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Shapur N, Pode D, Katz R, Shapiro A, Yutkin V, Pizov G, Appelbaum L, Zorn KC, Duvdevani M, Landau EH, Gofrit ON. Predicting the Risk of High-Grade Bladder Cancer Using Noninvasive Data. Urol Int 2011; 87:319-24. [DOI: 10.1159/000328635] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/18/2011] [Indexed: 11/19/2022]
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152
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Körner A, Augustin M, Zschocke I. Gesundheitsverhalten von Hautkrebspatienten während der Melanomnachsorge. ACTA ACUST UNITED AC 2011. [DOI: 10.1026/0943-8149/a000035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Das maligne Melanom ist die häufigste Krebserkrankung im mittleren Erwachsenenalter. Es zeichnet sich durch besonders hohe Heilungschancen in frühen Krankheitsstadien und Therapieresistenz metastasierter Melanome aus. Zudem ist das Melanom einer der wenigen soliden Tumore, die sich – beobachtbar für den Fachmann aber auch für den medizinischen Laien – an der Hautoberfläche entwickeln. Die Überlebenswahrscheinlichkeit wird primär durch das Melanomstadium zum Zeitpunkt der Diagnose bestimmt. Die frühzeitige Behandlung von Krankheitsprogression ist von entscheidender Bedeutung für die Dauer und Qualität der verbleibenden Lebenszeit. Dementsprechend fokussieren Interventionen zur Senkung melanombedingter Morbidität und Mortalität auf die frühestmögliche Entdeckung der Melanome und der Krankheitsprogression. Regelmäßige Hautselbstuntersuchungen als sekundäre und tertiäre Präventionsmaßnahme stellen ein hocheffektives Komplement zu ärztlicher Vor- und Nachsorge dar, da die Mehrzahl der Melanome sowie die Krankheitsprogression von Patienten, deren Familie und Freunden selbst entdeckt werden. Eine wichtige Fragestellung stellt daher das auf die Melanomerkrankung bezogene Selbstuntersuchungsverhalten und Möglichkeiten seiner Optimierung dar. Psychoonkologische Forschung hat bisher darauf fokussiert, Handlungsergebniserwartung und Selbstwirksamkeitserwartung durch dermatologische Patientenschulung zu erhöhen. Die vorliegende Studie untersucht psychosoziales Belastungserleben und Krankheitsbewältigung in ihrer Bedeutung für das Selbstuntersuchungsverhalten in einer Stichprobe von 164 Patienten in der Melanomnachsorge. Mehr als 70% der Patienten gaben an, nicht von ihrem Arzt zur Selbstuntersuchung angeleitet worden zu sein. Angeleitete Patienten maßen der Selbstuntersuchung höhere Bedeutung bei und praktizierten diese häufiger, obwohl sie sich dadurch unangenehm an die Krebserkrankung erinnert fühlten. Nichtinstruierte Patienten zeigen ein weniger funktionales Verhaltensmuster: Die Selbstuntersuchungshäufigkeit wurde u.a. durch erlebte Selbstunsicherheit, mangelnde ärztliche Unterstützung und berufliche/finanzielle Probleme bestimmt, während das objektive Rückfallrisiko keine Rolle spielte. Auf Basis dieser sowie weiterer psychoonkologischer Befunde und gesundheitspsychologischer Paradigmen wird ein integratives Modell für die dringend notwendige Forschung und evidenzbasierte Praxis der individuellen Gesundheitsfürsorge bei Personen mit erhöhtem Melanomrisiko vorgeschlagen.
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Affiliation(s)
- Annett Körner
- Departments of Educational & Counselling Psychology and of Oncology, McGill University Louise Granofsky Psychosocial Oncology Program, Segal Cancer Centre Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg
| | - Matthias Augustin
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Hamburg-Eppendorf
| | - Ina Zschocke
- Institut für angewandte und klinische Forschung, SCIderm GmbH Hamburg
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153
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Fernández-Lao C, Cantarero-Villanueva I, Fernández-de-las-Peñas C, Del-Moral-Ávila R, Menjón-Beltrán S, Arroyo-Morales M. Widespread mechanical pain hypersensitivity as a sign of central sensitization after breast cancer surgery: comparison between mastectomy and lumpectomy. PAIN MEDICINE 2010; 12:72-8. [PMID: 21143767 DOI: 10.1111/j.1526-4637.2010.01027.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the differences in widespread pressure pain hypersensitivity after two surgery approaches for breast cancer: mastectomy or lumpectomy. DESIGN A cross-sectional blinded study. SETTING Widespread pressure pain hypersensitivity has been suggested as a sign of central sensitization. No study has previously investigated the presence of widespread pain pressure hypersensitivity after breast cancer surgery. PATIENTS Twenty-one women (age: 52±9 years old) who had received lumpectomy after breast cancer, 21 women (mean age: 50±10 years old) who had received mastectomy surgery after breast cancer, and 21 healthy women (age: 51±10 years old) participated. OUTCOME MEASURES Pressure pain thresholds (PPT) were bilaterally assessed over C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and the tibialis anterior muscle. RESULTS Women with mastectomy had greater intensity of neck (t= -2.897; P=0.006) and shoulder/axillary (t= -2.609; P=0.013) pain as compared with those who received lumpectomy. The results showed that PPT were significantly decreased bilaterally over the C5-C6 zygapophyseal joint, deltoid muscle, second metacarpal, and tibialis anterior muscle in both lumpectomy and mastectomy groups as compared with healthy women in all points (P<0.001), without differences between both breast cancer groups (P=0.954). No significant differences in the magnitude of PPT levels between both breast cancer groups were found (all, P>0.450). PPT levels over some areas were negatively associated with the intensity of pain in the mastectomy, but not lumpectomy, group. CONCLUSION The current study found widespread pressure pain hyperalgesia in women who received breast cancer surgery suggesting central spreading sensitization. The degree of central sensitization was similar between lumpectomy and mastectomy surgery.
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154
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Laubert T, Habermann JK, Bader FG, Jungbluth T, Esnaashari H, Bruch HP, Roblick UJ, Auer G. Epidemiology, molecular changes, histopathology and diagnosis of colorectal cancer. Eur Surg 2010. [DOI: 10.1007/s10353-010-0581-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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155
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Kaikaris V, Samsanavičius D, Kęstutis Maslauskas, Rimdeika R, Valiukevičienė S, Makštienė J, Pundzius J. Measurement of melanoma thickness--comparison of two methods: ultrasound versus morphology. J Plast Reconstr Aesthet Surg 2010; 64:796-802. [PMID: 21123126 DOI: 10.1016/j.bjps.2010.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the association between non-invasive ultrasound examination and morphologic test results in the measurement of cutaneous melanoma thickness influencing surgical treatment strategy. METHODS Our prospective clinical study has been conducted in the Clinic of Plastic and Reconstructive Surgery of Kaunas University of Medicine Hospital (KUMH) since January 2004 until October 2008. A total of 100 patients with a clear clinical diagnosis of stage I-II cutaneous melanoma were enrolled in this study. Melanoma depth was measured using a linear 14-MHz frequency ultrasound sensor (Toshiba Xario XG). Surgically removed fragments of skin-subcutaneous tissue were fixated using 10% formalin solution in the operating theatre, and sent to KUMH Clinic of Pathological Anatomy. The most informative sections were analysed for tumour thickness, according to Breslow, as well as tumour type, vascular and lymphatic invasion and dissemination. A comparative data analysis of melanoma thickness measured by ultrasound (T) preoperatively and histologically estimated cutaneous melanoma (CM) thickness according to Breslow (pT) using the Bland-Altman method was performed. RESULTS Higher mean difference of melanoma thickness (60 μm) between T and pT measurements was found when tumour thickness matched pT1 and pT2 categories. In cases of CM depth exceeding 2mm, mean difference of measurements between CM thickness determined by ultrasound and histological examination was lower (30 μm). Data regression analysis showed that correlation between T and pT measurements was lower when CM was thinner (1-2 mm) (Pearson's correlation coefficient, r: 0.283). In cases of thicker melanoma (>2 mm), strong and statistically significant (p<0.0001) correlation (r: 0.869) was observed. CONCLUSIONS Correlation between melanoma thickness measured using a linear 14-MHz frequency ultrasound sensor and histologically estimated melanoma thickness according to Breslow was lower if melanoma was thinner (1-2 mm). However, in cases of thicker melanoma (>2 mm), very strong correlation between measurements was observed.
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Affiliation(s)
- Vygintas Kaikaris
- Department of Plastic and Reconstructive Surgery, Kaunas University of Medicine, Eivenių 2,50009 Kaunas, Lithuania.
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156
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Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res 2010; 3:25. [PMID: 21040565 PMCID: PMC2987777 DOI: 10.1186/1757-1146-3-25] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/01/2010] [Indexed: 01/07/2023] Open
Abstract
Malignant melanoma is a life threatening skin tumour which may arise on the foot. The prognosis for the condition is good when lesions are diagnosed and treated early. However, lesions arising on the soles and within the nail unit can be difficult to recognise leading to delays in diagnosis. These guidelines have been drafted to alert health care practitioners to the early signs of the disease so an early diagnosis can be sought.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, SO17 1BJ, UK.
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157
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Myofascial Trigger Points in Neck and Shoulder Muscles and Widespread Pressure Pain Hypersensitivtiy in Patients With Postmastectomy Pain. Clin J Pain 2010; 26:798-806. [DOI: 10.1097/ajp.0b013e3181f18c36] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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158
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Abstract
After a disease-free period of 10 years, a surgically treated case of cutaneous malignant melanoma is usually not followed up further and there is a tendency to assume that the disease is cured. Late recurrence (after 10 years) of cutaneous malignant melanoma, though infrequent, has been documented well in Western countries. In our country, the malignant melanoma is still considered uncommon and there is no data regarding its late recurrence. We report a case of pulmonary malignant melanoma as a late metastatic manifestation of primary plantar malignant melanoma in a 61-year-old man who presented with hemoptysis; metastatic malignant melanoma of the lung occurred 12 years after resection of primary malignant melanoma of sole of the right foot.
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Affiliation(s)
- Karanam Gowrinath
- Department of Pulmonary Medicine and Pathology, Kasturba Medical College, Manipal, Karnataka State, India
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159
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Genetic variation and risk of chronic lymphocytic leukaemia. Semin Cancer Biol 2010; 20:363-9. [PMID: 20833250 DOI: 10.1016/j.semcancer.2010.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 08/25/2010] [Accepted: 08/27/2010] [Indexed: 11/22/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common form of lymphoid malignancy in Western countries, accounting for around a quarter of all leukaemias. Evidence from epidemiological and family studies have provided evidence for familial clustering of CLL compatible with inherited genetic predisposition to CLL. Direct evidence for genetic susceptibility has been provided by a recent genome wide association study of CLL which has identified common variants at 10 different loci which influence CLL risk. Here we review the current knowledge regarding the allelic architecture of susceptibility to CLL and what the currently identified risk loci are telling us regarding disease aetiology.
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160
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Kojima M, Nakajima K, Ishii G, Saito N, Ochiai A. Peritoneal elastic laminal invasion of colorectal cancer: the diagnostic utility and clinicopathologic relationship. Am J Surg Pathol 2010; 34:1351-60. [PMID: 20716999 DOI: 10.1097/pas.0b013e3181ecfe98] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
To determine whether the peritoneal elastic lamina can be a useful pathologic hallmark to classify the level of tumor spreading in colorectal cancer, we performed elastica staining in 564 pT3 and pT4a colorectal cancer cases. Associations between peritoneal elastic laminal invasion of the tumor and clinicopathologic features were evaluated. Next, morphology of tumor was compared between cases with and those without peritoneal elastic laminal invasion to estimate the morphologic alteration that occurs when tumor invades beyond the peritoneal elastic lamina. Morphometric analysis of tumor area beyond the peritoneal elastic lamina was performed and compared with other tumor area to elucidate morphologic characteristics of the tumor area beyond the peritoneal elastic lamina. Clinicopathologic analysis revealed that peritoneal elastic laminal invasion was associated with higher tumor stage, palliative resection, deeper tumor invasion, deeper ulceration, over 5 mm of muscular layer elevation and peritoneal surface retraction with fibro-inflammation, higher budding grade, and high grade of lymphovascular invasion (P<0.01). Peritoneal elastic laminal invasion was associated with recurrence and prognosis in colon cancer and was an independent risk factor for the recurrence of stage II colon cancer. Furthermore, morphometric analysis revealed that tumor area in subserosal invasive front beyond peritoneal elastic lamina exhibited significantly more prominent fibrosis and tumor budding than other tumor area (P<0.01). Peritoneal elastic lamina was useful hallmark to determine the level of tumor invasion, and was powerful indicator to predict prognosis in colon cancer. Tumor area beyond the elastic lamina is characterized by extensive tumor budding and fibrosis.
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Affiliation(s)
- Motohiro Kojima
- Pathology Division, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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161
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Keating NL, Landrum MB, Lamont EB, Earle CC, Bozeman SR, McNeil BJ. End-of-life care for older cancer patients in the Veterans Health Administration versus the private sector. Cancer 2010; 116:3732-9. [PMID: 20564065 DOI: 10.1002/cncr.25077] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under fee-for-service Medicare arrangements. METHODS Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in fee-for-service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P<.001), be admitted to an ICU within 30 days of death (12.5% vs 19.7%, P<.001), or have >1 emergency room visit within 30 days of death (13.1 vs 14.7, P=.09). CONCLUSIONS Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in fee-for-service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes.
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Affiliation(s)
- Nancy L Keating
- The Division of General Internal Medicine, Brigham and Women's Hospital, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA.
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162
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Skin cancer risk factors among primary school children: investigations in Western Hungary. Prev Med 2010; 51:320-4. [PMID: 20637225 DOI: 10.1016/j.ypmed.2010.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/15/2010] [Accepted: 07/07/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the factors associated with sunburns and with sun protection practice in Hungarian primary school children. METHOD We investigated children's (the median age: 8, range 5 to 12 years) and parents' assessment of sun sensitivity and sun protection characteristics in cities Gyor and Zalaegerszeg (Hungary) in 2004. This cross-sectional study was part of a programme intended to increase children's and parents' awareness of harmful effects of excessive sunbathing. Analyses were based on 1804 multiple choice questionnaires. RESULTS At multivariate analysis a significant association between sunburns and fairness of complexion, freckles, use of sunscreens and T-shirts, and higher school-class level was observed. Sunburn was inversely associated with hat-wearing. Parents were more likely to apply sunscreen to children with light eyes and to the younger ones, to protect fair skinned children with T-shirts; to protect males and children with fair skin and light eyes with hats. CONCLUSION Since environmental factors play an important role in the development of skin cancer, morbidity could be reduced by primary prevention. Sun protection habits should therefore be taught early in life, and parents' behaviour adapted. Phenotype is not only related to sunburns but it also appears to influence parents' sun safety behaviour.
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163
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Asgeirsson T, Senagore AJ, Dujovny N, Hoedema R, Kim D, Slay H, Luchtefeld M. Implementation of colonoscopic process measures: does it improve quality? Surg Endosc 2010; 25:826-9. [PMID: 20721584 DOI: 10.1007/s00464-010-1269-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Accepted: 06/30/2010] [Indexed: 11/25/2022]
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164
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Fang YJ, Lu ZH, Wang F, Wu XJ, Li LR, Zhang LY, Pan ZZ, Wan DS. Prognostic impact of ERβ and MMP7 expression on overall survival in colon cancer. Tumour Biol 2010; 31:651-8. [PMID: 20680712 DOI: 10.1007/s13277-010-0082-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/07/2010] [Indexed: 02/06/2023] Open
Abstract
Estrogen receptor beta (ERβ) is the most highly expressed protein in patients with colon cancer. Matrix metalloproteinase 7 (MMP7) is consistently expressed throughout cancer progression. We have previously shown that endocrine therapy can inhibit MMP7 expression in colon cancer cells. In this study, we aim to identify the prognostic effects and correlation of ERβ and MMP7 in the context of colon cancer. ERβ and MMP7 levels were assessed by immunohistochemistry in normal mucosa and tumoral tissues from 423 patients with stage I-III colon cancer. The Cox proportional hazards regression model was applied to analyze the lifetime data, including overall survival (OS) and cause-specific survival (CSS). The 5-year survival rate was significantly higher in patients with high expression of nuclear ERβ than in patients with low expression (84.3% vs. 63.9%, respectively, p < 0.05). High expression of MMP7 was related to decreased OS (72% vs. 90%, respectively, p = 0.008) and 5-year survival (86.6% vs. 88.8%, respectively, p = 0.005) compared to patients with low expression of MMP7. In the subset of patients with high expression levels of tumoral nuclear ERβ, high expression of MMP7 was related to OS and CSS among colon cancer patients with high expression of ERβ. In conclusion, our results suggest that low expression of ERβ was a risk factor in colon cancer, and high expression of MMP7 was an independent prognostic factor of ERβ-positive patients with colon cancer.
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Affiliation(s)
- Yu-Jing Fang
- Department of Experimental Research, State Key Laboratory of Oncology in South China, Cancer Center, Sun Yat-sen University, No. 651, Dongfeng Road East, Guangzhou 510060, China
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165
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Performance improvements of imaging-based screening tests. Best Pract Res Clin Gastroenterol 2010; 24:493-507. [PMID: 20833352 DOI: 10.1016/j.bpg.2010.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 03/19/2010] [Accepted: 04/03/2010] [Indexed: 01/31/2023]
Abstract
Endoscopic and radiologic tests appear to be more accurate than stool-tests in detecting advanced neoplasia because of direct visualisation of colorectal mucosa. Further technological advances are expected to improve the performance and acceptability of these tests. Several attempts at increasing the adenoma detection rate of colonoscopy have been tested, and in vivo histologic differentiation between neoplastic and hyperplastic polyps may lead to substantial saving in economic and medical resources. Low-volume and non-cathartic bowel preparations may improve CT colonography acceptability, whilst computer-aided detection and low-dose protocols may result in a higher accuracy and safety of this procedure. Despite the lack of ionising radiation, significant drawbacks will likely to limit the role of MR colonography in screening programs. Colon capsule endoscopy appears to be a safe and technically feasible procedure. The suboptimal accuracy of the first generation seems to be substantially improved by the second generation of this device.
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166
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Han YY, Dinse GE, Umbach DM, Davis DL, Weissfeld JL. Age-period-cohort analysis of cancers not related to tobacco, screening, or HIV: sex and race differences. Cancer Causes Control 2010; 21:1227-36. [PMID: 20373012 PMCID: PMC2904415 DOI: 10.1007/s10552-010-9550-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify trends in a residual category of cancers not typically associated with tobacco, screening, or human immunodeficiency virus (HIV) infection. METHODS For persons aged 20-84, we used sex- and race-specific age-period-cohort (APC) models to describe temporal patterns of incidence (1975-2004) and mortality (1970-2004) in the U.S. for a residual cancer category that excluded non-Hodgkin lymphoma, Kaposi sarcoma, and cancer of the oral cavity and pharynx, esophagus, pancreas, larynx, lung and bronchus, urinary bladder, kidney and renal pelvis, colon and rectum, prostate, female breast, and cervix uteri. RESULTS Age-specific incidence rose (0.1-0.9% per year, on average) in every sex-race group, with factors related to both time period and birth cohort membership appearing to accelerate the increases in women. Age-specific mortality fell (0.6-0.9% per year, on average) for black and white men and women, with the declines decelerating in white women but accelerating in the other sex-race groups. Extrapolations of APC models predicted higher age-adjusted incidence rates in white women (11%), black women (5%), and white men (4%) in 2005-2009, relative to 2000-2004, and lower rates in black men (-3%), accompanied by lower age-adjusted mortality rates in every sex-race group (-8% in black men, -3% in black women, -1% in white men, and -1% in white women). CONCLUSIONS The possibility that increased incidence in women over time reflects changes in underlying risks, diagnostic practices, or better case ascertainment should be actively explored. Declining mortality may signify improvements in cancer care.
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Affiliation(s)
- Yueh-Ying Han
- Department of Epidemiology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15232
| | - Gregg E. Dinse
- Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709
| | - David M. Umbach
- Biostatistics Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina 27709
| | - Devra L. Davis
- Department of Epidemiology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15232
| | - Joel L. Weissfeld
- Department of Epidemiology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania 15232
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167
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Jin P, Lu XJ, Sheng JQ, Fu L, Meng XM, Wang X, Shi TP, Li SR, Rao J. Estrogen stimulates the expression of mismatch repair gene hMLH1 in colonic epithelial cells. Cancer Prev Res (Phila) 2010; 3:910-6. [PMID: 20663978 DOI: 10.1158/1940-6207.capr-09-0228] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Estrogen is reported to have a protective effect on colon cancer; however, the underlying mechanism is unclear. Impaired mismatch repair plays an important role in colonic carcinogenesis. The purpose of this study was to investigate the association of estrogen on regulating mismatch repair expression in colonic epithelial cells. In cultured COLO205 cells, the effect of estradiol (E2) and antagonist ICI182.780 on the expression of hMLH1 and hMSH2 was studied using reverse transcription-PCR and Western blotting. The correlation between serum level E2 and the expression of hMLH1 and hMSH2 in colonic mucosal tissue of 42 healthy individuals was also examined using reverse transcription-PCR and immunohistochemical staining. E2 increased the expression of hMLH1 in COLO205 cells, which was suppressed by ICI182.780. However, the effect of E2 on hMSH2 expression was not significant in COLO205 cells. In healthy individuals, a strong positive correlation of E2 level with hMLH1 expression in normal colonic epithelial cell was observed when serum E2 level was >45 pg/mL, but no correlation was seen between E2 and hMSH2 expression. E2 affects the expression of hMLH1 but not hMSH2 in vitro, and high serum E2 level correlates with hMLH1 expression in vivo. These findings suggest that the anticolonic cancer effect of estrogen may be related to hMLH1 regulation.
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Affiliation(s)
- Peng Jin
- Department of Gastroenterology, Beijing Military General Hospital, People's Republic of China
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168
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Hartman J, Gustafsson JA. Estrogen receptors in colorectal cancer: goalkeepers, strikers, or bystanders? Cancer Prev Res (Phila) 2010; 3:897-9. [PMID: 20663982 DOI: 10.1158/1940-6207.capr-10-0132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This perspective on Jin et al. (beginning on page 910 in this issue of the journal) discusses the importance of estrogen signaling in colorectal carcinogenesis, with a focus on estrogen receptor beta (ERbeta), which is the predominant ER in the colorectal epithelium. The importance of ERbeta in breast cancer is well described in the literature, and recent studies reveal that ERbeta functions similarly in colorectal cancer. The implications of this pathway include new possibilities to treat or prevent colorectal cancer with targeted endocrine drugs and the potential of ERbeta as a novel diagnostic tool.
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Affiliation(s)
- Johan Hartman
- Department of Oncology, Karolinska University Hospital, Solna, Sweden
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169
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Nicolay C, Purkayastha S, Darzi A. Minimally invasive surgery for colorectal cancer. Expert Rev Anticancer Ther 2010; 10:469-71. [PMID: 20397909 DOI: 10.1586/era.10.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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170
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Abstract
PURPOSE A retrospective study was conducted to review the treatment and outcomes of mainly melanomas in acral location in a single institution in Korea, and to evaluate the prognostic significance of anatomic locations of the tumor. MATERIALS AND METHODS A retrospective review was completed on 40 patients between 2001 and 2006 to obtain pertinent demographic data, tumor data, treatment characteristics, and follow-up data. RESULTS Forty melanoma patients were identified and analyzed. Of these, 18 were male and 22 were female patients and the mean age at the time of diagnosis was 55.9 years. Of the tumors, 65% were located on the hands and feet with acral lentiginous melanoma being the most common histological subtype. Univariate analysis for the overall melanoma survival revealed that the thickness of the tumor and the clinical stage have prognostic significances. The most significant factor as analyzed by a multivariate analysis was shown to be the advanced clinical stage. Acral melanomas did not show statistically significant differences in the age at diagnosis, thickness of the tumor, stage, ulceration, and survival rates compared to non-acral melanomas. There was also no significant difference in the survival rate between the patients treated by amputation versus wide local excision in acral melanomas. CONCLUSION In Korean melanoma patients, thickness and advanced stages are significant factors for poorer prognosis. However, the location of melanoma did not have a significant prognostic value. In treating the melanomas in acral location, local wide excisions resulted in a similar prognosis compared to amputations.
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Affiliation(s)
- Mi Ryung Roh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jihyun Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kee Yang Chung
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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171
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Abstract
Colorectal carcinoma is common, but screening for this cancer has found less acceptance with the public than screening for breast, prostate, and cervical cancer. Available methods include fecal occult blood tests (FOBTs), flexible sigmoidoscopy (FOS), double-contrast barium enema, colonoscopy, computed tomographic colography, and fecal DNA. Evaluation of these options demonstrates that colonoscopy at ages 55 and 65 offers the best combination of reduction in colorectal cancer at the lowest cost. However, when compliance with screening recommendations is very high, costs are high, and the proportion of cancers arising from adenomas is low, the combination of FOS and FOBT is most cost effective. Malignant polyps look friable and irregular and feel hard. Sessile malignant polyps need to be treated by formal resection. Patients with pedunculated polyps with favorable histology (clear margin, well or moderately differentiated, no lymphovascular invasion) can be observed, and those whose polyps show unfavorable histology should have the polyp-bearing segment of colon resected along with its draining lymph nodes.
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Affiliation(s)
- James M Church
- Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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172
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Press OA, Zhang W, Gordon MA, Yang D, Haiman CA, Azuma M, Iqbal S, Lenz HJ. Gender-related survival differences associated with polymorphic variants of estrogen receptor-β (ERβ) in patients with metastatic colon cancer. THE PHARMACOGENOMICS JOURNAL 2010; 11:375-82. [PMID: 20548329 PMCID: PMC2941547 DOI: 10.1038/tpj.2010.45] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Estrogen replacement therapy in women has demonstrated a protective effect in the development of colonic carcinomas. Gender-related differences in the development of colonic carcinomas have also been reported. Estrogen receptor beta (ERβ) is expressed in colon carcinomas and has demonstrated prognostic value in colon cancer patients. This study investigated an ERβ 3’ non-coding polymorphism associated with transcriptional activity to determine clinical outcome in patients with metastatic colon cancer. Genomic DNA from 318 metastatic colon cancer patients, 177 males and 141 females, were collected from 1992 to 2003. These patients were analyzed for CA repeat polymorphism of the ERβ gene. Gender-related survival differences were associated with an ERβ (CA)n repeat polymorphism (P for interaction=0.003, the likelihood ratio test). Female patients with any short <22 (CA)n repeat alleles had shorter overall survival compared to female patients that had both long ≥22 (CA)n repeat alleles. In the male patients the opposite overall survival difference was found. This study supports the role of an ERβ (CA)n repeat polymorphism as a prognostic marker in metastatic colon cancer; however, this prognostic factor had opposite implications based on gender.
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Affiliation(s)
- O A Press
- Division of Medical Oncology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA 90033, USA
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173
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Inoue Y, Yokobori T, Yokoe T, Toiyama Y, Miki C, Mimori K, Mori M, Kusunoki M. Clinical significance of human kallikrein7 gene expression in colorectal cancer. Ann Surg Oncol 2010; 17:3037-42. [PMID: 20544292 DOI: 10.1245/s10434-010-1132-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND The human kallikrein-related peptidases (KLK) are considered important prognostic biomarkers in cancer. The aim of the current study is to demonstrate gene expression of KLK7 in colorectal cancer (CRC) and to correlate the relative KLK7 expression level with clinicopathological factors of CRC. METHODS KLK7 messenger RNA (mRNA) expression was examined in nine CRC cancer cell lines by real-time polymerase chain reaction. The expression levels of KLK7 mRNA in cancerous tissues (n = 136) and paired normal tissues (n = 136) of CRC patients were also examined. RESULTS Six of the nine cell lines expressed the KLK7 gene. KLK7 mRNA expression levels in cancer tissues were significantly higher than those in normal tissues. Multivariate analysis revealed that the KLK7 mRNA expression level in cancer was an independent prognostic factor, especially in liver metastasis. CONCLUSIONS We provide evidence suggesting that KLK7 mRNA expression is correlated with prognosis in CRC patients, especially in liver metastasis.
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Affiliation(s)
- Yasuhiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan.
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174
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Gaddameedhi S, Kemp MG, Reardon JT, Shields JM, Smith-Roe SL, Kaufmann WK, Sancar A. Similar nucleotide excision repair capacity in melanocytes and melanoma cells. Cancer Res 2010; 70:4922-30. [PMID: 20501836 DOI: 10.1158/0008-5472.can-10-0095] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sunlight UV exposure produces DNA photoproducts in skin that are repaired solely by nucleotide excision repair in humans. A significant fraction of melanomas are thought to result from UV-induced DNA damage that escapes repair; however, little evidence is available about the functional capacity of normal human melanocytes, malignant melanoma cells, and metastatic melanoma cells to repair UV-induced photoproducts in DNA. In this study, we measured nucleotide excision repair in both normal melanocytes and a panel of melanoma cell lines. Our results show that in 11 of 12 melanoma cell lines tested, UV photoproduct repair occurred as efficiently as in primary melanocytes. Importantly, repair capacity was not affected by mutation in the N-RAS or B-RAF oncogenes, nor was a difference observed between a highly metastatic melanoma cell line (A375SM) or its parental line (A375P). Lastly, we found that although p53 status contributed to photoproduct removal efficiency, its role did not seem to be mediated by enhanced expression or activity of DNA binding protein DDB2. We concluded that melanoma cells retain capacity for nucleotide excision repair, the loss of which probably does not commonly contribute to melanoma progression.
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Affiliation(s)
- Shobhan Gaddameedhi
- Department of Biochemistry and Biophysics, University of North Carolina School of Medicine, Chapel Hill, North Carolina 27599, USA
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175
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Gallagher DJ, Vijai J, Cronin AM, Bhatia J, Vickers AJ, Gaudet MM, Fine S, Reuter V, Scher HI, Halldén C, Dutra-Clarke A, Klein RJ, Scardino PT, Eastham JA, Lilja H, Kirchhoff T, Offit K. Susceptibility loci associated with prostate cancer progression and mortality. Clin Cancer Res 2010; 16:2819-32. [PMID: 20460480 DOI: 10.1158/1078-0432.ccr-10-0028] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Prostate cancer is a heterogeneous disease with a variable natural history that is not accurately predicted by currently used prognostic tools. EXPERIMENTAL DESIGN We genotyped 798 prostate cancer cases of Ashkenazi Jewish ancestry treated for localized prostate cancer between June 1988 and December 2007. Blood samples were prospectively collected and de-identified before being genotyped and matched to clinical data. The survival analysis was adjusted for Gleason score and prostate-specific antigen. We investigated associations between 29 single nucleotide polymorphisms (SNP) and biochemical recurrence, castration-resistant metastasis, and prostate cancer-specific survival. Subsequently, we did an independent analysis using a high-resolution panel of 13 SNPs. RESULTS On univariate analysis, two SNPs were associated (P<0.05) with biochemical recurrence, three SNPs were associated with clinical metastases, and one SNP was associated with prostate cancer-specific mortality. Applying a Bonferroni correction (P<0.0017), one association with biochemical recurrence (P=0.0007) was significant. Three SNPs showed associations on multivariable analysis, although not after correcting for multiple testing. The secondary analysis identified an additional association with prostate cancer-specific mortality in KLK3 (P<0.0005 by both univariate and multivariable analysis). CONCLUSIONS We identified associations between prostate cancer susceptibility SNPs and clinical end points. The rs61752561 in KLK3 and rs2735839 in the KLK2-KLK3 intergenic region were strongly associated with prostate cancer-specific survival, and rs10486567 in the 7JAZF1 gene were associated with biochemical recurrence. A larger study will be required to independently validate these findings and determine the role of these SNPs in prognostic models.
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Affiliation(s)
- David J Gallagher
- Department of Medicine, Clinical Genetics Service, Sloan-Kettering Institute, Memorial Sloan-Kettering Cancer Center, Albert Einstein College of Medicine, New York, New York 10065, USA
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176
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The changing face of cancer in the elderly: Only a demographic change? Arch Gerontol Geriatr 2010; 50:e59-62. [DOI: 10.1016/j.archger.2009.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 05/19/2009] [Accepted: 05/21/2009] [Indexed: 01/02/2023]
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177
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Subsite-specific differences of estrogen receptor beta expression in the normal colonic epithelium: implications for carcinogenesis and colorectal cancer epidemiology. Eur J Gastroenterol Hepatol 2010; 22:614-9. [PMID: 20173645 DOI: 10.1097/meg.0b013e328335ef50] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study aimed at investigating whether a differential estrogen receptor beta (ER-beta) expression between the colonic subsites could correspond to a modification in proliferation, apoptosis, and adhesion of the normal colonocytes. METHODS ER-beta, Ki-67, Bcl-2, and E-cadherin expressions were investigated immunohistochemically, in normal epithelium biopsies from the ascending and the descending colon of 53 individuals, who underwent colonoscopy for the investigation of anemia and in whom no local pathology was identified. RESULTS ER-beta immunoreactivity has been shown to be stronger at the superficial epithelium than the crypts' base, the difference being important only for the ascending colon. In addition, ER-beta expression was higher in the superficial epithelium of the ascending colon than that of the descending colon. The variations of ER-beta expression did not correspond to the alterations in Ki-67, Bcl-2, and E-cadherin expression. CONCLUSION A subsite-specific variation of ER-beta expression has been shown in the normal colonic epithelium. This modulation of ER-beta might account for some well established specificities of colorectal cancer epidemiology like the right-sided predominance of the neoplasm in women and its gradual shift to more proximal sites over time.
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178
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Abstract
The definition of "polypharmacy" ranges from the use of a large number of medications; the use of potentially inappropriate medications, which can increase the risk for adverse drug events; medication underuse despite instructions to the contrary; and medication duplication. Older adults are particularly at risk because they often present with several medical conditions requiring pharmacotherapy. Cancer-related therapy adds to this risk in older adults, but few studies have been conducted in this patient population. In this review, we outline the adverse outcomes associated with polypharmacy and present polypharmacy definitions offered by the geriatrics literature. We also examine the strengths and weaknesses of these definitions and explore the relationships among these definitions and what is known about the prevalence and impact of polypharmacy.
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Affiliation(s)
- Ronald J Maggiore
- Yale Comprehensive Cancer Center and Yale University School of Medicine, New Haven, Connecticut, USA
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179
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Rokkas T, Papaxoinis K, Triantafyllou K, Ladas SD. A meta-analysis evaluating the accuracy of colon capsule endoscopy in detecting colon polyps. Gastrointest Endosc 2010; 71:792-8. [PMID: 20363421 DOI: 10.1016/j.gie.2009.10.050] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Accepted: 10/22/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a new, noninvasive method for examining the entire colon. The reported yield of CCE in detecting colorectal polyps has shown variable results. OBJECTIVE To assess the accuracy of CCE by pooling data of existing trials. DESIGN Meta-analysis. The fixed-effects or random-effects model was used as appropriate, based on whether homogeneity or heterogeneity, respectively, was indicated by the Cochran Q test. SETTING Studies that estimated the accuracy of CCE were identified. Two investigators independently conducted the search and data extraction. PATIENTS A total of 626 individuals were included in this meta-analysis. INTERVENTION Each patient underwent CCE and conventional colonoscopy. MAIN OUTCOME MEASUREMENTS Per-patient sensitivity and specificity, with 95% confidence intervals (CI). RESULTS Findings were categorized as "significant polyps," that is, a report of a polyp >6 mm in size or 3 or more polyps of any size, or "any polyp," that is, a report of any polyp found, independent of size. Pooled data on sensitivity and specificity with a 95% CI were estimated. For any polyp found, the pooled data showed per-patient CCE sensitivity of 73% (95% CI, 68%-77%) and specificity of 89% (95% CI, 81%-94%). For significant polyps, the respective values were 69% (95% CI, 62%-75%) and 86% (95% CI, 82%-90%). LIMITATIONS A small number of studies met inclusion criteria. CONCLUSION CCE is a reasonable method for screening asymptomatic individuals for colorectal polyps. It may be particularly useful for patients with "incomplete" colonoscopy, those with contraindications for conventional colonoscopy, and those unwilling to undergo colonoscopy because of its perceived inconvenience and discomfort.
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Affiliation(s)
- Theodore Rokkas
- Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece
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180
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Cheung MC, Yang R, Byrne MM, Solorzano CC, Nakeeb A, Koniaris LG. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer 2010; 116:723-33. [PMID: 19998350 DOI: 10.1002/cncr.24758] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P = .003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.
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Affiliation(s)
- Michael C Cheung
- DeWitt Daughtry Family Department of Surgery, University of Miami School of Medicine, Miami, Florida 33136, USA
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181
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Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LAG. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010. [PMID: 19998273 DOI: 10.1002/cncr.24760]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year's report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions. METHODS Information regarding invasive cancers was obtained from the NCI, CDC, and NAACCR; and information on deaths was obtained from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (based on the year 2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term trends (1975-2006) and for short-term fixed-interval trends (1997-2006). All statistical tests were 2-sided. RESULTS Both incidence and death rates from all cancers combined significantly declined (P < .05) in the most recent time period for men and women overall and for most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the 3 most common cancers in men (ie, lung and prostate cancers and CRC) and for 2 of the 3 leading cancers in women (ie, breast cancer and CRC). The long-term trends for lung cancer mortality in women had smaller and smaller increases until 2003, when there was a change to a nonsignificant decline. Microsimulation modeling demonstrates that declines in CRC death rates are consistent with a relatively large contribution from screening and with a smaller but demonstrable impact of risk factor reductions and improved treatments. These declines are projected to continue if risk factor modification, screening, and treatment remain at current rates, but they could be accelerated further with favorable trends in risk factors and higher utilization of screening and optimal treatment. CONCLUSIONS Although the decrease in overall cancer incidence and death rates is encouraging, rising incidence and mortality for some cancers are of concern.
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Affiliation(s)
- Brenda K Edwards
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-8315, USA.
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ADAM10 Is Upregulated in Melanoma Metastasis Compared with Primary Melanoma. J Invest Dermatol 2010; 130:763-73. [DOI: 10.1038/jid.2009.335] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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183
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Abstract
Transnasal upper endoscopy has been implemented in the last decade as it is perceived as less fastidious than peroral endoscopy, and small-caliber gastroscopes are widely available in the endoscopic centres. We report the feasibility of performing a full colonic study with ileal intubation, using a small-caliber endoscope commonly used for transanal endoscopy, after failing with a standard gastroscope.
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184
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Hwang ST, Cho YK, Park JH, Kim HJ, Park DI, Sohn CI, Jeon WK, Kim BI, Won KH, Jin W. Relationship of non-alcoholic fatty liver disease to colorectal adenomatous polyps. J Gastroenterol Hepatol 2010; 25:562-7. [PMID: 20074156 DOI: 10.1111/j.1440-1746.2009.06117.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Metabolic syndrome and insulin resistance are associated with a higher risk of colon cancer. Non-alcoholic fatty liver disease (NAFLD) is regarded as a manifestation of metabolic syndrome in the liver. This investigation was initiated to determine whether NAFLD has a relationship to colorectal adenomatous polyps. METHODS We examined the 2917 participants who underwent a routine colonoscopy at Kangbuk Samsung Hospital in 2007. We divided the 2917 subjects into the adenomatous polyp group (n = 556) and the normal group (n = 2361). Anthropometric measurements, biochemical tests for liver and metabolic function, and abdominal ultrasonographs were assessed. RESULTS The prevalence of NAFLD was 41.5% in the adenomatous polyp group and 30.2% in the control group. By multiple logistic regression analysis, NAFLD was found to be associated with an increased risk of colorectal adenomatous polyps (odds ratio, 1.28; 95% confidence interval, 1.03-1.60). An increased risk for NAFLD was more evident in patients with a greater number of adenomatous polyps. CONCLUSION NAFLD was associated with colorectal adenomatous polyps. Further studies are needed to confirm whether NAFLD is a predictor for the development of colorectal adenomatous polyps and cancer.
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Affiliation(s)
- Sang Tae Hwang
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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185
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Shokar NK, Carlson CA, Weller SC. Informed decision making changes test preferences for colorectal cancer screening in a diverse population. Ann Fam Med 2010; 8:141-50. [PMID: 20212301 PMCID: PMC2834721 DOI: 10.1370/afm.1054] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. METHODS In a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientific evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coefficient (r) among participants was used to measure the degree of consistency in choices. RESULTS Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specific attributes, preferences were for high test accuracy (r = 0.63, P < .001), amount of colon examined (r = 0.64, P < .001), strong scientific evidence for efficacy (r = 0.59, P < .001), minimum discomfort (r = 0.50, P < .001), and low risk of complications (r = 0.38, P < .001). When all 13 attributes were considered together, agreement dropped (r = 0.13, P < .001), but attributes considered most important for decision making were test accuracy, scientific evidence for efficacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r = 0.20, P < .001), and choices were fairly consistent before and after exposure to test-specific attributes (kappa = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specific attributes, the modal choice was colonoscopy (54%). CONCLUSION Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients.
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Affiliation(s)
- Navkiran K Shokar
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas 77555-1123, USA.
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186
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Lee H, Baik SY. Health disparities or data disparities: sampling issues in hepatitis B Virus infection among Asian American Pacific Islander studies. Appl Nurs Res 2010; 24:e9-e15. [PMID: 20974087 DOI: 10.1016/j.apnr.2009.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Revised: 12/12/2009] [Accepted: 12/21/2009] [Indexed: 11/17/2022]
Abstract
Hepatitis B virus (HBV) infection in Asian American Pacific Islanders (AAPIs) is an important health problem that must be recognized and addressed by the U.S. public health policy. However, AAPIs have been to a large degree invisible in public health data and debates and their interests have been disregarded. Moreover, an estimation of HBV infection rates reported from the National Nutritional and Health Survey Examinations III was 1.25 million; however, an estimate based on AAPI-targeted studies places the number at almost 2 million. This article discusses the perils of application of textbook methods of sampling coverage, selection, and nonresponse in studies related to AAPIs and the importance to note that some rapidly increasing racial/ethnic groups such as AAPIs have linguistic and cultural differences and these differences often cause such groups to be omitted from data collection.
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Affiliation(s)
- Haeok Lee
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125-3393, USA.
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187
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Colorectal cancer and adenomas are rare in individuals of Turkish descent living in the Zaanstreek region in the Netherlands. J Cancer Res Clin Oncol 2010; 136:1439-43. [PMID: 20140623 PMCID: PMC2908754 DOI: 10.1007/s00432-010-0799-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 01/20/2010] [Indexed: 11/18/2022]
Abstract
Background Colorectal cancer is one of the most common malignancies in the Western world. Screening and detection of its precursor lesion, the adenoma could prevent development of colorectal cancer. Many studies have been done to evaluate the prevalence of colorectal cancer in different countries. In daily practice, it was noticed that colorectal cancer was rarely seen in patients of Turkish decent. Aim To evaluate the prevalence of colorectal cancer and adenoma in patients living in the Zaanstreek region, the Netherlands, and correlate these findings with ethnicity. Materials and methods All patients undergoing endoscopy of the colon and rectum during a period of 16 consecutive years in whom colorectal cancer and/or a polyp were diagnosed, were included in this study. All available histological data were retrieved in order to confirm the endoscopic diagnosis. Results In the study period, 907 patients were diagnosed with colorectal cancer. Of these 13 (1.4%) were of Turkish descent (10 men and 3 women). The remaining 894 were authentic Dutch (473 men and 421 women). A total of 2,744 patients had one or more polyp(s) during endoscopy. There were 2,705 authentic Dutch (1,386 men, 1,319 women) and 39 Turkish patients (25 men, 14 women). There was no significant difference in gender in either of the groups. Conclusion Colorectal cancer and colonic adenoma are rare in patients of Turkish descent living in the Zaanstreek region, the Netherlands.
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188
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Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LAG. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010; 116:544-73. [PMID: 19998273 PMCID: PMC3619726 DOI: 10.1002/cncr.24760] [Citation(s) in RCA: 1434] [Impact Index Per Article: 102.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The American Cancer Society, the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the United States. This year's report includes trends in colorectal cancer (CRC) incidence and death rates and highlights the use of microsimulation modeling as a tool for interpreting past trends and projecting future trends to assist in cancer control planning and policy decisions. METHODS Information regarding invasive cancers was obtained from the NCI, CDC, and NAACCR; and information on deaths was obtained from the CDC's National Center for Health Statistics. Annual percentage changes in the age-standardized incidence and death rates (based on the year 2000 US population standard) for all cancers combined and for the top 15 cancers were estimated by joinpoint analysis of long-term trends (1975-2006) and for short-term fixed-interval trends (1997-2006). All statistical tests were 2-sided. RESULTS Both incidence and death rates from all cancers combined significantly declined (P < .05) in the most recent time period for men and women overall and for most racial and ethnic populations. These decreases were driven largely by declines in both incidence and death rates for the 3 most common cancers in men (ie, lung and prostate cancers and CRC) and for 2 of the 3 leading cancers in women (ie, breast cancer and CRC). The long-term trends for lung cancer mortality in women had smaller and smaller increases until 2003, when there was a change to a nonsignificant decline. Microsimulation modeling demonstrates that declines in CRC death rates are consistent with a relatively large contribution from screening and with a smaller but demonstrable impact of risk factor reductions and improved treatments. These declines are projected to continue if risk factor modification, screening, and treatment remain at current rates, but they could be accelerated further with favorable trends in risk factors and higher utilization of screening and optimal treatment. CONCLUSIONS Although the decrease in overall cancer incidence and death rates is encouraging, rising incidence and mortality for some cancers are of concern.
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Affiliation(s)
- Brenda K Edwards
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-8315, USA.
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189
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Stock C, Haug U, Brenner H. Population-based prevalence estimates of history of colonoscopy or sigmoidoscopy: review and analysis of recent trends. Gastrointest Endosc 2010; 71:366-381.e2. [PMID: 19846082 DOI: 10.1016/j.gie.2009.06.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/15/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lower GI endoscopy, such as colonoscopy or sigmoidoscopy, is thought to have a substantial impact on colorectal cancer incidence and mortality through detection and removal of precancerous lesions and early cancers. We aimed to review prevalence estimates of history of colonoscopy or sigmoidoscopy in the general population and to analyze recent trends. METHODS A systematic review of the medical literature, including MEDLINE (1966 to August 2008) and EMBASE (1980 to August 2008), was undertaken, supplemented by searches of the European Health Interview & Health Examination Surveys database and bibliographies. Detailed age-specific and sex-specific prevalence estimates from the United States were obtained from the Behavioral Risk Factor Surveillance System surveys 2002, 2004, and 2006. RESULTS The search yielded 55 studies that met our inclusion criteria. The majority of the reports (43) originated from the United States. Other countries of origin included Australia (2), Austria (2), Canada (5), France (1), Germany (1), and Greece (1). Estimates from the United States were generally increasing over time up to 56% (2006) for lifetime use of colonoscopy or sigmoidoscopy in people aged 50 years and older. Analysis of national survey data showed higher prevalences among men aged 55 years and older than for women of the same age. Prevalences were highest for people aged 70 to 79 years. CONCLUSION Data from outside the United States were extremely limited. Prevalence estimates from the United States indicate that a considerable and increasing proportion of the population at risk has had at least 1 colonoscopy or sigmoidoscopy in their lives, although differences between age and sex groups persist. Prevalences of previous colonoscopy or sigmoidoscopy need to be taken into account in the interpretation of time trends in, and variation across, populations of colorectal cancer incidence and mortality.
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Affiliation(s)
- Christian Stock
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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190
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Santillan AA, Messina JL, Marzban SS, Crespo G, Sondak VK, Zager JS. Pathology Review of Thin Melanoma and Melanoma in Situ in a Multidisciplinary Melanoma Clinic: Impact on Treatment Decisions. J Clin Oncol 2010; 28:481-6. [DOI: 10.1200/jco.2009.24.7734] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose Patients with thin melanoma (≤ 1.0 mm) and melanoma in situ (MIS) represent the majority of newly diagnosed melanoma. We estimated the impact of expert review of outside pathology material on the staging and thus treatment decisions affecting patients referred to a multidisciplinary clinic with early-stage melanoma. Patients and Methods We studied patients with a diagnosis of thin melanoma or MIS referred to H. Lee Moffitt Cancer Center from 2006 to 2009. After comparing the referring laboratory and in-house dermatopathologic interpretations, we calculated any differences in diagnosis and tumor staging and the potential impact of differences in diagnosis and staging on prognosis and surgical treatment using the National Comprehensive Cancer Network clinical guidelines. Results The overall pathologic discordance rate in diagnosis was 4% (15 of 420 patients; 95% CI, 2% to 6%). The overall change in tumor staging rate was 24% (97 of 405 patients; 95% CI, 20% to 28%). Pathology review led to changes in surgical excision margins in 12% of patients (52 of 420 patients; 95% CI, 9% to 16%) and in the decision about whether to perform a sentinel lymph node biopsy in 16% of patients (67 of 420 patients; 95% CI, 13% to 20%). Key pathologic factors, particularly mitotic rate, were frequently missing from outside pathology reports. Conclusion Our data suggest that review of thin melanoma or MIS by an expert dermatopathologist results in frequent, clinically meaningful alterations in diagnosis, staging, prognosis, and surgical treatment. Referral of these patients to a multidisciplinary melanoma clinic is appropriate, and management of such patients should include review of the biopsy whenever feasible.
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Affiliation(s)
- Alfredo A. Santillan
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jane L. Messina
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Suroosh S. Marzban
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Gema Crespo
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Vernon K. Sondak
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
| | - Jonathan S. Zager
- From the Department of Surgery, Section of Surgical Oncology, University of Texas Health Science Center at San Antonio; Section of Surgical Oncology, Audie L. Murphy Veterans Affairs Hospital, San Antonio, TX; Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center and Research Institute; and Departments of Oncologic Sciences, Dermatology, and Surgery, University of South Florida College of Medicine, Tampa, FL
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191
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Mejia A, Schulz S, Hyslop T, Weinberg DS, Waldman SA. Molecular staging estimates occult tumor burden in colorectal cancer. Adv Clin Chem 2010; 52:19-39. [PMID: 21275338 PMCID: PMC7012399 DOI: 10.1016/s0065-2423(10)52007-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tumor cells in regional lymph nodes are a key prognostic marker of survival and predictive marker of response to adjuvant chemotherapy in colorectal cancer. However, clinicopathologic techniques to detect lymph node metastases remain imperfect, and approximately 30% of patients with lymph nodes negative by histology (pN0) develop recurrent disease, reflecting occult metastases that escape detection. These observations underscore an unmet clinical need for accurate approaches to identify occult nodal metastases in colorectal cancer patients. GUCY2C is a receptor whose expression normally is restricted to intestinal epithelial cells, but is universally overexpressed by colorectal cancer cells. A prospective, multicenter, blinded clinical trial established the prognostic utility of GUCY2C qRT-PCR to detect occult nodal metastases in pN0 colorectal cancer patients. Molecular staging revealed that approximately 13% of pN0 patients were free of cancer cells, while approximately 87% had GUCY2C results that suggested occult metastases. The presence of occult nodal metastases was the most powerful independent predictor of time to recurrence and disease-free survival. These observations establish the utility of molecular detection of occult nodal metastases for assessing prognostic risk in pN0 colorectal cancer patients. Advancing GUCY2C into staging paradigms in clinical laboratories will require validation in independent patient populations, definition of the relationship between the quantity of occult tumor metastases and risk, and determination of the utility of GUCY2C qRT-PCR to identify pN0 patients who might benefit from adjuvant chemotherapy.
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Affiliation(s)
- Alex Mejia
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephanie Schulz
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Terry Hyslop
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David S. Weinberg
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Scott A. Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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192
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Anhang Price R, Zapka J, Edwards H, Taplin SH. Organizational factors and the cancer screening process. J Natl Cancer Inst Monogr 2010; 2010:38-57. [PMID: 20386053 PMCID: PMC3731433 DOI: 10.1093/jncimonographs/lgq008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cancer screening is a process of care consisting of several steps and interfaces. This article reviews what is known about the association between organizational factors and cancer screening rates and examines how organizational strategies can address the steps and interfaces of cancer screening in the context of both intraorganizational and interorganizational processes. We reviewed 79 studies assessing the relationship between organizational factors and cancer screening. Screening rates are largely driven by strategies to 1) limit the number of interfaces across organizational boundaries; 2) recruit patients, promote referrals, and facilitate appointment scheduling; and 3) promote continuous patient care. Optimal screening rates can be achieved when health-care organizations tailor strategies to the steps and interfaces in the cancer screening process that are most critical for their organizations, the providers who work within them, and the patients they serve.
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Affiliation(s)
- Rebecca Anhang Price
- SAIC-Frederick, Inc., Applied Cancer Screening Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, EPN 4103A, Rockville, MD 20852, USA.
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193
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Park SY, Kim HS, Yoon KW, Cho SB, Lee WS, Park CH, Joo YE, Choi SK, Rew JS. [Prevalence of colorectal adenoma is increased in patients with gastric adenoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 54:220-6. [PMID: 19844141 DOI: 10.4166/kjg.2009.54.4.220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS It has been reported that patients with gastric cancer may be at increased risk of synchronous or metachronous colorectal cancer. However, the incidence of colorectal adenoma in patients with gastric adenoma has not been discussed earlier. The aims of this study were to investigate the incidence of colorectal adenoma and to evaluate the necessity of colonoscopic surveillance in patients with gastric adenoma. METHODS We performed colonoscopy in 221 patients with gastric adenoma between January 2002 and June 2008. As a control group, 387 consecutive patients without gastric adenoma on gastroscopy who underwent colonoscopy were included. We retrospectively examined the endoscopic and colonoscopic findings as well as the clinicopathologic features. RESULTS Colorectal adenoma were diagnosed in 57.5% (127/221) of the gastric adenoma group and 38.0% (147/387) of the control group (p<0.001). Univariate analysis demonstrated that gender, age, past history of diabetes, and past history of gastric adenoma were associated with the risk of colorectal adenoma. Multivariate analysis demonstrated that gender (male, aOR 2.31, 95% CI 1.61-3.31), age (> or =50 years, aOR 2.47, 95% CI 1.53-4.01), past history of diabetes (aOR 2.35, 95% CI 1.32-4.20), and presence of gastric adenoma (aOR 1.63, 95% CI 1.13-2.36) appeared to be independent risk factors for colorectal adenoma. CONCLUSIONS The risk of colorectal adenoma increases significantly in patients with gastric adenoma. We suggest that colonoscopic surveillance may be necessary in patients with gastric adenoma.
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Affiliation(s)
- Seon Young Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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194
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Transoral endoscopic inner layer esophagectomy: management of high-grade dysplasia and superficial cancer with organ preservation. J Gastrointest Surg 2009; 13:2104-12. [PMID: 19826883 DOI: 10.1007/s11605-009-1053-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 09/16/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Limitations of endoscopic therapies for Barrett's esophagus and superficial cancer include a compromised histological assessment, the need for surveillance, subsequent procedures, and stricture formation. Circumferential en bloc resection of the mucosa-submucosa complex followed by deployment of a biologic scaffold onto the remaining muscularis propria may address these concerns. The objective of this study was to determine technical feasibility of transoral resection of the esophageal lining. MATERIALS AND METHODS Transoral endoscopic inner layer esophagectomy was performed in ten swine. Endpoints included procedure duration, hemorrhage, number of perforations, and adequacy of resection length and depth. RESULTS Procedures were successfully completed in all animals without perioperative mortality. Procedure times averaged 179 min (range 125-320). No perforations were found, and a mean of 1.7 (0-4) interventions for hemorrhage was required. Complete longitudinal resection was achieved in nine of ten animals. Resection depth included all mucosal layers in 100% of tissue sections, the submucosal layers, SM1 in 100%, and SM2 in 96%. A portion of SM3 was adherent to the muscularis propria in 70%. CONCLUSION Transoral endoscopic resection of the inner esophageal layers was feasible and reproducible. This technique may facilitate a single-step definitive treatment and staging tool for early neoplastic lesions, obviating the need for esophagectomy.
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195
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La Vecchia C, Bosetti C, Lucchini F, Bertuccio P, Negri E, Boyle P, Levi F. Cancer mortality in Europe, 2000-2004, and an overview of trends since 1975. Ann Oncol 2009; 21:1323-1360. [PMID: 19948741 DOI: 10.1093/annonc/mdp530] [Citation(s) in RCA: 300] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To update the pattern of cancer mortality in Europe. MATERIALS AND METHODS We analysed cancer mortality in 34 European countries during 2000-2004, with an overview of trends in 1975-2004 using data from the World Health Organization. RESULTS From 1990-1994 to 2000-2004, overall cancer mortality in the European Union declined from 185.2 to 168.0/100 000 (world standard, -9%) in men and from 104.8 to 96.9 (-8%) in women, with larger falls in middle age. Total cancer mortality trends were favourable, though to a variable degree, in all major European countries, including Russia, but not in Romania. The major determinants of these favourable trends were the decline of lung (-16%) and other tobacco-related cancers in men, together with the persistent falls in gastric cancer, and the recent appreciable falls in colorectal cancer. In women, relevant contributions came from the persistent decline in cervical cancer and the recent falls in breast cancer mortality, particularly in northern and western Europe. Favourable trends were also observed for testicular cancer, Hodgkin lymphomas, leukaemias, and other neoplasms amenable to treatment, though the reductions were still appreciably smaller in eastern Europe. CONCLUSION This updated analysis of cancer mortality in Europe showed a persistent favourable trend over the last years.
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Affiliation(s)
- C La Vecchia
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri'; Institute of Medical Statistics and Biometry 'G.A. Maccacaro', Università degli Studi di Milano, Milan, Italy
| | - C Bosetti
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri'.
| | - F Lucchini
- Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
| | - P Bertuccio
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri'
| | - E Negri
- Department of Epidemiology, Istituto di Ricerche Farmacologiche 'Mario Negri'
| | - P Boyle
- International Prevention Research Institute, Lyon, France
| | - F Levi
- Cancer Epidemiology Unit and Cancer Registries of Vaud and Neuchâtel, Institut de médecine sociale et préventive, Centre Hospitalier Universitaire Vaudois et Université de Lausanne, Lausanne, Switzerland
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196
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Mejia A, Schulz S, Hyslop T, Weinberg DS, Waldman SA. GUCY2C reverse transcriptase PCR to stage pN0 colorectal cancer patients. Expert Rev Mol Diagn 2009; 9:777-85. [PMID: 19895223 PMCID: PMC2810399 DOI: 10.1586/erm.09.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The most important prognostic marker of survival and predictive marker of response to adjuvant chemotherapy in colon cancer patients is tumor cells in regional lymph nodes. Despite their importance, standard techniques to assess nodal metastases remain imperfect, as approximately 30% of patients with histology-negative lymph nodes (pN0) die of recurrent disease, reflecting occult metastases that escape detection. These observations highlight the clinical need for novel, accurate approaches to detect occult lymph node metastases in patients with colon cancer. GUCY2C is a biomarker whose expression normally is restricted to intestinal cells, but is near universally overexpressed by colorectal cancer cells. Recently, a prospective, multicenter, blinded clinical trial demonstrated for the first time that the prognostic utility of GUCY2C quantitative reverse transcriptase (qRT)-PCR to detect occult lymph node metastases in pN0 colorectal cancer patients. Molecular staging revealed that approximately 13% of pN0 patients were free of tumor cells, while approximately 87% had GUCY2C results that suggested occult metastases. The presence of occult lymph node metastases was the strongest independent predictor of time to recurrence and disease-free survival. These observations establish the utility of molecular detection of occult lymph node metastases for estimating prognostic risk in pN0 colorectal cancer patients. Advancing this molecular diagnostic into staging paradigms in clinical laboratories will require validation in independent patient populations, definition of the relationship between the quantity of occult tumor metastases and risk, and determination of the utility of GUCY2C qRT-PCR to identify pN0 patients who might benefit from adjuvant chemotherapy.
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Affiliation(s)
- Alex Mejia
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107, USA
| | - Stephanie Schulz
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107, USA
| | - Terry Hyslop
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107, USA
| | - David S Weinberg
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Scott A Waldman
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main, Philadelphia, PA 19107, USA, Tel.: +1 215 955 6086
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197
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Crowther-Swanepoel D, Houlston RS. The molecular basis of familial chronic lymphocytic leukemia. Haematologica 2009; 94:606-9. [PMID: 19407315 DOI: 10.3324/haematol.2009.006296] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Our understanding of the genetic basis of chronic lymphocytic leukemia is only just starting to be recognized. This perspective article by Drs. Crowther-Swanepoel and Houlston provides an up-to-date review the molecular epidemiology of chronic lymphocytic leukemia, with emphasis on the integration of biology and genomics.
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198
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Yan B, Noone AM, Yee C, Banerjee M, Schwartz K, Simon MS. Racial differences in colorectal cancer survival in the Detroit Metropolitan Area. Cancer 2009; 115:3791-800. [PMID: 19598220 DOI: 10.1002/cncr.24408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Colorectal carcinoma is the second most common cause of cancer death with African Americans having lower survival compared with White Americans. The purpose of this study was to investigate the effect of demographics, clinical factors, and socioeconomic status (SES) on racial disparities in colorectal cancer survival in the Detroit Metropolitan Area. METHODS The study population included 9078 individuals with primary invasive colorectal cancer identified between 1988 and 1992 through the Surveillance, Epidemiology, and End Results (SEER) program. Demographics, clinical information, and survival were obtained through SEER. SES was categorized using occupation, educational level, and poverty status at the census tract level. Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare overall survival by race. RESULTS African Americans were more likely to be diagnosed with stage IV disease (P < .001), and to reside within poor census tracts (P < .001) compared with White Americans. Unadjusted analysis showed that African Americans had a significantly higher risk of death compared with their White American counterparts (hazards ratio [HR], 1.13; 95% confidence interval [CI], 1.07-1.20). After adjusting for age, marital status, sex, SES group, TNM stage, and treatment, race was no longer significantly associated with overall survival (HR, 1.00; 95% CI, 0.92-1.09). Similar results were seen with colorectal cancer-specific survival. CONCLUSIONS Racial disparities in colorectal cancer survival dissipate after adjusting for other demographic and clinical factors. These results can potentially affect medical guidelines regarding screening and treatment, and possibly influence public health policies that can have a positive impact on equalizing racial differences in access to care.
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Affiliation(s)
- Ben Yan
- Department of Internal Medicine, Henry Ford Hospital and Medical Center, Detroit, Michigan, USA
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199
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Kort EJ, Paneth N, Vande Woude GF. The decline in U.S. cancer mortality in people born since 1925. Cancer Res 2009; 69:6500-5. [PMID: 19679548 DOI: 10.1158/0008-5472.can-09-0357] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The conventional practice of analyzing overall age-adjusted cancer mortality rates heavily emphasizes the experience of older, higher mortality age groups. This may conceal shifts in lifetime cancer mortality experience emerging first in younger age groups. We examined age-specific cancer mortality rates and birth cohort-specific cancer mortality rates in U.S. mortality data recorded since 1955 to assess the effects of age, period, and cohort in secular mortality trends. Cancer mortality and population data were obtained from WHO Statistical Information System. Age-specific cancer mortality rates have been steadily declining in the United States since the early 1950s, beginning with children and young adults and now including all age groups. During the second half of the 20th century, each successive decade of births from 1925 to 1995 experienced a lower risk of cancer death than its predecessor at virtually every age for which such a comparison can be made. A major decline in cancer mortality has been occurring in the United States for the past 50 years, affecting birth cohorts born as long as 80 years ago. Excepting lung cancer, much of this decline has occurred despite relatively stable cancer incidence. These findings suggest that improvements in cancer detection, treatment, and/or prevention have reduced the risk of cancer death across the life span for individuals born in the last three quarters of the 20th century.
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Affiliation(s)
- Eric J Kort
- Laboratory of Molecular Epidemiology, Van Andel Research Institute, Grand Rapids, Michigan 49503, USA.
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200
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Couceiro TCDM, Menezes TCD, Valênça MM. Post-mastectomy pain syndrome: the magnitude of the problem. Rev Bras Anestesiol 2009; 59:358-65. [PMID: 19488550 DOI: 10.1590/s0034-70942009000300012] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 01/20/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Breast cancer is the most frequent neoplastic tumor in women, and surgical treatment is indicated in most patients. Complications related to this treatment, such as post-mastectomy pain syndrome (PMPS), a persistent pain that develops after surgery, have been reported. Although the genesis of the pain is multifactorial, sectioning of the intercostobrachial nerve is the nerve lesion diagnosed more often. The objective of this study was to review the etiopathogeny, diagnosis, presentation, aggravating or attenuating factors, and risk factors related with the post-mastectomy pain syndrome. CONTENTS Provides the definition of the post-mastectomy pain syndrome and the knowledge to facilitate its diagnosis and prevention. CONCLUSIONS The approach to patients undergoing surgery for breast cancer requires pre- and postoperative follow-up by a multidisciplinary team. This approach can provide a rational choice of surgical technique, identify patients with risk factors, minimize or eliminate risk factors whenever possible, diagnose beforehand the post-mastectomy pain syndrome, and provide adequate treatment to improve the quality of life for this specific patient population.
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Affiliation(s)
- Tania Cursino de Menezes Couceiro
- Responsável pela Residência Médica em Anestesiologia do Instituto de Medicina Integral Professor Fernando Figueira; Mestre em Neuropsiquiatria e Ciência do Comportamento, pela Universidade Federal de Pernambuco.
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