Multimodality treatment for patients with hepatocellular carcinoma: a single institution retrospective series.

BACKGROUND: The main therapeutic options for hepatocellular carcinoma (HCC) are hepatic resection, transcatheter arterial embolization (TAE), percutaneous ethanol injection therapy (PEIT) and regional chemotherapy (RC). METHODS: This study retrospectively examined the results of primary treatment of 600 patients with hepatocellular carcinoma selected according to the treatment guidelines of our facility and the results of various combination therapies for recurrent cases. The selection criteria of therapeutic options included the number and size of tumours and hepatic function. RESULTS: The selected primary treatment was hepatic resection for 53.7% of the cases, TAE for 31.5%, PEIT for 8.2% and RC for 6.6%,. The treatment for post-resection recurrence was TAE alone for 62.4% of the cases, TAE + RC for 4.0%, PEIT for 15.2%, TAE + PEIT alone for 4.8%, RC for 8.0% and hepatic resection for 5.6%. The treatment for post-TAE recurrence was TAE alone for 83% of the cases, TAE + PEIT for 9%, TAE + RC for 3%, RC alone for 3% and PEIT alone for 2%. For post-PEIT, therapy was PEIT alone for 71.4% of the cases and PEIT + TAE for 28.6%. For post-RC, RC alone was used for 92.5% and RC + PEIT for 7.5%. The cumulative 3 and 5-year survival rates were 84.4% and 70.6%, respectively for stage I; 61.5% and 48.6% for stage II; 52.7% and 20.5% for stage III; and 22.8% and 17.1% for stage IVA. The cumulative 5 and 7-year survival rates after the primary treatments were 52.% and 40.1%, respectively, for hepatic resection; 46.5% and 38.7%, for TAE; 49.6% and 33.1% for PEIT; and 16.7% and 8.3% for RC. CONCLUSIONS: To improve the treatment results for HCC, early detection is essential and various modalities of treatments in combination should be used for recurrence after primary treatment.     

Fast neutron irradiation of metastatic cervical adenopathy: the results of a randomized RTOG study

Between 1977 and 1982, 199 evaluable patients with measurable cervical adenopathy were entered on a prospective, randomized RTOG study evaluating the use of fast neutrons in treatment of advanced, inoperable squamous cell carcinomas of the head and neck region. One hundred-eleven patients were randomized to receive mixed beam radiation therapy, and 88 were randomized to the photon control treatment. The complete response rates were 86% for mixed beam vs 75% for photons for Stage N1 nodes, 62% for mixed beam vs 48% for photons for Stage N2 nodes, and 63% for mixed beam vs 53% for photons for N3 nodes. The percents of patients remaining free of their adenopathy for two years were 78% for mixed beam vs 55% for photons for Stage N1 nodes, 39% for both mixed beam and photons for N2 nodes and 24% for mixed beam vs 13% for photons for N3 nodes. The median disease-free status was 20.3 months for mixed beam treated patients and 6.4 months for photon-treated patients. Patients who had clearance of cervical adenopathy survived significantly longer than those who did not.     

Salvage reirradiation for local prostate cancer recurrence after radiation therapy. For who? When? How?

PurposeLiterature review reporting results of salvage brachytherapy and stereotactic body radiotherapy for prostate recurrence only after radiotherapy for prostate cancer.Materials and methodsA total of 38 studies (including at least 15 patients per study) were analysed: 19 using low-dose-rate brachytherapy, nine high-dose-rate brachytherapy and ten stereotactic body radiotherapy. Only five studies were prospective. The median numbers of patients were 30 for low-dose-rate brachytherapy, 34 for high-dose-rate brachytherapy, and 30 for stereotactic body radiotherapy. The median follow-up were 47 months for low-dose-rate brachytherapy, 36 months for high-dose-rate brachytherapy and 21 months for stereotactic body radiotherapy.ResultsLate genitourinary toxicity rates ranged, for grade 2: from 4 to 42% for low-dose-rate brachytherapy, from 7 to 54% for high-dose-rate brachytherapy and from 3 to 20% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 24% for low-dose-rate brachytherapy, from 0 to 13% for high-dose-rate brachytherapy and from 0 to 3% for grade 3 or above (except 12% in one study) for stereotactic body radiotherapy. Late gastrointestinal toxicity rates ranged, for grade 2: from 0 to 6% for low-dose-rate brachytherapy, from 0 to 14% for high-dose-rate brachytherapy and from 0 to 11% for stereotactic body radiotherapy, and for grade 3 or above: from 0 to 6% for low-dose-rate brachytherapy, and from 0 to 1% for high-dose-rate brachytherapy and stereotactic body radiotherapy. The 5-year biochemical disease-free survival rates ranged from 20 to 77% for low-dose-rate brachytherapy and from 51 to 68% for high-dose-rate brachytherapy. The 2- and 3-year disease-free survival rates ranged from 40 to 82% for stereotactic body radiotherapy. Prognostic factors of biochemical recurrence have been identified.ConclusionDespite a lack of prospective data, salvage reirradiation for prostate cancer recurrence can be proposed to highly selected patients and tumours. Prospective comparative studies are needed.     

Study of acute 60Co, low dose rate CF-252 and CS-137 radiation on LSA ascites lymphoma in vivo

Dose response curves were determined for the LSA lymphoma for acute 60Co, low dose rate Cs-137 and Cf-252 radiations using in vivo survival time bioassay. Mean survival times increased with dose with a prominent oxygen effect noted for acute 60Co and Cs-137. OER was lowest for Cf-252 where it was approximately 1.4. The RBEn for oxic LSA cells to Cf-252 neutrons was 3.1 for acute 60Co and 4.2 for Cs-137. It was larger for hypoxic tumor and RBE was 5.3 for 60Co and 5.8 for Cs-137. Survival curves based on survival data used a multitarget dose-response model for photon radiation and exponential dose-response for Cf-252 radiation. When LSA was irradiated in advanced tumor stages in vivo, Cf-252 was much more effective than acute 60Co or LDR Cs-137 for increasing survival time. Tumor response in vivo matched the in vitro irradiated tumor data. No schedule dependence was observed for mixing of 60Co and Cf-252 radiations.     

A radiotherapeutic experience for localized extranodal non-Hodgkin's lymphoma: prognostic factors and re-evaluation of treatment modality

Between 1966 and 1988, 149 patients were treated with radiotherapy for localized extranodal lymphoma. The average total dose given was 39.8 Gy for low grade disease and 48.7 Gy for all other disease. Of the 149 patients, 60 also received adjuvant chemotherapy. Twenty-four had low grade lymphoma, 109 had intermediate grade disease, and 16 had high grade disease, histologically. The distribution of histological grade and T/B phenotype varied with the primary site. Low grade lymphomas were found mainly in the orbit, and T-cell lymphomas were found in the nasal cavity and nasopharynx. The 5-year survival rates according to tumor location were 89% for oral cavity, 86% for paranasal sinus, 83% for thyroid, 69% for orbit, 47% for Waldeyer's ring (WAR), 44% for testis, 23% for CNS, 21% for nasal cavity and 60% for other sites. Histological grade and T/B phenotype both had prognostic importance. Combined chemotherapy significantly improved the survival rate only for disease with intermediate or high grade histology. Other prognostic factors according to the primary site were the bulk of lymph node for WAR disease, the radiation dose for CNS disease, bone erosion for orbital disease, stridor for disease of the thyroid, and the tumor stage for disease of both the testis and the thyroid.     

RBE for lung and cord

The sparing effect of fractionation of neutron dose is very small for late damage in tissues. This is seen in the almost flat isoeffect curve for damage to skin, CNS and to lung. This means that differences in the RBE curves for these tissues are determined by differences in the slopes of the photon isoeffect curves. The relevant slopes of the photon isoeffect curves giving the exponent of N in the Ellis formula are 0.24 for subcutaneous tissue, 0.27 for lung damage and 0.38–0.45 for damage to spinal cord, while the exponent for N for neutrons for these tissues is 0.04 for subcutaneous tissues and zero for lung and spinal cord. The slopes of the RBE curves for lung and cord or for skin and cord when RBE is plotted against dose/fraction of photons are significantly different, and the RBE at a γ ray dose/fraction normally used in therapy of about 2 Gy, is significantly higher for spinal cord than for lung or skin. The sparing of damage by extending overall treatment time for both lung and CNS is small for X or γ-irradiation. For neutron irradiation the sparing is similar to that with photons for the CNS but is much less with neutrons than with photons for the lung. This is because different mechanisms are responsible for this type of sparing of damage in the two tissues. In lung slow, repair is involved while in the spinal cord, the sparing is related to the slow cell proliferation.     

Childhood cancer epidemiology in New Mexico's American Indians, Hispanic whites, and non-Hispanic whites, 1970-82

The statewide population-based New Mexico Tumor Registry identified 473 malignant tumors among children of ages 0-14 years, during the period 1970-82. There were 235 non-Hispanic whites (50%), 189 Hispanic whites (40%), 38 American Indians (8%), and 11 other nonwhites (2%). The average annual age-adjusted incidence rates per million for non-Hispanic whites were 138.6 for males and 108.3 for females; for Hispanic whites, the rates were 108.5 for males and 80.9 for females; for American Indians, the rates were 75.5 for males and 78.0 for females. The incidence rates for all sites of cancer combined were lower for Hispanics and American Indians than for New Mexico's non-Hispanic whites and U.S. whites. Leukemia was the most common cancer in all racial-ethnic groups. In comparison with U.S. whites, American Indians were at low risk for leukemias, lymphomas, central nervous system (CNS), sympathetic nervous system (SNS), and kidney tumors and were at high risk for retinoblastoma, bone, and sex organ tumors. Hispanics were at low risk for CNS, SNS, kidney, sex organ, and liver tumors. Hispanic and non-Hispanic white males both were at increased risk for melanoma.     

Skin cancer and non-Hodgkin's lymphoma as second malignancies. markers of impaired immune function?

Successes in cancer therapy have led to increasing numbers of cancer survivors, who are at risk of developing second primary cancers. Therapy- or disease-induced suppression of the immune function may predispose cancer patients to a second malignancy. An excess of squamous cell skin cancers (SCC) and non-Hodgkin's lymphomas has been found in immunosuppressed patients. We used the nationwide Swedish Family-Cancer Database on 10.2 million individuals to calculate the risk of second primary skin cancers and non-Hodgkin's lymphomas following a previous malignancy. A total of 4301 second skin cancers and 1672 non-Hodgkin's lymphomas were identified. Standardised incidence ratios (SIR)s and 95% Confidence Intervals (CIs) were calculated and compared. Among 14 different sites for male or female first primary malignancies, 11 of these sites were followed by an increased risk of skin cancer (SIRs for males for risk of skin cancer as a second primary cancer: 14.1 for SCC; 9.7 for melanoma; 6.1 for leukaemia as the first site; SIRs for females for risk of skin cancer: 14.6 for SCC; 6.8 for larynx; 6.2 for upper aerodigestive tract (UADT) as the first site). The risk of non-Hodgkin's lymphoma was increased after 10 of 14 different male neoplasms and 12 of 17 different female neoplasms. (SIRs for males for risk of non-Hodgkin's lymphoma as a second primary cancer: 6.4 for non-Hodgkin's lymphoma; 3.2 for leukaemias; 3.1 for multiple myeloma as the first site; SIRs for females for risk of non-Hodgkin's lymphoma as a second primary cancer: 12.5 for leukaemias; 7.0 for Hodgkin's disease; 3.6 for UADT as the first site). The high, and after certain sites, very high risks of second skin cancer and non-Hodgkin's lymphoma suggest that immune suppression may be a contributory mechanism.     

乳腺导管原位癌的诊断和治疗--附371例报道

对371例乳腺导管原位癌(ductal carcinoma in situ,DCIS)患者的临床资料进行回顾性分析,结果钼靶、B超、乳头溢液涂片、乳管内视镜、针吸活检、空心针活检以及冰冻病理检查的诊断阳性率分别为86.5%(302/349)、58.4%(208/356)、43.8%(89/203)、92.0%(23/25)、80.0%(18/23)、91.0%(10/11)和90.0%(287/319).治疗方式仍以乳房切除术为主.全组局部复发率1.9%(4/205),5、10年生存率分别为100.0%(106/106)、94.0%(32/34).初步研究结果提示,钼靶、乳管内视镜、空心针活检诊断价值较高,治疗上可依据Van Nuys预后指数(van nuys prog-nostic index,VNPI)采用不同手术方式.     

Chemosensitivity testing of anticancer agents in head and neck tumors. I: Comparison between head and neck squamous cell cancers and thyroid cancers

In vitro chemosensitivity was evaluated in 28 patients with head and neck squamous cell carcinomas (12 pharyngeal cancers, 7 oral cavity cancers, 4 laryngeal cancers, 4 maxillary sinus cancers and 1 esophageal cancer) and 19 patients with thyroid cancer. Tumor fragments obtained at biopsy or surgery were exposed to anticancer drugs and assayed for succinate dehydrogenase (SD) activity. The average of SD activity in squamous cell carcinomas was 63.2% for 5-FU, 24.6% for HCFU, 26.1% for CDDP, 41.0% for ADM, 28.4% for THP-ADM, 27.1% for ACR, 27.4% for CQ and 45.3% for VLB. In thyroid cancers, the average SD activity was 73.9% for 5-FU, 16.7% for HCFU, 32.6% for CDDP, 48.3% for ADM, 38.3% for THP-ADM, 57.3% for ACR, 39.0% for CQ and 75.3% for VLB. The SD activity inhibition rate by anticancer drugs was larger in cases of head and neck squamous cell carcinomas than in cases of thyroid cancers except for HCFU. Higher sensitivity to each antitumor drug detected in cancer tissues from metastatic lymph-nodes than in tissues from primary lesions needs further investigation.     

Trends in survival for childhood cancer in Britain diagnosed 1971-85

Survival rates were analysed for a population-based series of over 15,000 childhood cancers registered in Great Britain during 1971-85. There were highly significant improvements (P less than 0.001 for trend) in survival for many major diagnostic groups. Between 1971-73 and 1983-85 the actuarial 5-year survival rates increased from 37% to 70% for acute lymphoblastic leukaemia, from 4% to 26% for acute non-lymphoblastic leukaemia, from 76% to 88% for Hodgkin's disease, from 22% to 70% for non-Hodgkin's lymphoma, from 61% to 72% for astrocytoma, from 24% to 42% for medulloblastoma, from 15% to 43% for neuroblastoma, from 58% to 79% for Wilms' tumour, from 17% to 54% for osteosarcoma, from 26% to 61% for rhabdomyosarcoma, from 59% to 94% for malignant testicular germ-cell tumours and from 43% to 77% for malignant ovarian germ-cell tumours. These increases in population-based survival rates reflect the substantial advances in treatment of a wide range of childhood cancers since 1970. The two principal diagnostic groups for which there was no evidence of any trend were retinoblastoma, which already had an excellent prognosis with a 5-year survival rate of over 85%, and Ewing's sarcoma, for which the survival rate remained below 45%.     

On the role of aging in cancer incidence: analysis of the skin cancer data

Worldwide age-incidence patterns for melanoma, non-melanoma skin cancer, and the group of all cancers except non-melanoma skin cancer from 1971 to 1976 were normalized for differences in frequency of occurrence and compared. The percentage of total cancer incidence that occurred in young subjects was greater for melanoma and less for non-melanoma skin cancer than for the group of all cancers. The risk for melanoma was apparent by age 15, much earlier than for non-melanoma skin cancer and the group of all cancers. While the risk for non-melanoma skin cancer and the group of all cancers increased continuously with advancing age, the risk for melanoma was constant beyond age 35. We conclude that risk for melanoma is unusually concentrated among the young, and, therefore, that protection from sun exposure is particularly important for this group.     

Reliability and validity of a questionnaire to measure colorectal cancer screening behaviors: does mode of survey administration matter?

Valid and reliable self-report measures of cancer screening behaviors are important for evaluating efforts to improve adherence to guidelines. We evaluated test-retest reliability and validity of self-report of the fecal occult blood test (FOBT), sigmoidoscopy (SIG), colonoscopy (COL), and barium enema (BE) using the National Cancer Institute colorectal cancer screening (CRCS) questionnaire. A secondary objective was to evaluate reliability and validity by mail, telephone, and face-to-face survey administration modes. Consenting men and women, 51 to 74 years old, receiving care at a multispecialty clinic for at least 5 years who had not been diagnosed with colorectal cancer were stratified by prior CRCS status and randomized to survey mode (n = 857). Within survey mode, respondents were randomized to complete a second survey at 2 weeks, 3 months, or 6 months. Comparing self-report with administrative and medical records, concordance estimates were 0.91 for COL, 0.85 for FOBT, 0.85 for SIG, and 0.92 for BE. Overall sensitivity estimates were 0.91 for COL, 0.82 for FOBT, 0.76 for SIG, and 0.56 for BE. Specificity estimates were 0.91 for COL, 0.86 for FOBT, 0.89 for SIG, and 0.97 for BE. Sensitivity and specificity varied little by survey mode for any test. Report-to-records ratio showed overreporting for SIG (1.1), COL (1.15), and FOBT (1.57), and underreporting for BE (0.82). Reliability at all time intervals was highest for COL; there was no consistent pattern according to survey mode. This study provides evidence to support the use of the National Cancer Institute CRCS questionnaire to assess self-report with any of the three survey modes.     

抚顺、盘锦两市城乡宫颈癌及宫颈上皮内瘤变的现患率调查及危险因素分析

[目的]探讨辽宁省抚顺、盘锦两市城乡宫颈癌及宫颈上皮内瘤变（CIN）的现患率,并对相关的危险因素进行分析。[方法]采用随机抽样的方法确定研究对象,并进行流行病学问卷调查,液基细胞学检查及阴道镜检查。如阴道镜下可疑病变则行活检。[结果]抚顺市宫颈癌及CIN的患病率为宫颈癌0.17%,CIN5.84%,CINⅡ-Ⅲ2.17%,抚顺农村为CIN2.83%,CINⅡ-Ⅲ0.67%;盘锦市CIN2.83%,CINⅡ-Ⅲ0.5%,盘锦农村CIN1.87%,CINⅡ-Ⅲ0.51%。抚顺市的患病率在四个筛查地点中明显居高。城市的患病率（宫颈癌0.08%,CIN4.34%,CINⅡ-Ⅲ1.33%）均高于农村（CIN2.35%,CINⅡ-Ⅲ0.59%）。CIN发病的高峰年龄在30-34岁和45-49岁,高峰职业在工厂手工业者。吸烟、初次性生活年龄小于21岁是CINⅡ-Ⅲ发生的高危因素。而教育程度、自然流产、人工流产、性伴侣的婚外性伴侣、生产史和避孕措施显示出不具有统计学意义。[结论]辽宁省抚顺市区的宫颈癌及CIN的患病率明显高于抚顺农村和盘锦市及农村,且高于沈阳市区,提醒我们应重点预防。吸烟、过早的性生活是我们应预防的高危因素。     

Basic dosimetric verification in water of the anisotropic analytical algorithm for Varian, Elekta and Siemens linacs

Since early 2007 a new version of the Anisotropic Analytical Algorithm (AAA) for photon dose calculations was released by Varian Medical Systems for clinical usage on Elekta linacs and also, with some restrictions, for Siemens linacs. Basic validation studies were performed and reported for three beams. 4,6 and 15 MV for an Elekta Synergy, 6 and 15 MV for a Siemens Primus and, as a reference, for 6 and 15 MV from a Varian Clinac 2100C/D. Generally AAA calculations reproduced well measured data and small deviations were observed for open and wedged fields. PDD curves showed in average differences between calculation and measurement smaller than 1% or 1.2 mm for Elekta beams, 1% or 1.8 mm for Siemens beams and 1% or 1 mm for Varian beams. Profiles in the flattened region matched measurements with deviations smaller than 1% for Elekta and Varian beams, 2% for Siemens. Percentage differences in Output Factors were observed as small as 1% in average.     

Differences in outcome for positive margins in a large cohort of breast cancer patients treated with breast-conserving therapy

A study of the possible difference in outcome for positive margins for invasive carcinoma (IC) versus ductal carcinoma in situ (DCIS), and with regard to different age categories in a large prospective cohort of patients with invasive breast cancer. A total of 2 291 BCT were analyzed. Margins were positive for IC in 8.7% and for DCIS in 4.6%. The median follow-up was 83 months. The 10-year local recurrence-free survival for negative margins vs. positive margins for IC vs. positive for DCIS for women < or = 40 years were 84.4% vs. 34.6% (HR 4.5) vs. 67.5%, and for women >40 years 94.7% vs. 92.6% vs. 82.6% (HR4.2). The 10-year distant disease-free survival for negative margins vs. positive margins for IC vs. positive for DCIS women < or = 40 years were 72.0% vs. 39.7% (HR 3.4) vs. 77.8%. The disease-specific survival showed a significant relation to positive margins for IC in young women. The effect of positive margin for IC seems to be limited to young women only, and is not only restricted to local control, but also to distant metastasis and survival. On the other hand a positive margin for DCIS is a risk factor for local control in women >40 years.     

Recent results in the surgical treatment of gastric cancer according to the Japanese and TNM classification

BACKGROUND: Recent outcomes based on surgical long-term follow-up of patients with gastric cancer using current staging systems have not been fully evaluated. MATERIALS AND METHODS: A total of 1357 patients with primary gastric carcinoma (911 males and 446 females, ranging in age from 20 to 87 years; average 59.1 years) who had undergone gastric resection between 1986 and 1996 were examined with respect to their clinicopathological features, surgical procedures and patient survival according to Japanese and UICC-TNM classifications. RESULTS: The 5-year survival rate was 95.3% for stage Ia, 85.5% for stage Ib, 73.8% for stage II, 45.7% for stage IIIa, 20.9% for stage IIIb, 17.3% for stage IVa and 5.8% for stage IVb (8.8% for IVa and IVb) on the Japanese classification. By way of contrast, the 5-year survival rate was 95.6% for stage Ia, 85.0% for stage Ib, 72.1% for stage II, 49.3% for stage IIIa, 30.2% for stage IIIb and 12.0% for stage IV on the TNM classification. CONCLUSION: Although minor problems are associated with both the Japanese and TNM classification systems, both appear to be clinically significant and appropriate independent predictors of prognosis. The findings of the present study provide important information for comparing results among different institutes and for introducing new clinical trials for gastric cancer at the beginning of the new century.     

Clinical trial of MCNU for malignant brain tumors

A total of 71 cases with primary brain tumors (44 cases) and metastatic brain tumors (30 cases) were entered into our clinical studies with MCNU and radiation therapy or MCNU alone. With regard to tumor reduction on CT scan, the response rates obtained for MCNU and radiation were 21.7% for malignant gliomas and 50.0% for metastatic brain tumors. With regard to improvement of neurological signs, the response rates obtained for MCNU and radiation were 62.9% for malignant gliomas and 71.4% for metastatic brain tumors. The response rates for MCNU were 5.8% for malignant gliomas and 46.1% for metastatic brain tumors. In the improvement of performance status, the response rates for MCNU and radiation were 51.8% for malignant gliomas and 64.2% for metastatic brain tumors. The response rates for MCNU were 46.1% for malignant gliomas and 30.7% for metastatic brain tumors. A minimal degree of hematological toxicity occurred but this gradually disappeared. These results suggested that MCNU has relatively effective antitumor activity against metastatic brain tumors and an enhanced effect with radiation against malignant gliomas.     

Differences in Cancer Mortality Trends between Metropolitan and Non-Metropolitan Areas in Japan, 1999–2018

Background: Although socioeconomic statuses affect cancer mortality rates, the specific difference between metropolitan and non-metropolitan areas in Japan has not been evaluated. This study analyzed differences in cancer mortality between metropolitan and non-metropolitan areas in Japan, using an age-period-cohort (APC) analysis. Methods: Data on cancer mortality from 1999 to 2018 for metropolitan and non-metropolitan areas in Japan were used. Here metropolitan areas were defined as government ordinance-designated municipalities in 1999 and special wards of Tokyo. In addition to general mortality data for all cancer sites, data on mortality for stomach, colorectal, liver, gallbladder, pancreatic, lung, prostate, and breast cancers were used for analysis. A Bayesian APC analysis was administered to the data for each type of cancer for area and for sex-distinguished data. Additionally, the ratios for estimated mortality rate by periods and cohorts between the two areas were calculated. Results: The age-standardized mortality rate for cancer in all sites in non-metropolitan areas was lower than that in metropolitan areas throughout the analyzed years for both men and women, but the mortality difference decreased during the periods for men. The rates of decrease in mortality rate in cohorts differed for some cancers between the two area types, and the mortality rate ratios of metropolitan compared with non-metropolitan areas decreased for cancer in all sites over the analyzed cohorts for men. Also, the rate of decrease in mortality rate over the cohorts was completely different between the areas for stomach cancer in men and for liver cancer for women. Conclusion: Mortality rates for cancer in all sites tended to diverge between the two area types in younger cohorts for men, and people in younger cohorts in non-metropolitan areas should take more extensive preventive measures against cancer than their counterparts in metropolitan areas.     

Validation of self-reported colorectal cancer screening behavior from a mixed-mode survey of veterans.

OBJECTIVE: The aim of the study was to validate self-reported colorectal cancer (CRC) screening using the National Cancer Institute Colorectal Cancer Screening questionnaire. MATERIALS AND METHODS: 890 patients, ages 50 to 75 years, from the Minneapolis Veterans Affairs (VA) Medical Center were surveyed by mail. Phone administration was attempted with mail nonresponders. VA and non-VA records were combined for the reference standard. Sensitivity, specificity, concordance, and report-to-records ratio (R2R) were estimated for overall and test-specific CRC adherence among respondents providing complete medical records. Secondary analyses examined variation in estimates by patient characteristics, treatment of missing and uncertain responses, and whether a strict or liberal time interval was used for assessing concordance. RESULTS: Complete medical records were available for 345 of the 686 survey responders. For overall adherence, sensitivity was 0.98, specificity was 0.59, concordance was 0.88, and R2R was 1.14. Sensitivity was 0.82 for fecal occult blood test (FOBT), 0.75 for sigmoidoscopy, 0.97 for colonoscopy, and 0.63 for double-contrast barium enema (DCBE). Specificity was 0.89 for FOBT, 0.76 for sigmoidoscopy, 0.72 for colonoscopy, and 0.85 for DCBE. Concordance was >0.80 for all tests other than sigmoidoscopy (0.76). R2R was 1.31 for FOBT, 1.33 for sigmoidoscopy, 1.42 for colonoscopy, and 6.13 for DCBE. The R2R was lower for a combined sigmoidoscopy and colonoscopy measure. Overreporting was more pronounced for older, less-educated individuals with no family history of CRC. Sensitivity and R2R improved using a liberal interval and treating uncertain responses as nonadherent (versus missing), but differences were not statistically significant. CONCLUSIONS: Self-reported CRC screening validity is generally acceptable and robust across definitional decisions, but varies by screening test and patient characteristics.