Reviews & Analysis

Patients rely on health-care professionals to provide them with relevant and clear information about their disease and its treatment. Recent research has shown that physicians are viewed as the most important source of information for patients with breast cancer; however, physicians do not necessarily provide patients with the information they need to be able to make an informed decision, as discussed in this Viewpoint.

Breast cancer screening requires a high level of compliance in order to be effective. The author of this Viewpoint discusses the socio-economic and cultural factors associated with screening in developing countries.

Tubercular lymphadenitis of the cervical lymph nodes can be easily confused with node metastases. Chaturvedi et al. present the case of a 66-year-old man who was diagnosed with tongue carcinoma. PET–CT imaging suggested extensive neck-node metastases but frozen sections revealed tuberculosis of the neck nodes. The patient underwent surgery and received multidrug antitubercular therapy. The need for cautious interpretation of PET–CT reports, especially in tuberculosis-endemic areas, is discussed.

Active surveillance for favorable-risk prostate cancer has become increasingly popular in populations in which prostate cancer screening is widespread because of evidence that screening results in the detection of disease that is not clinically significant in many patients. This Review discusses the results of active surveillance, the criteria for patient selection and the appropriate thresholds for intervention.

Patients with primary plasma-cell leukemia (PCL) are usually treated with regimens used for multiple myeloma because no official guidelines exist for the treatment of PCL. Ballanti et al. discuss the case of a 68-year-old man with primary PCL who developed sustained ventricular tachycardia that was thought to be caused by thalidomide. The authors emphasize the need for complete cardiac evaluation and clinical monitoring of patients undergoing thalidomide treatment.

Primary tumor removal is usually considered as intrinsically beneficial, but this can perturb metastatic homeostasis and, for some patients, results in the acceleration of metastatic cancer. This Review analyzes the recent evolution of two paradigms related to the development of breast cancer metastases, and discusses the limitations of these paradigms in terms of how they explain breast cancer recurrence dynamics for patients undergoing surgery with or without adjuvant chemotherapy.

The pathogenic relationship between bisphosphonates and osteonecrosis of the jaw is unclear, but there is evidence to indicate an association between high-dose bisphosphonate treatment and exposure to dental infections and oral surgical procedures. The authors of this Review highlight that a better knowledge of the interactions between these agents and of the jaw and maxillary bone biology will improve clinical and therapeutic approaches to osteonecrosis of the jaw.

The incidence of the skin malignancy, melanoma, is increasing and it often becomes refractory to common therapies after metastasis. In this Viewpoint the author discusses different therapeutic approaches for metastatic melanoma.

The immunosuppressive impact of melanoma upon the human body is now beginning to be understood and interferon α2b at high dosage is critical to the reversal of signaling defects in the T cells of melanoma patients. The authors of this Viewpoint discuss the use of high dose interferon α2b in patients with high risk melanoma.

Techniques that combine the skills of resection with reconstruction have led to a third approach called oncoplastic breast-conserving reconstruction. Emerging data on the oncological and cosmetic outcomes of this technique confi rm the clinical utility of this new approach to the surgical management of patients with breast cancer, as discussed in this Review.

Poorly differentiated thyroid cancers (PDTCs) are usually aggressive tumors with high rates of recurrence and distant metastases that are often resistant to radioactive iodine therapy. Tuttle and colleagues present the case of a 55-year-old man who was diagnosed with metastatic PDTC and was managed with radioactive iodine therapy. The authors discuss the current management options for patients with PDTCs that are nonresponsive to RAI therapy and highlight the need for the discovery of new systemic treatments for these patients.

While many studies assessing the cost of cancer care have been conducted in the US, to date, these studies and the underlying methods used to estimate costs have not been reviewed systematically. The authors of this article conducted a descriptive review of the published literature on the cost of cancer care in the US, and discuss the implications of the heterogeneity of their findings.

The current choice for men with localized prostate cancer lies between active surveillance and radical therapy, but overtreatment associated with therapy poses a significant challenge. The authors of this Review propose a new concept whereby only the tumor focus and a margin of normal tissue are treated. The advantages and limitations of active surveillance and of radical therapy are reviewed, with focal therapy presented as a means for bridging these two approaches. With emerging techniques that can treat to millimeter accuracy, focal therapy of prostate cancer is now possible.

Women who carry a germline mismatch-repair mutation causal to Lynch syndrome have increased risks of developing endometrial carcinoma and ovarian cancer, as well as colorectal carcinoma. This Viewpoint outlines the rationale for the use of lifesaving prophylactic gynecologic surgery in these women following childbearing, with testing and surveillance unless and until such surgery is performed.

Hypothyroidism seems to be a risk of sunitinib therapy for cancer. The authors of this Viewpoint review the evidence for the occurrence of hypothyroidism in this setting and discuss possible actions of thyroid hormone replacement in the cancer patient.

For patients with non-small-cell lung cancer (NSCLC) and brain metastasis, effective treatment strategies are required because systemic chemotherapy is usually ineffective. Pan and colleagues present the case of a 73-year-old man who was diagnosed with NSCLC with brain metastasis, who carried anEGFR mutation and was managed with erlotinib and whole-brain irradiation. The authors discuss the treatment options for patients with metastatic NSCLC and propose erlotinib as an appropriate therapy for patients with a high probability of harboring classic EGFRmutations.

Germline mutations inPTEN result in the uncommon Cowden Syndrome. Heterozygous mutations of SDH B, C and D are associated with the hereditary pheochromocytoma–paraganglioma syndrome. Zbuk et al. present the first-reported case of a woman with both PTEN and SDHCmutations, which resulted in multiple neoplasias. The authors highlight the need for predictive genetic tests and close clinical surveillance of patients with suspected Cowden or pheochromocytoma–paraganglioma syndromes.

There is no standard treatment forBRCA1/2carriers with a new diagnosis of breast cancer. Personal and family-history-based criteria do not accurately predict the probability of a positive test result and thresholds for deciding who should be tested vary considerably among countries. The authors of this Review discuss how preventive and therapeutic approaches can be tailored to individuals by integrating the latest translational and clinical research findings. They also propose an individualized management algorithm on the basis of existing evidence, and discuss the challenges related to genetic testing, prevention and treatment strategies.

Population-based survival data can provide valuable comparative data on outcome but should be interpreted with caution. Ideally, data from the whole population, including clinical-only diagnoses, should be reported and the methods of case identification described. Erridge et al. highlight the need for methods of data collection and comparison to be as similar as possible, and for important factors related to the patient, tumor characteristics and treatment that might impact outcome to be reported.

The insulin-like growth factor 1 (IGF1) signaling pathway is implicated in the development of cancer. IGF1R signaling has been found to correlate with resistance to anti-EGFR and HER2-based therapies in experimental systems. This Review highlights the most relevant studies in this exciting area of research, focusing in particular on the role of the IGF1R in the resistance of other receptor-targeted therapies.