An Assortment of Journal Abstracts to Enhance Oncology Care

CERVICAL PRECANCER Evidence of decreased long-term risk of cervical pre-cancer after negative primary HPV screens compared to negative cytology screens in a longitudinal cohort study New research demonstrated that the risk of detecting cervical precancer 8 years after a negative human papillomavirus (HPV) screening is similar to the risk after 3 years past a negative cytology screening, according to data recently published in Cancer Epidemiology, Biomarkers & Prevention (2024; https://doi.org/10.1158/1055-9965.EPI-23-1587). In this study, researchers examined the long-term risk of cervical precancer after HPV screening to help inform screening interval recommendations. This longitudinal, cohort study included four cohorts of patients: 5,546 who had one negative HPV screen; 6,624 who had two consecutive negative HPV screens four years apart; 782,297 who had one negative cytology screen; and 673,778 who had two consecutive negative cytology screens given 2-3 years apart. Data from the Canadian HPV For Cervical Cancer Prevention (HPV FOCAL) randomized trial and its 14-year longitudinal follow-up FOCAL-DECADE study was used for the HPV screening cohorts. For the cytology cohorts, data was used from the British Columbia Cervix Screening Program. Participants from each cohort were between the ages of 25 and 65 at the initial screen. Researchers compared the long-term risk of cervical precancer or worse (CIN2+) between HPV and cytology cohorts. They calculated cumulative risk of cervical intraepithelial neoplasia Grades 2 (CIN2), 3 (CIN3), and higher (referred to as CIN2+ or CIN3+) for each cohort. The study authors reported that the risk of CIN2+ 8 years after one (3.2/1,000) or two (2.7/1,000) negative HPV test(s) was similar to that of 3 years after one (3.3/1,000) or two (2.5/1,000) negative cytology screen(s). Risk of CIN2+ 8 years after a negative screen in HPV cohorts was comparable to risk after 3 years in cytology cohorts (the benchmark for acceptable risk), according to the research team. They noted that these findings suggest that “primary HPV screening intervals could be extended beyond the current 5-year recommendation potentially reducing barriers to screening.” AUTHOR COMMENTARY: “There is currently a global shift from conventional cervical cancer screening methods like cytology, or the Pap smear, to HPV-based screening because HPV-based screening has a higher sensitivity to detect precancerous lesions,” said corresponding author Anna Gottschlich, PhD, MPH, Assistant Professor at Wayne State School of Medicine and the Barbara Ann Karmanos Cancer Institute. “However, some have expressed concern that the longer interval between HPV screens may increase the risk for the development of cervical cancer. These findings should provide assurance that the 5-year interval recommended for HPV screening is even safer than the 3-year interval for cytology screening.” OVARIAN CANCER The association of body composition phenotypes before chemotherapy with epithelial ovarian cancer mortality A recent study, which shed light on how body composition at the time of diagnosis relates to mortality in patients with epithelial ovarian cancer, showed that overweight/obesity, sarcopenia/overweight-obesity, and sarcopenia/cachexia phenotypes were each associated with increased mortality in epithelial ovarian cancer and high-grade serous ovarian cancer (J Natl Cancer Inst 2024; https://doi.org/10.1093/jnci/djae112). The research team analyzed pre-chemotherapy clinical data and CT image-based body composition data from 500 epithelial ovarian cancer patients in the ongoing Body Composition and Epithelial Ovarian Cancer Survival (BComES) study. They classified four phenotypes: fit/reference (normal SMI/low adiposity; 16.2%), overweight/obese (normal SMI/high adiposity; 51.2%), sarcopenia/overweight-obese (low SMI/high adiposity; 15.6%), and sarcopenia/cachexia (low SMI/low adiposity; 17%). Multivariable Cox models were used to estimate associations of each phenotype with mortality for epithelial ovarian cancer overall and high-grade serous ovarian carcinoma (HGSOC). Data showed that overweight/obesity was associated with up to 51 percent and 104 percent increased mortality in epithelial ovarian cancer and HGSOC, according to the study authors, who also reported that sarcopenia/overweight-obesity was associated with up to 66 percent and 67 percent increased mortality in epithelial ovarian cancer and HGSOC, respectively. Additionally, there was an association between sarcopenia/cachexia and up to 73 percent and 109 percent increased mortality in epithelial ovarian cancer and HGSOC. AUTHOR COMMENTARY: “Our work, which accounts for both skeletal muscle mass and adiposity, shows no evidence of an overweight or obesity paradox when patients with low muscle mass are removed from the healthy comparison group,” stated principal investigator and senior author Rikki Cannioto, PhD, EdD, MS, Assistant Professor of Oncology in the Department of Cancer Prevention & Control at Roswell Park Comprehensive Cancer Center. “Rather, we show that epithelial ovarian cancer patients with any combination of high adiposity and/or low muscle had up to a twofold increased risk of mortality in comparison with patients with optimal muscle and low adiposity—a ‘fit’ phenotype, with the greatest increases in mortality seen in patients with high-grade serous ovarian cancer, the most common and fatal epithelial ovarian cancer tumor.” BREAST CANCER Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study Findings from a recent analysis suggest that women with high-risk breast cancer who are 65 years old or older and undergo chemotherapy are more likely to develop a significant decline in physical function (J Cancer Surviv 2024; doi:10.1007/s11764-024-01594-3). Researchers prospectively sampled three groups of patients aged 65 years and above. These cohorts included 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). They assessed physical function at baseline and 3, 4, or 6 months (timepoint 2) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. Data revealed that baseline PF-10 scores were similar across all groups. However, the study authors observed a significant decline at timepoint 2 among patients in the BC Chemo cohort, with a median change in PF-10 of -5. Comparatively, BC Control and NC Control groups showed a median change of 0. Results showed that over 30 percent of study participants who underwent chemotherapy had a substantial decline in PF-10 versus 8 percent in the BC Control and 5 percent in the NC Control arms. “The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes,” the study authors concluded. AUTHOR COMMENTARY: “We have previously shown that chemotherapy can contribute to a decline in physical function in breast cancer survivors, but it wasn't fully understood if the decline was primarily driven by the cancer, chemotherapy or both,” said first author Mina Sedrak, MD, Associate Professor of Medicine at the David Geffen School of Medicine at UCLA and Director of the Cancer and Aging Program at the UCLA Health Jonsson Comprehensive Cancer Center. “It's important to have this comparison to determine whether or not this decline represents an acceleration of the aging process itself.”

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