Cancer is one of the major public health problems in our society. It is estimated that more than 18 million new cases are diagnosed worldwide every year; 280,000 in Spain. Incidence in following a growing trend. This epidemic could be controlled with research into new treatments and, above all, with adequate prevention. Primary prevention could prevent avoid up to half of all cases. For many others, secondary prevention is essential, as it make diagnosis possible in the stages of the disease when it is easily curable. These guidelines present the scientific evidence regarding secondary prevention in tumors in which its use is well-accepted: breast, cervical, colorectal, prostate, lung, ovarian, melanoma, and gastric cancer.
PurposeThe current incidence of cancer in the world is 14 million cases in 2012, with a mortality rate of 8.2 million in that year. The incidence of cancer in Spain exceeds 215,000 cases a year, and survival rates are the highest when compared to those of our neighbouring countries. Among the reasons for the steady decrease in cancer mortality rates in Spain, two causes must be highlighted: the increasing efficacy of treatment and prevention measures. It is important evaluate the opportunity of early detection and prevention in these tumors. MethodsWe have reviewed the evidence published in the most prevalent tumors. The evidence levels described in this paper are based on the GRADE system.ResultsWe show the recommendations about primary and secondary prevention in breast cancer, cervical cancer, colorectal cancer, prostate cancer and lung cancer.ConclusionThe diffusion of these preventive tools can reduce the incidence of cancer and increase the number of early diagnostics in the most prevalent tumors.
e18513 Background: TNM staging is the most important prognostic factor in Non-Small Cell Lung Cancer (NSCLC). The MAPK pathway, including p38, JNK and ERK, has been slightly studied in NSCLC, with controversial prognostic significance. Methods: The records of 211 patients with stage I-II NSCLC, surgically resected at Asturias University Hospital between 2000 and 2004 were retrospectively reviewed. Formalin-fixed, paraffin-embedded histological tumour specimens were used to construct tissue microarrays. The nuclear level of phosphorilated p38alpha (nP-p38), JNK (nP-JNK) and ERK (nP-ERK) was assessed using inmunohistochemistry (IHC). Phosphorilated protein expression was considered positive if the staining was present in at least 100% of the nucleus studied. EGFR was also analyzed with IHC following previous studies and was considered positive (EGFR+) if staining was observed in >10% of the cells. Clinicopahological data and outcome differences in terms of overall survival (OS) were compared between positive and negative patients. Results: Patients with nP+ for p38, JNK or ERK had a trend to better OS than those respectively negative for each protein (HR=0.68, p=0.14; HR= 0.75, p=0.16; HR=0.64, p=0.14), and the difference was significative for nP-p38+ in adenocarcinoma histology (p=0.012). EGFR+ patients had worse OS than EGFR- (HR=1.59, p=0.02), but in nP-p38+ patients, those with EGFR+ tumors had similar survival than EGFR- (p=0.9). Fifteen patients were positive for the three MAPK (MAPK “Triple Positive”, MTP), and had better OS than the rest not MTP (HR=0.20, p=0.01). In the univariant analysis, stage, histologic grade, surgery (pneumonectomy vs lobectomy), EGFR status and MTP had significant influence on OS. Multivariant analysis only confirmed the stage as an independent factor (p=0.01). Conclusions: TNM staging remains the most important factor in the prognosis of NSCLC. The activation of the MAPK pathway, its interaction with EGFR, and the MTP feature might have prognostic influence in this tumor and warrant confirmation in a large prospective trial. The potential therapeutic implications of pharmacological manipulation of the MAPK pathway highlight the importance of this study.
e19034 Background: RFC is the major transport system in mammalian cells for folate cofactors and antifolate therapeutics. The aim of this study was to assess the predictive value of RFC expression in patients receiving pemetrexed for advanced NSCLC. Methods: The study was carried out in a population of 48 patients with advanced NSCLC which have received pemetrexed monotherapy in second and third line. RFC expression was assessed using a two-step model of immunohistochemical staining in paraffin-embedded tissue samples. Results: RFC expression was detected in 16 (33%) patients. In the global population, the median progression free survival (PFS) and the median overall survival (OS) were 3.3 and 6.5 months respectively. The subgroup of patients with expression of RFC had a tendency to better median PFS (4.5 vs 2.8 months; p=0.926) and median OS (11.7 vs 4.8; p=0.150). In patients with adenocarcinoma histology and RFC expression median OS after treatment with pemetrexed was 14.4 months versus 5.0 in those with adenocarcinoma but without RFC expression (p=0.039). Conclusions: These results suggest the possible relation between RFC expression and response to treatment with antifolates (pemetrexed) independently of the tumor histology. Further studies are required to confirm these results.
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