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Biomedical subjects

B F Hankey

Publications and source records attributed to B F Hankey.

At least 55 records · Page 3Linked to original sources
PubMed1988

Skin window reactivity to autologous breast cancer. An index of prognostically significant cell-mediated immunity.

The relationship between cell-mediated immunity (CMI) to autologous breast cancer tissue and subsequent clinical behavior has been studied by one of the authors since 1953. In this article the prognostic significance of CMI as measured by a skin window (SW) procedure is reported. The procedure examines cellular responses to coverslip-mounted sections of autologous breast cancer tissue that have been applied to a microabrasion of the skin. Using criteria routinely employed in conventional hematologic and pathologic diagnoses, diverse patterns of SW responses can be identified. Specific patterns are recognizable that are consistent with CMI and that vary significantly with stage and subsequent behavior of the disease. Intrastage variations in behavior were found for patients with invasive breast cancer according to nuclear grade (NG) and postoperative SW reactivity to autologous breast cancer. Positive SW reactivity was associated with a significantly reduced risk of metastases and also appeared to impede the occurrence of metachronous second primary invasive breast cancers. The findings demonstrate the current value of NG and SW response characteristics with regard to prognosis and immunotherapy. Moreover, they are consistent with the development of immunoprophylaxis.

Adult↗
PubMed1987

Black/white differences in bladder cancer patient survival.

Black bladder cancer patients have been found to have a substantially poorer survival experience than white patients; the 5-year relative survival rates are 71% for whites and 54% for blacks. To explore this difference in survival, data were analyzed on 4289 white and 380 black bladder cancer patients diagnosed during the period 1977-80 in three geographic areas covered by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The orientation of the analysis was to identify variables, using multivariable procedures, that were not only prognostic but which also were important in regard to explaining black/white differences in patient survival. Such variables are referred to as explanatory variables. Three variables were analyzed in regard to their importance as explanatory variables, i.e. histologic type, stage, and histologic grade, and all were found to be of roughly equal importance. The effects of other factors on black/white differences in survival are also discussed including the possible importance of lead-time bias and the possible lack of diagnosis of the more benign forms of bladder cancer in blacks.

Black or African American↗
PubMed1986

Factors associated with survival differences between black women and white women with cancer of the uterine corpus.

Prognostic factors leading to the survival advantage of white women over black women with uterine corpus cancer were evaluated by using a series of patients diagnosed from 1973-1977 in three geographic areas of the United States participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Higher survival rates were observed among women under age 55 years, with stage I disease, and living in higher socioeconomic census tracts. Significant survival differences by race for patients with adenocarcinomas were found at almost all factor levels. Within each racial group, patients with adenocarcinomas had better prognosis than did those with sarcomas. A multivariate analysis found stage of disease and age at diagnosis to be the major predictors of survival among women with adenocarcinomas of the uterine corpus, followed by race, median family income, and mean highest education received. Adjustment of the black survival rates for these factors reduced the gap among patients with adenocarcinomas, but significant differences in survival between blacks and whites remained. Race was not a predictive factor for survival of patients with sarcomas, but age at diagnosis, stage of disease, and education were. After adjustment for the significant factors, prognosis was equally poor for black patients and white patients with sarcomas of the uterine corpus. These findings suggest that, even when controlling for known markers of racial differences, there remain other underlying prognostic factors associated with survival of black women and white women with adenocarcinomas of the uterine corpus that have yet to be determined.

Adenocarcinoma↗
PubMed1985

An evaluation of the effect of vincristine added to cyclophosphamide, 5-fluorouracil, methotrexate, and prednisone in advanced breast cancer.

A multi-institutional randomized clinical trial was carried out to evaluate the effect of vincristine (V) added to cyclophosphamide, methotrexate, 5-fluorouracil, and prednisone (CMFP) for the treatment of metastatic breast cancer. There were 427 patients entered into the study and randomly assigned to one of the two treatments, i.e. the five drug therapy CMFPV or the four drug therapy CMFP. The differences in patient survival and tumor response between the two treatment groups were not statistically significant. The data were also analyzed using multivariate procedures to determine those factors ascertained at entry into the study which were predictors of survival or predictors of response to therapy. The one factor that predicted both response and survival was performance status. An additional important predictor of survival was sites of metastatic involvement. Other significant predictors of response were menopausal age, BUN, and hematocrit.

Adult↗
PubMed1984

Possible immunological implications of an association between the stages of first and second independent breast cancers.

Concepts regarding cell-mediated immunity and breast cancer are reviewed. Patients having in situ breast cancers have been found by in vivo and in vitro measurements to have cell-mediated immunity to autologous and homologous in situ breast cancer tissue which may last for some time after diagnosis. These observations suggest that antigenically similar cancers arising subsequently in the contralateral breast should be less likely to progress beyond the in situ stage and, if they do become invasive, should exhibit prognostically favorable signs of cell-mediated immunity, e.g. sinus histiocytosis in the lymph nodes and/or lymphoid infiltrate and perivenous lymphoid infiltrate associated with the primary tumor. Cell-mediated immunity has also been shown to be negatively associated with the stage of disease at diagnosis for invasive cancers, i.e. the proportion of patients exhibiting cell-mediated immunity decreases as the stage at diagnosis increases. These observations suggest that the stages of independent breast cancers occurring in the same woman should be positively correlated. Data from the SEER Program of the National Cancer Institute were examined in this regard and a strong positive association between the stage of first and second independent primary breast cancers was found with the effect on the stage of a second breast cancer following a the first invasive breast cancer appearing to decrease with time subsequent to diagnosis. These observations are consistent with the immunogenicity of breast cancer.

Age Factors↗
PubMed1984

Risk of leukemia associated with the first course of cancer treatment: an analysis of the Surveillance, Epidemiology, and End Results Program experience.

The risk of leukemia associated with the first course of cancer treatment was evaluated in over 440,000 patients diagnosed during 1973-80 (average follow-up = 1.91 yr) from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Although the reporting of the first course of therapy probably was incomplete, 34 acute nonlymphocytic leukemias (ANLL) developed compared with 7.6 expected among 70,674 patients known to receive initial chemotherapy [relative risk (RR) = 4.5, 95% confidence interval (Cl) = 3.1-6.3]. Significant ANLL excesses were observed following chemotherapy for breast cancer (RR = 8.1), ovarian cancer (RR = 22.2), and multiple myeloma (RR = 9.5). Patients initially treated with radiation (with no record of chemotherapy) also had a significantly increased ANLL risk; 45 leukemias occurred versus 17.9 expected (RR = 2.5, 95% Cl = 1.8-3.4). In this group, excess ANLL were found following irradiation for uterine corpus cancer (RR = 4.0). Kidney and renal pelvis cancer patients had a twofold leukemia risk (all types) that was unrelated to treatment (RR = 2.2).

Antineoplastic Agents↗
PubMed1983

Parity as a prognostic factor in young breast cancer patients.

Data were analyzed concerning 219 female breast cancer patients less than 36 years of age who were diagnosed and treated in the Province of Saskatchewan, Canada, during 1946-72. Pathology slides were available for review on 171 of these patients, and invasive breast cancer could be confirmed in 136. Nulliparous patients had more favorable age-adjusted survival rates than parous patients for the total patient group and for those patients whose tumor was verified to be invasive cancer on pathologic review. Adjustment for potential confounding factors indicated that differences in survival among parity groups could be explained to a substantial degree by differences in distribution over node status and the nuclear grade of the primary tumor. Because these factors relate to the biologic behavior of breast cancer and because the distributions of these factors were significantly associated with the parity categories utilized in the analysis, the data provide some evidence that parity influences the behavior of breast cancer in young women.

Adult↗
PubMed1983

A retrospective cohort analysis of second breast cancer risk for primary breast cancer patients with an assessment of the effect of radiation therapy.

Second breast cancer experience was examined for 27,175 primary breast cancer patients diagnosed in the State of Connecticut during 1935-75 with follow-up for second breast cancers through 1980. The overall ratio of observed to expected second breast cancers was 3.2. Relative risk was found to be inversely related to age at diagnosis and directly related to stage of the first breast cancer. The overall risk of second breast cancers was 711 per 100,000 person-years at risk. Risk of second breast cancers showed a similar relationship to age and stage as relative risk and was also directly related to calendar period of diagnosis of the first breast cancer. Some interactions were observed because patients less than 45 years old at diagnosis with positive nodes had elevated risks and relative risks in the early followup period, whereas less of an effect of stage on relative risk and risk was seen for older patients. The effect of the use of adjunctive radiation therapy on second breast cancer risk was also assessed by the ratio of the risk of second breast cancers for those patients who received both surgery and radiation to the risk of those patients who only received surgery being estimated for patients diagnosed during 1935-59 and for patients diagnosed during 1960-75. For both cohorts relative risks of 1.2-1.4 were found for the 5-year period immediately following diagnosis, likely resulting from the uncontrolled effect of stage in the analysis. Elevated long-term relative risks were not found for patients diagnosed during 1935-59. A long-term marginally statistically significant relative risk of 1.4 (greater than or equal to 10 yr after diagnosis) was found for patients diagnosed during 1960-75. The data do not indicate an overall pattern of relative risks consistent with an effect on long-term second breast cancer risk of radiation exposure to the opposite breast incurred during adjunctive radiation therapy for a first breast cancer.

Age Factors↗
PubMed1982

Long-term patient survival for some of the more frequently occurring cancers.

Conditional five-year relative survival rates were calculated for patients diagnosed during 1950-1959 to examine long-term survival patterns for some of the more frequently occurring cancers. The data on the patients studied were collected as part of the national cancer institute's End Results Program. Breast cancer patients with localized disease were found to have only slightly increasing conditional rates for 20 years subsequent to diagnosis beginning at 85% at diagnosis and exceeding 90% at 20 years subsequent to diagnosis. Conditional five-year rates for patients with distant involvement approached the conditional rates for patients with regional involvement 15 years after diagnosis. Conditional rates by stage for patients with cancer of the cervix or cancer of the corpus increased initially and then became somewhat constant at a level related to stage of disease at diagnosis. For cancer of the colon, the conditional rates for female patients in each stage of disease category approached the same value 7-8 years subsequent to diagnosis. These observations may provide additional insight into the biological behavior of these cancers.

Adult↗
PubMed1982

Intrastage prognostic heterogeneity: implications for adjuvant chemotherapy of breast cancer.

The precise role of the use of adjuvant chemotherapy in the treatment of primary breast cancer has been questioned by some clinicians. One of the most important questions regarding the use of adjuvant chemotherapy is the identification of appropriate patients to receive it. The presence of positive axillary nodes has been the determining factor for the evaluation of chemotherapy in clinical trials. The possibility that other factors should be considered in deciding on the routine use of chemotherapy is discussed here on the basis of data from breast cancer patients diagnosed in the Province of Saskatchewan, Canada, none of whom received chemotherapy as part of their primary treatment. The data illustrate the prognostic heterogeneity that exists among patients with negative axillary nodes and among patients with positive axillary nodes. The implications of such heterogeneity include the possibilities that some patients may not benefit from adjunctive chemotherapy and that some may actually be harmed by it. Specific procedures are described for the analysis of existing clinical trial data to determine whether there is any evidence that some patients may not have benefited from adjunctive chemotherapy. Additional clinical trials would have to be done to substantiate such observations.

Aged↗
PubMed1982

Changing patterns of Hodgkin's disease at autopsy: a 25-year experience at the National Cancer Institute, 1953--1978.

The pathologic findings at autopsy in 124 patients with an initial diagnosis of Hodgkin's disease (HD) were evaluated to assess the effects of treatment on the anatomic extent and histologic appearance of residual HD. Further, the effects of duration of disease, vascular invasion, and histologic subtype at diagnosis on sites of involvement were considered. The 124 autopsied cases came from a cohort of 345 patients admitted for treatment at the National Cancer Institute between 1953 and 1969, with followup extended to 1978. The pathologic review included extensive organ sampling; greater than 12,000 slides were reviewed. The study period spans 25 years, ranging from a period of palliative therapy (81 cases, pre-1965) to the modern curative treatment era (43 cases, 1965 or later). A distinct reduction in the extent of disease at autopsy was noted in the group treated with curative intent. Reduced involvement was the rule for most, but not all, organ sites, with the reduction greater for certain histologic types. Some organs had a comparable incidence of involvement with early and late deaths. Histologic assessment identified an atypical monomorphic form of residual HD (treatment-altered HD) in patients from both treatment eras but most consistently in the post-1965 group. Vascular invasion occurred in 43% of cases. The incidence of extranodal involvement was considerably higher in patients with vascular invasion, indicating that vascular spread is a factor in extranodal spread and in lethal cases of HD.

Adult↗
PubMed1980

Identification of breast cancer patients with high risk of early recurrence after radical mastectomy: III. Steroid hormones measured in urine.

The relationship of the levels of selected urinary steroid metabolites to breast cancer recurrence after radical mastectomy was studied. An analysis of variance of the steroid measurements suggested that the measurements standardized to per gram of creatinine were the appropriate measure to use in exploring these relationships. No significant associations were found for premenopausal patients; however, for postmenopausal patients, low levels of total 17-ketosteroids were associated with a reduced two-year recurrence-free rate whereas low and high levels of OHA and high levels of total estrogens were associated a relatively low high two-year recurrence-free rate. Because of the large number of significance tests performed and the lack of consistent patterns, it is questionable whether the observed associations are of any importance. Including these steroid quantities in a multivariate regression model along with previously determined clinical prognostic factors indicated that the steroid determinations were the least important variables and did not make a significant contribution to the fit of the model.

17-Ketosteroids↗
PubMed1975

Prognosis in breast cancer utilizing histologic characteristics of the primary tumor.

A study was made of the inter-relationships and prognostic significance of structural characteristics found in primary breast cancers and their associated axillary lymph nodes. The prognostically favorable characteristics included the following. For the primary tumor: nuclear differentiation of the cancer cells, diffuse lymphoid cell infiltrations (LI) and perivenous lymphoid cell infiltrations (PVI). For the axillary lymph nodes: sinus histiocytosis (SH). Perivenous lymphoid cell infiltrations (PVI) in the primary tumor are found to be as important a prognostic factor as SH in the axillary lymph nodes; these two characteristics are found to be positively associated. Evaluation of the nuclear grade (NG), LI, and PVI in the primary tumor allows for the definition of association with cancer cells having a low (anaplastic) nuclear grade, and to be positively associated with follicular hyperplasia (FH) in the lymph nodes. We also found a positive association between the cellular responses to areas of in situ carcinoma and the cellular responses to accompanying invasive breast breast cancer tissue. They also provide a prognostic system for classifying breast cancer patients on the basis of the microscopic characteristics of the primary tumor and surrounding breast tissue. The latter system should be of value in comparing the therapeutic benefits of various treatments.

Breast Neoplasms↗