What caused the decline in breast cancer mortality in the united kingdom?

BACKGROUND: The marked improvement in breast cancer mortality in the United Kingdom (UK) has attracted worldwide interest. To understand the details of this phenomenon the morbidity and mortality rates of breast cancer in the UK during the past 30 years were analyzed. METHODS: The official publications and statistical data were available and downloaded at the official UK Web sites of the National Health Service, National Statistics and Cancer Research Organization. Parts of the data were obtained directly from the National Cancer Intelligence Centre of UK. RESULTS: After the beginning of breast screening the morbidity of the subject age group soared up to the level of an age group that was 10 years older. Noninvasive carcinoma was often discovered in the subject age group after the beginning of breast screening and constituted 8.3%of all cases. The mortality rates, however, began to decrease before the start of screening and fell clearly even in age groups other than that of the study group and particularly in elderly women. CONCLUSIONS: Not only the prevalence of breast screening but also the increase of early stage cancer in all age groups have probably resulted from improvements in diagnostic technology and heightened social interest and awareness. In addition, the development of adjuvant endocrine therapy must have influenced the evident improvement in mortality of breast cancer in the UK.     

Targeted therapies in oncology: in the crosshairs or at the crossroads?

Normal cellular behavior depends on functional integration of extracellular stimuli with intracellular signal transduction pathways. Coupling cell surface message reception to nuclear gene expression is no longer a linear model constructed with molecular components acting merely as conduits to relay signals that cascade toward the nucleus. What has emerged instead is a highly integrated circuit comprised of numerous molecular components harmoniously programmed to communicate a multitude of internal signals that controls cellular response. Despite increasing understanding of cell signaling, mutinous elements embedded in these pathways have defied complete resolution. Research indicates that propagation of signals emanating from the extracellular environment to the cell nucleus follows a complex internal circuit equipped with sophisticated molecular components that provide rigid control over a variety of cellular responses. Although increasing understanding of genetic aberrations and signaling pathway transgressions can lead to novel strategies for targeting cancer cells, the disappointing results from clinical trials suggest that the occult processes responsible for neoplastic transformation remain largely unexplained.     

Was the drop in mammography rates in 2005 associated with the drop in hormone therapy use?

BACKGROUND:

In 2005, mammography rates in the United States dropped nationally for the first time among age‐eligible women. An increased risk of breast cancer related to hormone therapy (HT) use reported in 2002 led to a dramatic drop in its use by 2005. Because current users of HT also tend to have higher mammography rates, the authors examined whether concurrent drops in HT and mammography use were associated.

METHODS:

Multivariate logistic regression was used to test for an interaction between HT use and survey year, controlling for a range of measurable factors in data from the 2000 and 2005 National Health Interview Surveys (NHIS).

RESULTS:

Women ages 50 to 64 years were more likely to report a recent mammogram if they also reported more education, a usual source of care, private health insurance, any race except non‐Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT. Women aged ≥65 years were more likely to report a recent mammogram if they also reported younger age (ages 65‐74 years), more education, a usual source of care, having Medicare Part B or other supplemental Medicare insurance, excellent health, any race except non‐Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT.

CONCLUSIONS:

The change in HT use was associated with the drop in mammography use for women ages 50 to 64 years but not for women aged ≥65 years. NHIS data explained 70% to 80% of the change in mammography use. Cancer 2011;. © 2011 American Cancer Society.     

The carer's place in the cancer situation: where does the carer stand in the medical setting?

Recent thinking about policy on cancer services in the UK has highlighted the importance of recognising the needs of carers, but is unclear about the ways in which this might be done. Our recent study on the psychosocial needs of cancer patients and their main informal carers was unusual in its combined focus on patients and carers experiencing the ‘cancer journey’ together. One of our aims was to contribute to an understanding of what it means to be the main carer of someone with cancer. Using the qualitative data from the 79 carers and patients we interviewed, we ask how carers negotiate their place in the cancer situation, and particularly how do carers identify their role in relation to the patient and the medical setting? We posit carers as taking part in a shifting process of ‘carerhood’ in which competing needs vie for space. Our evidence suggests carers actively negotiate the challenges of their position in dealing with issues of identity, support, and sharing. We suggest that when the carer's involvement in the cancer scenario is recognised and legitimised by others it is easier for them to attend to their own needs alongside those of the patient.     

Do changes in cigarette design influence the rise in adenocarcinoma of the lung?

Background  

Incidence rates for adenocarcinoma of the lung are increasing and are higher in the United States than in many other developed countries. We examine whether these trends may be associated with changes in cigarette design.     

When Should the Seminal Vesicles be Included in the Target Volume in Prostate Radiotherapy?

External beam radiotherapy to the prostate and seminal vesicles as a radical treatment for prostate cancer can result in a significant dose being delivered to the rectum. This can be reduced if the target volume includes the prostate only. Using a Medline search, published studies are reviewed to show that the risk of seminal vesicle involvement can be accurately predicted using readily available pre-treatment parameters. We recommend when to exclude the seminal vesicles from a target volume, and the proportion of seminal vesicles that should be included in a target volume in higher risk patients.     

Gastrointestinal Stromal Tumors in the Rectum

OBJECTIVE To investigate the clinical and pathologic features of rectal gastrointestinal stromal tumors （GIST） and to evaluate their reasonable management. METHODS The clinical and pathological data for 19 patients with rectal GIST over the past 19 years were studied retrospectively. RESULTS The diagnosis of the 19 cases was identified by surgery and pathology. All the rectal GISTs were spindle cell type with immunohistochemical analysis showing positive reactivity for CD117 （100%） and CD34 （73.7%）. There were 4 cases of high risk, 3 cases of intermediate risk, 5 cases of low risk and 7 cases of very low risk of aggressive behavior in this study. CONCLUSION Rectal GIST, without specific symptoms in the early stage, has a low incidence and usually shows low risk of aggressive behavior. It is difficult to produce an accurate pathological diagnosis before operation and it is difficult to decide whether to save the sphincter before or during operation. Reasonable initial treatment includes trans-anal local resection as the best recommend management of low risk submucosal rectal GIST （〈3.0 cm）.     

Variation in the prevalence of gastric cancer in Perú

Most cases of gastric cancers occur in non-industrialized countries but there is scarce information about the epidemiology of this illness in these countries. Our study examined whether there was a variation in the prevalence of gastric cancer in Lima, Perú over the last 2 decades. Subjects older than 29 years of age were included. They underwent an esophagogastroduedonoscopy at 3 socioeconomically different health facilities in Lima: a county hospital (7,168 subjects), a Peruvian-Japanese Clinic (14,794 individuals) and a private hospital (4,893 individuals). Birth cohort prevalence of gastric cancer was used. Regression models were calculated to predict the future prevalence of gastric cancer. It was found that the birth cohort prevalence of gastric cancer decreased in Perú from 22.7 to 2% (p < 0.001), from 12 to 0.5% (p < 0.001), and from 6.5 to 0.1% (p < 0.001) in the low, middle and high socioeconomic group, respectively. The prevalence of intestinal metaplasia decreased from 44.3 to 12.5% (p < 0.001), from 28.4 to 5% (p < 0.001), and from 19.4 to 2.2% (p < 0.001) in the low, middle and high socioeconomic status, respectively. These trends will likely persist over the future decades. Nevertheless, the prevalence of gastric cancer remains high in subjects older than 59 years of age in the low socioeconomic status. It is concluded that the prevalence of gastric cancer is decreasing in Perú, similar to the current trend undergoing in industrialized nations. However, there are still specific groups with high prevalence that might benefit from screening for early detection and treatment.     

Trends in cervical cancer in the Netherlands until 2007: Has the bottom been reached?

We explored trends in incidence and mortality of cervical cancer by age, stage and morphology, and linked the observed trends to screening activities. Data was retrieved from the Netherlands Cancer Registry during 1989–2007 (incidence) and Statistics Netherlands during 1970–2007 (mortality). Trends were evaluated by calculating the estimated annual percentage change (EAPC). Joinpoint regression analysis was used to detect changes in trends. Cervical intraepithelial neoplasia (CIN) detection rates were calculated by data from “the nationwide network and registry of histo‐ and cytopathology” during 1990–2006. Total age‐adjusted incidence rate (European standardized rate (ESR)) was 7.9 per 100,000 woman years in 2007. During 1989–1998, incidence rates decreased with an EAPC of ?1.3% (95% confidence interval (CI) ?2.2 to ?0.3), during 1998–2001 with ?6.7% (95% CI: ?16.4 to 4.1), and increased during 2001–2007 with 2.3% (95% CI: 0.4 to 4.2). Total mortality ESR was 1.9 per 100,000 woman years in 2007. Mortality rates decreased during 1970–1994 annually with ?4.1% (95% CI: ?4.6% to ?3.7%), and with ?2.6% (95% CI: ?3.8% to ?1.5%) during 1994–2007. The observed trend in total incidence is similar to the trend in squamous cell carcinomas in age group 35–54 years, suggesting that the observed trends are likely to be associated to changes in the screening program. This is supported by the trend in CINIII detection rates. In conclusion, incidence and mortality overall decreased and leveled off. On top of that there was an extra decrease that was compensated by a following recent increase in incidence, probably resulting from reorganization of the Dutch screening program.     

What and Where for Publications by Cancer Registries in the Asian Pacific? - Roles for the APJCP in the Future

The absolute necessity of cancer registration for cancer control planning is well accepted. The registry at thenational or local level can provide not only essential data for cancer incidence, mortality and survival but mayalso point to risk and protective factors and efficacy of interventions by conducting epidemiological research.Timely publication of research findings in PubMed indexed journals is of the essence, especially in examplesthat allow free access so that the widest dissemination of information can be achieved. The present commentarycovers the scope of research in Asia or using Asian data the period 2008-2013, nearly 40% of a total of over 300papers being published in the APJCP. In order to reach its full potential the registry should incorporate manyskills. Cooperation for this purpose, whether it be national, regional, Asia-wide or international, is a high priorityand the International Agency for Research on Cancer, together with the National Cancer Institute in Thailandand the APOCP/APJCP are staging an Asian Cancer Network Forum in Bangkok in February of 2014 to allowdiscussion of ways forward. It is hoped that representatives from all regions of Asia will decide to attend anda l so contribute country reports for publication in a special supplement of the APJCP.     

Specific changes in the parameters of blood antioxidant status in patients with cervical carcinoma in the course of cancer therapyĭ

Parameters of the blood and plasma antioxidant systems were investigated at different stages of specific therapy for T3NxM0 cervical tumors in 23 patients to identify mechanisms of "relative" drug resistance. Treatment included preoperative telegammatherapy (10 Gy), aregional and regional lymphinfusion with low and high doses of cytostatics, respectively, complemented with endolymphatic injection of tocopherol acetate 100 ng. As a result, surgery after Wertheim became feasible in 14 out of 23 patients following external exposure to 30-40 Gy. Morphological examination detected metastases into the regional lymph nodes in 3 patients. The advantages offered by the treatment modality include adequate response to therapy as well as access to control of free-radical processes taking place in membranes of immunocompetent cells which in turn assures good clinical results.     

RES function and tumour take and tumour growth in the liver and in the kidney—An experimental study in rats

This experimental study in rats examines tumour take and growth after RES modulation in an organ rich in macrophages—the liver—vs. an organ poor in macrophages—the kidney. A control group of 16 rats had 1.0 × 10⁶ transplantable adenocarcinoma cells inoculated in the liver and the same number in the left kidney. They were compared with a RE-stimulated group of 16 rats treated i.v. with Zymosan (3 mg/100 g for 3 days) and a RE-depressed group of 16 rats treated with i.v. methylpalmitate (100 mg/100 g for 3 days) before tumour inoculation. Tumour size was measured on days 7 and 14. The animals were killed on day 14. Mortality was significantly higher in methylpalmitate-treated rats than in control groups. Tumour take in the kidney was not affected by RES stimulation or depression. In the liver, RES stimulation caused significantly less tumour take. Depression of RES with methylpalmitate did not increase tumour take or tumour growth in the liver, which was very high in the control group.     

Progress in the Management of Malignant Pleural Mesothelioma in 2017

Malignant pleural mesothelioma (MPM) is an uncommon, almost universally fatal, asbestos-induced malignancy. New and effective strategies for diagnosis, prognostication, and treatment are urgently needed. Herein we review the advances in MPM achieved in 2017. Whereas recent epidemiological data demonstrated that the incidence of MPM-related death continued to increase in United States between 2009 and 2015, new insight into the molecular pathogenesis and the immunological tumor microenvironment of MPM, for example, regarding the role of BRCA1 associated protein 1 and the expression programmed death receptor ligand 1, are highlighting new potential therapeutic strategies. Furthermore, there continues to be an ever-expanding number of clinical studies investigating systemic therapies for MPM. These trials are primarily focused on immunotherapy using immune checkpoint inhibitors alone or in combination with other immunotherapies and nonimmunotherapies. In addition, other promising targeted therapies, including pegylated adenosine deiminase (ADI-PEG20), which focuses on argininosuccinate synthase 1–deficient tumors, and tazemetostat, an enhancer of zeste 2 polycomb repressive complex 2 subunit inhibitor of BRCA1 associated protein 1 gene (BAP1)-deficient tumors, are currently being explored.     

Trends in the Incidence of Non-Hodgkin’s Lymphoma in India

Non-Hodgkin’s Lymphoma is the 11th most common cause of cancer incidence. It is most frequent in highincome countries, with rates more than twice those of middle - to low – income countries. It is usually fatal, witha 5 year survival rate of less than 35 percent. It is not a single cancer, but rather a wide group of cancers(including entities such as Burkitt’s lymphoma and diffuse large B-cell lymphoma), each with a districtgeographical distribution, development path, age profile and prognosis. Non-Hodgkin’s lymphoma is increasingin incidence world wide. On this background, in this paper an attempt has been made to study the trends inNon-Hodgkin’s Lymphoma in various Indian populations in both sexes.