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Betz-Stablein B, Llewellyn S, Bearzi P, Grochulska K, Rutjes C, Aitken JF, Janda M, O'Rouke P, Soyer HP, Green AC. High variability in anatomic patterns of cutaneous photodamage: a population-based study. J Eur Acad Dermatol Venereol 2021; 35:1896-1903. [PMID: 33991136 DOI: 10.1111/jdv.17352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Skin cancer is strongly associated with photodamaged skin, but body sites are often referred to as 'exposed' or 'unexposed' to sun without recognizing extent of site-specific variation. OBJECTIVES To assess whole-body patterns of photodamage in an Australian population. METHODS A random sample of adult residents of Queensland underwent imaging across 10 body sites. Photodamage was graded from images using an ordinal photonumeric scale. We used cluster analysis to identify whole-body photodamage patterns and prevalence proportion ratios (PPRs) to assess associated factors. RESULTS Of 190 adults (median age 52; 58% males), 58% showed severe or moderate-to-severe photodamage on most body sites. A higher proportion of woman had severe photodamage on the arms (upper: P = 0.002, lower: P = 0.034). A higher proportion of men had moderate or severe photodamage on the lower back (P = 0.004). We identified four photodamage patterns: 'severe general' (n = 24, 13%), 'moderate-severe general' (n = 86, 45%), 'moderate-severe v-neck' (n = 40, 21%) and 'mild-moderate upper body' (n = 12, 6%). All participants with 'severe-general' photodamage were >50 years and more likely to have past skin cancer (PPR: 2.54, 95% CI: 1.44-4.49) than those with 'moderate-severe v-neck' photodamage. Those with 'moderate-severe general' photodamage showed similar associations and were more likely female (PPR: 1.33, 95% CI: 1.04-1.69). Past or current smoking was associated with having higher levels of photodamage, with no smokers in those with 'mild-moderate upper body' photodamage. CONCLUSIONS Moderate-to-severe photodamage across much of the body is common in Queensland adults and associated with age, sex, past skin cancer and smoking. Assuming a universal pattern of site-specific sun exposure could lead to spurious correlations, while accurate and objective assessment of site-specific photodamage can add to understanding of the development of sun-associated skin cancers, in particular site-specific skin carcinogenesis. Additionally, degree of site-specific photodamage has the potential to assist skin cancer screening.
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Affiliation(s)
- B Betz-Stablein
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - S Llewellyn
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - P Bearzi
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia.,Università Vita-Salute San Raffaele, Milan, Lombardy, Italy
| | - K Grochulska
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - C Rutjes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - J F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - M Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - P O'Rouke
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland, Australia.,Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia
| | - A C Green
- Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
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2
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Vuong K, Armstrong BK, Espinoza D, Hopper JL, Aitken JF, Giles GG, Schmid H, Mann GJ, Cust AE, McGeechan K. An independent external validation of melanoma risk prediction models using the Australian Melanoma Family Study. Br J Dermatol 2020; 184:957-960. [PMID: 33270216 DOI: 10.1111/bjd.19706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 12/23/2022]
Affiliation(s)
- K Vuong
- School of Population Health, The University of New South Wales, Sydney, Australia
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research (Sydney School of Public Health), The University of Sydney, Sydney, Australia
| | - D Espinoza
- Cancer Epidemiology and Prevention Research (Sydney School of Public Health), The University of Sydney, Sydney, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - J F Aitken
- Cancer Council Queensland, Brisbane, Australia
| | - G G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - H Schmid
- Centre for Cancer Research (Westmead Institute for Medical Research), The University of Sydney, Sydney, Australia
| | - G J Mann
- Centre for Cancer Research (Westmead Institute for Medical Research), The University of Sydney, Sydney, Australia.,John Curtin School of Medical Research, Australian National University, Canberra, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research (Sydney School of Public Health), The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - K McGeechan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
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Vuong K, Armstrong BK, Drummond M, Hopper JL, Barrett JH, Davies JR, Bishop DT, Newton-Bishop J, Aitken JF, Giles GG, Schmid H, Jenkins MA, Mann GJ, McGeechan K, Cust AE. Development and external validation study of a melanoma risk prediction model incorporating clinically assessed naevi and solar lentigines. Br J Dermatol 2020; 182:1262-1268. [PMID: 31378928 PMCID: PMC6997040 DOI: 10.1111/bjd.18411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Melanoma risk prediction models could be useful for matching preventive interventions to patients' risk. OBJECTIVES To develop and validate a model for incident first-primary cutaneous melanoma using clinically assessed risk factors. METHODS We used unconditional logistic regression with backward selection from the Australian Melanoma Family Study (461 cases and 329 controls) in which age, sex and city of recruitment were kept in each step, and we externally validated it using the Leeds Melanoma Case-Control Study (960 cases and 513 controls). Candidate predictors included clinically assessed whole-body naevi and solar lentigines, and self-assessed pigmentation phenotype, sun exposure, family history and history of keratinocyte cancer. We evaluated the predictive strength and discrimination of the model risk factors using odds per age- and sex-adjusted SD (OPERA) and the area under curve (AUC), and calibration using the Hosmer-Lemeshow test. RESULTS The final model included the number of naevi ≥ 2 mm in diameter on the whole body, solar lentigines on the upper back (a six-level scale), hair colour at age 18 years and personal history of keratinocyte cancer. Naevi was the strongest risk factor; the OPERA was 3·51 [95% confidence interval (CI) 2·71-4·54] in the Australian study and 2·56 (95% CI 2·23-2·95) in the Leeds study. The AUC was 0·79 (95% CI 0·76-0·83) in the Australian study and 0·73 (95% CI 0·70-0·75) in the Leeds study. The Hosmer-Lemeshow test P-value was 0·30 in the Australian study and < 0·001 in the Leeds study. CONCLUSIONS This model had good discrimination and could be used by clinicians to stratify patients by melanoma risk for the targeting of preventive interventions. What's already known about this topic? Melanoma risk prediction models may be useful in prevention by tailoring interventions to personalized risk levels. For reasons of feasibility, time and cost many melanoma prediction models use self-assessed risk factors. However, individuals tend to underestimate their naevus numbers. What does this study add? We present a melanoma risk prediction model, which includes clinically-assessed whole-body naevi and solar lentigines, and self-assessed risk factors including pigmentation phenotype and history of keratinocyte cancer. This model performs well on discrimination, the model's ability to distinguish between individuals with and without melanoma, and may assist clinicians to stratify patients by melanoma risk for targeted preventive interventions.
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Affiliation(s)
- K Vuong
- School of Public Health and Community Medicine, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M Drummond
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - J H Barrett
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J R Davies
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - D T Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J Newton-Bishop
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, Leeds University, Leeds, U.K
| | - J F Aitken
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Australia
| | - G G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - H Schmid
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
| | - M A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - G J Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of New South Wales, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - K McGeechan
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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4
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Betz-Stablein B, Koh U, Plasmeijer EI, Janda M, Aitken JF, Soyer HP, Green AC. Self-reported naevus density may lead to misclassification of melanoma risk. Br J Dermatol 2020; 182:1488-1490. [PMID: 31833052 DOI: 10.1111/bjd.18802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- B Betz-Stablein
- Cancer and Population studies, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - U Koh
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - E I Plasmeijer
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - J F Aitken
- Cancer Council Queensland, Brisbane, QLD, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, QLD, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia
| | - A C Green
- Cancer and Population studies, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,Australian Skin and Skin Cancer Research Centre, Brisbane, Queensland, Australia.,CRUK Manchester Institute and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, U.K
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5
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Cust AE, Aitken JF, Baade PD, Whiteman DC, Soyer HP, Janda M. Why a randomized melanoma screening trial may be a good idea. Br J Dermatol 2018; 179:1227-1228. [PMID: 30101459 DOI: 10.1111/bjd.17089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - J F Aitken
- Cancer Council Queensland, Brisbane, Australia.,Menzies Health Institute, Griffith University, Southport, QLD, Australia
| | - P D Baade
- Cancer Council Queensland, Brisbane, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - D C Whiteman
- QIMR-Berghofer Medical Research Institute, Brisbane, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - M Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
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6
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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Youlden DR, Baade PD, Aitken JF, Green AC, Khosrotehrani K. Prognostic importance of a second invasive primary melanoma according to tumour stage. Br J Dermatol 2017; 177:e336-e337. [PMID: 28771669 DOI: 10.1111/bjd.15863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D R Youlden
- Cancer Council Queensland, Brisbane, Qld, Australia.,Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - P D Baade
- Cancer Council Queensland, Brisbane, Qld, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Qld, Australia
| | - J F Aitken
- Cancer Council Queensland, Brisbane, Qld, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Qld, Australia
| | - A C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Qld, Australia.,CRUK Manchester Institute and Institute of Inflammation and Repair, The University of Manchester, Manchester, U.K.,Australian Skin and Skin Cancer Research Centre, Brisbane, Qld, Australia
| | - K Khosrotehrani
- Australian Skin and Skin Cancer Research Centre, Brisbane, Qld, Australia.,UQ Centre for Clinical Research, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia.,UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Qld, Australia
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8
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Youl PH, Dasgupta P, Youlden D, Aitken JF, Garvey G, Zorbas H, Chynoweth J, Wallington I, Baade PD. A systematic review of inequalities in psychosocial outcomes for women with breast cancer according to residential location and Indigenous status in Australia. Psychooncology 2016; 25:1157-1167. [DOI: 10.1002/pon.4124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/29/2015] [Accepted: 02/22/2016] [Indexed: 12/26/2022]
Affiliation(s)
- PH Youl
- Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University, Gold Coast Campus; Southport Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Australia
| | - P Dasgupta
- Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - D Youlden
- Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
| | - JF Aitken
- Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Australia
- School of Population Health; University of Queensland; Brisbane Australia
| | - G Garvey
- Menzies School of Health Research; Charles Darwin University; Brisbane Australia
| | - H Zorbas
- Cancer Australia; Sydney New South Wales Australia
| | - J Chynoweth
- Cancer Australia; Sydney New South Wales Australia
| | - I Wallington
- Cancer Australia; Sydney New South Wales Australia
| | - PD Baade
- Cancer Research Centre; Cancer Council Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University, Gold Coast Campus; Southport Australia
- School of Public Health and Social Work; Queensland University of Technology; Kelvin Grove Australia
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Baade PD, Youlden DR, Valery PC, Hassall T, Ward L, Green AC, Aitken JF. Population-based survival estimates for childhood cancer in Australia during the period 1997-2006. Br J Cancer 2010; 103:1663-70. [PMID: 21063404 PMCID: PMC2994235 DOI: 10.1038/sj.bjc.6605985] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study provides the latest available relative survival data for Australian childhood cancer patients. METHODS Data from the population-based Australian Paediatric Cancer Registry were used to describe relative survival outcomes using the period method for 11,903 children diagnosed with cancer between 1983 and 2006 and prevalent at any time between 1997 and 2006. RESULTS The overall relative survival was 90.4% after 1 year, 79.5% after 5 years and 74.7% after 20 years. Where information onstage at diagnosis was available (lymphomas, neuroblastoma, renal tumours and rhabdomyosarcomas), survival was significantly poorer for more-advanced stage. Survival was lower among infants compared with other children for those diagnosed with leukaemia, tumours of the central nervous system and renal tumours but higher for neuroblastoma. Recent improvements in overall childhood cancer survival over time are mainly because of improvements among leukaemia patients. CONCLUSION The high and improving survival prognosis for children diagnosed with cancer in Australia is consistent with various international estimates. However, a 5-year survival estimate of 79% still means that many children who are diagnosed with cancer will die within 5 years, whereas others have long-term health morbidities and complications associated with their treatments. It is hoped that continued developments in treatment protocols will result in further improvements in survival.
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Affiliation(s)
- P D Baade
- [1] Viertel Centre for Research in Cancer Control, Cancer Council Queensland, 553 Gregory Terrace, GPO Box 201 Spring Hill, Fortitude Valley QLD 4006, Australia.
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Affiliation(s)
- G J S Cooper
- School of Biological Sciences, and Maurice Wilkins Centre of Excellence for Molecular Biodiscovery, Faculty of Science, University of Auckland, Auckland, New Zealand.
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11
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Jago JD, Aitken JF, Chapman PJ. Dental knowledge and behaviour of pregnant women attending a Brisbane maternity hospital, 1982. Community Health Stud 2010; 8:45-53. [PMID: 6713820 DOI: 10.1111/j.1753-6405.1984.tb00423.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Thompson B, Austin R, Coory M, Aitken JF, Walpole E, Francis G, Fritschi L. Completeness of histopathology reporting of melanoma in a high-incidence geographical region. Dermatology 2008; 218:7-14. [PMID: 18832807 DOI: 10.1159/000161116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Accepted: 05/29/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Appropriate histopathology reporting helps to ensure effective therapy and prognosis. OBJECTIVE To examine compliance with clinical practice guidelines for histopathology reports of melanomas. METHODS A sample of melanoma histopathology reports in Queensland was audited for inclusion of recommended information. The quality of documentation was constructed and multivariate analysis used to determine factors affecting the quality of reporting practices. RESULTS Documentation of the most important features of melanoma was high: clear diagnosis (99.8%; 95% CI 98.6-100), thickness (99.8%; 95% CI 98.6-100), comment on adequacy of excision (87.9%; 95% CI 84.9-91.0) and measurement of margins (91.9%; 95% CI 88.8-91.4). Overall reporting of ulceration and regression was of lesser completeness (83.0 and 77.8%, respectively) and these features were more likely to be reported by high-volume laboratories (p < 0.001 and p = 0.037, respectively). This trend was not apparent for other features. Fewer than 50% of reports documented mitotic rate per square millimetre, predominant cell type, microsatellites, growth phase and desmoplasia. CONCLUSION Awareness of current reporting practices and identification of areas in which insufficiencies exist enable the revision of systems and potential improvements to the transfer of information to treating clinicians.
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Affiliation(s)
- B Thompson
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Qld., Australia.
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13
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Youl PH, Raasch BA, Janda M, Aitken JF. The effect of an educational programme to improve the skills of general practitioners in diagnosing melanocytic/pigmented lesions. Clin Exp Dermatol 2007; 32:365-70. [PMID: 17433042 DOI: 10.1111/j.1365-2230.2007.02414.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Skin cancer is a major public health issue in fair-skinned populations, and general practitioners (GPs) play an important role in the diagnosis and management of this disease. AIMS To evaluate a self-instructional education module with audit and feedback, designed to increase the skills of GPs in diagnosing melanocytic lesions and skin cancer. METHODS This study, conducted in Queensland, Australia, included 16 GPs who participated in an 18-month programme, comprising a 6-month baseline audit of skin excisions, a 6-month educational programme and a 6-month posteducation audit. RESULTS The overall diagnostic accuracy of malignant lesions was 63.2% (95% CI 60.0-66.3) during baseline and 64.5% (95% CI 61.1-67.7) posteducation. Significant improvements were seen posteducation in the proportion of melanocytic lesions confirmed as malignant (6.1% baseline and 13.5% posteducation, chi(2) = 6.6, P = 0.01). GPs with < 15 years of practice recorded significantly lower levels of diagnostic accuracy at baseline compared with those with >/= 25 years of practice (P = 0.001). There were no differences in diagnostic skill posteducation according to years of practice. CONCLUSIONS The education programme improved the malignant : benign ratio of melanocytic lesions, resulting in a doubling in the number of melanomas diagnosed. We found that GPs with less experience benefited most from the programme, indicating that tailoring of programmes to individual skills and years of practice might be beneficial.
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Affiliation(s)
- P H Youl
- Epidemiology Unit, Queensland Cancer Fund, Queensland, Australia.
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14
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Abstract
Screening by whole-body clinical skin examination may improve early diagnosis of melanoma and reduce mortality, but objective scientific evidence of this is lacking. As part of a randomized controlled trial of population screening for melanoma in Queensland, Australia, the authors assessed the validity of self-reported history of whole-body skin examination and factors associated with accuracy of recall among 2,704 participants in 2001. Approximately half of the participants were known to have undergone whole-body skin examination within the past 3 years at skin screening clinics conducted as part of the randomized trial. All positive and negative self-reports were compared with screening clinic records. Where possible, reports of skin examinations conducted outside the clinics were compared with private medical records. The validity of self-reports of whole-body skin examination in the past 3 years was high: Concordance between self-reports and medical records was 93.7%, sensitivity was 92.0%, and specificity was 96.3%. Concordance was lower (74.3%) for self-reports of examinations conducted in the past 12 months, and there was evidence of "telescoping" in recall for this more recent time frame. In multivariate analysis, women and younger participants more accurately recalled their history of skin examinations. Participants with a history of melanoma did not differ from other participants in their accuracy of recall.
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Affiliation(s)
- J F Aitken
- Epidemiology Unit, Queensland Cancer Fund, Brisbane, Queensland, Australia.
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15
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Abstract
OBJECTIVE To measure recent changes in prostate-cancer mortality across 24 developed countries. METHODS Mortality data for men aged 50-79 years were obtained from the World Health Organisation mortality database and we assessed trends in age-standardised mortality rates using joinpoint regression models. RESULTS Significant reductions in prostate-cancer mortality were observed in United Kingdom, United States, Austria, Canada, Italy, France, Germany, Australia and Spain, and downward trends were also observable in the Netherlands, Ireland and Sweden. CONCLUSIONS Mortality declines for prostate cancer are now evident in 12 out of the 24 developed countries considered in this analysis. Increases in PSA screening and better treatment of early-stage disease, possibly acting in combination, remain plausible hypotheses.
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Affiliation(s)
- P D Baade
- Cancer Epidemiology Unit, Queensland Cancer Fund, PO Box 201, Spring Hill QLD 4004, Australia.
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16
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17
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Vajdic C, Kricker A, Duffy DL, Aitken JF, Stark M, ter Huurne JAC, Martin NG, Armstrong BK, Hayward NK. Ocular melanoma is not associated with CDKN2A or MC1R variants--a population-based study. Melanoma Res 2003; 13:409-13. [PMID: 12883368 DOI: 10.1097/00008390-200308000-00011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Germline variants in the melanocortin 1 receptor gene (MC1R) and the p16 gene (CDKN2A) are associated with an increased risk of cutaneous melanoma. The frequency of these germline variants was examined in a population-based, incident series of 62 ocular melanoma cases and ethnicity-matched population controls. In both cases and controls, 59% of individuals carried at least one MC1R variant and there were no significant differences in the frequency of any of the five most common variants of MC1R. We also found no significant differences between cases and controls in the frequency of any of the four most common variants of CDKN2A, and no melanoma case carried a deleterious germline CDKN2A mutation. Our findings argue against an important predisposing effect of the MC1R and CDKN2A genes for ocular melanoma.
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Affiliation(s)
- C Vajdic
- National Centre for HIV Epidemiology and Clinical Research, Darlinghurst, NSW, Australia
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18
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Abstract
OBJECTIVES Melanoma is a significant cause of morbidity and mortality worldwide and incidence is increasing. Survival after treatment is inversely related to the thickness of the tumour at diagnosis. Population screening has the potential to reduce mortality but there is no conclusive evidence of benefit. Such evidence can come best from a randomised trial. Here we describe the design of a community based randomised trial of a population screening programme for melanoma in Queensland, Australia and early results of the first phase of the trial. METHODS A total of 44 communities (aggregate population 560 000 adults aged 30 years or more) will be randomised to receive either a community based screening programme for 3 years or normal practice. The screening programme promotes thorough skin self examination and whole body skin examination by a doctor and provides open access skin cancer screening clinics. In its first phase, the trial is underway in nine intervention and nine control communities. The primary outcome measure is mortality from melanoma during 15 years of follow up. RESULTS The first phase of the trial has shown the feasibility of implementing a population skin screening programme including regular skin cancer screening clinics, and has shown the strong support of communities and doctors for the programme. There has been a significant 2.5-fold increase in participation in screening in the intervention communities in this first phase after the first 12 months of the trial and no significant increase in participation in screening in control communities during this period. CONCLUSIONS The design of a community based randomised trial of screening for melanoma has been successfully peer reviewed and the intervention has been shown to be feasible in practice. This randomised trial may be one of the last opportunities to develop the evidence required for public health recommendations for population screening for melanoma.
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Affiliation(s)
- J F Aitken
- Epidemiology Unit, Queensland Cancer Fund, Brisbane, Australia.
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19
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Pollock PM, Stark MS, Palmer JM, Walters MK, Aitken JF, Martin NG, Hayward NK. Mutation analysis of the CDKN2A promoter in Australian melanoma families. Genes Chromosomes Cancer 2001; 32:89-94. [PMID: 11477665 DOI: 10.1002/gcc.1170] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Approximately 50% of all melanoma families worldwide show linkage to 9p21-22, but only about half of these have been shown to contain germ line CDKN2A mutations. It has been hypothesized that a proportion of these families carry mutations in the noncoding regions of CDKN2A. Several Canadian families have been reported to carry a mutation in the 5' UTR, at position -34 relative to the start site, which gives rise to a novel AUG translation initiation codon that markedly decreases translation from the wild-type AUG (Liu et al., 1999). Haplotype sharing in these Canadian families suggested that this mutation is of British origin. We sequenced 1,327 base pairs (bp) of CDKN2A, making up 1,116 bp of the 5' UTR and promoter, all of exon 1, and 61 bp of intron 1, in at least one melanoma case from 110 Australian families with three or more affected members known not to carry mutations within the p16 coding region. In addition, 431 bp upstream of the start codon was sequenced in an additional 253 affected probands from two-case melanoma families for which the CDKN2A mutation status was unknown. Several known polymorphisms at positions -33, -191, -493, and -735 were detected, in addition to four novel variants at positions 120, -252, -347, and -981 relative to the start codon. One of the probands from a two-case family was found to have the previously reported Q50R mutation. No family member was found to carry the mutation at position -34 or any other disease-associated mutation. For further investigation of noncoding CDKN2A mutations that may affect transcription, allele-specific expression analysis was carried out in 31 of the families with at least three affected members who showed either complete or "indeterminate" 9p haplotype sharing without CDKN2A exonic mutations. Reverse transcription polymerase chain reaction and automated sequencing showed expression of both CDKN2A alleles in all family members tested. The lack of CDKN2A promoter mutations and the absence of transcriptional silencing in the germ line of this cohort of families suggest that mutations in the promoter and 5' UTR play a very limited role in melanoma predisposition.
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Affiliation(s)
- P M Pollock
- Joint Experimental Oncology Program of the Queensland Institute of Medical Research, University of Queensland, and the Queensland Cancer Fund, P.O. Royal Brisbane Hospital, Brisbane, Australia
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20
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Abstract
To investigate whether the familial clustering of cutaneous melanoma is consistent with Mendelian inheritance of a major autosomal gene, maximum likelihood segregation analyses were performed in a population-based sample of 1,912 families ascertained through a proband with melanoma diagnosed in Queensland between 1982 and 1990. Analyses were performed with the S.A.G.E. statistical package, using the REGTL program for a binary trait with a variable age of onset. We sought medical confirmation for all family members reported to have had melanoma, and only medically verified cases among relatives were included in the analyses. The hypothesis of codominant Mendelian inheritance gave a significantly better fit to the data than either dominant or recessive Mendelian inheritance, or environmental transmission. Overall, both Mendelian inheritance of a single major gene, and purely environmental transmission were rejected (P < 0.001). In both the single major gene and environmental models, there was strong evidence of familial dependence in melanoma occurrence (P < 0.001). These results are consistent with reported genetic heterogeneity in melanoma inheritance and suggest that other familial factors, such as pigmentation, skin type, and sun exposure habits, may play an important role in the familial clustering of melanoma.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane, Australia
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21
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McGregor B, Pfitzner J, Zhu G, Grace M, Eldridge A, Pearson J, Mayne C, Aitken JF, Green AC, Martin NG. Genetic and environmental contributions to size, color, shape, and other characteristics of melanocytic naevi in a sample of adolescent twins. Genet Epidemiol 2000; 16:40-53. [PMID: 9915566 DOI: 10.1002/(sici)1098-2272(1999)16:1<40::aid-gepi4>3.0.co;2-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The presence of melanocytic naevi is the strongest known risk factor for malignant melanoma. We have developed a computer imaging system with which it is possible to make quantitative measures of the size, color, and shape of pigmented lesions. The objective of this study was to examine the genetic and environmental contributions to these characteristics of naevi as measured by computer image analysis in a sample of adolescent twins. We captured video images of the 5 most atypical pigmented skin lesions (i.e., the largest, darkest, or most irregularly shaped) on each individual from 322 Australian adolescent twin pairs. Features extracted by computer image analysis for each lesion included color, size, symmetry, elongation, boundary irregularity, and edge distinctness. We found major genetic influences on the color and size of lesions accounting for between 40 and 80% of total variance. There were significant components of shared environmental influence (22-45% of total variance) for the color variables, with sun exposure the most obvious explanation. Differences between individuals in naevus color and size are largely genetic in origin although there are significant environmental contributions to color as well.
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Affiliation(s)
- B McGregor
- Queensland Institute of Medical Research, Brisbane, Australia
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22
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Zhu G, Duffy DL, Eldridge A, Grace M, Mayne C, O'Gorman L, Aitken JF, Neale MC, Hayward NK, Green AC, Martin NG. A major quantitative-trait locus for mole density is linked to the familial melanoma gene CDKN2A: a maximum-likelihood combined linkage and association analysis in twins and their sibs. Am J Hum Genet 1999; 65:483-92. [PMID: 10417291 PMCID: PMC1377947 DOI: 10.1086/302494] [Citation(s) in RCA: 180] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Important risk factors for melanoma are densely clustered melanocytic nevi (common moles) and mutations in the p16 (CDKN2A) gene. Nevi may be subclassified as raised or flat. In our sample, raised nevi were 27% of the total, and the two kinds had a correlation of.33. Correlations for total-nevus count (TNC) in 153 MZ and 199 DZ twin pairs were.94 and.60, respectively, which are compatible with a very-high degree of genetic determination. We hypothesized that some of the genetic variance might be due to variation in the p16 gene. Analysis of linkage to a highly polymorphic marker (D9S942), located close to p16, detected quantitative-trait-loci (QTL) effects accounting for 27% of variance in TNC, rising to 33% if flat but not raised moles were considered. Total heritability was higher for raised (.69) than for flat (.42) moles, but QTL linkage was 0 for raised moles, whereas it accounted for 80% of the heritability of flat moles; additionally, family environment accounted for only 15% of variance in raised versus 46% in flat moles. These findings suggest that raised and flat nevi have very different etiologies. Longer alleles at D9S942 were associated with higher flat-mole counts, and a novel modification to a within-sibship association test showed that this association is genuine and not due to population stratification, although it accounts for only 1% of total variance. Since germline mutations in the exons of CDKN2A are rare, it is likely that variants in the noncoding regions of this gene, or in another gene nearby, are responsible for this major determinant of moliness and, hence, of melanoma risk.
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Affiliation(s)
- G Zhu
- Queensland Institute of Medical Research and Joint Genetics Program, University of Queensland, Brisbane, Australia
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23
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Abstract
A positive family history is used in clinical practice as an indication of increased melanoma risk, yet there are no data on the accuracy of reported family histories of melanoma. The validity of case-reported family history of melanoma was assessed in the course of a family and twin study of melanoma in Queensland, Australia, conducted among the families of 2,118 melanoma cases diagnosed in Queensland between 1982 and 1990. A total of 913 melanoma cases made 1,267 reports of melanoma among their first-degree relatives. A total of 1,040 of these reports were checked, first through relatives themselves and then, if the relative also said they had had melanoma, through the relative's medical records. Medical confirmation of melanoma as the diagnosis was obtained for 623 reports (59.9%; 95% confidence interval 56.9-62.9): a false-positive reporting rate by cases of 40.1%. The level of false-positive reporting was lower for cases under 70 years of age, for women, for cases whose own diagnosis of melanoma was more than 5 years earlier, and for cases with three or more relatives with melanoma. Media campaigns in Queensland aimed at increasing skin cancer awareness, and confusion between melanoma and other more common actinic neoplasma (basal and squamous cell carcinomas), may partly explain the high false-positive reporting rate observed here. For this reason, It is difficult to generalize these findings to northern hemisphere populations where skin cancer is not such an important public health issue.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane Hospital, Queensland, Australia
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24
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Abstract
BACKGROUND The diagnosis of melanomas at an early stage is associated with improved survival, so the recognition of changes in pigmented skin lesions over time is important. We have developed a computer imaging system with the aim of assisting clinicians in differentiating early melanomas from benign pigmented skin lesions. The objective of this study was to investigate the system's reliability over time in measuring diagnostic characteristics of pigmented skin lesions, including their color, size, shape, and distinctness of boundary. METHODS We captured video images of 5 lesions, all larger than 2 mm in greatest dimension, on each of 66 Australian adolescents on 2 occasions approximately 1 month apart. Features extracted by computer image analysis included area, perimeter, and regularity of outline of the lesions, the mean and standard deviation of reflectance at red, green, and blue wavelengths, and the mean and standard deviation of the gradients of red, green, and blue reflectance at the lesion boundary. RESULTS All measurements showed moderate to high reliability (intraclass correlation coefficients 0.66-0.94), except for the standard deviations of the color gradients, whose reliability improved to moderate levels (0.68-0.71) when the mean of 5 lesions was considered. For most outcomes, reasonable within subject reliability was achieved when five lesions per subject were measured. CONCLUSIONS These results, in combination with previous work demonstrating the reasonable ability of this computer imaging system to discriminate between malignant melanomas and other pigmented lesions, indicates that the system has the potential to become a useful tool for clinicians in following people with pigmented lesions over time to detect early malignant changes.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane, Australia
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25
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Aitken JF, Bain CJ, Ward M, Siskind V, MacLennan R. Risk of colorectal adenomas in patients with a family history of colorectal cancer: some implications for screening programmes. Gut 1996; 39:105-8. [PMID: 8881819 PMCID: PMC1383241 DOI: 10.1136/gut.39.1.105] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS Most colorectal cancers (CRC) arise in colorectal adenomas. A case-control study was conducted to see whether a family history of CRC is associated with a higher prevalence of colorectal adenomas. SUBJECTS Subjects were drawn from all patients who underwent colonoscopy at the Royal Brisbane Hospital between 1980-1982 and 1985, and included 141 cases with colorectal adenomas diagnosed at colonoscopy and 882 controls who were free of polyps at colonoscopy. METHODS The prevalence of family history of CRC was compared between patients with adenomas and negative colonoscopy controls. RESULTS Overall, patients with one first degree relative with CRC were at no greater risk for adenomas at colonoscopy than patients with no family history (odds ratio (OR) = 0.8, 95% confidence intervals (CI) = 0.4, 1.5). Patients with two or more affected first degree relatives had a more than doubled risk for adenomas (OR = 2.3, 95% CI = 0.5, 8.2), and were also more likely to carry moderately or severely dysplastic adenomas (OR = 14.1, 95% CI = 2.0, 62.9). CONCLUSIONS These findings are consistent with the hypothesis that some families, in addition to those with familial adenomatous polyposis, have an increased susceptibility to develop colorectal adenomas, and that adenomas in such families may have a greater tendency to undergo malignant transformation.
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Affiliation(s)
- J F Aitken
- Department of Social and Preventive Medicine, University of Queensland, Brisbane
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26
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Eich RF, Li T, Lemon DD, Doherty DH, Curry SR, Aitken JF, Mathews AJ, Johnson KA, Smith RD, Phillips GN, Olson JS. Mechanism of NO-induced oxidation of myoglobin and hemoglobin. Biochemistry 1996; 35:6976-83. [PMID: 8679521 DOI: 10.1021/bi960442g] [Citation(s) in RCA: 524] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Nitric oxide (NO) has been implicated as mediator in a variety of physiological functions, including neurotransmission, platelet aggregation, macrophage function, and vasodilation. The consumption of NO by extracellular hemoglobin and subsequent vasoconstriction have been suggested to be the cause of the mild hypertensive events reported during in vivo trials of hemoglobin-based O2 carriers. The depletion of NO from endothelial cells is most likely due to the oxidative reaction of NO with oxyhemoglobin in arterioles and surrounding tissue. In order to determine the mechanism of this key reaction, we have measured the kinetics of NO-induced oxidation of a variety of different recombinant sperm whale myoglobins (Mb) and human hemoglobins (Hb). The observed rates depend linearly on [NO] but show no dependence on [O2]. The bimolecular rate constants for NO-induced oxidation of MbO2 and HbO2 are large (k.ox,NO = 30-50 microM-1 s-1 for the wild-type proteins) and similar to those for simple nitric oxide binding to deoxygenated Mb and Hb. Both reversible NO binding and NO-induced oxidation occur in two steps: (1) bimolecular entry of nitric oxide into the distal portion of the heme pocket and (2) rapid reaction of noncovalently bound nitric oxide with the iron atom to produce Fe(2+)-N=O or with Fe(2+)-O-O delta- to produce Fe(3+)-OH2 and nitrate. Both the oxidation and binding rate constants for sperm whale Mb were increased when His(E7) was replaced by aliphatic residues. These mutants lack polar interactions in the distal pocket which normally hinder NO entry into the protein. Decreasing the volume of the distal pocket by replacing Leu(B10) and Val(E11) with aromatic amino acids markedly inhibits NO-induced oxidation of MbO2. The latter results provide a protein engineering strategy for reducing hypertensive events caused by extracellular hemoglobin-based O2 carriers. This approach has been explored by examining the effects of Phe(B10) and Phe(E11) substitutions on the rates of NO-induced oxidation of the alpha and beta subunits in recombinant human hemoglobin.
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Affiliation(s)
- R F Eich
- Department of Biochemistry and Cell Biology, Rice University, Houston, Texas 77005-1892, USA
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27
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Abstract
Family history of melanoma is associated with an increased risk for the disease. Neither the relative contributions of genetic and shared environmental factors to familial risk nor how genetic susceptibility is mediated are known. The Queensland Familial Melanoma Project was undertaken to investigate (a) the role of genetic susceptibility as indicated by skin type, pigmentation and the prevalence of naevi and (b) exposure to solar ultraviolet radiation, and their interaction in the aetiology of familial melanoma. After obtaining doctor's consent, a brief family history questionnaire was mailed to all Queensland residents with a first primary cutaneous melanoma diagnosed between 1982 and 1990. Detailed information on melanoma history and standard melanoma risk factors was sought from all responding twins and familial cases, from a sample of non-familial cases and from cases' relatives. Medical confirmation was sought for all relatives reported to have had melanoma. The final sample comprises 15,907 persons in the 1,912 families of 2,118 melanoma cases, including 509 families in which there are two or more individuals with confirmed melanoma. Melanoma history and risk factors were obtained for 9,746 relatives, including 94 twins of cases. This is the largest family and twin study of cutaneous melanoma yet conducted in an unselected, geographically-defined population. We describe the design of the study and the characteristics of the total study population.
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Affiliation(s)
- J F Aitken
- Epidemiology Unit, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Australia
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28
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Abstract
While it is recognized that relatives of melanoma patients are at increased risk for this disease, the source and extent of variation in melanoma risk between families of melanoma cases is unknown. Heterogeneity of familial melanoma risk was assessed among the families (comprising 7,666 first-degree relatives) of 1,149 cutaneous melanoma cases diagnosed in Queensland, Australia, between 1982 and 1987. The measure of familial melanoma risk was based on the number of cases of melanoma in the family in excess of those predicted from the age-, sex-, and birth cohort-specific cumulative incidences of melanoma among all relatives in the sample. Probands over-reported melanoma occurrence among their relatives, with a false positive reporting rate of 44.5% (216 false reports out of 485). Only medically verified cases among relatives were included in the analysis. There was statistically significant heterogeneity in family risk, with 53 (4.7%) of the total 1,116 unrelated families containing significantly more melanoma cases than expected considering the size of the family, and the age, sex, and birth cohort distributions of family members. In univariate analyses, members of the high-risk families were significantly more likely to have poor ability to tan, a propensity to sunburn, fair skin color, red hair, and many melanocytic nevi. When all variables were included simultaneously in a multiple logistic regression model, only the associations with tanning ability, skin color, and number of nevi remained significant. There were no significant differences overall between high-risk and other families in the sites and ages at diagnosis of melanoma, although melanomas on variably sun-exposed sites (trunk and legs) were diagnosed earlier in the high-risk families, independent of the stage at diagnosis.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane, Australia
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29
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Aitken JF, Green A, Eldridge A, Green L, Pfitzner J, Battistutta D, Martin NG. Comparability of naevus counts between and within examiners, and comparison with computer image analysis. Br J Cancer 1994; 69:487-91. [PMID: 8123478 PMCID: PMC1968854 DOI: 10.1038/bjc.1994.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In the course of an investigation of melanocytic naevus development in Queensland, Australia, whole-body naevus counts of 66 adolescents were performed separately by two nurse examiners on two occasions on average 4 weeks apart. There was good agreement between the two examiners for counts of total naevi on the whole body (intra-class correlation coefficient = 0.96) and at selected subsites (face, neck, back, upper arms, lower arms). Agreement was lower when raised naevi only were counted (0.83). Intra-examiner repeatability was high for both nurses, particularly for the more experienced examiner (intra-class correlation coefficients = 0.98 and 0.91 for total naevi on the whole body), and was consistently better when all naevi were counted rather than naevi of a particular size. Independent counts of naevi on the back using a computer imaging technique were reproducible (intra-class correlation coefficient = 0.92), but showed only moderate agreement with counts by the nurse examiners. Overall, these results demonstrate high comparability of naevus counts between and within similarly trained examiners. They do not support the common practice in epidemiological studies of restricting counts to naevi larger than 2 mm, or of counting raised naevi only.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane, Australia
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30
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Abstract
Surrogate reports by patients about their relatives, and vice versa, are potentially of great use in studies of the genetic and environmental causes of the familial aggregation of cancer. To assess the quality of such information in a family study of melanoma aetiology in Queensland, Australia, the authors compared surrogate reports with self-reports of standard melanoma risk factors obtained by mailed self-administered questionnaire. There was moderate agreement between surrogate reports provided by the cases and relatives' self-reports for questions on ability to tan (polychoric correlation coefficient (pc) = 0.60), skin colour (pc = 0.57), average propensity to burn (pc = 0.56), and hair colour at age 21 (kappa coefficient = 0.55), although relatives in the extreme risk factor categories were misclassified by surrogates at least half of the time. Agreement was lower for questions on degree of moliness (pc = 0.45), tendency to acute sunburn (pc = 0.42), and number of episodes of painful sunburn (pc = 0.23). The quality of relatives' surrogate reports about cases was similar to that of cases' surrogate reports about relatives. Cases who reported a family history of melanoma provided better surrogate information than did cases who indicated no family history, and female cases provided better surrogate reports than did males. Cases were better able to report for their parents and children than for their siblings. The authors conclude that when the use of surrogate reports of melanoma risk factors is unavoidable, results should be interpreted cautiously in the light of potentially high rates of misclassification. In particular, surrogate reports appear to be a comparatively poor measure of self-assessment of number of moles, the strongest known phenotypic indicator of melanoma risk, and may bias comparisons between families with and without a history of melanoma.
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Affiliation(s)
- J F Aitken
- Queensland Institute of Medical Research, Brisbane, Australia
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Aitken JF, van Heusden GP, Temkin M, Dowhan W. The gene encoding the phosphatidylinositol transfer protein is essential for cell growth. J Biol Chem 1990; 265:4711-7. [PMID: 2407740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Phosphatidylinositol transfer proteins (PI-TPs) catalyze the transfer of phosphatidylinositol and phosphatidylcholine between membranes in vitro. However, the in vivo function of these proteins is unknown. In this paper, we use a combined biochemical and genetic approach to determine the importance of PI-TP in vivo. An oligonucleotide based on the amino-terminal sequence of the PI-TP from Saccharomyces cerevisiae was used to screen a yeast genomic library for the gene encoding PI-TP (PIT1 gene). Positive clones showed overproduction of transfer activities and transfer protein in the 100,000 x g supernatants. The 5' terminus of the PIT1 gene correlates with the predicted codons for residues 3-30 of the determined protein sequence. A putative intron is located between the codons for residues 2 and 3 of the protein sequence. The codons for the first two amino acids of the protein and the presumptive initiation methionine precede the intron. Tetrad analysis of a heterozygous diploid (PIT1/pit1::LEU2) revealed that the PIT1 gene is essential for cell growth. Nonviable spores could be rescued by transformation of the above diploid prior to sporulation, with a plasmid-borne copy of the wild type gene.
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Affiliation(s)
- J F Aitken
- Department of Biochemistry and Molecular Biology, University of Texas Medical School, Houston 77225
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Aitken JF, van Heusden GP, Temkin M, Dowhan W. The gene encoding the phosphatidylinositol transfer protein is essential for cell growth. J Biol Chem 1990. [DOI: 10.1016/s0021-9258(19)39620-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
A sample of 314 consecutive women attending for their first antenatal visit at a public hospital were examined according to the WHO survey procedure. The women's age ranged from 16 to 42 yr with a mean of 23.5 yr. Only 3% were edentulous in both jaws, but 13% had some form of denture. A quarter had pocketing in at least one sextant and only 16% were free of gingivitis. The average number of DMF teeth was 15.8, comprising 2.7 decayed, 4.5 missing and 8.6 filled teeth; 70% had teeth needing restoration and 10% had at least one tooth needing extraction. There were significant relationships between DMF score and age (positive) and between number of teeth needing restoration and age, educational level, and the woman's own perception of her dental health (all inverse). Some form of dental attention was needed by 86% of the women; 12% had conditions needing immediate attention. By comparison with a 1971 study of pregnant women in Brisbane, there has been a marked decline in DMFT score (from 19.1 to 15.8).
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Christie DL, Birch NP, Aitken JF, Harding DR, Hancock WS. Antisera to synthetic peptide recognize high molecular weight enkephalin-containing proteins. Biochem Biophys Res Commun 1984; 120:650-6. [PMID: 6203524 DOI: 10.1016/0006-291x(84)91305-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Antisera to a synthetic peptide corresponding to the 95-117 sequence of proenkephalin were used to develop a sensitive radioimmunoassay. Gel-filtration of acid extracts of bovine adrenal medulla and purified chromaffin granules revealed that the antisera recognized high molecular weight material (Mr approximately 5,000-30,000). The material in peak I ( Mr 20 ,000-30,000) and peak II (Mr 10,000-20,000) was further purified by immunoaffinity chromatography. Sequential digestion of each of these fractions with trypsin and carboxypeptidase B generated immunoreactive Met-enkephalin. This study demonstrates that antisera against a synthetic peptide cross-react with high molecular weight enkephalin-containing precursors, validating the use of these antisera in studies of enkephalin biosynthesis.
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Abstract
AN EXPERIMENTAL GINGIVITIS STUDY was carried out to relate the clinical parameters (plaque and gingival index) to the histologic appearance of the associated gingival lesions. Fifteen third-year dental students took part in the study. Following the withdrawal of oral hygiene, biopsies were taken on days 0, 4, 8 and 21 of the experimental period. A statistically significant association was found between the plaque and gingival indices and the various time intervals throughout the experimental period (P less than 0.001). At day 0, although all sites had a GI of 0, all but 2 of the 15 specimens showed some degree of inflammation. Histologically, these lesions consisted of over 60% lymphocytes, while plasma cells comprised less than 5% of the infiltrating population. Although the degree of inflammation increased both clinically and histologically throughout the experimental period, the nature of the infiltrate did not change significantly. Lymphocytes remained as the dominant cell type. In fact, no association was seen between the degree of inflammation and the nature of the infiltrating cells.
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Seymour GJ, Powell RN, Cole KL, Aitken JF, Brooks D, Beckman I, Zola H, Bradley J, Burns GF. Experimental gingivitis in humans. A histochemical and immunological characterization of the lymphoid cell subpopulations. J Periodontal Res 1983; 18:375-85. [PMID: 6227722 DOI: 10.1111/j.1600-0765.1983.tb00373.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
A retrospective study was carried out to determine the frequency of early periodontal bone loss in 15 year olds as seen in bite-wing radiographs. A total of 468 radiographs of 15 year olds was examined, 246 from 1970-74 and 222 from 1978-80. The alveolar bone crest on the mesial and distal of the first permanent molar teeth was examined for radiographic evidence of early chronic periodontitis. The condition of the adjacent proximal tooth surfaces was also recorded. No significant difference was found between the two groups; 39% of the 1978-80 and 43% of the 1970-74 group showed radiographic evidence of early chronic periodontitis (P less than 0.05). Males and females showed a similar frequency of periodontal disease levels. The mesial interproximal space of the first molars had significantly higher frequencies of radiographic evidence of chronic periodontitis than the distal interproximal spaces in the two groups examined. Fewer proximal restorations with overhangs were noted in the 1978-80 group, however more proximal subgingival calculus was found in this group than the 1970-74 group.
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Latcham NL, Powell RN, Jago JD, Seymour GJ, Aitken JF. Changes in proximal caries status of Brisbane 15-year-old children over a ten year period. Aust Dent J 1982; 27:357-9. [PMID: 6963149 DOI: 10.1111/j.1834-7819.1982.tb02464.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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