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Other highlights in the June 5 issue of JNCI

Journal of the National Cancer Institute

Cancer Registries Provide Information on Quality of Cancer Care
Data from cancer registries may, in some cases, be more accurate than data from patient medical records, suggesting that registries could be a good resource for collecting data on the quality of cancer care. The findings appear in the June 5 issue of the Journal of the National Cancer Institute.

Various groups have called for a national system to monitor the quality of cancer care. However, the validity of cancer registry data has not yet been proven. In this study, Jennifer L Malin, M.D., of the Jonsson Comprehensive Center at the University of California at Los Angeles, and her colleagues compared registry data regarding cancer care with medical records from 304 breast cancer patients.

Malin and her colleagues found that the accuracy of registry data was higher for hospital-based services such as mastectomy and lymph node dissection than for ambulatory services such as biopsy and chemotherapy. The authors conclude that registries could provide the infrastructure for collecting data on the quality of cancer care; they recommend that funding be increased to support data collection by cancer registries.

Blocking Growth Factor Receptor Prevents Local But Not Distant Metastases
Blocking signaling by the vascular endothelial growth factor receptor-3 (VEGFR-3), which stimulates tumor lymphogianesis (the formation of lymphatic vessels), can suppress regional metastasis to the lymph nodes, a new study suggests. The findings were published in the June 5 issue of the Journal of the National Cancer Institute.

Kari Alitalo, Ph.D., of the University of Helsinki in Finland, and her colleagues used a receptor-antibody fusion protein to block two vascular endothelial growth factors (VEGF-C and VEGF-D) that induce angiogenesis and lymphangiogensesis in tumors via VEGFR-3 signaling.

The authors found that blocking VEGFR-3 signaling suppressed primary tumor and regional lymph node metastasis but had no effect on distant lung metastasis. Moreover, they found that overexpression of VEGF-C did not increase the incidence of lymph node metastasis. These findings suggest that lymph node metastasis is regulated by additional factors besides VEGF-C and that its inhibition may not block distant organ metastasis.

Computer Model, Risk Counselors Identify Likely BRCA Mutation Carriers
A new study suggests that cancer risk counselors and computer models have similar sensitivity when it comes to identifying women likely to carry BRCA gene mutations. The findings appear in the June 5 issue of the Journal of the National Cancer Institute.

Genetic testing can be costly and sometimes they clinical relevance of the results can be ambiguous. Therefore, people considering testing must first receive pretest counseling to determine their likelihood of carrying a genetic mutation. Pretest counseling is traditionally done by cancer risk counselors; however, more recently, a computer model has been developed for this purpose.

In this study, David M. Euhus, M.D., of the University of Texas Southwestern Medical Center, and his coworkers compared the performance of eight cancer risk counselors with that the computer model, BRCAPRO at identifying families likely to carry a BRCA mutation. The sensitivity (ability to identify mutation carriers) of both the risk counselors and BRCAPRO was greater than 90%. However, BRCAPRO consistently demonstrated greater specificity (ability to rule out mutation non-carriers) than the risk counselors.

Genetic Changes in Benign Breast Tissue May Indicate Increased Risk of Breast Cancer
A genetic change called loss of heterozygosity (LOH) in benign breast epithelial cells may be an early step in the process of breast cancer carcinogenesis, a new study concludes. In the future, this molecular analysis could be used to determine a woman's risk for breast cancer, the authors conclude in the June 5 issue of the Journal of the National Cancer Institute.

DNA alterations such as structural rearrangement of chromosomes and changes in chromosome copy number are known to be present in breast cancer cells. These genetic changes result in genomic instability. David M. Euhus, M.D., and colleagues from the University of Texas Southwestern Medical Center at Dallas, investigated whether LOH--the deletion of chromosomal material during DNA replication or repair--was associated with abnormal cytology in the breast and a woman's overall risk of breast cancer.

The investigators measured LOH in breast epithelial cells obtained by random fine needle aspiration (FNA) biopsy from 30 asymptomatic women whose risk of breast cancer had been estimated by the Gail model. LOH was detected in two of 11 women with normal cytology and in 14 of 19 women with abnormal cytology. The mean lifetime risk for developing breast cancer, calculated using the Gail model, was 16.7% for women with no LOH compared with 22.9% for women with LOH.

The authors conclude that the identification of LOH in benign breast epithelium obtained by random FNA is strongly associated with cytologic features of typical and atypical proliferation and is nominally associated with calculated breast cancer risk level.

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