Beta-carotene didn't prevent cancer: what's up doc?

binations in the treatment of oral premalignancy, and we welcome the op- portunity of contributing knowledge, along with that of Dr. Garewal and Dr. Meyskens, to the area of natural agents for the chemoprevention of cancer. SCOTT M. LIPPMAN* WAUN KI HONG Section of Head, Neck and Medical Oncology The University of Texas M. D. Anderson Cancer Center Houston, Tex. References (J) GAREWAL H, MEYSKENS FL JR: Correspon- dence: Beta-carotene didn't prevent cancer What's up doc? J Natl Cancer Inst 82:1851- SMIGEL K: News: Beta-carotene didn't prevent cancer: What's up doc? J Natl Can- cer Inst 82:899-900, 1990 HONG WK, ENDICOTT, J, I T R I L M , ETAL 13- c/5-retinoic acid in the treatment of oral leukoplakia. N Engl J Med 315:1501-1505, HONG WK, LIPPMAN SM, ITRI LM, ET AL: Prevention of second primary rumors with isotretinoin in squamous-cell carcinoma of the head and neck. N Engl J Med 323:795- Response Dr. Scott M. Lippman and Dr. Waun Ki Hong are understandably upset by our comments regarding widespread press coverage of their as yet non-peer reviewed, unpublished study. Much has been said about the implications of this practice by leading academicians and editors of prominent medical journals. We appreciate the considerable effort in their current response to state that their goal was not to discredit beta-carotene, and comments to this effect are con- tained in the Journal News item Beta- Carotene Didn't Prevent Cancer: What's Up Doc? However, this was clearly not the impact of the press coverage. Al- though accrual to beta-carotene trials may not have dropped, as stated by 'Correspondence to: Scott M. Lippman, M.D., F.A.C.P., Department of Medical Oncology, Box 80, The University of Texas M. D. Anderson Can- cer Center, 1515 Holcombe Blvd., Houston, TX Vol. 83, No. 15, August 7, 1991 Downloaded from http://jnci.oxfordjournals.org/ at University of California, Irvine on July 1, 2015 Smigel and Van Nevel (7) in their Rejoinder response to our letter, we can vouch for the problems created for ongoing and planned studies in the context of the Apparently, we and many of our ac- extra effort required by involved inves- quaintances in the academic world had tigators to keep participants interested in been unclear about the main point of the continuing after they brought in copies December 5, 1990, letter to the Journal of news stories from the national and by Dr. Harinder Garewal and Dr. Frank local press. Meyskens. We are happy that they have In the absence of a hard copy of a now stated clearly that the main point of peer-reviewed publication, critically their letter concerned the premature dis- analyzing the study in question remains semination of study results. We under- problematic, since we are faced with a stand that they referred to the original moving target consisting of the latest in- News item in the Journal, not to our terpretation of an ongoing trial. Testing report to the American Cancer Society these agents and concepts is an exciting Science Writers' Seminar or to our slide avenue of clinical investigation with presentation at the meeting of the several active or planned local, national, American Society of Clinical Oncology, and international studies. We concur both of which were subjected to peer with Dr. Lippman and Dr. Hong that no review. scientific study attempting to advance knowledge of uncharted areas is prob- SCOTT M. LIPPMAN lem free. But this emphasis misses the WAUN KI HONG main point of our original letter which is that premature and, therefore necessari- ly incomplete, dissemination of the re- sults of an ongoing trial must be Colorectal Cancer Screening thoroughly discouraged. Our critique of their study and their response only serve to highlight the problems created by this In their otherwise excellent review of practice. We invite Dr. Lippman and Dr. colorectal cancer screening, Winawer et Hong to join us, along with most aca- al. (J) present in Table 3, for the first demicians and editors of prominent time in print, I believe, some of the mor- medical journals, in condemning prema- tality data from the Memorial Sloan- ture release of information. Their valua- Kettering Cancer Center-Preventive ble contributions to the field of head and Medicine Institute-Strang Clinic trial. neck cancer management are well The data presented are for the patients known, and such a gesture will only en- who had not been examined previously hance, not detract from, their reputations. at the clinic. However, as reported pre- viously by Flehinger et al. (2) [reference HARINDER GAREWAL* {17) of Winawer et al.], there were in Cancer Prevention and Control addition to the original total of 21 756 University of Arizona people admitted to this trial, 7168 Tucson, Ariz. patients assigned to the study group and 2109 patients assigned to the control FRANK, MEYSKENS, JR. group who had previously attended the University of California Preventive Medicine Institute-Strang Irvine Cancer Center Orange, Calif. Clinic at least once before the visit at which they were enrolled in the trial. As reported in the discussion on Reference screening for colorectal cancer in the book Screening for Gastrointestinal SMIGEL K, VAN NEVEL JP: Response. J Nat! Cancer Inst 82:1853, 1990 Cancer (5), There was some discussion over the appropriateness of basing the analysis of the New York study on the initial screen group alone, rather than *Correspondence to: Harinder Garewal, M.D., Section Hematology/Oncology, University of combining the initial and annual screen Arizona Health Science Center, 1501 N. Campbell group, as this appeared to be a post- Ave., Tucson, AZ 85724. CORRESPONDENCE 1111