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This Week in NEJM: Mar 3, 2011

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In NEJM this week, Harvard's David Christiani says the best way to prevent cancer is to be more aware of its environmental causes. In April 2010, the President's Cancer Panel, which was convened in 2006 by US President George W. Bush, released a report "emphasizing the need for stronger regulations to control Americans' exposure to toxins," Christiani says. Despite decreases in certain kinds of cancer, the disease remains "highly lethal and very common," he says, adding that "during the past three decades, increases in the incidence of some childhood cancers, such as leukemia and brain tumors, may implicate prenatal exposure to environmental carcinogens — and more than 300 industrial chemicals have been detected in umbilical-cord blood." Recent research has focused on carcinogenesis and the epidemiology of the disease, and it's well known that environmental factors contribute to a person's risk for developing cancer. Despite the contribution genomics has made to fighting cancer, the incidences of the disease have not declined as much as other diseases, and better therapies and screening methods are always needed, Christiani says. "However," he adds, "the most valuable approaches to reducing cancer morbidity and mortality lie in primary prevention — avoiding the introduction of carcinogenic agents into the environment and eliminating exposure to carcinogenic agents that are already there." The first step, he says, is to identify carcinogenic substances before they are introduced into the environment.

Also in NEJM this week, researcher Anil Potti and his collaborators from institutions across the country, have retracted a study — "A Genomic Strategy to Refine Prognosis in Early-Stage Non–Small-Cell Lung Cancer" — that appeared in NEJM in August 2006. The 2006 paper concluded that a lung metagene model that the team had developed provided a way for clinicians to more precisely calculate an NSCLC patient's risk of relapse and then base treatment decisions on that calculation. The retraction states the researchers tried and failed to replicate their results using a sample set from a study by the American College of Surgeons Oncology Group and a collection of samples from a study by the Cancer and Leukemia Group B. "We deeply regret the effect of this action on the work of other investigators," they add. Potti resigned from Duke University in November after being accused of faking his research. Other journals have also retracted some of his studies after the results were found to be irreproducible.

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