Familial Risk of Lung Cancer Greater in African Americans

Family members of African Americans with early-onset lung cancer are twice as likely to develop lung cancer themselves, as are family members of white early-onset lung cancer patients, according to a study in the June 22/29 Journal of the American Medical Association.

Study leader Dr. Michele L. Coté of Wayne State University and her colleagues analyzed case reports of 692 early-onset (before age 50) lung cancer patients and 773 healthy controls. The study population or their proxies provided information about 7,576 of their biological parents, siblings, and children. The family members were analyzed for age, race, smoking history, and whether they had been diagnosed with certain obstructive lung diseases or lung cancer. Two-thirds of the study population were white, and the remainder were African American.

Family members of African American lung cancer patients had a 3.23 times greater risk of developing lung cancer than did the relatives of African American control group members. Family members of white lung cancer patients had a 1.48 times greater risk of developing lung cancer than did relatives of healthy whites.

The researchers found a 1.7-fold increased risk of lung cancer for people with first-degree relatives with lung cancer compared with those without a family history of the disease, after adjusting for race, age, sex, and smoking. "Familial risk in the black population was higher than that in the white population," the researchers wrote. "These findings provide further evidence that lung cancer aggregates in families and that aggregation is stronger in blacks."

Bortezomib Is Superior to High-Dose Dexamethasone for Relapsed Multiple Myeloma

A randomized, phase III clinical trial concludes that bortezomib (Velcade) is superior to high doses of dexamethasone for treating relapsed multiple myeloma. The results, from the Assessment of Proteasome Inhibition for Extending Remissions (APEX) trial, appeared in the June 15 New England Journal of Medicine (NEJM).

Bortezomib is the first of a new class of drugs, proteasome inhibitors, that works against several types of tumors. In 2003, the Food and Drug Administration made bortezomib available to relapsed myeloma patients through fast-track approval, and full approval was given this year. Multiple myeloma is a progressive blood disease, and no standard treatment exists for relapsed patients.

The study, led by Drs. Paul Richardson and Kenneth Anderson of the Dana-Farber Cancer Institute with investigators across North America and Europe, included 669 patients who had undergone 1 to 3 previous treatment regimens. Patients taking bortezomib had higher response rates, a significantly longer time to disease progression, and longer survival than patients taking dexamethasone.

The combined complete and partial response rate was 38 percent for bortezomib versus 18 percent for dexamethasone. After interim analyses strongly favored treatment with bortezomib, the data monitoring committee recommended all patients in the study begin taking the drug, resulting in a relatively short follow-up period of 8.3 months.

"The take-home message is that bortezomib is an effective therapy against relapsed myeloma," writes Dr. Angela Dispenzieri of the Mayo Clinic in an NEJM editorial. More research is needed, she notes, given the short follow-up period, and such factors as differences in toxicity and the greater expense of bortezomib compared with high-dose dexamethasone, but bortezomib nonetheless constitutes "a much-needed additional tool against this devastating disease."

Physical Activity and Weight Control Lowers Breast Cancer Risk

A large Chinese epidemiological study provided strong evidence that being more physically active and leaner can significantly reduce the risk of getting breast cancer, particularly among postmenopausal women, according to a report in the June Cancer Epidemiology, Biomarkers & Prevention.

The Shanghai Breast Cancer Study compared data from interviews of 1,459 breast cancer cases and 1,556 controls in China. Researchers reported that women in the study with low levels of physical activity and higher body mass index (BMI) levels were at more than twice the risk of developing breast cancer than women who had lower BMIs, and who exercised for the equivalent of about 45 minutes of brisk walking or 20 minutes of vigorous exercise daily.

The women's BMIs were calculated based on measurements, taken by the interviewers, of their weight, height, and circumference of waist and hips. Lead author Dr. Alecia S. Malin of Meharry Medical College noted that, "This direct approach enabled us to overcome the primary problem affecting the accuracy of energy balance assessments" based on self-reporting that "leads to underreporting, particularly when overweight people account for their own energy intake."

Extrapolation of the results for Westerners, Dr. Malin added, should take into account the inherent differences in the relationship between BMI levels and disease risk that appear to exist between Western and Asian women. A BMI of 25 kg/m² among Western women is considered to be normal weight, while the same BMI level among Asian women is considered to be in the overweight category and was associated with an increased breast cancer risk in this study.