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Alfred I Neugut

Publications and source records attributed to Alfred I Neugut.

103 records · Page 6Linked to original sources
PubMed2002

Variations in the use of chemotherapy for elderly patients with advanced ovarian cancer: a population-based study.

PURPOSE: Since 1986, the recommended therapy for patients with ovarian cancer has included surgery and chemotherapy with a platinum compound (cisplatin or carboplatin). The purpose of this study is to assess the use of chemotherapy in elderly patients with advanced ovarian cancer. METHODS: The Surveillance, Epidemiology, and End Results-Medicare database represents approximately 14% of the United States population and provides clinical and demographic information on cancer patients covered by Medicare, along with health care-utilization data from Medicare claims files. We analyzed the association of demographic and clinical factors with treatment among patients diagnosed from 1992 to 1996 with stage III or IV ovarian cancer, who survived > or = 120 days beyond diagnosis, and were > or = 65 years of age (N = 1,775). RESULTS: Approximately 83% of elderly patients received some form of chemotherapy within 4 months of diagnosis. In a multiple logistic regression model with patients aged 65 to 69 years as the reference, the odds ratios of receiving chemotherapy were 0.96 (95% confidence interval [CI], 0.63 to 1.46) for ages 70 to 74, 0.65 (95% CI, 0.43 to 1.00) for 75 to 79, 0.24 (95% CI, 0.15 to 0.37) for 80 to 84, and 0.12 (95% CI, 0.07 to 0.19) for 85+. Hispanic patients were less likely to receive chemotherapy than non-Hispanic white patients. Since 1992, paclitaxel has gradually replaced cyclophosphamide as the drug most commonly used with platinum. CONCLUSION: Despite its proven efficacy in treating ovarian cancer, chemotherapy seems to be used less among patients over age 65, especially those who are nonwhite and/or in the oldest age groups. Further research is needed to elucidate to what degree this represents appropriate clinical judgment and to what degree other factors, such as patient choice, play a role.

Age Factors↗
PubMed2002

Outcomes of tamoxifen chemoprevention for breast cancer in very high-risk women: a cost-effectiveness analysis.

PURPOSE: To estimate the effects on survival, quality-adjusted survival, and health care costs of using tamoxifen for primary prevention in subgroups of women at very high risk for breast cancer. PATIENTS AND METHODS: A decision analysis was performed using a hypothetical cohort of women that included subgroups with atypical hyperplasia, Gail risk greater than 5, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. Data sources were the Breast Cancer Prevention Trial, the Surveillance, Epidemiology, and End-Results program, time trade-off preference ratings, the Group Health Cooperative of Puget Sound, and the United States Health Care Financing Administration. RESULTS: Our model predicted that tamoxifen would prolong the average survival of cohort members initiating use at ages 35, 50, and 60 years by 70, 42, and 27 days, respectively. It would prolong survival even more for those in the higher-risk groups, especially those with atypical hyperplasia (202, 89, and 45 days). Tamoxifen use was also projected to extend quality-adjusted survival by 158, 80, and 50 days in the atypical hyperplasia group. For younger women in the highest risk groups, chemoprevention with tamoxifen was estimated to have cost savings or be cost-effective, both with and without quality adjustments. CONCLUSION: Chemoprevention with tamoxifen may be particularly beneficial to women with atypical hyperplasia, 5-year Gail model risk greater than 5%, lobular carcinoma-in-situ, or two or more first-degree relatives with breast cancer. The benefits may be greater if tamoxifen is initiated before age 50 years rather than after and if the breast cancer risk reduction conferred by tamoxifen lasts longer than 5 years. For women with a very high risk of invasive breast cancer, chemoprevention with tamoxifen seems to be cost-effective.

Adult↗
PubMed2002

The Long Island Breast Cancer Study Project: description of a multi-institutional collaboration to identify environmental risk factors for breast cancer.

The Long Island Breast Cancer Study Project is a federally mandated, population-based case-control study to determine whether breast cancer risk among women in the counties of Nassau and Suffolk, NY, is associated with selected environmental exposures, assessed by blood samples, self-reports, and environmental home samples. This report describes the collaborative project's background, rationale, methods, participation rates, and distributions of known risk factors for breast cancer by case-control status, by blood donation, and by availability of environmental home samples. Interview response rates among eligible cases and controls were 82.1% (n = 1,508) and 62.8% (n = 1,556), respectively. Among case and control respondents who completed the interviewer-administered questionnaire, 98.2 and 97.6% self-completed the food frequency questionnaire; 73.0 and 73.3% donated a blood sample; and 93.0 and 83.3% donated a urine sample. Among a random sample of case and control respondents who are long-term residents, samples of dust (83.6 and 83.0%); soil (93.5 and 89.7%); and water (94.3 and 93.9%) were collected. Established risk factors for breast cancer that were found to increase risk among Long Island women include lower parity, late age at first birth, little or no breast feeding, and family history of breast cancer. Factors that were found to be associated with a decreased likelihood that a respondent would donate blood include increasing age and past smoking; factors associated with an increased probability include white or other race, alcohol use, ever breastfed, ever use of hormone replacement therapy, ever use of oral contraceptives, and ever had a mammogram. Long-term residents (defined as 15+ years in the interview home) with environmental home samples did not differ from other long-term residents, although there were a number of differences in risk factor distributions between long-term residents and other participants, as anticipated.

Adult↗
PubMed2002

Diabetes mellitus and the risk of prostate cancer.

BACKGROUND: Little is known about etiologic factors for prostate cancer. Several studies have suggested a protective effect of diabetes mellitus on the risk of prostate cancer, though a study by our group has found an elevated risk of prostate cancer following ischemic heart disease. PURPOSE: The purpose of this study was to investigate the association of diabetes mellitus with prostate cancer in the same setting in which we had found an elevated risk following ischemic heart disease. Our study differed from prior studies in utilizing a multi-racial population. Another purpose was to investigate stage-specific effects. METHODS: We conducted a hospital-based case-control study in our University Medical Center in New York City. Cases were patients with prostate cancer seen at our Medical Center between January 1, 1984 and December 31, 1986. All cases were histologically diagnosed and had undergone a biopsy or surgical procedure at Columbia-Presbyterian Medical Center (CPMC). The controls were patients who underwent a surgical procedure for benign prostatic hypertrophy (BPH) during the same time frame and were not found to have prostate cancer. Prior history of diabetes was determined by review of the medical records. Logistic regression was used to assess the association between prior history of diabetes mellitus and prior history of prostate cancer. RESULTS: We compared 320 cases to 189 controls, and found a lower risk for prostate cancer in diabetics overall (adjusted Odds Ratios (OR) 0.6, 95% Confidence Interval (CI) 0.3-1.1), though it was not statistically significant. No association was seen with Stage A prostate cancer, but there was a significant reduction in risk for stages B, C, and D combined (adjusted OR 0.47, 0.2-0.9). This effect appeared to be mainly concentrated among whites and Hispanics. CONCLUSIONS: Diabetics appear to have a lower risk of prostate cancer, though this effect may be limited to whites. An understanding of this association and its race specificity may help to explain the major difference in incidence rates for prostate cancer between blacks and whites.

Aged↗
PubMed2002

Internet use and social support in women with breast cancer.

Many Web sites offer information to breast cancer patients, who are increasingly using these sites. The authors investigated the potential psychological benefits of Internet use for medical information by breast cancer patients. Of the 251 women approached, 188 were successfully interviewed (74.9%). Forty-two percent used the Internet for medical information related to breast health issues and did so for an average of 0.80 hr per week. The Interpersonal Support Evaluation List and the UCLA Loneliness Scale, with results controlled for covariates, showed that Internet use for breast health issues was associated with greater social support and less loneliness than Internet use for other purposes or nonuse. Breast cancer patients may obtain these psychological benefits with only a minimal weekly time commitment.

Adaptation, Psychological↗
PubMed2002

Risk factors for advanced colorectal adenomas: a pooled analysis.

Although most colorectal cancers arise from adenomatous polyps, most adenomas do not progress to invasive cancer. Understanding the epidemiology of advanced adenomas, specifically those with severe dysplasia, carcinoma in situ, or intramucosal carcinoma, is crucial to uncovering why some adenomas progress and some do not. Using data from four colonoscopy-based adenoma case-control studies, we compared two case groups: subjects with advanced adenomas (those with severe dysplasia, carcinoma in situ, or intramucosal carcinoma; n = 119) and subjects with nonadvanced adenomas (those with none, mild, or moderate dysplasia; n = 441) to a polyp-free control group (n = 1866) in regard to frequently studied risk factors for colorectal neoplasia. All of the cases were newly diagnosed and had no prior history of adenomas. We used an unordered polytomous logistic model to calculate multivariate odds ratios for advanced and nonadvanced adenoma cases relative to polyp-free controls. Among women, ever use of hormone replacement therapy was more strongly associated with reduced risk of advanced adenomas relative to polyp-free controls [odds ratio (OR), 0.4; 95% confidence interval (CI), 0.2-0.9] than with reduced risk of nonadvanced adenomas (OR, 0.7; 95% CI, 0.4-1.0). Among men, increased physical activity (>or=2 h/week) was more strongly associated with reduced risk for advanced adenomas (OR, 0.4; 95% CI, 0.2-1.0) than with reduced risk for nonadvanced adenomas (OR, 0.8; 95% CI, 0.5-1.2). Apart from these differences, most other risk factors, including body size and cigarette smoking were similar in their association with advanced and nonadvanced adenomas, suggesting that many risk factors for colorectal neoplasia may be important to adenoma formation but not to dysplasia per se.

Adenoma↗
PubMed2002

Reliability in the classification of advanced colorectal adenomas.

In conjunction with a pooled analysis of risk factors for advanced adenomas [adenomas with severe dysplasia, carcinoma in situ (CIS), and intramucosal carcinoma], we undertook a reliability study on the pathological diagnosis of advanced adenomas. We assessed intraobserver agreement (using Kappa (kappa) as the measure of agreement) across two time periods 10 years apart with a single pathologist and interobserver agreement (using Kappa) between two pathologists rating the same slides concurrently. The study pathologists were blinded to the original case classification. We used the slides of 190 colorectal adenomatous polyp cases (104 originally diagnosed as advanced adenomas, 86 adenomas without advanced lesions) from a colonoscopy-based case-control study conducted in New York City between 1986 and 1988. We also assessed conditional agreement for 71 slides of advanced adenomas from four adenoma case-control studies conducted in different geographic regions of the United States in the 1990s. Intra- and interobserver agreement was only fair to moderate on the classification of both histological type (villous, tubulovillous, and tubular: intraobserver kappa = 0.28; 95% confidence interval (CI), 0.17-0.39; interobserver kappa = 0.48; 95% CI, 0.33-0.62) and degree of dysplasia (none/mild, moderate, severe, CIS, and intramucosal: intraobserver kappa = 0.20; 95% CI, 0.12-0.28; interobserver kappa = 0.42; 95% CI, 0.29-0.55). Using broader, rather than finer, classifications for degree of dysplasia substantially improved the reliability (interobserver agreement for high-grade dysplasia (including severe dysplasia, CIS, and intramucosal carcinoma) versus low-grade dysplasia: kappa = 0.69; 95% CI, 0.55-0.83). These findings suggest that future epidemiological studies of advanced adenomas should use broad categories, such as high-grade versus low-grade dysplasia, include central review of all slides, and take measurement error into account in sample size calculations.

Adenoma↗
PubMed2002

Environmental toxins and breast cancer on Long Island. I. Polycyclic aromatic hydrocarbon DNA adducts.

Polycyclic aromatic hydrocarbons (PAH) are potent mammary carcinogens in rodents, but their effect on breast cancer development in women is not clear. To examine whether currently measurable PAH damage to DNA increases breast cancer risk, a population-based case-control study was undertaken on Long Island, NY. Cases were women newly diagnosed with in situ and invasive breast cancer; controls were randomly selected women frequency matched to the age distribution of cases. Blood samples were donated by 1102 (73.0%) and 1141 (73.3%) of case and control respondents, respectively. Samples from 576 cases and 427 controls were assayed for PAH-DNA adducts using an ELISA. The geometric mean (and geometric SD) of the log-transformed levels of PAH-DNA adducts on a natural scale was slightly, but nonsignificantly, higher among cases [7.36 (7.29)] than among controls [6.21 (4.17); P = 0.51]. The age-adjusted odds ratio (OR) for breast cancer in relation to the highest quintile of adduct levels compared with the lowest was 1.51 [95% confidence interval (CI), 1.04-2.20], with little or no evidence of substantial confounding (corresponding multivariate-adjusted OR, 1.49; 95% CI, 1.00-2.21). There was no consistent elevation in risk with increasing adduct levels, nor was there a consistent association between adduct levels and two of the main sources of PAH, active or passive cigarette smoking or consumption of grilled and smoked foods. These data indicate that PAH-DNA adduct formation may influence breast cancer development, although the association does not appear to be dose dependent and may have a threshold effect.

Adult↗
PubMed2002

Environmental toxins and breast cancer on Long Island. II. Organochlorine compound levels in blood.

Whether environmental contaminants increase breast cancer risk among women on Long Island, NY, is unknown. The study objective is to determine whether breast cancer risk is increased in relation to organochlorines, compounds with known estrogenic characteristics that were extensively used on Long Island and other areas of the United States. Recent reports do not support a strong association, although there are concerns with high risks observed in subgroups of women. Blood samples from 646 case and 429 control women from a population-based case-control study conducted on Long Island were analyzed. No substantial elevation in breast cancer risk was observed in relation to the highest quintile of lipid-adjusted serum levels of p,p'-bis(4-chlorophenyl)-1,1-dichloroethene (DDE) [odds ratio (OR), 1.20 versus lowest quintile; 95% confidence interval (CI), 0.76-1.90], chlordane (OR, 0.98; 95% CI, 0.62-1.55), dieldrin (OR, 1.37; 95% CI, 0.69-2.72), the sum of the four most frequently occurring PCB congeners (nos. 118, 153, 138, and 180; OR, 0.83; 95% CI, 0.54-1.29), and other PCB congener groupings. No dose-response relations were apparent. Nor was risk increased in relation to organochlorines among women who had not breastfed or were overweight, postmenopausal, or long-term residents of Long Island; or with whether the case was diagnosed with invasive rather than in situ disease, or with a hormone receptor-positive tumor. These findings, based on the largest number of samples analyzed to date among primarily white women, do not support the hypothesis that organochlorines increase breast cancer risk among Long Island women.

Adult↗
PubMedDate not supplied

Association of esophageal adenocarcinoma with other subsequent primary cancers.

PURPOSE: Esophageal adenocarcinoma shares risk factors such as obesity and smoking with other common cancers. The association of esophageal adenocarcinoma with other primary cancers has not been systematically evaluated. The authors used the Surveillance, Epidemiology and End-Results database of the National Cancer Institute to explore the association of esophageal adenocarcinoma with other primary cancers. PATIENTS AND METHODS: All adult patients with esophageal cancers, both adenocarcinoma and squamous cell carcinoma diagnosed between 1973 and 2001, were identified from the Surveillance, Epidemiology, and End-Results database, and standardized incidence rates were calculated for all subsequent primary cancers in these patients. The analysis was reversed to estimate the standardized incidence rate for subsequent primary esophageal cancer after a first primary cancer. RESULTS: In comparison with a standard population, patients with esophageal adenocarcinoma were at higher risk for the development of another subsequent cancer, specifically, cancers of the oral cavity and pharynx, lung and bronchus, and kidney and renal pelvis, and adenocarcinoma of the colon/rectum and pancreas. With squamous cell esophageal cancer, there was an association with tobacco-related cancers such as those of the oral cavity and pharynx, the lung and bronchus, and the breast. There was either no association or even a negative association of esophageal adenocarcinoma with other obesity-related cancers such as breast, uterine, and prostate cancers. CONCLUSIONS: Patients with esophageal adenocarcinoma and squamous cell carcinoma are at increased risk for the development of specific second primary cancers that share smoking as a common risk factor. Esophageal adenocarcinoma does not have a strong association with obesity-related cancers with respect to the relative risk for the development of subsequent primary cancers.

Adenocarcinoma↗
PubMedDate not supplied

Use of the Internet by women with breast cancer.

BACKGROUND: Recently, many cancer patients have been using the Internet for information with which to make informed choices. We are not aware of any studies that investigate this Internet use among breast cancer patients or women. OBJECTIVE: We investigate the prevalence and predictors of Internet use for medical information among women with breast cancer. METHODS: We used a cross-sectional design and approached 251 women with breast cancer being treated at a university-based hospital. We successfully interviewed 188 (74.9%), through mailed self-report questionnaires. Medical information was obtained from the hospital tumor registry. We used t tests and chi-square tests to assess differences in Internet use for breast health issues and binary logistic regression to estimate the odds ratio (OR) for predictors of Internet use for breast health issues. RESULTS: In our sample, 41.5% of patients used the Internet for medical information. Internet users differed from nonusers on income level, educational level, and by race/ethnicity. After controlling for the other predictors, Internet users had a higher income (OR = 3.10; 95% CI = 1.09-8.85) and tended to be more educated (OR = 2.59; 95% CI = 0.87-7.74) than nonusers. There was also a suggestion that those of nonwhite ethnicity were less likely to use the Internet (OR = 0.39; 95% CI = 0.14-1.11). Increasing age, length of time since diagnosis, and breast cancer stage had no effect. CONCLUSIONS: A substantial proportion of breast cancer patients used the Internet as a source of information. Patients with higher income or education, and patients of white race/ethnicity are more likely to use the Internet for breast health issues.

Attitude to Computers↗
PubMedDate not supplied

Breast cancer knowledge and beliefs in subpopulations of African American and Caribbean women.

OBJECTIVE: To examine breast cancer belief and knowledge deficits among previously unstudied African and Caribbean subpopulations and to consider the particular knowledge and belief components that are most lacking in each group. METHODS: 1,364 African American, US-born white, English-speaking Caribbean, Haitian, Dominican, and Eastern European women were recruiting via stratified-cluster sampling. Participants provided demographics and measures of beliefs and knowledge. RESULTS: There were between-group differences in cancer knowledge and beliefs and within-group variation in terms of which particular knowledge and belief items varied. CONCLUSIONS: Studying how cognitive factors relate to screening in well-defined minority groups will capacitate interventions suited to the knowledge and belief deficits that characterize populations of diverse women.

Black or African American↗