Second primary cancers after sporadic and familial colorectal cancer.

Second cancers were studied among 68,104 cases of colorectal cancer (CRC) from the Swedish Family-Cancer Database. A total of 1,113 patients received a diagnosis of second CRC; 25 of them had a family history of CRC. Cases of second CRC with a family history were diagnosed up to 10 years before sporadic cases. The relative risk (RR) of all second CRCs was 2.21 compared with the first CRC. Familial second CRCs had a 2-fold risk compared with the sporadic forms. Age of onset was the most important covariate of second CRCs; the relative risk at ages 15-39 years was 27 compared with the first CRC. Familial CRC was associated with a high risk of small-intestinal, endometrial, and gastric cancers apart from CRC, all typical of hereditary nonpolyposis CRC (HNPCC). Among familial cases, 36% of second CRCs and 100% of endometrial cancers came from families that fulfilled the Bethesda criteria for HNPCC. Only 12 families conformed to the Amsterdam criteria; in family members, the risk of second CRC was 127-fold and that of endometrial cancer 257-fold. Other sites that were in excess among all second cancers were many cancers linked to HNPCC and, additionally, breast, prostate, thyroid and other endocrine, skin, and genital cancers. The high risk of second cancer after early-onset CRC calls for evaluation of family history and clinical surveillance.     

Sporadic breast, ovarian, or uterine cancers as risk factors for colorectal cancer

Sporadic colorectal, breast, endometrial, and ovarian cancers are common human malignancies. Not surprisingly, epidemiologic studies have identified multiple shared risk factors, including obesity, low exercise levels, and possibly hormonal (particularly estrogen) modulation. In addition, unlike hereditary nonpolyposis colorectal cancer syndrome, in which colorectal, endometrial, and ovarian cancers may occur because of a germline mutation in important mismatch repair genes, sporadic versions of these cancers may develop because of shared epigenetic alterations. These changes may be useful predictors of clinical outcome and response to disease-specific therapies.     

Salivary gland toxicity after radioiodine therapy for thyroid cancer

AimsSalivary gland toxicity is a common, but not widely appreciated, adverse effect of high-dose radioiodine (¹³¹I). This study was carried out to determine the incidence of symptoms of salivary gland damage after ¹³¹I treatment for differentiated thyroid cancer.Materials and methodsThis was a prospective study of 76 consecutive patients attending thyroid cancer treatment. Symptoms of salivary gland damage (dry mouth, pain and swelling) were assessed during hospital admission and at follow-up visits. Additionally, a retrospective analysis was carried out of patients recorded in our database as having chronic salivary gland swelling after ¹³¹I ablation.ResultsTwenty patients (26%) developed salivary gland toxicity, 11 (15%) had symptoms within the first 48 h, continuing for 12 months in seven of these patients. The onset of toxicity in a further nine (12%) patients with persistent symptoms did not occur until 3 months after therapy. In total, 16 (21%) patients had evidence of chronic toxicity, typically xerostomia, at 12 months. Toxicity was more common after repeated ¹³¹I administration. After searching our thyroid cancer database, we identified an additional five patients to have chronic salivary gland swelling (chronic sialadenitis or pleomorphic adenoma) 20 months to 23 years after ¹³¹I.ConclusionsPain, swelling and dry mouth occurred frequently after ¹³¹I, with some developing symptoms months or years after administration. Early recognition of salivary gland complications may help to reduce morbidity in these patients.     

Role of chance in familial aggregation of colorectal cancer

A prospective population-based study recorded family trees of 77 colorectal cancer patients younger than 50 years of age. Using mathematical modeling of population age-incidence data, we estimate that 1 (95% confidence limits 0 and 3) of these families is expected to meet the Amsterdam criteria I for HNPCC due to chance clustering of colorectal cancer.     

Radiotherapy for primary thyroid cancer as a risk factor for second primary cancers

Although radiation is considered a risk factor for thyroid cancer, the potential relationship between radiation therapy and the risk of second primary cancer among patients with first primary thyroid cancer has not been evaluated. We identified 26,639 patients with first primary thyroid cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2000. Information on radiation therapy as well as second primary cancers was recorded in SEER. The proportional hazards model was utilized to estimate adjusted risk ratios (RRs) and their 95% confidence intervals (CIs) to assess the potential association between radiation therapy for thyroid cancer and the risk of second primary cancers. With 270,674.33 person-years of follow-up, 1,896 (7.1%) of the 26,639 patients with first primary thyroid cancer developed second primary cancers. Among the second primaries, 35 occurred in the thyroid. No obvious association was observed between radiation therapy and the overall risk of second primary cancer after ten years of follow-up (RR=1.07, 95% CI=0.88-1.30). However, an increased risk was seen for several cancers, including upper digestive system cancers (RR=1.66, 95% CI=1.07-2.57) and myeloid malignancies (RR=3.26, 95% CI=1.39-7.67). Radiation therapy was associated with reduced second cancer risks for thyroid cancer (RR=0.18, 95% CI=0.04-0.76). Beam radiation might be important to the digestive system, radioactive implants might be associated with the male genital system, radioisotopes might have an effect on myeloid malignancies, and combined beam radiation with radioactive implants or radioisotopes might be related to the increased risk of respiratory system cancers. This study suggests that radiation therapy for patients with first primary thyroid cancer might be associated with an increased risk of developing a second primary cancer in the upper digestive system and second primary myeloid malignancies. Radiation therapy for adult patients with thyroid cancer might be associated with a reduced risk of second primary thyroid cancer.     

Follicular thyroid carcinoma: prognostic factors and the role of radioiodine

BACKGROUND: The objective of this study was to investigate the patterns of recurrence, various prognostic factors, and the role of radioiodine in the treatment of patients with follicular thyroid carcinoma (FTC). METHODS: The clinical outcomes of 215 patients with FTC who were treated at a single institution were analyzed retrospectively. The mean follow-up was 10.8 years. RESULTS: The actuarial rates of cause specific survival (CSS), locoregional (LR) control, and freedom from distant metastasis (DM) at 10 years were 81%, 83%, and 72.3%, respectively. The independent prognostic factors for survival were metastasis at presentation (relative risk [RR], 47.7), radioiodine (RAI) treatment (RR, 0.25), extrathyroidal extension (RR, 3.8), and the postoperative absence of macroscopic disease in the neck region (RR, 0.06). In patients who were treated with RAI, both the LR failure rate (RR, 0.24) and the mortality rate (RR, 0.25) were reduced to about 25%. Subgroup analysis revealed that RAI improved the survival of patients with DM at presentation (RR, 0.17) and improved the LR control rate in patients who had no DM at presentation (RR, 0.13). For patients who underwent total thyroidectomy with negative resection margins, RAI significantly reduced the rate of LR recurrence (RR, 0.05). Patients with the minimally invasive type of FTC had a good prognosis. The 10-year rates for CSS, LR control, and freedom from DM were 97.6%, 100%, and 90.6%, respectively. The prognosis of patients with frankly invasive FTC was much poorer. The 10-year rates for CSS, LR control, and freedom from DM were 66.7%, 100%, and 45%, respectively. CONCLUSIONS: RAI is an effective treatment for patients with FTC. It was associated with improved survival rates and fewer recurrences.     

Increased cancer incidence after radioiodine treatment for hyperthyroidism

BACKGROUND: Concerns remain about risk of cancer after radioactive iodine (RAI) treatment for hyperthyroidism, especially in organs that concentrate iodine. The objective was to assess the long-term cancer risk from RAI treatment for hyperthyroidism. METHODS: A total of 2793 hyperthyroid patients treated with RAI at Tampere University Hospital between 1965 and 2002, and 2793 age- and sex-matched reference subjects were followed for an average of 10 years through the Finnish Cancer Registry. RESULTS: Cancer incidence among hyperthyroid patients treated with RAI was higher than in the population-based control group (118.9 vs 94.9 per 10,000 person-years, rate ratio [RR], 1.25; 95% confidence interval [CI]: 1.08-1.46). Furthermore, incidence of stomach (RR, 1.75, 95% CI: 1.00-3.14), kidney (RR, 2.32; 95% CI: 1.06-5.09), and breast (RR, 1.53; 95% CI: 1.07-2.19) cancer was increased among RAI-treated patients. The relative risk of cancer increased with higher RAI dose administered. The increase in cancer incidence was statistically significant in patients treated at the age of 50-59 (RR, 1.44; 95% CI: 1.05-1.97) or older than 70 years (RR, 1.39; 95% CI: 1.05-1.82). There was a 5-year latent period after the RAI treatment before the cancer incidence began to differ between the RAI-treated hyperthyroid patients and the control group. CONCLUSIONS: Cancer incidence, especially cancer of the stomach, kidney, and breast, was higher in patients treated with RAI for hyperthyroidism.     

Synthesis of thyroglobulin in thyroid carcinoma patients after radioiodine therapy

Endogenously radioiodinated thyroglobulin (Tg) and the serum concentration of Tg have been measured in patients with metastatic thyroid carcinoma after therapeutic doses of radioiodine. Serial samples of blood were analyzed for both these parameters over a period of 10 to 22 days. The specific activity of Tg (cpm/ng) was calculated for each sample. Among the six patients studied, three showed constant specific activity. The specific activity of the other three fell, indicating the entering of newly synthesized Tg into the circulation. The respective amounts of Tg entering into the circulation in these three patients were 120, 852, and 20,935 ng/ml serum/day.     

甲状腺癌的流行现状及危险因素

甲状腺癌的发病与多种因素有关,辐射是明确的危险因素,碘摄取量与甲状腺癌的关系仍存在争议.研究表明,多个信号传导通路中遗传学和表观遗传学的改变是甲状腺癌分子致病机制的核心.另外,促甲状腺素、体重指数和慢性淋巴细胞性甲状腺炎也与甲状腺癌的发生有关.     

Psychological risk factors for colorectal cancer?

The paper deals with personality correlates of colorectal cancer patients in the framework of the cognitive orientation theory. The cognitive-motivational approach and the construction and testing of a reliable and valid questionnaire for assessing the personality correlates of colorectal cancer are reviewed in the first part. In the second part in a new sample of 230 colorectal cancer patients the themes in the questionnaire are clustered and their structure is tested in a confirmatory factor analysis. Further, following the expectation that colorectal cancer is gender bound, the differences in the themes and belief types are applied to testing differences between men and women corresponding to the medical differences. Finally the questionnaire was applied to identifying the detected personality correlates in an attenuated form in a sample of Crohn’s disease patients who are known to be at risk for colorectal cancer. Discriminant analysis showed that the questionnaire provided a highly significant correct identification of cases of the three groups (165 healthy controls, 90 patients with Crohn’s disease and 230 colorectal cancer patients). The thematic clusters that constitute the personality correlates of colorectal cancer were found to be tendencies for compulsiveness, control of oneself and especially of anger, self effacement, pleasing others, self assertion, distancing oneself from others, keeping regulations, and performing to perfection all ones obligations. The three major foci of these tendencies are perfect duty performance, and two contradictory pairs: self effacement versus self assertion, and closeness to others versus distancing from others. The clusters and the contrasts constitute potentially sources of tension. It is suggested that the identified personality correlates be considered as psychological risk factors for colorectal cancer.     

结直肠癌术后急性肠梗阻的危险因素分析

目的:探讨结直肠癌术后急性肠梗阻的危险因素。方法:回顾性分析我院248例行择期结直肠癌根治术的结直肠癌患者临床资料,根据术后1个月内是否发生急性肠梗阻分为急性肠梗阻组和非急性肠梗阻组,对两组相关因素进行单因素和多因素Logistic回归分析。结果:248例行择期结直肠癌根治术的结直肠癌患者中,35例（14.11%）发生急性肠梗阻（急性肠梗阻组）,213例（85.89%）未发生急性肠梗阻（非急性肠梗阻组）。两组性别、肿瘤直径、胃肠手术史、手术方法、手术时间比较,差异无统计学意义（P＞0.05）;急性肠梗阻组年龄＞60岁、肿瘤分期偏高、开腹手术发生率均高于非急性肠梗阻组（P＜0.05）,而术后生长抑素使用率低于非急性肠梗阻组（P＜0.05）;其中年龄＞60岁、肿瘤分期偏高、开腹手术为影响结直肠癌根治术后急性肠梗阻发生的独立危险因素（OR=3.564、3.149、2.895,P＜0.05）,而术后使用生长抑素为影响结直肠癌根治术后急性肠梗阻发生的独立保护因素（OR=0.271,P＜0.05）。结论:对年龄＞60岁、肿瘤分期偏高、开腹手术治疗等术后急性肠梗阻高危的结直肠癌患者,应在术后予以生长抑素等防治措施,以减少急性肠梗阻等并发症发生,促进患者术后康复。     

Recombinant human thyrotropin-aided versus thyroid hormone withdrawal-aided radioiodine treatment for differentiated thyroid cancer after total thyroidectomy: A meta-analysis

Background and purpose

We conducted a meta-analysis of randomized controlled trials (RCTs) to compare the effects of recombinant human thyrotropin (rhTSH) and thyroid hormone withdrawal (THW) on thyrotropin stimulation prior to remnant ablation of differentiated thyroid cancer (DTC).

Material and methods

A comprehensive search was conducted for articles discussing rhTSH and THW prior to December 2012. After applying the inclusion criteria, all the available data were summarized to analyze the efficacy of rhTSH and THW for stimulating TSH.

Results

Seven RCTs that involved a total of 1535 patients, were included in the analysis. The ablation rates of the rhTSH group and the THW group were not significantly different (RR = 0.97, 95% CI: 0.94–1.01, p = 0.1). Patients in the rhTSH group had a better quality of life (QoL) than those in the THW group on the day of ablation (RR = 3.92, 95% CI: 3.44–5.40, p < 0.00001). However, there was no difference in the QoL 3 months after ablation (RR = −0.9, 95% CI: −2.20–0.39, p = 0.17). Additionally, there were no significant differences in serum thyroglobulin (Tg) levels measured just before radioiodine remnant ablation (preablation thyroglobulin levels) (RR = −0.14, 95% CI: −0.73–0.45, p = 0.65), or in days of hospital isolation (RR = −10.51, 95% CI: −32.79–11.73, p = 0.35)

Conclusions

Our findings indicate that the administration of rhTSH had resulted in an ablation rate similar to that of THW for DTC patients, but rhTSH provided a better QoL at the time of ablation.     

Racial differences in the familial aggregation of breast cancer and other female cancers

Summary Although breast cancer familial aggregation has been studied in Caucasians, information for African–Americans is scant. We used family cancer history from the Womens Contraceptive and Reproductive Experiences study to assess the aggregation of breast and gynecological cancers in African–American and Caucasian families. Information was available on 41,825 first and second-degree relatives of Caucasian and 28,956 relatives of African–American participants. We used a cohort approach in which the relatives cancer status was the outcome in unconditional logistic regression and adjusted for correlated data using generalized estimating equations. Race-specific models included a family history indicator, the relatives age, and type. Relative risk (RR) estimates for breast cancer were highest for first-degree relatives, and the overall RR for breast cancer among case relatives was 1.96 (95% CI = 1.68–2.30) for Caucasian and 1.78 (95% CI = 1.41–2.25) for African–Americans. The effect of CARE participants reference age on their relatives breast cancer risk was greatest among first-degree relatives of African–American patients with RRs (95% CI) for ages <45 and 45 of 2.97 (1.86–4.74) and 1.48 (1.14–1.92), respectively. Among Caucasians, first-degree relatives of case subjects were at greater risk for ovarian cancer, particularly relatives younger than 45 years (RR (95% CI) = 2.06 (1.02–4.12)), whereas African–American first-degree relatives of case subjects were at increased cervical cancer risk (RR (95% CI) = 2.17 (1.22–3.85). In conclusion, these racially distinct aggregation patterns may reflect different modes of inheritance and/or environmental factors that impact cancer risk.*The first two authors contributed equally to this work.     

Multiple behavioral risk factors for colorectal cancer and colorectal cancer screening status.

BACKGROUND: Individuals who are not adherent to colorectal cancer screening have a greater prevalence of several other behavioral risk factors for colorectal cancer than adherent individuals. However, previous relevant studies have typically not considered the co-occurrence of such behavioral risk factors at the individual level. In the current study, we examined the prevalence, patterns, and predictors of multiple behavioral risk factors for colorectal cancer according to colorectal cancer screening status (adherent versus not adherent). METHODS: The study sample consisted of 11,090 individuals ages 50 years and older who participated in the 2000 National Health Interview Survey. Based on responses to survey questions, individuals were categorized as being adherent or not adherent to colorectal cancer screening guidelines and were also denoted as having or not having each of seven behavioral risk factors for colorectal cancer (smoking, low physical activity, low fruit and vegetable intake, high caloric intake from fat, obesity, high alcohol intake, and low intake of multivitamins). RESULTS: Individuals who were not adherent to screening reported having a greater number of risk factors than adherent individuals. For each screening group, there was a high prevalence of having low physical activity, low fruit and vegetable intake, and low intake of multivitamins. Demographic and health-related correlates of behavioral risk factor prevalence were identified in both screening groups. CONCLUSIONS: In combination with efforts to promote colorectal cancer screening uptake and adherence, there is a need to develop interventions to modify the colorectal cancer behavioral risk factors that are common among screening-adherent and nonadherent individuals.     

Meta-analyses of colorectal cancer risk factors

Purpose

Demographic, behavioral, and environmental factors have been associated with increased risk of colorectal cancer (CRC). We reviewed the published evidence and explored associations between risk factors and CRC incidence.

Methods

We identified 12 established non-screening CRC risk factors and performed a comprehensive review and meta-analyses to quantify each factor’s impact on CRC risk. We used random-effects models of the logarithms of risks across studies: inverse-variance weighted averages for dichotomous factors and generalized least squares for dose–response for multi-level factors.

Results

Significant risk factors include inflammatory bowel disease (RR = 2.93, 95 % CI 1.79–4.81); CRC history in first-degree relative (RR = 1.80, 95 % CI 1.61–2.02); body mass index (BMI) to overall population (RR = 1.10 per 8 kg/m² increase, 95 % CI 1.08–1.12); physical activity (RR = 0.88, 95 % CI 0.86–0.91 for 2 standard deviations increased physical activity score); cigarette smoking (RR = 1.06, 95 % CI 1.03–1.08 for 5 pack-years); and consumption of red meat (RR = 1.13, 95 % CI 1.09–1.16 for 5 servings/week), fruit (RR = 0.85, 95 % CI 0.75–0.96 for 3 servings/day), and vegetables (RR = 0.86, 95 % CI 0.78–0.94 for 5 servings/day).

Conclusions

We developed a comprehensive risk modeling strategy that incorporates multiple effects to predict an individual’s risk of developing CRC. Inflammatory bowel disease and history of CRC in first-degree relatives are associated with much higher risk of CRC. Increased BMI, red meat intake, cigarette smoking, low physical activity, low vegetable consumption, and low fruit consumption were associated with moderately increased risk of CRC.     

Radiation dose,chemotherapy and risk of lung cancer after breast cancer treatment

It is of particular concern to evaluate the risk of lung cancer occurrence after breast cancer treatment as women with breast cancer quite often undergo radiation therapy as part of their initial treatment and their life expectancy remains long. From a roster of 7711 women initially treated for breast cancer between 1954 and 1984, a cohort-study was performed among 4171 1-year survivors followed during the period 1975-1995. The relationship between the radiation dose received by the lung and the risk of lung cancer was then evaluated in a nested case-control study of 11 breast-cancer patients who developed lung cancer and 22 controls matched for age at diagnosis of breast cancer, period of initial treatment and length of follow-up. Among the 4171 women, six developed lung cancer during the entire follow-up as compared to 5.4 cases expected (SIR = 1.1, 95% CI: 0.4-2.3). When considering only the women initially treated by radiotherapy with or without adjunction of chemotherapy and excluding the 10 first years of follow-up, the SIR was significantly increased (SIR = 3.2, 95%CI: 1.0-7.4). In the case-control study, nine of the 11 lung cancers occurred in the ipsilateral lung and two in the trachea. The overall odds ratio (OR) of lung cancer associated with initial radiotherapy was 1.4 (95% CI: 0.2-11.1) and an excess in the OR of 7% (90% CI: ? to 41%, p = 0.10) per gray delivered to the site of lung cancer was evidenced. Our results agree with previous studies in favor of an increased risk of lung cancer after radiation therapy for breast cancer.