Does hereditary nonpolyposis colorectal cancer explain the observed excess risk of colorectal cancer associated with family history?

Several studies have found an increased risk of colorectal cancer associated with a family history of colorectal cancer. Some studies, although not all, have also suggested that family history of colorectal cancer may be a risk factor for adenomatous polyps. Hereditary nonpolyposis colorectal cancer is a known genetic syndrome predisposing to colorectal cancer. The hypothesis of this paper is that the preponderance of the genetic or familial risk for colorectal cancer in the United States is mediated by hereditary nonpolyposis colorectal cancer. To test this hypothesis, I have incorporated what is known about hereditary nonpolyposis colorectal cancer into a genetic model that generates probabilities of family clustering of colorectal cancer. Using this model, which assumes that all familial risk for colorectal cancer is due to hereditary nonpolyposis colorectal cancer, the expected relative risks for colorectal cancer (and adenomas) associated with given types of family histories were calculated. The relative risks predicted by the model fairly closely matched the results found in the literature, especially those reported from a large cohort study. As observed in several studies, the model predicts that relative risks decrease sharply with age. In contrast to the elevated risk for colorectal cancer, the model predicts no elevated risk for adenomas associated with family history of colorectal cancer.     

Current issues with the immunization program in Japan: Can we fill the “vaccine gap”?

The "vaccine gap" is a term which has been used in Japan to indicate that the current immunization program is behind compared to the programs in other developed countries. The current national immunization program (NIP) which was established under the Japanese Immunization Law includes only six vaccines (eight targeted diseases), and the rest of available vaccines have been categorized as voluntary vaccines, which require out-of-pocket expense in order for the patients to receive them. This has led the vaccination rates for the voluntary vaccines remaining low, and the incidence of the target diseases remaining high. In addition, there are a few domestic rules that exist for immunizations including (1) subcutaneous injection is the standard method of vaccination, (2) the thigh is not considered to be the common site of vaccination in infants, and (3) the intervals of administration of inactivated and live vaccines are strictly determined by law. Along with the "vaccine gap" and the domestic rules, some movements to improve our current NIP are underway; including increased calls to change the NIP from civilians and professionals, the establishment of a group by the representatives from 13 medical professional societies asking the government to consider the immunization policy a "national policy" and seeking the establishment of a new and reorganized national immunization technical advisory group (NITAG). In addition, the Vaccination Subcommittee of Health Sciences Council was formed in the government to reform the current Immunization Law and NIP, which established a new national program for three voluntary vaccines funded by a temporary budget. We hope these new movements will fill the "vaccine gap" and that the NITAG will help ensure that vaccine policy becomes a national policy, and will provide necessary vaccinations without out-of-pocket expense to protect children in Japan from vaccine preventable diseases.     

Is the Magnesium Content in Food Supplements Consistent with the Manufacturers’ Declarations?

Food supplements (FS) are gaining more and more popularity because they are a quick way to compensate for deficiencies in the diet. Due to their affordable price and easy-to-take form, they are eaten by all age groups and by healthy and sick people. There are many categories of this type of preparations on the market, and FS with magnesium (Mg) are some of the most commonly used. Therefore, the aim of the study was to determine the Mg content in FS and to compare the estimated value with that declared by the manufacturer. The study included 116 FS containing Mg. In order to determine the Mg content, the atomic absorption spectrometry (AAS) method was used. The tested FS were divided in terms of the declared content, pharmaceutical form, chemical form of Mg, composition complexity, and price. It was shown that in the case of 58.7% of the samples, the Mg content was different than the permissible tolerance limits set by the Polish chief sanitary inspectorate, which range from −20% to +45%. It has been estimated that as a result of the differences in the content, the patient may take up to 304% more Mg per day or 98% less than it is stated in the declaration. The above results indicate that the quality and safety of FS should be more closely monitored.     

Does entertainment-education work with Latinos in the United States? Identification and the effects of a telenovela breast cancer storyline

This article examines the proposition that a popular form of entertainment, the telenovela, can educate Spanish-speaking viewers in the United States if accurate health information is presented in a dramatic, narrative format. Health professionals consulted on a breast cancer storyline in a Spanish-language telenovela, Ladrón de Corazones, and the impact on viewers' knowledge and behavioral intentions were assessed using three methods. First, an analysis of call attempts to 1-800-4-CANCER demonstrated a significant increase in calls when a PSA featuring the number aired during the program. Second, a nationwide telephone survey indicated that viewers, especially those who identify with Spanish-language television characters, gained specific knowledge from viewing the story and that male viewers were significantly more likely to recommend that women have a mammogram. Third, these trends were confirmed and further explored using focus groups of Ladrón viewers. Implications for educating viewers using dramatic serials in the United States are discussed.     

Managing hope,denial or temporal anomie? Informal cancer carers’ accounts of spouses’ cancer diagnoses

Carers of cancer patients' emotional responses to cancer diagnoses have been a central focus within psycho-oncology. Some of this literature asserts that the maladaptive coping strategy denial is prevalent amongst carers. Using semi-structured, longitudinal interviews with 32 Australian Capital Territory carers of a spouse with cancer and an interactionist sociology of emotions framework to understanding their emotions, this study aimed to both contribute to the literature on cancer carers' coping strategies and provide a richer sociological depiction of carers' emotional reactions to a cancer diagnosis. The results raise questions about the value of singularly examining denial in cancer carers. Instead, these data suggest that carers use a range of coping strategies in the short-term and do emotion work to adapt to a challenged temporal orientation. The term temporal anomie is offered to describe carers' disrupted orientations in time and facilitate further discussion on the link between time and emotion work. Findings also show the importance of medical professionals' casting of the prognosis, from imminent death to certain future, to this temporal re-orientation and emotion work process. Instead of 'managing hope,' as much of the cancer communication literature describes it, findings suggest that physicians address cancer carers' and patients' temporal anomie. Future research might benefit from moving beyond individualistic conceptualisations of carers' emotions to include the cultural, temporal and interactionist influences.     

Are U.S. cancer screening test patterns consistent with guideline recommendations with respect to the age of screening initiation?

Background  

U.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation.     

Could treatments with beta-blockers be associated with a reduction in cancer risk?

BACKGROUND: The relationship between the use of anti-hypertensive drugs and cancer risk remains controversial. The main objective of this study was to assess the potential effect of beta-blocker use on cancer risk. METHODS: In a cohort of 839 patients with cardiovascular disease, followed up prospectively for an average period of 10 years, cancer occurrence was recorded according to the exposure to beta-blockers. The relative risk of cancer associated with beta-blocker use was estimated using a Cox model adjusted on gender and age. Ever- vs never-use of beta-blockers and duration of exposure to the drug were analyzed as time-dependent variables. In addition, the standardized incidence ratios (SIR) were calculated using the corresponding age- and gender-adjusted cancer incidences in the French general population. RESULTS: A total of 326 beta-blocker users and 513 users of other treatments were included in the cohort. During the follow-up period, representing 8,466 person-years, incident cancer cases were 15 and 59 in beta-blocker ever-users versus never-users, respectively. Using the Cox model, the overall relative risk of cancer was 0.51 (95% confidence interval [95% CI]: 0.29-0.90) in the beta-blocker ever-users versus never-users (p=0.02), with a 6% decrease per year of use (95% CI: 1%-12%; p=0.03). The corresponding SIR ratio between these two groups was 0.44 (95% CI: 0.24-0.76). CONCLUSION: In this cohort, the beta-blocker treatments appeared to decrease the cancer risk significantly. However, this result should be considered with caution; further work is needed, as some sources of bias associated with this type of epidemiological study cannot be totally excluded.     

Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message?

OBJECTIVES: This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites. Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening. METHODS: Men (n = 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening. RESULTS: Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening. CONCLUSIONS: Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.     

Time away from “smelling the roses”: Where do mothers raising children with disabilities find the time to work?

Using the Australian Time Use survey (TUS), this study examined time allocation among working parents raising children with disabilities. Findings showed that raising children with disabilities reduced the time working mothers had for leisure activities, but increased the time for socializing activities. Consistent with the literature, the latter effect probably reflects the special need of working mothers raising children with disabilities for strong social networks offering regular support. While a mother's time for personal care was reduced by a child with a disability, a father's time for personal care was unaffected. Thus, mothers were relatively more disadvantaged than fathers in terms of total time for themselves. This study offers new knowledge on the impact of childhood disability on working parents' time for personal care and leisure, activities that can improve their psychological and physical well-being.     

Tailored breast cancer screening with ultrasound and MRI?

The ACRIN 6666 trial has shown that the addition of ultrasound or MRI to mammography screening detects more breast cancers in women with dense breasts and at least one other breast cancer risk factor. This higher detection yield is accompanied by an increase in false-positive findings. Unfortunately, this study was not randomized into groups with and without the addition of ultrasound and MRI. It is therefore impossible to investigate if the improved detection rate also results in a smaller number of interval tumours which would be the best indication of the ultimate goal - a decrease in breast cancer mortality. Before any new and costly imaging is added to the breast cancer screening program, it is necessary to investigate if this will not merely increase the detection of indolent tumours. If additional imaging is implemented too hastily it will be hard to turn it back, and impossible to assess it in a randomized study.     

Are patients with skin cancer at lower risk of developing colorectal or breast cancer?

Ultraviolet exposure may reduce the risk of colorectal and breast cancer as the result of rising vitamin D levels. Because skin cancer is positively related to sun exposure, the authors hypothesized a lower incidence of breast and colorectal cancer after skin cancer diagnosis. They analyzed the incidence of colorectal and breast cancer diagnosed from 1972 to 2002 among 26,916 Netherlands skin cancer patients (4,089 squamous cell carcinoma (SCC), 19,319 basal cell carcinoma (BCC), and 3,508 cutaneous malignant melanoma (CMM)). Standardized incidence ratios were calculated. A markedly decreased risk of colorectal cancer was found for subgroups supposedly associated with the highest accumulated sun exposure: men (standardized incidence ratio (SIR) = 0.83, 95% confidence interval (CI): 0.71, 0.97); patients with SCC (SIR = 0.64, 95% CI: 0.43, 0.93); older patients at SCC diagnosis (SIR = 0.59, 95% CI: 0.37, 0.88); and patients with a SCC or BCC lesion on the head and neck area (SIR = 0.59, 95% CI: 0.36, 0.92 for SCC and SIR = 0.78, 95% CI: 0.63, 0.97 for BCC). Patients with CMM exhibited an increased risk of breast cancer, especially advanced breast cancer (SIR = 2.20, 95% CI: 1.10, 3.94) and older patients at CMM diagnosis (SIR = 1.87, 95% CI: 1.14, 2.89). Study results suggest a beneficial effect of continuous sun exposure against colorectal cancer. The higher risk of breast cancer among CMM patients may be related to socioeconomic class, both being more common in the affluent group.     

Is there a problem with the problems in problem‐based learning?

OBJECTIVE: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools. METHODS: Analysis of 162 PBL cases. RESULTS: Cases concentrate on acute problems in young people and neglect chronic disease in the old. CONCLUSION: This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.     

Survey of the life-styles and factors associated with the occurrence of cancer in smokers from the city of Sidrolândia (MS, Brazil)

The study refers to a survey of the life-styles and factors associated with the occurrence of cancer in smokers of Sidrolandia (MS, Brazil). Study participants were 501 smokers registered in the Family Health Program, which were identified by community health agents. They answered a questionnaire based on the surveys used by the National Institute of Cancer and Prevention and Surveillance Program. The results showed that: the subjects are mostly women from 26 to 45 years of age (p= 0,035), living with a partner, do not work out, have little schooling and per capita family income of up to one minimum wage. Also they began to smoke in adolescence and smoke industrialized cigarette. They smoke an average of ten cigarettes a day, even indoors, even knowing that this is harmful to health, exposing the family to passive smoking. As for health problems, 30.6% have respiratory problems/allergy, 17.4% high-pressure and 10.8% depression. The sedentary was reported by 77.6% of the interviewees, the frequent habit of drinking alcohol by 48.7% and over-weight by 37.1%. Only 5.8% of respondents reported only smoking, 94.2% presented one or more of these factors associated with the occurrence of cancer.