Life stress and risk of precancerous cervical lesions: a pretest directed by the life stress model

PURPOSE/OBJECTIVES

To present the results of a pilot study to pretest instruments designed to measure selected variables named in the Life Stress Model, a model of health outcomes. Additional aims were to determine the effect of completing personal risk assessments for precancerous squamous-cell intraepithelial lesions of the cervic (SIL) on receptivity to cervical cancer prevention information and to extend knowledge of stressful life events experienced by inner-city women attending high-risk health clinics.

DESIGN

Cross-sectional.

SAMPLE

20 adult women attending high-risk prenatal or human immunodeficiency virus (HIV) outpatient clinics in one of two New York City hospitals. Most were recovering drugs abusers; half were diagnosed with HIV infections.

METHODS

Data were collected by self-report using standard measures. Demographics, medical histories of immunosuppressive states, and investigator-developed screening inventories of behavioral and dietary risk factors associated with SIL also were administered.

MAIN RESEARCH VARIABLES

Life event stressors, psychological state, social support, symptom distress, and SIL diagnosis.

FINDINGS

Instruments met acceptable psychometric standards for internal consistency, but the standard measure of stressful life events did not capture the full range of stressors experienced by this group of patients: hovering relatives, abusive spouses, HIV diagnosis, changes in welfare benefits, the HIV status of the unborn, and mandatory foster care. Although unable to recall cancer histories of family members, about half of the women who completed study instruments were interested in receiving more information cervical cancer. Exploratory analyses suggest that women diagnosed with SIL experience more psychological distress and family disfunction than women without SIL.

CONCLUSIONS

Completing personal SIL risk assessments may stimulate patients' receptivity to cancer risk factor information. Health outcomes studies guided by the Life Stress Model may prove fruitful.

IMPLICATIONS FOR NURSING PRACTICE

Cancer risk factor assessments may be an important method for promoting receptivity to cancer prevention information.

Etiological factors of laryngeal cancer

In order to evaluate the etiological factors, all 318 cases of laryngeal cancer diagnosed during the period of 1962-91 in the Tampere University Hospital area with a population of 400,000 were reviewed. Among males the annual age-adjusted incidence decreased significantly from 7.1 to 2.3 per 100,000. No significant difference in the occurrence was found between urban and rural areas. In males the relative risk (RR) was significantly higher in the lower socio-economic groups. In both sexes smokers had significantly higher risk compared to non-smokers. For male smokers RR was 15.5 (95% CI 10.0-25.4) and for female smokers 12.4 (95% CI 3.9-39.5). Changes in smoking habits seem to be the most important factor contributing to the decreasing incidence of laryngeal cancer in Finland, but other factors like changes in dietary and sauna habits may also have some significance.

Skin cancer in a subtropical Australian population: incidence and lack of association with occupation. The Nambour Study Group

Because it is not possible to monitor skin cancer accurately using routine methods, special surveys have been undertaken in Nambour, a typical subtropical community in Queensland, Australia. Estimates of incidence reported here are based on skin cancers medically treated between 1985 and 1992 and new cases diagnosed by dermatologists in two examination clinics in 1986 and 1992. Among men and women aged 18-69 years in 1986, age-adjusted incidence rates of basal cell carcinoma were 2,074 and 1,579 per 100,000 per year, respectively-the highest incidence rates of a specific cancer ever reported. Squamous cell carcinoma occurred at half the rate of basal cell carcinoma among men and at about one third the rate among women. Although as expected, fair skin, a history of repeated sunburns, and nonmalignant solar skin damage diagnosed by dermatologists were strongly associated with both types of skin cancer, outdoor occupation was not. Significant self-selection was observed among outdoor workers, whereby people with fair or medium complexions and a tendency to sunburn were systematically underrepresented among those in long-term outdoor occupations although they accounted for more than 80 percent of the community study sample. The mitigating effect of this selection bias may partly explain the paradox of the lack of quantitative evidence of a causal link between sun exposure and skin cancer in humans.

Squamous cell carcinoma of the foot arising in chronic ulcers in leprosy patients

Squamous cell carcinoma (SCC) of the foot is a rare sequelae of chronic ulceration secondary to leprosy neuropathy. Most of the tumours are relatively slow growing and tend to metastasize late. Survival after local excision is generally good. In this series of 17 patients so far there have been 3 deaths attributable to SCC, all of whom presented with locally advanced tumours and lymph node metastasis.

[Cancer of the oral cavity in machine workers]

BACKGROUND

So far, only few studies exist which investigated the influence of occupational factors on the risk of oral cancer.

PATIENTS

A case control study enrolling 100 patients with carcinomas of the oral cavity and 400 randomized control persons was performed to analyze occupational risk factors for oral cancer.

RESULTS

Twenty-two percent of the tumor patients and only 8.5% of the control persons were employed as machine workers. The relative risk for squamous cell carcinoma of the oral cavity was 3.4 (K.I.: 1.7-7.0) for machine workers (adjusted for alcohol and tobacco). Single case analysis showed that 96.3% of the machine workers with oral cancer and only 17.3% of the machine workers in the control group were exposed to dust, especially metal dust (55.5% vs. 9.7%). Also the exposure to paint, lacquer, and varnish containing chromium and nickel was significantly higher in machine workers with cancer of the oral cavity than in the machine workers without cancer (29.6% vs. 10.9%).

CONCLUSIONS

The findings suggest that exposition to various types of dust, especially metal dust, increases the risk of oral cancer in machine worker patients.

Current status of retinoids in chemoprevention of oral squamous cell carcinoma: an overview

Squamous cell carcinoma of the oral cavity and oropharynx may be amenable to chemoprevention. This review focuses on current concepts of mechanisms in oral carcinogenesis, as well as the evidence that retinoids have a role in the primary and secondary prevention of this malignancy.

Squamous cell carcinoma arising in osteomyelitis and chronic wounds. Treatment with Mohs micrographic surgery vs amputation

BACKGROUND

Squamous cell carcinoma (SCC) is a rare, but well-documented complication of osteomyelitis and chronic wounds. Treatment of choice for these tumors commonly occurring on the legs has been amputation. Two recent articles have suggested the utility of Mohs micrographic surgery (MMS) as a limb saving procedure.

OBJECTIVE

To discuss the process of decision analysis in patients with SCC arising in osteomyelitis and chronic wounds.

METHODS

Four patients with SCC (three developing in association with chronic osteomyelitis, one after a burn wound) are presented.

RESULTS

Two patients underwent MMS as a limb-saving procedure, while the other two underwent amputation. Only two of our patients were able to have MMS since we were confronted with factors that precluded the use of this technique. These factors included the presence of metastatic disease and the potential for the loss of a functional limb after surgery.

CONCLUSIONS

Our series confirms the utility of MMS as a potentially limb-saving procedure in patients with SCC arising in either chronic wounds or in association with osteomyelitis. Despite this, patients with distant spread of their disease or extensive local disease leading to the potential loss of functional stability of the leg postoperatively may not be candidates for MMS and may require amputation.

Squamous cell carcinoma of the gingiva in an HIV-positive patient: a case report

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.

Gender differences in smoking and risk for oral cancer

Based on studies that show gender differences in cigarette smoking and lung cancer risk, we hypothesized that sex differences also exist in the risk for cancer of the oral cavity and pharynx. A hospital-based study of 1009 patients with oral neoplasia and 923 age-matched controls was conducted from 1981-1990. All subjects were interviewed directly with an extensive questionnaire containing items on tobacco smoking, alcohol consumption, and occupational exposures. Using a cumulative lifetime measure of exposure to cigarette tar, the adjusted odds ratio for men, according to increasing quartile of tar consumption and relative to never smokers, was 1.0 [95% confidence interval (CI), 0.6-1.6) for the lowest category, 0.9 (95% CI, 0.6-1.6) for the second category, 1.6 (95% CI, 1.0-2.5) for the third category, and 2.1 (95p5 CI, 1.4-3.2) for the highest category. Among women, the corresponding odds ratios were 1.8 (95% CI, 1.1-3.0), 2.8 (95% CI, 1.6-4.9), 3.2 (95% CI, 1.9-5.6), and 4.6 (95% CI, 2.5-8.7). The linear increase in risk was significantly higher for women than for men. Among nonsmoking cases, there was a significantly higher proportion of women than men over the age of 50 years. This was consistent for all subsites within the oral cavity. These findings support the hypothesis that there are gender differences in the smoking-related risks for oral cancer and in the risk for nonsmoking-related oral cancer as well. The role of nutrition in relation to these findings is discussed.

Diet and risk of esophageal cancer by histologic type in a low-risk population

In a hospital-based case-control study of esophageal cancer undertaken in Athens (1989-1991), 43 patients with incident esophageal squamous-cell carcinoma and 56 patients with incident esophageal adenocarcinoma were compared to 200 injury patients. Personal interviews were conducted in the hospital setting, and dietary intake was assessed using a validated semi-quantitative food-frequency questionnaire. Nutrient intakes for individuals were calculated by multiplying the nutrient content of a typical portion size for each specified food item by the frequency with which the food was consumed per month and summing these estimates for all food items. Data were modeled through logistic regression, controlling for socio-demographic factors, tobacco smoking, consumption of alcoholic beverages and total energy intake. Consumption of vegetables and fruits as well as intake of vitamin A, vitamin C and crude fiber were inversely associated with esophageal cancer in general, but the respective associations were stronger for adenocarcinoma. There was evidence that added oils and fats and intake of polyunsaturated fat were positively associated with adenocarcinoma but inversely associated with squamous-cell carcinoma.

Lung cancer in patients with idiopathic pulmonary fibrosis: CT findings

PURPOSE

The frequency of lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is higher than that of general population. To evaluate CT findings of lung cancer associated with IPF, we analyzed 32 patients with lung cancer associated with IPF.

METHOD

We analyzed retrospectively 32 patients with histologically confirmed lung cancer out of 244 consecutive cases diagnosed as IPF by either CT and clinical findings (n = 220) or histologically (n = 24). The patients were 40-85 years old (mean 66 years, M/F = 31/1). Scanning techniques were conventional CT in 24 patients, high-resolution CT (HRCT) in 2 patients, and both conventional CT and HRCT in 6 patients. We analyzed the CT patterns, locations, and histologic types of lung cancer.

RESULTS

The frequency of lung cancer in patients with IPF was 13.1% (32/244). In 17 of 32 patients, the CT findings of lung cancer were ill defined lesions mimicking air-space consolidation. Lung cancer was located mainly in the lower lobes (21/32) and peripheral portion (21/32). Histologically, squamous cell carcinoma was the most common type (18/32).

CONCLUSION

Typical CT findings of lung cancer were ill defined consolidation-like masses at the peripheral portion where the most advanced fibrosis was located.

A review of the aetiology of squamous cell carcinoma of the conjunctiva

Squamous cell carcinoma of the conjunctiva is a rare tumour with a multifactorial aetiology. There is strong epidemiological evidence that exposure to solar ultraviolet radiation is an important cause and that HIV infection predisposes to its development. The role of other factors, such as human papillomavirus infection, is unclear.

Carcinoma of the larynx in patients with gastroesophageal reflux

PURPOSE

To study the relationship between gastroesophageal reflux disease (GERD) and the development of laryngeal cancer in patients who lack other accepted risk factors for the development of squamous cell carcinoma of the larynx.

PATIENTS AND METHODS

A retrospective review of patients either treated surgically or with radiation therapy for stage 1 or stage 2 laryngeal carcinoma with specific reference to smoking history and the presence of GERD.

RESULTS

We present 9 lifetime nonsmoking patients with stage 1 or 2 laryngeal carcinoma in whom GERD was clinically and/or radiographically shown. Also, 14 patients are identified who quit smoking more than 15 years before the development of laryngeal cancer and who also had evidence of GERD.

CONCLUSION

We propose that the development of laryngeal carcinoma in this cohort of patients who lack typical risk factors supports the notion that GERD plays a role in the etiology of carcinoma of the larynx. Because the accepted risk factors for laryngeal carcinoma such as smoking and alcohol use increase the likelihood of reflux, GERD may act as a cocarcinogen in smokers and drinkers. Of interest, the treatment of GERD can reverse the signs of chronic laryngitis and should be instituted in patients with laryngeal pathology who have GERD.

Issues of justice in dentistry

Perhaps the greatest appeal of holding individuals responsible for behavior-related health problems arises from the idea of just desserts. Some individuals believe that a person who engages in risky behaviors deserves to suffer and should not expect pity. Health care providers with such opinions are not permitted to discriminate against patients in high-risk behavior groups. Some conduct may seem offensive or unnecessary to health care providers; however, they must care compassionately for those whose problems arise from such behaviors. Beneficence requires that dentists use their skills to help those in need, and set aside notions of punishing patients.

Cyclin D1 abnormalities and tobacco exposure in head and neck squamous cell carcinoma

BACKGROUND

Amplification of the cyclin D1 (CCND1) gene, which encodes a cell cycle regulating protein, has been described in several solid tumors including head and neck squamous cell carcinoma (HNSCC). While correlations between CCND1 amplification and tumor behavior have been suggested, no investigation has focused on risk factor exposure as a potential cause of CCND1 alteration.

METHODS

Southern blotting was used to identify CCND1 amplification in 57 previously untreated HNSCC tumor specimens Tissue from 27 cases was analyzed for CCND1 mRNA expression by Northern biot analysis.

RESULTS

In 13/57 (23%) cases, a 2-5 fold amplification of CCND1 was found. CCND1 mRNA expression was higher in amplified than in non-amplified tumors and supported an association between CCND1 amplification and increased expression of CCND1 mRNA. No correlation was found between CCND1 amplification or CCND1 expression and clinical or pathological parameters. However, analysis of risk factor exposure revealed that patients with greater tobacco exposure were more likely to have tumors with CCND1 amplification (p = .037). Also, tobacco exposure was correlated with CCND1 expression in tumors.

CONCLUSION

Tobacco exposure is a well-known risk factor for HNSCC. CCND1 amplification and alterations in expression may be causally related to tobacco carcinogen exposure and lead to a loss of cell cycle regulation.

Non-melanoma skin cancer and solar keratoses II analytical results of the South Wales Skin Cancer Study

This study aimed to identify risk markers for prevalent solar keratoses (SKs) and squamous cell carcinomata (SCC) combined, for incident SKs and for spontaneous remission of SKs and to evaluate primary preventative measures. It was a cross-sectional study, with follow-up, conducted in South Wales, and involved 1034 subjects aged 60 years and over. The main outcome measures were the presence of and changes in SKs, and presence of skin cancers, on sun-exposed skin, and risk factors for prevalent SKs/SCCs and for incidence and remission of SKs. We found that variables independently associated with prevalent SKs/SCCs were: age [80 + years vs 60-64 years, odds ratio (OR) 3.7]; sex (male vs female OR 2.2); cumulative sun exposure (top quintile vs bottom quintile OR 3.3) and skin type (skin type 1 vs 4 OR 12.4). Use of sunscreen or protective clothing was not protective after controlling for confounders. Males and those who sunbathe infrequently showed greater remission of SKs. Older subjects and those spending most time in the sun in the preceeding 2 years were most likely to develop new SKs. We conclude that the risk factors identified are consistent with results from sunnier countries. The failure of sunscreen or clothing to emerge as protective raises doubts as to whether these measures are as effective in routine use in the general population as theoretical considerations and the limited trial evidence would predict. Recently reported sun exposure appears to influence the risk of developing new SKs.

Pleural epidermoid carcinoma from displaced skin following extrapleural pneumothorax in a patient exposed to asbestos

This report illustrates a rare case of primary epidermoid carcinoma of the pleura in a patient previously treated by artificial extrapleural pneumothorax for active tuberculosis. The patient had also been occupationally exposed to asbestos. Light microscopic examination showed two different lesions: laminar pleural fragments were covered by normal squamous epithelium that was similar in all respects to epidermis, whereas nodular fragments were composed of well-differentiated infiltrating carcinoma. These findings support the hypothesis that the carcinoma arose from normal epidermis seeded in the pleural cavity during multiple air refills to maintain the pneumothorax. A possible interaction between asbestos fibres and chronic inflammation might have potentiated tumour development.

Case-control study of risk factors for cervical squamous cell neoplasia in Denmark. IV: role of smoking habits

The role of smoking and other risk factors for cervical neoplasia was investigated in a population-based case-control study of 586 women with histologically verified cervical squamous-cell carcinoma in situ (CIS), and 59 women with invasive squamous-cell cervical cancer from Copenhagen. Controls were randomly selected from the general female population using the computerized Danish Central Population Register. After adjustment for a variety of confounding variables, which were all significantly associated with CIS risk and included age, number of partners, proportion of sexually active life without barrier contraceptive use, years with intra-uterine devices, number of births, and age at first episode of genital warts (as a proxy measure for human papillomavirus exposure), current cigarette smoking was found to be significantly associated with CIS [adjusted relative risk (RR) = 2.4; 95% confidence interval (CI): 1.7-3.4]. Ex-smokers had a lower, but still significantly increased risk (RR = 1.6; 95% CI: 1.0-2.7). A dose-response relationship was present, especially for number of cigarettes smoked per day. In contrast, the crude estimates showed a weak association between invasive cervical cancer and smoking, which however disappeared after confounder control. The results of the present study support the hypothesis implicating smoking as a risk factor for CIS.

Nursing challenges of caring for patients with HIV-related malignancies

As many as 40% of individuals infected with HIV will be diagnosed with a malignancy during the course of their illness. Although neoplasms of all organ systems have been reported in infected patients, Kaposi's sarcoma (KS), non-Hodgkin's lymphoma (NHL), primary central nervous system (CNS) lymphoma, and invasive squamous cell cervical carcinoma are considered to be diagnostic of AIDS in the presence of HIV infection. The rapidity with which these malignancies are diagnosed can affect the morbidity experienced by patients. The management of patients with AIDS-related malignancies poses several challenges for oncology nurses. First, most such patients are treated with either chemotherapy or radiotherapy, and use of these modalities is complicated by the underlying HIV infection. Second, patients with AIDS-related malignancies experience numerous symptoms, and again, management of these symptoms is compounded by the underlying disease. By applying their knowledge and experience, oncology nurses can greatly lessen morbidity in these patients.