CERVICAL CANCER

Senescence-Associated Secretory Phenotype Determines Survival and Therapeutic Response in Cervical Cancer

How well women with cervical cancer respond to treatment and survive correlates with the level of 10 proteins in their blood that also are associated with a cell state called senescence, a new study reports (Cancers 2020; doi:10.3390/cancers12102899). Researchers looked at pretreatment levels of these proteins in the blood of 565 Peruvian women with stage II and III cervical cancer who received standard treatments of internal radiation (brachytherapy), external radiation, or both. They found that women with low levels of the proteins secreted by senescent cells had higher survival rates than those with high levels of these senescence-associated secreted phenotypes (SASPs). Additionally, they found that brachytherapy greatly improved survival of patients who had high levels of these SASPs, but had little impact on those with low levels. Researchers then looked at blood levels of a total of 19 proteins they had found secreted by cells in a pathological site like a precancerous or cancerous cervix, although why the proteins are made is a question they can't yet answer, according to the study. This type of liquid biopsy can enable regular monitoring without actually doing a tissue biopsy each time, researchers note about the approach gaining ground in the cancer field. They found that levels of 10 of the proteins had an impact on cervical cancer survival in the women who were an average of 49 years old. All 10 were associated with cellular senescence, either as the largely destructive and inflammatory SASPs themselves or involved in regulating SASPs. Researchers used machine learning to make the association between high SASP level and low survival and vice versa. In the patients included in the study, everyone with stage II and most with stage III cancer received both internal and external radiation; 86 patients with stage III only received external beam radiation. Whether patients with low SASP levels could benefit from brachytherapy should be further explored, but researchers found no clear benefit to them.

BREAST CANCER

False-Negative Rates of Breast Cancer Screening With and Without Digital Breast Tomosynthesis

Breast cancer screening with digital breast tomosynthesis (DBT) offers significant advantages over digital mammography, including improved cancer detection and lower false-negative rates, according to a recent study (Radiology 2020; doi:10.1148/radiol.2020202858). While research has illuminated DBT's edge over digital mammography in cancer detection, its impact on patient survival has not been established. For the new study, researchers looked at more than 380,000 screening examinations to compare the performance of DBT and digital mammography. Among the performance metrics they assessed were the rates of false-negative screening examinations. Analysis showed that screening with DBT improved sensitivity and specificity for breast cancer and identified more invasive cancers with fewer nodal or distant metastases. Screening with DBT demonstrated a trend toward lower rates for overall false-negatives and symptomatic false-negatives, or those that present with a symptom like pain, discharge, or a lump. The results also showed advantages for DBT in imaging women with mammographically dense breasts, or breasts with a higher proportion of fibrous and glandular tissue compared with fatty tissue. Cancers can be more difficult to see in dense breasts, and breast density itself is a risk factor for cancer. Recall rates were significantly lower in both heterogeneously dense breasts and extremely dense breasts in the DBT group compared to digital mammography. The study results add to a growing body of literature supporting DBT for regular breast cancer screening. Its superior cancer detection translates to fewer recalls and fewer additional imaging exams needed.

TELEMEDICINE

Disparities in the Uptake of Telemedicine During the COVID-19 Surge in a Multidisciplinary Head and Neck Cancer Population by Patient Demographic Characteristics and Socioeconomic Status

The use of telemedicine services has shown to be exceptionally effective in meeting the health care needs of patients throughout the COVID-19 pandemic. But an analysis found that socioeconomic factors may affect certain patient populations on how they use the technology for accessing care (JAMA Otolaryngol Head Neck Surg 2020; doi:10.1001/jamaoto.2020.3052). Researchers report that head and neck cancer patients who were low-income, on Medicaid, or uninsured were more likely to complete a virtual visit by telephone rather than by video. They also said women with a lower median household income were less likely to complete a telemedicine visit than men in the same income bracket. Researchers said further study was needed to explain patients' reticence with completing a video visit, which provides a more comprehensive health care assessment than a phone call with their doctor. In their retrospective study, they analyzed census-based socioeconomic data of head and neck cancer patients who had a telemedicine visit between March 17 and April 24, 2020, and compared the results to a similar cohort from the same time frame in 2019. Data included patients' age, sex, race, insurance status, household income, education, marital and employment status, and English-speaking households. Patient visits were categorized by virtual visits using live audio and video, visits completed by telephone only, in-person visits, and no-show or canceled visits. Data from 401 patient encounters during the 2020 study period was collected. From those numbers, 346 encounters (86.3%) were completed by 234 patients. In-person visits consisted of 87 patients (25.1%), 170 (49.1%) were virtual visits, and 89 (23.6%) were telephone visits. In comparison, the 2019 study found 551 of 582 visits (94.7%) were completed by 394 patients, with no telemedicine visits completed that year. Since the retrospective study was observation-based, the research team did not evaluate whether patients had access to mobile "smart" phones and internet connectivity.

TUMOR RECCURENCE

Reactivation of Dormant Tumor Cells By Modified Lipids Derived From Stress-Activated Neutrophils

Stress hormones and immune cells called neutrophils may contribute to the recurrence of tumors years after treatment by awakening dormant cancer cells, suggests a study of mice and data from 80 patients with lung cancer (Sci Transl Med 2020; doi:10.1126/scitranslmed.abb5817). The experiments help answer the enduring question of why cancers can return long after seemingly being cured with chemotherapy or surgery. The results also hint that targeting stress hormones with beta-blockers could potentially help prevent tumors from returning. The recurrence of tumors is one of the biggest causes of deaths in cancer patients, but it's unclear exactly what biological mechanisms prompt tumors to recur. However, studies have suggested that recurrence unfolds as dormant tumor cells, which initially spread during the early stages of cancer, become active once more. Researchers discovered that stress hormones such as norepinephrine reactivated dormant lung and ovarian cancer cells in mice. Specifically, the scientists found that exposing the mice to stressful situations elevated levels of stress hormones, which caused neutrophils to release S100A8/A9 proteins and fatty molecules that in turn prompted tumor cells to reawaken from dormancy. However, tumor cells remained dormant in stressed-out mice that received an experimental beta-blocker. The team also studied serum samples from 80 patients who had their lung cancers surgically removed and saw that patients who harbored higher concentrations of S100A8/A9 were more likely to have experienced recurrence 33 months after surgery. The researchers concluded that beta-blockers or compounds that target S100A8/A9 proteins should be evaluated as potential therapies to disrupt the reactivation process, but stress the need for more sophisticated models of tumor cell dormancy.