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Identification of K-ras Mutations in Pancreatic Juice
- Andres A. Gutierrez, MD;
- Francisco Martinez, MD; and
- Jaime Mas-Oliva, MD, PhD
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•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
We are concerned that the brief communication by Berthelemy and colleagues [1] may have overstated the clinical implications of a K-ras mutation found in the pancreatic juice of patients with chronic abdominal pain leading to pancreatic cancer.
No doubt exists that the authors brought out a powerful approach for the early diagnosis of pancreatic cancer by combining endoscopic retrograde pancreatography with a sensitive diagnostic tool such as polymerase chain reaction (PCR)-mediated restriction fragment-length polymorphism. It is well known, however, that tumorigenesis is a multistep process in which several genetic alterations must accumulate before the malignant phenotype is produced. For example, the exhaustive work done by Vogelstein and Kinzler [2] has shown that several mutation-activated oncogenes must accompany the inactivation of other tumor suppressor genes to produce colorectal cancer [2, 3]. It is clear from these series that no single genetic alteration pattern or specific chronologic order of symptom appearance has been noted within a studied population. Therefore, it is not surprising that only half of the patients with colonic carcinoma showed a mutational-activated ras oncogene in one of these series [3]. Furthermore, and despite the vast knowledge accumulated in this area, practical assays to detect these genetic alterations are still being developed. These assays must be validated as screening tools for colorectal cancer in high-risk families, particularly in those with a history of adenomatous polyposis.
On the contrary, information on the molecular pathogenesis of pancreatic cancer is insufficient to recommend a risk-assessment program for this fatal disease based on a single mutated oncogene detected by PCR. The authors are to be commended for their innovative approach, and their findings represent a good starting point. More studies on the molecular events that lead to pancreatic cancer are needed, however, to fully develop a panel of genetic tests to be used as prognostic and risk-assessment tools. Only then will it be possible to properly advise patients with pancreatic cancer about their therapeutic options.
Andres A. Gutierrez, MD
Francisco Martinez, MD
Jaime Mas-Oliva, MD, PhD
Universidad Nacional Autonoma de Mexico School of Medicine
Mexico 04510
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
