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Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, Bannon F, Ahn JV, Johnson CJ, Bonaventure A, Marcos-Gragera R, Stiller C, Azevedo e Silva G, Chen WQ, Ogunbiyi OJ, Rachet B, Soeberg MJ, You H, Matsuda T, Bielska-Lasota M, Storm H, Tucker TC, Coleman MP. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015; 385:977-1010. [PMID: 25467588 PMCID: PMC4588097 DOI: 10.1016/s0140-6736(14)62038-9] [Citation(s) in RCA: 1632] [Impact Index Per Article: 181.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems. FUNDING Canadian Partnership Against Cancer (Toronto, Canada), Cancer Focus Northern Ireland (Belfast, UK), Cancer Institute New South Wales (Sydney, Australia), Cancer Research UK (London, UK), Centers for Disease Control and Prevention (Atlanta, GA, USA), Swiss Re (London, UK), Swiss Cancer Research foundation (Bern, Switzerland), Swiss Cancer League (Bern, Switzerland), and University of Kentucky (Lexington, KY, USA).
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Affiliation(s)
- Claudia Allemani
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah K Weir
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Helena Carreira
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rhea Harewood
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Devon Spika
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Xiao-Si Wang
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Finian Bannon
- Northern Ireland Cancer Registry, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Jane V Ahn
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Audrey Bonaventure
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rafael Marcos-Gragera
- Unitat d'Epidemiologia i Registre de Càncer de Girona, Departament de Salut, Institut d'Investigació Biomèdica de Girona, Girona, Spain
| | - Charles Stiller
- South East Knowledge and Intelligence Team, Public Health England, Oxford, UK
| | - Gulnar Azevedo e Silva
- Department of Epidemiology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Wan-Qing Chen
- National Office for Cancer Prevention and Control and National Central Cancer Registry, National Cancer Center, Beijing, China
| | - Olufemi J Ogunbiyi
- Ibadan Cancer Registry, University City College Hospital, Ibadan, Nigeria
| | - Bernard Rachet
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Soeberg
- New South Wales Central Cancer Registry, Australian Technology Park, Sydney, NSW, Australia
| | - Hui You
- Cancer Institute NSW, Sydney, NSW, Australia
| | - Tomohiro Matsuda
- Population-Based Cancer Registry Section, Division of Surveillance, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Magdalena Bielska-Lasota
- Department of Health Promotion and Postgraduate Education, National Institute of Public Health and National Institute of Hygiene, Warsaw, Poland
| | - Hans Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - Thomas C Tucker
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY, USA
| | - Michel P Coleman
- Cancer Research UK Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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Karlsson KY, Wallenius I, Nilsson-Wikmar LB, Lindman H, Johansson BBK. Lymphoedema and health-related quality of life by early treatment in long-term survivors of breast cancer. A comparative retrospective study up to 15 years after diagnosis. Support Care Cancer 2015; 23:2965-72. [DOI: 10.1007/s00520-015-2662-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/15/2015] [Indexed: 11/27/2022]
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153
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Calero M, Chiappi M, Lazaro-Carrillo A, Rodríguez MJ, Chichón FJ, Crosbie-Staunton K, Prina-Mello A, Volkov Y, Villanueva A, Carrascosa JL. Characterization of interaction of magnetic nanoparticles with breast cancer cells. J Nanobiotechnology 2015; 13:16. [PMID: 25880445 PMCID: PMC4403785 DOI: 10.1186/s12951-015-0073-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/28/2015] [Indexed: 01/02/2023] Open
Abstract
Background Different superparamagnetic iron oxide nanoparticles have been tested for their potential use in cancer treatment, as they enter into cells with high effectiveness, do not induce cytotoxicity, and are retained for relatively long periods of time inside the cells. We have analyzed the interaction, internalization and biocompatibility of dimercaptosuccinic acid-coated superparamagnetic iron oxide nanoparticles with an average diameter of 15 nm and negative surface charge in MCF-7 breast cancer cells. Results Cells were incubated with dimercaptosuccinic acid-coated superparamagnetic iron oxide nanoparticles for different time intervals, ranging from 0.5 to 72 h. These nanoparticles showed efficient internalization and relatively slow clearance. Time-dependent uptake studies demonstrated the maximum accumulation of dimercaptosuccinic acid-coated superparamagnetic iron oxide nanoparticles after 24 h of incubation, and afterwards they were slowly removed from cells. Superparamagnetic iron oxide nanoparticles were internalized by energy dependent endocytosis and localized in endosomes. Transmission electron microscopy studies showed macropinocytosis uptake and clathrin-mediated internalization depending on the nanoparticles aggregate size. MCF-7 cells accumulated these nanoparticles without any significant effect on cell morphology, cytoskeleton organization, cell cycle distribution, reactive oxygen species generation and cell viability, showing a similar behavior to untreated control cells. Conclusions All these findings indicate that dimercaptosuccinic acid-coated superparamagnetic iron oxide nanoparticles have excellent properties in terms of efficiency and biocompatibility for application to target breast cancer cells. Electronic supplementary material The online version of this article (doi:10.1186/s12951-015-0073-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Macarena Calero
- Departamento de Biología, Universidad Autónoma de Madrid, Cantoblanco, 28049, Madrid, Spain. .,Instituto Madrileño de Estudios Avanzados en Nanociencia (IMDEA Nanociencia), Cantoblanco, 28049, Madrid, Spain.
| | - Michele Chiappi
- Department of Macromolecular Structure, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain.
| | - Ana Lazaro-Carrillo
- Departamento de Biología, Universidad Autónoma de Madrid, Cantoblanco, 28049, Madrid, Spain. .,Instituto Madrileño de Estudios Avanzados en Nanociencia (IMDEA Nanociencia), Cantoblanco, 28049, Madrid, Spain.
| | - María José Rodríguez
- Department of Macromolecular Structure, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain.
| | - Francisco Javier Chichón
- Department of Macromolecular Structure, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain.
| | - Kieran Crosbie-Staunton
- Department of Clinical Medicine, Trinity Centre for Health Science, James's Street, Dublin, 8, Ireland.
| | - Adriele Prina-Mello
- Department of Clinical Medicine, Trinity Centre for Health Science, James's Street, Dublin, 8, Ireland. .,Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), and AMBER Centre, Trinity College Dublin, College Green, Dublin, 2, Ireland.
| | - Yuri Volkov
- Department of Clinical Medicine, Trinity Centre for Health Science, James's Street, Dublin, 8, Ireland. .,Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), and AMBER Centre, Trinity College Dublin, College Green, Dublin, 2, Ireland.
| | - Angeles Villanueva
- Departamento de Biología, Universidad Autónoma de Madrid, Cantoblanco, 28049, Madrid, Spain. .,Instituto Madrileño de Estudios Avanzados en Nanociencia (IMDEA Nanociencia), Cantoblanco, 28049, Madrid, Spain.
| | - José L Carrascosa
- Department of Macromolecular Structure, Centro Nacional de Biotecnología, Consejo Superior de Investigaciones Científicas, 28049, Madrid, Spain. .,Instituto Madrileño de Estudios Avanzados en Nanociencia (IMDEA Nanociencia), Cantoblanco, 28049, Madrid, Spain.
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154
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Toftegaard BS, Bro F, Vedsted P. A geographical cluster randomised stepped wedge study of continuing medical education and cancer diagnosis in general practice. Implement Sci 2014; 9:159. [PMID: 25377520 PMCID: PMC4229614 DOI: 10.1186/s13012-014-0159-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/16/2014] [Indexed: 01/07/2023] Open
Abstract
Background Denmark has inferior cancer survival rates compared with many European countries. The main reason for this is suggested to be late diagnosis at advanced cancer stages. Cancer diagnostic work-up begins in general practice in 85% of all cancer cases. Thus, general practitioners (GPs) play a key role in the diagnostic process. The latest Danish Cancer Plan included continuing medical education (CME) on early cancer diagnosis in general practice to improve early diagnosis. This dual aims of this protocol are, first, to describe the conceptualisation, operationalisation and implementation of the CME and, second, to describe the study design and outcomes chosen to evaluate the effects of the CME. Methods/Design The intervention is a CME in early cancer diagnosis targeting individual GPs. It was developed by a step-wise approach. Barriers for early cancer diagnosis at GP level were identified systematically and analysed using the behaviour system involving capability, opportunity and motivation described by Michie et al. The study will be designed as a geographical cluster randomised stepped wedge study. The study population counts 836 GPs from 417 general practices in the Central Denmark Region, geographically divided into eight clusters. GPs from each cluster will be invited to a CME meeting at a certain date three weeks apart. The primary outcomes will be primary care interval and GP referral rate on cancer suspicion. Data will be obtained from national registries, GP-completed forms on patients referred to cancer fast-track pathways and GP-completed online questionnaires before and after the intervention. Discussion To our knowledge, this will be the first study to measure the effect of a theory-based CME in early cancer diagnosis at three levels: GP knowledge and attitude, GP activity and patient outcomes. The achieved knowledge will contribute to the understanding of whether and how general practice’s ability to perform cancer diagnosis may be improved. Trial registration Registered as NCT02069470 on ClinicalTrials.gov. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0159-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Berit Skjødeberg Toftegaard
- Research Unit for General Practice, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark. .,Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark. .,Department of Public Health, Section for General Medical Practice, Bartholins Allé 2, DK-8000, Aarhus, Denmark.
| | - Flemming Bro
- Research Unit for General Practice, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark. .,Department of Public Health, Section for General Medical Practice, Bartholins Allé 2, DK-8000, Aarhus, Denmark.
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark. .,Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000, Aarhus, Denmark. .,Department of Public Health, Section for General Medical Practice, Bartholins Allé 2, DK-8000, Aarhus, Denmark.
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155
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Ellis L, Woods LM, Estève J, Eloranta S, Coleman MP, Rachet B. Cancer incidence, survival and mortality: explaining the concepts. Int J Cancer 2014; 135:1774-82. [PMID: 24945976 DOI: 10.1002/ijc.28990] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/04/2013] [Indexed: 12/11/2022]
Abstract
Cancer incidence, survival and mortality are essential population-based indicators for public health and cancer control. Confusion and misunderstanding still surround the estimation and interpretation of these indicators. Recurring controversies over the use and misuse of population-based cancer statistics in health policy suggests the need for further clarification. In our article, we describe the concepts that underlie the measures of incidence, survival and mortality, and illustrate the synergy between these measures of the cancer burden. We demonstrate the relationships between trends in incidence, survival and mortality, using real data for cancers of the lung and breast from England and Sweden. Finally, we discuss the importance of using all three measures in combination when interpreting overall progress in cancer control, and we offer some recommendations for their use.
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Affiliation(s)
- Libby Ellis
- Cancer Research UK Cancer Survival Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
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156
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Bell RJ. Screening mammography--early detection or over-diagnosis? Contribution from Australian data. Climacteric 2014; 17 Suppl 2:66-72. [PMID: 25224048 DOI: 10.3109/13697137.2014.956718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this review was to examine the benefits and harms of organized screening mammography, with particular reference to data from Australia. METHODS Published literature was examined relating to the impact of screening mammography on breast cancer-specific mortality, the trends in use of adjuvant treatments for breast cancer, the effectiveness of adjuvant treatment in terms of breast cancer-specific mortality, the impact of breast cancer treatment on non-breast cancer mortality and the magnitude of the issue of over-diagnosis. RESULTS Most of the recent reduction in breast cancer-specific mortality is explained by use of adjuvant therapy rather than screening mammography. The impact of screening mammography in countries where women present with early disease and have access to adjuvant treatment is modest. There is a wide range of estimates for the magnitude of over-diagnosis. All-cause mortality (rather than breast cancer-specific mortality) should be used when assessing the impact of mammographic screening as otherwise the harm of breast cancer treatment in women who are over-diagnosed will be missed. CONCLUSIONS The benefits and harms of screening mammography are finely balanced. The impact of screening mammography is at best neutral but may result in overall harm. Women should be informed of the issue of over-diagnosis. It is time to review whether organized mammographic screening programs should continue.
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Affiliation(s)
- R J Bell
- Women's Health Research Program, Monash University School of Public Health and Preventive Medicine , Melbourne, Victoria , Australia
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157
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Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014; 5:465-477. [PMID: 25114860 PMCID: PMC4127616 DOI: 10.5306/wjco.v5.i3.465] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
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158
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Srur-Rivero N, Cartin-Brenes M. Breast cancer characteristics and survival in a Hispanic population of costa rica. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2014; 8:103-8. [PMID: 25125980 PMCID: PMC4125366 DOI: 10.4137/bcbcr.s15854] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Breast cancer characteristics may vary according to the patient’s ethnic group. The goal of this cohort study was to evaluate the characteristics of a group of Costa Rican breast cancer patients and their relationship with survival. METHODS Age, stage, tumor grade, immunohistochemistry, lymphovascular invasion, recurrence, and survival data on 199 Hispanic patients with breast cancer diagnosis, treated between January 2009 and May 2010, were collected from a single institution in San Jose, Costa Rica. The data were statistically analyzed for significance. RESULTS Median age at diagnosis was 53 years. With a median follow-up of 46.5 months, there was an 88% overall survival rate. Thirty-seven percent of the patients (p < 0.001) were at stages III and IV during diagnosis. The hormone receptor human epidermal receptor negative phenotype (HR−HER2−) (p < 0.001) was present in 17% of the cases. In a multivariate analysis, local (risk ratio, RR: 7.2; confidence interval, CI 95%: 3.8–7.6; p = 0.06) and distant recurrence (RR: 14.9; CI 95%: 7.7–28.9; p = 0.01) showed the strongest association with the probability of death from the disease. Patients with HR−HER2− phenotype tumors reported more local recurrences (p = 0.04), a higher tumor grade (p < 0.01), and lower overall survival than patients with other breast cancer phenotypes (p = 0.01). CONCLUSIONS Although this study analyzes a modest number of cases, it is an initial insight into factors that may contribute to differences in breast cancer outcomes among Hispanic women in Costa Rica. The higher proportion of triple negative tumors, advanced stage, and younger median age at diagnosis could contribute to the inferior prognostic described among Hispanic women. There may be a different distribution of tumor subtypes compared to non-Hispanic white women. Further studies are necessary to confirm such findings.
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Affiliation(s)
- Nadia Srur-Rivero
- Servicio de Oncología Quirúrgica, Unidad de Mama, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Mayra Cartin-Brenes
- Escuela de Salud Pública, Universidad de Costa Rica, San Pedro Montes de Oca, Costa Rica
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159
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Differences in metastatic patterns in relation to time between primary surgery and first relapse from breast cancer suggest synchronized growth of dormant micrometastases. Breast Cancer Res Treat 2014; 146:627-36. [PMID: 25038878 PMCID: PMC4112046 DOI: 10.1007/s10549-014-3057-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/07/2014] [Indexed: 01/05/2023]
Abstract
A significant variation in the metastatic pattern among breast cancer patients exists. Clinical observations suggest that these differences are related to time to recurrence (TTR), thus suggesting a common systemic growth signal at the time of surgery. Our goal was to identify a marker for synchronized growth of micrometastases. To quantify the metastatic pattern at first relapse, 180 patients with metastatic breast cancer were studied. Standard deviation (SD) of lesions size and lesion number was calculated and served as a marker for variation. Patients with low SD (multiple/similar sized lesions) were assumed to have synchronized growth, whereas patients with high SD were assumed to have unsynchronized growth. Patients were grouped according to TTR; early (< 3 years-) or late (> 3 years- after surgery). In patients not receiving systemic adjuvant treatment, median SD was significantly lower in the early group (2.5 mm) compared with 6.4 mm in the late group (p = 0.005). In node negative patients, median SD was significantly lower in the early group (3.0 mm) when compared with the late group (5.7 mm, p = 0.02). An additional drop in SD was observed immediately after end of adjuvant endocrine therapy. Our results identify SD as a marker of synchronized metastatic growth in breast cancer. A metastatic phenotype characterized by multiple similar sized metastases, suggesting synchronized onset of growth of micrometastases was predominantly found in patients recurring early after surgery and was counteracted by adjuvant treatment. Systemic growth signals caused by surgery might be antagonized during the time window following surgery.
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160
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Nickson C, Mason KE, Kavanagh AM. Rebuttal to: Letter to the Editor by Robert Burton, in response to doi:10.1007/s10549-013-2794-5. Breast Cancer Res Treat 2014; 145:565-6. [DOI: 10.1007/s10549-014-2952-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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161
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Bhoo-Pathy N, Subramaniam S, Taib NA, Hartman M, Alias Z, Tan GH, Ibrahim RI, Yip CH, Verkooijen HM. Spectrum of very early breast cancer in a setting without organised screening. Br J Cancer 2014; 110:2187-94. [PMID: 24736587 PMCID: PMC4007242 DOI: 10.1038/bjc.2014.183] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/07/2014] [Accepted: 03/15/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Within a setting without organised breast cancer screening, the characteristics and survival of very early breast cancer were determined. METHODS All 4930 women diagnosed with breast cancer in University Malaya Medical Center, Malaysia from 1993 to 2011 were included. Factors associated with very early presentation (stage I) at diagnosis were identified. Tumour characteristics, management patterns, and survival of very early breast cancer were described, and where appropriate, compared with other settings. RESULTS Proportion of women presenting with stage I breast cancer significantly increased from 15.2% to 25.2% over two decades. Factors associated with very early presentation were Chinese ethnicity, positive family history of breast cancer, and recent period of diagnosis. Within stage I breast cancers, median tumour size at presentation was 1.5 cm. A majority of stage I breast cancer patients received mastectomy, which was associated with older age, Chinese ethnicity, postmenopausal status, and larger tumours. Chemotherapy was administered in 36% of patients. Five-year age-adjusted relative survival for women with stage I breast cancer was 99.1% (95% CI: 97.6-99.6%). CONCLUSIONS The proportion of women presenting with very early breast cancer in this setting without organised screening is increasing. These women seem to survive just as well as their counterparts from affluent settings.
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Affiliation(s)
- N Bhoo-Pathy
- Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
| | - S Subramaniam
- National Clinical Research Centre, Hospital Kuala Lumpur, Level 3, Dermatology Block, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
| | - N A Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - M Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Z Alias
- Department of Social and Preventive Medicine, Julius Centre University of Malaya, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - G-H Tan
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - R I Ibrahim
- Faculty of Science and Technology, Islamic Science University of Malaysia (USIM), 71800 Nilai, Negeri Sembilan, Malaysia
| | - C-H Yip
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - H M Verkooijen
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
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162
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Hyperglycemia, a neglected factor during cancer progression. BIOMED RESEARCH INTERNATIONAL 2014; 2014:461917. [PMID: 24864247 PMCID: PMC4016871 DOI: 10.1155/2014/461917] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 12/11/2022]
Abstract
Recent evidence from large cohort studies suggests that there exists a higher cancer incidence in people with type 2 diabetes (DM2). However, to date, the potential reasons for this association remain unclear. Hyperglycemia, the most important feature of diabetes, may be responsible for the excess glucose supply for these glucose-hungry cells, and it contributes to apoptosis resistance, oncogenesis, and tumor cell resistance to chemotherapy. Considering associations between diabetes and malignancies, the effect of hyperglycemia on cancer progression in cancer patients with abnormal blood glucose should not be neglected. In this paper, we describe the role that hyperglycemia plays in cancer progression and treatment and illustrate that hyperglycemia may contribute to a more malignant phenotype of cancer cells and lead to drug resistance. Therefore, controlling hyperglycemia may have important therapeutic implications in cancer patients.
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Lyratzopoulos G. Markers and measures of timeliness of cancer diagnosis after symptom onset: a conceptual framework and its implications. Cancer Epidemiol 2014; 38:211-3. [PMID: 24742794 DOI: 10.1016/j.canep.2014.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/13/2014] [Accepted: 03/17/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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164
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Christiansen P, Vejborg I, Kroman N, Holten I, Garne JP, Vedsted P, Møller S, Lynge E. Position paper: breast cancer screening, diagnosis, and treatment in Denmark. Acta Oncol 2014; 53:433-44. [PMID: 24495043 DOI: 10.3109/0284186x.2013.874573] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND During the last decades the diagnosis, treatment, and prognosis of breast cancer have changed and improved in Denmark. The first mammography screening programme started in 1991. However, for many years only about 20% of Danish women aged 50-69 were offered screening. The national roll-out of screening took place in 2008-2010. MATERIAL AND METHODS Based on published Danish data, this overview describes the status of diagnosis and treatment, and the screening programme. For further evaluating the potential overdiagnosis and overtreatment, additional Danish Breast Cancer Cooperative Group (DBCG) data are included. RESULTS AND CONCLUSION Using incidence-based mortality method, reduction in breast cancer mortality was estimated to be 25% in the target group of women after 10 years of screening in Copenhagen; an outcome comparable to that of randomised controlled trials. A recent Danish study has indicated overdiagnosis to be around 4%. Others have estimated overdiagnosis to be 33%. National DBCG data showed that the rude breast cancer incidence increased during the period 1990-2011 from 126 to 206 per 100 000. The incidence was almost constant for women younger than 50 years. In regions not offering screening, the incidence increased with 3% per year for women aged 50-69 years with similar trends for small and large tumours. After introduction of screening the increase in the age group 50-69 years was confined to small tumours ≤ 20 mm, and most pronounced for node negative patients. From the 1990s, the use of breast conserving surgery has increased from around 25% to 69% in 2010. Screening has not increased the number of mastectomies. Breast cancer treatment in Denmark is evidence based and in agreement with international recommendations. After the introduction of mammography screening the absolute number of patients with a more advanced stage at diagnosis and the absolute number of patients undergoing mastectomy have decreased.
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Affiliation(s)
- Peer Christiansen
- Breast and Endocrine Section, Department of Surgery P, Aarhus University Hospital,
Aarhus, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital,
Copenhagen, Denmark
| | - Niels Kroman
- Department of Breast Surgery, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
| | - Iben Holten
- Department of Prevention and Documentation, Danish Cancer Society,
Copenhagen, Denmark
| | - Jens Peter Garne
- Department of Breast Surgery, Aalborg University Hospital,
Aalborg, Denmark
| | - Peter Vedsted
- The Research Unit for General Practice, Danish Research Centre for Cancer Diagnosis in Primary Care (CaP), School of Public Health, Aarhus University,
Aarhus, Denmark
| | - Susanne Møller
- DBCG Data Center, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, Denmark
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen,
Copenhagen, Denmark
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165
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Lousdal ML, Kristiansen IS, Møller B, Støvring H. Trends in breast cancer stage distribution before, during and after introduction of a screening programme in Norway. Eur J Public Health 2014; 24:1017-22. [PMID: 24596400 DOI: 10.1093/eurpub/cku015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening is intended to advance diagnosis thereby shifting the stage distribution towards more locally confined stages. Consequently we aimed to estimate trends in stage-specific breast cancer in relation to the introduction of population-based screening. METHODS From the Cancer Registry of Norway we retrieved cancer stage, age and year of diagnosis on all women aged 20 or older diagnosed with breast cancer during the period 1987-2010 in Norway (approximate source population: 1.8 million). Three calendar-time periods were defined: before (1987-95), during (1996-2004), and after (2005-10) screening was introduced; and two age groups: women eligible for screening (50-69 years) or younger (20-49 years). Poisson regression was used to estimate the incidence of localized (stage I) and more advanced cancer (stages II+), respectively, and logistic regression to estimate the proportion of localized cancer. RESULTS The annual incidence of localized breast cancer among women aged 50-69 years rose from 63.9 per 100 000 before the introduction of screening to 141.2 afterwards, corresponding to a ratio of 2.21 (95% confidence interval: 2.10; 2.32). The incidence of more advanced cancers increased from 86.9 to 117.3 per 100 000 afterwards, corresponding to a 1.35 (1.29; 1.42)-fold increase. Advanced cancers also increased among younger women not eligible for screening, whereas their incidence of localized cancers remained nearly constant. CONCLUSION Incidence of localized breast cancer increased significantly among women aged 50-69 years old after introduction of screening, while the incidence of more advanced cancers was not reduced in the same period when compared to the younger unscreened age group.
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Affiliation(s)
- Mette L Lousdal
- 1 Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ivar S Kristiansen
- 2 Department of Health Management and Health Economics, Oslo University, Oslo, Norway
| | | | - Henrik Støvring
- 4 Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
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166
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Huang YH, Luo MH, Ni YB, Tsang JYS, Chan SK, Lui PCW, Yu AMC, Tan PH, Tse GM. Increased SOX2 expression in less differentiated breast carcinomas and their lymph node metastases. Histopathology 2013; 64:494-503. [PMID: 24382260 DOI: 10.1111/his.12257] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023]
Abstract
AIMS SOX2 is a key regulatory gene in embryonic stem cells. Although it has been implicated in cancer progression, its role in breast carcinoma is poorly understood. MATERIALS AND METHODS Fifty-seven ductal carcinomas in situ (DCIS), 552 invasive breast carcinomas and 107 corresponding metastatic lymph nodes were evaluated immunohistochemically for the expression of SOX2. Its correlation with clinicopathological features, other biomarker profiles and patients' outcomes were analysed. RESULTS SOX2 was detected in 19.0% (105 of 552) of invasive breast carcinomas and 12.3% (seven of 57) of DCIS. Expression correlated with larger tumour size (P = 0.005) and higher grade (P = 0.002). It was associated negatively with ER (P = 0.015) and PR (P = 0.046) expression, but positively with Ki67 index (P = 0.013). Interestingly, it was also associated with neuroendocrine marker expression (synpatophysin and chromogranin/synaptophysin, P = 0.048 and 0.028, respectively). Expression appeared to be independent from that of common stem cell markers, namely CD44, CD24 and aldehyde dehydrogenase 1 (ALDH1). Furthermore, a higher rate of expression was observed in metastatic lymph nodes than in the corresponding primary tumours (P = 0.034). High SOX2 expression was correlated with poor disease-free survival (log-rank=9.489, P = 0.012) and was an independent prognostic factor (HR=2.918, P = 0.015) in patients with high nodal stages. CONCLUSIONS In summary, SOX2 expression was related to adverse breast carcinoma profile and poor outcome in selected patient groups.
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Affiliation(s)
- Yu-Hua Huang
- Department of Pathology, Shenzhen Second People Hospital, Shenzhen, China
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167
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Expression and clinical significance of carcinoembryonic antigen-related cell adhesion molecule 6 in breast cancers. Breast Cancer Res Treat 2013; 142:311-22. [PMID: 24186057 DOI: 10.1007/s10549-013-2756-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 10/25/2013] [Indexed: 01/02/2023]
Abstract
Carcino-embryonic antigen-related cell adhesion molecule 6 (CEACAM6), one of the members of human carcino-embryonic antigens, is a multifunctional regulatory protein involved in various cellular processes in cancers. Its role in malignant transformation and the clinical significance has been extensively studied in colonic and pancreatic cancers. However, relatively few studies have been done on breast cancers. In the current study, CEACAM6 expression in two independent cohorts of invasive breast cancers were evaluated immunohistochemically and correlated with clinico-pathological features, biomarker profiles and patient survival. In the primary cohort, CEACAM6 expression was detected in 37.1 % (312/840) of primary invasive cancers. It was positively correlated with HER2 (p < 0.001). Concordantly, HER2-OE subtype showed the highest CEACAM6 expression (62.7 %) among all molecular subtypes; whereas, other subtypes also showed substantial CEACAM6 expression (21.8-37.5 %). Interestingly, a significantly worse overall survival was found in high pN stage HER2 positive cancers with CEACAM6 positivity (log-rank = 4.452, p = 0.035) and this could be validated in an independent cohort. Additionally, HER2 signaling was found to induce SMAD3 phosphorylation and CEACAM6 expression in a cell line model. Likewise, in the primary tumors, a positive association was found between HER2 and SMAD3 phosphorylation in CEACAM6 positive cancers (p = 0.012). Overall, CEACAM6 was widely expressed in different molecular subtypes, but highest and significantly in HER2-OE breast cancer. Within this group, CEACAM6 was associated with adverse high nodal stage patient outcome. Given the wide expression of CEACAM6 in all breast cancers, its roles as prognostic marker and therapeutic target warrant further evaluation.
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168
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Development of Magnetic Nanoparticles for Cancer Gene Therapy: A Comprehensive Review. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/646284] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Since they were first proposed as nonviral transfection agents for their gene-carrying capacity, magnetic nanoparticles have been studied thoroughly, both in vitro and in vivo. Great effort has been made to manufacture biocompatible magnetic nanoparticles for use in the theragnosis of cancer and other diseases. Here we survey recent advances in the study of magnetic nanoparticles, as well as the polymers and other coating layers currently available for gene therapy, their synthesis, and bioconjugation processes. In addition, we review several gene therapy models based on magnetic nanoparticles.
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169
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Butler J, Foot C, Bomb M, Hiom S, Coleman M, Bryant H, Vedsted P, Hanson J, Richards M. The International Cancer Benchmarking Partnership: an international collaboration to inform cancer policy in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom. Health Policy 2013; 112:148-55. [PMID: 23693117 DOI: 10.1016/j.healthpol.2013.03.021] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 03/24/2013] [Accepted: 03/29/2013] [Indexed: 10/26/2022]
Abstract
The International Cancer Benchmarking Partnership (ICBP) was initiated by the Department of Health in England to study international variation in cancer survival, and to inform policy to improve cancer survival. It is a research collaboration between twelve jurisdictions in six countries: Australia (New South Wales, Victoria), Canada (Alberta, British Columbia, Manitoba, Ontario), Denmark, Norway, Sweden, and the United Kingdom (England, Northern Ireland, Wales). Leadership is provided by policymakers, with academics, clinicians and cancer registries forming an international network to conduct the research. The project currently has five modules examining: (1) cancer survival, (2) population awareness and beliefs about cancer, (3) attitudes, behaviours and systems in primary care, (4) delays in diagnosis and treatment, and their causes, and (5) treatment, co-morbidities and other factors. These modules employ a range of methodologies including epidemiological and statistical analyses, surveys and clinical record audit. The first publications have already been used to inform and develop cancer policies in participating countries, and a further series of publications is under way. The module design, governance structure, funding arrangements and management approach to the partnership provide a case study in conducting international comparisons of health systems that are both academically and clinically robust and of immediate relevance to policymakers.
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Affiliation(s)
- John Butler
- Royal Marsden Hospital, Fulham Road, London SW3 6JJ, England, UK; Cancer Research UK, Angel Building, 407 St John Street, London EC1 V 4AD, England, UK.
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170
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Redaniel MT, Martin RM, Cawthorn S, Wade J, Jeffreys M. The association of waiting times from diagnosis to surgery with survival in women with localised breast cancer in England. Br J Cancer 2013; 109:42-9. [PMID: 23799851 PMCID: PMC3708566 DOI: 10.1038/bjc.2013.317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/31/2013] [Accepted: 06/04/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Survival from breast cancer in the United Kingdom is lower than in other developed countries. It is unclear to what extent waiting times for curative surgery affect survival. METHODS Using national databases for England (cancer registries, Hospital Episode Statistics and Office of National Statistics), we identified 53 689 women with localised breast cancer, aged ≥ 15 years, diagnosed between 1996 and 2009, who had surgical resection with curative intent within 62 days of diagnosis. We used relative survival and excess risk modelling to determine associations between waiting times and 5-year survival. RESULTS The median diagnosis to curative surgery waiting time among breast cancer patients was 22 days (interquartile range (IQR): 15-30). Relative survival was similar among women waiting between 25 and 38 days (RS: 93.5%; 95% CI: 92.8-94.2%), <25 days (RS: 93.0%; 95% CI: 92.5-93.4%) and between 39 and 62 days (RS: 92.1%; 95% CI: 90.8-93.4%). There was little evidence of an increase in excess mortality with longer waiting times (excess hazard ratio (EHR): 1.06; 95% CI: 0.88-1.27 comparing waiting times 39-62 with 25-38 days). Excess mortality was associated with age (EHR 65-74 vs 15-44 year olds: 1.23; 95% CI: 1.07-1.41) and deprivation (EHR most vs least deprived: 1.28; 95% CI: 1.09-1.49), but waiting times did not explain these differences. CONCLUSION Within 62 days of diagnosis, decreasing waiting times from diagnosis to surgery had little impact on survival from localised breast cancer.
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Affiliation(s)
- M T Redaniel
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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171
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Rutherford MJ, Hinchliffe SR, Abel GA, Lyratzopoulos G, Lambert PC, Greenberg DC. How much of the deprivation gap in cancer survival can be explained by variation in stage at diagnosis: an example from breast cancer in the East of England. Int J Cancer 2013; 133:2192-200. [PMID: 23595777 DOI: 10.1002/ijc.28221] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/11/2013] [Indexed: 12/12/2022]
Abstract
Socioeconomic differences in cancer patient survival exist in many countries and across cancer sites. In our article, we estimated the number of deaths in women with breast cancer that could be avoided within 5 years from diagnosis if it were possible to eliminate socioeconomic differences in stage at diagnosis. We analysed data on East of England women with breast cancer (2006-2010). We estimated survival for different stage-age-deprivation strata using both the observed and a hypothetical stage distribution (assuming all women acquired the stage distribution of the most affluent women). Data were analysed on 20,738 women with complete stage information (92%). Affluent women were less likely to be diagnosed in advanced stage. Relative survival decreased with increasing level of deprivation. Eliminating differences in stage at diagnosis could be expected to nearly eliminate differences in relative survival for women in deprivation groups 3 and 4, but would only approximately halve the difference in relative survival for women in the most deprived group (5). This means, for a typical cohort of women diagnosed in a calendar year with breast cancer, eliminating deprivation differences in stage at diagnosis would prevent ∼40 deaths in the East of England from occurring within 5 years from diagnosis. Using appropriate weighting we estimated the respective number of avoidable deaths for the whole of England to be ∼450. The findings suggest that policies aimed at reducing inequalities in stage at diagnosis between women with breast cancer are important to reduce inequalities in breast cancer survival.
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Affiliation(s)
- M J Rutherford
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
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