MEMORANDUM FOR: Science Writers and Editors on the Journal Press List

August 26, 1999 (EMBARGOED FOR RELEASE 4 P.M. EDT August 31)

Julianne Chappell, Executive Editor, Dan Eckstein, (301) 986-1891, ext. 119

New Insights on American Cancer Survivors

New insights regarding the growing population of adult cancer survivors are presented by Maria Hewitt, Dr. P.H., National Academy of Science, Nancy Breen, Ph.D., and Susan Devesa, Ph.D., both with the National Cancer Institute, in the September 1 issue of the Journal of the National Cancer Institute.

The authors worked with cancer survivor data contained in the 1992 National Health Interview Survey. Conducted by the National Center for Health Statistics, the survey involved 24,040 household interviews dealing with cancer survivorship.

The 1992 data indicate that an estimated 11 million Americans, or 6.1% of the adult population, were cancer survivors. If skin cancers other than melanoma are excluded, there were 7.2 million people with a history of cancer diagnosis, or 3.9% of the adult population. These estimates are probably somewhat low because the survey missed individuals with cancer who were in institutions (e.g., hospitals, nursing homes, hospices) or who were too sick to participate in the household survey. The leading types of cancers reported by survivors are female reproductive cancers (27.8%), female breast cancer (20.4%), prostate and male reproductive organ cancers (9.5%), and colorectal cancer (9.1%). The majority (52.4%) of the survivors were diagnosed with cancer at ages 35-64 years. Most survivors (63.3%) had lived 5 or more years after diagnosis, and 9.9% had lived 25 years or more.

Fifty-eight percent reported that their cancer was detected when they noticed something was wrong and went to a doctor, while 29.8% had no symptoms and had their cancer detected during a routine checkup. The rest (12.2%) had their cancer detected in some other way. Among survivors diagnosed within the last 10 years, over half (55.7%) had sought second (or multiple) opinion(s) regarding their treatment. Very few (13.1%) patients saw only their internist or general practitioner for their cancer diagnosis and treatment.

While 58.0% of the patients received written information from a health care provider regarding their cancer, relatively few (10.9%) reported having contact with cancer organizations after their diagnosis. Only 4.7% participated in a research study or clinical trial as part of their treatment.

About one in nine survivors (10.7%) reported having been denied health or life insurance because of their cancer, and among those with private health insurance coverage, cost increases were reported by 4.9%. Of the individuals who were working but not self-employed at the time of their cancer diagnosis and treatment, 13.2% felt that they could not take a new job because of insurance considerations, 4.5% faced on-the-job problems directly related to their cancer, 4.4% refrained from applying for a new job because they did not want their medical records made public, and 3.7% lost their job because of cancer.

While cancer appears to be underreported on the 1992 National Health Interview Survey, the survey provides valuable information about the medical, insurance, and employment experience of cancer survivors selected from a nationally representative sample of U.S. households, the authors say.

Contact: Dr. Maria Hewitt, National Academy of Science, (202) 334-1721; fax (202) 334-1317.

Removing the Ovaries May Cut Breast Cancer Risk in Women With BRCA1 Mutations

Women at high risk of breast cancer because of a mutation in the BRCA1 gene may have that risk reduced substantially if their ovaries are removed prior to the onset of cancer.

This finding is reported by Timothy Rebbeck, Ph.D., University of Pennsylvania School of Medicine, and colleagues, in the September 1 issue of the Journal of the National Cancer Institute.

The surgery subjects in this study were 43 women who had no history of breast cancer but who had BRCA1 mutations known to confer a high risk of breast cancer and whose ovaries had been removed for reasons other than ovarian cancer. These women were matched with 79 control women who had disease-causing BRCA1 mutations, no history of breast or ovarian cancer, and whose ovaries were intact. Both surgical and control subjects were enrolled at five institutions — Creighton University, the Dana-Farber Cancer Institute, the Fox Chase Cancer Center, the University of Pennsylvania, and the University of Utah. Breast cancer risk was determined over many years by obtaining information from clinical records, telephone interviews, and self-administered questionnaires. Surgical subjects were followed for an average of 9.6 years after their ovaries were removed, and control subjects were followed for an average of 8.1 years after the time of their matched subject's surgery.

The women whose ovaries had been removed showed a 47% reduction in risk of breast cancer, and those who were followed 10 or more years after surgery showed a 67% risk reduction. Use of hormone replacement therapy did not appear to negate the reduction in breast cancer risk after surgery.

The authors suggest that the decreased exposure to ovarian hormones that occurs after surgery may be responsible for altering the breast cancer risk in the BRCA1 mutation carriers. While their study is the first to show that removing the ovaries is associated with a statistically significant reduction of breast cancer risk among BRCA1 mutation carriers, they note that the costs and benefits of such surgery must be considered. The surgery itself carries some risk, and the resulting induction of menopause carries some risk of osteoporosis and cardiovascular disease. Finally, since 10 of the women who had surgery developed breast cancer, there is still a risk of developing the disease.

In an editorial, Kathy Helzlsouer, M.D., M.H.S., The Johns Hopkins School of Hygiene and Public Health, notes that genetic testing can identify women at high risk of breast cancer, but there are only preliminary data available on the effectiveness of management options. Studies of cancer prevention in genetically susceptible women, studies that consider the goal of maintaining overall health, not just preventing breast cancer, are desperately needed, she claims. In the near future, she says, we need to be able to say to women with mutations in cancer susceptibility genes — the bad news is that you are at risk, the good news is that we know what we can do about it.

Contact: Sue Montgomery, University of Pennsylvania, (215) 349-5657; fax (215) 349-8312. Editorial: Liz Pettengill, The Johns Hopkins University, (410) 955-6878; fax (410) 955-4775.

Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.



             
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