Nearly half of the men found to have elevated prostate-specific antigen (PSA) levelswho would normally be recommended for a prostate biopsyhave levels that returned to normal on a subsequent visit, a new study has found. The findings suggest that a single abnormal PSA test should be confirmed before a biopsy is performed.
In a retrospective study published May 28 in the Journal of the American Medical Association, James A. Eastham, M.D., of the Memorial Sloan-Kettering Cancer Center, New York, and his colleagues analyzed serum PSA levels in 972 men between the ages of 35 and 89 who had participated in the Polyp Prevention Trial. The men had provided blood samples every year for 4 consecutive years.
Twenty-one percent of the men had a PSA level of more than 4 ng/mL at some time during the study, but in 44% of these men, the level returned to normal and remained normal during subsequent visits.
"While PSA testing does lead to the early detection of prostate cancer, a single abnormal PSA level should be viewed with caution," the researchers wrote. "A newly elevated level should be confirmed before expensive or invasive tests, such as a prostate biopsy, are recommended."
Boyle To Head International Cancer Agency
Cancer epidemiologist and biostatistician Peter Boyle, Ph.D., has been elected director of the International Agency for Research on Cancer (IARC) by IARCs Governing Council. He will succeed Paul Kleihues, M.D., who will be retiring at the end of the year. Boyle is currently the director of the Division of Epidemiology and Biostatistics at the European Institute of Oncology in Milan, Italy. He will begin his new position on Jan. 1, 2004, and is elected initially for a 5-year term.
IARC is a part of the World Health Organization. The director of IARC is responsible for the developing and implementing the scientific program and overseeing the day-to-day operation of the agency.
ACS Updates Breast Cancer Screening Guidelines
The American Cancer Society has updated its breast cancer screening guidelines to include more specific advice for older women and for women at an increased risk of breast cancer. The new guidelines support the organizations earlier recommendations on mammography screening in women at average risk of breast cancer but downplay the importance of breast self-examination.
The guidelines, last updated in 1997, recommend that older women continue annual mammography, regardless of age, as long as they are in reasonably good health. Women with serious health problems or short life expectancy should evaluate with their provider whether to continue screening. The guidelines recommend that women at increased risk of breast cancer discuss with their providers the possibility of beginning screening early or considering screening in combination with other approaches, including ultrasound and magnetic resonance imaging.
For women at average risk of breast cancer, the new guidelines uphold previous recommendations to have a mammogram every year starting at age 40. The recommendations also remain unchanged for clinical breast examinationevery 3 years for women in their 20s and 30s and every year for women ages 40 and older. However, the new recommendations have made breast self-examination optional.
Risks From Second-Hand Smoke Exposure Exaggerated, Study Says
A new study is casting some doubt on the long-held belief that prolonged exposure to second-hand smoke, also known as environmental tobacco smoke, is associated with an increased risk of coronary heart disease, lung cancer, and other health problems.
James E. Enstrom, Ph.D., of the University of California, Los Angeles, and Geoffrey C. Kabat, Ph.D., of the State University of New York, Stony Brook, examined data from 118,094 California adults who had enrolled in the American Cancer Society cancer prevention study in 1960. The researchers focused on 35,561 individuals who had never smoked but had a spouse in the study who had known smoking habits.
After 40 years of follow-up, the researchers found no statistically significant association between exposure to environmental tobacco smoke and rates of death from coronary heart disease, lung cancer, and chronic obstructive pulmonary disease. Exposure to environmental tobacco smoke was estimated to be roughly equivalent to smoking one cigarette per day. When the researchers considered an environmental smoke exposure of 1 to 9 cigarettes per day, there was no association with coronary heart disease but a 20% increased risk of lung cancer and chronic obstructive pulmonary disease. However, among active smokers, there was a strong, positive association between smoking and deaths from coronary heart disease, lung cancer, and chronic obstructive pulmonary disease.
The researchers say that, based on these findings, exposure to environmental tobacco smoke could not plausibly cause a 30% increase in risk of coronary heart disease in this cohort. But the authors reported that they could not rule out a small effect in lung cancer and chronic obstructive pulmonary disease. "Given the limitations of the underlying data in this and the other studies of environmental tobacco smoke and the small size of the risk, it seems premature to conclude that environmental tobacco smoke causes death from coronary artery disease and lung cancer," the researchers concluded. The study appeared in the May 17 issue of the British Medical Journal.
Linda Wang
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