Sleep apnea and subsequent cancer incidence

Purpose

In vitro and animal models suggest that the physiological effects of sleep apnea could contribute to cancer risk, yet epidemiologic studies have been inconsistent.

Methods

We identified a cohort of adults diagnosed with sleep apnea between 2005 and 2014 using regional administrative databases. Linking this cohort to a population-based cancer registry, we identified first incident cancers diagnosed after sleep apnea diagnosis through 2015. We calculated age–sex standardized cancer incidence ratios (SIRs) to compare the observed number of cancers among those with sleep apnea with expected population estimates over a comparable period.

Results

Among 34,402 individuals with sleep apnea, 1,575 first incident cancers were diagnosed during follow-up (mean?±?SD; 5.3?±?2.0 years). Compared to the general population, cancer incidence (SIR 1.26, 95% CI 1.20–1.32) was elevated among sleep apnea patients. We observed significantly elevated incidence for kidney (SIR 2.24, 95% CI 1.82–2.72), melanoma (SIR 1.71, 95% CI 1.42–2.03), breast (SIR 1.43, 95% CI 1.76–2.00), and corpus uteri (SIR 2.80, 95% CI 2.24–2.47) while risk for lung (SIR 0.66, 95% CI 0.54–0.79) and colorectal cancer (SIR 0.71, 95% CI 0.56–0.89) was lower.

Conclusion

These findings suggest an elevated cancer burden, particularly at certain sites, among individuals with diagnosed sleep apnea. Results should be interpreted with caution due to unmeasured confounders (e.g., BMI, diabetes).

     

Hormone receptor status of contralateral breast cancers: analysis of data from the US SEER population-based registries

Background

Women diagnosed with breast cancer display higher propensity to develop second primary cancer in the contralateral breast (CBC). Identification of patients with increased risk of CBC and understanding relationships between hormone receptor (HR) statuses of the first and second breast cancers is desirable for endocrine-based prevention strategies.

Methods

Using 1992–2012 data from 13 SEER registries, the risk of developing CBC was determined as ratio of observed and expected second breast cancers (SIR). Association between HR statuses was examined by exploratory data analysis and multivariable logistic regression. Results: Women with ER-positive and ER-negative breast cancers have increased risk of developing CBC with SIR values 2.09 (CI 95 = 1.97–2.21) and 2.40 (CI 95 = 2.18–2.63), respectively. ER statuses of the CBC are moderately positively associated. In metachronous CBC, most cases with ER-positive first cancers had ER-positive second breast cancers (81.6 %; CI 95 = 80.2–82.9 %); however, considerable proportion of cases with ER-negative first cancers had ER-positive second cancers (48.8 %; CI 95 = 46.2–51.4 %).

Conclusions

Some women with ER-negative breast cancers may benefit from endocrine-based prevention of ER-positive CBC.

     

Occupational variation in the risk of female breast cancer in the Nordic countries

Objective

This study aimed to determine occupational variations in the incidence of breast cancer in the population-based cohort of Nordic Occupational Cancer Study (NOCCA).

Methods

The study included long-term follow-up data from almost 7.5 million Nordic women. Participants were assigned to one of the 54 occupational categories based on census records at the ages of 30–64 years. Sixty-two thousand cases of breast cancer were identified through record linkages between nationwide cancer registries in Finland, Sweden, Norway, Denmark, and Iceland, followed up between 1961 and 2005. Country-specific standardized incidence ratios (SIRs) with 95% confidence intervals were estimated.

Results

Overall, the highest risk elevations were seen among military personnel (SIR 1.58, 95% CI 1.03–2.32), dentists (SIR 1.43, 95% CI 1.31–1.56), and physicians (SIR 1.35, 95% CI 1.26–1.46). The lowest risks were observed among gardeners (SIR 0.76, 95% CI 0.74–0.78), farmers (SIR 0.80, 95% CI 0.78–0.82), and woodworkers (SIR 0.75, 95% CI 0.70–0.81). Welders, tobacco workers, and painters had higher SIRs for breast cancer diagnosed at age?<?50. A reduced risk was observed among forestry workers, welders, and fishery workers for breast cancers diagnosed both before and after age 50. The SIRs for breast cancer did not vary substantially by histology. A significantly increased risk of breast cancer was observed among laboratory workers in the latest calendar period (1991–2005) compared with earlier periods (1976–1990 and 1961–1975). Occupations such as farming, forestry, driving, and gardening had low SIRs during all periods.

Conclusions

The study suggests that the risk of breast cancer varies by occupation. Heterogeneity is also observed in some occupational categories according to age (before or after 50), histology, and calendar period.

     

Short-term and long-term survival of interval breast cancers taking into account prognostic features

Purpose

The aim of this population-based study was to estimate short-term and long-term survival of interval breast cancers and to compare them to clinically detected cancers, taking into account prognostic features.

Methods

This study included all interval cancers and clinically detected cancers diagnosed in the Loire-Atlantique population-based cancer registry from 2000 to 2010 in women aged 50–76 years. We used the Pohar-Perme method to estimate 5- and 10 year net survival rates and a flexible parametric model to compare interval cancer and clinically detected cancer prognosis with and without adjustment for the main prognostic factors (age, stage, histological grade, and phenotype).

Results

This study included 813 interval cancers and 1,354 clinically detected cancers. Interval cancers were diagnosed at a significantly less advanced stage than clinically detected cancers, but more often with a triple-negative phenotype. Interval cancer age-standardised net survival was 88.0% at 5 years (95% CI 84.9–91.2) and 81.7% at 10 years (95% CI 76.9–86.9), whereas clinically detected cancer age-standardised net survival was 77.8% (95% CI 75.1–80.6) and 64.6% (95% CI 60.7–68.7), respectively. After adjustment for covariates, survival no longer differed between interval cancers and clinically detected cancers at 5 and 10 years.

Conclusion

Although the interval cancer net survival rate was higher, interval cancers had a similar short-term and long-term prognosis than clinically detected cancers after taking into account the main prognostic factors.

     

Smoking cessation among men following cancer diagnosis: a matched cohort study

Purpose

Cigarette smoking among cancer survivors increases the risk of recurrence and secondary cancers. We sought to investigate smoking cessation following diagnosis of cancer compared to those not diagnosed with cancer. We also investigated cessation following diagnosis of a smoking-related and non-smoking-related cancer separately.

Methods

We conducted a matched cohort study within the Health Professionals Follow-Up Study (HPFS). We identified 566 men diagnosed with cancer who were current cigarette smokers at the time of diagnosis between 1986 and 2010 (exposed). Men diagnosed with cancer were age-matched 1:4 to men without a diagnosis of cancer who were also current cigarette smokers (unexposed). Multivariable conditional logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) to evaluate the association between a cancer diagnosis and smoking cessation within 2 and 4 years post diagnosis adjusted for potential confounders, overall and for smoking-related and non-smoking-related cancers.

Results

Of the men with cancer, 38% quit within 2 years and 42% within 4 years of diagnosis. Men diagnosed with cancer were more likely to quit smoking within 2 (OR?=?2.5, 95% CI: 2.0–3.0) and 4 years (OR?=?1.6, 95% CI: 1.3–2.0) post diagnosis, compared to matched men without cancer. The association was similar for smoking-related (OR?=?3.4, 95%: 1.6–7.2) and non-smoking-related cancers (OR?=?3.8, 95%: 2.8–5.2).

Conclusions

Men diagnosed with cancer were more likely to quit smoking compared to men not diagnosed with cancer. A cancer diagnosis may be a “teachable moment” in which strategies to promote smoking cessation for individuals diagnosed with smoking-related and non-smoking-related cancers should be investigated.

Implications for Cancer Survivors

There is a continued need for the widespread implementation of cessation interventions for cancer survivors.

     

Incidence,risk and prognostic role of anti-epidermal growth factor receptor-induced skin rash in biliary cancer: a meta-analysis

Background

Anti-epidermal growth factor receptor (EGFR)-induced skin rash is a common adverse event and is considered a prognostic factor of various cancers. However, the role of rash is rarely known in biliary cancer, possibly owing to the low incidence of this frequently fatal malignancy. We thus performed a meta-analysis to investigate the incidence, risk and prognostic significance of skin rash related to anti-EGFR treatment for biliary cancer.

Methods

Eligible studies were enrolled after a systematic search of electronic databases. A fixed-effects or random-effects model was utilized according to the heterogeneity.

Results

Fourteen clinical trials published between 2006 and 2017 comprising 1,106 patients with advanced biliary cancer were included. The overall incidence of all-grade and high-grade (grade ≥3) rash was 78.2% [95% confidence interval (CI) 70.4–84.3] and 11.3% (7.6–16.5), respectively. Anti-EGFR treatment correlates with a significantly increased risk of all-grade [risk ratio (RR) 7.37, 95% CI 5.11–10.64, p < 0.0001] and high-grade (RR 6.94, 95% CI 1.89–25.45, p = 0.0035) rash compared with control medication. Higher grades of skin rash correlate with a higher objective response rate (RR 3.50, 95% CI 1.47–8.33, p = 0.0048), and a longer overall [hazard ratio (HR) 0.47, 95% CI 0.31–0.71, p = 0.0003) and progression-free survival (HR 0.51, 95% CI 0.36–0.72, p = 0.0001) compared with lower grades or no rash in patients who received anti-EGFR treatment.

Conclusions

Anti-EGFR treatment correlates with an increased risk of skin rash in advanced biliary cancer. Stratifying patients by the severity of rash may have major implications for survival benefit regarding anti-EGFR treatment for biliary cancer.

     

An update of the WCRF/AICR systematic literature review on esophageal and gastric cancers and citrus fruits intake

Purpose

The 2007 World Cancer Research Fund/American Institute for Cancer Research expert report concluded that foods containing vitamin C probably protect against esophageal cancer and fruits probably protect against gastric cancer. Most of the previous evidence was from case–control studies, which may be affected by recall and selection biases. More recently, several cohort studies have examined these associations. We conducted a systematic literature review of prospective studies on citrus fruits intake and risk of esophageal and gastric cancers.

Methods

PubMed was searched for studies published until 1 March 2016. We calculated summary relative risks and 95 % confidence intervals (95 % CI) using random-effects models.

Results

With each 100 g/day increase of citrus fruits intake, a marginally significant decreased risk of esophageal cancer was observed (summary RR 0.86, 95 % CI 0.74–1.00, 1,057 cases, six studies). The associations were similar for squamous cell carcinoma (RR 0.87, 95 % CI 0.69–1.08, three studies) and esophageal adenocarcinoma (RR 0.93, 95 % CI 0.78–1.11, three studies). For gastric cancer, the nonsignificant inverse association was observed for gastric cardia cancer (RR 0.75, 95 % CI 0.55–1.01, three studies), but not for gastric non-cardia cancer (RR 1.02, 95 % CI 0.90–1.16, four studies). Consistent summary inverse associations were observed when comparing the highest with lowest intake, with statistically significant associations for esophageal (RR 0.77, 95 % CI 0.64–0.91, seven studies) and gastric cardia cancers (RR 0.62, 95 % CI 0.39–0.99, three studies).

Conclusions

Citrus fruits may decrease the risk of esophageal and gastric cardia cancers, but further studies are needed.

     

History of uterine leiomyoma and risk of endometrial cancer in black women

Background

Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL.

Methods

We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women’s Health Study. During 1995–2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95 % confidence intervals (CI).

Results

There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42 % greater incidence of endometrial cancer compared with no such history (95 % CI 1.12–1.80). IRRs for cancer diagnosed 0–2, 3–9, and ≥10 years after UL diagnosis were 3.20 (95 % CI 2.06–4.98), 0.95 (95 % CI 0.60–1.52), and 1.35 (95 % CI 1.03–1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR = 2.25, 95 % CI 1.09–4.63) and type II/III cancers (IRR = 3.13, 95 % CI 1.64–5.99).

Conclusions

In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within 2 years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.

     

Population mixing and incidence of cancers in adolescents and young adults between 1990 and 2013 in Yorkshire,UK

Purpose

Epidemiological evidence suggests a role for an infectious etiology for cancers in teenagers and young adults (TYAs). We investigated this by describing associations between infection transmission using the population mixing (PM) proxy and incidence of cancers in TYAs in Yorkshire, UK.

Methods

We extracted cancer cases from the Yorkshire Specialist Register of Cancer in Children and Young People from 1990 to 2013 (n = 1929). Using multivariable Poisson regression models (adjusting for effects of deprivation and population density), we investigated whether PM was associated with cancer incidence. We included population mixing–population density interaction terms to examine for differences in effects of PM in urban and rural populations.

Results

Nonsignificant IRRs were observed for leukemias (IRR 1.20, 95% CI 0.91–1.59), lymphomas (IRR 1.09, 95% CI 0.90–1.32), central nervous system tumors (IRR 1.06, 95% CI 0.80–1.40) and germ cell tumors (IRR 1.14, 95% CI 0.92–1.41). The association between PM and cancer incidence did not vary in urban and rural areas.

Conclusions

Study results suggest PM is not associated with incidence of cancers among TYAs. This effect does not differ between rural and urban settings.

     

Aspirin use and the incidence of breast,colon, ovarian,and pancreatic cancers in elderly women in the Iowa Women’s Health Study

Purpose

Few studies have evaluated the chemopreventive effect of aspirin on the cancer risk in elderly women. We examined associations between frequency, dose, and duration of aspirin use with incidence of 719 aspirin-sensitive cancers (cancers of colon, pancreas, breast, and ovaries) in the Iowa Women’s Health Study (IWHS), a prospective cohort of women over 70 years old.

Methods

Aspirin frequency, dose, and duration were self-reported in the 2004 IWHS questionnaire. Women were followed-up to 2011. Cancer cases were ascertained by linkage to the Iowa State Health Registry. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CI).

Results

Among the 14,386 women, 30 % were nonusers of aspirin; 34 % used low-dose aspirin, and 36 % used regular- or high-dose aspirin. Compared with nonuse of aspirin, the HRs (95 % CI) for incidence of aspirin-sensitive cancers were 0.87 (0.72–1.06) for regular to high doses of aspirin use, 0.95 (0.80–1.13) for aspirin use 6+ times per week, and 0.93 (0.74–1.17) for aspirin use for 10+ years. For cumulative aspirin use, HR (95 % CI) was 0.87 (0.70–1.09) for >60,000 mg of aspirin per year and 0.95 (0.75–1.21) for >280,000 mg of aspirin in their lifetime, versus nonuse of aspirin. Results were similar for the all-cause cancer death as an endpoint, with a significant inverse association observed between lifetime aspirin dose and cancer mortality [<95,000 mg vs nonuser HR 0.76 (0.61–0.95)].

Conclusions

These findings suggest that aspirin use may prevent incident breast, colon, pancreatic, and ovarian cancer in elderly women.

     

Inverse associations between serum concentrations of zeaxanthin and other carotenoids and colorectal neoplasm in Japanese

Background

To investigate the associations between serum concentrations of carotenoids and the presence of colorectal polyps and cancers in Japanese using a cross-sectional study.

Methods

893 subjects who underwent colorectal endoscopy between 2001 and 2002 provided serum samples and information on lifestyle factors. Serum concentrations of six carotenoids were compared among patients with polyps, cancers, and controls.

Results

In males, high serum zeaxanthin was associated with decreased rates of polyps [odds ratio (OR) = 0.48, 95 % confidence interval (CI) 0.27–0.87] and cancer (OR = 0.35, 95 % CI 0.12–1.06), adjusting for age, body mass index, serum cholesterol, smoking status, and alcohol intake. In females, zeaxanthin (OR = 0.25, 95 % CI 0.07–0.82), lutein (OR = 0.30, 95 % CI 0.10–0.94), alpha-carotene (OR = 0.30, 95 % CI 0.10–0.90), and beta-carotene (OR = 0.27, 95 % CI 0.09–0.85) showed significant inverse associations with cancer development. These associations were consistent with findings of inverse associations between the ingestion of green–yellow vegetables (OR = 0.44, 95 % CI 0.23–0.84), carrots and pumpkins (OR = 0.46, 95 % CI 0.25–0.86), and fruits (OR = 0.53, 95 % CI 0.30–0.94) and polyp in males, and between carrots and pumpkins (OR = 0.30, 95 % CI 0.09–0.99), legumes (OR = 0.14, 95 % CI 0.04–0.44), and seaweed (OR = 0.23, 95 % CI 0.07–0.75) and cancer development in females.

Conclusions

These results provide further support for the protective effects of carotenoids contained in green–yellow vegetables and fruits against colorectal neoplasm in Japanese.

     

Age at cancer diagnosis,amenability to medical interventions,and racial/ethnic disparities in cancer mortality

Purpose

Racial disparities in cancer mortality may be greater for cancers that are amenable to available early detection and treatment (amenability level). We investigated whether these patterns vary by age at cancer diagnosis.

Methods

Using 5-year relative survival rates (5Y-RSR), we classified 51 cancer sites into least amenable, partly amenable, and mostly amenable cancers (<40 %, 40–69 %, ≥70 % 5-YRS, respectively). We examined whether racial disparities in mortality rates (African-Americans, Asian/Pacific Islanders, Hispanics, whites), as estimated through Cox regression models, were modified by age at diagnosis and amenability level in 516,939 cancer cases diagnosed in 1995–1999.

Results

As compared with whites, all racial minority groups experienced higher cancer mortality rates in the youngest age group of 20–34 years. African-Americans and Hispanics diagnosed with partly and mostly amenable cancers had higher mortality rates relative to whites with cancers of the same amenability levels; further, these differences decreased in magnitude or reversed in direction with increasing age. In contrast, the racial differences in mortality were smaller and remained fairly constant across age groups for least amenable cancers. For example, in the youngest (20–34) and oldest (80–99) age groups, the adjusted hazard ratios (HRs) for African-Americans versus whites with least amenable cancers were, respectively, 1.26 (95 % CI 1.02, 1.55) and 0.90 (95 % CI 0.85, 0.96), while the HRs for African-Americans versus whites with mostly amenable cancers were 2.77 (95 % CI 2.38, 3.22) and 1.07 (95 % CI 0.98, 1.17).

Conclusions

Cancer survival disadvantage for racial minorities is larger in younger age groups for cancers that are more amenable to medical interventions.

     

Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women

Purpose

To assess tumor subtype distribution and the relative contribution of clinical and sociodemographic factors on breast cancer survival between Hispanic and non-Hispanic whites (NHWs).

Methods

We analyzed data from the California Cancer Registry, which included 29,626 Hispanic and 99,862 NHW female invasive breast cancer cases diagnosed from 2004 to 2014. Logistic regression was used to assess ethnic differences in tumor subtype, and Cox proportional hazard modeling to assess differences in breast cancer survival.

Results

Hispanics compared to NHWs had higher odds of having triple-negative (OR = 1.29; 95% CI 1.23–1.35) and HER2-overexpressing tumors (OR = 1.19; 95% CI 1.14–1.25 [HR?] and OR = 1.39; 95% CI 1.31–1.48 [HR+]). In adjusted models, Hispanic women had a higher risk of breast cancer mortality than NHW women (mortality rate ratio [MRR] = 1.24; 95% CI 1.19–1.28). Clinical factors accounted for most of the mortality difference (MRR = 1.05; 95% CI 1.01–1.09); however, neighborhood socioeconomic status (SES) and health insurance together accounted for all of the mortality difference (MRR = 1.01; 95% CI 0.97–1.05).

Conclusions

Addressing SES disparities, including increasing access to health care, may be critical to overcoming poorer breast cancer outcomes in Hispanics.

     

Nasopharyngeal carcinoma: 30-year experience of a single institution in a non-endemic area

Purpose

Over the past years, radiotherapy techniques have changed significantly. The impact of these changes in the management of nasopharyngeal carcinoma (NPC) has not been fully evaluated.

Methods/patients

Between 1984 and 2014, 223 NPC were diagnosed in our hospital. Prior to 2000, patients were treated with 2D treatment plan (RT2D) that evolved to 3D schemes thereafter (RT3D).

Results

Tumors in the RT3D period showed significantly lower stages than those in the RT2D period. 5-year cause-specific survival improved from 55.7% (95% CI: 46.7–64.7%) in the RT2D period to 78.7% (95% CI: 68.7–88.7%) in the RT3D period (P = 0.006). This difference was greater for non-keratinizing NPC, where specific survival went from 63.2% (95% CI: 52.2–74.2%) to 84.4% (95% CI: 74.4–94.4%) (P = 0.014).

Conclusion

Recent changes in treatment strategies including concurrent chemoradiation and 3D radiotherapy may have impacted in better survival for NPC. Improved imaging techniques may have contributed by earlier detection and better treatment planning.

     

Active smoking and risk of Luminal and Basal-like breast cancer subtypes in the Carolina Breast Cancer Study

Purpose

Growing evidence suggests an association between active cigarette smoking and increased breast cancer risk. However, the weak magnitude of association and conflicting results have yielded uncertainty and it is unknown whether associations differ by breast cancer subtype.

Methods

Using population-based case–control data from phases I and II of the Carolina Breast Cancer Study, we examined associations between self-reported measures of smoking and risk of Luminal and Basal-like breast cancers. We used logistic regression models to estimate case–control odds ratios (OR) and 95 % confidence intervals (CI).

Results

Ever smoking (current and former) was associated with a weakly increased risk of Luminal breast cancer (OR 1.12, 95 % CI 0.92–1.36) and was not associated with risk of Basal-like breast cancer (OR 0.96, 95 % CI 0.69–1.32). Similarly, smoking duration of more than 20 years was associated with increased risk of Luminal (OR 1.51, 95 % CI 1.19–1.93), but not Basal-like breast cancer (OR 0.90, 95 % CI 0.57–1.43). When stratified by race, elevated odds ratios between smoking and Luminal breast cancer risk were found among black women across multiple exposure measures (ever smoking, duration, and dose); conversely, among white women odds ratios were attenuated or null.

Conclusions

Results from our study demonstrate a positive association between smoking and Luminal breast cancer risk, particularly among black women and women with long smoking histories. Addressing breast cancer heterogeneity in studies of smoking and breast cancer risk may elucidate associations masked in prior studies.

     

Residential cancer cluster investigation nearby a Superfund Study Area with trichloroethylene contamination

Purpose

Trichloroethylene (TCE) is an industrial solvent associated with liver cancer, kidney cancer, and non-Hodgkin’s lymphoma (NHL). It is unclear whether an excess of TCE-associated cancers have occurred surrounding the Middlefield–Ellis–Whisman Superfund site in Mountain View, California. We conducted a population-based cancer cluster investigation comparing the incidence of NHL, liver, and kidney cancers in the neighborhood of interest to the incidence among residents in the surrounding four-county region.

Methods

Case counts and address information were obtained using routinely collected data from the Greater Bay Area Cancer Registry, part of the Surveillance, Epidemiology, and End Results program. Population denominators were obtained from the 1990, 2000, and 2010 US censuses. Standardized incidence ratios (SIRs) with two-sided 99 % confidence intervals (CIs) were calculated for time intervals surrounding the US Censuses.

Results

There were no statistically significant differences between the neighborhood of interest and the larger region for cancers of the liver or kidney. A statistically significant elevation was observed for NHL during one of the three time periods evaluated (1996–2005: SIR = 1.8, 99 % CI 1.1–2.8). No statistically significant NHL elevation existed in the earlier 1988–1995 (SIR = 1.3, 99 % CI 0.5–2.6) or later 2006–2011 (SIR = 1.3, 99 % CI 0.6–2.4) periods.

Conclusion

There is no evidence of an increased incidence of liver or kidney cancer, and there is a lack of evidence of a consistent, sustained, or more recent elevation in NHL occurrence in this neighborhood. This evaluation included existing cancer registry data, which cannot speak to specific exposures incurred by past or current residents of this neighborhood.

     

Ramucirumab as Second-Line Therapy in Metastatic Gastric Cancer: Real-World Data from the RAMoss Study

Background

Ramucirumab—alone or combined with paclitaxel—represents one of the main options for patients failing first-line treatment for advanced gastric cancer.

Objective

The RAMoss study aimed to evaluate the safety and efficacy profile of ramucirumab in the “real-life setting”.

Patients and Methods

Patients from 25 Italian hospitals started therapy consisting of ramucirumab 8 mg/kg i.v. d1,15q28 with or without paclitaxel 80 mg/m² i.v. d1,8,15q28. The primary endpoint was safety, and secondary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS).

Results

One hundred sixty-seven patients with disease progression on first-line therapy received ramucirumab as monotherapy (10%) or combined with paclitaxel (90%). Median treatment duration was 4 months (1–17 months). Global incidence of grade (G) 3–4 toxicity was 9.6%, and for neutropenia 5.4%; treatment was discontinued due to toxicity in 3% of patients. The most frequent adverse events (AE) were G1–2 fatigue (27.5%), G1–2 neuropathy (26.3%), and G1–2 neutropenia (14.9%). ORR was 20.2%. Stable disease was observed in 39.2% of patients, with a disease control rate of 59.4%. With a median follow-up of 11 months, median PFS was 4.3 months (95% confidence interval [CI] 4.1–4.7), whereas median OS was 8.0 months (95% CI: 7.09–8.9). In a multivariate analysis, ECOG performance status <1 or ≥1 (HR 1.13, 95% CI 1.0–1.27, p?=?0.04) and the presence versus absence of peritoneal metastases (HR 1.57, 95% CI 1.63–2.39, p?=?0.03) were independent poor prognostic factors.

Conclusions

These “real-life” efficacy data on ramucirumab treatment are in line with previous randomized trials. Ramucirumab is well tolerated in daily clinical practice.

     

<Superscript>99m</Superscript>Tc-rituximab as a tracer for sentinel lymph node biopsy in breast cancer patients: a single-center analysis

Purpose

This study aimed to determine the long-term prognosis of breast cancer patients with ^99mTc-rituximab for sentinel lymph node biopsy (SLNB).

Methods

A total of 2947 patients with negative sentinel lymph nodes (SLNs) omitting axillary lymph node dissection (ALND), treated between June 2005 and December 2013, were retrospectively analyzed. SLNB was performed prior to adjuvant therapy.

Results

After a median follow-up of 62 months, 22 cases of axillary recurrence (AR) were observed. The 5-year AR rate (ARR) was 0.7% [95% confidence interval (CI) 0.3–1.1%] and the 5-year relapse-free survival (RFS) was 95.2% (95% CI 94.4–96.0%). Multivariate analysis showed that abnormal axillary ultrasound with negative fine-needle aspiration (FNA) [hazard ratio (HR) 3.79, 95% CI 1.55–9.28; P = 0.004], not receiving radiotherapy (HR 4.38, 95% CI 1.47–13.05; P = 0.008), and age ≤ 40 years (HR 2.93, 95% CI 1.19–7.20; P = 0.020) were independent risk factors for AR.

Conclusions

ARR of SLNB-negative patients with ^99mTc-rituximab is low. Abnormal axillary ultrasound with negative FNA, not receiving radiotherapy, and age ≤ 40 years were prognostic factors for higher ARRs.

     

Residential exposure to solar ultraviolet radiation and incidence of childhood hematological malignancies in France

Purpose

Few studies have investigated the relationship between solar ultraviolet radiation (UV) and childhood hematological malignancies (CHM). This study addresses the associations between residential UV exposure at diagnosis and the incidence of types and subtypes of CHM, by age and gender, in France, over a long period, on the fine scale of the 36,326 Communes that constitute mainland France.

Methods

The 9,082 cases of acute leukemia and 3,563 cases of lymphoma diagnosed before the age of 15 years from 1990 to 2009 were provided by the French National Registry of Childhood Hematological Malignancies. The incidence of CHM was calculated by Commune, year, age and gender and expressed as the standardized incidence ratio (SIR). UV data from 1988 to 2007 were extracted from the EUROSUN database.

Results

The annual daily average UV exposure of the children ranged from 85.5 to 137.8 J/cm². For each additional 25 J/cm², there was a significant increase in precursor B-cell acute lymphoblastic leukemia (PBC-ALL) in children aged less than 5 years (SIR 1.18; 95 % CI 1.10–1.27). Further analysis of PBC-ALL in the young children suggested a better fit of models with a threshold, with the risk increasing above 100 J/cm², for which the SIR was 1.24 (95 % CI 1.14–1.36) for a 25 J/cm² increase. The results remained stable in analyses stratifying by deprivation index or degree of urbanization of the Communes.

Conclusion

The study suggests that higher residential UV exposure may be positively associated with a higher incidence of PBC-ALL in early childhood.

     

Variable aromatase inhibitor plasma concentrations do not correlate with circulating estrogen concentrations in post-menopausal breast cancer patients

Purpose

To determine the effect of tomosynthesis imaging as a function of age for breast cancer screening.

Methods

Screening performance metrics from 13 institutions were examined for 12 months prior to introduction of tomosynthesis (period 1) and compared to those after introduction of tomosynthesis (period 2, range 3–22 months). Screening metrics for women ages 40–49, 50–59, 60–69, and 70+ , included rates per 1000 screens for recalls, biopsies, cancers, and invasive cancers detected.

Results

Performance parameters were compared for women screened with digital mammography alone (n = 278,908) and digital mammography + tomosynthesis (n = 173,414). Addition of tomosynthesis to digital mammography produced significant reductions in recall rates for all age groups and significant increases in cancer detection rates for women 40–69. Largest recall rate reduction with tomosynthesis was for women 40–49, decreasing from 137 (95% CI 117–156) to 115 (95% CI 95–135); difference, ?22 (95% CI ?26 to ?18; P < .001). Simultaneous increase in invasive cancer detection rate for women 40–49 from 1.6 (95% CI 1.2–1.9) to 2.7 (95% CI 2.2–3.1) with tomosynthesis (difference, 1.1; 95% CI 0.6–1.6; P < .001) was observed.

Conclusions

Addition of tomosynthesis to digital mammography increased invasive cancer detection rates for women 40–69 and decreased recall rates for all age groups with largest performance gains seen in women 40–49. The similar performance seen with tomosynthesis screening for women in their 40s compared to digital mammography for women in their 50s argues strongly for commencement of mammography screening at age 40 using tomosynthesis.