Infections with certain viruses, bacteria, and parasites have been identified as strong risk factors for specific cancers. To examine the link between infections and cancer, researchers performed a systematic analysis of the proportion of cancer cases attributable to infection in 2008. They used data on cancer incidence from the GLOBOCAN project along with epidemiological data regarding the causal effects of infection on cancer. The data included information on 27 types of cancer from 182 countries.

They found that of the 12.7 million new cancer cases that occurred worldwide in 2008, 16 percent—or roughly two million—were attributable to infections. The rate of infection-related cancer was about three times higher in developing countries. For example, 3.3 percent of cancers in Australia and New Zealand were infection related, whereas 32.7 percent of cancers in sub-Saharan Africa were attributable to infections. The four main infections associated with cancer were human papillomavirus, hepatitis C, hepatitis B, and Helicobacter pylori. These infections were responsible for approximately 1.9 million cancer cases in 2008, mainly gastric, liver, and cervical cancers.

Cervical cancer accounted for about half of the infection-related cancers in women. Liver and gastric cancers accounted for more than 80 percent of the infection-related cancers in men.  About 30 percent of infection-related cancers occurred in people younger than 50 years. It’s important to note that it takes decades of chronic infection before an infection progresses to cancer.

Based on the statistics, the researchers noted that approximately two million cancer cases each year might be preventable with better public health methods for preventing infection. In an accompanying editorial, Dr. Goodarz Danaei, an assistant professor of global health at Harvard School of Public Medicine in Boston, noted that vaccines for HPV and hepatitis B are effective and that increasing their availability should be a priority for higher risk countries.[2] He suggests that increasing vaccine coverage could reduce the global burden of cancer.

References:

Melanoma is a deadly type of skin cancer that arises from melanocytes, which are cells located in the upper layer of the skin that are responsible for producing pigment (skin color). Melanoma is more likely than other types of skin cancer to spread to other parts of the body. According to an editorial that accompanied the study in the Journal of Clinical Oncology, approximately 70,000 Americans were diagnosed with invasive melanoma in 2011, and about 43 percent of those were women.[2] There were approximately 8,800 melanoma-related deaths in 2011, of which only 35 percent were females.

Previous studies have observed that female melanoma patients tend to fare better than their male counterparts. To evaluate this notion, researchers from Europe analyzed follow-up data from nearly 2,700 melanoma patients enrolled in four phase III melanoma treatment trials conducted in Europe. All patients had been diagnosed with either stage I or stage 2 melanoma. Patients were tracked for disease remission, relapse, disease spread, and death.

The results indicated that women consistently had a survival advantage as well as a lower risk of metastasis (spread) when compared to men. Male melanoma patients were found to have worse disease characteristics at diagnosis and worse disease progression. In contrast, women had a 30 percent improved survival—meaning they were 30 percent more likely to survive—as well as a 30 percent lower risk of cancer spread to lymph nodes and other organs. This was true regardless of age, menopausal status, and subtype of cancer—with the only exception being head and neck melanomas, where gender differences disappeared.

The reasons for the gender differences are unclear, but the researchers speculate that their might be a biologic sex difference that causes the cancer to behave differently in men and women. They evaluated a number of possibilities, including estrogen levels, vitamin D metabolism, testosterone levels, and more—but the data could no prove or disprove any of these theories. Part of the gender difference could be the result of a somewhat true gender stereotype—women are more likely than men to detect skin changes early and see a doctor. Because early detection is critical in melanoma, this could mean a significant difference in survival.

Regardless of the reasons, the data remains—men tend to have worse outcomes with melanoma.

Reference:

How does cancer treatment affect fertility in men?

Chemotherapy: Chemotherapy can temporarily—and in some cases, permanently—stop sperm production by the testes.[1] The extent to which chemotherapy affects sperm production depends on several factors, including the type and dose of chemotherapy.

Radiation: Radiation to the abdomen or pelvis can also reduce or eliminate sperm production by the testes.

Surgery: Surgery that involves the removal of both testicles (an option for some men with prostate cancer) eliminates sperm production, but other types of surgery can also affect a man’s fertility. Some types of pelvic surgery, for example, can change or eliminate ejaculation.

Options for preserving fertility in men

Although many men are able to conceive naturally after cancer treatment, others are not.

If possible, men should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

Sperm banking is the most well-established method of preserving fertility in men.[2] It involves the collection and storage of sperm, ideally before cancer treatment begins. The samples are kept frozen at a lab or sperm bank until they are needed. Sperm can be stored in this way for many years. After being thawed, the sperm can be used for intrauterine insemination (IUI) or in vitro fertilization (IVF). During IUI, sperm are placed directly into a woman’s uterus. During IVF, mature eggs are removed from a woman’s ovary and mixed with the sperm in the lab. Embryos that result from IVF can then be placed in a woman’s uterus or frozen for later use.

If a sample contains very few viable sperm (or if a man has already undergone cancer treatment and has a low sperm count), another approach may be used to fertilize an egg. Intracytoplasmic sperm injection (ICSI) requires only a small number of healthy sperm, along with mature eggs that have been collected from a woman’s ovary. A single sperm is injected directly into each egg. The embryos that develop can then be placed in a woman’s uterus or frozen for later use.

If it is not possible to collect sperm from ejaculate, it may in some cases be possible to collect sperm directly from the testicles. This approach is still investigational.

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. During radiation therapy, for example, it may be possible to shield the testes in order to preserve sperm production.

Pregnancy after cancer

In the event that your fertility is not affected by cancer treatment (or recovers quickly or unexpectedly), you and your partner should use birth control if you do not wish to have a child. If you are trying to conceive a child naturally, your doctor may advise you to wait for several months after treatment; this allows for the elimination of sperm that may have been damaged during treatment.

In general, the risk of birth defects in children born to cancer survivors appears to be similar to the risk in the general population.[3] If your cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), your children may inherit the gene mutation responsible for your family’s increased risk of cancer. Talking with a genetic counselor may be helpful.

Other options for parenthood

Not all men have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all men will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for men who want to father a child but cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, you may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Donor Sperm: Donor sperm is readily available from sperm banks and can be used for either intrauterine insemination or in vitro fertilization.

Individual decisions within a larger community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.  To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More information?

Discuss with others…. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

How does cancer treatment affect fertility in women?

Chemotherapy: Many chemotherapy drugs are toxic to the egg cells (oocytes) in the ovaries. If the number of remaining oocytes in the ovaries reaches a critically low point during treatment, women experience “acute ovarian failure.” This means that the ovaries stop functioning during or shortly after cancer treatment. If oocytes are lost during treatment but do not reach this critically low point, women are at risk for early menopause but may still be able to get pregnant for some time after treatment.

Radiation: Radiation to the pelvis can also destroy oocytes. Radiation to the pelvis can also affect uterine growth and blood flow, particularly if received before puberty.[1] A poorly developed uterus may make a woman more likely to have a miscarriage, or more likely to have a preterm or low-birthweight infant.

Surgery: Some cancers require surgical removal of the uterus, the ovaries, or both.

The effects of cancer treatment on fertility can vary substantially by age. Younger women, who have a larger pool of oocytes when they start cancer treatment, are more likely than older women to be able to get pregnant after treatment.[2]

Options for preserving fertility in women

If possible, women should talk with their doctor about their future fertility before beginning cancer treatment. Some options for preserving fertility require that steps be taken before cancer treatment begins.

One of the most established approaches for preserving fertility among female cancer patients is embryo freezing.[3] Before starting cancer treatment, a woman would be given hormones to stimulate the development of eggs in her ovaries. Mature eggs would be removed and fertilized with the sperm of her husband, partner or a sperm donor. The embryos that result from these fertilized eggs would be frozen for later use.

Although embryo freezing is an established approach to helping women become pregnant after cancer, there are downsides. A woman may not currently have a male partner and may be unwilling to use an anonymous sperm donor. It’s also important to be aware that embryo freezing takes approximately two weeks after the start of a woman’s period. If a woman needs to begin cancer treatment immediately, she may not be able to go through this process. Finally, this approach is only an option for women of childbearing age; stimulating the ovaries to produce mature eggs is not an option for girls who develop cancer during childhood.

Several other options are still in the experimental phase. One approach being explored is the freezing of unfertilized eggs.3 Once again, the ovaries would be stimulated to produce mature eggs before cancer treatment begins. The eggs would then be frozen without being fertilized by sperm. Currently, freezing unfertilized eggs is less likely to result in pregnancy than freezing embryos, largely because unfertilized eggs are less likely than embryos to survive the process of freezing and thawing. Nevertheless, it may be an option for women who do not have a male partner at the time of their cancer diagnosis, and it avoids the difficult issue of what to do with unused embryos.

Another promising but still experimental approach is to freeze all or a part of an ovary before cancer treatment.[4] After treatment, the ovarian tissue is implanted either back in the woman’s pelvis or in another location (such as under her skin). If this process is successful, the ovarian tissue will begin producing eggs. A safety concern with this approach is the possibility of reintroducing cancer cells along with the ovarian tissue, and the tissue will need to be carefully screened for cancer before it is transplanted.4

Finally, it may also be possible to modify some cancer treatments to minimize their effects on subsequent fertility. For example, shielding the ovaries during radiation, or moving the ovaries out of the radiation field, may protect them from the effects of radiation. Scientists are also exploring whether using drugs to suppress the activity of the ovaries during chemotherapy will make the ovaries less susceptible to damage by chemotherapy.[5] For women with certain types of cervical or ovarian cancer, fertility-preserving surgery may also be an option.[6] It’s important to understand that only specific subsets of patients will be candidates for these approaches, and that some of the methods are still in the early stages of evaluation.

Pregnancy after cancer

In addition to having concerns about their ability to get pregnant, women may have concerns about whether pregnancy after cancer treatment will be safe for themselves and their children. While there is a limited amount of information about these topics, the news is generally good.

The risk of cancer recurrence during or after pregnancy has been most studied in women with breast cancer, and these studies generally have reported that pregnancy does not increase the risk of breast cancer recurrence. [7] Many doctors, however, suggest waiting for a period of time after treatment before becoming pregnant. [8]

If chemotherapy or radiation therapy has damaged her heart or lungs, a woman may also have concerns about the strain that pregnancy will put on her body. Studies of breast cancer survivors suggest that long-term heart problems are uncommon after chemotherapy or radiation therapy, [9] but a woman may wish to talk with her doctor about her current health status and the likely effects of pregnancy.

Children born after their mother’s cancer treatment do not appear to be more likely than other children to have birth defects or cancer.[10] If a woman’s cancer was due to a hereditary cancer syndrome, such as Lynch syndrome (hereditary nonpolyposis colorectal cancer), her child may inherit the gene mutation responsible for her family’s increased risk of cancer. Talking with a genetic counselor may help clarify the child’s risk.

When planning for pregnancy, be aware that some cancer treatments may cause you to have an early menopause even if your periods resume after treatment. Also be aware that you may be capable of conceiving even if your periods do not resume; continue to use birth control if you do not wish to become pregnant.

Other Options for Parenthood

Not all women have the luxury of being able to explore their reproductive options before beginning cancer treatment, and not all women will find a fertility preservation option that meets their needs. But there are still ways to become a parent. Discussion of other routes to parenthood may be a painful topic for women who want to become pregnant and cannot. But as cancer survivors consider how best to build their families, methods such as adoption are important options.

Adoption: Couples and individuals who wish to adopt have a range of options, including different types of domestic and international adoptions. You may wish to start by learning about the adoption laws in your state and by talking with other adoptive parents about the professionals and agencies they worked with. Before selecting an adoption agency, women may wish to talk with them about their attitudes toward placing a child with a cancer survivor. Many agencies will be receptive toward this, but it’s important to know before making a final decision.

Egg Donation: Women who still have a uterus may be able to become pregnant using an egg donated by another woman. Through in vitro fertilization, the donated egg would be fertilized by the cancer survivor’s male partner or a sperm donor, and implanted in her uterus. Alternatively, another couple may donate a frozen embryo that could be implanted in her uterus.

Gestational Carrier or Surrogate: Women who do not have a uterus, or who are otherwise unable to sustain a pregnancy, may be able to have another woman carry a pregnancy for them. If the cancer survivor has functioning ovaries, her own egg can be fertilized by her male partner’s sperm and transferred to the uterus of another woman. In this case, the woman who carries the pregnancy is known as a gestational carrier. If the cancer survivor does not have functioning ovaries, another woman can both donate an egg and carry the pregnancy. This is the arrangement traditionally known as surrogacy.

Individual Decisions Within a Larger Community

The decisions that you make about building a family (or about coming to terms with not building a family) will be intensely personal, but know that you are part of a larger community of patients and healthcare providers who are grappling with these issues.

To think about future parenthood is to think about life after cancer. For many people with cancer, planning for the future may provide the motivation needed to get through treatment.

More Information?

Discuss with others….. http://cancerconnect.com/groups/young-adults/topics/fertility-after-cancer-treatment

Fertile Hope (www.fertilehope.org) provides a range of fertility resources for people with cancer.

References:

A growing body of evidence suggests that aspirin may reduce the risk of several types of cancer, with particularly strong evidence for colorectal cancer. Not all studies have found a benefit, however, and any potential benefits of aspirin must be weighed against risks such as bleeding.

To further explore the relationships between daily aspirin and cancer, researchers conducted a combined analysis of 51 previous randomized trials.[1] The trials were originally designed to evaluate the effect of daily aspirin on outcomes such as heart disease, but information about cancer was also available.

• Daily aspirin reduced cancer deaths. After five years, aspirin users had a 37 percent reduction in risk of cancer death.
• Aspirin also reduced the likelihood of developing cancer. From three years onward, aspirin users had a 24 percent reduction in the risk of being diagnosed with cancer.
• As expected, aspirin carried a risk of major bleeding, but this risk appeared to diminish over time.

Another study published in the same issue of The Lancet evaluated the effect of daily aspirin on cancer metastasis (the spread of cancer from its original site to other parts of the body). The study focused on 987 people who were diagnosed with cancer while participating in one of five trials of aspirin use. Those who were taking aspirin were less likely to have metastatic cancer than those who were not taking aspirin.[2]

These results suggest that regular aspirin use may reduce cancer incidence and mortality, but concerns remain about the risks of regular aspirin use in healthy individuals. People who are considering using aspirin on a regular basis are advised to discuss the risks and benefits with their physician.

References:

Of the more than one million new diagnoses of skin cancer each year, roughly 68,000 involve melanoma. More than 8,000 people die of melanoma each year in theUnited States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to spread (metastasize) to other parts of the body.

In order to provide more individualized and more effective cancer therapy, much research has been focused on determining specific pathways involved in cancer cell growth or survival. The BRAF gene is known to play a part in cell growth, and mutations in BRAF are common in several types of cancer. Approximately half of all melanomas carry a specific BRAF mutation known as V600E. Zelboraf targets this mutation, and was approved in 2011 for treatment of certain patients with advanced melanoma that carries the V600E mutation.

To further evaluate Zelboraf in the treatment of advanced melanoma, researchers conducted a Phase II clinical trial among 132 patients with previously treated metastatic melanoma. The study was restricted to patients with melanomas that carried the V600E BRAF mutation. All study participants were treated with Zelboraf.

• 53 percent of patients had a response to treatment (a reduction in detectable cancer)
• Median progression-free survival (survival without a worsening of the cancer) was 6.8 months.
• Median overall survival was almost 16 months. This is better than the 6- to 10-month median survival that was seen in the past among patients with metastatic melanoma.
• The most common side effects of treatment were joint pain, rash, sensitivity to light, fatigue, and hair loss.
• Squamous cell skin cancer was diagnosed in 26 percent of patients. Increased rates of squamous cell skin cancer have also been reported in other studies of Zelboraf, and patients should be aware of this risk. Squamous cell skin cancer usually does not spread to other parts of the body and can be treated with surgery.

These results provide additional evidence that Zelboraf improves outcomes among patients with advanced melanoma that carries a V600E BRAF mutation.

Reference: Sosman JA, Kim KB, Schuchter L et al. Survival in BRAF V600-mutant advanced melanoma treated with vemurafenib. New England Journal of Medicine. 2012;366:707-714.

By Mia James

Melanoma is considered the deadliest form of skin cancer. Survival rates for melanoma fall dramatically once the disease has spread to other parts of the body; and because melanoma is able to spread more proficiently than other skin cancers, it’s particularly dangerous. Given the lethal nature of the disease, effective forms of treatment are greatly needed.

Quite a Breakthrough

“It’s been almost 20 years since we’ve had new drugs that proved [to be effective] in melanoma,” says Lynn N. Schuchter, MD, an official with ASCO’s Cancer Communications Committee and division chief of hematology/oncology at the Abramson Cancer Center of the University of Pennsylvania. The emergence of new therapies is particularly exciting news in the melanoma research community, where promising treatments have been limited. “We really haven’t had a very effective therapy for this disease,” Dr. Schuchter explains.

The development of two new treatments marks significant progress. “Really, what’s so exciting is that it’s sort of unprecedented to have two new approaches at the same time that are really beneficial for patients [with advanced melanoma],” says Dr. Schuchter. “This is quite a breakthrough.”

These two significant advances involve drugs that fight melanoma in two distinct ways. One drug, vemurafenib, is a targeted therapy that’s directed at a specific gene mutation associated with melanoma; the other, Yervoy, is an immunotherapy, a treatment to boost the immune system.

According to Paul B. Chapman, MD, of Memorial Sloan-Kettering Cancer Center in New York, the principal investigator on the recent trial of vemurafenib, there’s been plenty of room for improvement in the treatment of advanced melanoma. “The standard had been chemotherapy,” he says, “which can shrink melanoma in about 10 to 15 percent of patients but has never been shown to improve overall survival of patients in general.”

On Target: Vemurafenib

“In about 50 percent of melanomas, there’s a mutated or activated gene called BRAF,” Dr. Schuchter explains. The BRAF gene is known to play a part in cell growth, and mutations in BRAF are common in several types of cancer. The specific BRAF mutation associated with melanoma is known as V600E. By targeting this mutation, vemurafenib is able to shut down the pathway and reduce the size of the melanoma, which can extend a patient’s survival. “This,” she says, “is really quite a dramatic response in patients with advanced melanoma, and it has improved overall survival.”

Dr. Chapman’s Phase III trial of vemurafenib compared the drug’s performance with that of the chemotherapy drug DTIC (dacarbazine) among 675 patients with previously untreated, inoperable Stage IIIC or Stage IV melanoma. All patients had a V600E mutation in the BRAF gene. Patients who received vemurafenib experienced improved overall and progression-free survival compared with those treated with chemotherapy: overall survival was improved by 63 percent and progression-free survival by 74 percent.1

The immediate next step for vemurafenib, says Dr. Chapman, is approval by the US Food and Drug Administration (FDA). He explains that to ensure appropriate treatment, testing for the BRAF mutation must become standard among all patients diagnosed with metastatic melanoma. “This,” he says, “is going to be an important sea change in the evaluation of melanoma—and it’s long overdue.” Furthermore, Dr. Chapman explains that continued clinical trials are “critical” and will need to investigate such issues as a lack of response among some patients, a tendency to develop resistance among some, and the effects of combining vemurafenib with other drugs.

Revving Up the Immune System: Yervoy

“Immunotherapy,” says Dr. Schuchter, “is a therapy to rev up the immune system,” which is how Yervoy fights advanced melanoma. Approved by the FDA in March 2011, Yervoy has extended survival in two studies among patients with advanced melanoma.

Yervoy targets a molecule known as CTLA4, which is found on the surface of T-cells and is thought to inhibit immune responses. By targeting this molecule, Yervoy may enhance the immune system’s response to tumor cells.

“A large study was presented at ASCO [2011] that showed that ipilimumab [Yervoy] could prolong survival in patients with advanced melanoma,” Dr. Schuchter says. In this study researchers evaluated the combination of Yervoy and the chemotherapy drug DTIC for the initial treatment of advanced melanoma. The Phase III clinical trial included 502 patients with Stage III or Stage IV melanoma that could not be surgically removed. Overall survival was better in the group that received Yervoy: three-year overall survival was 20.8 percent among patients treated with chemotherapy plus Yervoy compared with 12.2 percent among patients treated with chemotherapy alone.2

This current study provides additional evidence that Yervoy is active against advanced melanoma and can improve overall survival. A study presented at ASCO in 2010 also indicated that Yervoy could improve outcomes in advanced melanoma.3

What’s Next for Melanoma Treatment?

Though these new therapies for advanced melanoma are encouraging, according to Dr. Schuchter there’s much progress still to be made and exciting possibilities on the horizon. The recent advances with vemurafenib and Yervoy stand to launch yet more significant research. “There’s a lot of momentum to build upon these results,” she says. For example, future studies that combine immunotherapy with targeted therapy as well as evaluate new combinations of targeted therapy could further change the outlook for patients with melanoma. It will also be important to find ways to identify patients who are the best candidates for these therapies so that the greatest number will benefit. As well, continued investigation into gene mutations in melanoma could yield additional targeted therapies. “BRAF is just one of the genes that can be broken [mutated] in melanoma,” Dr. Schuchter says, making the case for expanding the targeted-therapy arsenal.

Earlier, effective treatment for melanoma is also called for, says Dr. Schuchter, as these recent breakthroughs are specific to advanced disease but haven’t been tested in early stages. “Studies will be looking at whether we can apply these therapies earlier and increase the percentage of patients who are cured of melanoma,” she explains. One goal is to increase the chance of cure by treating the disease before it metastasizes.

Early treatment is made possible by early detection, which is another area in which Dr. Schuchter foresees progress. This includes, she says, methods to identify moles that have the potential to become melanoma before they are cancerous. This will require new diagnostic technology that can detect melanoma before skin changes become visible to the human eye.

With such significant progress in melanoma treatment in 2011, there’s ample reason to look forward to more breakthroughs in coming years. “There’s a lot of enthusiasm in the field,” Dr. Schuchter says of the future of melanoma research.

References

1. Chapman PB, Hauschild A, Robert C, et al. Phase III randomized, open-label, multicenter trial (BRIM3) comparing BRAF inhibitor vemurafenib with dacarbazine (DTIC) in patients with V600E BRAF-mutated melanoma. Paper presented at: 47th Annual Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. Abstract LBA4.

2.  Wolchok JD, Thomas L, Bondarenko IN, et al. Phase 3 randomized study of ipilimumab (IPI) plus dacarbazine (DTIC) vs. DTIC alone as first line treatment in patients with unresectable Stage III or IV melanoma. Paper presented at: 47th Annual Meeting of the American Society of Clinical Oncology; June 3-7, 2011; Chicago, IL. Abstract LBA5.

3. O’Day S, Hodi FS, McDermott DF, et al. A phase III, randomized, double-blind, multicenter study comparing monotherapy with ipilimumab or gp100 peptide vaccine and the combination in patients with previously treated, unresectable Stage III or IV melanoma. Paper presented at: 46th Annual Meeting of the American Society of Clinical Oncology; June 4-8, 2010; Chicago, IL. Abstract 4.

One Patient’s Story

With her strawberry-blond hair and blue eyes, Grace Guckin of Pennsburg, Pennsylvania, knows that she fits one of the higher-risk profiles for skin cancer. But the real awareness of her risk hit the 20-year-old hard when she was diagnosed in 2010 with Stage IIIA melanoma. Even with her pale complexion, Grace, a student at Pennsylvania College of Technology, was stunned when what she thought was a wart on her foot turned out to be melanoma. “I was completely shocked,” she says. “I had no idea at all.”

But looking back on her previous tanning practices, Grace now sees that her behavior was risky. “I never wore sunscreen,” she says. “Or if I did, I would never reapply.” And seeking to brown her ivory skin, Grace admits to lots of time in the sun and a history of frequent sunburns.

Grace had surgery to remove the cancerous spot on her foot in the spring of 2010 as well as a sentinel lymph node biopsy to determine whether the melanoma had spread to her lymph nodes. The biopsy turned up positive for lymph node involvement, so she underwent another surgery to remove about 13 nodes from her left groin.

Treatment followed with interferon, an FDA-approved therapy for patients with Stage III, lymph node–positive melanoma. Interferon stimulates the immune system to help fight cancer but is also associated with some difficult side effects. “I did have a couple of setbacks during the year,” Grace says. These included cellulitis (a skin infection), occasional severe back pain, and flulike symptoms.

Now, having experienced a cancer diagnosis and undergone a difficult year of treatment, Grace has transformed her attitude toward tanning and sun protection—or lack thereof. “Just don’t do it!” she says, noting that not only cancer but the long-term cosmetic effects of sun damage are not worth the temporary bronzing. Grace now wears high-SPF (sun protection factor) sunscreens and lotions daily, which she makes sure she reapplies.

In addition to sun-safety advice, Grace has an encouraging message for others who face a melanoma diagnosis: “Talk to people who have gone through it.” Grace adds that looking for stories of survival helped her stay optimistic, as did finding a solid support system. “You have to talk to the people around you who are always going to be there for you and love you and give you positive thoughts.” Finally, Grace says, as treatment progresses, people with melanoma have plenty of promising treatment options. “There’s so much more technology and different treatments out there right now.”

Tanning Beds: Not a Safer Alternative

According to Dr. Schuchter, recent data show that there is a rising incidence of melanoma among young women, which may be related to tanning salons. Tanning beds, she says, “are not a safe way to get a tan.” Because UV radiation is a known carcinogen, any type of exposure, natural or artificial, is dangerous.

Of the more than one million new diagnoses of skin cancer each year, roughly 68,000 involve melanoma. More than 8,000 people die of melanoma each year in the United States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to spread (metastasize) to other parts of the body.

In order to provide more individualized and more effective cancer therapy, much research has been focused on determining specific pathways involved in cancer cell growth or survival. The BRAF gene is known to play a part in cell growth, and mutations in BRAF are common in several types of cancer. Approximately half of all late-stage melanomas carry a specific BRAF mutation known as V600E. Zelboraf blocks the function of the protein produced by this mutated gene and inhibits cell growth.

Patients treated with BRAF inhibitors such as Zelboraf have been reported to have high rates of secondary squamous cell skin cancers. To understand the reasons for this, researchers evaluated tumor samples from melanoma patients who had developed squamous cell carcinoma during treatment with Zelboraf.

• Roughly 60 percent of the secondary squamous cell carcinomas had a mutation in the RAS gene. These RAS mutations are thought to be the result of prior skin damage from sun exposure. Zelboraf appears to accelerate the development of squamous cell carcinoma in skin cells with a preexisting RAS mutation.

Researchers are now exploring the use of a second type of drug in combination with Zelboraf; the goal is to preserve the effectiveness of Zelboraf against melanoma while also reducing the occurrence of secondary skin cancers.

Reference: Su F, Viros A, Milagre C et al. RAS mutations in cutaneous squamous-cell carcinomas in patients treated with BRAF inhibitors. New England Journal of Medicine. 2012;366:207-15.

Of the more than one million new diagnoses of skin cancer each year, roughly 68,000 involve melanoma. More than 8,000 people die of melanoma each year in the United States. What makes melanoma so dangerous is that it is more likely than other types of skin cancer to spread (metastasize) to other parts of the body.

Factors that increase the likelihood of developing melanoma include sun exposure and fair skin. To explore whether people with a history of cancer are more likely to develop melanoma, researchers collected information from a large US cancer database (the Surveillance, Epidemiology, and End Results database).

• Having an initial diagnosis of melanoma before the age of 45 increased the risk of a subsequent diagnosis of melanoma by almost 12 times. Certain other cancer diagnoses before the age of 45 were linked with a smaller increase in melanoma risk. These other cancers were nonepithelial skin cancer, Kaposi sarcoma, female breast cancer, and lymphoma.
• Having an initial diagnosis of melanoma after the age of 45 increased the risk of a subsequent diagnosis of melanoma by more than 8 times. Other cancers that were linked with a smaller increase in melanoma risk were nonepithelial skin cancer, ocular melanoma, female breast cancer, prostate cancer, thyroid cancer, lymphoma, and leukemia.

These results suggest that certain groups of cancer survivors may be at increased risk of melanoma. Risk of melanoma is particularly high for people who have already had a first diagnosis of melanoma, highlighting the importance of ongoing skin surveillance in this group.

Reference: Yang GB, Barnholtz-Sloan JS, Chen Y, Bordeaux JS. Risk and survival of cutaneous melanoma diagnosed subsequent to a previous cancer. Archives of Dermatology. 2011;147:1395-1402.