Effect of race on thyroid cancer care in an equal access healthcare system

Background

Thyroid cancer is more likely to present at an advanced age with larger tumor size in black patients. The aim of this study was to assess the influence of race on the presentation, treatment, and survival in an equal access healthcare system.

Methods

This retrospective study included all black and white patients with thyroid cancer who were treated at a Department of Defense facility from 1986 to 2008. Patients' age, tumor size, lymph node status, treatment, and survival were compared.

Results

A total of 4,625 patients were identified. There was no difference between black and white patients in regards to age at presentation, tumor size, use of surgical and/or radiation therapy, and overall 5-year survival rate. Black patients had a lower rate of lymph node involvement.

Conclusions

In an equal access healthcare system, black patients have similar disease presentation, undergo similar treatment, and have the same survival as white patients.     

Incidence of Prostate Cancer After Termination of Screening in a Population-based Randomised Screening Trial

Background

In a previous publication from the Göteborg randomised screening trial from 2010, biennial prostate-specific antigen (PSA) screening for men ≤69 yr of age was shown to lower prostate cancer (PCa) mortality by 44%. The evidence of the optimal age to stop screening, however, is limited.

Objective

To examine the risk of PCa after the discontinuation of screening.

Design, setting, and participants

In December 1994, 20 000 men in Göteborg, Sweden, between the ages of 50 and 65 yr were randomised to a screening arm (invited biennially to PSA testing) and a control arm (not invited). At the upper age limit (average: 69 yr), a total of 13 423 men (6449 and 6974 in the screening and control arms, respectively) were still alive without PCa. The incidence of PCa hereafter was established by matching with the Western Swedish Cancer Register. Participants were followed until a diagnosis of PCa, death, or final follow-up on June 30, 2012, or for a maximum of 12 yr after the last invitation.

Outcome measurements and statistical analysis

Incidence rates and disease-free survival were calculated with life table models and Kaplan-Meier estimates. A competing risk model was also applied.

Results and limitations

Postscreening, 173 cases of PCa were diagnosed in the screening arm (median follow-up: 4.8 yr) and 371 in the control arm (median follow-up: 4.9 yr). Up to 9 yr postscreening, all risk groups were more commonly diagnosed in the control arm, but after 9 yr the rates in the screening arm caught up, other than those for the low-risk group. PCa mortality also caught up after 9 yr.

Conclusions

Nine years after the termination of PSA testing, the incidence of potentially lethal cancers equals that of nonscreened men. Considering the high PCa mortality rate in men >80 yr of age, a general age of 70 yr to discontinue screening might be too low. Instead, a flexible age to discontinue based on individual risk stratification should be recommended.     

上海市胃癌发病率和死亡率的变化与预测

分析1980年～1998年上海市胃癌发病率、死亡率变化及其发展趋势,了解胃癌的危害程度,提出胃癌防治策略的建议。方法：收集上海市肿瘤登记和死因登记资料中胃癌发病、死亡资料,计算发病率、死亡率和标化发病率、死亡率,采用线性回归方程拟合分析发病率和死亡率和变化趋势,并预测2005年上海市胃癌发病、死亡情况。结果和结论：目前胃癌居上海市恶性肿瘤发病、死亡第2位,上海市胃癌的发病和死亡近19年来有下降的趋势,60岁以上人群是胃癌发病死亡的高发人群,男性的发病和死亡情况比女性严重。     

上海市区乳腺癌流行现状及趋势分析

目的：分析1972－1999年上海市区女性乳腺癌发病情况,并据此预测今后20年上海市乳腺癌的发病趋势,为确定乳腺癌的研究方向和制定防治策略提供依据。方法：收集上海市肿瘤登记资料中乳腺癌发病历史资料, 计算发病率和标化发病率,采用线性回归方程拟合分析发病率的变化趋势,结合人口学资料预测未来20年发病情况。结果：上海市区女性乳腺癌发病率呈明显上升趋势,1999年比1972年上升了180．30％,25岁以上各年龄组女性的发病率均呈明显上升趋势,45－59岁组女性上升速度最快。乳腺癌发病率在地区分布上呈现从城区向郊县由高向低分布的态势。人口学预测结果推算,到2015年全市乳腺癌新发病人将超过6000例。分析结果提示乳腺癌上升趋势可能与相关危险因素变化有关。     

Thyroid Metastases from Gallbladder Cancer

Background  Gallbladder cancer is an aggressive malignancy and radical resection is the only curative therapy available. Metastatic disease in the thyroid is rarely seen; however, different studies have confirmed that the most common primary tumor source is the kidney. Case Report  Thyroid metastases from tumors originating in the gastrointestinal tract have been reported. We report a patient with gallbladder cancer (T2N1M0) treated with radical resection and postoperative chemoradiation who developed thyroid metastases.     

合并转移的甲状腺微小癌诊治(附16例分析)

目的：探讨合并转移的甲状腺微小癌的危害性及其诊断和治疗。方法：总结我科１９７８～２０００年收治的合并转移的甲状腺微小癌１６例,结合文献进行临床分析。结果：术中及住院期间无一死亡。５例发生术后转移（３１.２５％）,远处转移为主,与同期无转移的甲状腺微小癌９２例相比（仅２例复发）,具有明显统计学意义上的差别（Ｐ＜０．００１）。病理切片结果提示本组资料的癌灶均已穿透包膜,存在包膜外血管浸润。其中７例因远处转移于术后５年内死亡。结论：应高度重视本病的危害性。掌握本病的临床特点,甲状腺Ｂ超检查结合转移灶穿刺活检可提高其诊断率。手术为首选治疗方法。术后可辅以甲状腺素Ｉ同位素或化疗等治疗。     

Racial/Ethnic Differences in Cancer Risk After Kidney Transplantation

Transplant recipients have elevated cancer risk, but it is unknown if cancer risk differs across race and ethnicity as in the general population. US kidney recipients (N = 87,895) in the Transplant Cancer Match Study between 1992 and 2008 were evaluated for racial/ethnic differences in risk for six common cancers after transplantation. Compared to white recipients, black recipients had lower incidence of non‐Hodgkin lymphoma (NHL) (adjusted incidence rate ratio [aIRR] 0.60, p<0.001) and higher incidence of kidney (aIRR 2.09, p<0.001) and prostate cancer (aIRR 2.14, p<0.001); Hispanic recipients had lower incidence of NHL (aIRR 0.64, p = 0.001), lung (aIRR 0.41, p < 0.001), breast (aIRR 0.53, p = 0.003) and prostate cancer (aIRR 0.72, p = 0.05). Colorectal cancer incidence was similar across groups. Standardized incidence ratios (SIRs) measured the effect of transplantation on cancer risk and were similar for most cancers (p≥0.1). However, black and Hispanic recipients had larger increases in kidney cancer risk with transplantation (SIRs: 8.96 in blacks, 5.95 in Hispanics vs. 4.44 in whites), and only blacks had elevated prostate cancer risk following transplantation (SIR: 1.21). Racial/ethnic differences in cancer risk after transplantation mirror general population patterns, except for kidney and prostate cancers where differences reflect the effects of end‐stage renal disease or transplantation.     

Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents

Purpose

While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs.

Methods

A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity.

Results

Of 1248 patients, 11.3% wore helmets, with decreased use among children 12 years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality.

Conclusion

Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.     

Molecular Phenotyping of Thyroid Tumors Identifies a Marker Panel for Differentiated Thyroid Cancer Diagnosis

Background  Currently, a large proportion of individuals undergo thyroidectomy as a diagnostic procedure for cancer. The objective of this work was to evaluate the molecular phenotype of differentiated thyroid cancer (DTC) and benign thyroid lesions to identify molecular markers that allow for accurate thyroid cancer diagnosis. Methods  Tissue microarrays consisting of 100 benign and 105 malignant thyroid lesions, plus 24 lymph node samples, were stained for a panel of 57 molecular markers. Significant associations between marker staining and tumor pathology (DTC versus benign) were determined using contingency table and Mann-Whitney U (MU) tests. A Random Forests classifier algorithm was also used to identify useful/important molecular classifiers. Results  Of the 57 diagnostic markers evaluated 35 (61%) were significantly associated with a DTC diagnosis after multiple testing correction. Of these, in DTC compared with benign thyroid tumors, 8 markers were downregulated and 27 upregulated. The most significant markers for DTC diagnosis were: Galectin-3, Cytokeratin 19, Vascular Endothelial Growth Factor, Androgen Receptor, p16, Aurora-A, and HBME-1. Using the entire molecular marker panel, a Random Forests algorithm was able to classify tumors as DTC or benign with an estimated sensitivity of 87.9%, specificity of 94.0%, and an accuracy of 91.0%. Conclusion  Evaluation of the DTC and benign thyroid tumor molecular phenotype has allowed for identification of a marker panel, composed of both established and novel markers, useful for thyroid cancer diagnosis. These results suggest that further study of the molecular profile of thyroid tumors is warranted, and a diagnostic molecular marker panel may potentially improve patient selection for thyroid surgery.     

高频彩色多普勒超声诊断甲状腺癌的声像图特征分析

目的观察应用高频彩色多普勒超声诊断甲状腺癌的声像图特征,分析高频彩色多普勒超声对诊断甲状腺癌的应用价值。方法对笔者所在医院2008年4月～2010年12月应用高频彩色多普勒超声诊断甲状腺癌的声像图特征进行总结分析。结果甲状腺癌以乳头状癌最多见,其彩色多普勒超声的声像图特征主要表现为彤态不规则、边界清晰的低同声,内部多有钙化,以砂砾样钙化为多见,部分病例后方回声有衰减,含纤维组织越多的病灶,衰减越明显,病灶纵横比接近1：1,血流信号没有特点。滤泡状癌为低回声,多有完整包膜,边缘欠规整,血流多丰富。木分化癌与髓样癌体积较大,回声不均,无包膜,未分化癌常有坏死液化及钙化,髓样癌可有钙化。结论高频彩色多普勒超声的广泛应用为甲状腺癌的诊断及鉴别诊断提供了可靠的依据。     

The Acceleration in Papillary Thyroid Cancer Incidence Rates is Similar Among Racial and Ethnic Groups in the United States

Background

Reports of similar age-specific incidence rates and a female-to-male gender disparity by racial/ethnic groups suggests that further consideration of race-specific patterns may confer insight into the possible causes of thyroid cancer or explanations for the increase in incidence.

Methods

We used the National Cancer Institute’s (NCIs) surveillance, epidemiology, and end results (SEER) program and Joinpoint Regression for cases diagnosed during 1992–2009 to investigate trends and rates of acceleration for papillary thyroid cancer by gender and race/ethnicity.

Results

We determined the annual percent change (APC) and found a yearly increase of 7.0 % for papillary thyroid cancer for the most recent APC trend, with an APC of 6.3 and 7.1 % for white males and females, respectively; an APC of 4.3 and 8.4 % for black males and females, respectively; an APC of 4.2 and 6.7 % for Hispanic males and females, respectively; and an APC of 3.4 and 6.4 % in Asian/PI males and females, respectively. The APC projections show the rates of papillary thyroid cancer rising in males, but the patterns are more dramatic in females, with rates of papillary thyroid cancer in females surpassing rates of common cancers and becoming the third most common cancer in women of all ages by 2019.

Conclusions

Although the lowest rates of thyroid cancer are observed in blacks, the greatest rate of acceleration is occurring in black females. Our data also show that the rate of papillary thyroid cancer will continue to surpass rates of ovarian cancer, and in white women: it is projected to be more incident than colorectal cancer as well; and in Hispanic and Asian/Pacific Islander women, rates of papillary thyroid cancer are projected to be higher than lung, colorectal, and ovarian cancers in the near future.     

Racial disparities in the use of outpatient mastectomy

Background

Racial disparities exist within many domains of cancer care. This study was designed to identify differences in the use of outpatient mastectomy (OM) based on patient race.

Methods

We identified patients in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File (during the years 2007–2010) who underwent a mastectomy. The association between mastectomy setting, patient race, patient age, American Society of Anesthesiology physical status classification, functional status, mastectomy type, and hospital teaching status was determined using the chi-square test. A multivariable logistic regression analysis was developed to assess the relative odds of undergoing OM by race, with adjustment for potential confounders.

Results

We identified 47,318 patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent a mastectomy during the study time frame. More than half (62.6%) of mastectomies were performed in the outpatient setting. All racial minorities had lower rates of OM, with 63.8% of white patients; 59.1% of black patients; 57.4% of Asian, Native Hawaiian, or Pacific Islander patients; and 43.9% of American Indian or Alaska Native patients undergoing OM (P < 0.001). After adjustment for multiple confounders, black patients, American Indian or Alaska Native patients, and those of unknown race were all less likely to undergo OM (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.80–0.93; OR, 0.55; 95% CI, 0.41–0.72; and OR, 0.70; 95% CI, 0.64–0.76, respectively) compared with white patients.

Conclusions

Disparities exist in the use of OM among racial minorities. Further studies are needed to identify the role of cultural preferences, physician attitudes, and insurer encouragements that may influence these patterns of use.     

Outcome of Patients Surgically Treated for Various Forms of Hyperthyroidism with Differentiated Thyroid Cancer: Experience at an Endocrine Center in Italy

Purpose The incidence and aggressiveness of thyroid cancer associated with hyperthyroidism remains a subject of much controversy. The aim of this study was to analyze the frequency of coexisting hyperthyroidism and thyroid cancer, and to determine whether cancer becomes more aggressive with different forms of hyperthyroidism. Methods We retrospectively studied 2 449 patients assessed for hyperthyroidism between 1985 and 2001. All patients with a “cold” nodule on scintigraphy, such as those with Graves' disease and a concomitant solid nodule, underwent fine-needle aspiration biopsy (FNAB). Criteria for surgery were cytological findings indicative of malignancy, goiter with signs of tracheal or esophageal compression, side effects of antithyroid drug therapy, or Graves' disease with multiple relapses after therapy withdrawal or responsiveness to antithyroid drugs. Results Thyroid cancer was diagnosed more frequently in patients with Graves' disease (6.5%) than in those with uninodular toxic goiter (UTG) (4.4%) or multinodular toxic goiter (MTG) (3.9%). Lymph node involvement was found in 56% of the patients with Graves' disease, in 23% of those with MTG, and in none of those with UTG. Distant metastases were found in one patient with Graves' disease. Conclusions Cancers associated with Graves' disease seems to be more aggressive than those associated with MTG or UTG. Thus, we suggest that patients with Graves' disease be carefully monitored for the detection of thyroid nodules. Ultrasonography seems to be the best modality to detect such nodules.     

Brachiocephalic Vein Thrombus of Papillary Thyroid Cancer: Report of a Case

Differentiated thyroid cancer sometimes shows microscopic vascular invasion but rarely causes a tumor thrombus in a great vein. A preoperative diagnosis of the latter condition is difficult if a patient does not have any overt symptoms, but it is important for operative planning. We encountered a 26-year-old woman with papillary thyroid cancer and a tumor thrombus extending from the brachiocephalic vein to the superior vena cava. The tumor was successfully treated by surgical resection. To our knowledge only 19 such cases have so far been reported. We herein report our case, review the literature, and discuss the associated diagnostic problems and treatments including such areas as age, gender, symptoms, pathology, extension, and outcome. Received: October 20, 2000 / Accepted: July 17, 2001     

Ultrasonography as a Method of Screening for Tracheal Invasion by Papillary Thyroid Cancer

Purpose To assess the reliability of ultrasonography (US) for detecting tracheal invasion by papillary thyroid cancer (PTC).Methods We reviewed the clinical and surgical data of 509 patients who underwent surgery for primary PTC during 2003, after routine preoperative US.Results Ultrasonography showed possible tracheal invasion in 43 of the 509 patients. However, the US findings could not be evaluated in 32 patients because of high tumor calcification, a tumor diameter greater than 4 cm, or tumor extension inferior to the clavicle. We shaved the tracheal wall in 11 patients and resected the tracheal wall in 2 patients. The sensitivity of US for diagnosing of tracheal invasion was 91%, the specificity 93%, the predictive value of a positive test 25%, the predictive value of a negative test 99%, and the accuracy 93%.Conclusion Ultrasonography is a useful method of screening for tracheal invasion. A negative sonogram is a reliable indicator of the absence of tracheal invasion, except when tumors are highly calcified or extend inferior to the clavicle.