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PubMed1997

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991.

Data from the New South Wales Central Cancer Registry for the period 1972-1991 were examined to determine the risk of second primary cancers after an initial invasive cancer of the colon (ICD-9 153) or rectum (ICD-9 154). The expected numbers of cancers were obtained by assuming that subjects experienced the same cancer incidence as prevailed in the corresponding general population and by applying sex-, age-, and calendar-specific rates to the appropriate person-years at risk. The relative risk (RR) of a second primary cancer was taken to be the ratio of observed:expected numbers of second cancers. After colon cancer, there was an excess of cancers of the small intestine in both sexes (RRs of 4.5 and 4.4); prostate (RR = 1.4) and kidney (RR = 1.8) in men; and breast (RR = 1.3), body of uterus (RR = 1.9), ovary (RR = 2.8), and thyroid (RR = 2.7) in women. Lung cancer occurred less frequently in men than expected (RR = 0.7). After rectal cancer, men had increased risks of cancers of the colon (RR = 1.5) and prostate (RR = 1.3) and a reduced risk of pancreatic cancer (RR = 0.3). A reciprocal relationship of increased risk was seen between cancers of the proximal (but not the distal) colon and rectum. Shared luminal risk factors for proximal colon cancer and rectal cancer and three syndromes of hereditary predisposition to colon cancer seem to be the major contributors to second primary cancers in patients with an initial colon cancer. Sources of bias have been considered.

Age Factors↗

PubMedDate not supplied

Expression of a novel Bcl-2 related gene, Bfl-1, in various human cancers and cancer cell lines.

The expression of Bfl-1 gene, a novel Bcl-2 related gene, was determined by Northern blot analysis using a radiolabeled cDNA specific for Bfl-1 gene in 82 surgically resected tissue specimens of 28 gastric cancers, 15 colon cancers, nine breast cancers, eight bone and soft tissue sarcomas, five ovarian cancers, nine colon adenomas and eight gastric adenomas. A high rate of expression was observed in gastric and colon cancer, at 86 and 93%, respectively. In breast cancer, bone and soft tissue sarcoma and ovarian cancer, the expression rate was 33, 25 and 40%, respectively. In stomach cancer, the expression rate of Bfl-1 gene in metastatic lymph nodes was 82%, which was higher than 50% of the primary sites (p < 0.02). The intensity of RNA bands of the gastric cancer specimens was compared according to the stage, demonstrating that there was no difference in the expression levels of Bfl-1 gene between the stages in both primary sites and metastatic lymph nodes. Bfl-1 gene was expressed in three (33%) out of nine adenomas of the colon, while it was not detected in all eight gastric adenomas, We also examined the RNA expression of Bfl-1 gene in 22 human cancer cell lines consisting of five stomach cancer, four squamous cell carcinoma, three lung cancer, three cervical cancer, two colon cancer, two brain cancer, two leukemia and one osteosarcoma cell lines. Bfl-1 gene band was detected in one (5%) cervical cancer cell line, SiHa. The results of cancer tissue specimens indicate that Bfl-1 gene may play an important role in carcinogenesis of human cancers and may be involved in a relatively early phase of the adenoma-carcinoma sequence in colon cancer development. However, the mechanism responsible for the very low rate of expression in established cell lines is not clearly understood and further investigation is necessary to clarify the mechanism involved.

Adenoma↗

PubMed1997

Smoking history and cancer patient survival: a hospital cancer registry study.

While tobacco use is clearly the most preventable cause of cancer, little is known about whether smoking adversely influences cancer patients' survival. The goal of this study was to examine the effect of smoking history on survival among cancer patients. Data from Memorial Sloan-Kettering Cancer Center's tumor registry was used to identify 25,436 cases of cancer (12,447 male patients and 12,989 female patients). Information regarding smoking and alcohol consumption, histologic grade, tumor stage, and survival time was available. Proportional hazard analysis was used to examine the effect of smoking on the death from all causes among patients. Patients who had a history of smoking were found to have a lower rate of survival than nonsmokers. After controlling for age, race, alcohol use, and histologic grade, the risk ratios were 1.55 for males and 1.43 for females. A dose-response relationship was found between ever-smoking and cancer patient survival. The predictive effect of smoking on survival was significant for patients with oral, pancreatic, breast, and prostate cancers, but not for esophageal, stomach, colon, rectum, laryngeal, lung, cervix uteri, urinary bladder, and kidney cancers. Black patients with oral or breast cancer had a poorer prognosis associated with smoking compared with white and other nonwhite patients. The strongest effect of smoking on survival was found mainly among patients with breast cancer with a distant tumor stage or with prostate cancer with a regional tumor stage. Alcohol use alone was associated with a higher risk of death for nonsmokers with oral and pancreatic cancers than for similar cancer patients without a history of alcohol use. Smoking history plays a critical role in influencing cancer patient survival, especially for patients diagnosed with oral, pancreatic, breast, or prostatic cancers. In addition, alcohol consumption is independently related to survival in patients with oral and pancreatic cancers. Our study suggests that a potential means of improving cancer patient survival, especially from oral, pancreatic, breast, and prostatic cancers, may be achieved through smoking cessation.

Adult↗

PubMed2004

Does this patient have a family history of cancer? An evidence-based analysis of the accuracy of family cancer history.

CONTEXT: A family history of certain cancers is associated with an increased risk of developing cancer. Both cancer screening and genetic services referral decisions are often based on self-reported pedigree information. OBJECTIVE: To determine the accuracy of self-reported family cancer history information. DATA SOURCES: English-language articles were retrieved by searching MEDLINE (1966-June 2004) using Medical Subject Headings family, genetic predisposition to disease, medical history taking, neoplasm, and reproducibility of results. Additional articles were identified through bibliography searches. STUDY SELECTION: Original studies in which investigators validated self-reported family history by reviewing the identified relatives' medical records, death certificate, or cancer registry information were included, as well as studies that evaluated breast, colon, ovarian, endometrial, and prostate cancers. DATA EXTRACTION: Two of the 3 investigators independently reviewed and abstracted data for estimating the likelihood ratios (LRs) of self-reported family cancer history information. Only data from studies that evaluated both positive and negative family cancer histories were included within the analyses. A total of 14 studies met the search criteria and were included in the review. DATA SYNTHESIS: For patients without a personal history of cancer, the positive and negative LRs of a family history of the following cancers in a first-degree relative were 23.0 (95% confidence interval [CI], 6.4-81.0) and 0.25 (95% CI, 0.10-0.63) for colon cancer; 8.9 (95% CI, 5.4-15.0) and 0.20 (95% CI, 0.08-0.49) for breast cancer; 14.0 (95% CI, 2.2-83.4) and 0.68 (95% CI, 0.31-1.52) for endometrial cancer; 34.0 (95% CI, 5.7-202.0) and 0.51 (95% CI, 0.13-2.10) for ovarian cancer; and 12.3 (95% CI, 6.5-24.0) and 0.32 (95% CI, 0.18-0.55) for prostate cancer, respectively. Positive predictive values tended to be better in articles concerning first-degree relatives compared with second-degree relatives. CONCLUSIONS: Patient-reported family cancer histories for first-degree relatives are accurate and valuable for breast and colon cancer risk assessments. Negative family history reports for ovarian and endometrial cancers are less useful, although the prevalence of these malignancies within families is low.

Family↗

PubMed1997

Changes in patterns of prostate cancer care in the United States: results of American College of Surgeons Commission on Cancer studies, 1974-1993.

BACKGROUND: Advances in medical and public health practice have led to many changes in patterns of prostate cancer care. Data from several studies of prostate cancer by the Commission on Cancer of the American College of Surgeons provide information on the directions, magnitudes, and consequences of these changes. METHODS: The Commission on Cancer conducts patient care evaluation (PCE) studies based on the voluntary participation of hospital cancer programs and their tumor registries. PCE studies have been conducted repeatedly for prostate cancer covering patients diagnosed as early as 1974 and as recently as 1990. In addition, the National Cancer Data Base of the Commission on Cancer collects data for all forms of cancer from throughout the country. The Commission on Cancer, the American Cancer Society, and the American Urologic Association also has conducted a focused survey of radical prostatectomy outcomes. In aggregate, these multiple studies have accrued 179,366 reports on treatment of prostate cancer patients. RESULTS: Predominant among practice changes are new techniques of prostate cancer detection and initial evaluation which have led to shifts in disease stage at the time of initial therapy. The proportion of prostate cancer that is localized at the time of detection has increased. Use of radiation therapy and radical prostatectomy has increased as the selection of hormone treatment and no cancer-directed treatment have decreased. Five-year prostate cancer survival has improved for every stage of disease. CONCLUSIONS: The multiple studies by the Commission on Cancer provide data that are not available from other sources. Continued monitoring of prostate cancer patterns of care may be useful in measuring progress in control of this common disease.

Aged↗

PubMed2000

Nuclear profiles of cancer cells reveal the metastatic potential of gastric cancer.

Nuclear profiles have been reported as useful prognostic predictors in various cancers. Data from computerized morphometry are objective and can be quickly derived using conventional microscopic analysis, but image analysis of nuclear features has only rarely been applied to investigations of gastric cancer. The aim of this study was to evaluate the correlation between one of these morphological nuclear features and the clinicopathological parameters in patients with gastric cancer. The morphometric nuclear feature (nuclear area) was analysed in 400 patients with gastric cancer. In each case, 300 cancer nuclei on routine haematoxylin and eosin-stained slides were analysed through the use of a computer-assisted image analysis system which traced the nuclear profiles (magnificationx400) on a computer monitor. The morphometric data were compared with the patients' clinicopathological status and survival rate. The mean nuclear area (NA) of cancer cells from 400 cases of gastric cancer was 47.2 microm(2). The NAs of cancer cells from tumours with microvessel invasion (lymphatic or venous invasion), lymph node metastasis or hepatic metastasis at the time of operation were significantly larger than those of cancer cells from tumours without such invasion or metastases. Cytokeratin (CK) immunostaining was performed on 2577 lymph nodes from 91 patients with advanced gastric cancer (pT3, pN0, pM0, stage II) to detect micrometastases. CK-positive lymph nodes were detected in 350 of 2577 lymph nodes (13. 6%) and in 62 of 91 patients (68.1%). The mean NA of cancer cells from 62 tumours with micrometastases (44 microm(2)) was larger than that of cancer cells from 29 tumours without micrometastases (38.8 microm(2), p=0.043), and a significant positive correlation was detected between the NAs of cancer cells from 91 tumours and the number of micrometastatic lymph nodes of 91 patients (rho=0.278, p=0. 008). Cancer cells with large NA correlated strongly with haematogenous and lymph node recurrence or relapse after gastrectomy and the NA of cancer cells was identified as an independent prognostic factor in gastric cancer. Nuclear morphometry is an objective, reproducible, and technically uncomplicated procedure. The NA of cancer cells correlates closely with the metastatic potential of gastric cancer. Nuclear morphometry may therefore be useful for the selection of patients who are at risk of haematogenous or lymph node metastatic recurrence after surgery.

Adenocarcinoma↗

PubMed2002

Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden.

BACKGROUND: The American Cancer Society, the National Cancer Institute, the North American Association of Central Cancer Registries (NAACCR), the National Institute on Aging (NIA), and the Centers for Disease Control and Prevention, including the National Center for Health Statistics (NCHS) and the National Center for Chronic Disease Prevention and Health Promotion, collaborated to provide an annual update on cancer occurrence and trends in the United States. This year's report contained a special feature focusing on implications of age and aging on the U.S. cancer burden. METHODS: For 1995 through 1999, age-specific rates and age-adjusted rates were calculated for the major cancers using incidence data from the Surveillance, Epidemiology, and End Results Program, the National Program of Cancer Registries, and the NAACCR, and mortality data from NCHS. Joinpoint analysis, a model of joined line segments, was used to examine 1973-1999 trends in incidence and death rates by age for the four most common cancers. Deaths were classified using the eighth, ninth, and tenth revisions of the International Classification of Diseases. Age-adjusted incidence and death rates were standardized to the year 2000 population, which places more emphasis on older persons, in whom cancer rates are higher. RESULTS: Across all ages, overall cancer death rates decreased in men and women from 1993 through 1999, while cancer incidence rates stabilized from 1995 through 1999. Age-specific trends varied by site, sex, and race. For example, breast cancer incidence rates increased in women aged 50-64 years, whereas breast cancer death rates decreased in each age group. However, a major determinant of the future cancer burden is the demographic phenomenon of the aging and increasing size of the U.S. population. The total number of cancer cases can be expected to double by 2050 if current incidence rates remain stable. CONCLUSIONS: Despite the continuing decrease in cancer death rates and stabilization of cancer incidence rates, the overall growth and aging of the U.S. population can be expected to increase the burden of cancer in our nation.

Adolescent↗

PubMed2002

Cancer patterns in eastern India: the first report of the Kolkata cancer registry.

There are no population-based data available for the cancer patterns in Eastern India. This is the first report of cancer incidence in the region from the population-based cancer registry in Kolkata (Calcutta), the capital city of the state of West Bengal, India, for the period 1998-1999. The cancer registry collects data on all new cases of cancer diagnosed in the resident population of Kolkata. Since cancer is not a notifiable disease in India, registration is carried out by active data collection by the registry staff. The cancer registry staff visits 50 data sources comprising cancer hospitals, secondary and tertiary care hospitals, nursing homes, diagnostic laboratories and death registration offices; scrutinizes medical records and collects details on incident cancer cases. A customized version of CanReg-3 software was used for data entry and analysis. A total of 11,700 cases were registered during the 2-year period from 1 January 1998 to 31 December 1999. The overall age-adjusted (world population) incidence rates were 102.1 per 100,000 males and 114.6 per 100,000 females. The most frequently reported malignancies in males were lung cancer (16.3%), followed by cancers of the oral cavity (7.1%), pharynx (5.7%) and larynx (5.7%). In females, the most frequently reported malignancies were breast (22.7%) followed by uterine cervix (17.5%), gallbladder (6.4%) and ovary (5.8%). The data reported by the Kolkata cancer registry provide information on the cancer profile in Eastern India for the first time. The highest incidence rate of lung cancer in males in India is reported from Calcutta. A high risk of gallbladder cancer is observed in women. The observed cancer patterns indicate that tobacco-control measures and early detection of head and neck, breast and cervical cancers are of importance for cancer control in this population.

Age Factors↗

PubMed2004

Familial association of histology specific breast cancers with cancers at other sites.

Breast cancer histologies show important differences in their incidence pattern, method of detection and management. Aggregation of breast cancer occurs also in families diagnosed for cancer at sites different from the breast. Therefore, the familial association of histology specific breast cancers with cancers at other sites is of great interest. The nationwide Swedish Family-Cancer Database was used to calculate standardised incidence ratios (SIRs) for breast cancer when parents or sibling were diagnosed with cancer at the most common sites. Significant SIRs were found when parents had breast, ovarian, laryngeal, endometrial, prostate, lung and colon cancers. If women were diagnosed before the age of 50 years, the SIRs were significant when parents were diagnosed with breast, ovarian, and prostate cancers, and leukaemia, and when siblings were diagnosed with squamous cell skin, pancreatic, breast and endometrial cancers. If mothers were diagnosed with breast cancer, histology-specific SIRs were ranked as comedo > tubular > ductal > lobular; SIR for medullary carcinoma was not significant but it was high when mothers presented with ovarian cancer. Other associations were between the upper aerodigestive tract and lobular, colon and comedo, larynx and ductal cancer. Moreover, cervical cancer was associated with comedo and endometrial cancer with the medullary histology. In conclusion, histology-specific breast cancers were associated with specific cancer sites and the strength of the association varied among histologies.

Aged↗

PubMed1990

Cancer incidence correlations: genital, urinary and some tobacco-related cancers.

Bivariate correlations between sex-specific age-adjusted incidence rates of 10 genital and urinary tract cancer sites and lung cancer were calculated. The data base used was that published in the 5th edition of the series Cancer incidence in five continents. The purpose of the analyses was to test the consistency of the data with the hypothesis of a common risk factor for genital cancers and other cancers of the urinary tract and for lung and genital cancers. The results indicate that the incidence of cervical cancer is strongly correlated with that of cancer of the penis, of other cancers of the female genital tract and of chorioepithelioma. In countries at low/intermediate risk for cervical cancer (mostly developed Western countries), the incidence of cervical cancer is also correlated with that of lung cancer in males. The incidence of male lung cancer is, moreover, strongly correlated with cancers of the prostate, penis, testis, bladder and other urinary tract cancers. These analyses support the views that: urogenital cancers in both sexes might share (a) common risk factor(s), which may be certain types of human papilloma-virus; and that cigarette smoking is likely to be a risk factor for most of these cancers in countries where the use of tobacco has been widespread for a long time. Other suggestive etiological conclusions about less well-studied cancer sites are also presented.

Age Factors↗

PubMed2005

Population-based risk assessment for other cancers in relatives of hereditary prostate cancer (HPC) cases.

BACKGROUND: To identify associations of other cancers with hereditary prostate cancer (HPC) we estimated relative risks (RRs) of 36 different cancers in relatives of prostate cancer cases in the Utah Population Data Base (UPDB), which combines genealogical and cancer data for Utah. METHODS: We utilized known genetic relationships between prostate cancer cases and their relatives with cancer, combined with age- and sex-specific cancer rates calculated internally from the UPDB, to estimate RRs for cancer in relatives of prostate cancer cases. RESULTS: Multiple other cancers were observed in excess in both first- and second-degree relatives of HPC cases including colon cancer, non-Hodgkins lymphoma, multiple myeloma, rectal cancer, cancer of the gallbladder, and melanoma (skin). CONCLUSIONS: This analysis supports the existence of heritable prostate cancer syndromes that include other cancers. We hypothesize that the study of homogeneous pedigrees co-segregating prostate cancer and another cancer could allow more straightforward localization and identification of the gene(s) responsible.

Adult↗

PubMed1997

Age at onset of ovarian cancer in women with a strong family history of ovarian cancer.

OBJECTIVE: To determine whether women with a strong family history of ovarian cancer develop ovarian cancer at a younger age than the general population, and to determine if the age at onset of ovarian cancer in families with multiple cases of ovarian cancer is progressively younger with successive generations. METHODS: Using a large voluntary familial ovarian cancer registry, 90 probands were identified whose grandmothers had developed ovarian cancer and for whom the age at onset was known. The distribution of age at onset of ovarian cancer in the grandmothers was compared to the expected distribution based on data from the Surveillance Epidemiology End Results (SEER) project. In addition, 131 families were identified for whom complete pedigrees were available and in whom 3 or more family members had developed ovarian cancer. Ovarian cancer-free survival curves were constructed for each aggregate generation (using the probands as the reference generation) utilizing the Kaplan-Meier method. RESULTS: Among the 90 grandmothers, 18 from families with 3 or more cases of ovarian cancer had a distribution of age of onset that was younger than expected (P = 0.02). However, the distribution of age at onset among the 72 grandmothers from families with only 2 cases of ovarian cancer was not significantly different from that expected based on the SEER data (P = 0.18). Among the 131 families with 3 or more cases of ovarian cancer, the probands' daughters developed ovarian cancer at a younger age than the probands (P = 0.018), probands developed ovarian cancer at a younger age than their mothers (P = 0.0008), and the probands' mothers developed ovarian cancer at a younger age than the probands' grandmothers (P = 0.0038). CONCLUSIONS: Ovarian cancer patients from families with 3 or more cases of ovarian cancer tend to develop their cancer at a younger than expected age. This is consistent with the phenomenon known as anticipation.

Adult↗

PubMed2001

The clinical features of ovarian cancer in hereditary nonpolyposis colorectal cancer.

OBJECTIVE: Hereditary nonpolyposis colorectal cancer (HNPCC) is a hereditary cancer susceptibility disorder associated with a very high risk for carcinoma of the colon and an elevated risk for certain extracolonic cancers including ovarian cancer. Our aim in this study was to describe the clinicopathologic features of ovarian cancer in HNPCC family members. METHODS: . Members of the International Collaborative Group on HNPCC collected retrospective data on 80 ovarian cancer patients who were members of HNPCC families, including 31 known mutation carriers, 35 presumptive carriers (by colorectal/endometrial cancer status), and 14 at-risk family members. RESULTS: Mean age at diagnosis of ovarian cancer was 42.7. Nonepithelial tumors made up only 6.4% of the cancers, and borderline tumors comprised just 4.1% of the epithelial cancers. Among frankly malignant epithelial cases, most cancers were well or moderately differentiated, and 85% were FIGO stage I or II at diagnosis. Synchronous endometrial cancer was reported in 21.5% of cases. CONCLUSIONS: Ovarian cancer in HNPCC differs from ovarian cancer in the general population in several clinically important respects. It occurs at a markedly earlier age. It is more likely to be epithelial. If it is a frankly invasive epithelial cancer, it is more likely to be well or moderately differentiated. HNPCC patients with ovarian cancer are more likely to have a synchronous endometrial cancer than other ovarian cancer patients and are more likely to be diagnosed at an early stage.

Adult↗

PubMed2002

Biliary tract cancer treatment: results from the Biliary Tract Cancer Statistics Registry in Japan.

BACKGROUND/PURPOSE: A registry project for cancers of the biliary tract accumulated a total of 11,030 cases for 10 years. In the present study, registered cases were analyzed for information bearing on problems with the treatment of cancer of the biliary tract. The Japanese classification of lymph nodes was also considered on the basis of the results of this study. METHODS: In 11,030 cases, the site of cancer was the gallbladder in 4,774, the bile duct in 4,833, and the papilla of Vater in 1,423. Those cases were analyzed with regard to patient survival according to the stage of disease and the extent of lymph node metastasis. RESULTS: More than 11,000 cases of cancer of the biliary tract have been registered to date from 158 member institutions of the Japanese Society of Biliary Surgery. While the 5-year survival rates for stage I gallbladder cancer and cancer of the papilla were 77% and 75%, respectively, those for stage I hilar or upper bile duct cancer and middle or lower bile duct cancer were 47% and 54%. For stage II and stage III disease, the 5-year survival rates were about 50% for gallbladder cancer and 30% or higher for cancer of the papilla, while survival was only 20% to 30% for bile duct cancer, regardless of specific site. For stage IV, the 5-year survival rate was unexpectedly high, being about 10% or higher for cancers at all sites, with 19% for cancer of the papillary region being the highest. Thus, there still seem to remain surgical indications for stage IV cancers. The lymph node metastasis rate was about 40% for cancers at all sites. Changes in surgical procedures to improve the 5-year survival rate in patients with n2 metastasis or less will be needed. Noncurative resection occurred frequently for cancers at all sites, particularly in cancers of the hilar or upper bile duct, accounting for 60% of cases or more. We have to recognize that measures to reduce inadvertent noncurative resection are fundamental to the treatment of cancer. CONCLUSIONS: Considering the survival results according to specific lymph nodes involved, we concluded that the Japanese classification of lymph nodes, particularly hepatoduodenal ligament lymph nodes, should be reexamined, while another procedure to remove such lymph nodes completely should be developed.

Ampulla of Vater↗

PubMed2006

Bone mass and the risk of breast cancer: the influence of cumulative exposure to oestrogen and reproductive correlates. Results of the Marburg breast cancer and osteoporosis trial (MABOT).

BACKGROUND: Recent studies suggest an inverse relation between breast cancer and osteoporosis. Oestrogen is important in the pathophysiology of both breast and bone, and although cumulative exposure to oestrogen may explain the link between breast cancer and bone mass, this has never been proved. The Marburg breast cancer and osteoporosis trial (MABOT) aimed to elucidate the relation between breast cancer and bone mass ascertained by ultrasonometry measurement and to investigate whether endogenous and exogenous exposure to oestrogen and reproductive correlates has a role in this association. METHODS: We performed a case-control study including 2492 women (mean age+/-S.D., 54.4+/-10.3 years) in whom diseases and drug treatments known to affect bone metabolism, except for HT, had been excluded. All women underwent ultrasonometry measurement at the heel; 242 of the women had an incident breast cancer without a prior, specific pharmacological breast cancer treatment. The ultrasonometry variables - speed of sound (SOS), broadband ultrasound attenuation (BUA) and the stiffness index (SI) - were calculated and compared in women with and without breast cancer. Because of significant intergroup differences in factors such as age, body mass index and exposure to oestrogen, a multiple linear regression analysis as well as a second analysis of ultrasonometry variables was undertaken using a randomly selected sample of 242 healthy women post-matched with the breast cancer group for possible confounding variables. Odds ratios were used to compare the relation between breast cancer risk and ultrasonometry heel measurements. RESULTS: Women with breast cancer were significantly older, weighed more, had a higher body mass index, were more likely to be parous and to have breast fed, were older at the menopause and had been exposed to oestrogen for longer than control women. In addition, the ultrasonometry variables speed of sound and the stiffness index T- and Z-score were significantly higher in women with breast cancer even after a matched pair analysis was performed (p<0.001). Additionally, results of a multiple linear regression showed that women with breast cancer had a significantly higher SOS (p<0.001), body weight (p<0.05) and duration of breast feeding (p<0.05) while osteoporotic fracture were reduced (p<0.001). When women with breast cancer and their matched controls were finally grouped according to SOS and T-score quartiles, the odds ratios (95% confidence intervals) for breast cancer risk in the second, third and fourth quartiles compared with the lowest quartile were 2.5 (1.4-4.3), 3.1 (1.8-5.3) and 4.7 (2.7-8.2) as well as 1.9 (1.1-3.2), 2.3 (1.3-3.9) and 2.9 (1.7-5.0), respectively. CONCLUSIONS: The ultrasonometry variables speed of sound, stiffness index, T- and Z-score are higher in women with an incident breast cancer than in healthy controls, even after post-matching for possible confounding variables. This association was confirmed in a multiple linear regression model. Women with SOS and T-score values in the higher quartiles have a greater risk of breast cancer than women in the lowest quartile. We found no association between the higher ultrasonometry variables and cancer specific characteristics or reproductive correlates such as age at menarche and menopause or cumulative oestrogen exposure. Although the biological mechanisms linking bone mass and the risk of breast cancer are not fully understood, factors other than reproductive correlates, endogenous and exogenous exposure to oestrogen must play a part.

Adult↗

PubMed2001

Risk of colorectal cancer after breast cancer.

BACKGROUND: History of breast cancer has been reported as a risk factor for colorectal cancer in women. In view of the ambiguous nature of existing evidence and the growing interest in targeted colorectal cancer prevention, we sought to quantify this risk. METHODS: We used the Surveillance Epidemiology and End Results (SEER) database to estimate risk of colorectal cancer after breast-cancer diagnosis in women with first incident breast cancer between 1974 and 1995. Observed colon and rectal cancer risk was compared with that expected in the general population. We stratified comparisons by age at breast-cancer diagnosis, stage of cancer, ethnic origin of patient, and follow-up time. FINDINGS: Overall, women with previous breast cancer were 5% less likely (95% CI 1-9) to develop colon and 13% less likely (6-19) to develop rectal cancer than women in the general population. Stratified analyses suggested that the risk reductions observed for colon and rectal cancer were most pronounced for women with breast cancer diagnosed after age 65 years, in white women, women with local stage breast cancer, and women diagnosed in the later study years (1990-94). INTERPRETATIONS: Breast cancer does not increase subsequent colorectal cancer risk, and reduced risk was seen for certain subgroups of women. Because no biologically plausible endogenous protective factor has been identified, we suggest that reduced risk could stem from an accumulation of exposures that increase breast-cancer frequency but protect against colorectal cancer.

Adult↗

PubMed2003

Second primary cancers in patients with laryngeal cancer: a population-based study.

BACKGROUND: Literature regarding incidence of site-specific second cancers after laryngeal cancer is limited. Risk factors associated with second primaries are unknown. METHODS: Second primaries after laryngeal cancer in the SEER database (1973-1996) were analyzed for incidence, relative risk compared with the general population, and potential risk factors, including radiotherapy. Information on chemotherapy and tobacco smoking was not available in the SEER database. RESULTS: Of 20,074 laryngeal cancer patients surviving at least 3 months, 3533 (17.6%) developed second cancers. The cumulative risk of developing a second cancer was 26% at 10 years and 47% at 20 years. Compared with age-adjusted, gender, and tumor-specific rates in the general population, laryngeal cancer patients had higher risks of second cancers overall (observed-to-expected ratio [O/E] = 1.68, 95% confidence interval [CI] = 1.58-1.79), head-and-neck (4.81 [4.31-5.58]), esophageal (3.99 [3.29-4.83]), and lung (3.56 [3.34-3.79]) cancer. Advanced age at initial diagnosis was associated with increased risks of second cancers (p = 0.0001). Radiotherapy was associated with increased risk of second cancers overall (relative risk [RR] = 1.10 [1.02-1.18], p = 0.012), especially second cancers of the lung (RR = 1.18, [1.05-1.33], p = 0.006) and possibly second cancers of the head and neck (RR = 1.26, [0.99-1.60], p = 0.061). Radiotherapy was associated with a 68% excess risk (RR = 1.68, [1.16-2.43], p = 0.007) of developing a second head-and-neck cancer in patients who survived more than 5 years. Second primary was associated with a poor survival (p = 0.0001). CONCLUSIONS: Second cancers after laryngeal cancer are common, especially for long-term survivors. Radiotherapy was associated with a small increased risk of developing second cancers overall and long-term risk of head-and-neck cancers. This data should be interpreted with caution in light of the lack of information on chemotherapy and tobacco smoking in the SEER database. Prevention and early detection are indicated.

Analysis of Variance↗

PubMed2001

Cancer pain management skills among medical students: the development of a Cancer Pain Objective Structured Clinical Examination.

Recent surveys suggest that most physicians have inadequate knowledge to assess and manage cancer pain; however, the important domain of clinical performance has not yet been clearly evaluated. The Objective Structured Clinical Examination (OSCE) has become a widely- used and accepted method to evaluate the clinical abilities of medical students. The purpose of this study was to develop and test a Cancer Pain OSCE for medical students evaluating their clinical competence in the area of cancer pain management. A four-component Cancer Pain OSCE was developed and presented to 34 third-year medical students during a sixteen-week combined medicine/surgery clerkship. The content of the objective criteria for each component of the OSCE was developed by a multidisciplinary group of pain experts. The OSCE was designed to assess the students' cancer pain management skills of pain history-taking, focused physical examination, analgesic management of cancer pain, and communication of opioid analgesia myths. Actual cancer survivors were used in the five-minute individual stations. The students were asked to complete a cancer pain history, physical examination, manage cancer pain using analgesics, and communicate with a family member regarding opioid myths. Clinical performance was evaluated using pre-defined checklists. Results showed the student's average performance for the history component was the highest of all four components of the examination. Out of 34 points possible on this clinical skills item, students on average (SD) scored 24.5 (5.2), or 72%. For the short-answer analgesic management component of the Cancer Pain OSCE, the overall score was 32%. Most students managed cancer pain with opioids, however, very few prescribed regular opioid use, and the use of adjuvant analgesics was uncommon. Student performance on the focused cancer pain physical examination was, in general, poor. On average students scored 61% on the musculoskeletal system, but only 31% on both the neurological and lymphathic examination. The overall percent score for the cancer pain OSCE was 48%. We conclude that the Cancer Pain OSCE is a useful performance-based tool to test individual skills in the essential components of cancer pain assessment and management. Of the four components of the Cancer Pain OSCE, medical students performed best on the cancer pain history and performed poorly on the cancer pain physical examination. Information gained from this study will provide a foundation on which future small-group medical student structured teaching will be based.

Analgesics↗