american society of preventive oncology 1 7th...

Vol. 2, 499-504, September/October 1993 Cancer Epidemiology, Biomarkers & Prevention 499

Meeting Report

American Society of Preventive Oncology 1 7th Annual Meeting

Elizabeth 1. H. Fontham and Pelayo CorreaDepartment of Pathology, Louisiana State University Medical Center, New

Orleans, Louisiana 70112

The 1 7th Annual Meeting of the American Society of Pre-ventive Oncology, hosted by President Thomas Moon (Uni-vensity ofAnizona, Tucson, AZ), was held in Tucson, Arizona,March 20-23, 1 993. Barbara Rimer (Duke University Com-prehensive Cancer Center) chained the 1 993 Program Com-mittee.

A New Investigators Workshop was conducted at thisyear’s ASPO1 meeting for the first time. Eight pnedoctonal andpostdoctoral trainees were selected from numerous appli-cants to describe their research projects to the other traineesand to the workshop faculty. The presentation and discus-sions proved to be an excellent opportunity to review thescope, design, and research problems as well as networkingwith fellow preventive oncology trainees from across the

country. The workshop was organized by Alfred I. Neugut(The Columbia University College of Physicians and Sun-geons). The faculty included David Albents (University ofArizona Cancer Center), Mary Daly (Fox Chase Cancer Cen-ten), Barbara Rimem, and Victor Vogel (M.D. Anderson CancerCenter). Tom Moon, President of ASPO, also attended andparticipated. The workshop was followed by a joint meetingof NCI cancer prevention fellows and preventive oncologyawardees led by Douglas Weed (National Cancer Institute).

The Diet and Cancer Study Group was chaired by LarryKushi (University of Minnesota) and focused on the epide-miological evidence of a protective effect of fruit and veg-etable consumption and methodological issues relevant tofood frequency questionnaires. Alan Knistal (University ofWashington) suggested that the larger the number of mdi-vidual fruits and vegetables included in the food frequencylist, the greaten the likelihood of ovemmeporting intake. Theinclusion of 6 summary questions (how often do you eatvegetables not counting salad and potatoes, fruits not count-ing juice, green salad, fruit juice, french fries, and potatoes?)provides a mechanism to correct for ovenmeporting. The needfor a cancer control study section at NCI was expressed, andit was suggested that ASPO pursue the matter.

The Tobacco Study Group, chaired by C. Tracy Orleans(Fox Chase Cancer Center), held a workshop on motiva-tional interviewing conducted by William R. Miller, a clini-cal psychologist (University of New Mexico). It focused onbrief intervention as an instrument in modifying behavior.Miller developed this concept mostly from experience with

Received 5/1 0/93; revised 6/1 4/93; accepted 6/23/93.I The abbreviations used are: ASPO, American Society of Preventive Oncol-

ogy; NCI. National Cancer Institute; PSA, prostate-specific antigen; BCPT,breast cancer prevention trial; QL, quality of life; RA, retinoic acid; PHC,primary hepatocellular carcinoma; BrdU, bromodeoxyuridine; PCNA, pro-liferating cell nuclear antigen.

alcohol addiction. Rather than prolonged psychotherapy, al-cohol addicted subjects in the studies reported had one shortinterview. The technique is based on 5 principles: (a) Expressempathy. By reflective listening and understanding the nor-mal ambivalence of the subject, the interviewer strives tofacilitate behavioral change. (b) Develop self-awareness ofthe consequences of the habit. The client should presentarguments for change, verbalize his/hen internal conflicts

and the awareness of the consequences of his/hen behavior.(c) Avoid argumentation. This is antithenapeutic; resistanceis a signal to change strategies; labeling should be avoided.

(d) Roll with resistance. This is a “judo” technique to let thesubject use his/hen own reasoning to change perceptions. (e)Support self-efficacy. A menu of possible alternatives forchange should be available, butthe subject is responsible forchoosing and carrying out personal change. The discussion

centered around the applicability of the brief motivationalinterview technique to tobacco addiction, which has simi-lanities and differences with alcohol addiction, using (i.e.,

doctors and nurses) trained to utilize BMI.The Cancer Risk Algorithm Study Group reviewed po-

tential applications for cancer risk algorithms: communica-tion with the general public on causes ofcancen; facilitation

of public health interventions; counseling individuals; pre-ventive practices; and facilitation of research into etiologyand prevention. Reducing the number of interview variablesto a limited number of targeted variables requiring 5 to 10mm would have the potential to improve the efficiency ofstudies in which biomankers are increasingly receiving at-tention. Presentations were made by George Roush (CancerPrevention Research Cancer Center), chairperson of themeeting, Cohn Begg, and Zuo-Feng Zhang (Memorial Sloan-Kettering Cancer Center) on the assessment of risk in mo-leculan epidemiological studies; Marianne Berwick (CancerPrevention Research Institute), on study design to test pre-

diction of cancer from reproductive variables in two cohortsstudies; Lui Ping Zhao (University of Hawaii at Manoa), onassessing familial aggregation of cancer via population-based sampling; Brenda Breuer (Strang Cancer PreventionCenter), on two risk prediction models in women with afamily history ofbreast cancer with application to the registryfor women at high risk of breast cancer; and David Schot-tenfeld (University of Michigan), who discussed neproduc-tive, familial, and lifestyle risk factors common to breast,ovarian, and endometnial cancers.

Kathy Helzlsouen (Johns Hopkins University) began theWomen’s Cancers Study Group session with a report on arecent international workshop on mammography screeningi n younger women, which also included evaluation of breast

self-examination. Discussion included a suggestion that inthe United States a clinical trial of mammography versus

mammography plus breast self-examination in women un-den 50 years of age might be warranted given equivocalfindings in this younger group. Virginia Ennsten (University of

California-San Francisco) urged that ASPO be a participant

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50(.) Meeting Report: 1 7th Annual Meeting of ASPO

in the development of a consensus recommendation. Shepointed out the high proportion of false positives and me-suIting costs to women under 50 years ofage. Barbara Rimemnoted that the effectiveness of mammography in womenaged 50-69 years has been clearly demonstrated in many ofthese trials and that these are the women who most need tobe reached. This discussion was followed by presentation ofthree outreach programs utilizing community health work-ens in undemsenved populations. Gilbert Fniedell (Universityof Kentucky) led this discussion. Programs are ongoing ineastern Kentucky, Los Angeles, and Tucson, using indig-enous women from the community as intermediates be-

tween the community and health cane providers. RoshanBastani (University ofCalifonnia-Los Angeles) and Joel Meis-ten (University of Arizona) discussed programs in Los An-geles County and Tucson, respectively. The success of theseprograms is strongly suggested by high levels of adherence

to recommendations for Pap and mammography screening.The Chemoprevention Study Group was dedicated

to a discussion of the Prostate Cancer Prevention Study(PROSCAR) to be launched soon by NCI. Rodgen Winn

(M. D. Anderson Cancer Center) briefly described the studywhich plans to recruit 1 8,000 subjects over 3 years to befollowed for a total of 7 years. The active agent will be Fin-astenide, which blocks the enzymatic conversion of testos-terone to its more active metabolite dihydnotestosterone.Subjects 55-70 years old with normal digital rectal exami-nation and normal levels of PSA will be randomized to Fin-astenide or placebo and followed up annually with digitalrectal examination and PSA assays. Prostate biopsies will be

performed on all men 7 years after initiation. Ellen Gnitz(UCLA Jonsson Comprehensive Cancer Center) discussedthe strategies for recruitment and emphasized the need toinclude African Americans because ofthein higher mortalityrates from prostate cancer. Difficulties with recruitment andadherence are anticipated because approximately 5% of thesubjects on Finastenide report sexual dysfunction. Anotherproblem is thatthe intervention may interfere with observingthe end point, which is histologically proven carcinoma.Subjects on the active agent are expected to develop lowerPSA levels and smaller prostates, which will influence thefrequency of prostate biopsies and, therefore, the chances ofdiagnosis. Lessons from the tamoxifen trials and their impacton recruitment of African Americans were discussed, suchas avoiding mass media publicity, avoiding the word “me-search” (emphasize “clinical study”), and utilization ofgroups and individuals who have gained thetnust ofthe com-munity.

Victor Vogel chained a symposium on: A Breast CancerPrevention Tria! (BCPT): Conduct, Concerns and A!ternate

Strategies. Carol Redmond (University of Pittsburgh) pre-sented the design and rationale for the trial. The four primaryobjectives are to evaluate the effect of tamoxifen on: (a) in-vasive breast cancer incidence and mortality; (b) coronaryheart disease mortality; (c) incidence of bone fractures; and(d) toxicity and side effects of tamoxifen. She reported thatrecruitment is approximately 3% ahead of schedule in the2-year recruitment period which has a goal of 16,000women. Few minority women are being enrolled, however.Vogel next described the recruitment strategy used at M.D.Anderson Cancer Center, based on media publicity and me-cruitment letters sent to women with at least one first-degreerelative with breast cancer and to women with a history oflobular carcinoma in situ. The greatest barriers to recruit-

ment in this population were cost (2i%), followed by theneed to stop estrogen replacement and concerns about tox-icity of tamoxifen. Richard Love (University of Wisconsin)discussed the potential for differential effects oftamoxifen onpnemenopausal and postmenopausal women in the BCPT,given the major hormonal shifts observed in only premeno-pausal women. He suggested that the biological rationaleand clinical evidence for tamoxifen intervention are bothpoorly defined and limited in premenopausal women.Evaluation of QL of women enrolled in the BCPT was de-scnibed by Patricia Ganz (University of California School ofMedicine-Sepulveda), including physical, emotional, and

general well-being, subjective symptoms, depression, andsexual function. The baseline evaluation indicates thatwomen in the study sample have a high level of physical and

social functioning, and general health perception sconesabout 20 points higher than the general population. Thebaseline data demonstrate the feasibility of assessing QL inthis trial. Inclusion of QL measures should be helpful in thetotal evaluation of the effects of tamoxifen in healthywomen. Leslie Bernstein (University of Southern California

School of Medicine) discussed two alternative strategies forthe prevention of breast cancer: (a) increased physical ac-tivity; and (b) treatment with an oral contraceptive that con-tains a gonadotnopic releasing hormone agonist. Reductionsin risk of breast cancer have been demonstrated amongwomen with high levels of energy expenditure during theS-year period after menarche and also at age 25. Bernsteinalso discussed the work of hem colleague Malcolm Pike (Uni-vemsity of Southern California) who is conducting a small (n

= 1 9) randomized trial of a prototype contraceptive (GnRHagonist + low dose estrogen + progestogen every 4 months).The hypothesis is that maintaining estrogen at low but physi-

ological levels will reduce risk of breast cancer.President Tom Moon welcomed participants to the an-

nual meeting and presented the ASPO DistinguishedAchievement Award to Joseph F. Fraumeni, Jr., (NationalCancer Institute) for his remarkable contributions to cancerepidemiology and for his role as a founder and past presidentof ASPO. Dr. Fraumeni traced the origins of ASPO in hisaddress and then discussed two types of cancer clusters,geographic and genetic, which have given direction to stud-ies that have greatly expanded our understanding ofthe eti-ology of many cancers. He emphasized the benefits of in-tendisciplmnany collaboration between epidemiologists,clinicians, and laboratory scientists.

A symposium . on Issues in Endpoint Ascertainment

in Cancer Prevention Tria!s was cochaimed by Richard Samp-liner (University of Arizona Cancer Center) and DennisAhnen (Denver Veterans Administration Hospital) who dis-cussed the possible utility of precancerous end points asdisplayed by the Harris model of carcinogenesis. EugeneGennen (University ofAmizona Cancer Center) discussed fac-tons affecting measurement of onnithine decamboxylase ac-tivity and polyammnes in colomectal tissue. Biopsy size andlaboratory assay methods can contribute to sources of errorin polyamine content, but variability can be reduced whenvalues are analyzed as ratios (spemmidine:spenmine). DavidAlbents (University of Arizona Cancer Center) then com-pared three measures of proliferation, [3Hithymidmne, BndUand PCNA labeling indices. Unlike [3Hlthymidine andBndU, which label cells primarily in the S phase, PCNA is anendogenous protein that may be present in nuclei through-out the cell cycle. An advantage of PCNA is that incubation



Cancer Epidemiology, Biomarkers & Prevention 501

does not have to be performed atthe site ofcollection. Thereis, however, considerable variation in staining (heavy, in-tenmediate, and light) with this immunohistochemical tech-nique. Intensely stained PCNA cells may represent the Sphase since theme is a high correlation between BndU and[3H]thymidine with intense stainingfon PCNA. There is goodintraobserven repnoductibility for BmdU-labeling indices, but

interobsenven consistency depends on training and expeni-ence of observers.

Lee J. Hixson (University ofAnizona Cancer Center) dis-cussed the impact of the polyp miss mate during colonoscopy

on a polyp prevention trial. Both missed polyps and incom-pletely removed polyps result in overestimation of recur-nence rates. Consequently, sample size for a trial must besubstantially increased as the miss rate increases. Brian Fen-nerty (University of Arizona Cancer Center) then discusseddesign of polyp prevention trials in the context of end pointassessment, growth, and occurrence. Polyps were “tatooed”and followed for 2 years. The general recurrence rate forpolyps is estimated at 1 0%/yean for adenomatous polyps. Inthis study, the new po1yp rate was 36% in 2 years, unaffectedby the number of polyps at first colonoscopy.

The first of the presented paper sessions held concur-rently were chained by Bruce Trock (Lombardi Cancer Cen-

ten, Georgetown University) and Roshan Bastani. EugeniaCalle (American Cancer Society) described a telephone in-tervention to increase mammography usage that was con-ducted in Jacksonville and Orlando, Florida. From lists of 10friends provided by each American Cancer Society volun-teen, S were randomly selected and contacted up to 3 timesoven a 6-month period to encourage each to have a mam-mognam. Subsequent mammography was compared to that

of the remaining friends not contacted by each volunteer.The approach was most effective among women with low to

moderate incomes. Carole Chrvala (Colorado Department ofHealth) presented results of diagnostic follow-up amongmore than 70,000 women screened for breast cancer in theColorado Mammography Advocacy Program. Results con-firm the efficacy of mammography based recommendationfor surgical consults. Of 949 women recommended for sun-gical consults, 776 complied and 656 underwent biopsywith a positive biopsy nate of 31 .3%. Richard Love reported

on screening mammography in primary cane group practicesin the upper Midwest based on a randomized clinical trialwith before and after (2 years) measures in 45 groups prac-tices. The data suggest a large impact of the clinic staff onscreening mammography usage. A high level of use ofscreening mammography was also found.

Jenrold Hill (Mathematica Policy Research) comparedscreening mammography at mobile units at the workplaceto stationary nonwonkplace setting. Although mobile unitshad higher costs, increased adherence rates were observedwith these units. Carol Lerman (Fox Chase Cancer Center)reported that psychological distress and education were sig-nificant independent predictors of adherence among first-degree relatives of cancer patients. The adherence odds ratiowas 2.5 for “not worried” compared to “worried” women,and less educated women were much less likely to adhere.

Two papers focusing on prostate cancer began with anupdate of U.S. geographic trends in mortality by Karen Kafa-dam (National Cancer Institute). Paul Godley (University ofNorth Carolina-Chapel Hill)then presented results ofa case-control study in which fatty acid profiles were determinedfrom samples of adipose tissue. Stores of total omega-6 fatty

acids were associated with increased risk of prostate cancer,

and omega-3 fatty acid levels tended to exhibit a protective

effect.Katherine A. McGlynn (Fox Chase Cancer Center) pre-

sented results of a historical prospective study which mdi-

cate that tumor progression may be enhanced in an iron-richenvironment. Increased iron stones were associated with sig-

nificantly decreased survival for cancers of the lung, breast,

and colon. Eugenia Calle (American Cancer Society) ne-

ported that in the Cancer Prevention Study II cohort, historyof breast cancer is strongly predictive of early fatal breast

cancer especially ifthe relative was also young at diagnosis.An evening poster session was held and included a total

of 50 posters. The Best Poster Award was presented to Anna

Giuliano (University of Arizona) for hen presentation on theprevalence of human papillomavinus and cervical dysplasiaamong low-income Hispanic women. The poster sessionwas followed by dinner and a delightful, insightful presen-

tation by Natalie Angier, New York Times science writer, on

issues and relations between scientists and the press.

Larry Clark (University of Arizona Cancer Center)

chaired the symposium The First Generation ofCancer Pre-vention Tria!s: Lessons, Resu!ts and Directions for the Future.

Jenny McLanty (University of Texas Health Center at Tyler)

discussed a chemoprevention trial of lung cancer with neti-nol and f3-canotene using sputum atypia as an intermediate

marker in asbestos workers. The trial is now in its ninth and

final year. Preliminary findings indicate very low levels of

serum a-carotene at baseline, significantly lower levels incurrent smokers than never smokers, and no decline in se-rum a-tocophenol levels associated with intervention. Tom

Moon presented results of a phase III trial following a series

of pre-clmnical, phase I and II chemoprevention studies off3-trans-RA to reverse cervical intnaepithelial neoplasia. Theresults indicate that topically applied RA is both safe and

effective. There was no change in the progression nate of

cervical intraepithelial neoplasia in either the RA on placebogroup, but there was a higher regression rate in the RA-

treated women: 43 versus 27%; P = 0.041.

Larry Clank presented an overview of a nonmelanomaskin cancer chemoprevention trial using selenium at two

dose levels, 200 and 400 pg. The original end points of thetrial, squamous cell and basal cell carcinoma, have been

extended to include all cause mortality, cancer mortality,

and cancer incidence (all sites, malignant melanoma, lung,

colorectal, and prostate). The 24-month relative risk of squa-

mous cell carcinoma for high versus low baseline plasmaselenium levels was 0.71 ; P < 0.01 . Study participants are

now offered colorectal screening (fecal occult and flexiblesigmoidoscopy) as well as PSA screening and melanoma

screening. Many Daly (Fox Chase Cancer Center) served asdiscussant for the symposium with directions for the future.

The morning session ended with two concurrent ses-

sions for presented papers. Cigarette smoking was the focus

of the session chained by Alfred Neugut. Zuo-feng Zhang(Memorial Sloan-Kettering Cancer Center) presented results

demonstrating a dose-response relationship between daily

cigarette consumption and p53 ovenexpression in bladder

cancer patients. Michael Thun (American Cancer Society)used data from the Cancer Prevention Study II to demon-strate marked reductions of both absolute and relative risk oflung cancer, coronary heart disease, and stroke in persons of



502 Meeting Report: 1 7th Annual Meeting of ASPO

all ages who stopped smoking compared to those who con-tinue. Linda Lillington (Harbor-UCLA Medical Center) de-scnibed a successful self-help, minimal contact smoking ces-sation program for minority pregnant women. The program

uses both self-help and self-monitoring for cessation and me-lapse prevention. Polly Newcomb (University of WisconsinComprehensive Cancer Center) reported findings of a case-control study of colomectal cancer in women which exam-med the association of cigarette smoking and menopausalstatus. The effect of smoking was dependent upon meno-pausal status. Smoking was associated with a decreased riskof premenopausal colon and rectal carcinomas and a sig-nificantly increased risk among postmenopausal women.

Barbara Rimen chained the session in which presentedpapers focused on the area of nutrients and chemopreven-tion. Robert Bostic (University of Minnesota) reported datafrom a nested case-control study of colon cancer from theIowa Women’s Health Study. Significantly lower vitamin E

intake was observed in cases than was observed in controls.The association was not uniform across all age groups. Theprotective effects were strongest in the youngest age groupand no risk reduction was observed in women over age 65.Vitamin supplementation and its effect on basal cell canci-noma was examined in a case-control study reported byQingyi Wei (Johns Hopkins School of Hygiene and PublicHealth). Significantly reduced odds ratios were observed forany vitamin supplement use, multivitamins, or vitamins A,C, and E used singly.

Data from the two phase II pilottnials which culminatedin the Carotene and Retinal Efficiency Trial (CARET) trialwere presented. Gamy Goodman (University of Washington

School of Public Health) described the methods of evalua-tion of side effects of f3-canotene and netinol in the smokers’pilot. As result of the pilot study, side effect monitoring forCARET has been modified and includes a better definedsymptom grading scale. Carolyn Harvey (University of TexasHealth Science Center-Tyler) described patterns of adher-ence observed among subjects in the asbestos pilot. Betteradherence was observed among olden participants, whites,females, married subjects, those willing to travel longer dis-tances, those at higher risk, exercisers, and regular vitaminusers.

Jeffrey Koplan, Director of the National Center for

Chronic Disease Prevention and Health Promotion at theCenters for Disease Control, was the invited speaker at aluncheon session. His talk Prevention: The Bandwagon’sCrowded, Wi!! it Move? was an entertaining, at times imnev-

ement, but substantive overview of the status of preventiontoday.

C. Tracy Orleans (Fox Chase Cancer Center) and 1992recipient Ellen Gritz introduced the 1993 Joseph W. CullenAward winner, Thomas Glynn (National Cancer Institute),who was presented his award by Tom Moon. His lecture willbe published in Cancer Epidemio!ogy, Biomarkers and Pre-vention.

Glynn chained a symposium on planned large scaleprevention trials. The ASSIST (American Stop Smoking In-tervention Study) trial, which will include 91 millionAmericans in 1 7 states, has as its goal a reduction insmoking prevalence to 1 7% by 1 998 and 1 5% by the year2000. Laurence Freedman (National Cancer Institute) andSuzanne Haynes (National Cancer Institute) discussed twocomponents of the Women’s Health Trial, the IndividualRandomized Trial, and the Community Health Trial, me-spectively. The trial will include multiple interventions and

end points. Dietary modification, hormone replacement,and supplementation with calcium and vitamin D are in-cluded as the intervention regimen. The primary endpoints selected for the dietary modification interventionare breast and colonectal cancer, with coronary heart dis-ease as a secondary end point. Coronary heart disease isthe primary end point for the hormone replacement com-ponent of the trial, with hip fracture and other fracturessecondary endpoints. The primary endpoint for thecalcium/vitamin D arm is hip fracture, with other fractures

and colomectal cancer as secondary end points.A symposium posing the question !s There a Case for

Prophy!actic Mastectomy? was chaired by KatherineHelzlsouem. Prophylactic mastectomy is being increasingly

carried out in women of perceived high risk, mostly becauseoffamily history, on a diagnosis ofcancen in the contralatemalbreast (especially lobular carcinoma) on fear of cancer ingeneral. Florence Houn (National Cancer Institute) pre-sented results of a survey of 1 480 Maryland surgeons witha 46% response mate. The procedure was generally recom-mended when the risk was perceived as extremely high(around 50%). A small cluster of surgeons performed a dis-proportionately large number of mastectomies and were lessdemanding with respect to the perceived risk. Susan Love(UCLA School of Medicine) discussed the biological and so-cietal issues involved in the procedure and emphasized thelimited experimental data in animals and observational datain humans which support this procedure. Douglas Weed(National Cancer Institute) concluded with a discussion of

ethical approaches to decision making.A symposium, chaired by C. Tracy Orleans, traced To-

bacco: from Bio!ogy to Community. Oliver Hankinson(UCLA Laboratory of Biomedical and Environmental Sci-ences) described studies with the cytochnome P450 1 Al en-zyme, important in the activation of many carcinogens intobacco smoke. Recent work includes cloning of the Ah me-cepton nuclear translocaton (ARNfl gene, required for ac-tivity of Ah receptor and induction of P450 1 Al , and iden-tification of a restriction fragment length polymorphism inthe gene. Differences in alleles of the ARNT gene in whiteand black populations will be examined. Michael Fione(University of Wisconsin Medical School) summarized thecurrently available data on nicotine patches in terms of ef-ficacy and safety. He highlighted the importance ofthe phy-sician in the cessation process, urged that effective coun-seling be demystified, and suggested that cigarette smokingshould be treated as a chronic disease. Orleans and MargaretWalsh (University ofCalifomnia-San Francisco) described theNCI-Major League Baseball Partnership for smokeless to-bacco control designed to combat the strategy used by thetobacco industry to target athletes for use of smokeless to-bacco. Effective tobacco industry strategies have resulted ina 50% increase from 1 981 to 1 990 in use of moist snuff, themost carcinogenic form of smokeless tobacco. John P. Pierce

(University ofCalifonnia-San Diego) presented findings fromthe California tobacco surveys, the main evaluation instru-ment of the Proposition 99-funded campaign to reducesmoking prevalence in the state by 75% before the year2000. The state appears to be on target for adults, butchanges in smoking by teenagers are less clean. Tobacco ad-vertising and the lack of smoke-free schools have proved astrong impediment to prevention of smoking by adolescents.

A symposium on the completed breast cancer consor-tium trials was chained by Suzanne Haynes. A book on theresults of these NCI-funded trials will be published soon.



Cancer Epidemiology, Biomarkers & Prevention 503

Barbara Rimer reported that the intervention had a greaten

effect in women with incomes less than or equal to $30,000pen year. A significant intervention effect was observed forthe years 1 988-1 990, 67 versus 40% mammography usage.The difference was much less in subsequent years. NicoleUrban (Fred Hutchinson Cancer Research Center) discussedthe costs and effectiveness of community organization topromote breast cancer screening. The total cost pen womanin their target population was six dollars. Efforts includedidentification of key groups; building coalitions; forming ad-

visony boards; facilitating decision making; educating andmobilizing the provider community; and promotion ofbreast cancer screening in community. The intervention in-creased mammography usage: 60.6 versus48.9% in controlcommunity for women aged 65-75 years in 1991.

Dorothy Lane (State University of New York-StonyBrook) presented results of an intervention in Suffolk Countyusing one on more ofthree approaches: (a) public education;(b) physician education; and (c) lower cost mammography.Results indicated a significant increase in the proportion ofphysicians recommending mammography, and a significantincrease in mammography use during the years 1988-1990by low income, minority women via mobile van. Sarah Fox

(University ofCalifomnia-Los Angeles) reported the results ofa church-based intervention in Los Angeles targeting His-

panic women. Hispanic women in the target communitywere significantly more likely to have heard of mammog-raphy, to have even had a mammognam, and to havehad a mammognam in the last year compared to Hispanicsin the control community. Mary Costanza (University ofMassachusetts-Worcester) and Jorge Gonzalez (New HavenMemorial Hospital) reported similar successful interventioneffects in trials conducted in the northeastern United states.

The address by the president ofASPO, Tom Moon, dealtwith the etiology and chemoprevention of nonmelanomaskin cancers. He presented the rationale for the use of neti-noids as chemopreventive agents for basal and squamous

cell carcinomas, as well as the results of two trials initiatedin 1984.

John Bertram (University of Hawaii Cancer ResearchCenter) cha i med a symposium, Genotoxic Damage: Causa-tion, Detection and Prevention. He introduced the subjectby describing the delicate balance between oxidative stressand antioxidant protection which is continuous in living on-ganisms. Adequate balance promotes health and may bebroken by forces which induce mutations and excessive cellreplication, resulting in disease states. Brian Henderson(University of Southern California Norris ComprehensiveCancer Center) discussed the role of antioxidants in protec-tion against cancer and played devil’s advocate by reviewingsome of the epidemiological studies which do not supportthe hypothesis. Some of the examples given include the dis-crepancy between cancer mates and dietary practices in eth-nic groups of Los Angeles; the lack of a protective effect ofthe ingestion of fruits and vegetables on lung cancer in aretirement community of California; and the lack of pre-ventive effect of �-canotene on the incidence of skin cancerin a chemoprevention trial. He discussed possible reasonsfor the discrepancy between those studies and many otherswhich report a preventive mole offnesh fruits and vegetables.

Robert Cooney (Cancer Research Center of Hawaii) pre-sented the mole of nitrogen oxides in the processes of agingand carcinogenesis as well as the mole of antioxidants inslowing down such processes. He described the products ofoxidation, the sources of reactive oxygen radicals, and the

specificity of antioxidants in relation to their targets. Of spe-

cial interest was his discussion of the specific antioxidantmoles of carotenes and tocophenols. Although more attentionhas been given to a-tocophenol, his results show that

-y-tocopherol is a more effective inhibitor of cellular trans-formation in the C3H-10 T1/2 mouse fibroblast system.These results are supported by the limited number of epi-demiological studies which have examined the role of-y-tocophemol, the primary tocophenol in the U.S. diet.

Daniel Lieblen (University of Arizona) explained themechanism of action of the canotenoid and tocophenol an-tioxidants which compete with other species to trap freeradicals and prevent further reactions and the generation ofother oxidants. He emphasized the need to assay specificproducts of specific oxidants to evaluate the effects of che-mopreventive agents.

John Bertram explored the mechanisms of action ofcarotenoids in cancer prevention. More than 100 canote-noids are present in the diet, 10-15 are detectable in the

serum, and approximately one-third of these can be con-vented to retinoids (vitamin A). The antineoplastic effect of

netinoids requires that the compound bind to a receptorwithin the nucleus and exert its function from within the cell.

One prominent function displayed by �-canotene and othercanotenoids appears independent ofthein role as retinol pre-

cursors, i.e., the induction of gap junctions which serve assignal conductors and allow the passage of messenger mol-ecules from one cell to its neighboring cells. Bertram hasidentified a protein in mouse and human cells required forthe formation of gap junctions (connexin) and has preparedantibodies against it. Cultures of 1 OT1/2 cells in the presenceof �-canotene increased the number of their gap junctions,a phenomenon captured in spectacular photographs withfluorescent antibodies. It would appear that �-canotene, in-dependently of its pro-vitamin A activity, places preneoplas-tic cells in junctional communication with normal cells andremoves from the preneoplastic cells their growth advan-tage, which is ultimately responsible for the formation oftumor masses. This effect is not related to the effect of cano-

tenoids as antioxidants.The final presented paper session was chained by Susan

Gapstun (University of Arizona). Alison Evans (Fox ChaseCancer Center) presented the first of two papers on PHC inHaimen County, China. Using data from a population surveywith retrospective information on staple diet during the1 960s through the 1 990s, little association was observed

between corn consumption (a major source of aflatoxin B1exposure) and PHC incidence. Thomas London (Fox ChaseCancer Center) then presented: (a) prevalence data for PHCin this same county based on a screening program con-ducted prior to initiation of a randomized clinical trial; (b)an evaluation of a-fetopnotein as a screening tool for PHC;and (c) the design of the upcoming trial.

Raymond Demens (Michigan Cancer Foundation) de-scnibed an ongoing colonectal screening program in auto-motive pattern and model makers who have been shownto be a high-risk group. Comparison of screened versus

unscreened cohorts shows a significant excess rate of inva-sive colorectal cancer in the unscreened group. Theseworkers will be followed for an additional 1 0 years be-cause they are a relatively young group. Gary Friedman(Kaiser Penmanente) described his work evaluating the roleof depression as a predisposing factor for cancer. No in-creased risks were observed among persons who reportedthemselves to be “the worrying type” or who “often felt



504 Meeting Report: 1 7th Annual Meeting of ASPO

unhappy or depressed” based on follow-up of a multipha-sic checkup completed during the years 1964-1972. Useof certain antidepressant drugs was also evaluated throughthe data base. A significant elevation in liven cancer wasobserved after 1 5 years of follow-up associated with pre-scnibed amitniplytmne. However, a lower nonsignificantrelative risk was observed after an additional 4 years of

follow-up. No other cancer-antidepressant drug associa-tions were observed. A standard mortality ratio of 1.38(95% confidence interval, 1 .06-1 .1 6) was observed for

cancer associated with a psychiatry clinic diagnosis of“depressive neurosis” allowing for a 2-year lag period tomule out depression associated with prediagnostic cancersymptoms. Although uncertainty persists, theme may be asmall elevation of cancer risk in persons with accuratelydiagnosed, marked depression.

Ellen Gmitz was elected President of ASPO. She willserve a 2-year term. Elizabeth A. Holly (University ofCalifornia-San Francisco) was elected to serve a 3-year termas Director-at-Large.



1993;2:499-504. Cancer Epidemiol Biomarkers Prev E T Fontham and P Correa American Society of Preventive Oncology 17th annual meeting.

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