Is cancer incidence decreased in the frail elderly? Evidence from a prospective cohort study

ObjectivesLower rates of cancer in the oldest old and in nursing home populations may reflect the increasing prevalence of frailty and a diminished capacity to sustain cancer cell growth and proliferation. This study aimed to determine cancer incidence in the frail relative to non-frail community resident older adults.Materials and methodsData from 3969 participants free of diagnosed cancer at the sixth follow‐up from three sites of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), a population-based cohort study. Frailty status was determined from physical performance testing and self reported dependency in activities of daily living. Cancer incidence over the four subsequent years was identified through linkage with Medicare claims data. Logistic regression was used to estimate the odds of cancer incidence with respect to frailty status in multiple models with progressive adjustment for covariates.ResultsOf the 3969 participants, 1340 (33.8%) were identified as frail. Cancer incidence at 4 years was lower in frail participants overall (OR 0.64; 95% CI 0.46–0.89) and frail men in particular (OR 0.54; 95% CI 0.33–0.87). Incidence was lower in women (3.7%) than in men (8.8%), but was not lower in frail women compared with non-frail women (OR 0.77; 95% CI 0.48–1.23).ConclusionFrailty status was associated with decreased cancer incidence, particularly in men, and suggests that mechanisms related to the pathogenesis of frailty may also play a role in inhibiting tumorigenesis. Why this would be more apparent in men than women remains to be clarified.     

Peritoneal metastases from extra-abdominal cancer – A population-based study

Introduction

Peritoneal metastases (PM) are predominantly seen as a manifestation of intra-abdominal malignancy such as colorectal or ovarian cancer. However, extra-abdominal primary cancer can also metastasise to the peritoneum. Population-based data on the incidence of PM from extra-abdominal cancer is lacking. This study aims to assess the patterns and survival of patients in Ireland with PM from extra-abdominal cancers.

Is a cancer diagnosis a teachable moment for the patient’s relative who smokes?

Purpose

This study examined a cancer diagnosis, versus orthopedic surgery, as a teachable moment for recruiting smokers and treating nicotine dependence among patients’ relatives.

Methods

Cancer patients and, for comparison, orthopedic patients at the University of Pennsylvania Health System were approached for referrals of relatives for a smoking cessation program, which involved behavioral counseling and nicotine patches. Primary outcomes were rate of program enrollment and rate of smoking abstinence. Potential mediators of smoking cessation were explored (e.g., treatment adherence, depression, anxiety). Two hundred and thirty-four relatives (113 cancer, 121 orthopedic) were considered eligible for the cessation program and comprised the study sample.

Results

Relatives of oncology patients were significantly more likely to enroll in the smoking cessation program, vs. orthopedic relatives (75 % vs. 60 %; OR = 1.96, 95 % CI 1.07–3.61, p = .03), but they were not significantly more likely to remain in the program (61 % vs. 52 %) or quit smoking (19 % vs. 26 %; p’s > .05). Compared to orthopedic relatives, oncology relatives showed significantly lower nicotine patch adherence and significantly greater levels of negative affect and depression and anxiety symptoms during treatment (p’s < .05). Further, orthopedic relatives, compared to oncology relatives, showed a greater reduction in the perceived benefits of smoking (p = .06), which was significantly associated with abstinence (p = .02).

Conclusions

While a family member’s cancer diagnosis may serve as a teachable moment for a smoker to enroll in a smoking cessation treatment program, high levels of psychological distress and perceptions of the benefits of smoking and low levels of treatment adherence may undermine successful abstinence among this population.     

Is the incidence of brain tumors really increasing? A population-based analysis from a cancer registry

Recently, an increasing incidence of brain tumors has been reported from multiple studies. Brain tumors diagnosed in the period 1985–2005 were identified through the Tuscan Cancer Registry, a population-based registry active since 1985 in the area of Florence and Prato. Age-standardized incidence rates and average annual percent change (APC) was calculated for the entire period from 1985 to 2005 for sex and behavior. A total of 4,417 brain tumors was registered, 1,900 (43%) in male and 2,517 (57%) in female patients. Malignant and benign tumor incidence rates were 8.3 and 4.1, respectively, among males and 6.4 and 7.2, respectively, among females. The age-adjusted annual incidence rate of all brain tumors was 13.9, with a statistically significant increasing rate throughout the period (APC: +3.2, CI 2.2–4.2). The annual incidence rate remained stable for malignant brain tumors but increased significantly for benign brain tumors (APC: +6.2, CI 4.5–7.9). In our population-based study, the incidence of brain tumors increased from 1985 to 2005 overall and for benign tumors, but not for malignant tumors. Part of the temporal variations may be attributed to improvement in diagnostic imaging techniques and, particularly for benign tumors, in changes in registration practice.     

Meat intake and bladder cancer in a prospective study: a role for heterocyclic aromatic amines?

BACKGROUND: The suspect carcinogens, heterocyclic amines (HAAs), found in well-done meat require host-mediated metabolic activation before inducing DNA mutations. The role of SULT1A1 and of NAT2 on the activation of HAAs suggests that NAT2 rapid acetylator genotype and SULT1A1 allele variants can have an effect on HAA carcinogenicity. METHODS: Data were collected as part of a case-control study nested within the EPIC cohort, the Gen Air investigation. EPIC is a prospective study designed to investigate the relationship between nutrition and cancer. Information was collected through a non-dietary questionnaire on lifestyle variables and through a dietary questionnaire. The subjects were restricted to non-smokers. We calculated the matched odds ratio for bladder cancer risk using logistic regression, controlling for potential confounders. RESULTS: There were 227 bladder cases and 612 controls matched 1:3. Meat intake and NAT2 genotype were not independently associated with bladder cancer risk. A significant relationship was observed between bladder cancer risk and consumption of meat only among subjects with the rapid NAT2 genotype (odds ratios [OR] 2.9, 95% CI 1.0-7.9 for the 2nd quartile of meat intake; 3.6, 95% CI 1.3-9.7 for the 3rd quartile; and 3.5, 95% CI 1.2-9.7 for the 4th quartile), and was not present among subjects with the slow genotype. An interaction between NAT2 and meat intake was found in logistic regression (P = 0.034). No association was observed for SULT1A *1/2 genotype (1.0; 95% CI 0.7-1.5) and for SULT1A1 *2/2 genotype (0.9; 95% CI 0.5-1.7). CONCLUSIONS: These results are suggestive of a role of meat intake and NAT2 on bladder cancer risk. They support the hypothesis that among subjects with the rapid NAT2 acetylation genotype higher levels of HAAs exposure are a bladder cancer risk factor. We did not observe an effect of SULT1A1 allele variants on this cancer. The present study adds new information on the possible long-term adverse effects of diets with high meat intake.     

Is cancer a prognostic factor for severe COVID-19, especially for breast cancer patients?

The coronavirus disease 2019 (COVID-19) pandemic has caused a global upheaval in our health care system. Our hospital facilities have been subjected to a major influx of patients and the prevention of cross-contamination has been a key issue in the spread of the virus. New recommendations for good hygiene practice and new recommendations for disease management have emerged to limit the spread of the virus and reorganize the provision of care in key services. Many studies have attempted to identify factors that contribute to poor prognosis for COVID-19 infection. Among them, cancer patients, were considered more at risk of developing severe forms of COVID-19. In this article, we provide an overview of the current state of the pandemic as well as new recommendations for disease management that have emerged in oncology and radiation therapy in particular. In this article, we will try to provide some answers through a review of the literature to the question: is cancer a prognostic factor for severe COVID-19?     

Does alcohol increase breast cancer risk in African-American women? Findings from a case–control study

Background:

Alcohol is an important risk factor for breast cancer in Caucasian women, but the evidence in African-American (AA) women is limited and results are inconclusive.

Methods:

Associations between recent and lifetime drinking and breast cancer risk were evaluated in a large sample of AA women from a case–control study in New York and New Jersey. Multivariable logistic regression models provided odds ratios (ORs) and 95% confidence intervals (CIs).

Results:

There was no association between recent drinking and breast cancer risk, even when stratified by menopausal status or by hormone receptor status. A borderline decreased risk with increased lifetime consumption was found (OR=0.77; 95% CI: 0.58–1.03), which was stronger among women who drank when under 20 years of age (OR=0.65; 95% CI: 0.47–0.89), regardless of menopausal or hormone receptor status.

Conclusion:

Breast cancer risk associated with recent alcohol consumption was not apparent in AA women, while early age drinking seemed to decrease risk. This is the first investigation on recent and lifetime drinking in subgroups and drinking during different age periods in AA women. If findings are replicated, racial differences in biological pathways involving alcohol and its metabolites should be explored.     

Do bowel cancer patients participate in treatment decision‐making? Findings from a qualitative study

The views of bowel cancer patients towards treatment decision-making and the extent to which they participate in this process were investigated. A prospective longitudinal qualitative study was conducted based on 55 new consultations between oncologists and bowel cancer patients and interviews with 37 recently diagnosed patients, 28 of whom were re-interviewed after 6 months. The interview and consultation data were transcribed verbatim and coded. Theoretical comparisons were made between the interviews and themes emerging from the consultation narratives. The analysis revealed that most bowel cancer patients preferred a limited role in the treatment decision-making process, preferring to delegate the responsibility to the clinician. However, they did not always consider themselves as 'passive' participants within the consultation and many felt that they had made the final decision to accept or refuse treatment. The consultation data shows that when a treatment recommendation was not forthcoming from the oncologist, patients became more proactive in the consultation, often taking the initiative to participate. It is concluded that patients who indicate a desire to participate in these types of consultations should be encouraged to do so and oncologists should try to identify those patients who could benefit from a greater role in treatment decision-making.     

Is there a general autoantibody signature for cancer?

BackgroundThere is longstanding evidence for the diagnostic potential of single autoantibodies for cancer and other diseases and more recently for the potential of complex autoantibody signatures. Here we address the question whether cancer specific signatures exist.MethodsWe analysed our autoantibody screening data both newly and previously generated using a single array platform with 1827 identified immunogenic clones. These clones were tested for their reactivity against a total of 428 human sera including 191 sera of patients with different cancer entities, 60 sera of healthy individuals and 177 sera of patients with non-cancer diseases by using bioinformatics approaches.ResultsPrincipal Component Analysis and hierarchical clustering revealed significant differences between the three cohorts. Evaluating the autoantibody reactivities in the three groups using Support Vector Machines, we were able to separate cancer sera from normal sera with an accuracy of 94.08%. A pathway analysis that was based on antigens with an increased reactivity in patients’ sera as compared to controls indicated glycolysis as central pathway. The separation between cancer and non-cancer disease sera was possible with an accuracy of only 69.58%, which is still significantly higher than by random classification.ConclusionAs for single autoantigens, we show that proteins that are frequently reactive with cancer sera are also frequently reactive with non-cancer sera. While these results underline the potential of autoantibody signatures for cancer diagnosis, they also caution to premature claim specificity of a signature.     

Risk factors for anal cancer: results of a population-based case–control study

OBJECTIVE: Although the incidence of anal cancer is higher in women than in men, the reasons for this gender difference are not clear. The purpose of this study was to identify risk factors for anal cancer in both men and women. METHODS: We conducted in-person interviews with 102 males and 106 females with squamous or transitional cell carcinoma of the anus and 208 individually matched controls. RESULTS: Compared with persons who had never experienced receptive anal intercourse, those who had experienced it more than 130 times were 18 times as likely to develop anal cancer (adjusted odds ratio [OR] = 17.6 (95% confidence interval [CI] = 1.3-234). This elevated risk occurred primarily among males. The adjusted OR for males having more than 10% of their sexual experiences with other men was 5.6 (95% CI = 1.4-22.0). A history of other anogenital or endometrial cancers increased the risk in women but not men. A history of anal warts, syphilis, severe hemorrhoids, physical inactivity, multiple sexual partners who smoked, and current smoking were also associated with increased risk. CONCLUSIONS: The results of this study suggest that both sexual and non-sexual factors are important in the etiology of anal cancer.     

Risk factors for early-onset colorectal cancer: a population-based case–control study in Ontario,Canada

Cancer Causes & Control - There has been an alarming increase in colorectal cancer (CRC) incidence among young adults aged?&lt;?50&nbsp;years, and factors driving this...     

Is lack of surgery for older breast cancer patients in the UK explained by patient choice or poor health? A prospective cohort study

Background:

Older women have lower breast cancer surgery rates than younger women. UK policy states that differences in cancer treatment by age can only be justified by patient choice or poor health.

Methods:

We investigate whether lack of surgery for older patients is explained by patient choice/poor health in a prospective cohort study of 800 women aged ⩾70 years diagnosed with operable (stage 1–3a) breast cancer at 22 English breast cancer units in 2010–2013. Data collection: interviews and case note review. Outcome measure: surgery for operable (stage 1–3a) breast cancer <90 days of diagnosis. Logistic regression adjusts for age, health measures, tumour characteristics, socio-demographics and patient''s/surgeon''s perceived responsibility for treatment decisions.

Results:

In the univariable analyses, increasing age predicts not undergoing surgery from the age of 75 years, compared with 70–74-year-olds. Adjusting for health measures and choice, only women aged ⩾85 years have reduced odds of surgery (OR 0.18, 95% CI: 0.07–0.44). Each point increase in Activities of Daily Living score (worsening functional status) reduced the odds of surgery by over a fifth (OR 0.23, 95% CI: 0.15–0.35). Patient''s role in the treatment decisions made no difference to whether they received surgery or not; those who were active/collaborative were as likely to get surgery as those who were passive, that is, left the decision up to the surgeon.

Conclusion:

Lower surgery rates, among older women with breast cancer, are unlikely to be due to patients actively opting out of having this treatment. However, poorer health explains the difference in surgery between 75–84-year-olds and younger women. Lack of surgery for women aged ⩾85 years persists even when health and patient choice are adjusted for.     

Is it possible to make a diagnosis of cancer by smelling?

It had been reported that a house dog could make notify the dog's owner to have malignant melanoma through sniffing intently and trying to bite off a pigment lesion on the thigh of its owner. This fact resulted in extensive study of training dogs to distinguish the special odour of exhaled breath or urine of patients with cancer from those of the healthy subjects. These studies have promoted further development of detecting and identifying the special odour substances excreted from the patients with cancer using Gas chromatography-Mass spectrometry (GC-MS) technique and further expanded to the exploitation of the electronic noses. Here, the authors made a brief general survey on these progressions. Though the field of electronic noses has made a great progress in recent years, there remain many difficulties in predicting cancer with excellent accuracy. We hope that there should be a breakthrough in this field and every clinic could obtain a useful instrument at a moderate price and, in the near future, could predict with high reliability whether a patient has cancer or not.     

Is sextant biopsy a valid method in diagnosis of prostatic cancer?

We evaluated effectiveness of a laterally directed sextant biopsy on large prostates and analysed the results of this biopsy technique in a group of men with obstructive voiding symptoms and suspected prostatic cancer (PC). Biopsy was performed in 386 men because of elevated PSA and/or abnormality in digital rectal examinations (DRE). The mean prostate volume was 79.6 +/- 39.1 cm3, and in 72.3% of the cases the volume of the prostate was > or = 50 cm3. PC was diagnosed in 107 of 386 cases (27.7%). In groups of patients with < 50 cm3 (small), 50 to 79 cm3 (medium) and > or = 80 cm3 (large) prostate volume and normal DRE, PC was detected in 27.5, 19.4 and 9.5% of cases, respectively (p < 0.018). PC detection rate was statistically insignificant (SI) in the same groups of patients with abnormal findings at DRE, 49.2, 54.2 and 51.9%, respectively (SI). Repeat sextant biopsy revealed PC in 14.5% patients. After TURP prostatic cancer was found in 7.7% patients who had undergone biopsy two times before. Thus, our results show that laterally directed sextant biopsy is an effective method of PC detection among suspected patients (PSA > 4 ng/ml) with large volume prostates and abnormal findings at DRE. An extensive biopsy protocol should be considered as a more appropriate method for markedly enlarged prostates with normal DRE findings but also for repeat biopsies.     

Unemployment risk 2 years and 4 years following gastric cancer diagnosis: a population-based study

Purpose

The needs of gastric cancer survivors have received limited attention. Returning to work after gastric cancer has not yet been described in a population-based study. We aimed to examine the unemployment risk at 2 and 4 years after gastric cancer.

Methods

The present historical prospective cohort study included baseline measurements from the Israeli Central Bureau of Statistics 1995 National Census, with follow-up until 2011. A group with gastric cancer and an age-, sex-, and ethnicity-matched control group were sampled from the census population. Binary logistic regression analyses were used to assess odds ratios (ORs) for the study outcomes, controlling for socioeconomic factors, and employment status at 2 years before diagnosis.

Results

Data for 152 gastric cancer cases and 464 matched controls were analyzed. Those who died during the study period were excluded. Two years after diagnosis, 53.3 % of gastric cancer survivors and 43.8 % of controls were unemployed (p = 0.04); 4 years after diagnosis, 53.9 % of survivors, and 47.2 % of controls were unemployed (p = 0.15). In the adjusted models, gastric cancer was only associated with unemployment 2 years after diagnosis (OR = 1.47, 95 % confidence interval [CI] = 1.02–2.12). This association weakened and lost significance 4 years after diagnosis (OR = 1.42, 95 % CI = 0.89–2.28). Gastric cancer was not associated with decreased income at 2 (OR = 1.48, 95 % CI = 0.91–1.48) or 4 years (OR = 1.65, 95 % CI = 0.99–2.74) after diagnosis.

Conclusions

Gastric cancer survivorship was associated with unemployment 2 years after diagnosis. Longer-term survivors may have the prospect of returning to work.

Implications for cancer survivors

For patients with cancer, returning to work may be an indicator for returning to a normal lifestyle after serious illness. This study highlights the need for early social support in gastric cancer survivors to promote faster recovery.