Annual Meeting Proceedings Part 1 - American Society of Clinical ...

100s Cancer Prevention/Epidemiology
1559 General Poster Session (Board #4A), Sat, 1:15 PM-5:15 PM
Public perception of cancer risk. Presenting Author: Lisa Burns, University
College Cork, Cork, Ireland
Background: The public’s knowledge of cancer risk factors has rarely been
studied in Ireland. An understanding of this can help inform cancer
prevention programs. Methods: An online surveywas used to assess the
public’s perception of cancer risk. Results: 525 people completed the
survey. Mean age was 40yrs (range:18-74), 82% were female and 36% had
college degrees. 81% were concerned about developing cancer, however
20% believed if cancer was in their family there was nothing they could do
about personal cancer risk. 20% did not know that cancer risk increased
with age, 27% believed that �50% of cancers are inherited, and 54%
believed 10-20% of cancers are inherited. The top 5 risk factors listed by
respondents were: smoking 85%, diet 74%, alcohol 44%, genetics 38%,
and environment 31%. Only 32% were aware that obesity is a risk factor for
cancer and 33% did not think the location of fat was important for cancer
prevention. When given a list of potential behaviours relevant to cancer risk
33% believed wearing a tight bra and 49% believed a blow to the breast
could increase cancer risk. 87% believed genetics ‘strongly’ increased risk,
85% stress, and 86% believed cell phones increased risk. 12% believed
‘luck’ was important in avoiding cancer, 35% thought ‘detox’ diets and
61% believed organic food reduced risk. Only 33% agreed with the
statement that ‘frozen vegetables/fruit are as good as fresh’, 40% were
unaware of the link between red meat and cancer. The following foods were
thought to increase risk: cheese (29%), soy (9%), milk chocolate (30%),
red wine (25%), and eggs (11%). Aerosol use (71%), cleaning agents
(73%), smoking (99%), cooking methods (68%), processed meat (86%),
food irradiation (77%), and genetically modified foods (81%) were believed
to increased risk. The majority were aware that berries, green tea, garlic,
brassica vegetables and physical activity of 30 minutes a day can reduce
cancer risk. Conclusions: There is a sizable portion of the population who
are misinformed about cancer risk. Most are aware of classic risk factors
(e.g. smoking, poor diet). Many overestimate risk attributable to genetics,
environment, stress, and underestimate age, obesity and sunlight. One in 5
believes lifetime risk of cancer is non-modifiable.
1561 General Poster Session (Board #4C), Sat, 1:15 PM-5:15 PM
Clinical and genetic predictors of weight gain in patients diagnosed with
breast cancer. Presenting Author: Sangeetha M. Reddy, Northwestern
University Feinberg School of Medicine, Chicago, IL
Background: Obesity and weight gain in breast cancer patients has been
associated with decreased quality of life, decreased response to chemotherapy,
increased cancer recurrence, and higher all-cause mortality. Our
study was designed to identify factors that contribute to this weight gain.
Methods: Chart review was conducted on 565 breast cancer patients to
obtain weights and BMIs over an 18 month period from diagnosis, tumor
characteristics (ER/PR/Her2 status, grade, presence of LN metastases,
stage), demographics (age, race), clinical factors (menopausal status), and
treatment regimens (chemotherapy, hormone therapy, radiation). Blood
samples were genotyped for polymorphisms in FTO (fat mass and obesityassociated
protein) and the adiponectin pathway, two pathways found to be
associated with obesity and breast cancer risk. Results: See table. For
genetic analysis, one statistically significant epistatic and three gene x
environmental interactions were detected for adiponectin SNPs: rs822396d
x BMI at diagnosis (effect size 8.65), rs2232853a x age (2.75),
rs1501299a x BMI at diagnosis (3.63), and rs266729d x rs7539542d
(6.40). Conclusions: We have identified multiple clinical and genetic
variables that are likely predictors of weight gain in breast cancer patients.
We are conducting a prospective study of 200 breast cancer patients to
validate the findings of this retrospective study. By identifying a high risk
patient population, we hope to target them for aggressive lifestyle interventions
to prevent weight gain and thereby improve their mortality and
morbidity.
OR for statistically significant clinical variables.
Univariate analysis
Multivariate
Variable
6 mo 1 yr 18 mo analysis
Chemotherapy 0.75** 0.88** 0.88**
Hormone therapy 1.28** 1.18** 1.18** 1.20**
Stage (3 or 4) 0.78** 0.86** 0.87** 0.85**
Postmenopausal status at diagnosis 0.87* 0.91**
LN metastases 0.84** 0.91* 0.91**
ER status 1.37** 1.18** 1.18** 1.22**
PR status 1.23** 1.11* 1.13**
Grade (2 or 3) 0.80* 0.87* 0.89**
African American vs. white 0.88* 0.90**
Hispanic vs. white 1.43* 1.17*
Asian vs. white
*p � 0.05
** p � 0.01
0.79* 0.87*
1560 General Poster Session (Board #4B), Sat, 1:15 PM-5:15 PM
The effects of BR-DIM (BioResponse 3, 3’-Diindolylmethane) administered
pre-prostatectomy on the androgen receptor (AR). Presenting Author:
Elisabeth I. Heath, Karmanos Cancer Institute, Wayne State University,
Detroit, MI
Background: Consumption of cruciferous vegetables is associated with
decreased risk of prostate cancer (PCa). 3,3’-diindolylmethane (DIM), an in
vivo active compound formed after consumption of cruciferous vegetables,
down-regulates the AR, and causes its nuclear exclusion which results in in
vitro growth arrest and apoptosis of PCa cells. We conducted a biomarker
trial evaluating BR-DIM in pre-prostatectomy patients with the primary
objective of measuring DIM levels in prostate tissue and in plasma.
Methods: Patients with organ-confined PCa who were candidates for surgery
were treated with BR-DIM at a dose of 225 mg orally twice daily for a
minimum of 14 days. Patients did not receive any androgen deprivation
therapy. Patients received their last dose of BR-DIM the day before surgery.
Blood samples for DIM levels were collected pre-treatment and just prior to
surgery. DIM concentration was measured in the plasma and in prostate
tissue specimens using a validated high-performance liquid chromatographic
method with tandem mass spectrometric detection. AR was
evaluated by immunohistochemistry (IHC). Results: 36 patients were
treated at 2 institutions. The 26 evaluable patients had median age of 60
years (range 41 - 76), 14 were Caucasian, and 10 were African American.
Reasons for inevaluability included change in surgery date (n�4), inadequate
BR-DIM treatment (2), withdrawal from study (2), canceled surgery
(1), and other (1). Toxicity was minimal; only two patients with grade 3
headache. Post dosing, DIM was found at a mean trough level of 10.2 ng/ml
(range, 0.5 to 24.7) and 12.3 ng/gm of tissue (range, 0.0 to 26.8) in
plasma and in prostate tissue, respectively. PSA levels had a slightly
downward trend after BR-DIM treatment. In 18 of 20 evaluable PCa
specimens, IHC showed nuclear exclusion of AR. Conclusions: BR-DIM was
well tolerated, and DIM was detected in both plasma and prostate tissues at
~12 h post dosing. Nuclear exclusion of AR was found in 90% of PCa
specimens post BR-DIM dosing, suggesting in vivo inactivation of AR
activity. PSA levels were slightly reduced overall. Accrual is ongoing and
nearly complete. Additional studies with BR-DIM in PCa are warranted.
1562 General Poster Session (Board #4D), Sat, 1:15 PM-5:15 PM
Breast cancer risk reduction among patients with DCIS. Presenting Author:
Melanie R. Palomares, City of Hope, Duarte, CA
Background: The incidence of ductal carcinoma in situ (DCIS) has dramatically
increased with widespread mammographic screening. Although risk of
recurrence of DCIS is low, it is associated with a higher risk for subsequent
contralateral breast cancer (CBC), for which preventive measures are
available. We evaluated the uptake of surgical and pharmacologic interventions
to reduce CBC risk at our institution and investigated factors that may
influence treatment choices for DCIS. Methods: City of Hope (COH) DCIS
patients were identified using two sources, the Circulating Breast Tumor
Marker (BrTM) Registry and the National Comprehensive Cancer Network
(NCCN) database. Datasets were linked together, and treatment variables
were cross-tabulated with patient and tumor characteristics. Results: Of
782 patients with breast malignancy diagnosed since 1997, 370 were
excluded due to concurrent or prior invasive disease, 8 due to suspected
misclassification based on therapies received, and 4 due to treatment on
protocol. Of the remaining pure DCIS patients, treatment choices were
recorded for 289. Of those, 40 (14%) chose bilateral risk reduction
mastectomy (BRRM), 82 (28%) unilateral mastectomy, 165 (57%) lumpectomy,
and 2 had no surgery. Hormonal therapy (HT) was recorded for 215
individuals who did not pursue BRRM: 124 (57%) took tamoxifen, 3 of
whom switched to raloxifene, 5 (2%) started with raloxifene, and 7 (3%)
took an unspecified hormonal agent, for a total HT uptake of 55%. This
included 8 of 29 women with ER-negative DCIS who chose HT for CBC risk
reduction. Younger age at diagnosis was associated with BRRM (24% of
women diagnosed before age 50, 10% of those diagnosed 50-64, and 5%
of women 65� had BRRM, p�0.001) and HT (59% of women �65 chose
HT compared to 40% of women 65�,p�0.009). Within ethnic minorities,
more Asian women chose BRRM (22% vs 7% of other minorities, p�0.08).
Interestingly, fewer high grade DCIS women opted for HT (39% vs 55% for
low to intermediate grade, p�0.06). Conclusions: Young women tend to
pursue surgical prophylaxis. Among women who keep their breasts, HT
uptake was high across all age and ethnic groups, except for those older
than 65 at diagnosis. It is unclear if this is due to patient choice or reflects
age bias in physician recommendation.
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