WEDNESDAY, April 30 (HealthDay News) -- Breakthroughs in understanding the extremely fine genetic underpinnings of acute myeloid leukemia may allow doctors to quickly decide which existing therapies will most benefit individual patients.

"This can now help the bedside physician pick a course of action" using existing drugs, said Dr. Barton Kamen, chief medical officer of the Leukemia & Lymphoma Society. "It's telling us, with the tools we have at hand, who needs more [therapy] and where the risk is worth it."

Eventually, added Kamen, pharmaceutical companies may be able to produce drugs to specifically target the genetic mutations identified in two new studies published in the May 1 issue of the New England Journal of Medicine.

Acute myeloid leukemia, or AML, is a cancer of the bone marrow that is diagnosed in about 13,000 people in the United States each year. The incidence of the disease increases with age, while the survival rate decreases. Only 10 percent of people with AML over the age of 60 will survive two years, according to Kamen.

Scientists used to see eight kinds of AML under the microscope, but with advances in genetic knowledge, they now realize there are many more forms of the disease.

In about half of AML patients, chromosomal changes help guide doctors to select specific therapies. Deciding which treatments are best for the remaining half of patients whose cancers don't have chromosomal abnormalities remains a challenge.

"We don't know whether they will do well or not with current treatment," said Dr. Guido Marcucci, lead author of one of the studies and associate professor of medicine at Ohio State University's Comprehensive Cancer Center. "That is why we and other groups are looking at genetic mutations or changes in [gene] expression to predict the outcome of patients with no chromosomal abnormalities."

Marcucci and his team analyzed bone marrow and blood samples of 64 patients with AML who were younger than 60 and had leukemia cells with normal-looking chromosome structure. The goal: To see if microRNA profiles might help determine which treatments were best suited for which patients, and which patients were most prone to relapse.

MicroRNAs are RNAs that do not translate into proteins (unlike encoding RNAs), but instead bind to coding RNAs and shut off their ability to regulate protein production, Marcucci explained.

"We hypothesized that microRNA contributes to damage in the functioning of hematopoietic cells (stem cells that give rise to different blood cell types) by being too low or too highly expressed," he said.

And, in fact, the Ohio State team identified seven "families" (or clusters) of microRNA whose expression was associated with better (in the case of one family) or worse (six families) outcomes.

The findings were then validated in a separate group of patients.

The researchers were also able to ascertain that the microRNAs in question are involved in regulating genes that play a role in the immune system. "These microRNAs may affect native immunity function," Marcucci said.

That raises the very interesting and pertinent question that some drugs that target the immune system might have an effect on AML cells.

The second study, conducted by the German-Austrian Acute Myeloid Leukemia Study Group, was a large one, involving 872 adults under the age of 60 with AML with different genetic profiles.

Participants were enrolled in one of four different trials, each of which involved a stem-cell transplantation. The overall remission rate was 77 percent, but this rate differed depending on the genetic make-up of the cancer.

Two different subtypes had four-year survival rates of 60 percent and 62 percent; in these groups, stem cell transplantation conferred no added benefit.

Patients with two other genotypes, on the other hand, had much poorer prognoses, with four-year relapse-free survival rates of 24 percent or 25 percent and overall survival rates of 24 and 33 percent, respectively. Stem cell transplantation did help some of these patients.

More information

Learn more about AML at The Leukemia & Lymphoma Society  .

TUESDAY, April 29 (HealthDay News) -- Screening for cervical cancer reduces the risk for all types of the disease in women of all ages, say Swedish researchers. They also concluded that better follow-up of women who have cervical cancer screening could lower rates of the disease.

The researchers reviewed data from the National Cervical Cancer Screening Registry on 1,230 cervical cancer patients diagnosed between 1999 and 2001, and 6,124 age-matched women who hadn't been diagnosed with cervical cancer.

Women who hadn't had a Pap smear screening test within the recommended three-year interval were 2.5 times more likely to be diagnosed with cervical cancer than women who had regular Pap tests. Women who didn't have regular screening were also nearly five times more likely to be diagnosed with advanced cervical cancer than those were had regular screening.

Regular screening reduced the risk for all types of cervical cancer and reduced the risk of women between ages 23 and 30, which were new findings, according to the researchers.

They noted that screening didn't completely protect women from cervical cancer. Women who were screened at the recommended interval and were found to have abnormal cells were 7.6 times more likely to develop cervical cancer than women who were screened and had normal results.

Women with abnormal Pap results accounted for 11.5 percent of all cervical cancer cases. This increased risk was not noted in women diagnosed with advanced cervical cancer.

The study was published online April 29 in the Journal of the National Cancer Institute.

The researchers said their findings show that irregular screening is the most important risk factor for incident cervical cancer and that abnormal smears, if not followed up by a biopsy, are also an important risk factor.

In an accompanying editorial, Jack Cuzick, of the Cancer Research UK Centre in London, emphasized the importance of systematic audits of cancer screening programs.

"Audits, such as the one described (in this study), need to become routine within screening programs if screening is to achieve its full potential," Cuzick wrote. These reviews identify areas of screening programs that are ineffective and need to be restructured and improved.

More information

The U.S. National Women's Health Information Center has more about cervical cancer.

TUESDAY, April 29 (HealthDay News) -- Treating elderly cancer patients for five years costs Medicare $21.1 billion, and these costs are expected to increase dramatically as the population ages, a new study says.

The costs for treating patients varies by type of cancer, with expenditures highest for lung, colorectal and prostate tumors, said the researchers, who based their estimates on patients diagnosed with cancer in 2004.

"Because the U.S. population is aging and growing, we think that these costs are going to get higher in the future," said lead researcher Robin Yabroff, an epidemiologist at the U.S. National Cancer Institute. "We think there are going to be a lot more cancer patients in the future."

"The main goal of this study," Yabroff added, "was to provide cost of care estimates that could be useful for policy makers and health planners and researchers that might want to do cost-effectiveness analyses."

The findings are published in the April 29 issue of the Journal of the National Cancer Institute.

For the study, Yabroff's team estimated the cost of cancer care among 718,907 cancer patients and compared that to 1,623,651 people without cancer. The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) and SEER-linked Medicare files to identify these patients.

The researchers then subtracted Medicare costs for people without cancer from costs among those with cancer. The resulting number was the estimated cost of cancer care per person.

Costs varied over five years from about $20,000 for people with breast cancer or melanoma to $40,000 for people with lymphoma, brain or other cancers of the nervous system, as well as malignancies of the esophagus, ovaries or stomach.

The study authors found that costs were highest during the first year of treatment and also during the last year of life. Patients are more likely to be hospitalized during the last year of life, which increases costs, Yabroff said.

"We also found the cost of care is generally higher for patients diagnosed with a later stage disease, compared with patients diagnosed with earlier stage disease," Yabroff said.

To help contain costs, Yabroff suggested that more emphasis be placed on cancer screening and early diagnosis, as well as lifestyle changes, such as not smoking.

Paul Precht, policy director at the Medicare Rights Center, said he thinks Medicare will have to change some of its policies to keep costs down while continuing to offer care to the elderly with cancer.

"Clearly, treatment of cancer is expensive," he said. "When people talk about the sustainability of Medicare, they have to look at findings like this, because we are paying for treatments of very serious diseases, and that's why it's so expensive."

Precht agreed that one way to lower costs is to put more emphasis on early detection and increase Medicare benefits for prevention. Also, federal law needs to be changed to allow Medicare to negotiate drug prices with the pharmaceutical companies, he said.

"The cost of cancer drugs is going through the roof," he said. "Medicare really has to look at ways to deal with that."

People are already paying high co-payments and coinsurance for care under Medicare, and these costs are likely to grow, Precht added. And as those costs increase, it could reach a breaking point. "People will say: 'Yes, I want to live, but I don't have the money, so I guess I'm not going to,' and that's not right," he said.

Increasing costs don't necessarily lead to the rationing of health care, Precht said. "But there needs to be cost-effectiveness analysis, so there is some relationship to the effectiveness of the treatment we are paying for," he said.

More information

To learn about financial assistance and other resources for people with cancer, visit the U.S. National Cancer Institute.

FRIDAY, April 25 (HealthDay News) -- An immune-boosting treatment for lung cancer patients reduces the risk of cancer relapse after surgery to the same extent as chemotherapy but without the risk of unpleasant side effects, says a Phase II study by Belgian researchers.

The study included 182 patients with non-small-cell lung cancer, the most common form of the disease. All the patients had surgery to remove their cancer and were then randomly assigned to receive either a placebo or MAGE-A3 ASCI (antigen-specific cancer immunotherapeutic) injections over 27 months -- five given at three-week intervals, followed by eight given once every three months.

MAGE-A3 is a tumor-specific antigen produced in 35 percent to 50 percent of non-small-cell lung cancer. It's not produced by normal cells.

"The aim is to help the body's immune system to recognize the MAGE-A3 antigen and therefore eliminate the cancer cells that express MAGE-A3. In other words, it is a kind of treatment method that makes the body's immune system specifically attack cancer cells," study author Professor Johan Vansteenkiste, of the University Hospital Gasthuisberg, said in a prepared statement.

After 44 months of follow-up, cancer had recurred in 69 of the 182 patients, including 57 deaths. Patients who received the MAGE-A3 injections were less likely to have any recurrence, went longer without recurrence, and were less likely to die.

The findings were to be presented April 25 at the European Lung Cancer Conference in Geneva.

"Surgical resection is the standard treatment for patients with early stage lung cancer, but after complete resection, about 50 percent will relapse and die from their cancer," Vansteenkiste said. "Postoperative chemotherapy is able to improve cure rates but is sometimes poorly tolerated by patients recovering from thoracic surgery. In addition, not all patients are fit to receive chemotherapy."

This study shows that MAGE-A3 ASCI provides benefits similar to chemotherapy with only minimal side effects, such as mild reactions at the injection site and fever within 24 hours of the injection.

"Therefore, it is suitable for long-term maintenance treatment and, for most patients, including older patients or patients in weak physical condition after surgery, allowing them to live a normal life whilst on cancer treatment," Vansteenkiste said.

A Phase III trial of MAGE-A3 ASCI is now under way.

More information

The U.S. National Cancer Institute has more about lung cancer.