Dietary intervention as adjuvant therapy in breast cancer patients — a feasibility study

Summary To evaluate the feasibility of using a low-fat diet (i.e. 20–25% of energy (E%) as fat) as a component of adjuvant therapy for breast cancer patients, 240 females aged 50–65 years and operated for a stage I-II breast cancer were entered into a randomized study. The intervention group (n = 121) was to reduce dietary fat intake to 20–25 E% and to increase the intake of carbohydrates. Dietary counselling complemented other adjuvant treatments and the patients were followed for two years. No dietary advice was given to patients in the control group (n = 119).There was no significant difference between the groups in terms of base-line nutrient intake except for higher energy intake in the control group (p < 0.05). Only 52% of the patients in the intervention group followed through with the dietary regimen for two years, and 89% of the patients in the control group had a two-year follow-up. Energy intake decreased in both groups after two years, and the difference between the two groups remained (p < 0.01). Total fat intake decreased from 36.2 E% to 22.2 E% after one year in the intervention group and remained at that level after two years. Total fat intake in the control group decreased by 3.6 E% after two years.The low compliance raises concern about the protocol design. The study nevertheless indicates that a long-term reduction of dietary fat intake can be implemented in breast cancer patients.     

Mapping the categories of the Swedish primary health care version of ICD-10 to SNOMED CT concepts: Rule development and intercoder reliability in a mapping trial

Background

Decision aids (DA) are tools designed to help patients make specific and deliberative choices among disease management options. DAs can improve the quality of decision-making and reduce decisional conflict. An area not covered by a DA is the decision of a patient with chronic obstructive pulmonary disease (COPD) to use inhaled steroids which requires balancing the benefits and downsides of therapy.

Methods

We developed a DA for COPD patients considering inhaled steroid therapy using the Ottawa Decision Support Framework, the best available evidence for using inhaled steroid in COPD and the expected utility model. The development process involved patients, pulmonologists, DA developers and decision making experts. We pilot tested the DA with 8 COPD patients who completed an evaluation questionnaire, a knowledge scale, and a validated decisional conflict scale.

Results

The DA is a computer-based interactive tool incorporating four different decision making models. In the first part, the DA provides information about COPD as a disease, the different treatment options, and the benefits and downsides of using inhaled steroids. In the second part, it coaches the patient in the decision making process through clarifying values and preferences. Patients evaluated 10 out of 13 items of the DA positively and showed significant improvement on both the knowledge scale (p = 0.008) and the decisional conflict scale (p = 0.008).

Conclusion

We have developed a computer-based interactive DA for COPD patients considering inhaled steroids serving as a model for other DAs in COPD, in particular related to inhaled therapies. Future research should assess the DA effectiveness.     

A Snapshot of CNVs in the Pig Genome

Recent studies of mammalian genomes have uncovered the extent of copy number variation (CNV) that contributes to phenotypic diversity, including health and disease status. Here we report a first account of CNVs in the pig genome covering part of the chromosomes 4, 7, 14, and 17 already sequenced and assembled. A custom tiling oligonucleotide array was used with a median probe spacing of 409 bp for screening 12 unrelated Duroc boars that are founders of a large family material. After a strict CNV calling pipeline, 37 copy number variable regions (CNVRs) across all four chromosomes were identified, with five CNVRs overlapping segmental duplications, three overlapping pig unigenes and one overlapping a RefSeq pig mRNA. This CNV snapshot analysis is the first of its kind in the porcine genome and constitutes the basis for a better understanding of porcine phenotypes and genotypes with the prospect of identifying important economic traits.     

Radiation-induced thyroid neoplasia

Summary Thyroid cancer is a well documented late effect of exposure to ionizing radiation. The excess risk begins 5–10 years after exposure and continues until at least 40 years after exposure. Females are roughly three times more susceptible to both radiogenic thyroid cancer and to thyroid cancer of other origins than are males. Therefore, relative risk estimates for radiogenic thyroid cancer do not necessarily differ by sex. The excess risk is higher among children exposed prior to five years of age than in those exposed later. The risk for radiogenic cancer following exposure to¹³¹I appears to be lower than that following exposure to high doserate external irradiation, and in the Swedish diagnostic study¹³¹I was nearly one fourth as effecient as external X-rays in inducing thyroid cancer. The Swedish data suggest that¹³¹I is substantially less efficient in inducing thyroid cancer than high doserate exposures. In that study, however, 95% of the exposed individuals were 20 years or older (mean age 45 years).

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Schilddrüsenkrebs infolge ionisierender Strahlung

Zusammenfassung Dass ionisierende Strahlung als Spätfolge Schilddrüsenkrebs induzieren kann, ist epidemiologisch wohl belegt. Das Risiko steigt 5–10 Jahre nach der Strahlenexposition an und bleibt mindestens 40 Jahre nach der Exposition erhöht. Das absolute Risiko ist für Frauen etwa dreimal so hoch als beim Mann. Dies gilt sowohl für die strahleninduzierten als auch die übrigen Schilddrüsenkrebse, so dass das relative Krebsrisiko durch Strahlung bei beiden Geschlechtern etwa gleich hoch ausfällt. Das strahlenbedingte Zusatzrisiko ist höher, wenn die Bestrahlung vor dem fünften Lebensjahr erfolgt ist.¹³¹I scheint ein deutlich geringeres Krebsrisiko mit sich zu bringen als externe Strahlenbelastung mit hohen Dosisraten; in der schwedischen Studie an Patienten, bei denen¹³¹I zur Schilddrüsendiagnostik gegeben worden war, fiel die strahlenassoziierte Krebserhöhung etwa viermal schwächer aus als nach entsprechenden Dosen externer Röntgenbestrahlung (wobei allerdings—bei einem Durchschnittsalter von 45—nur 5% der diagnostisch Exponierten jünger als 20 Jahre alt waren).

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Cancer thyroïdien dû aux radiations

Résumé Le cancer de la thyroïde est un effet tardif bien connu de l'exposition aux radiations ionisantes. L'excès de risque commence 5 à 10 ans après l'exposition et dure au moins 40 ans après l'exposition. Les femmes sont trois fois plus sensibles que les hommes au cancer de la thyroïde provoqué par la radiation, mais aussi aux cancers thyroïdiens d'autres origines; c'est pourquoi les risques relatifs des cancers thyroïdiens radiogéniques ne diffèrent pas selon le sexe. L'excès de risque est plus grand chez les enfants exposés avant l'âge de 5 ans. Le risque d'un cancer radiogénique suite à l'exposition au iode 131 est plus faible que le risque associé à une irradiation externe à haute dose. Une étude suédoise a montré que le pouvoir cancérigène du iode 131 était d'environ un quart par rapport aux rayons X externes. Dans cette étude, cependant, 95% des individus exposés étaient âgés de plus de 20 ans (âge moyen 45 ans).

     

Treatment of superficial basal cell carcinomas using topically applied delta-aminolaevulinic acid and a filtered xenon lamp

Received: 27 September 1995     

Nutrients and gastric cancer risk. A population-based case-control study in Sweden

A population-based case-control study of gastric cancer was conducted in areas with contrasting incidence rates in Sweden. Face-to-face interviews were carried out with 338 (74.1 %) of all eligible cases and 679 (77.3%) of the selected controls. Consumption of selected nutrients during adolescence and 20 years prior to interview was estimated, together with life-time intake of vitamin supplements. Ascorbic acid and β-carotene had an unequivocal protective effect, but α-tocopherol and nitrate were also negatively associated with gastric-cancer risk. In a multivariate analysis including all of these factors, only ascorbic acid remained a significant protective factor. The only macronutrient positively associated with the risk of gastric cancer was fat: intake 20 years prior to interview, but not during adolescence, was found to have a significant impact. Supplementation with vitamins almost halved the risk after adjustment for dietary intake of the corresponding vitamins. While the protective effect of vitamin C and β-carotene could conceivably be ascribed to other agents in the diet, the strong negative association between supplementation with vitamin C and risk of gastric cancer supports the hypothesis of a protective role of this anti-oxidant.     

An assessment of the risk of developing hyperparathyroidism and thyroid disorders subsequent to neck irradiation in middle-aged women

We investigated the occurrence of thyroid and parathyroid disorders in 100 women (age 66-70 years) irradiated for cervical spondylosis on average 25 years previously and in 100 control women of similar age. Hyperparathyroidism (HPT), proven by operation, was diagnosed in one patient of each group, and three additional cases were diagnosed biochemically among irradiated women. The difference in incidence is not significant. Nor was there any significant difference in incidence of thyroid disorders. No thyroid carcinoma was found in either group. Even if there is a moderate increase of HPT after neck irradiation in middle-aged women the risk is not so great as to warrant organised follow-up.     

Quantitative analysis of muscle biopsies from volunteers and patients with neuromuscular disorders

106 muscle biopsies from patients with neuromuscular diseases or symptoms were assessed by routine inspection and quantitative examination. Eighty-six specimens were classed as pathological on routine evaluation and 84 on quantitative examination. Eleven specimens that were pathological on routine evaluation were 'missed'by quantitative examination. Nine judged normal on routine examination were pathological according to quantitative criteria. Relative measures including the coefficient of variance, the difference between type I and type II fibres, and the difference between fascicles proved valuable for distinguishing between normal and pathological specimens. Quantitative analysis is a valuable complementary method which improves the detection of pathological states in muscle.