A <Emphasis Type="Italic">Promotora</Emphasis>-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.–Mexico border: a randomized controlled trial

Background  

Breast cancer is the most common neoplasm among Hispanic women. Cervical cancer has a higher incidence and mortality among Hispanic women compared with non-Hispanic White women.     

Patterns of cancer incidence among US Hispanics/Latinos, 1995–2000

Objective Current and comprehensive data on cancer incidence in US Latinos has been limited. Methods Using a standardized approach to uniformly assign Hispanic/Latino race/ethnicity to cancer records, data from 15 central cancer registries, representing more than 85% of the US Latino population, were included in the analysis. Average annual age-adjusted incidence rates and standard errors were calculated for Hispanic, non-Hispanic white and non-Hispanic black males and females. To compare cancer incidence among Hispanic and non-Hispanic populations, standardized incidence ratios (SIRs) also were calculated. Results Latino populations had overall lower incidence for all cancers combined and the four leading cancers (breast, prostate, lung and colorectal) than non-Hispanic populations, however, cancers of lesser impact in non-Hispanic populations (liver, gallbladder, stomach, penis and cervix) were more commonly diagnosed among Latinos. Conclusions Understanding the patterns of cancer incidence in this diverse racial/ethnic minority group can serve to both stimulate research into the unique behaviors, exposures and genetics that drive cancer risk among Latinos and to direct prevention and control efforts tailored to this population.     

Associations between human papillomavirus and history of cancer among U.S. adults in the National Health and Nutrition Examination Survey (2003–2010)

Background:

Human papillomavirus (HPV) is an infectious agent that has been associated with human cancer. We have updated the U.S. population sero-prevalence using a large National Health and Nutrition Examination Survey (NHANES) sample of adults from 2003 to 2010, and have analysed the associations between HPV seropositivity and self-reported history of cancer.

Methods:

Four cross-sectional cycles (2003–2004, 2005–2006, 2007–2008, and 2009–2010) were used, for a total of 12 759 participants who had both cancer history and HPV serum information.

Results:

The sero-prevalences of HPV types 6, 11, 16, and 18 were 15.0%, 4.8%, 11.5%, and 4.1%, respectively. Females had significantly higher HPV prevalence than males (P<0.05) for all subtypes. Positive associations between HPV 16/18 seropositivity and lifetime history of any cancer (adjusted odds ratio-OR_adj=1.68; 95% CI: 1.35, 2.01), history of any of eight selected cancers (OR_adj=2.63; 95% CI: 1.78, 3.90), lung cancer (OR_adj=5.14; 95% CI: 1.29, 20.44), and cervical cancer (OR_adj=2.55; 95% CI: 1.63, 3.98) were observed.

Conclusions:

The finding of significant associations between HPV 16/18 seropositivity and lifetime history of cancer adds epidemiological evidence to the carcinogenicity potential of HPV 16 and 18 in other tissues. With increasing coverage of the HPV vaccine in the U.S., future NHANES data and sample collection may allow further detailed evaluation of the population impact of the HPV vaccination on cancer prevention.     

Colorectal cancer statistics in Japan: data from JSCCR registration, 1974–1993

Japanese colorectal cancer statistics from 1974 to 1993 are reported, based on the accumulated data registered by the member institutions of the Japan Society for Cancer of the Colon and Rectum (JSCCR). Both colon and rectal cancers were more prevalent in men than in women. In both sexes, colonic cancers were more prevalent than rectal cancers, and a greater increasing trend was seen in colonic cancers. Moderately differentiated adenocarcinoma seemed to have increased in recent years. The resectability and operative death rates improved slightly, but the ratio of stage I + II/III + IV cancers (both colonic and rectal) did not change at all during the 20-year period reported. The yearly improved survival in both colonic and rectal cancers, particularly in stages II and III, may well reflect improved surgical techniques. Received: May 17, 2001     

Mortality following bone metastasis and skeletal-related events among women with breast cancer: a population-based analysis of U.S. Medicare beneficiaries, 1999–2006

The aim of the study is to quantify the impact of bone metastasis and skeletal-related events (SREs) on mortality in older breast cancer patients. Using the linked Surveillance, Epidemiology and End Results-Medicare database, we identified women aged 65 years or older diagnosed with breast cancer between July 1, 1999 and December 31, 2005 and followed them to determine deaths occurring through December 31, 2006. We classified patients as having possible bone metastasis and SREs using discharge diagnoses from inpatient claims and diagnoses paired with procedure codes from outpatient claims. We used Cox regression to estimate mortality hazards ratios (HR) among women with bone metastasis with or without SRE, compared with women without bone metastasis. Among 98,260 women with breast cancer (median follow-up, 3.3 years), 7,189 (7.3%) had bone metastasis either at breast cancer diagnosis (1.5%) or during follow-up (5.8%). SREs occurred in 3,319 (46%) of women with bone metastasis. HRs for risk of death were 4.9 (95% CI 4.7–5.1) and 6.2 (95% CI 5.9–6.5), respectively, for women with bone metastasis but no SRE and for women with bone metastasis plus SRE, compared with women without bone metastasis. In analyses restricted to women with bone metastasis, the adjusted HR was 1.5 (95% CI 1.4–1.6) for women with bone metastasis plus SRE, compared with women with bone metastasis but without SRE. Having a bone metastasis, as indicated by Medicare claims, was associated strongly with mortality among women with breast cancer. This association was stronger for bone metastasis complicated by SRE than for bone metastasis without SRE.     

The American Cancer Society challenge goals. How far can cancer rates decline in the U.S. by the year 2015?

BACKGROUND: Cancer incidence and mortality rates both began to decline in the U. S. in the early 1990s. Recognizing the unprecedented potential benefits of accelerating this decline, the American Cancer Society (ACS) has set ambitious challenge goals for the American public for a 25% reduction in cancer incidence rates and a 50% reduction in cancer mortality rates by the year 2015. This analysis examined the feasibility of reaching those goals by estimating future changes in cancer rates that can result from past and future reductions in cancer risk factors. METHODS: Estimates for future declines in cancer risk factors in the U. S. under alternative scenarios were applied to conservative population-attributable risk estimates for cancer incidence and mortality rates in 1990 to estimate cancer rate trends in the year 2015. RESULTS: If the current trends toward a decline in the prevalence of cancer risk factors continue over the next decade, by the year 2015 one can expect a 13% decline in cancer incidence rates and a 21% decline in cancer mortality rates below their 1990 levels. With redoubled efforts to reduce the prevalence of known cancer risk factors further, by the year 2015 cancer incidence rates could be reduced by 19% and cancer mortality rates reduced by 29%. Such redoubled efforts would equate to approximately 100,000 cancer cases and 60,000 cancer deaths prevented each year by the year 2015. CONCLUSIONS: Past reductions in cancer risk factors in the U.S. population have led to recent declines in the rates of cancer incidence and mortality in the U.S. Redoubled efforts to act on current knowledge regarding how to prevent, detect, and treat cancer can result in attaining approximately 80% of the ACS challenge goal for cancer incidence rates and 60% of the ACS challenge goal for cancer mortality rates by the year 2015. New findings from cancer research are needed and will have to be applied quickly if the ACS challenge goals are to be met fully.     

Lung cancer screening by spiral CT. What is the optimal target population for screening trials?

The purpose of this document is to provide recommendations for the selection of the optimal target population for lung cancer screening trials with Spiral Computer Tomography based on an analysis of risk factors and high-risk populations. Our recommendations are to include current or ex-smokers (<5 years) with a smoking history of at least 30 years and an average consumption of at least 20 cigarettes a day. When these selection criteria are applied there is no need for a lower age cut-off. Elderly people can be included as long as their life expectancy is more than 10 years. Participants should be fit enough to undergo thoracic surgery. They may have a history of previous cancer, provided that the cancer has been curatively treated at least 5 years ago without evidence of relapse, except for breast cancer, melanoma and hypernephroma. People with an inability to lie flat, who are unable to hold their breath for 20 s, with a body weight above 140 kg, a chest CT scan within 1 year before enrolment or a previous pneumonectomy should not be invited. The inadequacy of the unit 'Pack-Years' (PY) to estimate the individual lung cancer risk is recognised, and future initiatives to develop an appropriate lung cancer risk model are encouraged.     

Does where you live play an important role in cancer incidence in the U.S.?

Some studies have shown disproportionate cancer incidence burden in rural areas which may be attributable partly due to the use of ‘rural’ as a generic term implying homogeneity of risk/protective factors across wide geographic spans. Counties in SEER 18 registries (years 2001-2011) were classified by their Rural-Urban Continuum Code (RUCC) and aggregated into urban, adjacent rural, and non-adjacent rural and were also aggregated into 3 regions: North, South, and West. Two-way ANCOVA was performed with region and RUCC as factors with adjustment for rates of common risk factors obtained from the County Health Rankings (2013). RUCC has a significant effect on incidence rate in urban areas on breast (P =0.001) and prostate (P =0.009). Colorectal significantly varies by region (P<0.0001), and the effect of rurality significantly varies across regions with North highest (P=0.0005). Lung rates significantly vary across both region and RUCC (P<0.0001 and P=0.0001, respectively). The analysis shows that risk-adjusted cancer incidence varies significantly across regions. However, we also found that rural cancer incidence significantly varied across otherwise-similar rural areas implying that ‘rural’ is not a homogeneous classification.     

Are U.S. trends a barometer of future cancer transitions in emerging economies?

The currently high cancer incidence rates in the U.S. and other high-income countries have been strongly affected by the acquisition of environmental and lifestyle risk factors that accompanied socioeconomic growth in the second half of the last century. The very same factors are now operating in many low- and middle-income countries (LMIC) undergoing rapid socioeconomic transition. A parallel is drawn between the past cancer trends in the U.S. and those anticipated in LMIC transitioning towards higher levels of socioeconomic development. We expect to see a major upsurge in the (still low to intermediate) cancer incidence and mortality rates in LMIC over the next decades, which coupled with population aging and growth, would translate to a scale of individuals diagnosed with, living and dying from cancer unparalleled in history. On account of resource constraints and organizational limitations, prevention strategies need to be prioritized in LMIC.     

Lung cancer mortality reduction by LDCT screening—Results from the randomized German LUSI trial

In 2011, the U.S. National Lung Cancer Screening Trial (NLST) reported a 20% reduction of lung cancer mortality after regular screening by low-dose computed tomography (LDCT), as compared to X-ray screening. The introduction of lung cancer screening programs in Europe awaits confirmation of these first findings from European trials that started in parallel with the NLST. The German Lung cancer Screening Intervention (LUSI) is a randomized trial among 4,052 long-term smokers, 50–69 years of age, recruited from the general population, comparing five annual rounds of LDCT screening (screening arm; n = 2,029 participants) with a control arm (n = 2,023) followed by annual postal questionnaire inquiries. Data on lung cancer incidence and mortality and vital status were collected from hospitals or office-based physicians, cancer registries, population registers and health offices. Over an average observation time of 8.8 years after randomization, the hazard ratio for lung cancer mortality was 0.74 (95% CI: 0.46–1.19; p = 0.21) among men and women combined. Modeling by sex, however showed a statistically significant reduction in lung cancer mortality among women (HR = 0.31 [95% CI: 0.10–0.96], p = 0.04), but not among men (HR = 0.94 [95% CI: 0.54–1.61], p = 0.81) screened by LDCT (p_{heterogeneity} = 0.09). Findings from LUSI are in line with those from other trials, including NLST, that suggest a stronger reduction of lung cancer mortality after LDCT screening among women as compared to men. This heterogeneity could be the result of different relative counts of lung tumor subtypes occurring in men and women.     

Serum triglycerides and colorectal adenoma in a case–control study among cancer screening examinees (Japan)

Objective Most epidemiologic studies have shown serum triglycerides to be associated with colorectal adenoma. However, whether the association can be modified by smoking is unknown. We cross-sectionally investigated the association of serum triglycerides with the risk of adenoma by smoking status. Methods We identified 782 newly diagnosed adenoma cases from the examinees of a colorectal cancer screening program. All cases were diagnosed by a magnifying colonoscopy with dye spreading. We determined 738 controls without present illness or past history of adenoma from among the examinees. They provided their lifestyle information and fasting blood samples to measure their serum triglycerides. We calculated odds ratios (OR) and 95% confidence intervals (CI) of colorectal adenoma for serum triglycerides. Results High serum triglycerides were associated with colorectal adenoma (OR 1.5; 95% CI 1.1–2.0 for the highest versus the lowest quartile, P _trend, 0.030). A stronger association was observed between three or more adenoma cases and study controls (OR 2.3; 95% CI 1.3–4.2, P _trend, < 0.0010). After classifying the study subjects by smoking status, a significant linear risk trend was found in ever-smokers (P _trend, 0.0018) but not in never-smokers (P _trend, 0.94; P _interaction, 0.067). Conclusions Our results suggested that a higher serum triglyceride level may be related to a larger number of adenomas. Adenoma development involving an elevated serum triglyceride level may be modified by smoking.     

The excess burden of side-effects from treatment in men allocated to screening for prostate cancer. The Göteborg randomised population-based prostate cancer screening trial

Background

The number of men needed to treat to prevent one death is rather high in prostate cancer screening. How this affects the burden of treatment-related side-effects is unclear. The aim of this study was to evaluate the treatment related morbidity following radical prostatectomy in men participating in the Göteborg randomised population-based prostate cancer screening trial.

Methods

In 1995, 20,000 men aged 50-64 years were randomly allocated (1:1) to biennial PSA-screening or to a control group not invited. A subset of prostate cancer patients undergoing radical prostatectomy between 2001 and 2008 responded to questionnaires preoperatively and at 18 months postoperatively. The primary endpoint was patient-reported frequencies of erectile dysfunction as measured by the validated International Index of Erectile Function-5 questionnaire and urinary incontinence as assessed by use of pads. Analyses were made according to intention to screen.

Findings

After 14 years of follow-up, a total of 1849 men were detected with prostate cancer (1138 screened versus 711 controls, excluding 7 cancers detected at autopsy in the control group). Overall, 1047 received treatment with curative intent and radical prostatectomy was performed in 829 cases (79.2%). In this study, 294 of these men participated (205 screened and 89 controls). Of preoperatively potent men 79.1% (91/115) in the screening-group and 90.7% (49/54) in the control-group became impotent or sexually inactive 18 months postoperatively, whereas 14.3% (29/203) of screened men and 20.5% (18/88) of controls were considered postoperatively incontinent (regular use of pads). Extrapolated data yields that 120/10,000 more men become impotent and 25/10,000 more men will have the need of pads among men invited to regular PSA screening. The ‘cost’ per life saved at the same follow-up of screening is four men impotent and less than one man incontinent.

Interpretation

Despite the relatively high risk of erectile dysfunction and incontinence following radical prostatectomy for prostate cancer, the excess burden of permanent side-effects after population-based screening can be regarded as relatively low, when related to the number of men saved from prostate cancer death. These data can be useful when calculating the harms and benefits of screening. However, the outcome on a population-level may differ from the benefit for the individual.