statistically significant among men.

Overall, a 1-unit increase in the HLI score was associated with a 3% lower risk for CRC.

When the HLI scores were grouped into tertiles, improvements from an “unfavorable lifestyle” (0-9) to a “favorable lifestyle” (12-16) were associated with a 23% lower risk for CRC (compared with no change). Likewise, a decline from a “favorable lifestyle” to an “unfavorable lifestyle” was associated with a 34% higher risk.

Changes in the BMI score from baseline showed a trend toward an association with CRC risk.

Decreases in alcohol consumption were significantly associated with a reduction in CRC risk among participants aged 55 years or younger at baseline.

Increases in physical activity were significantly associated with a lower risk for proximal colon cancer, especially in younger participants.

On the other hand, reductions in smoking were associated with an increase in CRC risk. This correlation might be the result of “inverse causation,” the researchers note; that is, people may have quit smoking because they experienced early symptoms of CRC. Smoking had only a marginal influence on the HLI calculations in this study because only a small proportion of participants changed their smoking rates.

Information on diet was collected only at baseline, so changes in this factor could not be measured. The researchers adjusted their analysis for diet at baseline, but they acknowledge that their inability to incorporate diet into the HLI score was a limitation of the study.

Similarly, they used education as a marker of socioeconomic status but acknowledge that this is only a proxy.

“The HLI score may therefore not accurately capture the complex relationship between lifestyle habits and risk for CRC,” they write.

Still, if the results of this observational study are confirmed by other research, the findings could provide evidence to design intervention studies to prevent CRC, they conclude.

The study was supported by the grant LIBERTY from the French Institut National du Cancer. Financial supporters of the national cohorts and the coordination of EPIC are listed in the published study. The researchers reported no relevant financial relationships.

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

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Laird Harrison
Author(s)
Laird Harrison

Changes regarding smoking, drinking, body weight, and physical activity may alter the risk for colorectal cancer (CRC), the results of a study on a large European cohort suggest.

“This is a clear message that practicing clinicians and gastroenterologists could give to their patients and to CRC screening participants to improve CRC prevention,” write Edoardo Botteri, PhD, Cancer Registry of Norway, Oslo, and colleagues in an article published in the American Journal of Gastroenterology.

Previous studies have shown a correlation between cancer in general and unhealthy lifestyle factors. They have also shown an association between weight gain and an increased risk for CRC and a reduced risk with smoking cessation. But Dr. Botteri and colleagues could not find any published research on the association of other lifestyle factors and the risk for CRC specifically, they write.

To help fill this gap, they followed 295,865 people who participated in the European Prospective Investigation into Cancer (EPIC) for a median of 7.8 years. The participants were mostly aged from 35 to 70 years and lived in Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

The researchers calculated a healthy lifestyle index (HLI) score on the basis of smoking status, alcohol consumption, body mass index, and physical activity. The median time between baseline and the follow-up questionnaire was 5.7 years.

They awarded points as indicated in the following table.

 

Participants’ scores ranged from 0 to 16. At baseline, the mean HLI score was 10.04. It dipped slightly to 9.95 at follow-up.

Men had more favorable changes than women, and the associations between the HLI score and CRC risk were only statistically significant among men.

Overall, a 1-unit increase in the HLI score was associated with a 3% lower risk for CRC.

When the HLI scores were grouped into tertiles, improvements from an “unfavorable lifestyle” (0-9) to a “favorable lifestyle” (12-16) were associated with a 23% lower risk for CRC (compared with no change). Likewise, a decline from a “favorable lifestyle” to an “unfavorable lifestyle” was associated with a 34% higher risk.

Changes in the BMI score from baseline showed a trend toward an association with CRC risk.

Decreases in alcohol consumption were significantly associated with a reduction in CRC risk among participants aged 55 years or younger at baseline.

Increases in physical activity were significantly associated with a lower risk for proximal colon cancer, especially in younger participants.

On the other hand, reductions in smoking were associated with an increase in CRC risk. This correlation might be the result of “inverse causation,” the researchers note; that is, people may have quit smoking because they experienced early symptoms of CRC. Smoking had only a marginal influence on the HLI calculations in this study because only a small proportion of participants changed their smoking rates.

Information on diet was collected only at baseline, so changes in this factor could not be measured. The researchers adjusted their analysis for diet at baseline, but they acknowledge that their inability to incorporate diet into the HLI score was a limitation of the study.

Similarly, they used education as a marker of socioeconomic status but acknowledge that this is only a proxy.

“The HLI score may therefore not accurately capture the complex relationship between lifestyle habits and risk for CRC,” they write.

Still, if the results of this observational study are confirmed by other research, the findings could provide evidence to design intervention studies to prevent CRC, they conclude.

The study was supported by the grant LIBERTY from the French Institut National du Cancer. Financial supporters of the national cohorts and the coordination of EPIC are listed in the published study. The researchers reported no relevant financial relationships.

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

Changes regarding smoking, drinking, body weight, and physical activity may alter the risk for colorectal cancer (CRC), the results of a study on a large European cohort suggest.

“This is a clear message that practicing clinicians and gastroenterologists could give to their patients and to CRC screening participants to improve CRC prevention,” write Edoardo Botteri, PhD, Cancer Registry of Norway, Oslo, and colleagues in an article published in the American Journal of Gastroenterology.

Previous studies have shown a correlation between cancer in general and unhealthy lifestyle factors. They have also shown an association between weight gain and an increased risk for CRC and a reduced risk with smoking cessation. But Dr. Botteri and colleagues could not find any published research on the association of other lifestyle factors and the risk for CRC specifically, they write.

To help fill this gap, they followed 295,865 people who participated in the European Prospective Investigation into Cancer (EPIC) for a median of 7.8 years. The participants were mostly aged from 35 to 70 years and lived in Denmark, France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom.

The researchers calculated a healthy lifestyle index (HLI) score on the basis of smoking status, alcohol consumption, body mass index, and physical activity. The median time between baseline and the follow-up questionnaire was 5.7 years.

They awarded points as indicated in the following table.

 

Participants’ scores ranged from 0 to 16. At baseline, the mean HLI score was 10.04. It dipped slightly to 9.95 at follow-up.

Men had more favorable changes than women, and the associations between the HLI score and CRC risk were only statistically significant among men.

Overall, a 1-unit increase in the HLI score was associated with a 3% lower risk for CRC.

When the HLI scores were grouped into tertiles, improvements from an “unfavorable lifestyle” (0-9) to a “favorable lifestyle” (12-16) were associated with a 23% lower risk for CRC (compared with no change). Likewise, a decline from a “favorable lifestyle” to an “unfavorable lifestyle” was associated with a 34% higher risk.

Changes in the BMI score from baseline showed a trend toward an association with CRC risk.

Decreases in alcohol consumption were significantly associated with a reduction in CRC risk among participants aged 55 years or younger at baseline.

Increases in physical activity were significantly associated with a lower risk for proximal colon cancer, especially in younger participants.

On the other hand, reductions in smoking were associated with an increase in CRC risk. This correlation might be the result of “inverse causation,” the researchers note; that is, people may have quit smoking because they experienced early symptoms of CRC. Smoking had only a marginal influence on the HLI calculations in this study because only a small proportion of participants changed their smoking rates.

Information on diet was collected only at baseline, so changes in this factor could not be measured. The researchers adjusted their analysis for diet at baseline, but they acknowledge that their inability to incorporate diet into the HLI score was a limitation of the study.

Similarly, they used education as a marker of socioeconomic status but acknowledge that this is only a proxy.

“The HLI score may therefore not accurately capture the complex relationship between lifestyle habits and risk for CRC,” they write.

Still, if the results of this observational study are confirmed by other research, the findings could provide evidence to design intervention studies to prevent CRC, they conclude.

The study was supported by the grant LIBERTY from the French Institut National du Cancer. Financial supporters of the national cohorts and the coordination of EPIC are listed in the published study. The researchers reported no relevant financial relationships.

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

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FROM THE AMERICAN JOURNAL OF GASTROENTEROLOGY

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