Anal cancer: ESMO–ESSO–ESTRO clinical practice guidelines for diagnosis,treatment and follow-up

Squamous cell carcinoma of the anus (SCCA) is a rare cancer but its incidence is increasing throughout the world, and is particularly high in the human immunodeficiency virus positive (HIV+) population. A multidisciplinary approach is mandatory (involving radiation therapists, medical oncologists, surgeons, radiologists and pathologists). SCCA usually spreads in a loco-regional manner within and outside the anal canal. Lymph node involvement at diagnosis is observed in 30–40% of cases while systemic spread is uncommon with distant extrapelvic metastases recorded in 5–8% at onset, and rates of metastatic progression after primary treatment between 10% and 20%. SCCA is strongly associated with human papilloma virus (HPV, types 16–18) infection. The primary aim of treatment is to achieve cure with loco-regional control and preservation of anal function, with the best possible quality of life. Treatment dramatically differs from adenocarcinomas of the lower rectum. Combinations of 5FU-based chemoradiation and other cytotoxic agents (mitomycin C) have been established as the standard of care, leading to complete tumour regression in 80–90% of patients with locoregional failures in the region of 15%. There is an accepted role for surgical salvage. Assessment and treatment should be carried out in specialised centres treating a high number of patients as early as possible in the clinical diagnosis. To date, the limited evidence from only 6 randomised trials [[1], [2], [3], [4], [6] and [7]], the rarity of the cancer, and the different behaviour/natural history depending on the predominant site of origin, (the anal margin, anal canal or above the dentate line) provide scanty direction for any individual oncologist. Here we aim to provide guidelines which can assist medical, radiation and surgical oncologists in the practical management of this unusual cancer.     

ESTRO/CSRO临床放射生物学习班成功举办

由欧洲放射肿瘤学会、中华医学会放射肿瘤学会(放射生物专业组)主办,中国医学科学院肿瘤医院承办,2007年6月3～7日在北京天坛饭店成功举办了"临床放射生物学学习班(ESTRO/CSRO Basic clinical radiobiology course)"。此次学习班主要针对临床放疗医生提高临床放射生物学基础知识进行培训,授课教授来自欧美各大研究机构及著名大学,包括Prof. A van der Kogel, Prof. B Wouters, Prof. M Joiner, Prof. M Verheij, Prof. V Gregorie, Prof. W Dorr。所有教师均具有丰富扎实的研究和     

Prevalence of Cancer Visits by Physician Specialty, 1997–2006

Understanding the prevalence of cancer-related visits by physician specialty may help target educational and quality improvement initiatives. Using the 1997–2006 National Ambulatory Medical Care Survey, adult ambulatory visits (N = 161,278) were classified by cancer diagnosis and patients’ characteristics and compared with physician specialty. The prevalence of cancer visits within each specialty varied from 0% to 62%. Aside from hematology/oncology (hem/onc) specialties, nine surgical specialties and four medical specialties had more than 1% cancer visits. Cancer patients with private insurance or Medicaid coverage were less likely to see hem/onc specialists compared to Medicare patients. Whereas hem/onc specialists primarily see cancer patients, general surgeons and primary care physicians provide a large amount of cancer services, particularly to underinsured patients. Thus, when trying to contact cancer patients or their physicians, health administrators, researchers, and practitioners should consider targeting general surgeons and primary care physicians in addition to hem/onc specialists.     

Residential Traffic Density and Cancer Incidence in Amsterdam, 1989–1997

OBJECTIVE: To examine the association between cancer incidence in 1989-1997 in Amsterdam and residential traffic intensity. METHODS: We linked data on the daily traffic intensity for individual addresses along the main roads with the population-based regional cancer registry. Information on smoking habits was derived from a smoking survey. RESULTS: During 1989-1997, 27,157 cancer cases were diagnosed in Amsterdam residents. Using the age group- and sex-specific cancer incidence in the population not residing along the main roads as a reference, the standardized incidence ratio (SIR) of the population residing along the main roads was 1.03, (3384 cases), while the 95% confidence interval (CI) included unity (1.00-1.07). For most cancer sites the SIR was close to one, except for gastrointestinal cancer in males (SIR 1.16, CI: 1.04, 1.28), cancer of the respiratory tract in females (SIR 1.13, CI: 0.97, 1.31) and hematological malignancies in adult females (SIR 1.23, CI: 1.04, 1.44). Five cases of acute lymphocytic leukemia were diagnosed in children along the main roads (SIR 2.5, CI: 0.8, 5.9). Smoking habits did not differ between residents along the main roads and those living along other roads. CONCLUSIONS: We found no clear evidence for an association between residence along main roads and the incidence of cancer in adults, but we cannot exclude an association with hematological malignancies in females and children.     

Regional variations in breast cancer incidence among California women, 1988–1997

Background: Internationally, California has some of the highest breast cancer rates; these rates also show substantial regional variations within the state. This study describes geographic breast cancer incidence patterns within California and evaluates the degree to which socioeconomic status (SES) and urbanization explain the regional variability.Methods: Invasive breast cancer cases in women 20 year of age were identified from the California Cancer Registry, for 1988–1997, then assigned to one of three regions (San Francisco Bay Area, Southern Coastal Area and the rest of California), based on residence at diagnosis. Neighborhood SES and urbanization were derived from U.S. Census data. Rate ratios (RR) and 95% confidence intervals (CI) were computed using Poisson regression. Analyses were conducted for all invasive breast cancer cases (n=176,302) and by selected histologic subtypes: ductal (n=121,619); lobular (n=13,410); mixed ductal and lobular (n=9744).Results: Compared to block groups with the lowest quartile of SES, rates were highest in block groups with high SES. Rates also were higher in suburban and city areas than in small town/rural areas. Compared to the rest of California, age- and race-adjusted rates for all breast cancer were approximately 20% higher in the San Francisco Bay Area and 10% higher in the Southern Coastal Area. After adjusting for SES and urbanization the rate ratios were reduced to near unity (RR=1.06, 95% CI: 1.03–1.09 for San Francisco Bay Area; RR=1.02, 95% CI: 0.99–1.04 for Southern Coastal Area). Rates ratios for ductal carcinomas mirrored those for all cases. For lobular cases, rate ratios remained elevated after adjustment for age, race/ethnicity, neighborhood SES and urbanization (RR=1.18, 95% CI: 1.11–1.27 for San Francisco Bay Area; RR=1.10, 95% CI: 1.04–1.17 for Southern Coastal Area). For the subset of cases with mixed ductal and lobular histologies, the rate ratio for the San Francisco Bay Area was no longer elevated after adjusting for age, race/ethnicity, SES and urbanization (RR=0.92, 95% CI: 0.84–1.01); the adjusted rate ratio for the Southern Coastal Area, however, remained elevated (RR=1.22, 95% CI: 1.12–1.32).Conclusions: Regional differences in neighborhood SES and urbanization appear to largely explain regional rate differences in California for all breast cancers and ductal carcinomas but do not fully explain geographic patterns of breast cancer with a lobular component.