A Clue to Cancer Recurrence
The presence of cancer cells in bone marrow is the most effective predictor yet found for determining whether breast cancer victims will suffer a relapse, according to German researchers, but the test is painful and physicians say it would be premature to start using it widely.
Currently, a large tumor size and the presence of cancer cells in lymph nodes under the arm are taken as signs that the patient is at high risk of a recurrence and thus should be treated with aggressive chemotherapy after removal of the tumor. But cancer returns in as many as 30% of those with cancer-free nodes, suggesting the need for a better test.
Following up on an earlier study, Dr. Wolfgang Janni and his colleagues from Ludwig Maximilians University in Munich studied 552 women with breast cancer. They reported in Thursday’s New England Journal of Medicine that 49 of the 199 women with cancer cells in their bone marrow died from cancer within four years, contrasted with just 22 of the 353 patents without such cells. Overall, the women with cancer cells in their marrow were 4.2 times more likely to have died or have had a relapse in that time than those without the cells, while women whose cancer had spread to their lymph glands were only 2.9 times more likely to die or suffer a relapse than those whose cancer hadn’t spread to lymph glands.
The researchers used a needle to withdraw bone marrow from the hips of the patients at the same time that they performed surgery to remove the tumor.
Aiding Patients in Ending Life
Physicians who wish to help suffering patients die would serve them better by intervening directly rather than by just prescribing lethal drugs, according to a new study by researchers in the Netherlands, where physician-assisted suicide and euthanasia have been legal for years.
In nearly one in every five cases in which patients were simply given prescriptions, complications developed and physicians were forced to intervene to end suffering, the study found.
Dr. Johanna Groenewound and her associates at Erasmus University in Rotterdam reviewed 535 cases of euthanasia and 114 of physician-assisted suicide. Among the physician-assisted cases, they reported in Thursday’s New England Journal of Medicine, the prescribed medication did not work as expected in 16% of the cases and technical problems arose in an additional 7%. Problems arose so often that, in 18% of the 114 cases, physicians witnessing them felt compelled to intervene. Problems included an inability to swallow the medication and vomiting it back up.
In an accompanying editorial, Dr. Sherwin Nuland of the Yale University School of Medicine said physicians need better training in end-of-life medicine. “Once the decision to intervene has been made, the goal should be to ensure that death is as merciful and serene as possible,” he wrote.
In a related paper in the same journal, Oregon officials reported that 27 terminally ill residents of the state took their own lives last year, up from 16 the year before. Their median age was 71. Seventeen of those who received lethal drugs from their physicians had cancer, while the others had chronic lung disease, AIDS or Lou Gehrig’s disease. Oregon legalized physician-assisted suicide in 1997.
U.S. Teen Pregnancy Still Unusually High
Although the teenage pregnancy rate in the United States dropped 17% during the 1990s, the rate is still abnormally high, ranking the United States with Russia and other Eastern European countries as the worst among developed countries, according to a new report from the Alan Gutmacher Institute. Belarus, Bulgaria, Romania, the Russian Federation and the United States all have teen pregnancy rates of more than 70 per 1,000, with Russia heading the pack at 101.7 per 1,000 and the U.S. with 83.6 per 1,000, according to a report in the January/February issue of Family Planning Perspectives, released Thursday.
By contrast, the Netherlands has a teen pregnancy rate of only 12 per 1,000, while Japan and most Western European countries have rates below 40 per 1,000. The researchers attributed the differences to a more pragmatic attitude toward sex in the countries with low pregnancy rates, leading to greater availability of birth control.
Gene May Aid Treatment of Tumors
A gene that plays a key role in the growth of pituitary tumors has also been found to be crucial in the spread of colorectal tumors and may help physicians decide treatment strategies for the colon tumors, according to researchers at Cedars-Sinai Medical Center in Los Angeles.
The gene, called pituitary tumor promoting gene, or PTTG1, was identified in 1997 by Dr. Shlomo Melmed at Cedars. It activates another chemical, called basic fibroblast growth factor, which stimulates the growth of blood vessels to provide nourishment for growing tumors.
Dr. Anthony P. Heaney and his colleagues at Cedars studied samples from 68 colorectal tumors and 20 colonic polyps. They reported in Saturday’s Lancet that the gene was present in all the tumors and 19 of the 20 polyps. But the levels of the gene were significantly higher, they found, when the cancer had spread to the patient’s nearby lymph nodes or to the liver than they were when it was confined to the bowel wall. Measuring high levels of the gene could identify patients who require the most aggressive cancer treatment, they said.
Hormone May Not Indicate Rare Cancer
Many women have undergone unnecessary chemotherapy or hysterectomies based upon the presence of human chorionic gonadtropin, or hCG, in the blood serum when more thorough analyses would have shown that they did not have a tumor, according to researchers from the University of New Mexico.
The hormone, produced by the fetal placenta, is elevated in pregnant women and in nonpregnant women with a rare cancer called choriocarcinoma.
In findings reported in Saturday’s Lancet, Dr. Laurence A. Cole and his co-workers described 12 women who had been referred to them because of persistently high blood levels of hCG. Seven of the women had undergone hysterectomy, hysterectomy and removal of both ovaries, or chemotherapy in an attempt to treat the suspected malignancy. The team tested for hCG and its metabolites not only in blood but also in urine and concluded that none of the women had ever had choriocarcinoma.
Accurate data about the incidence of choriocarcinoma are not available because it is very rare, according to the American Cancer Society. The women in the study were referred to the university because treatment did not lower their hCG levels as expected.
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Medical writer Thomas H. Maugh II can be reached at thomas.maugh@latimes.com.
