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PubMedDate not supplied

Comparison of three prognostic indexes in differentiated thyroid cancer.

We investigated epidemiological data and correlation coefficient among three prognostic indexes (TNM, AGES and DeGroot's) in 82 patients with differentiated thyroid carcinoma (mean age: 41.7 +/- 16.6 years and sex ratio F8:M1). Seventy eight cases (95.1%) had papillary and 4 (4.8%) follicular carcinoma. Surgical complications were: vocal cord paralysis 7 cases (8.4%), hypoparathyroidism 10 cases (12.2%) and both in four cases (4.8%). We did not find surgical complications in patients subjected to main limited procedures. After a follow up of 54.5 +/- 44.5 months one patient was dead due to thyroid cancer (1.2%) and 2 patients had tumor relapse (2.4%). We found positive correlation between TNM and AGES, AGES and DeGroot and DeGroot's and TNM indexes, with concordance between them (k = 0.2281, p = 0.001). In our series, follicular cancer prevalence is lower than literature reports. Our results suggest that TNM, DeGroot's and AGES indexes may have similar prognostic value in differentiated thyroid cancer.

Adult↗

PubMed1995

The risk of esophageal cancer in patients with achalasia. A population-based study.

OBJECTIVE: To determine more precise and accurate cancer risk estimates for achalasia that could be used to plan surveillance. DESIGN: Cohort. SETTING: Swedish population. PARTICIPANTS: All patients with achalasia listed in the population-based Swedish Inpatient Register from 1964 through 1989. MAIN OUTCOME MEASURES: The observed number of cancers in the cohort was compared with expected numbers of cancers (standardized incidence ratio [SIR]) for each 5-year age group and calendar year of observation, calculated using data from the Swedish Cancer Registry. RESULTS: A total of 1062 patients with achalasia accumulated 9864 years of follow-up. The mean age at entry was 57.2 years, and the mean age at cancer diagnosis was 71.0 years. Esophageal cancer occurred in 24 patients. The risk of esophageal cancer in the first year after achalasia diagnosis was extremely high (SIR, 126.3; 95% confidence interval [CI], 63.0 to 226.1) as a consequence of prevalent cancers leading to distal esophageal obstruction simulating achalasia. During years 1 to 24, the risk was increased more than 16-fold (SIR, 16.6; 95% CI, 8.8 to 28.3). Annual surveillance after the first year would require 406 endoscopic examinations in men and 2220 in women to detect one cancer. CONCLUSIONS: Patients with achalasia are at markedly increased risk of developing esophageal cancer. A substantial number of surveillance examinations might be required to screen for cancers, especially in women. It is not known whether surveillance will result in improved survival.

Adult↗

PubMed2005

Demographic and genetic characteristics of patients with borderline ovarian tumors as compared to early stage invasive ovarian cancer.

OBJECTIVE: Evaluation whether Jewish founder mutations in BRCA predispose to borderline tumors as they do to early invasive ovarian cancers. METHODS: All Jewish women with borderline or invasive ovarian tumors, diagnosed over a 5-year period (1994-1999), were identified in the frame of a nationwide epidemiological study on ovarian cancer in Israel. Out of a total of 1489 patients, 1269 were interviewed; of them 256 (20.2%) patients were identified with stage I and II invasive epithelial ovarian tumors, and 233 (18.3%) patients were identified with borderline tumors. All patients underwent interviews, and blood or tissue samples from 117 borderline tumors and 161 early stage invasive tumors were analyzed for the presence of the 185delAG and 5382insC BRCA1, and the 6174delT BRCA2 Jewish founder mutations. RESULTS: Patients with borderline tumors were younger at diagnosis, and more frequently of the serous type (P < 0.001) as compared to patients with early stage ovarian cancer. Prevalence of Jewish founder mutations in BRCA1 and BRCA2 was only 4.3% of patients with borderline tumors as compared to 24.2% of patients with early stage ovarian cancer (P = 0.001). CONCLUSIONS: This nationwide study comparing patients with early stage borderline and invasive epithelial tumors of the ovary confirms our previous pilot study that showed a lower incidence of BRCA mutations in patients with borderline tumors. Our results suggest that the genetic predisposition and the molecular mechanisms underlying tumor initiation differ between invasive and borderline tumors of the ovary.

Adult↗

PubMed2006

The epidemiology of sepsis in patients with malignancy.

STUDY OBJECTIVES: To evaluate the longitudinal epidemiology of sepsis in patients with a history of cancer and to specifically examine sepsis-related disparities in risk or outcome. DESIGN: Sepsis cases from 1979 through 2001 using a nationally representative sample of nonfederal acute-care hospitalizations in the United States (the National Hospital Discharge Survey) integrated with cancer prevalence from the Surveillance, Epidemiology, and End Results database. SETTING: Eight hundred fifty-four million acute-care hospitalizations and 8.9 million patients with cancer. PATIENTS OR PARTICIPANTS: Patients with a history of cancer hospitalized with a diagnosis of sepsis. MEASUREMENTS AND RESULTS: From 1979 to 2001, there were a total of 1,781,445 cases of sepsis in patients with cancer, yielding a mean annual incidence rate of 1,465 cases per 100,000 cancer patients and a relative risk [RR] of 9.77 compared to noncancer patients (95% confidence interval [95% CI], 9.67 to 9.88). In contrast to the absolute number of cases, the incidence rate of sepsis decreased over time, from a peak of 1,959 cases per 100,000 cancer patients in 1987 to 995 cases per 100,000 in 2001. The distribution of infectious sources causing sepsis was associated with the type of malignancy. White cancer patients had a lower risk for sepsis compared to nonwhites (African-American RR, 1.28; 95% CI, 1.16 to 1.40) and other races (RR, 1.47; 95% CI, 1.22 to 1.72); and male cancer patients had a higher risk for sepsis compared to female cancer patients (male RR, 1.17; 95% CI, 1.10 to 1.23). Cancer was an independent predictor of death among sepsis patients by multivariable analysis (adjusted odds ratio for death, 1.98; 95% CI, 1.97 to 1.99). CONCLUSIONS: Patients with a history of cancer are at increased risk for acquiring and subsequently dying from sepsis, compared to the general population, although incidence and fatality rates are decreasing over time. There are significant racial and gender disparities in the incidence and outcome of sepsis among cancer patients that require explanation.

Black or African American↗

PubMed1984

Characteristics of breast cancer in an incident cancer population.

The effectiveness of film mammography is a source of concern to radiologists because neither the ribs nor retromammary space is included on the films in good quality examinations. One hundred seven incident cancers were detected in 10,034 self-referred women followed at the University of Michigan Breast Cancer Detection Demonstration Project (UM-BCDDP) for 5 years. These cancers were analyzed for location on the film, method of detection, size, histology, and the number of films required for detection. Mammography alone detected 52 (49%) of the cancers, whereas physical examination alone detected 15 (14%). The other 40 cancers were detectable on both examinations. All of the 92 cancers detected by mammography were visible in both the mediolateral and the craniocaudal views. Only 2.2% of these cancers were within 1 cm of the posterior edge of the film in the mediolateral view; 18.7% were within 1 cm of the posterior edge in the craniocaudal view. These incident cancers were smaller, and fewer were located within the posterior 1 cm of the breast than in a similar study using the UM-BCDDP prevalent cancer population. Mammography consistently detected cancer in the breast, regardless of tumor size, histologic type, or location within the breast.

Adult↗

PubMed2003

Human epithelial cancers secrete immunoglobulin g with unidentified specificity to promote growth and survival of tumor cells.

Immunoglobulins (Igs) are found thus far only to be produced by differentiated B lymphocytes. By immunohistochemistry analysis, in situ hybridization, and laser capture microdissection-assisted single-cell PCR, we demonstrate that human cancers of epithelial origin, including carcinomas of breast, colon, liver, lung, established epithelial cancer lines, as well as some normal lung tissues, also produce IgG in both cytoplasmic and secreted forms. Furthermore, blockade of tumor-derived IgG by either antisense DNA or antihuman IgG antibody increased programmed cell death and inhibited growth of cancer cells in vitro. More importantly, administration of antihuman IgG antibody also suppressed the growth of an IgG-secreting carcinoma line in immunodeficient nude mice. Our results support a role of tumor-derived IgG as growth factor for epithelial cancers. Prevalent expression of IgG in human carcinomas and its growth-promoting functions may have important implications in growth regulation and targeted therapy of human cancers.

Amino Acid Sequence↗

PubMed1999

Factor analysis of digestive cancer mortality and food consumption in 65 Chinese counties.

Dietary factors were analyzed for the regional difference of GI tract cancer mortality rates in China. Sixty-five rural counties were selected among a total of 2,392 counties to represent a range of rates for seven most prevalent cancers. The dietary data in the selected 65 counties were obtained by three-day dietary record of households in 1983. The four digestive cancer mortality rates (annual cases per 100,000 standardized truncated rates for ages 35-64) and per capita food consumption were analyzed by the principal components factor analysis. Esophageal cancer associated with poor area, dietary pattern rich in starchy tubers, and salt, lack of consumption of meat, eggs, vegetables and rice. Stomach cancer seemed to be less associated with diet in this study because of its small model Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy, suggesting some other carcinogenic factors would play more important role in the development of this cancer in China. The colon and rectal cancer showed close relation to diet; rich in sea vegetables, eggs, soy sauce, meat and fish, while lack in consumption of milk and dairy products. Rapeseed oil was more important risk factor for colon cancer than that of rectum. Rice, processed starch and sugar were closely associated with colon cancer, supporting the insulin/colon cancer hypothesis.

Adult↗

PubMed1981

Familial breast cancer and its recognition in an oncology clinic.

Family history of cancer was evaluated for 79 breast cancer probands from among a series of consecutively ascertained cancer patients undergoing treatment in the authors' Oncology clinic. Cancer prevalence for each family was quantified by using a statistic that accounts for variable size and age structure among families. To test the null hypothesis that cancer risk is independent of family membership, the distribution of this statistic for families in their original configuration was compared with the distributions observed when relatives were randomly assigned to families in 99 random permutations of family membership. The results indicated significant heterogeneity for cancer risk among relatives of breast cancer probands, which suggests that the isolation of high risk families can provide a meaningful resource for in-depth studies in breast cancer genetics. Using an objective criterion for selection of such families, high risk for early onset breast cancer was confirmed in a prospective follow-up study fof four families from the original resource.

Adult↗

PubMed2005

From gene mutations to tumours--stem cells in gastrointestinal carcinogenesis.

Stem cells share many properties with malignant cells, such as the ability to self-renew and proliferate. Cancer is believed to be a disease of stem cells. The gastrointestinal tract has high cancer prevalence partly because of rapid epithelial cell turnover and exposure to dietary toxins. The molecular pathways of carcinogenesis differ according to the tissue. Work on hereditary cancer syndromes including familial adenomatous polyposis (FAP) has led to advances in our understanding of the events that occur in tumour development from a gastrointestinal stem cell. The initial mutation involved in the adenoma-carcinoma sequence is in the 'gatekeeper' tumour-suppressor gene adenomatous polyposis coli (APC). Somatic hits in this gene are non-random in FAP, with the type of mutation selected for by the position of the germline mutation. In the stomach, a metaplasia-dysplasia sequence occurs and is often related to Helicobacter pylori infection. Clonal expansion of mutated cells occurs by niche succession. Further expansion of the aberrant clone then occurs by the longitudinal division of crypts into two daughter units--crypt fission. Two theories seek to explain the early development of adenomas--the 'top down' and 'bottom up' hypotheses. Initial studies suggested that colorectal tumours were monoclonal; however, later work on chimeric mice and a sex chromosome mixoploid patient with FAP suggested that up to 76% of early adenomas were polyclonal. Introduction of a homozygous resistance allele has reduced tumour multiplicity in the mouse and has been used to rule out random collision of polyps as the cause of these observations. It is likely that short-range interaction between adjacent initiated crypts is responsible for polyclonality.

Animals↗

PubMed2007

Apigenin and cancer chemoprevention: progress, potential and promise (review).

Cancer is one of the major public health burdens in the United States and in other developed countries, causing approximately 7 million deaths every year worldwide. Cancer rates vary dramatically in different regions and populations around the globe, especially between developing and developed nations. Changes in cancer prevalence patterns occur within regions as their populations age or become progressively urbanized. Migration has also contributed to such variations as changes in dietary habits influence cancer rates. These epidemiologic findings strongly suggest that cancer rates are influenced by environmental factors including diet, which is largely preventable. Approaches to prevent cancer include overlapping strategies viz. chemoprevention or dietary cancer prevention. Chemoprevention aims at prevention or reversal of the initiation phase of carcinogenesis or arrest at progression of carcinogenesis through the administration of naturally occurring constituents or pharmacological agents. Cancer prevention through diet may be largely achievable by increased consumption of fruits and vegetables. Considerable attention has been devoted to identifying plant-derived dietary agents which could be developed as promising chemopreventives. One such agent is apigenin. A naturally occurring plant flavone (4', 5, 7,-trihydroxyflavone) abundantly present in common fruits and vegetables including parsley, onions, oranges, tea, chamomile, wheat sprouts and some seasonings. Apigenin has been shown to possess remarkable anti-inflammatory, antioxidant and anti-carcinogenic properties. In the last few years, significant progress has been made in studying the biological effects of apigenin at cellular and molecular levels. This review examines the cancer chemopreventive effects of apigenin in an organ-specificity format, evaluating its limitations and its considerable potential for development as a cancer chemopreventive agent.

Anticarcinogenic Agents↗

PubMedDate not supplied

Epidemiology of cancer in the elderly. Current status and projections for the future.

This paper provides an epidemiologic overview for the international conference, "Problems of Treatment of Cancer in the Elderly," Rome, Italy. The current cancer burden in the elderly and demographic situation and what can be anticipated in coming decades is profiled for the United States with data from epidemiologic perspective of cancer and aging. The National Institute on Aging (NIA), Geriatrics Program is promoting interest in integrating aging and cancer research. In the United States, the cancer burden of the elderly is high and has increased over time. Currently, 60% of all malignant tumors occur in the age group 65 years and older, 69% of all cancer deaths are in this age group. As the U.S. population ages, the needs for cancer control will continue to increase. The age segment of the U.S. population is 2.5% (31.1 million). Based on current projections by the U.S. Bureau of the Census, by 2030, one in five Americans will be 65+, reflecting a proportion of 20.1% of the total population (70.2 million persons). The paper describes cancer in the elderly, now and in the future, emphasizing several pertinent issues, the comorbidity burden of cancer patients, the impact of the expansion of the aged segment of the U.S. population over time, and cancer prevalence. Briefly mentioned, also, are two recent research announcements initiated by the NIA and cosponsored by the NCI and other NIH Institutes, "Aging Women and Breast Cancer", and "Aging, Race, and Ethnicity in Prostate Cancer".

Aged↗

PubMed2002

[Review of risk factors for breast cancer--what's new?].

Breast cancer is the most common malignancy in women and constitutes 18% of all cancers in women. Female gender, age and country of birth are the strongest determinants of disease risk. Family history and mutations in tumor suppressor genes BRCA1 and BRCA2 are important correlates of lifetime risk. Genetic polymorphisms associated with estrogen synthesis and metabolism are viewed as major factors in breast cancer prevalence in specific populations. Atypical hyperplasia and ductal/lobular carcinoma in situ although uncommon, are considered as pre-malignant conditions as well as markers for invasive breast cancer. Lately, increased bone density and high breast tissue density on mammogram in postmenopausal women have been reported in association with increased risk of breast carcinoma, probably attributable to increased levels of endogenous estrogen. Serum estrogen levels are higher in breast cancer cases as compared with controls. Current use of oral contraceptives and prolonged, current or recent use of postmenopausal hormonal replacement therapy are also considered as risk factors for breast cancer. Tamoxifen and raloxifene, selective estrogen receptor modulators, were shown to reduce breast cancer risk among high-risk women. Various nutrients were evaluated for their possible effect on breast cancer risk but further studies are needed. High socioeconomic status is found to be associated with increased risk of breast malignancy for as yet unestablished reasons. Studying breast cancer risk factors and further research into the molecular etiology of the disease will enable early diagnosis and detection of high-risk women and ultimately improve prognosis.

Breast Neoplasms↗

PubMed2004

Does the primary Lung Cancer rate increase among females?

Lung cancer is still the most frequently seen malignancy among males where as females are less affected. Recently the lung cancer prevalence has been reported to increase among females in parallel to the increment in cigarette consumption. In our 2 clinic 11.2% (44 cases) of 393 primary lung cancer cases between 1993-1997 were female. We evaluated the demographical characteristics and yearly distribution of our female patients. Mean age was 64+/-12.1 and 18.2% of the patients were smokers. The main complaints were dyspnoea (59%), chest pain (57%), fatigue (47%), cough (45%)and sputum production (32%). The cell type distribution rates were as follows;adenocarcinoma 45.4%, squamous cell cancer 29.5%, small cell cancer 20.5% and large cell cancer 4.6%. The diagnostic methods used were sputum cytology (27.3%),transbronchial biopsy and lavage (38.6%), thoracocentesis and pleural biopsy (15.8%),transthoracic fine needle aspiration (13,6%) and open lung biopsy (4.7%). As a result,we found a low percentage of smokers but a high rate of adenocarcinomas among our female patients.

Adenocarcinoma↗

PubMed1998

Rethinking breast cancer risk and the environment: the case for the precautionary principle.

The World Health Organization recently reported that breast cancer has become the most common cancer in women throughout the world. Known risk factors account for less than half of all cases of breast cancer, and inherited germ line mutations occur in at most only 10% of all cases. Cumulative exposure to estradiol and other hormones links many of the established risk factors for breast cancer. This paper reviews epidemiologic and toxicologic evidence on breast cancer risks and presents a comprehensive construct of risk factors intended to focus on the identification of those factors that can be controlled or modified. We attempt to provide a framework for interpreting the etiologic interplay of endogenous metabolic changes and environmental changes in the etiology of breast cancer. The construct we develop distinguishes between those risk factors that are directly causal, such as ionizing radiation and inherited germ cell defects, those vulnerability factors that extend the time period during which the breast undergoes development, and those contributing factors that increase total hormonal stimulation of the breast. Some hormonally active compounds, such as those in soy and broccoli and other phytoestrogen-containing foods, can be protective against breast cancer, while others, such as some environmental contaminants, appear to increase the risk of the disease by increasing levels of harmful hormones. Efforts to explain patterns of breast cancer should distinguish between these different risk factors. Identification of vulnerability and contributing risk factors can foster the development of public policy to reduce the burden of this prevalent cancer. Prudent precautionary principles suggest that reducing exposure to avoidable or modifiable risk factors should receive high priority from the public and private sectors.

Breast Neoplasms↗

PubMedDate not supplied

The risk of cancer in firefighters.

A substantial body of literature now exists on the carcinogenic hazards of firefighting. The authors discuss in detail the data on the carcinogens benzene, asbestos, PAHS, formaldehyde, and diesel exhaust, and they go on to examine the prevalent cancers in firefighters, including leukemia, non-Hodgkin's lymphoma, multiple myeloma, and cancer of the brain and bladder.

Air Pollutants, Occupational↗

PubMed2005

Ovarian cancer: can we make the clinical diagnosis earlier?

BACKGROUND: Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS: Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS: From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS: Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.

Abdominal Pain↗

PubMed1992

[Natural history of minimal and occult breast cancers. Long term survival and mass screening].

It is commonly admitted that small breast cancer detection is usefull for mortality reduction. One must take care of both "lead time bias" and "length biased sampling". An aggressive screening could detect an increased number of prevalent cancers in young women. The annual screening of asymptomatic women could be modified in the future by some compromise strategies fixed on high risk women isolation.

Adult↗

PubMed1997

Time trends in serum cholesterol before cancer death.

Following evidence of an association between low serum cholesterol and cancer from several prospective studies, this paper concentrates on individual time trends in serial measurements of serum cholesterol before a cancer-related death. The Framingham Heart Study contains repeated measurements of cholesterol at approximately 2-year intervals in 5,209 subjects, of whom 539 died from cancer during 30 years of follow-up. We quantify (1) the change in serum total cholesterol level before cancer death, and (2) the association between fall in serum total cholesterol and odds of cancer death. The mean fall in serum total cholesterol in the 4- to 6-year period before cancer death is 8.06 (95% confidence interval = 4.58-11.54) mg per dl, with some evidence of lowered cholesterol before that period. This pattern is corroborated by evidence of a substantially increased odds of cancer death if a large fall in cholesterol occurs over any 4- to 6-year period. We suggest that these time trends can plausibly be attributed to the effects of prevalent cancer on lowering serum cholesterol; our findings add weight to the argument that the low cholesterol-cancer mortality relation does not arise because of any causal contribution of low serum total cholesterol to the risk of cancer.

Age Distribution↗