Does skin cancer screening save lives?

BACKGROUND:

From July 1, 2003 to June 30, 2004, a population‐based skin cancer screening project was conducted in Schleswig‐Holstein, Germany. In total, 360,288 individuals aged ≥20 years were screened by means of a whole‐body examination. In this report, the authors compare trends in melanoma mortality in Schleswig‐Holstein with those in all adjacent regions, none of which had population‐based skin cancer screening.

METHODS:

Trends in melanoma mortality rates for Schleswig‐Holstein and the adjacent regions (Denmark and the German federal states of Mecklenburg‐Vorpommern, Hamburg, and Lower Saxony) and in Germany excluding Schleswig‐Holstein were compared. Log‐linear regression was used to assess mortality trends.

RESULTS:

In Schleswig‐Holstein during the pre skin cancer screening period (1998‐1999), the age‐standardized melanoma mortality rate (World standard population) was 1.9 per 100,000 for men and 1.4 per 100,000 for women. Melanoma mortality declined by 47% to 1.0 per 100,000 men and by 49% to 0.7 per 100,000 women by 2008/2009. The annual percentage change in the most recent 10‐year period (2000‐2009) was ?7.5% (95% confidence interval, ?14.0, ?0.5) for men and ?7.1% (95% confidence interval, ?10.5, ?2.9) for women. In each of the 4 adjacent regions and in the rest of Germany, mortality rates were stable, and the decline in Schleswig‐Holstein was significantly different from the changes observed in all of the other areas studied.

CONCLUSIONS:

The current data represent strong evidence, but not absolute proof, that the skin cancer screening program produced a reduction in melanoma mortality in Schleswig‐Holstein. Cancer 2012. © 2012 American Cancer Society.     

Does pizza protect against cancer?

We analyzed the potential role of pizza on cancer risk, using data from an integrated network of case-control studies conducted in Italy between 1991 and 2000. Cancer sites were: oral cavity and pharynx (598 cases), esophagus (304 cases), larynx (460 cases), colon (1,225 cases) and rectum (728 cases). Controls were 4,999 patients admitted for acute, non-neoplastic conditions to the same hospital network as cases. Odds ratios for regular pizza consumers were 0.66 (95% confidence interval, CI = 0.47-0.93) for oral and pharyngeal cancer, 0.41 (95% CI = 0.25-0.69) for oesophageal, 0.82 (95% CI = 0.56-1.19) for laryngeal, 0.74 (95% CI = 0.61-0.89) for colon and 0.93 (95% CI = 0.75-1.17) for rectal cancer. Pizza appears therefore to be a favorable indicator of risk for digestive tract neoplasms in this population.     

Can diet prevent nonmelanoma skin cancer progression?

Nonmelanoma skin cancer is the most prevalent malignant disease among light-skinned individuals in the USA, accounting for approximately 1 million new cases annually. Solar ultraviolet radiation is known to be the major cause of skin cancer. The idea that diet, particularly dietary fat, may play a role in modulating cancer incidence has been based largely upon indirect epidemiologic evidence. However, few studies have found correlations of dietary fat intake with skin cancer incidence. Nevertheless, a large body of evidence with experimental animals and one clinical intervention trial, the latter avoiding the pitfalls of many epidemiologic investigations, clearly demonstrate that the level of dietary fat intake can have a significant influence on the occurrence of skin cancer in individuals at high risk.     

Does increased urination frequency protect against bladder cancer?

Experimental studies suggest that increased urination frequency may reduce bladder cancer risk if carcinogens are present in the urine. Only 2 small studies of the effect of increased urination frequency on bladder cancer risk in humans have been conducted with conflicting results. Our purpose was to evaluate the effect of urination frequency on risk of bladder cancer in a large, multicenter case-control study. We analyzed data based on interviews conducted with 884 patients with newly diagnosed, bladder cancer and 996 controls from 1998 to 2001 in Spain. We observed a consistent, inverse trend in risk with increasing nighttime voiding frequency in both men (p = 0.0003) and women (p = 0.07); voiding at least 2 times per night was associated with a significant, 40-50% risk reduction. The protective effect of nocturia was apparent among study participants with low, moderate and high water consumption. The risk associated with cigarette smoking was reduced by nocturia. Compared with nonsmokers who did not urinate at night, current smokers who did not urinate at night had an OR of 7.0 (95% CI = 4.7-10.2), whereas those who voided at least twice per night had an OR of 3.3 (95% CI = 1.9-5.8) (p value for trend = 0.0005). Our findings suggest a strong protective effect of nocturia on bladder cancer risk, providing evidence in humans that bladder cancer risk is related to the contact time of the urothelium with carcinogens in urine. Increased urination frequency, coupled with possible dilution of the urine from increased water intake, may diminish the effect of urinary carcinogens on bladder cancer risk.     

Non-melanoma skin cancer: what drives tumor development and progression?

Non-melanoma skin cancer, i.e. basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most frequent tumors and their number is still increasing worldwide. Furthermore, immunosuppression in organ transplant patients strongly contributes to the increase in skin cancer incidence--being 65-250 times more frequent than in the general population. Often these patients suffer from a second and third lesion and the severity of these tumors is linked to their number. SCCs in transplant recipients also appear to be more aggressive. They tend to grow rapidly, show a higher rate of local recurrences and metastasize in 5-8% of the patients (all reviewed in Ref. 2). This largely differs from BCCs which are more frequent in the general population--at a ratio of 4:1 as compared with SCCs--but the number is only increased by a factor of 10 in transplant recipients. This may suggest that 'dormant' SCC precursor cells/lesions are present at a high frequency in the population but they are well controlled by the immune system. BCC, on the other hand, may be less dependent on immune surveillance thereby underlining its different etiology. While for BCC development the genetic hallmark is abrogation of the ptch-sonic hedgehog pathway, little is known about the causal alterations of SCCs. However, the complexity of the genetic alterations (numerical and structural aberration profiles) in SCCs argues for several levels of genomic instability involved in the generation and progression of skin cancer.     

Micrometastases in thyroid cancer. An important finding?

Differentiated thyroid cancer is a cancer with a good prognosis but the presence of lymph node metastases is associated with increased rates of loco-regional recurrence and in some reports decreased survival. This has led to an increased interest in the lymph node status with guidelines calling for routine central node dissection and increased interest in lateral compartment node sampling and sentinel node biopsy. We know from studies in regions where routine central and ipsilateral node dissection is the preferred surgical management of differentiated thyroid cancer that lymph node metastases are present in the majority of cases and that many of these are micrometastatic deposits. However, where routine node dissection is not performed recurrence rates are relatively low suggesting that not all micrometastatic disease progresses to a loco-regional recurrence or that the majority of disease is mopped up by adjuvant radioactive iodine. This review examines the available evidence for the significance of micrometastatic disease in differentiated thyroid cancer and suggests that it is probably of little clinical significance and does not warrant further aggressive surgical intervention. We would expect a conservative surgical approach combined with adjuvant radioactive iodine to lead to durable disease control.     

Immunotherapy for nonmelanoma skin cancer: does it have a future?

BACKGROUND: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin are the most common malignancies in the white human population, accounting for greater than 95% of nonmelanoma skin cancers (NMSCs). Current data show an increasing incidence of NMSC in recent decades. Although the mortality is low, this cancer group is associated with substantial morbidity. Multiple treatment modalities are available for NMSC, with surgery being a "cornerstone" of current therapy approaches. However, in patients with multiple lesions or in cases of tumors on critical locations, disfigurement and the disease recurrence may represent a serious problem associated with the surgical treatment. The purpose of this study was to review and analyze whether NMSC could represent a target for immune therapy, evaluating the aspects of the availability of tumor antigens and the existence of tumor specific immune response, including a summary of the major clinical studies dealing with immunotherapy for NMSC. METHODS: The authors have reviewed the available medical literature on NMSC, with a focus on tumor immunology and associated abnormalities, as well as immunotherapy-based treatment trials. RESULTS: The major advantage of NMSCs is that they arise from the skin, which makes them easily detectable and treatable. Furthermore, these tumors posses all the prerequisites, i.e., the presence of tumor-associated antigens as well as the tumor specific immune response, needed for immune intervention. This also was confirmed in various studies demonstrating clinical efficacy of cytokines and other immune response modifiers. CONCLUSIONS: In addition to clinical cure, by activating and stimulating patient's immune resources this therapeutic option may be a "silver bullet," providing a long-term protective immunity against initial tumor.     

Who attends skin cancer clinics within a randomized melanoma screening program?

BACKGROUND: Screening may reduce morbidity and mortality associated with melanoma, although in the absence of randomized-controlled trials, this remains unproven. METHODS: As part of a randomized community-based trial of melanoma screening in Queensland, Australia, sociodemographic characteristics, skin cancer risk factors and attitudes towards skin cancer associated with attendance at screening clinics and reasons for attendance or non-attendance were examined. A telephone survey was conducted among 743 attendees and 298 non-attendees. RESULTS: After adjustment, the following factors were associated with clinic attendance: age 40-49 years, having fair skin, a personal history of skin cancer or melanoma or concern about a specific spot or mole, and no recent whole-body skin examination by a doctor. The main reasons for attendance were "to see if I have melanoma", "to have a suspicious mole checked" or "to have a whole-body skin examination". The main reasons for non-attendance were lack of knowledge about the clinics, no time or being away while the clinics were held and having had a skin check in the recent past. Overall, 77% of non-attendees compared to 65% of attendees stated they planned to participate in future screening. CONCLUSIONS: The results suggest that we were able to attract both men and women equally to a skin screening clinic, along with those at all levels of education and indicate the importance of using well-designed promotional materials to attract community members to skin screening clinics. Future work should test strategies to remove barriers to participation in skin screening identified in this study.     

Do dietary lycopene and other carotenoids protect against prostate cancer?

To determine whether dietary intake of lycopene and other carotenoids has an etiological association with prostate cancer, a case-control study was conducted in Hangzhou, southeast China during 2001-2002. The cases were 130 incident patients with histologically confirmed adenocarcinoma of the prostate. The controls were 274 hospital inpatients without prostate cancer or any other malignant diseases. Information on usual food consumption, including vegetables and fruits, was collected by face-to-face interviews using a structured food frequency questionnaire. The risks of prostate cancer for the intake of carotenoids and selected vegetables and fruits rich in carotenoids were assessed using multivariate logistic regression, adjusting for age, locality, education, income, body mass index, marital status, number of children, family history of prostate cancer, tea drinking, total fat and caloric intake. The prostate cancer risk declined with increasing consumption of lycopene, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein and zeaxanthin. Intake of tomatoes, pumpkin, spinach, watermelon and citrus fruits were also inversely associated with the prostate cancer risk. The adjusted odds ratios for the highest versus the lowest quartiles of intake were 0.18 (95% CI: 0.08-0.41) for lycopene, 0.43 (95% CI: 0.21-0.85) for alpha-carotene, 0.34 (95% CI: 0.17-0.69) for beta-carotene, 0.15 (95% CI: 0.06-0.34) for beta-cryptoxanthin and 0.02 (95% CI: 0.01-0.10) for lutein and zeaxanthin. The corresponding dose-response relationships were also significant, suggesting that vegetables and fruits rich in lycopene and other carotenoids may be protective against prostate cancer.