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PubMed2004

Prospective risk of pancreatic cancer in familial pancreatic cancer kindreds.

Individuals with a family history of pancreatic cancer have an increased risk of developing pancreatic cancer. Quantification of this risk provides a rational basis for cancer risk counseling and for screening for early pancreatic cancer. In a prospective registry-based study, we estimated the risk of pancreatic cancer in individuals with a family history of pancreatic cancer. Standardized incidence ratios were calculated by comparing the number of incident pancreatic cancers observed with those expected using Surveillance, Epidemiology and End Results (SEER) rates. Familial pancreatic cancer (FPC) kindreds were defined as kindreds having at least one pair of first-degree relatives with pancreatic cancer, and sporadic pancreatic cancer (SPC) kindreds as families without such an affected pair. Nineteen incident pancreatic cancers developed among 5,179 individuals from 838 kindreds (at baseline, 370 FPC kindreds and 468 SPC kindreds). Of these 5,179 individuals, 3,957 had at least one first-degree relative with pancreatic cancer and contributed 10,538 person-years of follow-up. In this group, the observed-to-expected rate of pancreatic cancer was significantly elevated in members of FPC kindreds [9.0; 95% confidence interval (CI), 4.5-16.1], but not in the SPC kindreds (1.8; 95% CI., 0.22-6.4). This risk in FPC kindreds was elevated in individuals with three (32.0; 95% CI, 10.2-74.7), two (6.4; CI, 1.8-16.4), or one (4.6; CI, 0.5-16.4) first-degree relative(s) with pancreatic cancer. Risk was not increased among 369 spouses and other genetically unrelated relatives. Risk was higher in smokers than in nonsmokers. Individuals with a strong family history of pancreatic cancer have a significantly increased risk of developing pancreatic cancer.

Adult↗

PubMedDate not supplied

Microsatellite instability as a predictor of survival in head and neck cancer -- is there a link with colon cancer?

OBJECTIVE: A reliable genetic marker to predict outcome for head and neck cancer is needed. In colon cancer, microsatellite instability (MSI) predicts response to therapy and improved prognosis. Colon cancer patients with MSI have a 60% improvement in survival as compared to patients without MSI. To assess whether MSI is a predictor of improved prognosis in head and neck cancer we used our tumor registry to find 8 patients treated between 1995 and 1998 with head and neck squamous cell carcinoma and either a history of colon cancer or a parent who had colon cancer. As a control, 15 T(2) or T(3) oral cavity cancers were used. METHODS: The tumor specimens were obtained and laser capture microdissected for analysis using the following microsatellite markers: BAT25, BAT26, BAT40, D1S2883, D2S123, D3S1611, D5S346, D7S501 and D8S25. RESULTS: All 8 patients with head and neck cancer and a colon cancer history exhibited MSI or loss of heterozygosity (LOH) at 1 or more of the markers tested. Three patients had 2 abnormal markers, 1 patient had 3 abnormal markers and 1 had 7 abnormal markers. Only 1 of the patients with a colon cancer history, all of whom had MSI, developed recurrent head and neck cancer. Of the 15 control patients, 5 had MSI or LOH and 1 had MSI or LOH at 2 markers. Three of the 5 patients with MSI or LOH had a recurrence; hence MSI and LOH at these markers were uncommon, and there was no relation between MSI and outcome in patients without a history of colon cancer. CONCLUSIONS: These results support a possible alternative mode of carcinogenesis in patients with head and neck cancer and a history of colon cancer and, most significantly, that these cancers are a subgroup of head and neck cancer that may have a better prognosis.

Adult↗

PubMedDate not supplied

Comparison of human papillomavirus DNA levels in gynecological cancers: implication for cancer development.

We have previously demonstrated the presence of human papillomavirus (HPV) DNA in several gynecological cancers using conventional PCR. In the present study, to further understand the role of HPV in malignant transformation of these cancers, the infection rates and viral loads of HPV 16 and 18 in gynecological cancers were analyzed using real-time quantitative PCR (qPCR). HPV 16 DNA was detected in 61.0% (58/95), 15.2% (7/46) and 32.1% (18/56) of cases of cervical, endometrial and ovarian cancers, respectively. On the other hand, HPV 18 DNA was detected in 23.2% (22/95) of cervical cancers, 1.8% (1/56) of ovarian cancers, and in no cases of endometrial cancer. Thus, HPV 16 is much more prevalent than HPV 18 in malignancies of the female genital tract. We also found that both HPV 16 and 18 were significantly (p < 0.05) less frequently present in endometrial and ovarian cancers than in cervical cancer. The median copy numbers of HPV 16 DNA in endometrial and ovarian cancers were 3,500 and 7,590 copies/microg DNA, respectively. These amounts were also significantly (p < 0.05) lower than HPV 16 DNA in cervical cancer (492,800 copies/microg DNA). Thus, HPV 16 could be detected in all three types of gynecological cancer, whilst HPV 18 is extremely rare in endometrial and ovarian cancers. The lower HPV 16 infection rates and lower copy numbers when compared with cervical cancer tend to suggest that HPV plays a less essential role in the development of endometrial cancer and ovarian cancer.

Adult↗

PubMed2006

ATM variants and cancer risk in breast cancer patients from Southern Finland.

BACKGROUND: Individuals heterozygous for germline ATM mutations have been reported to have an increased risk for breast cancer but the role for ATM genetic variants for breast cancer risk has remained unclear. Recently, a common ATM variant, ATMivs38 -8T>C in cis with the ATMex39 5557G>A (D1853N) variant, was suggested to associate with bilateral breast cancer among familial breast cancer patients from Northern Finland. We have here evaluated the 5557G>A and ivs38-8T>C variants in an extensive case-control association analysis. We also aimed to investigate whether there are other ATM mutations or variants contributing to breast cancer risk in our population. METHODS: Two common ATM variants, 5557G>A and ivs38-8T>C, previously suggested to associate with bilateral breast cancer, were genotyped in an extensive set of 786 familial and 884 unselected breast cancer cases as well as 708 healthy controls. We also screened the entire coding region and exon-intron boundaries of the ATM gene in 47 familial breast cancer patients and constructed haplotypes of the patients. The identified variants were also evaluated for increased breast cancer risk among additional breast cancer cases and controls. RESULTS: Neither of the two common variants, 5557G>A and ivs38-8T>C, nor any haplotype containing them, was significantly associated with breast cancer risk, bilateral breast cancer or multiple primary cancers in any of the patient groups or subgoups. Three rare missense alterations and one intronic change were each found in only one patient of over 250 familial patients studied and not among controls. The fourth missense alteration studied further was found with closely similar frequencies in over 600 familial cases and controls. CONCLUSION: Altogether, our results suggest very minor effect, if any, of ATM genetic variants on familial breast cancer in Southern Finland. Our results do not support association of the 5557G>A or ivs38-8T>C variant with increased breast cancer risk or with bilateral breast cancer.

Ataxia Telangiectasia Mutated Proteins↗

PubMedDate not supplied

Expectations and beliefs about children's cancer symptoms: perspectives of children with cancer and their families.

PURPOSE/OBJECTIVES: To describe the childhood cancer symptom course experienced by children with cancer from the perspectives of the children and their families. DESIGN: Longitudinal, qualitative research approach. SETTING: The participants' homes and inpatient and outpatient pediatric cancer units in western Canada. SAMPLE: A theoretical purposive sample of 39 children (4.5-18 years of age) with a variety of cancer diagnoses and their family members. METHODS: Open-ended formal interviews with children and their family members (N = 230) and participant observation of children and their family members for more than 960 hours during various periods during their illness, at various locations, and at different points in time during the study period. MAIN RESEARCH VARIABLES: Children's and their families' perspectives of cancer symptoms experienced by children with cancer. FINDINGS: Children and families had definite beliefs and expectations about the cancer symptom experiences, including (a) short-term pain for long-term gain, (b) you never get used to them, (c) they all suck, (d) it sort of helps, and (e) they are all the same but they are all different. Underpinning all of the participants' beliefs and expectations was the experience of suffering. Their beliefs and expectations contributed to and were a direct result of cancer symptoms that were ignored, unrelieved, or uncontrolled. CONCLUSIONS: Children with cancer live with symptoms on a daily basis and have experiences of unrelieved cancer symptoms. Although cancer symptoms resulted in suffering by the children and families, they accepted the symptoms as an integral part of overcoming cancer and never expected complete symptom relief. IMPLICATIONS FOR NURSING: Oncology nurses need to be more vigilant in their assessment and management of children's cancer symptoms. Further research is warranted detailing not only children's and family's beliefs and expectations of cancer symptom experiences but also nurses' understanding and interpretations of children's cancer symptom experiences. Intervention studies designed to relieve all types of cancer symptoms experienced by children must be undertaken.

Adaptation, Psychological↗

PubMed2002

Cancer incidence in a population of Jewish women at risk of ovarian cancer.

PURPOSE: To evaluate the incidence and clinical characteristics of ovarian and other cancers in a cohort of women at risk of developing ovarian cancer. PATIENTS AND METHODS: The Gilda Radner Ovarian Cancer Detection Program in Los Angeles, CA, was established in 1991 to study the efficacy of screening in the early detection of ovarian cancer. We present findings from a historical cohort of 290 Jewish women who were offered BRCA testing for three common founder mutations (BRCA1 185delAG and 5382insC and BRCA2 6174delT). RESULTS: In 10 years, 17 cancers were observed (1,111 per 100,000 per year), including six breast and eight ovarian or related cancers. A high proportion of cancers of peritoneal origin was observed. The majority (86%) of women with incident breast or ovarian/peritoneal cancer carried a mutation in the BRCA1 gene. The overall cancer incidence among carriers of mutations in the BRCA1 gene was estimated to be 5,450 per 100,000 per year, corresponding to a cumulative incidence of 47.5% at 10 years. In contrast, the cumulative incidence of cancer among noncarriers was 2.5% (P < 10(-8)). After adjustment for sampling, the risks to BRCA1 mutation carriers at 10 years were estimated to be 21% for ovarian/peritoneal/tubal cancer, 16% for breast cancer, and 36% for all cancers. CONCLUSION: The excess risk of breast and ovarian cancer in Jewish women with a family history of ovarian cancer is largely attributable to mutations in BRCA1. Intensive surveillance by use of CA-125 and ultrasound does not seem to be an effective means of diagnosing early-stage ovarian cancer in this high-risk cohort.

Adult↗

PubMed2005

Impact of a family history of colorectal cancer on age at diagnosis, anatomic location, and clinical characteristics of colorectal cancer.

BACKGROUND: Among the risk factors for colorectal cancer (CRC) is a family history of colorectal cancer. Reliable evidence is needed regarding the clinical characteristics of cancer in patients with this history to determine if a change in the diagnostic approach is needed. AIM OF THE STUDY: This study set out to determine specific clinical outcomes in patients with CRC with a family history of one first-degree relative with sporadic colorectal cancer compared to control patients with colorectal cancer but without the family history. METHODS: We designed a case-control study of colorectal cancer registry data between 1988 and 1999. Patients with a family history of one first-degree relative with colorectal cancer were compared to those without the history with regard to four characteristics: age at cancer diagnosis, anatomic location of the cancer, presence of distal adenomas with proximal cancer, and stage of disease at diagnosis. RESULTS: Nine hundred and twenty-one patients met the inclusion criteria. Family history was positive in 124 patients. The demography of the populations was similar, except for mean age, which was 65 yr for men with a family history and proximal cancer compared to 70 yr for their counterparts without the family history (p = 0.03). The anatomic location of the cancer, presence of distal benign neoplasia when the cancer was proximal, and disease stage at diagnosis were not different between the groups. CONCLUSIONS: Men with a family history of sporadic colorectal cancer and proximal colon cancer were younger than men without the family history and proximal colon cancer. The overall results do not indicate that a change in the diagnostic approach is needed.

Adult↗

PubMed1998

Mp colorectal cancer should be defined as early colorectal cancer.

Little is known about the clinicopathologic features of mp colorectal cancer, defined as a cancer where the depth of invasion is limited to within the mucosa, the submucosa and the proper muscle. This study was designed to determine the clinicopathologic features of mp colorectal cancers. From 1973 to 1993, 83 mp colorectal cancer and 66 sm colorectal cancer patients were treated in our department and were enrolled in this study. During the same period, 66 patients with sm colorectal cancer defined as a cancer where the depth of invasion is limited to within the mucosa and the submucosa, were treated. The clinicopathologic findings of these patients were determined retrospectively from their hospital records. Clinicopathologic differences in sm and mp colorectal cancers were compared with sm and mp gastric cancers. The incidence of mp colorectal cancer increased from 7.9% in 1973-1977 to 16.2% in 1988-1993. An advanced macroscopic appearance, a larger tumor size, lymph node metastasis and lymph vessel invasion were more predominant in mp than sm colorectal cancer. Multivariate analysis demonstrated that these clinicopathologic factors were not statistically independent prognostic factors for mp colorectal cancer patients. There was no statistical difference in postoperative survival between sm and mp colorectal cancer patients. Mp colorectal cancer should be defined as early colorectal cancer, because the postoperative survival rate does not differ between mp and sm colorectal cancers, and the clinicopathologic differences between these two are negligible.

Colorectal Neoplasms↗

PubMed2004

Incidence of bladder cancer discovered by urethrocystoscopy at prostate biopsy: extraordinary high incidence of tiny bladder cancer in elderly males.

In order to clarify the incidence of bladder cancer with and without prostate cancer, we investigated bladder cancer discovered incidentally by urethrocystoscopy at prostate biopsy. Between April 1997 and December 2003, 498 patients who were suspected prostate cancer were performed prostate biopsy and urethrocystoscopy simultaneously. We investigate possible invasion of prostate cancer into the urethra or bladder mucosa as well as bladder cancer, including other benign lesions of the bladder by urethrocystoscopy. Prostate cancer was confirmed in 175 (35.1%) of the 498 patients histologically, and bladder cancer was discovered incidentally in 12 patients (2.4 %). The incidence of bladder cancer in patients with prostate cancer of 2.3% (4/175) was not significantly different from that in patients without prostate cancer, which was 2.5% (8/323). Superficial and those with a size less than 1 cm were noted in 11 patients (92%) and 10 patients (83%) respectively. High incidence rate of bladder cancer with prostate cancer was reported previously, however, there was no study to compare the incidence rate of bladder cancer between cases with and without prostate cancer. The present study suggests that asymptomatic tiny bladder cancer may be present at an unexpectedly high incidence rate in elderly males.

Adult↗

PubMed2006

Improved cancer detection using computer-aided detection with diagnostic and screening mammography: prospective study of 104 cancers.

OBJECTIVE: This study prospectively evaluated a computer-aided detection (CAD) device used with diagnostic and screening mammography by assessing cancers detected; tumor sizes, histology, and stage; positive predictive value (PPV) of biopsy recommendation; and recall rates before and after CAD introduction. SUBJECTS AND METHODS: Interpretations of 9,520 consecutive mammograms were recorded without and then with CAD for a 28-month period. Cancer detections based on initial radiologist review and additional detections based on CAD findings were noted. Recall rates, tumor size and histology, and PPV of biopsy recommendation before and after the introduction of CAD were compared. RESULTS: Cancers detected only with CAD assistance were 9.6% of all cancers (10 of 104); screening-detected cancers increased 13.3% with CAD assistance (four in addition to 30 screening-detected cancers). The 95% one-sided confidence boundary using binomial distribution is consistent with at least 5.3% for all cancers and 5.1% for nonpalpable cancers. The greatest impact was on ductal carcinoma in situ, for which CAD increased cancer detection by 14.2% (three added to 21). Similar percentages of cancers were detected only with CAD assistance in both screening (11.4%; 4 of 35) and diagnostic (9.5%; six of 63) studies. Additional cancers were detected using CAD in patients with implants and previous lumpectomy. The additional cancers detected with CAD were smaller (p = 0.01 for all cancers, p = 0.03 for nonpalpable invasive cancer). The screening recall rate increased from 6.2% to 7.8% after CAD, with a decrease in the biopsy rate and a nonsignificant increase in the biopsy PPV from 21.9% to 26.3%. CONCLUSION: CAD resulted in detection of more cancers in screening and diagnostic patients, with an increased recall rate but no deterioration in PPV of biopsy. Additional cancers detected were significantly smaller.

Biopsy↗

PubMed2000

[Clinical features of multiple primary cancers including prostate cancer].

We analyzed the clinical features of multiple primary cancers (MPCs) that included prostate cancer. MPCs were observed in 93 (15.2%) of the patients suffering from prostate cancer. In the MPC group, the organ most commonly involved was the stomach, followed by bladder, colon and lungs. The median age at diagnosis of the first, second and third cancers was 72, 74, and 75 years old, respectively, and the duration between the first and second cancers (median: 20 months) was longer than that between the second and third cancers (median: 8 months). In the 37 MPC patients whose cause of death was obvious, 29 (78.4%) died of a cancer; prostate cancer was not so common (6 patients) as the cause of death. Age at diagnosis and grade distribution of prostate cancer were not significantly different between the MPC and single primary cancer (SPC) groups. However, the proportion of earlier stage was significantly (p < 0.01) higher in the MPC group than in the SPC group, and this trend was more obvious in patients whose prostate cancer was diagnosed as the second cancer. The prostate cancer-specific survival rates were significantly higher in the patients with MPC, and this trend was more obvious in the patients with stage D or moderately differentiated cancer. It is important in the follow up of prostate cancer patients to be aware of the possibility of the occurrence of a second cancer.

Age Factors↗

PubMedDate not supplied

The impact of contralateral breast cancer on the outcome of breast cancer patients treated by mastectomy.

PURPOSE: To evaluate the clinical and pathological features of breast cancer patients who develop contralateral breast cancer (CBC) and assess the impact of the second breast cancer on their prognosis. PATIENTS AND METHODS: This retrospective study includes 2136 women with stage I-III breast cancer treated between 1927 and 1987 at the University of Chicago Hospitals. A total of 132 (6.2%) developed CBC during a median follow-up period of 14.2 years; all of them were treated with mastectomy for both breast cancers. We compare the prognostic characteristics, treatments, and outcomes of patients who developed bilateral breast cancer with those who had only unilateral breast cancer (UBC). We also compare the features of the first and the second tumors among patients with bilateral breast cancer (BBC). RESULTS: The annual incidence rate for CBC remained constant at an average rate of 0.23%, resulting in a cumulative incidence rate of 6.2%. Patients with BBC were significantly younger than those with UBC (median age, 51 years vs 54 years). No other significant differences were observed between BBC and UBC patients. Among BBC patients, the second cancer was smaller (2.0 cm vs 3.0 cm) and was associated with a lower incidence of axillary node involvement (29% vs 52%). The development of CBC was associated with worse survival (hazard ratio = 1.46 in comparison with patients who did not develop CBC, 95% CI of 1.09-1.95). On multivariate analysis, factors that decreased the disease-specific survival (DSS) in patients with BBC were a higher number of positive lymph nodes of the first and second cancers, a larger size of the second cancer, and a shorter interval between the two primaries. DISCUSSION: At the time of diagnosis of first breast cancer, BBC patients were significantly younger than UBC patients. The second cancer among the BBC patients was at an earlier stage than the first one; however, no difference was noticed in the pathological feature between the cancer in the UBC patients and the first cancer of BBC patients. There is an indication that the longer the interval between the two cancers, the better the survival of the BBC patients.

Adult↗

PubMed2000

BRCA1 and BRCA2 mutations in breast cancer families with multiple primary cancers.

Ninety-eight women ascertained from high-risk breast/ovarian cancer clinics with breast cancer reporting at least one other primary cancer in themselves or in a relative with breast cancer were compared with 99 women with breast cancer who reported a family history of breast cancer only. All DNA was screened for coding region mutations in BRCA1 and BRCA2 using heteroduplex analysis, followed by direct sequencing. Our data indicate that 42.9% of families reporting breast and any second nonbreast type of primary cancer in the same individual had a BRCA1 or BRCA2 mutation, as compared with the 12.1% of families reporting breast cancer only (P < 0.001). Among the 66 women reporting breast cancer and a nonovarian second primary cancer, 15 (22.7%) had mutations in BRCA1 or BRCA2 (P = 0.04). Among the 32 families where ovarian cancer was the second primary cancer, 27 (84.4%) had a mutation in BRCA1 or BRCA2 (P < 0.001). BRCA1 and BRCA2 mutations were twice as common in the presence of a reported second nonovarian cancer. These data suggest that the presence of multiple primary cancer of any kind may predict for an increased likelihood of finding a BRCA1 or BRCA2 mutation and supports previous studies suggesting that BRCA1 and BRCA2 mutations may be associated with an increased susceptibility to cancers other than breast and ovarian cancer.

BRCA2 Protein↗

PubMed2002

Expression and accumulation of lumican protein in uterine cervical cancer cells at the periphery of cancer nests.

Lumican is a member of a small leucine-rich proteoglycan (SLRP) family and is reported to be overexpressed during the wound healing process of the cornea, and ischemic and reperfused heart. In the carcinomatous tissues, lumican is overexpressed in human breast and pancreatic cancer tissues. In the present study, we aimed to clarify the expression of lumican mRNA and its protein in human cervical cancer cell lines (CaSki, ME-180 and HeLa cells) and their localization in normal and cancerous human cervical tissues. Reverse transcription-polymerase chain reaction and Western blot analysis revealed the expression of lumican mRNA and its protein in CaSki, ME-180 and HeLa cells. No or weak immunoreactivity of the lumican protein was observed in stroma but not in squamous and ductal cells of non-cancerous uterine cervical tissues. In 21 of 28 (75%) cervical cancer cases, the lumican protein was strongly expressed in cancer cells, and accumulated particularly in cancer cells at the periphery of the cancer nests. It was also expressed in the fibroblasts adjacent to the cancer cells. In situ hybridization analysis revealed that lumican mRNA was not expressed in squamous or ductal epithelial cells in non-cancerous tissues, but was expressed in most cancer cells and stromal fibroblasts in uterine cervical cancer tissues. The lumican protein was not localized in normal squamous or ductal cells close to cancer cells, but its mRNA was strongly expressed in the same cells. To our knowledge, this is the first report on lumican synthesized by squamous cell carcinomas. These findings may indicate that the accumulated lumican protein in cancer cells at the periphery of cancer nests may play roles in the growth or invasion of human cervical cancer cells.

Blotting, Western↗

PubMed2003

[p53 gene polymorphism with susceptibility to esophageal cancer and lung cancer in Chinese population].

OBJECTIVE: To investigate the association of p53 codon 72 polymorphism with susceptibility to esophageal cancer and lung cancer in the northern Chinese population. METHODS: p53 codon 72 genotyping was performed by amplifying DNA fragments with sequence specific primers among 173 patients with esophageal squamous cell carcinoma, 98 with non-small cell lung carcinoma as well as 136 healthy controls. RESULTS: No significant difference of p53 allelotype and genotype distribution was observed between esophageal cancer and lung cancer patients. The Pro allele frequency was significantly higher among esophageal cancer and lung cancer patients than among healthy controls (P value was 0.024 and 0.027 respectively). There were no significant differences in Pro/Arg and Arg/Arg genotype frequency among cancer patients and healthy controls (P > 0.05). However, the Pro/Pro genotype frequency was significantly higher among esophageal cancer and lung cancer patients than among healthy controls (P value was 0.041 and 0.026 respectively). The risk of Pro homozygotes for both esophageal cancer and lung cancer was about 2 times against Arg homozygotes with adjusted odds ratio of 2.12 (95% CI = 1.13 - 4.01) and 2.30 (95% CI = 1.13 - 4.93), respectively. There was no interaction between p53 Pro/Pro genotype and smoking status to the risk for esophageal cancer and lung cancer. CONCLUSION: In the northern Chinese population, p53 Pro/Pro genotype is an independent risk factor for both esophageal cancer and lung cancer. The possible common genetic basis of the development of these two cancers is suggested by this study.

Alleles↗

PubMed2004

Mutation analysis of the breast cancer gene BRCA1 among breast cancer Jordanian females.

OBJECTIVE: To screen mutations of the tumor suppressor breast cancer susceptibility gene 1 (BRCA1) within 3 exons among Jordanian breast cancer females. METHODS: A total of 135 Jordanian breast cancer females were genetically analyzed by denaturing gradient electrophoresis (DGGE) for mutation detection in 3 BRCA1 exons (2, 11 and 20) between 2000-2002 in Al-Basheer Hospital, Amman, Jordan. RESULTS: Of the studied patients 50 had a family history of breast cancer, 28 had a family history of cancer other than breast cancer, and 57 had no family history of any cancer. Five germline mutations were detected among breast cancer females with a family history of breast cancers (one in exon 2 and 4 mutations in exon 11). Another germline mutation (within exon 11) was detected among breast cancer females with family history of cancer other than breast cancer, and no mutation was detected among breast cancer females with no family history of any cancer or among normal control females. CONCLUSION: Screening mutations within exon 2, exon 11 and exon 20 showed that most screened mutations were within BRCA1 exon 11 among breast cancer Jordanian families with a family history of breast cancer.

Adult↗

PubMedDate not supplied

Karachi Cancer Registry Data--implications for the National Cancer Control Program of Pakistan.

Cancer registries play a major role in providing the data to justify establishment, implementation and monitoring of cancer control programs, therefore stability in cancer registration is of pivotal importance. An erroneous assessment of the cancer burden can have long-term negative implications for the limited health resources of a country. Thus, registries starting simultaneously with cancer control programs clearly cannot be adequate for the purpose. The Karachi Cancer Registry (KCR) is the first population-based registry of Pakistan, with 9 years proven data stability (1995-2003) for Karachi South (KS), a location with a population distribution similar to that for the country in general as regards age, gender, and religion. It also has the distinction of being the only district in the country with representation of all ethnic and socio-economic groups of the country. The primary recommended strategy for the 'National Cancer Control Program' (NCCP), Pakistan based on the assessment of eight common cancers in Karachi and the WHO estimates would be identical. A curb on the epidemic levels of tobacco and areca nut use would reduce malignancies in males by 43.7% and in females by 17.8%. WHO estimates put these figures at 45% and 18.5% for males and females respectively. Primary prevention in the form of diet control, checks on preservatives, dyes, and pesticides; protection from occupational hazards, control of biological agents and solar UV protection would help control of another half of the malignancies. Resource restrictions put high technology methods beyond the scope of Pakistan today. Early detection of cancers of accessible sites, though not an urgent requirement, would be warranted for oral, cervical and breast cancer, after sufficient capacity building, initially in the high-risk groups. In females, this could help target 47.6% (approximately half) of the malignancies and in men 13% of the total. Establishment of equitable pain control and a palliative care network throughout the country is an urgent and essential measure as more than 70% of cancer patients report with very advanced stages of malignancy. The estimated annual incident cancer cases for Pakistan, year 2000 on the basis of KCR data were 138,343 for males and 135,054 for females; approximately twice the number cited by WHO for the same year. The argument that higher KCR estimates reflect an urban catchment population may be justified, the urban: rural ratio being 2:1 in Pakistan. Evidence-based strategies, however,support the counter argument, that the rising incidence of cancer in Pakistan is primarily attributable to risk factors equally prevalent in the rural and urban areas viz. increasing tobacco use, low socio-economic conditions, dietary deficiencies and prevalence of oncogenic viruses. Pakistan has a significant cancer burden and rising trends of risk factors - it is a country in dire need of a Cancer Control Program. KCR data along with WHO estimates can form the initial framework of a NCCP in Pakistan; the lack of a national cancer registration should not deter initiatives. Benefits of an immediate, prompt and targeted implementation established today will be realized after 20-30 years. Otherwise the country should be prepared to face epidemic proportions of the disease in the next decade or two. Prerequisite 'qualification criteria' or 'sincerity of intent test' for NCCP funding by international donors should be legislation against tobacco and areca nuts in Pakistan and stringent evaluative criteria.

Adolescent↗

PubMed2005

[Cancer and surgical treatment impact the quality of life in patients with head and neck cancer].

OBJECTIVE: To evaluate head and neck cancer and surgical treatment impact the quality of life (QOL). METHODS: In this study, 49 cases of head and neck cancer patients were recruited. Among them, 27 cases were laryngeal cancer, 14 cases were tongue cancer and 8 patients were recurrence of nasal pharyngeal cancer after radical radiotherapy. To demonstrate the cancer in different sites of the head and neck impact QOL of the patients in a different way and cancer impact QOL on the physical well-being, social family well-being, emotional well-being, functional well-being of the patients and quality of life (QOL) changed in different time-point before and after operation, QOL was assessed before surgical treatment and at 1,6 months after operation by means of a performance status scale for head and neck cancer patients (PSS-HN) and the functional assessment of cancer therapy head and neck (FACT-H&N) questionnaire. RESULTS: QOL deteriorated significantly in head and neck cancer patients. Cancer in different sites impact on QOL differently especially in patients with tongue cancer (PSS-HN P = 0.0361, FACT-H&N P = 0.0487). Head and neck cancer impact QOL on the physical well-being, social family well-being, emotional well-being, functional well-being of the patients in FACT-H&N questionnaire especially for emotional well-being domains (F = 2.78, P = 0.0311). The QOL in patients deteriorated by surgical treatment and it could be improved following the time. At the 6 months after operation it nearly reached the same scores that assessed before the operation (PSS-HN t = 2.03, P = 0.1120 FACT-H&N t = 1.03, P = 0.1180). Different surgical approaches and different reconstruction methods have different impact on QOL for patients. Laryngeal cancer patients with partial laryngectomy were 107.20 in FACT-H&N while total laryngectomees were 97. 71 at the 6 months after operation, with statistically difference (t = 3.02, P = 0.0430). Tongue cancer patients without reconstruction were 119. 24 in FACT-H&N while the others with reconstruction were 111.39 at the 6 months after operation (t = 3.00, P = 0.0472). CONCLUSIONS: The QOL in head and neck cancer patients can be assessed by the questionnaire and it can be improved by selecting treatment regimen, surgical approaches and reconstructive methods.

Adult↗