European Journal of Cancer: Highlights of Issue 40:08

HPV testing is a relevant tool

HPV testing shows promise in cervical disease

Human Papilloma Virus (HPV) testing is a relevant tool to detect cervical disease, according to authors reporting in this issue. The Papanicolaou smear is widely recognised as being the most effective tool in preventing cervical disease and since its introduction mortality from cervical cancer has decreased, particularly in some high-risk countries. However, conventionally, the method suffers from a low sensitivity and poor reproducibility. Persistent infection with high-risk HPVs is thought to be important in the development of intra-epithelial and invasive cancer. Therefore, Dalstein and colleagues compared the results of different combinations of screening tests in identifying precancerous lesions in a hospital population (n=3574). HPV testing was more sensitive than cytology, while cytology was more specific. When both tests were combined, sensitivity reached 100%. The best way of combining cytology and HPV detection in screening programmes should be evaluated in large-scale studies, they said.

Breast-conserving therapy in the genetically predisposed patient

Hereditary breast cancer patients had a significantly higher 10-year rate of ipsilateral breast tumour recurrence (IBTR) following breast conservative therapy (BCT) compared with sporadic controls (30% versus 16%, respectively; P=0.05), authors report in this issue. Seynaeve and colleagues compared 87 hereditary breast cancer patients with 174 controls matched for age and year of diagnosis. An IBTR was detected in 19(22%) hereditary and 21(12%) sporadic patients. They suggest that their data should be taken into account when considering additional risk-reducing surgery after primary BCT. "BCT, with added prophylactic measures to reduce the risk of secondary malignancies of the ovaries and breast, remains a reasonable option for those genetically predisposed breast cancer patients desiring breast conservation" according to Drs. Haffty and Lannin who discuss this and other related studies in an accompanying Editorial. "Ultimately, the decision about lumpectomy or mastectomy is a very personal one and comes down to patient preference... Clearly, the data now emerging will help women make a more informed decision".

Increased serum folate is associated with reduced breast cancer risk

Increased serum concentrations of folate were associated with reduced risks of breast cancer, authors report in this issue. Beilby and colleagues compared serum folate concentrations in 141 breast cancer patients and 109 age-matched controls. Folate levels were significantly lower in the cases than the controls (geometric means of 5.7 versus 6.6 µg/l, respectively; P=0.005). Furthermore, comparing the highest and lowest quartiles of folate concentrations, a reduction in the breast cancer risk was observed - the Odds Ratio decreased by 0.23 (95% Confidence Interval 0.09, 0.54). The authors acknowledge there may have been some bias in the selection of the controls, but conclude that increased concentrations of serum folate were associated with a reduced risk of breast cancer.

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