Breast cancer, colorectal cancer, and esophageal cancer

This is the second of a six-part series on metastatic spread and natural history of 18 common tumors. Part one summarized symptom/problem anticipation, cancer metastasis, and the 18 tumors that each cause more than 6,000 deaths per year in the United States. Bladder and brain cancer were discussed, with information given on tumor types, metastatic spread and invasion, and common symptoms. Part two charts the natural histories of breast, colorectal, and esophageal cancers. Each of these cancers is presented separately, with information given on mortality rates, the most common tumor types, sites of metastases, common problems, and common oncologic emergencies. Sites of spread, resulting problems (including site-specific symptoms), and assessment parameters are presented as tables. Material is presented so that clinicians will be able to anticipate the spread of these cancers and thus identify problems early in their development so that the problems are more easily managed.     

Beliefs about causes of cancer in cancer patients

Beliefs about causes of cancer were studied in 120 patients with late-stage cancer and compared with beliefs of non-cancer patients matched for age, sex, and hospitalization. Cancer patients consistently had less strong beliefs about causes of cancer than did the other groups, even when causes such as smoking and having pulmonary cancer were probably associated with the development of their disease. Although some correlates of beliefs were found in cancer patients' personal and social background, these were generally of minimal levels of statistical significance. Those who had been diagnosed longer believed cancer was more often inherited. The non-cancer patients' beliefs were similar to those found in a large survey of the general population. It is likely that cancer patients need to defend themselves against self-blame as a means of coping with a terminal illness.     

Cervical cancer in Bangladesh: community perceptions of cervical cancer and cervical cancer screening

We investigated the awareness of, and the attitude towards screening for, cervical cancer in Bangladesh. We performed a qualitative study using focus group discussions (FGD). The framework approach to qualitative analysis was used. The study was performed in the catchment areas of Addin Hospital, Jessore, Southern Bangladesh (peri-urban) and LAMB hospital, Parbatipur, North West Bangladesh (rural). A total of 220 men, women and adolescents participated in 28 FGDs. Awareness of cervical cancer was widespread. Knowledge about causes was often inadequate. The perceived consequences of cervical cancer were numerous and awareness of the need for cervical cancer treatment was present. Barriers to accessing care include: low priority for seeking help for symptoms, limited availability of health services and cost. Most women were unaware of the possibility of screening via speculum examination, which was considered acceptable to women (and men), as long as the examination was done by a female healthcare provider in an environment with sufficient privacy. In conclusion, adequate gynaecological services are not available or accessible for most women in rural and peri-urban Bangladesh. However, awareness of cervical cancer is widespread. Screening for cervical cancer in these communities is acceptable if done by a female healthcare provider under conditions with sufficient privacy.     

人源性宫颈癌、子宫内膜癌、卵巢癌异种移植动物模型的建立

目的构建人来源的宫颈癌(cervical cancer,CC)、子宫内膜癌(endometrial cancer,EC)、卵巢癌(ovarian cancer,OC)人源性肿瘤异种移植动物模型,为研究和开发新药及个体化治疗提供实验模型。方法收集2018年2月至2019年4月新疆医科大学第一附属医院CC、EC、OC患者各5例的新鲜手术切除标本,移植至重度免疫缺陷(immunodeficiency,NOG)小鼠和非肥胖糖尿病/重症联合免疫缺陷(non-obese diabetes/severe combined immunodeficiency,NOD/SCLD)小鼠皮下,监测荷瘤小鼠体重和肿瘤体积,对长至500~1 000 mm^3大小的肿瘤进行传代移植,通过苏木精-伊红染色法(hematoxylin-eosin staining,HE)染色及免疫组化(immunohistochemistry,IHC)验证移植肿瘤组织与患者肿瘤组织的病理学一致性。结果本研究收集并移植15例CC、EC、OC肿瘤标本,成功构建CC、EC、OC PDX模型8例,建模成功率为53%。结论模型较好地保留了原发肿瘤的特征,为后续研究开发CC、EC、OC新的治疗方案、临床药物筛选以及个体化治疗提供了实验平台。     

Familial risk of cancer among randomly selected cancer probands

Several investigators have reported that relatives of lung cancer probands have a greater-than-normal likelihood for developing some form of cancer. To evaluate whether this familial risk is general for probands with cancer at any site or limited to lung cancer probands, we did a case-control study in which probands having cancer affecting any body site were identified and their pedigree data were tabulated. Telephone interviews and a mailed questionnaire were used to obtain cancer histories and environmental exposures on the families of 41 lung cancer probands, 105 probands with cancer other than lung, and 127 spouse families. Cumulative tobacco exposure (P less than .05), occupational hazards (P less than .005), and age of the family relatives (P less than .0001) were found to be statistically significant predictors of cancer risk. With consideration given for these variables, we determined that siblings of lung cancer probands were at slightly greater risk of cancer of any kind (odds ratio [OR] = 1.43, P = .06) than siblings in the control group. Much of the elevated risk was attributable to an excess of lung cancer (OR = 2.49, P = .06). Siblings of non-lung/non-breast cancer probands were also determined to be at increased risk of lung cancer as well (OR = 1.61, P = .06). For parents, the risk was lower, although parental information may have been underreported.     

Location of cancer surgery for older veterans with cancer

Objective

Many veterans undergo cancer surgery outside of the Veterans Health Administration (VHA). We assessed to what extent these patients obtained care in the VHA before surgery.

Data Sources

VHA-Medicare data, VHA administrative data, and Veterans Affairs Central Cancer Registry data.

Study Design

We identified patients aged ≥65 years in the VHA-Medicare cohort who underwent lung or colon cancer resection outside the VHA and assessed VHA visits in the year before surgery.

Principal Findings

Over 60% of patients in the VHA-Medicare cohort who received lung or colon cancer surgeries outside the VHA did not receive any care in VHA before surgery.

Conclusions

Veterans’ receipt of major cancer surgery outside the VHA probably reflects usual private sector care among veterans who are infrequent VHA users.     

Prevention of cancer

Etiology and prevention are not the same. Etiology is a noun, something that is known. Prevention comes from a verb, implying action. There are several steps required between etiology and prevention. There are three levels of prevention which roughly parallel three levels of regulation, being both complementary and interdependent if effective intervention is to be achieved. It is known that cigarette smoking causes cancer, and most agree that nutritional factors are related to some cancer. Intervention in these areas will be achieved by self-motivation, not by regulation. Food additives which are carcinogenic in animals have caused a conflict between presumed risk to humans and perceived benefit by society. Drugs used in cancer treatment offer the clearest intervention area based on risk/benefit assessment. Diagnostic radiation for early detection of breast cancer has been substantially reduced, and radiation exposure to the nonworker population of Three Mile Island was less than the average yearly background. Great potential for the future lies in the application of sophisticated viral techniques to the problems of chemical carcinogens.     

肿瘤干细胞在卵巢癌治疗中的进展

卵巢恶性肿瘤是死亡率最高的妇科恶性肿瘤。尽管标准化的治疗方法（包括理想的肿瘤细胞减灭术和以铂类／紫杉醇为基础的化疗方案）使得70％的患者得到一定程度的临床缓解,但绝大多数患者仍然会在2年内复发并出现耐药。肿瘤干细胞理论认为,肿瘤组织中有小部分细胞群体具有极强的增殖能力,它们具有类似正常干细胞的生物学特性,能通过自我更新和分化来高频度地启动肿瘤的发生发展,它们是导致肿瘤发生、发展、转移和耐药的主要细胞,是肿瘤复发的根源。该文将概述近几年卵巢癌干细胞的各项研究,包括卵巢癌干细胞的分离及其耐药机制、各种治疗方法等。     

Estimation and projections of cancer prevalence from cancer registry data

A method, PIAMOD (Prevalence, Incidence, Analysis MODel), which allows the estimation and projection of cancer prevalence patterns by using cancer registry incidence and survival data is presented. As a first step the method involves the fit of incidence data by an age, period and cohort model to derive incidence projections. Prevalence is then estimated from modelled incidence and survival estimates. Cancer mortality is derived as a third step from modelled incidence, prevalence and survival. An application to female breast cancer is given for the Connecticut State by using data from the Connecticut Tumor Registry (CTR), 1973-1993. The age, period and cohort model fitted incidence quite well and allowed us to derive long-term projections up to 2030. Patients' survival was also projected to future years according to a scenario approach based on two extreme hypotheses: steady, that is, no more improvements after 1993 (conservative), and continuously improving at the same rate as during the observation period. Age-standardized estimated incidence shows a changing trend around the year 2005, when it starts decreasing. Age-standardized prevalence is expected to increase and change trend at a later date. Breast cancer mortality is projected as decreasing, as the combined result of no further increase in incidence and improving cancer patients' survival. An easy-to-use PIAMOD software package, on which work is in progress, will be made available to individual cancer registries and/or health planning institutions or authorities once it is developed. The use of the PIAMOD method for cancer registries will allow them to provide results of paramount importance for the whole community involved in the assessment of future disease burden scenarios in an evolving society.     

Clustering of cancer in families of patients with primary lung cancer

We have previously shown that patients with a positive family history of lung cancer did not exhibit characteristics expected if the familial association was a surrogate for a genetic mechanism which was absent in those without such a history. In this study, we examine the incidence of cancer (all sites) in two groups of families: (a) those ascertained through a patient with primary lung cancer (n = 359 families) and (b) through a community control subject (n = 234). The index subjects were excluded from all incidence data analyses. Most families (62 vs 57%) reported at least one member with a history of neoplastic disease. Patients' families were more likely to have 2 or more affected members (p less than 0.05), to exhibit a multigenerational pattern (33 vs 24%) and to have a higher risk of multiple tumours (OR = 1.5) in the same individual. However, most of the sites with the highest odds ratios (males, vocal cord/esophagus 8.3; colon/rectum 2.3; lung 1.96; females, pancreas 4.8; vocal/cord esophagus 4.1; lung 1.8) are smoking associated although these were not necessarily the most frequently affected sites. In conclusion, these data support an ecogenetic etiology of cancer within families.     

Evaluation of linked cancer registry and hospital records of breast cancer

Background: Information on the treatment of women with breast cancer in Australia is generally available only from special surveys. Analysis of routinely collected datasets may be more timely and cost effective, if the data are sufficiently accurate and complete.
Objective: To evaluate the accuracy and completeness of data on treatment in linked records of breast cancer from two routinely collected datasets.
Methods: The NSW Department of Health linked NSW Central Cancer Registry (CCR) records for 2,636 women diagnosed with breast cancer in NSW in 1992 to all hospital admission records in the NSW In-patient Statistics Collection (ISC) from January 1991 to June 1994. We queried the original paper records of subsets of women to identify missing or miscoded information and cases not notified to the CCR. We also compared the treatment data with data collected independently from the medical records of 19% of the women.
Results: ISC records linked to 89% of the CCR records. The CCR had identified 94.9% of women with breast cancer treated as hospital in-patients and 83% of these women had surgical treatment recorded in the ISC. The linked dataset under-estimated the percentage of women having breast-conserving therapy (-4%) and slightly over-estimated the percentage having mastectomy (+1%).We estimated that 42% of women treated surgically for breast cancer had actually had breast-conserving surgery, compared with 39% in the original dataset. There was no evident bias by age or by urban or rural residence in the under-recording of breast conservation. There was 94% agreement on the type of surgery between the linked dataset and the independent dataset.     

Increased cancer risk among relatives of nonsmoking lung cancer cases

Lung cancer has been shown to aggregate in families of nonsmoking lung cancer cases with an earlier age at onset. The current study evaluates whether relatives of nonsmoking lung cancer cases are at increased risk of cancers at sites other than lung. Families were identified through 257 population‐based, nonsmoking lung cancer cases and 277 population‐based, nonsmoking controls residing in metropolitan Detroit. Data were collected for 2,252 relatives of cases and 2,408 relatives of controls. First‐degree relatives of nonsmoking lung cancer cases were at 1.52‐fold (95% CI, 1.02–2.27) increased risk of cancer of the digestive system after adjustment for each relative's age, race, sex, and smoking status. Relative risk estimates also were elevated, but not significantly, for tobacco‐related cancers (RR = 1.39) and breast cancer (RR = 1.72). Among first‐degree relatives of younger probands (age 40–59), risk was non‐significantly increased 72% (95% CI 0.95–3.10) for all cancers combined and 3.14‐fold for cancers of the digestive system (95% CI 0.76–12.9). Nonsmoking relatives of cases were at increased risk of all cancer sites combined (RR = 1.32; 95% CI 1.003–1.73), cancers other than lung (RR = 1.37; 95% CI 1.03–1.82), and digestive system cancers (RR = 2.01; 95% CI 1.20–3.37). These findings of moderate familial aggregation for cancers of the lung, digestive system, breast, and tobacco‐related sites suggest that common susceptibility genes may act to increase risk for a variety of cancers in families. Genet. Epidemiol. 17:1–15, 1999. © 1999 Wiley‐Liss, Inc.     

Attributed risk to smoking for lung cancer,laryngeal cancer and esophageal cancer

OBJECTIVE: Lung, laryngeal and esophageal cancers have smoking as one of their main risk factors. The objective of this study was to evaluate the population attributed risk (PAR) of smoking for these forms of cancer. METHODS: The study was based in three case-control studies conducted in medium size cities in Brazil. Incident cases of lung cancer, laryngeal cancer and esophageal cancer seen at a hospital setting and diagnosed through biopsy were analyzed; controls were hospitalized patients with another diagnoses. Smoking was the exposure factor measured at three levels: non-smokers, former smokers and smokers, which were defined using a questionnaire applied by trained interviewers. For effect measure, odds ratio was used and the populational attributed risk for smoking was then calculated for a 95% CI. RESULTS: A total of 122 lung cancer cases and 244 controls, 50 cases of laryngeal cancer and 48 cases of esophageal cancer, and 96 controls for both of them were studied. The prevalence of smoking exposure was 34%, which is the overall prevalence of smoking in this city's adult population. Odds ratios (OR) for the PAR analysis were the adjusted OR for confounding variables from each study. Lung cancer PAR was 63% (95% IC, 0.58-0.68) for former smokers and 71% (95%IC, 0.65-0.77) for smokers. Larynx cancer PAR was 74% (95% IC, 0.70-0.78) and 86% (95%IC, 0.81-0.85) for former smokers and smokers, respectively. Esophageal cancer PAR was 54% (95%IC, 0.46-0.62) for smokers. CONCLUSION: Smoking is an avoidable risk factor and smoking cessation could be responsible for significant reductions in the incidence of these three forms of cancer.