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Breast cancer screening for Hodgkin's lymphoma survivors |
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 Top Breast cancer screening for... Radiation dermatitis and acne...CNS involvement in mantle...Familial cancerQuote |
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Breast cancer remains the most common second malignancy among female survivors of Hodgkin's lymphoma, particularly in those treated at young ages with supradiaphragmatic radiation therapy. Cumulative risk increases with radiation dose, time from treatment, and age at end of follow up, with the increased rate of secondary breast cancer emerging following a latency of 10 years and persisting beyond 25 years of follow up. Consequently, many of these women are at significant risk for breast cancer at an age prior to when routine screening mammography is recommended. Moreover, there is little prospectively collected information on this topic and practice guidelines vary widely in their recommendations. In this issue, Lee et al. [62–67] report the results of a prospective breast cancer surveillance program based on annual mammography for female Hodgkin's lymphoma survivors, focusing on the method of detection and characteristics of secondary breast cancers in the screened cohort. These authors suggest that while screening mammography may be effective at detecting ductal carcinoma in situ, it may be inadequate for detection of early invasive breast cancer in this high-risk population.
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Radiation dermatitis and acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for SCCHN |
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TopBreast cancer screening for...Radiation dermatitis and acne...CNS involvement in mantle...Familial cancerQuote |
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Radiation dermatitis is experienced by the majority of patients receiving radiotherapy for locoregionally advanced head and neck cancer. The use of epidermal growth factor receptor (EGFR) inhibitors can further be associated with the development of skin reactions, including a macular, papular, pustular rash, commonly referred to as acne-like rash (or folliculitis). As radiation is known to upregulate EGFR, it would appear possible that there is some biological interplay between the pathophysiological effects of radiation on the skin and those of EGFR inhibitors. In this issue, Bernier et al. [142–149] present management options for skin reactions in patients receiving EGFR inhibitors and radiotherapy for squamous cell carcinoma of the head and neck (SCCHN). These authors suggest that where EGFR inhibitor-related acne-like rash and radiation dermatitis coexist within irradiated fields, management should be based on the grade of radiation dermatitis: for grade 1 (or no dermatitis), treatment recommendations for EGFR-related acne-like rash outside irradiated fields should be followed; for grades 2 and above, treatment recommendations for radiation dermatitis are proposed.
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CNS involvement in mantle cell lymphoma |
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Extranodal involvement, including bone marrow, gastrointestinal tract and Waldeyer's ring, is a well-known feature of mantle cell lymphoma. However, the incidence, predicting factors and outcome of central nervous system (CNS) involvement in patients with mantle cell lymphoma has not been thoroughly investigated. In this issue, Ferrer et al. [135–141] present the results of a study that aimed to assess the incidence and factors for CNS involvement in patients with mantle cell lymphoma diagnosed and followed up at a single institution. They further analyzed the clinical features, therapy, and outcome of patients with mantle cell lymphoma once CNS infiltration was detected. These authors conclude that CNS involvement is a frequent complication in patients with mantle cell lymphoma and that blastoid histology, high proliferative index, measured by Ki-67 immunostaining, high serum LDH or intermediate and high risk IPI are associated with a higher risk of developing this complication.
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Familial cancer |
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Whenever a family history of cancer is discussed, it needs to be specified as to the number of generations covered (first degree, second degree etc) and to the ages of at least the youngest generation. Further, in most literature on familial cancer, patients have been asked about cancers in their relatives without confirming the reports. The accuracy of reporting a family history depends on many factors, including the type of cancers; the reporting for many internal cancers being notoriously inaccurate. An unambiguous definition of the proportion of cases with an affected relative is possible through a nation-wide familial dataset with registered families and medically verified cancers from the relevant national cancer registry. In this issue, Hemminki et al. [163–167], using data from the Swedish Family-Cancer Database and the Swedish Cancer Registry define the proportion of concordant (same) familial cancers for all cancers in a population that has reached age 72 years. These authors report that prostate cancer showed the highest familial proportion (20.15%), followed by breast (13.58%) and colorectal (12.80%) cancers.
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"If we have learned one thing from the history of invention and discovery, it is that, in the long run – and often in the short one – the most daring prophecies seem laughably conservative."
Arthur C. Clarke in The exploration of space
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Related articles in Ann Oncol:
- Screening mammography for young women treated with supradiaphragmatic radiation for Hodgkin's lymphoma
- L. Lee, M. Pintilie, D. C. Hodgson, P. E. Goss, and M. Crump
Ann Oncol 2008 19: 62-67.[Abstract] [FREE Full Text] - Consensus guidelines for the management of radiation dermatitis and coexisting acne-like rash in patients receiving radiotherapy plus EGFR inhibitors for the treatment of squamous cell carcinoma of the head and neck
- J. Bernier, J Bonner, J. B. Vermorken, R.-J. Bensadoun, R. Dummer, J. Giralt, G. Kornek, A. Hartley, R. Mesia, C. Robert, S. Segaert, and K. K. Ang
Ann Oncol 2008 19: 142-149.[Abstract] [FREE Full Text] - Central nervous system involvement in mantle cell lymphoma
- A. Ferrer, F. Bosch, N. Villamor, M. Rozman, F. Graus, G. Gutiérrez, S. Mercadal, E. Campo, C. Rozman, A. López-Guillermo, and E. Montserrat
Ann Oncol 2008 19: 135-141.[Abstract] [FREE Full Text] - How common is familial cancer?
- K. Hemminki, J. Sundquist, and J. L. Bermejo
Ann Oncol 2008 19: 163-167.[Abstract] [FREE Full Text]
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