Faculty Bibliography

Women with breast cancer and high levels of insulin who received standard therapy were about eight times more likely to develop a recurrence and die of the disease than women who had normal insulin levels, said the study's leader, Dr. Pamela J. Goodwin of the University of Toronto. Dr. Goodwin said the study found that insulin, a hormone, was significantly associated with two known high-risk factors for progression of breast cancer: the presence of cancer in lymph nodes and the stage and grade of the cancer. The insulin levels were measured in blood taken after the women had fasted for several hours. Such tests are more sensitive for insulin levels than blood taken after meals, said Dr. Goodwin, who urged other researchers to introduce fasting insulin tests in their studies

Like New York Mayor Rudolph Giuliani, 180,000 U.S. men will suddenly learn this year that they have prostate cancer, and what makes their decisions about treatment so difficult is that doctors do not know which option is most effective. The alternatives include surgical removal of the prostate gland, radiation, techniques to freeze and destroy the entire prostate, and early hormonal therapy. And then there is watchful waiting. 'We don't know what the best treatment option is for men who are found to have prostate cancer and doctors do not always clearly say that to patients,' said Dr. Timothy Wilt, an internist and health services researcher at the University of Minnesota

The apparent new use for antidepressants presumably will also benefit women suffering hot flashes during menopause and men who suffer hot flashes during hormonal therapy for prostate cancer, said the researcher, Dr. Charles L. Loprinzi of the Mayo Clinic in Rochester, Minn. There are now three studies that show the benefit of antidepressants on hot flashes.Because the antidepressant drugs ''so clearly work and are reasonably tolerated,'' they may offer an effective alternative for women who do not want to take hormones, Dr. Loprinzi said at the meeting. However, Dr. Loprinzi said the antidepressants did not completely relieve hot flashes in every woman. In March, researchers from Georgetown University reported a similar benefit in a third study among 27 women using Paxil, also an S.S.R.I., Dr. Loprinzi said. In the pilot study from Georgetown in Washington, the women kept diaries of the frequency and severity of hot flashes while they took increasing amounts of Paxil for six weeks. The women also completed questionnaires. All women knew they were taking Paxil

In quitting the Senate race last week, Mayor Rudolph W. Giuliani discovered that choosing a therapy for prostate cancer was a far more daunting effort than he had expected. Mr. Giuliani said he had to focus entirely on the decision, letting his immediate political future fall by the wayside. Mr. Giuliani's is a case in point. His father died in 1981 at 73 of prostate cancer. The full facts in the elder Mr. Giuliani's case are not known. A blood test known as P.S.A., for prostate specific antigen, led to the detection of Mr. Giuliani's prostate cancer at an early stage. The test did not exist in his father's lifetime. Thus, its use has forced Mr. Giuliani to make decisions his father never had to consider

Relatively small amounts of antidepressant drugs quickly eased the frequency and severity of hot flashes in some women with breast cancer, a researcher said yesterday at the meeting of the American Society of Clinical Oncology here. The apparent new use for antidepressants presumably also will benefit women suffering hot flashes during menopause and men who suffer hot flashes during hormonal therapy for prostate cancer, said the researcher, Dr. Charles L. Loprinzi of the Mayo Clinic in Rochester, Minn. Although hormones known as estrogens and progesterones can relieve hot flashes, many doctors shy away from prescribing them for women with breast cancer because of concerns that hormones may stimulate the growth of malignant tumors

In quitting the Senate race last week, New York Mayor Rudolph Giuliani discovered that choosing a therapy for prostate cancer was a far more daunting effort than he had expected. Giuliani said he had to focus entirely on the decision, letting his immediate political future fall by the wayside. Making crucial decisions in one's own care has become increasingly complex. Tests now detect certain diseases such as prostate cancer earlier, increasing chances for a cure. Treatment choices are wider. Yet, for prostate cancer, doctors may not know which treatment is best. Giuliani's is a case in point. His father died in 1981 at 73 of prostate cancer. The full facts in the elder Giuliani's case are not known. But in that era, prostate cancer usually was not detected until it had spread and was well beyond any hope of cure. It also was an era when doctors decided the treatment, and few patients questioned them

Three large new studies are challenging the safety and benefits of clot-busting drugs for older people suffering heart attacks, particularly those 75 and older. The findings are surprising because of a widespread belief that clot-busting drugs help older patients just as they clearly do younger ones. The American Heart Association and the American College of Cardiology recommend use of clot-busting drugs in heart attack patients. But the two leading heart organizations caution that evidence for the drugs' effectiveness and safety in older people has been equivocal. TPA (tissue plasminogen activator) and streptokinase are the two main clot-busting drugs, also known as thrombolytics

Last year, Dr. Bart Barlogie, an oncologist at the University of Arkansas, reported that thalidomide could slow the course of multiple myeloma among people who had failed to respond to standard therapy. Multiple myeloma is a deadly cancer that damages the bone marrow and other organs. Today, Dr. Barlogie said at the meeting that his team had confirmed and extended the findings that thalidomide was active and could be used safely with chemotherapy in a larger group of people with advanced multiple myeloma in the same study. Response to thalidomide, however, often occurred rapidly in these patients. After 25 months of thalidomide and other chemotherapy, overall survival was 45 percent, and about 10 percent have not had a significant relapse, Dr. Barlogie said. He said he could not compare these figures with other treatments because a clinical trial of therapy in advanced multiple myeloma among patients who had had stem cell transplants had not been done. ''An educated guess'' is that most patients would have died in six months without thalidomide, Dr. Barlogie said

Responding to a call to improve the quality of cancer care in the United States, a leading cancer organization said here today that it was working with other groups to develop a national system to monitor how well each cancer patient is treated. The first phase will be conducted in Cleveland, Houston and Los Angeles and will involve 300 people with breast cancer and an additional 300 patients with cancer of the colon and rectum, the study's leaders said at the opening of a meeting here of the American Society of Clinical Oncologists, the leading group of cancer specialists in this country. The ultimate goal is to develop specific measures of quality spanning the entire course of care, from diagnosis to cure or death. Such measures could then be used to hold health care providers accountable for the quality of cancer care. An estimated 1.2 million Americans will develop cancer this year. Cancer is second to heart disease as a cause of death among Americans and one of the most expensive diseases to treat

The effort will begin this summer when researchers from Harvard University and Rand Corp. begin examining the medical records of 600 patients to determine their outcomes from two types of cancer. The first phase will be conducted in Cleveland, Houston and Los Angeles and will involve 300 people with breast cancer and 300 with cancer of the colon and rectum, the study's leaders said at the opening of a meeting here of the American Society of Clinical Oncologists, the leading group of cancer specialists in the United States. Breast and colorectal cancers were chosen because consensus for their care is greater than for other major cancers, said Dr. Deborah Kamin, the oncologist group's director of public policy