Several Colorectal Cancer Screening Methods Are Equally Effective, Panel Says

Adults aged 50 to 75 should be screened for colorectal cancer using one of three methods that are deemed equally effective in new recommendations from the U.S. Preventive Services Task Force (USPSTF). Several screening methods have now been shown to save lives, the panel of independent experts concluded: annual high-sensitivity fecal occult blood testing; sigmoidoscopy every 5 years with fecal occult testing between exams; or colonoscopy every 10 years. The recommendations appeared online October 6 in the Annals of Internal Medicine.

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In addition, the panel advised against routine screening for adults aged 76 to 85, saying that the potential benefits were small compared to the risks. For similar reasons, adults older than age 85 were urged to forgo screening. This was the first time the USPSTF has identified an upper age limit for colorectal cancer screening, but the group recently advised against routine screening for prostate cancer in men over age 74.

The Task Force concluded that there was insufficient evidence to assess the benefits and harms of computed tomographic (CT) colonography - also known as virtual colonoscopy - and of fecal DNA testing as screening methods.

Current levels of screening for colorectal cancer in the United States lag behind those of other effective cancer screening tests. In its previous (2002) recommendations, the Task Force endorsed colorectal cancer screening but said there was insufficient evidence to recommend one method over another.

The new report discusses the risks and benefits of the tests. While colonoscopy is considered the gold standard in screening, it is imperfect and may miss some polyps and colorectal cancer, the authors note. And because colonoscopy is an invasive procedure, it has a greater risk of complications than sigmoidoscopy or fecal occult blood testing, which are less invasive. Regardless of the screening method used, a patient who receives a positive test result requires a follow-up colonoscopy.

Shorter Course of Radiation Effective for Some Women with Breast Cancer

Women with low-risk, node-negative, early stage breast cancer who received a shorter, more intense course of radiation therapy after breast-conserving surgery had the same risk of disease recurrence and equivalent cosmetic outcomes (appearance of the treated breast compared with the untreated breast) 10 years after treatment compared with women who received a longer, standard course of radiation therapy, according to results presented September 22 at the American Society for Therapeutic Radiology and Oncology annual meeting in Boston, MA.

The study, conducted at 10 cancer centers in Canada, involved 1,234 women who underwent a lumpectomy and were randomly assigned to receive radiation at a dose of either 50 Gy in 25 fractions over 35 days (2 Gy per fraction) or a shorter course of 42.5 Gy in 16 fractions over 22 days (about 2.66 Gy per fraction).

After 10 years of follow-up, the risk of local recurrence remained approximately the same between the two groups: 6.7 percent for women receiving the standard course versus 6.2 percent for women receiving the short course.

Seventy-one percent of women receiving the standard course had excellent or good cosmetic outcomes compared with 70 percent of women receiving the short course. A small number of women in both groups had late radiation damage to the skin or underlying tissue after 10 years of follow-up, but the incidence of late radiation damage was not statistically significantly different between the groups.

For women with early stage, low-risk breast cancer, "[The shorter course of radiation therapy] was associated with excellent long-term local control and limited late morbidity, similar to that seen with conventional fractionation for whole breast irradiation," the researchers concluded. "Given the benefits of convenience and cost, such an approach should be considered for women with early breast cancer."

Kidney Cancer Drug Benefits Older Patients, Too

Patients with advanced kidney cancer who are aged 70 and older benefit as much from treatment with sorafenib (Nexavar) as younger patients, according to a new analysis of the largest randomized clinical trial for the disease. In the TARGET study, sorafenib improved the progression-free interval and provided a clinical benefit without compromising quality of life for both older and younger patients with advanced kidney cancer. The findings appear online today in the Journal of the National Cancer Institute.

The study, led by Dr. Tim Eisen of the University of Cambridge, U.K., addresses a gap in knowledge about cancer therapies in the elderly. Although advanced age is a risk factor for cancer, older patients are underrepresented in clinical trials due to a perception that they are at higher risk for toxicity and less likely to benefit from treatment. In the TARGET study, patients aged 70 or older were similar to patients aged 69 and younger in such measures as side effects and self-reported time to health status deterioration.

For younger patients, the median interval of progression-free survival was 23.9 weeks compared with 26.3 weeks for older patients. The percentage of older patients who had a complete response, partial response, or stable disease was 84.3 percent compared with 83.5 percent for younger patients. Adverse events, such as rash, diarrhea, and fatigue, were predictable and manageable regardless of age, the authors said.

The findings support the use of sorafenib for advanced kidney cancer in all age groups, the researchers conclude.

No Survival Benefit from Adjuvant Chemo in Stage 1B NSCLC

Long-term results of the only randomized trial, CALGB 9633, designed specifically to evaluate the benefits of adjuvant chemotherapy in patients with stage 1B non-small-cell lung cancer (NSCLC) show that, after a median of 6 years of follow up, the paclitaxel-plus-carboplatin regimen offers no survival advantage.

These findings, published online September 22 in the Journal of Clinical Oncology, contradict preliminary results of the same trial reported in 2004. The trial was terminated ahead of schedule in November 2003, based on slightly less than 3 years of follow-up, after data showed reductions in both lung cancer deaths and deaths from any cause in patients randomly assigned to the chemotherapy arm.

Guidelines released last November on adjuvant chemotherapy for patients being treated for NSCLC endorsed its use in patients with more advanced stages of the disease (IIA, IIB, IIIA), but concluded that the data on its use in patients with stage 1B disease were still inconclusive.

"Unfortunately, with longer follow-up, our encouraging preliminary findings have not been sustained," wrote Dr. Gary M. Strauss, of Tufts Medical Center in Boston, and colleagues. "Clearly, our results do not support routine use of adjuvant chemotherapy as standard of care in stage 1B NSCLC."

Three previous multicenter randomized trials of cisplatin-based adjuvant chemotherapy have also failed to show a survival advantage in patients with stage 1B NSCLC, although those trials did show that chemotherapy extended survival for patients with stage II or IIIA disease. In addition, a meta-analysis of five trials involving more than 4,500 patients failed to show a benefit of chemotherapy in patients with stage 1B disease.

A secondary analysis of CALGB 9633 suggests that chemotherapy did extend survival and delay disease recurrence for patients whose tumors measured at least 4 cm in diameter. A meta-analysis is now underway to further explore this observation.