The Cancer Prevention and Control Program collaborates with numerous Mayo Clinic faculty researchers on defined research focus areas: cancer risk reduction, including chemoprevention, tobacco control and cancer early-detection research; and control of cancer symptoms and cancer survivorship.
Cancer risk reduction, including chemoprevention, tobacco control and cancer early-detection research
In 2003, program leaders Paul J. Limburg, M.D., M.P.H., and Charles L. Loprinzi, M.D., helped establish the Cancer Prevention Network, an interdisciplinary, multicenter clinical trial network that provides an infrastructure for conducting trials focused on improving quality of life through cancer prevention, particularly for diseases for which treatment still offers a relatively poor prognosis. The research base for the Cancer Prevention Network is at Mayo Clinic in Rochester, Minnesota.
Recent Cancer Prevention Network clinical trial results include:
- Demonstrating minimal effects from metformin as a chemopreventive agent for carcinogenesis associated with Barrett's esophagus.
- Creating the first-reported population pharmacokinetic model for sulindac, a nonsteroidal anti-inflammatory drug that is a candidate chemopreventive agent for multiple organs, which provides new insights into the factors that may affect the pharmacokinetics of sulindac and its metabolites in generally healthy trial participants.
- Identifying novel risk and response factors to better inform future prevention trials. For example, in breast cancer, researchers detected functional SNPs in ZNF423 that could plausibly modify or potentially reverse the chemopreventive effects of selective estrogen receptor modulators. Researchers also reported a link between atypical hyperplasia and breast cancer risk, and provided data suggesting that women with a family history of breast cancer or a personal history of benign breast disease could be targeted for aspirin chemoprevention studies.
Cancer risk reduction through tobacco control
Tobacco use continues to be the leading preventable cause of cancer in the United States. Program researchers are investigating novel tobacco avoidance and cessation strategies and the health consequences of smokeless tobacco and alternate nicotine delivery systems, such as electronic cigarettes, also called e-cigarettes.
Recent clinical trial results include:
- Demonstrating that varenicline is an effective treatment option for the population of smokers whose needs are not addressed by clinical guidelines recommending abrupt smoking cessation.
- Demonstrating that just one tobacco quit line coaching call delivered to a nonsmoker increased treatment enrollment among smokers.
- Demonstrating that a participant-initiated phone contact coupled with direct mail or opportunistic telephone referrals and financial incentives successfully connected low-income smokers to cessation services and encouraged quit attempts and continuous smoking abstinence.
- Demonstrating that when compared with placebo, eight weeks of high-dose (42 milligrams a day) nicotine patch therapy was safe and increased short-term tobacco abstinence rates among smokeless tobacco users who were using three or more cans or pouches a week.
- Demonstrating that a combination of nicotine lozenges and coaching was significantly better at facilitating tobacco abstinence than was either intervention alone.
- Demonstrating that e-cigarette use could reduce cigarette cravings and cigarettes used per day. Researchers also demonstrated that providers are discussing e-cigarettes with their patients. More effort is needed to characterize the role, if any, that e-cigarettes might play in facilitating smoking reduction or cessation.
Cancer risk reduction through early detection
Program researchers are actively engaged in developing novel cancer screening and surveillance biomarkers using tissue, blood and stool samples. Program members are also evaluating innovative imaging techniques to improve the detection of pre-neoplasia and early-stage malignancies.
Highlights of recent advances include:
- Demonstrating that telomeres from peripheral blood leukocytes are different in patients with polyps that become malignant than in those whose polyps do not progress to cancer. Telomeres may therefore have clinical value in adenoma risk assessment and management. Learn about predicting which colon polyps might transform to cancer.
- Demonstrating that islet-1, a transcription factor involved in the embryogenesis of islets of Langerhans, could be used as a biomarker for pancreatic neuroendocrine neoplasms.
- Demonstrating that the presence of polysomy detected with fluorescence in situ hybridization, in combination with histological findings, identifies patients with high-risk Barrett's esophagus who are most likely to develop esophageal adenocarcinoma.
- Demonstrating that background parenchymal uptake is a novel breast cancer risk factor.
- Finding that ultrasound-associated shear wave elastography arrival time contour has favorable performance characteristics for identifying malignant breast tumors.
- Showing that quantitative comb-push ultrasound shear wave elastography was able to distinguish between benign and malignant breast masses with high sensitivity and specificity.
- Demonstrating that vibro-acoustography, a newly developed imaging technology based on low-frequency vibrations induced in the object by the radiation force of ultrasound, can detect benign breast abnormalities with a performance comparable to that of mammography.
- Demonstrating that volumetric laser endomicroscopy, a new imaging technique that allows real-time, cross-sectional microstructure imaging to detect Barrett's esophagus, had a high level of agreement and accuracy when eight high-volume users reviewed a standard image set.
- Demonstrating that endocytoscopy had an acceptable level of diagnostic accuracy and excellent interobserver agreement in a small pilot study.
Control of cancer symptoms and cancer survivorship
Program researchers also focus on preventing, alleviating and better understanding symptoms that result from cancer or the treatment of cancer.
Research in this area has evaluated:
- Methods of preventing or alleviating mucosal injury
- Therapy for hormone-deprivation symptoms, such as hot flashes and sexual health, when hormonal treatment is contraindicated
- Treatment and prevention of chemotherapy-induced peripheral neuropathy
- Treatment of cancer anorexia and cachexia
- Methods of improving care for patients with cancer fatigue
- Treatment of aromatase inhibitor arthralgias
- Nasal vestibulitis
- Treatment and prevention of nausea and vomiting associated with cytotoxic therapy
- Treatment of thromboembolic disease
- Bone health
- Heart health
- Lymphedema prevention and treatment
Recent research advances include:
- Publishing the definitive manuscript on the use of intravenous calcium/magnesium for decreasing oxaliplatin-induced sensory neurotoxicity, showing that calcium/magnesium is not clinically helpful for decreasing oxaliplatin-induced neuropathy. The results of this work were readily translated into clinical practice.
- Demonstrating that olanzapine is an effective agent for decreasing nausea and vomiting in patients receiving highly emetogenic chemotherapy. This led to changes in national and international emetogenic guidelines.
- Demonstrating that the use of vaginal DHEA gel for the treatment of vaginal atrophy provided more favorable effects on vaginal cytology than did plain moisturizer and that it improved sexual function without affecting bone formation.
- Providing data to support nasal vestibulitis as an under-recognized and undertreated side effect of cancer treatment.
- Demonstrating that patients with lung cancer-associated bone metastases are at markedly increased risk of declining mobility when their metastases are expanding in size and increasing in number or are associated with pain or new neurological deficits.
- Demonstrating that among patients with lung cancer and brain metastases, cerebellar/brainstem location, new and expanding metastases, and treatment with whole-brain radiation therapy may predict severe, near-term mobility losses and indicate a need to consider rehabilitation services.
- Leading a study of 1,466 survivors of lung cancer that found clinically meaningful higher quality of life for those who were physically active.
- Providing phase II data demonstrating that scrambler therapy appears to decrease previously established chemotherapy-induced neuropathy symptoms.
- Providing phase II data demonstrating that topical cryotherapy appears to decrease the development of paclitaxel-induced neuropathy symptoms.