Benefits and harms of cervical screening from age 20 years compared with screening from age 25 years

Background:

To quantify the benefits (cancer prevention and down-staging) and harms (recall and excess treatment) of cervical screening starting from age 20 years rather than from age 25 years.

Methods:

We use routine screening and cancer incidence statistics from Wales (for screening from age 20 years) and England (screening from 25 years), and unpublished data from the National Audit of Invasive Cervical Cancer to estimate the number of: screening tests, women with abnormal results, referrals to colposcopy, women treated, and diagnoses of micro-invasive (stage 1A) and frank-invasive (stage IB+) cervical cancers (under three different scenarios) in women invited for screening from age 20 years and from 25 years.

Results:

Inviting 100 000 women from age 20 years yields an additional: 119 000 screens, 20 000 non-negative results, 8000 colposcopy referrals, and an extra 3000 women treated when compared with inviting from age 25 years. Screening from age 20 years prevents between three and nine frank invasive cancers and between 0 and 23 cancers in total (depending on the scenario). A cumulative increase of nine stage IB+ cancers corresponds to an annual rate increase of 0.9 per 100 000 women aged 20–29 years.

Conclusions:

To prevent one frank invasive cancer, one would need to do between 12 500 and 40 000 additional screening tests in the age group 20–24 years and treat between 300 and 900 women.     

Breast cancer at present and 30 years ago

Comparison of the data on pathomorphosis of breast cancer and parameters of reproductive function of patients for 1983-1986 and 1953-1956 failed to establish increased aggressiveness of tumor during 30 years; however, the profile of factors influencing tumor development changed. At present, breast cancer is provoked by a longer and stronger estrogen stimulation; its duration has increased by 4.1 years which is an equivalent of more than 100 ovulatory cycles.     

Insulinoma: 31 years of tumor localization and excision

This report is based on 31 years of experience with 116 cases of hyperinsulinism. Six cases had hypertrophy of the islets of Langerhans, 3 had widespead metastasis from malignant insulinomas, and 107 were benign adenoma cases. An immunoreactive insulin to glucose ratio of 0.3 of the peripheral venous blood before operation is of great value in diagnosing hyperinsulinism. Intraoperatively, immunoreactive insulin assay of the portal blood (IRI) is very valuable in determining if an insulinoma remains. The dividing line is 100 microU.ml-1. In localizing the tumor, "differential" PTPC is important before operation. During the operation, fine needle aspiration cytology may assist in ascertaining if the palpable tumor is an insulinoma. Multiple fine needle aspiration cytology examinations can sometimes reveal an insulinoma in an indurated pancreas. Portal vein blood IRI and blood sugar assays may serve to confirm if removal of the insulinoma is complete. Removal of the insulinoma controls hypoglycemia satisfactorily, but the brain damage incurred by prolonged hypoglycemia cannot be significantly altered. Removal of the tumor should be by enucleation, and the raw surface of the pancreas should be drained not sutured.     

Juvenile nasopharyngeal angiofibroma-three years experience

Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, histologically benign but locally invasive tumour, affecting almost exclusively adolescent males. This is a prospective study of 37 patients with juvenile nasopharyngeal angiofibroma treated during 3 years in our institution. The various pharyngeal and extrapharyngeal presentation staging and proper surgical approaches as per extensions are discussed here with reference to past reports.     

45岁以下子宫内膜癌患者术后3年生存影响因素分析

目的:分析45岁以下子宫内膜癌患者术后3年生存影响因素。方法:收集2009年1月至2011年12月在唐山市妇幼保健院诊断为子宫内膜癌的患者,均行子宫全切术,术后病理证实为子宫内膜癌患者88例。并根据其年龄将其分为A组（≤35岁）35例,B组（36~45岁）53例,对2组患者的生存影响因素进行单因素及多因素分析。结果:对患者的预后因素中组织学类型、病理分级、肌层浸润深度、淋巴结转移、附件转移、腹腔细胞学、雌孕激素受体等7个因素行单因素分析,结果显示组织学类型、病理分级、肌层浸润深度、淋巴结转移、附件转移、腹腔细胞学对患者的预后有影响（P均<0.05）。雌激素受体阳性患者3年生存率高于雌激素受体阴性患者,有统计学意义（P<0.05）。孕激素受体对患者预后无影响(P>0.05)。45岁以下子宫内膜癌术后放疗、化疗、孕激素治疗三者3年生存比较,无明显差异（P>0.05）。未接受治疗患者3年生存率为57.14%,低于接受放疗、化疗、孕激素治疗患者的3年生存率,均有统计学意义（P<0.05）。多因素回归分析得出肿瘤浸润深度、淋巴结转移是影响预后的独立因素。结论:45岁以下子宫内膜癌患者其发生与雌激素有关,尤其是≤35岁者,高危因素少,预后较好。对于早期45岁以下子宫内膜癌患者可考虑保留生育功能或卵巢。早期发现、早期诊断是提高45岁以下子宫内膜癌患者术后3年生存率的核心,早期手术治疗及术后辅助治疗是提高患者术后3年生存率的保障。     

Breast carcinoma at the extremes of age: a comparison of patients younger than 35 years and older than 75 years

We assessed the prognosis of patients with breast carcinoma at the extremes of the age distribution of the disease. The groups examined were 166 women 35 years or less and 169 at least 75 years old. Analysis of recurrence and survival showed no significant difference between the groups as a whole or when they were stratified by nodal status. Life expectancy of elderly women with breast carcinoma was significantly reduced when compared with a "normal" age-matched population. Medullary carcinoma was more frequent in young women while a relatively higher proportion of colloid and invasive lobular carcinoma occurred in elderly women. Bilateral carcinoma was found with nearly equal frequency in both age groups. However, elderly women were more likely to have been treated previously for contralateral carcinoma while young women tended to develop asynchronous, subsequent carcinoma.     

Randomized study of 3 years versus 5 years of chemotherapy in childhood acute lymphoblastic leukemia

Between 1972 and 1975 the Children's Cancer Study Group conducted two clinical trials for the treatment of newly diagnosed patients with acute lymphoblastic leukemia. Upon achieving 3 yr of continuous complete remission, 316 children and young adults were randomly allocated either to discontinue chemotherapy or to continue chemotherapy for an additional 24 mo. With a median follow-up from the time of randomization of 50 mo, those patients who received 3 yr of therapy have demonstrated a statistically non-significant yet higher incidence of bone marrow relapse as compared to those patients treated for 5 yr (p = 0.09). However, the proportion of patients surviving 5 yr from randomization is 93% for the 3-yr treatment group and 89% for the 5-yr treatment group (p = 0.27). No significant difference was observed between the randomized groups for the occurrence of testicular relapse (p = 0.12), central nervous system relapse (p = 0.17), or first occurrence of relapse or death (p = 0.24). The relapse-free survival of patients treated for 5 yr as compared to those treated for 3 yr was not significantly higher in males (81% versus 75%, p = 0.14) or females (89% versus 89%, p = 0.95). This randomized study did not demonstrate a significant difference between treatment for either 3 or 5 yr.