Biomedical subjects

J T Flannery

Publications and source records attributed to J T Flannery.

At least 19 recordsLinked to original sources

PubMed1997

Cigarette smoking and changes in the histopathology of lung cancer.

BACKGROUND: Adenocarcinoma of the lung, once considered minimally related to cigarette smoking, has become the most common type of lung cancer in the United States. The increased incidence of this cancer might be explained by advances in diagnostic technology (i.e., increased ability to perform biopsies on tumors in smaller, more distal airways), changes in cigarette design (e.g., the adoption of filtertips), or changes in smoking practices. We examined data from the Connecticut Tumor Registry and two American Cancer Society studies to explore these possibilities. METHODS: Connecticut Tumor Registry data from 1959 through 1991 were analyzed to determine whether the increase in lung adenocarcinoma observed during that period could be best described by birth cohort effects (i.e., generational changes in cigarette smoking) or calendar period effects (i.e., diagnostic advances). Associations between cigarette smoking and death from specific types of lung cancer during the first 2 years of follow-up in Cancer Prevention Study I (CPS-I), initiated in 1959) and Cancer Prevention Study II (CPS-II, initiated in 1982) were also examined. RESULTS: Adenocarcinoma incidence in Connecticut increased nearly 17-fold in women and nearly 10-fold in men from 1959 through 1991. The increases followed a clear birth cohort pattern, paralleling gender and generational changes in smoking more than diagnostic advances. Cigarette smoking became more strongly associated with death from lung adenocarcinoma in CPS-II compared with CPS-I, with relative risks of 19.0 (95% confidence interval [CI] = 8.3-47.7) for men and 8.1 (95% CI = 4.5-14.6) for women in CPS-II and 4.6 (95% CI = 1.7-12.6) for men and 1.5 (0.3-7.7) for women in CPS-I. CONCLUSIONS: The increase in lung adenocarcinoma since the 1950s is more consistent with changes in smoking behavior and cigarette design than with diagnostic advances.

Adenocarcinoma↗

PubMed1997

Occupational exposure to machining fluids and laryngeal cancer risk: contrasting results using two separate control groups.

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls may have differed from that of the population controls.

Case-Control Studies↗

PubMed1997

Carcinogenic potential of silicone breast implants: a Connecticut statewide study.

To clarify the carcinogenic potential of silicone breast implants, 680 implant procedures performed on women in Connecticut with no prior history of cancer were correlated with the subsequent development of primary breast and nonbreast cancers. Neoplastic events after the placement of silicone breast implants during the 13-year interval from October 1, 1980, through September 30, 1993, were quantified using a retrospective, linked-registry method. ICD-9-CM discharge codes contained in the Uni formed Hospital Discharge Data Sets (UHDDS) from 34 hospitals across Connecticut were linked to procedure codes for unilateral and bilateral implants, and to medical histories for new malignancies after the implant procedures. Data were cross-linked to the Connecticut Tumor Registry to confirm the clinical history of each cancer. The rates of breast and nonbreast cancers in patients with silicone breast implants were compared with those of a control population drawn from the UHDDS of 1022 women undergoing sterilization by tubal ligation between 1981 to 1985. Ages (mean +/- SD) were similar in the implant group (34 +/- 10 years) and in the sterilization group (32 +/- 6 years). The mean follow-up in the implant group (4.6 years) was also similar to that of the control group (5.4 years). Compared with the control group, the implant group demonstrated lower rates of breast cancer (0.59 versus 0.88 percent, p = 0.35) and nonbreast cancer (0.59 versus 2.7 percent, p = 0.001). Correspondingly, the implant group had a lower relative risk of breast cancer (relative risk = 0.67, 95 percent, confidence interval = 0.20 to 2.17) and nonbreast cancer (relative risk = 0.21, 95 percent, confidence interval = 0.07 to 0.60). Based on these data, it was concluded that silicone breast implants are not carcinogenic, because they are not associated with increased rates of either breast or nonbreast cancers. The validity and threats to the conclusions are discussed, and the results are placed into context with similar findings from other studies.

Adult↗

PubMed1996

Family history of breast and ovarian cancer among breast-cancer patients in the Connecticut Tumor Registry.

Using the database of the population-based Connecticut Tumor Registry (CTR), along with the supplemental data obtained from Connecticut hospitals, 111 cases reporting one or more first-degree relatives with breast and/or ovarian cancer were identified among 1,077 incident female breast-cancer patients diagnosed at age <60 years in 1992. Stage at diagnosis and histology for invasive cancers did not differ between 99 family history-positive cases and 320 cases with no family history of any cancer. The CTR could be useful in clinical and epidemiologic studies involving inherited susceptibility to breast-cancer.

Adult↗

PubMed1996

Estimating breast cancer treatment charges in Connecticut.

Previous studies of estimated costs for cancer treatment have been limited to elderly patients or to specific health maintenance organizations. Data from the statewide population-based Connecticut Tumor Registry on a random sample of 407 breast cancer patients diagnosed in 1991 were linked with a statewide hospital-discharge database, to estimate charges (through September 1993) for inpatient and ambulatory surgery care. For the 377 cases (92.6% of 407) successfully linked, average charges attributed to breast cancer care declined with age, increased with extent of disease (stage at diagnosis), and increased with extent of surgery; these associations persisted in multivariate analyses. Total hospital-related charges for comorbid conditions (during 1991-93) were considerable by age 45 to 64 years. The merged database should be most useful in estimating charges for: cancers treated mainly by surgery (including ambulatory surgery at hospitals); comorbid conditions; and terminal care.

Adult↗

PubMed1995

Second primary cancer after treatment for cervical cancer. An international cancer registries study.

BACKGROUND: The pattern of second cancers after treatment for cervical cancer provides important information on the risk of radiation-induced malignancies. Large numbers of women survive many years and can be studied for late effects. METHODS: Incident second cancers in 86,193 patients with cervical cancer reported to 13 population-based cancer registries in 5 countries were evaluated to estimate the risk of second cancer among very long term survivors. RESULTS: Overall, 7543 second cancers were observed versus 6015 cancers expected based on population rates (observed/expected = 1.2). Lung cancer accounted for nearly half of the excess cancers. Among the 49,828 women treated with radiation, 3750 survived 30 or more years and a two-fold risk of cancers of heavily irradiated organs was seen. Most of the excess cancers were of the rectum, vagina, vulva, ovary, and bladder. Patterns of risk over time since treatment were consistent with a radiation etiology. Significant increases of nonchronic lymphocytic leukemia and cancers of the bone and kidney were also linked to radiotherapy. Women treated surgically were also at significant risk of second cancers, in all likelihood related to cigarette smoking and risk factors similar to those of cervical cancer. CONCLUSIONS: Curative therapy for cervical cancer results in large numbers of long term survivors who develop second cancers very late in life. Radiation is an important cause of this increase and there is no evidence that risk returns to normal levels.

Europe↗

PubMed1995

Brain, other central nervous system, and eye cancer.

BACKGROUND: The Surveillance, Epidemiology, and End Results (SEER) Program provides population-based data for the descriptive epidemiology of cancer incidence and survival rates by age, sex, race, and time period according to site and various histologic categories. METHODS: Relative frequencies, incidence rates, median age at diagnosis, and 5-year relative survival rates were analyzed by histologic type for microscopically confirmed primary malignant tumors of the brain, central nervous system (CNS) (except lymphomas), and eye, as well as olfactory neuroblastomas. RESULTS: Age-specific incidence rates for astrocytoma and glioblastoma, along with those for malignant meningioma, rose with increasing age up to 70-74 years, whereas rates for ependymoma and medulloblastoma (but not oligodendroglioma) showed a peak at age 0-4 years. Age-adjusted incidence rates for astrocytomas and glioblastomas were lower for blacks compared with whites, but there was little difference for rare types of brain/CNS cancers. Age-adjusted incidence rates increased slightly from 1973-1977 to 1983-1987 for astrocytoma, with little change for other histologic types. For cases diagnosed in 1983-1987, 5-year relative survival rates varied by histologic type and were low for astrocytoma, not otherwise specified (32%), and especially low for glioblastoma (4%); there was no evidence for improvement in survival rates for these two types from 1973-1977 to 1983-1987. Age-specific rates for eye melanoma rose with increasing age (especially for males), and age-adjusted rates were higher for whites than for blacks and declined from 1973-1977 to 1983-1987 in whites. Among cases diagnosed in 1983-1987, 5-year relative survival rates were high for melanoma of the eye (79%) and retinoblastoma (96%); only for retinoblastoma was there evidence of improvement in survival rates between 1973-1977 and 1983-1987. CONCLUSIONS: The SEER data are useful in examining the descriptive epidemiologic features, including time trends in incidence and survival rates, for primary cancers of the brain, CNS and eye. The lack of improvement in the low survival rates for some of these cancers emphasizes the remaining therapeutic challenges.

Adolescent↗

PubMed1995

The accuracy of prostate cancer staging in a population-based tumor registry and its impact on the black-white stage difference (Connecticut, United States).

Stage at diagnosis of prostate cancer is a major determinant of survival. Among Blacks, prostate cancer is diagnosed at a later stage of disease than among Whites. This study examined the accuracy of routine coding of prostate cancer stage in the Connecticut (United States) Tumor Registry (CTR) and its effect on the Black/White stage difference. Medical records were collected for 115 Black and 136 White men with prostate cancer diagnosed between 1987 and 1990. Stage at diagnosis was determined by a panel of two of the study members and compared with the stage in the CTR file. According to the panel, 32 percent of Blacks, but only 15 percent of Whites, were diagnosed with distant stage disease. Fifty-eight cases (26 percent of Whites and 20 percent of Blacks) were staged incorrectly by the CTR. Two-fifths of the errors were due to incomplete medical records at the CTR and three-fifths were due to CTR coding or data management errors. The more accurate staging did not have an appreciable impact on the Black/White stage difference. Further work is needed to characterize the accuracy of routinely coded cancer registry stage data for different cancer sites, to devise ways of improving accuracy, and to determine the impact of staging inaccuracies on research that utilizes these data.

Aged↗

PubMed1995

An assessment of oral cancer underregistration at the Connecticut Tumor Registry.

The purpose of this study was to investigate whether and to what extent cases of oral cancer diagnosed through the University of Connecticut Health Center Oral Pathology Biopsy Service went unregistered by the Connecticut Tumor Registry during the period 1984 to 1988. All Oral Pathology Biopsy Service pathology reports generated from 1984 to 1988 were reviewed to identify diagnosed oral cancer cases (International Classification of Diseases, 9th revision codes 140, 141, 143 to 145). The names of all identified patients were computer-linked to previously registered cases. Nineteen (8.6%) of the 221 reportable cases of oral cancer diagnosed through the Oral Pathology Biopsy Service from 1984 to 1988 went unregistered. The 19 unregistered cases represented 1.6% of all known Connecticut oral cancer cases diagnosed during the period. The finding of a past, albeit small, "gap" in oral cancer cases registered with the Connecticut Tumor Registry suggests that oral pathologists should confirm that cases of oral cancer diagnosed through their pathology services are being registered by their regional tumor registries.

Connecticut↗

PubMed1995

The screening histories of women with invasive cervical cancer, Connecticut.

OBJECTIVES: Each case of a continuous series of invasive cervical cancer cases was studied with a structured review procedure conducted by an expert panel to assess the reason that it was not detected before it became invasive. METHODS: All cases of invasive cervical cancer diagnosed in a 5-year period among Connecticut residents were identified; a screening history and screening outcome were obtained for 72% (481 of 664). RESULTS: Two hundred fifty women (51.9%) had suboptimal screening. One hundred thirty-seven women (28.5%) had never had a screening test, and their mean age was greater than that of the rest of the study population (64.5 years vs 46.5 years). Of the 344 women who had ever had a Pap test, 113 (32.8%) had their last Pap test 5 or more years before their diagnosis of invasive cancer; 52 (15.1%) were not followed up properly; 33 (9.6%) had their last smear misread as normal; and 118 (34.3%) developed cervical cancer within 3 years of their last Pap test. CONCLUSIONS: Physicians, nurses, and other care providers need to ensure that woman have timely and accurate screening with proper follow-up, make increased efforts to reach older women, and improve quality control of Pap smear readings.

Adenocarcinoma↗

PubMed1995

Surveillance of cancer incidence in Connecticut counties and towns, 1989-91.

Using the population-based Connecticut Tumor Registry, cancer incidence was examined for residents of Connecticut's eight counties and 169 towns in 1989-91. Findings included high standardized incidence ratios (SIRs) for: certain smoking-related cancers for women in New London County; several cancers (bladder, kidney, and mesotheliomas) for men in Middlesex County; Kaposi's sarcoma in Fairfield County, and in the towns of Hartford and New Haven; skin melanoma in certain ocean-shoreline towns; and invasive cervical cancer in several larger cities. Cancer surveillance data should be useful for promoting such efforts as smoking prevention and cessation, the collection of data on occupation and smoking by physicians and hospitals, reduction in excessive sun exposure, and increased screening for cervical cancer in large towns.

Adolescent↗

PubMed1994

Lung cancer risk and radiation dose among women treated for breast cancer.

BACKGROUND: Evidence shows ionizing radiation can cause lung cancer, but few studies have quantified risk in relation to radiation dose. PURPOSE: This study evaluated the long-term risk of lung cancer among women treated with radiation for breast cancer. METHODS: In this case-referent study, the Connecticut Tumor Registry was used to identify women diagnosed with histologically confirmed invasive breast cancer between 1935 and 1971 who survived for at least 10 years (8976) and to ascertain lung cancers occurring in this group between 1945 and 1981. Seventy-six cases of lung cancer were identified; however, 15 cases did not meet the criteria for inclusion. For the 61 remaining lung cancer case patients and 120 reference subjects (selected from the same registry and matched according to race, age at breast cancer diagnosis, year of breast cancer diagnosis, and survival without a second primary tumor), hospital charts were reviewed to collect medical history and radiotherapy information. A medical physicist estimated radiation dose to different segments of the lungs on the basis of radiotherapy reports and experimental simulations of treatments. RESULTS: For these 10-year survivors of breast cancer, the overall relative risk (RR) of lung cancer associated with initial radiotherapy for breast cancer was 1.8 (95% confidence interval [CI] = 0.8-3.8), and the RR increased with time following treatment. The RR for periods of 15 years or more after radiotherapy was 2.8 (95% CI = 1.0-8.2). Mean dose was 15.2 Gy to the ipsilateral lung, 4.6 Gy to the contralateral lung, and 9.8 Gy for both lungs combined. The excess RR was 0.08 per Gy, based on average dose to both lungs, and 0.20 per Gy to the affected (cancerous) lung. CONCLUSIONS: Breast cancer radiotherapy regimens in use before the 1970s were associated with an elevated lung cancer risk many years following treatment. The estimated risk coefficients are lower than those reported for atomic bomb survivors. The lower than expected risk might be attributable to high-dose cell killing or the fractionated nature of the exposure. IMPLICATIONS: Approximately nine cases of radiotherapy-induced lung cancer per year would be expected to occur among 10,000 women who received an average lung dose of 10 Gy and survived for at least 10 years. Current radiotherapy for breast cancer results in less extensive exposure of the lungs in comparison to treatments of years past, and the risk of secondary lung cancer need not play a major role in clinical decisions regarding treatment for breast cancer. Nonetheless, efforts to reduce unnecessary exposure of the lungs and heart should continue to further reduce possible adverse radiation effects.

Adult↗

PubMed1994

Increased risk of lung cancer after breast cancer radiation therapy in cigarette smokers.

BACKGROUND: Ionizing radiation is a lung carcinogen in a variety of settings, including after breast cancer radiation therapy. The authors explored whether cigarette smoking and breast cancer radiation therapy have a multiplicative effect on the risk of subsequent lung cancer. METHODS: This case-control study investigated women registered with primary breast cancer in the Connecticut Tumor Registry who developed a second malignancy between 1986 and 1989. Those diagnosed with a subsequent primary lung cancer were compared with those diagnosed with a subsequent nonsmoking, nonradiation-related second malignancy, and age-adjusted odds ratios were calculated with logistic regression. RESULTS: No radiation effects were observed within 10 years of initial primary breast cancer. Among both smokers and nonsmokers diagnosed with second primary cancers more than 10 years after an initial primary breast cancer, radiation therapy was associated with a 3-fold increased risk of lung cancer. A multiplicative effect was observed, with women exposed to both cigarette smoking and breast cancer radiation therapy having a relative risk of 32.7 (95% confidence interval [CI], 6.9-154). The radiation carcinogenic effect was observed only for the ipsilateral lung and not for the contralateral lung both in smokers and nonsmokers. CONCLUSIONS: Breast cancer radiation therapy, as delivered before 1980, increased the risk of lung cancer after ten years in nonsmokers, and a multiplicative effect was observed in smokers. For both smokers and nonsmokers, this effect was observed only for the ipsilateral lung and not the contralateral lung. Modern techniques, however, significantly decrease the radiation dose to the lungs, which may decrease the risk of lung cancer. Nonetheless, due to the available choices in early-stage breast cancer treatment, current practices may need to be revised for young breast cancer patients who smoke.

Breast Neoplasms↗

PubMed1994

Late-stage breast cancer in Connecticut's three largest cities.

Among 1,559 breast cancer patients diagnosed in 1984-89 in residents of Connecticut's three largest cities (Bridgeport, Hartford, and New Haven), the proportion of late- (ie, regional or distant) stage cancers increased with increasing poverty level in the census tract of residence. Many census tracts with the highest proportions of late-stage breast cancers were located near a federally-qualified community health center or a hospital. Changing the stage distribution of breast cancer through increased screening by mammography and clinical breast examination may require greater collaboration among community health centers, local hospitals, mammography facilities, and mobile mammography vans, along with continuing medical education programs for primary care physicians in these cities.

Adult↗

PubMed1993

Trends in breast cancer treatment in Connecticut.

Data from the population-based Connecticut Tumor Registry showed an increase in partial mastectomy (PM) from 18.9% for local-stage breast cancers diagnosed in 1983 to 47.3% for those diagnosed in 1990, with no change in axillary dissection. For local-stage cancers 4 cm or smaller in size that received PM, axillary dissection increased from 39.2% in 1983 to 60.8% in 1990, with larger increases for cases < 50 and 50-59 years old, while radiotherapy increased mainly for cases 70-79 and > 80 years old. Among regional-stage cases with positive nodes (but no extension to skin or beyond the breast tissue) and 4 cm or smaller in size, PM increased from 9.4% to 29.1%, but remained lower than that among local-stage cancers. Continued monitoring is needed to assess the full impact of the 1990 NIH Consensus Conference Panel's recommendations for the treatment of early-stage breast cancer.

Adult↗

PubMed1992

Black versus white racial differences in clinical stage at diagnosis and treatment of prostatic cancer in Connecticut.

BACKGROUND: There are few published data on stage-specific prostate cancer incidence rates in United States black patients versus white patients, and there are no data comparing treatment received by black versus white patients with prostate cancer. METHODS: Using data from a population-based cancer registry, the proportion of prostate cancers diagnosed in Connecticut from 1985-1988 at each clinical stage was examined for blacks and whites, along with stage-specific incidence rates. First course of treatment was also examined by clinical stage. RESULTS: The proportion of cases diagnosed at the metastatic stage was higher for black patients (35.4%) than for white patients (22.1%), and age-specific incidence rates for metastatic cancer were 1.5-3.3 times higher for black patients. Among localized-stage cases, the distribution of histologic grade (or degree of differentiation) did not differ in blacks versus whites, suggesting no difference in tumor aggressiveness or potential response to treatment. For localized (or A and B)-stage cancers, significantly lower use of prostatectomy in blacks versus whites younger than 70 years of age was the only important black-white difference, which requires confirmation in other studies. Frequency of use of hormonal therapy including endocrine surgery (orchiectomy) did not differ between black and white patients with pelvic metastases or disseminated disease. Comparisons were also made with data on treatment (all races combined) reported from the American College of Surgeons' national survey of prostate cancer cases diagnosed in 1983. CONCLUSIONS: Earlier detection of prostate cancer in blacks is needed to reduce black-white differences in stage at diagnosis and thereby reduce overall differences in survival rates. There was little evidence for inequities in treatment of prostate cancer for black patients versus white patients in Connecticut.

Black or African American↗

PubMed1992

Risk of leukemia after chemotherapy and radiation treatment for breast cancer.

BACKGROUND: Few studies have evaluated the late effects of adjuvant chemotherapy for breast cancer. Moreover, the relation between the risk of leukemia and the amount of drug given and the interaction of chemotherapy with radiotherapy have not been described in detail. METHODS: We conducted a case-control study in a cohort of 82,700 women given a diagnosis of breast cancer from 1973 to 1985 in five areas of the United States. Detailed information about therapy was obtained for 90 patients with leukemia and 264 matched controls. The dose of radiation to the active marrow was estimated from individual radiotherapy records (mean dose, 7.5 Gy). RESULTS: The risk of acute nonlymphocytic leukemia was significantly increased after regional radiotherapy alone (relative risk, 2.4), alkylating agents alone (relative risk, 10.0), and combined radiation and drug therapy (relative risk, 17.4). Dose-dependent risks were observed after radiotherapy and treatment with melphalan and cyclophosphamide. Melphalan was 10 times more leukemogenic than cyclophosphamide (relative risk, 31.4 vs. 3.1). There was little increase in the risk associated with total cyclophosphamide doses of less than 20,000 mg. CONCLUSIONS: Although leukemia occurs in few patients with breast cancer, significantly elevated risks were linked to treatments with regional radiation and alkylating agents. Melphalan is a more potent leukemogen than cyclophosphamide or radiotherapy. Low risks were associated with the levels of cyclophosphamide in common use today. Systemic drug therapy combined with radiotherapy that delivers high doses to the marrow appears to enhance the risk of leukemia.

Aged↗

PubMed1992

Incidence and mortality of carcinoids of the colon. Data from the Connecticut Tumor Registry.

The aims of this study were to calculate the true incidence of colonic carcinoids in Connecticut from 1976 to 1986 and to determine the outcome of patients with these lesions. Fifty-four patients with carcinoids of the colon were identified (23 male and 31 female patients). Their average age was 64.1 +/- 2.1 years, with a range of 12 to 83 years. The age-adjusted incidence was 0.31 cases/100,000 population/year. Forty-eight percent of the carcinoids were located in the cecum; 16%, ascending colon; 6%, transverse colon; 11%, descending colon; 13%, sigmoid colon; and 6%, not assigned. Follow-up information was available in all cases. The crude 2-year survival rate was 63%, whereas the 5-year survival rate was 37%. Only one of six (16.6%) lesions that were 2 cm or smaller metastasized, whereas 23 of 31 lesions larger than 2 cm metastasized (74%). Six patients have survived an average of 43.5 months after local excision of their carcinoids. Fourteen patients died of their carcinoids. Metachronous gastrointestinal malignant neoplasms developed in six patients. These results suggest that, when found at an early stage, carcinoids of the colon (2 cm or smaller) can be treated by local excision. The vast majority of colonic carcinoids, however, are discovered at an advanced stage and should be treated aggressively with standard colonic resection. In addition, surveillance of the entire gastrointestinal tract should be initiated in these patients because of a high rate of other gastrointestinal malignant neoplasms.

Adolescent↗