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PubMed2001

Rectal cancer in hereditary nonpolyposis colorectal cancer.

BACKGROUND: Hereditary nonpolyposis colorectal cancer (HNPCC) accounts for approximately 2% to 5% of all colorectal cancers. Rectal cancer in HNPCC is not well characterized. METHODS: A retrospective medical record review of HNPCC patients with colorectal cancer diagnosis from December 1948 to December 1999 was performed in an attempt to elucidate the natural history of rectal cancer in HNPCC. Group A consisted of patients diagnosed with rectal cancer as the index colorectal cancer. Group B consisted of patients diagnosed with rectal cancer as a metachronous colorectal cancer. RESULTS: Twenty-five of 104 patients developed rectal cancer in our HNPCC registry. There were 18 patients in group A with a median age at diagnosis of rectal cancer of 48 years (range 24 to 79) and 7 patients in group B diagnosed at a median age of 58 years (range 45 to 68). Three of 18 patients (17%) in group A developed metachronous colon cancers at a median of 203 months (range 27 to 373) from the index rectal cancer. Rectal cancer in group B was diagnosed at a median 245 months (range 51 to 564) from the index colorectal cancer diagnosis. CONCLUSIONS: Rectal cancer in HNPCC is not uncommon. The presentation of rectal carcinoma should not obviate the evaluation for HNPCC in suspected cases.

Adenocarcinoma↗

PubMed1996

Breast cancer and hormonal contraceptives: further results. Collaborative Group on Hormonal Factors in Breast Cancer.

The Collaborative Group on Hormonal Factors in Breast Cancer has brought together and reanalysed the worldwide epidemiological evidence on breast cancer risk and use of hormonal contraceptives. Original data from 54 studies, representing about 90% of the information available on the topic, were collected, checked and analysed centrally. The 54 studies were performed in 26 countries and include a total of 53,297 women with breast cancer and 100,239 women without breast cancer. The studies were varied in their design, setting and timing. Most information came from case-control studies with controls chosen from the general population; most women resided in Europe or North America and most cancers were diagnosed during the 1980s. Overall 41% of the women with breast cancer and 40% of the women without breast cancer had used oral contraceptives at some time; the median age at first use was 26 years, the median duration of use was 3 years, the median year of first use was 1968, the median time since first use was 16 years, and the median time since last use was 9 years. The main findings, summarised elsewhere, are that there is a small increase in the risk of having breast cancer diagnosed in current users of combined oral contraceptives and in women who had stopped use in the past 10 years but that there is no evidence of an increase in the risk more than 10 years after stopping use. In addition, the cancers diagnosed in women who had used oral contraceptives tended to be less advanced clinically than the cancers diagnosed in women who had not used them. Despite the large number of possibilities investigated, few factors appeared to modify the main findings either in recent or in past users. For recent users who began use before age 20 the relative risks are higher than for recent users who began at older ages. For women whose use of oral contraceptives ceased more than 10 years before there was some suggestion of a reduction in breast cancer risk in certain subgroups, with a deficit of tumors that had spread beyond the breast, especially among women who had used preparations containing the highest doses of oestrogen and progestogen. These findings are unexpected and need to be confirmed. Although these data represent most of the epidemiological evidence on the topic to date, there is still insufficient information to comment reliably about the effects of specific types of oestrogen or of progestogen. What evidence there is suggests, however, no major differences in the effects for specific types of oestrogen or of progestogen and that the pattern of risk associated with use of hormonal contraceptives containing progestogens alone may be similar to that observed for preparations containing both oestrogens and progestogens. On the basis of these results, there is little difference between women who have and have not used combined oral contraceptives in terms of the estimated cumulative number of breast cancers diagnosed during the period from starting use up to 20 years after stopping. The cancers diagnosed in women who have used oral contraceptives are, however, less advanced clinically than the cancers diagnosed in never users. Further research is needed to establish whether the associations described here are due to earlier diagnosis of breast cancer in women who have used oral contraceptives, to the biological effects of the hormonal contraceptives or to a combination of both. Little information is as yet available about the effects on breast cancer risk of oral contraceptive use that ceased more than 20 years before and as such data accumulate it will be necessary to re-examine the worldwide evidence.

Adult↗

PubMed2003

Second primary cancers after cervical intraepithelial neoplasia III and invasive cervical cancer in Southeast England.

OBJECTIVE: Multiple primary cancers may arise in an individual because they share a common environmental risk factor (such as smoking); genetic predisposition or immunodeficiency may predispose to both cancers, or treatment for one cancer may cause a second cancer. The objective of this analysis was to identify which, if any, cancers occur more often than would be expected in a cohort of women diagnosed with cervical intraepithelial neoplasia III (CIN III) and in women with invasive cervical cancer. METHODS: The Thames Cancer Registry was used to identify two cohorts of women diagnosed with either CIN III or invasive cervical cancer. The number of subsequent cancers at other sites was observed and compared to the expected number, based on relevant age-, sex-, and period-specific incidence rates. Standardised incidence rates (SIRs) were calculated assuming a Poisson distribution. RESULTS: The following cancer sites were significantly increased after a diagnosis of either CIN III or cervical cancer: anus (SIR 5.9 and 6.3, respectively), lung (SIR 1.8 and 2.5), vulva (SIR 4.4 and 1.9), vagina (SIR 18.5 and 8.0), and kidney (SIR 1.6 and 1.9). In addition, the incidence of cancers of the rectum, bladder, and connective tissue was significantly increased after invasive cervical cancer. Cervical cancers were seen significantly more often than expected after cancers of the anus and vagina. CONCLUSION: These results support the hypothesis that cancers of the cervix, anus, vulva, and vagina share common risk factors such as human papillomavirus and smoking.

Adult↗

PubMed1997

An assessment of the usefulness of serum prostate-specific antigen level and cancer volume in biopsy specimens to predict the extent of prostate cancer.

OBJECTIVE: To evaluate the usefulness of the combination of serum prostate-specific antigen (PSA) and cancer volume in biopsy specimens as markers to predict the extent of prostate cancer. PATIENTS AND METHODS: Of patients presenting at our hospital with urinary symptoms suggesting prostatic disease, 311 (median age 70 years, range 42-88) with either nodules in the prostate detected by digital rectal examination or with elevated serum PSA levels (> 2.0 ng/mL) underwent systematic biopsy; 69 had prostate cancer. The cancer volume in the biopsy specimens was examined pathologically by measuring the percentage of the biopsy core involved with cancer, the length of cancer tissue per biopsy core and the percentage of cancer in the biopsy specimen. The relationship of serum PSA level, cancer volume in the biopsy specimen and the extent of disease was examined. RESULTS: The volume of cancer in the biopsy specimens increased with increasing serum PSA concentration and the incidence of skeletal metastasis. The number of patients with extraprostatic disease or bony metastasis was significantly higher for these Japanese patients with a serum PSA of < 10 ng/mL. All six patients with a positive bone scan and who had a serum PSA level of < 10 ng/mL had a larger volume of cancer in their biopsy specimens. Among patients who underwent radical prostatectomy and pelvic lymphadenectomy, the incidence of extraprostatic disease increased with the value of each biopsy variable. Among patients with similar serum PSA levels, those showing higher values for the biopsy variables also showed extraprostatic disease. Among those with extraprostatic disease, seminal vesicles were involved by cancer in four of six patients with > 40% positivity in the biopsy cores, > 1.5 mm of cancer per biopsy core or > 20% cancer in the biopsy specimens. Lymph node metastasis was found in four of five patients with serum PSA levels of > 20 ng/mL and a large cancer volume in the biopsy specimen. CONCLUSIONS: These results indicate that a combination of serum PSA level and cancer volume in the biopsy specimen could be useful markers for predicting the extent of prostate cancer.

Adult↗

PubMed2002

Kidney cancer in the Swedish Family Cancer Database: familial risks and second primary malignancies.

BACKGROUND: Familial risks in kidney cancer and association with second primary malignancies were studied using the nationwide Swedish Family Cancer Database. METHODS: Cancer data were retrieved from the Swedish Cancer Registry from years 1961 to 1998 and included 23,137 cases of kidney cancer. Standardized incidence ratios (SIRs) were used to measure the cancer risks. RESULTS: Seventy-one families were identified where both a parent and an offspring had kidney cancer, giving a familial risk for offspring of 1.56 (1.22 to 1.95) and population attributable proportion of 0.78%. A risk for kidney cancer from an affected sibling was considerably higher with a SIR of 4.72 (2.28 to 9.20), giving an attributable proportion of 0.77%. The discordant tumor site that was associated with kidney cancer between two generations was hemangioblastoma of central nervous system. Discordant cancer sites that were associated with kidney cancer in siblings were ovaries, endocrine glands and pancreas. There was an over threefold increase of second primary malignancies of the urinary bladder, nervous system and endocrine gland in kidney cancer patients. The risks for second primary hemangioblastoma following kidney cancer or familial kidney cancer was 21.19 (6.69 to 43.83) and 1206 (114 to 3456), respectively. CONCLUSIONS: The high ratio of sibling risk to offspring risk in kidney cancer may reflect a recessive susceptibility. The high risk for second primary cancers in the patients without family history is consistent with a polygenic model and variable degree of environmental modification.

Adolescent↗

PubMed1991

Family history of gynaecological cancers: relationships to the incidence of breast cancer prior to age 55.

As part of a multi-centre epidemiological study of cancer in women between the ages of 20 and 54, data were collected concerning family history of gynaecological cancers in the female relatives of 4730 women with newly diagnosed breast cancer and the relatives of 4688 women from the general population. Women who were diagnosed with breast cancer prior to age 45 were more likely than controls to have a mother or sister with ovarian cancer (odds ratio (OR): 1.50), endometrial cancer (1.29), and cervical cancer (1.53), although none of these elevations achieved statistical significance. The corresponding odds ratios for women diagnosed with breast cancer between the ages of 45 and 54 were 1.88, 0.84 and 0.93. The association with ovarian cancer was statistically significant in this group (95% confidence interval (CI): 1.11-3.19). In this latter group, having a first degree relative with ovarian cancer was associated approximately as strongly with breast cancer as was having a first degree relative with breast cancer. The results suggest that there may be a shared genetic basis for some cancers of the breast and ovary. From a clinical perspective, the results indicate that in setting appropriate levels of screening for breast cancer and in establishing an appropriate age at which to begin such screening for a particular woman, her family history of ovarian cancer should be considered in addition to her family history of breast cancer.

Adult↗

PubMed2006

Comparison of observed and expected numbers of detected cancers in the research center for cancer prevention and screening program.

BACKGROUND: The Research Center for Cancer Prevention and Screening program is a one-arm prospective study designed to evaluate the effect of multiple modalities for cancer screening. Basic programs consist of screening tests for cancer of the lung, esophagus, stomach, colon, rectum, liver, gall bladder, pancreas and kidneys, in addition to prostate cancer screening for males and breast, cervical, endometrial and ovarian cancer screenings for females. OBJECTIVE: To investigate the possibility of overdiagnosis, we compared the observed numbers with expected numbers based on the model. METHODS: We calculated the expected number of cancers on the basis of negative or positive history of screening tests within the previous year, based on assumed sensitivity and sojourn time. Observed numbers of screen-detected cases for stomach, colorectal, lung, prostate and breast cancer were compared with expected numbers. RESULTS: From February 2004 to January 2005, 3786 participants were enrolled in our study. The overall cancer detection rate was 5.8% (119/2061) for males and 4.1% (71/1725) for females. No statistically significant difference was found between observed and expected cases for colorectal cancer screening, gastric cancer screening for females and lung cancer screening for males. Observed numbers of breast, prostate and lung cancer for females exceeded those expected (P < 0.05). CONCLUSIONS: Although cancer screening programs in the present study increased the detection of potentially curable cancers, these modalities, particularly lung, breast and prostate screening, might detect cancers which would not necessarily be clinically significant. We should therefore weigh up benefit and harm for such cancer screening programs.

Adult↗

PubMed1994

Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol.

BACKGROUND: The exceptionally high rate of second primary cancers among patients with oral and pharyngeal cancers is well recognized, yet there has been limited epidemiologic study of risk factors for second tumors. PURPOSE: To evaluate the relation of smoking and alcohol consumption to the development of second cancers among this high-risk patient group, we conducted a nested case-control study. METHODS: A total of 1090 patients enrolled in a 1984-1985 population-based, case-control study of oral cancer in four areas of the United States were followed through June 1989 for the occurrence of second primary cancers. Information on tobacco and alcohol consumption was obtained from the original interviews and was updated by follow-up interviews obtained for 80 case patients with second cancers and 189 sex-, study area-, and survival-matched cancer patients free of second cancers (control subjects). RESULTS: Tobacco smoking and alcohol drinking each contributed to risk of second cancers, with the effects of smoking more pronounced than those of alcohol. The odds ratios (ORs) for smoking (adjusted for alcohol) rose with duration and intensity of smoking and were strongest for tumors of the aerodigestive tract (oral cavity, pharynx, esophagus, larynx, and lungs), with ORs reaching 4.7 (95% confidence interval [CI] = 1.4-16) among smokers of 40 or more cigarettes per day for 20 or more years. Current smokers as of the baseline survey experienced a fourfold increased risk of a second aerodigestive tract cancer relative to nonsmokers and former smokers. No reduction in risk was associated with cessation of smoking or drinking at or after the index diagnosis, although the short median interval (27 months) between tumor diagnoses limited observation of the effects due to recent cessation. Risk was significantly reduced, however, 5 years after smoking cessation. Among drinkers, second cancer risk was greatest for beer intake, with an OR for a second aerodigestive tract cancer of 3.8 (95% CI = 1.2-12) for 15 or more beers per week. CONCLUSIONS: Oral and pharyngeal cancer patients with the highest intakes of tobacco and alcohol are the ones most prone to develop second primary cancers. IMPLICATIONS: Avoidance of tobacco smoking and alcohol drinking is the most desirable way not only to prevent primary oral cancers, but also to reduce risk of second cancers of the aerodigestive system.

Aged↗

PubMed1999

Tamoxifen therapy for breast cancer and endometrial cancer risk.

BACKGROUND: Tamoxifen is effective in treating breast cancer, reduces breast cancer incidence among high-risk women, and is associated with increased endometrial cancer risk. This study was designed to examine the possible modifying effects of endometrial cancer risk factors on the tamoxifen-endometrial cancer association. METHODS: We conducted a case-control study of endometrial cancer (324 case patients and 671 individually matched control subjects) nested within a population-based cohort of patients with breast cancer diagnosed from 1978 through 1992 within four regions of the United States. We obtained information on breast cancer treatment and endometrial cancer risk factors through interviews and reviews of medical records. All P values reported are two-sided. RESULTS: Endometrial cancer risk was associated with tamoxifen therapy for breast cancer (odds ratio = 1.52; 95% confidence interval [CI] = 1. 07-2.17). Risk increased with duration of tamoxifen use (P for trend =.0002). Women with more than 5 years of exposure to tamoxifen had 4. 06-fold greater odds of developing endometrial cancer than nonusers (95% CI = 1.74-9.47). Prior use of estrogen replacement therapy (ERT) increased risk associated with tamoxifen use (P for homogeneity of trends <.0001). Risk associated with tamoxifen use was stronger among heavier women than among thinner women, although trends did not differ statistically (P =.10). Tamoxifen dose-response effects were more pronounced among women with both previous ERT exposure and higher body mass index than among women in other risk groups. CONCLUSIONS: ERT use and obesity, both established endometrial cancer risk factors and markers of estrogen exposure, substantially modify the association between tamoxifen use and endometrial cancer risk among patients with breast cancer. Women with positive ERT histories and those who are obese, when prescribed tamoxifen, may warrant closer surveillance for endometrial cancer than women without such histories.

Aged↗

PubMed2001

Family history of breast and ovarian cancers and BRCA1 and BRCA2 mutations in a population-based series of early-onset breast cancer.

BACKGROUND: BRCA1 and BRCA2 are the two major susceptibility genes involved in hereditary breast cancer. This study was undertaken to provide reliable population-based estimates of genetic influence and to characterize the nature and prevalence of BRCA1 and BRCA2 germline mutations in early-onset breast cancer. METHODS: In a series comprising all women diagnosed with breast cancer under the age of 41 years in southern Sweden during 1990 through 1995 (n = 262), family history of cancer was evaluated in 95% (n = 250) of the case subjects and germline mutations in BRCA1 and BRCA2 were analyzed in 89% (n = 234). All statistical tests were two-sided. RESULTS: A total of 97 case subjects had at least one first- or second-degree relative with breast or ovarian cancer; 34 (14%; 95% confidence interval [CI] = 9.6% to 18%) cases had at least two first- or second-degree relatives, 22 (8.8%; 95%CI = 5.3% to 12%) had one first-degree relative, and 41 (16%; 95% CI = 12% to 21%) had one second-degree relative with either cancer. If two females affected with breast or ovarian cancer who were related through an unaffected male were also defined as first-degree relatives, then a higher number of case subjects, 120 (48%; 95% CI = 42% to 54%), had at least one first-degree or second-degree relative with breast or ovarian cancer. Sixteen (6.8%; 95% CI = 4.0% to 11%) BRCA1 mutation carriers and five (2.1%; 95% CI = 0.70% to 4.9%) BRCA2 mutation carriers were identified. Among case subjects with one first- or more than one first- or second-degree relative with breast or ovarian cancer, BRCA mutations were more frequent (P<.001) than among the case subjects without this degree of family history. BRCA mutations were also statistically significantly more common among women with bilateral breast cancer than among women with unilateral breast cancer (P =.002). BRCA mutations were more common among younger case subjects than among older ones (P =.0027). CONCLUSIONS: Almost half (48%) of women in southern Sweden with early-onset breast cancer have some family history of breast or ovarian cancer, and 9.0% of early-onset breast cancer cases are associated with a germline mutation in BRCA1 or BRCA2. Mutation carriers were more prevalent among young women, women with at least one first- or second-degree relative with breast or ovarian cancer, and women with bilateral breast cancer.

Adult↗

PubMed2004

Estrogen receptor status of primary breast cancer is predictive of estrogen receptor status of contralateral breast cancer.

BACKGROUND: Tamoxifen reduces the risk for contralateral breast cancer by approximately 30%-50%, with benefits probably limited to women with estrogen receptor (ER)-positive primary disease. In a retrospective analysis of data from National Surgical and Adjuvant Breast and Bowel Project trials B-18, B-22, and B-25, we determined whether the ER status of primary breast cancer predicts the ER status of a subsequent contralateral breast cancer and whether tamoxifen treatment affects this relationship. In these trials, tamoxifen at 20 mg/day had been administered only to women aged 50 years or older, rather than to those determined by the ER status of their primary tumor, allowing an assessment of the treatment's effects in ER-negative disease. METHODS: Among the 5513 eligible patients, 176 patients developed a contralateral breast cancer. The ER status of the primary and contralateral tumor was determined and cross-classified for women who did not receive tamoxifen (i.e., those aged 49 years or younger) and for women who did (i.e., those aged 50 years or older). ER data were available for 110 evaluable invasive contralateral breast cancers. RESULTS: Among patients who did not receive tamoxifen (n = 62), 89% with an ER-positive primary cancer had an ER-positive contralateral breast cancer and 70% with an ER-negative primary breast cancer had an ER-negative contralateral breast cancer (odds ratio for the association between primary and contralateral ER status = 14.8, 95% confidence interval = 3.8 to 74.3; P<.001). Among patients who received tamoxifen (n = 48), 56% with an ER-positive primary cancer had an ER-positive contralateral breast cancer and 78% with an ER-negative primary cancer had an ER-negative contralateral breast cancer (odds ratio = 3.4, 95% confidence interval = 0.53 to 39.2; P =.25). CONCLUSION: The ER status of the primary breast cancer was associated with that of the contralateral breast for patients not receiving tamoxifen. Patients with an ER-positive primary cancer who received tamoxifen had a lower concordance rate with fewer ER-positive contralateral breast cancers, which may be a result of tamoxifen treatment.

Age Factors↗

PubMed1993

Association of body fat distribution and family histories of breast and ovarian cancer with risk of postmenopausal breast cancer.

The authors recently published data from a prospective cohort study of postmenopausal women (N Engl J Med 1992;326:1323-9) which suggested that a high waist/hip ratio was associated with a significantly increased risk of breast cancer in women with a positive family history of breast cancer. Since families with aggregations of breast and ovarian cancer demonstrate more consistent genetic linkage to markers on chromosome 17q than do families with breast cancer alone, the authors performed additional analyses to examine whether the previously observed associations with waist/hip ratio differed when family history of breast cancer was partitioned according to whether or not ovarian cancer was also present in a close relative. Between 1986 and 1990, 620 incident cases of breast cancer were identified in a cohort of 37,105 postmenopausal Iowa women. A family history of breast cancer in first-degree relatives was associated with a relative risk of 1.34 (95% confidence interval (CI) 1.07-1.69); a family history of both breast cancer and ovarian cancer was associated with a relative risk of 2.36 (95% CI 1.12-4.98). Consistent with the authors' findings after 4 years of follow-up, a high waist/hip ratio (> or = 80th percentile vs. < 80th percentile) was associated with increased risk of breast cancer in the presence of a family history of breast cancer (relative risk (RR) = 2.10, 95% CI 1.43-3.09) but not in the absence of a family history of breast cancer (RR = 1.12). The combination of a high waist/hip ratio with a family history of breast and ovarian cancer was associated with 4.83-fold increased risk (95% CI 1.55-15.1). Neither a family history of breast cancer nor a family history of ovarian cancer was associated with significantly increased risk in the absence of a high waist/hip ratio.

Adipose Tissue↗

PubMed2002

Screening for second primary lung cancer after treatment of laryngeal cancer.

OBJECTIVES/HYPOTHESIS: As a result of smoking, patients who have received curative treatment for laryngeal cancer run a high risk of developing lung cancer. Therefore, these patients enter a screening program that aims to detect lung cancer at an asymptomatic stage. The study evaluated whether screening for lung cancer by means of regular chest x-ray examinations contributed to prolonging survival. STUDY DESIGN: A longitudinal follow-up study was performed to analyze the survival of patients who had received curative treatment for squamous cell laryngeal cancer and developed lung cancer during the follow-up period. METHODS: Patients with lung cancer were divided into two groups: 1) patients with asymptomatic screen-detected lung cancer and 2) patients with complaints indicating lung cancer, whose tumor was detected in the interval between screening examinations by chest x-ray films. RESULTS: In the complete group of patients with laryngeal cancer, no prognostic factors could be identified for developing lung cancer. There was no prolongation of survival in the screen-detected asymptomatic lung cancer patients. The median survival of both groups was 56 months (P =.57). The date of detection of the lung cancer was clearly brought forward by screening; a difference of 8 months was found between the median detection date of the two groups (P <.001). There was no difference in tumor-specific mortality between the two groups. CONCLUSION: Screening by chest x-ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.

Adult↗

PubMed2001

Physical activity and cancer risk: dose-response and cancer, all sites and site-specific.

PURPOSE: The association between physical activity and overall and site-specific cancer risk is elaborated in relation to whether any observed dose-response association between physical activity and cancer can be interpreted in terms of how much physical activity (type, intensity, duration, frequency) is needed to influence site- and gender-specific cancer risk. METHODS: Observational studies were reviewed that have examined the independent effect of the volume of occupational physical activity (OPA) and/or leisure time physical activity (LPA) on overall and site-specific cancer risk. RESULTS: The evidence of cohort and case-control studies suggests that both leisure time and occupational physical activity protect against overall cancer risk, with a graded dose-response association suggested in both sexes. Confounding effects such as diet, body weight, and parity are often included as a covariate in the analyses, with little influence on the observed associations. A crude graded inverse dose-response association was observed between physical activity and colon cancer in 48 studies including 40,674 colon/colorectal cancer cases for both sexes. A dose-response effect of physical activity on colon cancer risk was especially observed, when participation in activities of at least moderate activity (>4.5 MET) and demonstrated by activities expressed as MET-hours per week. An observed inverse association with a dose-response relationship between physical activity and breast cancer was also identified in the majority of the 41 studies including 108,031 breast cancer cases. The dose-response relationship was in particular observed in case-control studies and supported by observations in cohort studies when participation in activities of at least moderate activity (>4.5 MET) and demonstrated by activities expressed by MET-hours per week. This association between physical activity and breast cancer risk is possibly dependent on age at exposure, age at diagnosis, menopausal status and other effect modifiers, e.g., body mass index. Furthermore, data concerning carcinoma of other cancers (prostate, lung, endometrium, ovary, and testicular cancers) are required. CONCLUSION: A protective effect of physical activity on site-specific cancer risk with a dose-response association between physical activity and colon and pre- and postmenopausal breast cancer supported by identified biological mechanisms has been observed. The optimal permutation of type, intensity, duration, and frequency of physical activity across the lifespan is unclear, but it is gender, age, and site specific and supports moderate activity (>4.5 MET) more than light activities (<4.5 MET). The complicated nature of the physical activity variable, combined with lack of knowledge regarding possible biological mechanisms operating between physical activity and cancer, warrants further studies including controlled clinical randomized trials.

Adult↗

PubMed2005

Longitudinal trends of stomach cancer and esophageal cancer in Yangzhong County: a high-incidence rural area of China.

OBJECTIVE: This study aims to investigate the recent trends in incidence rates of stomach cancer and esophageal cancer in a high-incidence rural area of China. METHODS: All new cancer occurrences registered between 1991 and 2003 in the Yangzhong Cancer Registry were reviewed. Yearly age-specific and age-adjusted incidence rates were calculated for males and for females. Longitudinal trends of cancer incidence were estimated by the estimated annual percentage change method. RESULTS: In total 12 691 incident cancer cases were registered, with 7159 males (56.41%) and 5532 females (43.59%). Adjusting to the world standard population, the incidence rate of all cancers decreased significantly across the period 1991-2003 from 357.02 to 283.21 per 10 person-years. For males this rate decreased from 447.22 to 346.72 per 10 person-years, and for females the incidence rate decreased from 284.36 to 225.73 per 10 person-years. The major cancers in Yangzhong County were stomach cancer and esophageal cancer, accounting for more than 70% of all cancer occurrences. During the past 13 years, the incidence rates of stomach cancer decreased greatly from 231.92 to 145.26 per 10 person-years in males and from 114.16 to 74.59 per 10 person-years in females. The estimated annual percentage changes of stomach cancer incidence were -2.96% [95% confidence interval (CI), -2.99% to -2.92%] in males and -2.86% (95% CI, -2.89% to -2.82%) in females. Incidence rates for esophageal cancer decreased slightly from 121.48 to 93.84 per 10 person-years in males with an estimated annual percentage change of -1.39% (95% CI, -1.42% to -1.36%), and from 99.74 to 73.73 per 10 person-years in females at an annual change of -2.18% (95% CI, -2.22% to -2.14%). CONCLUSION: Findings from this study showed that, although there is a decreasing trend of stomach cancer and esophageal cancer in this high-incidence area, the rates remain high. Future effort should be directed toward identifying factors behind the high rates and those contributing to the decreasing trend.

Adult↗

PubMed2005

Little or no residual prostate cancer at radical prostatectomy: vanishing cancer or switched specimen?: a microsatellite analysis of specimen identity.

With more vigilant screening for prostate cancer, there has been an associated increase in patients with little or no residual cancer at radical prostatectomy after an initial diagnosis of minute cancer on needle biopsy. This raises a critical question as to whether the biopsy and subsequent radical prostatectomy in these patients are from the same patient. We used PCR-based microsatellite marker analysis to perform identity test in 46 men (35 with minute cancer and 11 with no residual cancer). Of them, 41 were interpretable, including 31 with minute cancer and 10 with no residual cancer. All 31 interpretable cases with minute cancer showed match between the initial biopsy and radical prostatectomy specimens. Nine of the 10 interpretable cases with no residual cancer showed match and 1 showed mismatch. The remaining 5 cases (4 with minute cancer and 1 with no residual cancer) were considered uninterpretable due to technical problems. The initial biopsy of the mismatched case had high-grade cancer (Gleason score 4 + 4 = 8) measuring 9.6 mm in length with perineural invasion. Our results confirm that, in most cases of "vanishing cancer" in radical prostatectomy specimens, it reflects a chance sampling of a minute cancer and not a switch in specimens. However, specimen switch can rarely occur, and if there is high grade or a lot of cancer on the biopsy with no or very minimal cancer in the radical prostatectomy specimen, one should evaluate for patient identity.

Adenocarcinoma↗

PubMed2004

Cancer and cancer risk in South Australia: what evidence for a rural-urban health differential?

OBJECTIVE: To determine the extent of evidence for a rural-urban health differential in cancer and cancer risk in South Australia. DESIGN: Secondary analysis and synthesis of data available between 1977 and 2000 from the publications of the South Australian Cancer Registry and reports of population health surveys carried out by the South Australian Department of Human Services. RESULTS: The mean annual age-standardised incidence of all forms of cancer combined was about 4% lower for rural residents (265.2 per 100,000 cf. 274.9 per 100,000). Of 31 types of cancer listed, the incidence of three was significantly higher among rural residents, the incidence of eight was significantly higher among urban residents and for 20 types there was no significant difference. Five year case survival for all cancers combined was 52% in both urban and rural residents. Significant survival differences were identified for only 10 cancers and survival for each was higher among urban residents. Melanomas were diagnosed in situ more often in the country, but invasive cases tended to be thicker. There was no rural-urban difference in early detection rates for breast cancer or bladder cancer. There were no substantial reported differences in major risk factors and early detection experiences apart from higher rates of smoking in the country. CONCLUSIONS: There is little evidence for substantial or systematic differences in risk factors for, and incidence and early detection of cancers between urban and rural South Australia. However, the apparent consistently poorer survival among rural residents warrants further study. WHAT THIS PAPER ADDS: It is widely reported that the health status of rural Australians is worse than that of their urban counterparts. There is an apparent increasing gradient in mortality from urban to remote areas of Australia. However, this apparent gradient is not evident for all diseases. This paper seeks to answer the question: is there any difference in the cancer disease experience (incidence, survival and early detection) and cancer risk factors between residents of rural and urban South Australia. Cancer registry data indicate that overall, the incidence of cancer is similar in rural and urban South Australia. The findings on survival differentials are of concern. While overall survival rates are very similar in country and city, and this is encouraging, analysis of individual types of cancer raises some concerns. The registry reports that significant differences in survival were only measured for 10 cancers and for all of these rural residents experienced higher mortality rates.

Adolescent↗

PubMed1991

Second primary cancers following colon and rectal cancer in Osaka, Japan.

The frequencies of second primary cancers following colon and rectal cancers were estimated using the Osaka Cancer Registry's population-based data for Osaka, Japan. A series of 7,312 colon and 6,923 rectal cancer cases newly diagnosed in the period of 1966-1986 were followed up until the end of 1986. The average follow-up period was 3.6 years for colon cancer and 3.7 years for rectal cancer. Significantly elevated risks of second primary cancers following colon cancer were observed for cancers of the rectum (O/E = 2.0; 95% confidence interval (CI) = 1.1-3.4 among males, O/E = 4.3; 95% CI = 2.4-7.2 among females), corpus uteri (O/E = 8.2; 95% CI = 3.3-16.9), ovary (O/E = 4.3; 95% CI = 1.0-5.0), and female thyroid gland (O/E = 4.7; 95% CI = 1.7-8.8). These findings were more notable among right-sided colon cancer patients than left-sided colon cancer patients. The elevated risks of second primary cancers were particularly evident among patients younger than 50 years of age at the time of diagnosis of the initial cancer (colon cancer: O/E = 3.1 among males, 3.4 among females, rectal cancer: O/E = 1.7 among males, 1.3 among females). These findings suggest that younger colorectal cancer patients should undergo more careful checkups throughout their lives.

Age Factors↗