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PubMed2001

Bladder cancer in Africa: update.

Carcinoma of the bladder is the most prevalent cancer in Egypt and in most African countries. At the National Cancer Institute (NCI), Cairo, it constitutes 30.3% of all cancers. The median age at diagnosis is 46 years, with a male preponderance of 5:1. Whether in Egypt or other African countries such as Sudan, Kenya, Uganda, Gold Coast, and Senegal, it is mostly of the squamous cell type, and arises in a background of schistosomiasis or bilharziasis. Tumors are usually advanced at the time of presentation. Bladder carcinogenesis is probably related to bacterial and human papilloma virus (HPV) infections, usually associated with bilharzial infestation. Management is mainly surgery, with 5-year survival rates after radical cystectomy increasing from 35% in the 1970s to 48% in the 1990s. The addition of adjuvant and neoadjuvant radiotherapy and chemotherapy to surgery since 1976 significantly improved both disease-free and overall survival rates. Molecular genetic studies concerning potential prognostic markers, tumorigenesis, and tumor progression in bilharzial bladder cancer are limited. However, a comprehensive detailed analysis of these factors is underway. Bilharzial bladder cancer is a preventable malignant disease. Primary prevention could be possible if the parasite is eliminated nationwide. Chemoprevention using retinoids or cyclooxygenase 2 (COX-2) inhibitors is a possible alternative. Semin Oncol 28:174-178.

Africa↗

PubMed2005

Early lung cancer detection using spiral computed tomography and positron emission tomography.

RATIONALE: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.

Adult↗

PubMed1995

The prevalence of Helicobacter pylori infection in gastric cancer.

The prevalence of Helicobacter pylori infection in gastric cancer patients is difficult to estimate because the infection may be lost from individuals with cancer or its precursor conditions. The bacterium does not colonize cancerous tissue and therefore studies using histopathology as a means of assessing infection require gastric biopsy material sampled separately from the tumour itself. Results from five such studies, with more than 50 patients, have demonstrated an H. pylori prevalence of 43%-78%. Studies using serological assessment of antibody presence have the advantage of enabling adequate case-control comparisons. Ten reported studies that were retrospective in design showed a range in prevalence from 52% to 89% among the cases and from 38% to 78% among the controls. Five studies showed a significant increase in infection prevalence among the cases, with odds ratios ranging from 1.6 to 4.2. The odds ratio increased in subjects who were younger. Retrospective studies may be biased in that the prevalence of H. pylori among cases may be systematically under-estimated. Three prospective serological studies showed a prevalence of 69%-95% among cases and 47%-76% among controls. All three studies had a significantly elevated odds ratio and a pooled estimate of this was 3.8 (95% CI: 2.3-6.2). In the pooled analysis there was a significant trend towards an increased odds ratio with increased time between the assessment of infection and cancer diagnosis. After 14 years of follow-up the overall infection prevalence among cases was 90% and the odds ratio was 8.7 (95% CI: 2.7-45.0). This might represent the best estimate of infection prevalence and associated risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Helicobacter Infections↗

PubMed2001

The burden of illness of cancer: economic cost and quality of life.

Cancer is a major public health issue and represents a significant burden of disease. In this chapter, we analyze the main measures of burden of disease as relate to cancer. Specifically, we review incidence and mortality, years of life lost from cancer, and cancer prevalence. We also discuss the economic burden of cancer, including cost of illness, phase-specific and long-term costs, and indirect costs. We then examine the impact of cancer on health-related quality of life as measured in global terms (disability-adjusted life years and quality-adjusted life years) and using evaluation-oriented applications of health-related quality of life scales. Throughout, we note the relative strengths and weaknesses of the various approaches to measuring the burden of cancer as well as the methodologic challenges that persist in burden-of-illness research. We conclude with a discussion of the research agenda to improve our understanding of the burden of cancer and of illness more generally.

Cost of Illness↗

PubMed2005

Helicobacter pylori and histopathological changes of gastric mucosa in Uganda population with varying prevalence of stomach cancer.

OBJECTIVES: Study the pathological changes in gastric mucosa of Nyarwanda, Nkole (both with high prevalence of stomach cancer) and Ganda (with low prevalence of this cancer) ethnic groups in the presence of Helicobacter pylori (H. pylori) infection. RESEARCH QUESTION: Do pathological changes accompanying H. pylori infection explain the varying prevalence of stomach cancer in these populations? DESIGN: Retrospective cross sectional study. SUBJECTS: A total of 114 patients of the above ethnic groups with upper gastrointestinal symptoms who underwent endoscopic biopsy examination between January 1996 and June 2002 formed the basis of this study. RESULTS: The severity of gastritis correlated with the presence of H. Pylori in Ganda and Nyarwanda but not in Nkole. Intestinal metaplasia (IM) was observed in Nyarwanda and Nkole and in some of these cases there was H. pylori. Gastric atrophy (GA) was also commonly observed in Nkole and Nyarwanda and H. pylori was detected more in the severe form of GA. Lymphoid follicle formation was not associated with H. pylori infection in all study groups. CONCLUSION: The major histological features relating stomach cancer to H. pylori in this study were presence of the infection in IM and GA that was observed mainly in Nyarwanda and Nkole. The lack of association between presence of lymphoid follicle and H. pylori infection probably explains the rarity of MALT lymphoma in Africa as these tumours are said to arise from H. pylori associated lymphoid follicles.

Adult↗

PubMed2006

Links between Propionibacterium acnes and prostate cancer.

Incidental foci of prostate cancer are found at autopsy in 30% of men in their third decade, and by their eighth decade more than 75% have histological evidence of cancer. This unprecedented cancer prevalence points to a ubiquitous causative agent or perhaps an interaction between multiple common carcinogenic cofactors. We propose that one of these carcinogens is Propionibacterium acnes. Several characteristics of prostate cancer suggest the involvement of an infectious agent and we provide evidence that P. acnes is an excellent candidate. We have cultured P. acnes from a substantial proportion of prostate glands containing cancer and shown a significant positive association with prostatic inflammation. P. acnes is well suited to cause persistent, low-grade infection involving a marked inflammatory response and the P. acnes subtypes most frequently associated with prostate cancer become highly prevalent in the urinary tract of males following puberty.

Gram-Positive Bacterial Infections↗

PubMed2005

Increased risk of cancer among relatives of patients with lung cancer in China.

BACKGROUND: Genetic factors were considered as one of the risk factors for lung cancer or other cancers. The aim of this work was to determine whether a genetic predisposition accounts for such familial aggregation of cancer among relatives of lung cancer probands. METHODS: A case-control study was conducted in 800 case families identified by lung cancer patients (probands), and in 800 control families identified by the probands'spouses. The data were analysed with logistic regression analysis model. RESULTS: The data revealed a significantly greater overall risk of cancer (OR = 1.82, P < 0.01) in the proband group. The relatives of lung cancer probands maintained an increased risk of non-lung cancer (P < 0.05) after adjusting for confounder factors. The crude odds ratio of a proband family having one family member with cancer was 1.67 compared with control families. Proband families were 2.56 times more likely to have two other family members with cancer. For three cancers and four or more cancers, the risk increased to 3.50 and 5.91, respectively. The most striking differences in cancer prevalence between proband and control families were noted for cancer risk among female relatives. The strongest effects were for not only lung cancer in any female relatives (OR 2.17, 95%CI 1.60-3.64) and mothers (OR 2.78, 95%CI 1.23-5.12) and sisters (OR 2.03, 95%CI 1.26-3.97), but also non-lung cancer in females and mothers (OR 2.00, 95%CI 1.26-3.01, and OR 2.34, 95%CI 1.28-4.40, respectively). CONCLUSION: These data support the hypothesis of a genetic susceptibility to cancer in families with lung cancer, and the female genetic susceptibility to cancer might be greater than male.

Adult↗

PubMed2001

Cancer in the Gambia: 1988-97.

We describe the incidence of cancer in The Gambia over a 10-year period using data collected through the Gambian National Cancer Registry. Major problems involved with cancer registration in a developing country, specifically in Africa are discussed. The data accumulated show a low overall rate of cancer incidence compared to more developed parts of the world. The overall age standardized incidence rates (ASR) were 61.0 and 55.7 per 100 000 for males and females, respectively. In males, liver cancer was most frequent, comprising 58% of cases (ASR 35.7) followed by non-Hodgkin lymphoma, 5.4% (ASR 2.4), lung 4.0%, (ASR 2.8) and prostate 3.3% (ASR 2.5) cancers. The most frequent cancers in females were cervix uteri 34.0% (ASR 18.9), liver 19.4% (ASR 11.2), breast 9.2% (ASR 5.5) and ovary 3.2% (ASR 1.6). The data indicate that cancers of the liver and cervix are the most prevalent cancers, and are likely to be due to infectious agents. It is hoped that immunization of children under 1 year against hepatitis B will drastically reduce the incidence of liver cancer in The Gambia.

Adolescent↗

PubMed2005

Risk of prostate cancer and family history of cancer: a population-based study in China.

We evaluated prostate cancer risk and family history of cancers using data from a case-control study in China. Cancer information among first-degree relatives was collected from 709 subjects (238 cases and 471 controls). None of the subjects reported a family history of prostate cancer. However, excess prostate cancer risk was associated with a family history of any cancer (OR = 1.79, 95% CI: 1.21-2.63) and esophageal cancer (OR = 2.39, 95% CI: 1.15-5.00). Nonsignificant risk was seen for family history of cancers of the stomach, lung, and female breast. Our results did not confirm the familial tendency toward prostate cancer but other cancers prevalent in China appeared to be aggregate, particularly esophageal cancer. Larger studies are needed to confirm these findings, and to clarify the genetic and lifestyle factors that may be involved.

Aged↗

PubMed1987

Increased familial risk for non-lung cancer among relatives of lung cancer patients.

Reports of two or more anatomically distinct cancer types clustering in families suggest the possible existence of a susceptibility-to-cancer gene. To determine whether a genetic predisposition accounts for such familial aggregation, a retrospective case-control study was conducted in 1976-1979 of 337 southern Louisiana families in each of which a deceased lung cancer patient was used as the proband. A comparison of first-degree relatives of proband families with spouse (control) families revealed a significantly greater overall risk of cancer (odds ratio (OR) = 2.0, p less than 0.0001) in the proband group. Using logistic regression techniques to control for the confounding effects of age, sex, cigarette smoking, and occupational/industrial exposures, relatives of lung cancer probands maintained an increased risk of non-lung cancer (p less than 0.05). The crude odds ratio of a proband family having one family member with cancer was 1.67 compared with control families. Proband families were 2.16 times more likely to have two other family members with cancer. For three cancers and four or more cancers, the risk increased to 3.66 and 5.04, respectively. Each risk estimate was significant at the 0.01 level. The most striking differences in cancer prevalence between proband and control families were noted for cancer of the nasal cavity/sinus, mid-ear, and larynx (OR = 4.6); trachea, bronchus and lung (OR = 3.0); skin (OR = 2.8); and uterus, placenta, ovary, and other female organs (OR = 2.1). These data support the hypothesis of a genetic susceptibility to cancer in families with lung cancer.

Aged↗

PubMed1996

Head and neck cancer: guidelines for chemotherapy.

Head and neck cancer is estimated to be one of the most prevalent cancers in the world. This tumour type accounts for 5% of all new cancer cases in the US and Europe each year. Patients with locally recurrent or metastatic squamous cell carcinoma of the head and neck have a poor prognosis, with a median duration of survival between 4 and 6 months. During the past few years, screening for potentially active new compounds, new associations and new modalities of chemotherapy administration have had some degree of success. Clinical investigations have also focused on the addition of chemotherapy to locoregional treatment for patients with locally advanced disease. Induction chemotherapy or concomitant chemo- and radiation therapy can result in high response rates, and reduced incidence of distant metastases. However, there is no clear demonstration of any benefit from the addition of chemotherapy to locoregional therapy on overall survival in patients with resectable disease. In patients with resectable laryngeal or hypopharyngeal cancer, chemotherapy combined with radiotherapy can be considered as a standard treatment option for larynx preservation, keeping total laryngectomy reserved for salvage therapy. In patients with unresectable head and neck cancer, simultaneous chemoradiotherapy has been shown to improve locoregional control and survival, at the cost of greater toxicity. Outside clinical trials, this approach can also be considered as a standard therapy for unresectable disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Causation and prevention of solely estrogen-induced oncogenesis: similarities to human ductal breast cancer.

Estrogens are intimately involved in the causation of some of the most prevalent cancers afflicting women, particularly, breast, endometrial, cervico-vaginal, and possibly ovarian. Therefore, it has become particularly pertinent to elucidate the molecular changes and mechanisms whereby estrogens elicit their oncogenic actions so that better prevention strategies can be developed. The estrogen-induced Syrian hamster tumors of the kidney have emerged as one of the most intensively studied in-vivo models in solely estrogen-induced oncogenesis. An advantage of this model is that the tumors occur in the absence of any intervening morphologic changes, but rather they are the result of the continuous progression of a subset of interstitial stem cells in the kidney leading to tumor formation. Evidence is presented that the origin of these tumors is derived from ectopic "uterine" stem cells, which are responsive to estrogenic hormones. The other animal tumor model studied is the highly sensitive estrogen-induced mammary tumors of female ACI rats. Their steroid receptor and other gene alterations have been delineated. Importantly, a crucial early event in this solely estrogen-induced oncogenic process, common to both animal tumor models, is the overexpression and amplification of c-myc and its protein product. Chromosomal instability, in both early and large well-established frank tumors, is another important characteristic found during early E-induced oncogenesis. These features have been shown to be characteristic of human ductal carcinomas in-situ and in primary invasive ductal breast carcinomas. The molecular alterations seen are considered crucial in eliciting estrogen-induced oncogenesis and have established for the first time a direct causal link between estrogen and the induction of chromosomal instability and aneuploidy in these estrogen-associated neoplasms.

Animals↗

PubMed1980

Neoplasia withstands cancer.

A theory is presented which regards cancer as a systemic disease caused by carcinogens. The organism protects itself by mobilizing its stem cell pool which proliferates in form of a neoplasm to withstand the deterioration of systemic cancer. These ideas are illustrated in form of a mathematical model which reproduces the known epidemiological functions such as: Age specific cancer incidence, prevalence, mortality and cancer survival. Their shap supports the theory and is consistent with the above assumptions. The model may be utilized further for the estimation of cancer prevalence and the degree of interaction between chronic systemic diseases and cancer. Since these features of the model are independent of the above assumptions, it may be applied to cancer epidemiology as such.

Age Factors↗

PubMed2002

Gastric cancer: prognostic and diagnostic advances.

Carcinoma of the stomach is one of the most prevalent cancer types in the world today. Only a limited number of biomarkers are available for detection and prognostic evaluation of gastric cancer. New advances in identifying molecular biomarkers are essential. Two major forms of gastric cancer are distinguished according to their morphological and clinicopathological classifications (well-differentiated/intestinal type and poorly differentiated/diffuse type)--characteristics that can also be attributed to different oncogene activations. Many genes related to cell cycle regulation and signal transduction have been implicated in gastric cancer progression. In particular, there is convincing evidence that protein tyrosine kinases (PTKs) are involved in oncogenesis and disease progression. To learn more about the biological significance of all expressed PTKs in human cancers, an improved and more-comprehensive PTK profiling approach has been developed to discover additional PTKs activated in cancer cells. With the completion of the human genome project and the availability of cDNA microarrays or DNA chips, the entire human transcriptome can be used for elucidating genes responsible for human gastric cancer oncogenesis and progression.

Humans↗

PubMed1994

[The incidence and prevalence of malignant diseases. A secondary data analysis of a representative random sample of those with local compulsory medical insurance in Dortmund].

Prevalence and distribution of malignant neoplasms were obtained in 1988 and 1989 from a representative random sample of 5% of insured members of the statutory health insurance company in Dortmund, Germany (7447 persons). Data were gathered from medical certificates the diagnosis being further validated internally by other patient data. The cancer prevalence in the sample was 2.3% (males 1.6%, females 3.0%). The average age of the 174 patients with cancer was 67.5 years, half of them 70 years or over. The most frequent cancer was that of the breast (32.2%), followed by that of the colorectum (14.3%) and the skin (12.5%). Standardized for age and sex the prevalence of cancer for the whole population of the Federal Republic of Germany (excluding the former German Democratic Republic) was calculated as 2.2% (males 1.7%, females 2.5%), i.e. 1.33 million patients. The incidence of cancer for 1989 was 0.54%. Taking into account special methodological considerations, the secondary analysis of data obtained from the described source provides information relevant to the care of patients with cancer and thus makes a valuable contribution to the documentation of medical care provision.

Adult↗

PubMed2005

The role of computed tomography in screening for cancer.

Recent technical developments have revolutionized computed tomographic (CT) capabilities, and therefore its clinical applications. Multidetector CT (MDCT) allows scanning of the entire body within a few minutes. Over 60 million CT examinations were performed last year in the United States and Western Europe. Many emergency room physicians use it as a virtual physical examination. Its applications to early cancer detection have been controversial. Targeted CT screening for widely prevalent cancers, namely lung and colon, has been advocated in the literature. Combining the two, a whole-body screening CT scan might be offered to appropriately selected, high-risk populations.

Colorectal Neoplasms↗

PubMed2005

Flavopiridol reduces malignant transformation of the esophageal mucosa in p27 knockout mice.

The cyclin-dependent kinase (cdk) inhibitor p27 preferentially inactivates cdk complexes required for progression through the G1/S transition. Loss of p27 is associated with aggressive behavior in a variety of tumors, including Barrett's associated adenocarcinoma (BAA). We have previously shown that gastroduodenal-esophageal reflux (GDER) together with N-methyl-N-benzylnitrosamine (MBN) induces Barrett's esophagus (BE) and malignant transformation of the esophageal mucosa in mice. This process is enhanced in a p27 null background. Here, we show that chronic flavopiridol administration sharply reduced the prevalence of BE in GDER/MBN-treated p27 knockout mice when compared to animals treated with diluent only (7 vs 26%, P=0.0079). Similarly, flavopiridol reduced the prevalence of BAA (11 vs 32%, P=0.0098) and overall cancer prevalence (15 vs 60%, P<0.0001). In addition, appropriate molecular targeting by flavopiridol in tumor cells was confirmed by downregulation of cyclin D1, a known target of this pan-cdk inhibitor. The results of this study represent the experimental basis for chemoprevention with cdk inhibitors in human BE and BAA.

Adenocarcinoma↗

PubMed1994

[Increased suicide risk in cancer patients].

It is a much debated question whether suicide risk is higher for cancer patients in comparison to general population. We analyse this problem by a literature review and focus on specific risk groups. We have identified two different research topics: (1) The study of cancer prevalence among suicides. (2) The study of suicide incidence among cancer patients. Mainly on a basis of the latter and more homogeneous researches, we have outlined that cancer diagnosis involves an increased suicide risk. It is difficult on the contrary to explain the sources of suicidal behaviour by means of the heterogeneous literature data. Most of authors agree that suicide risk is highest during the first to second year since diagnosis. The risk can be attributed to the information on cancer diagnosis, but mainly to the seriousness of neoplastic disease, because of negative short-term outcome of most serious patients. Furthermore the risk can be attributed to the period immediately following discharge from oncologic and surgical wards, especially for long-term patients who suffer from distress given by the treatment itself. Then it is at risk the relapse after symptom remission. The high-risk patients are those suffering from the most severe and rapidly progressive neoplasms, treated by chemotherapy or affected by terminal illness with intractable pain. Patients with previous psychiatric history (particularly including alcohol dependence and depression) are likely to kill themselves in the remission phase of illness. In conclusion cancer patients who commit suicide, are not a homogeneous group. The relationships between cancer, depression and suicide are crucial, because severe depression is particularly frequent among cancer patients but is sometimes misdiagnosed and lacking in treatment.

Depressive Disorder↗