Background The optimal clinical management of oral precancer remains uncertain. We investigated the natural history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician’s decision to biopsy a leukoplakia vis-à-vis progression, and histopathologic predictors of progression. Methods We conducted a retrospective cohort study (1996–2012) of patients with oral leukoplakia (n = 4886), identified using electronic medical records within Kaiser Permanente Northern California. Among patients with leukoplakia who received a biopsy (n = 1888), we conducted a case-cohort study to investigate histopathologic predictors of progression. Analyses included indirect standardization and unweighted or weighted Cox regression. Results Compared with the overall Kaiser Permanente Northern California population, oral cancer incidence was substantially elevated in oral leukoplakia patients (standardized incidence ratio = 40.8, 95% confidence interval [CI] = 34.8 to 47.6; n = 161 cancers over 22 582 person-years). Biopsied leukoplakias had a higher oral cancer risk compared with those that were not biopsied (adjusted hazard ratio = 2.38, 95% CI = 1.73 to 3.28). However, to identify a prevalent or incident oral cancer, the biopsy decision had low sensitivity (59.6%), low specificity (62.1%), and moderate positive–predictive value (5.1%). Risk of progression to oral cancer statistically significantly increased with the grade of dysplasia; 5-year competing risk-adjusted absolute risks were: leukoplakia overall = 3.3%, 95% CI = 2.7% to 3.9%; no dysplasia = 2.2%, 95% CI = 1.5% to 3.1%; mild-dysplasia = 11.9%, 95% CI = 7.1% to 18.1%; moderate-dysplasia = 8.7%, 95% CI = 3.2% to 17.9%; and severe dysplasia = 32.2%, 95% CI = 8.1%–60.0%. Yet 39.6% of cancers arose from biopsied leukoplakias without dysplasia. Conclusions The modest accuracy of the decision to biopsy a leukoplakia vis-à-vis presence or eventual development of oral cancer highlights the need for routine biopsy of all leukoplakias regardless of visual or clinical impression. Leukoplakia patients, particularly those with dysplasia, need to be closely monitored for signs of early cancer.

Multiple myeloma (MM) is an incurable clonal B-cell malignancy with terminally differentiated plasma cells. It afflicts approximately 55,000 people in the United States. Over the past 5 years, significant progress has been made in the diagnosis and assessment of patients with MM. Significant advances include a simplified staging system, which has replaced the more cumbersome Durie-Salmon staging system; an updated uniform international response criteria; the development of a sensitive new serum test to detect free light chain production (free light chain assay); the recognition of specific adverse cytogenetic abnormalities; and the evolution of genomics, which will identify specific and targeted therapies for individual MM To earn free CME credit for successfully completing the online quiz based on this article, go to http://CME.AmCancerSoc.org. EPIDEMIOLOGYMultiple myeloma (MM) accounts for 1% of all malignancies: 10% of all hematological malignancies in Caucasians and 20% in African Americans. It is the second most common hematologic malignancy in the United States. The overall incidence rate in the United States is 4.4/100,000/year with a male:female ratio of 1.4:1.1 The reason for the higher incidence in men and African Americans is not known.The American Cancer Society (ACS) estimates that about 19,900 new cases of MM (10,960 in men and 8,940 in women) will be diagnosed during 2007, and about 10,790 are expected to die of the disease.2 Internationally, MM accounts for 0.8% of all cancer deaths with approximately 86,000 new cases per year.3 The current 5-year survival for a patient newly diagnosed with MM in the United States was 33% (data from 1996 to 2002), 1 up from 26% 30 years ago. In patients treated on clinical trials, the median survival is approximately 50%. 4,5 DISEASE CHARACTERISTICSMultiple myeloma is a B-cell malignancy with terminally differentiated plasma cell phenotype. The characteristic findings in MM are lytic bone disease, renal insufficiency, anemia, hypercalcemia, and immunodeficiency. The most common presenting symptoms are fatigue, bone pain, and recurrent infections.6 Any of these findings should alert the clinician to the possibility of MM and warrant further clinical investigation. In newly diagnosed patients, skeletal abnormalities are present on conventional radiography in approximately 60% to 80% of patients, anemia is present in 70% of patients, hypercalcemia in 15%, and elevated serum creatinine in 20%. However, approximately 25% of patients present without symptoms and are identified incidentally by laboratory results, such as an elevated total protein, encountered during routine testing or in evaluation of other health problems.

Lung cancer is the leading cause of cancer deaths world-wide. Recent advances in cancer biology have led to the identification of new targets in neoplastic cells and the development of novel targeted therapies. At this time, two targeted agents are approved by the FDA in advanced nonsmall cell lung cancer (NSCLC): the epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) erlotinib, and the anitangiogenic bevacizumab. A third agent, cetuximab, which was recently shown to enhance survival when used with cisplatin and vinorelbine as first line therapy for advanced NSCLC, will likely be approved by regulatory agencies. With more than 500 molecularly targeted agents under development, the prospects of identifying novel therapies that benefit individual patients with lung cancer are bright.