Dual EEG alignment between participants during shared intentionality experiments

Electroencephalograph (EEG) analysis from human subjects have demonstrated that beta oscillations carried perceptual information across the cortex featuring amplitude and phase modulation occurrences when subjects are engaged in task-oriented activities. A hypothesis was tested that synchronized patterns could be found in the scalp EEG of two human subjects engaged in similar intentional activity. Signals were recorded from scalp electrodes and band-pass filtered. The Hilbert transform decomposes the EEG signals into the analytic phase and amplitude. With these components of the EEG signal, a systematic search of the alpha, beta, delta, gamma, and theta spectrum is executed to locate temporal patterns. The amplitude and phase modulation were classified with respect to task intervals. Temporal patterns were found in the alpha-beta range (15-30 Hz). Our results suggest that the scalp EEG can yield information about the timing of episodically synchronized brain activity in higher cognitive function between two individuals engaged in similar task-oriented activities.

Auditory and olfactory findings in patients with USH2A-related retinal degeneration-Findings at baseline from the rate of progression in USH2A-related retinal degeneration natural history study (RUSH2A)

Sensorineural hearing loss (SNHL) is characteristic of Usher syndrome type 2 (USH2), but less is known about SNHL in nonsyndromic autosomal recessive retinitis pigmentosa (ARRP) and olfaction in USH2A-associated retinal degeneration. The Rate of Progression of USH2A-related Retinal Degeneration (RUSH2A) is a natural history study that enrolled 127 participants, 80 with USH2 and 47 with ARRP. Hearing was measured by pure-tone thresholds and word recognition scores, and olfaction by the University of Pennsylvania Smell Identification Test (UPSIT). SNHL was moderate in 72% of USH2 participants and severe or profound in 25%, while 9% of ARRP participants had moderate adult-onset SNHL. Pure-tone thresholds worsened with age in ARRP but not in USH2 participants. The degree of SNHL was not associated with other participant characteristics in either USH2 or ARRP. Median pure-tone thresholds in ARRP participants were significantly higher than the normative population (p < 0.001). Among 14 USH2 participants reporting newborn hearing screening results, 7 reported passing. Among RUSH2A participants, 7% had mild microsmia and 5% had moderate or severe microsmia. Their mean (±SD) UPSIT score was 35 (±3), similar to healthy controls (34 [±3]; p = 0.39). Olfaction differed by country (p = 0.02), but was not significantly associated with clinical diagnosis, age, gender, race/ethnicity, smoking status, visual measures, or hearing. Hearing loss in USH2A-related USH2 did not progress with age. ARRP patients had higher pure-tone thresholds than normal. Newborn hearing screening did not identify all USH2A-related hearing loss. Olfaction was not significantly worse than normal in participants with USH2A-related retinal degeneration.

Seizure localization using EEG analytical signals

OBJECTIVE

Localization of epileptic seizures, usually characterized by abnormal hypersynchronous wave patterns from the cortex, remains elusive. We present a novel, robust method for automatic localization of seizures on the scalp from clinical electroencephalogram (EEG) data.

METHODS

Seizure patient EEG data was decomposed via the Hilbert Transform and processed through the following methodology: sorting the analytic amplitude (AA) in the time instance, locating the maximum amplitude within the vector of channels, cross-correlating amplitude values in the time index with the channel vector. The channel with highest AA value in time was located.

RESULTS

Our approach provides an automated way to isolate the epi-genesis of seizure events with 93.3% precision and 100% sensitivity. The method differentiates seizure-related neural activity from other common EEG noise artifacts (e.g., blinks, myogenic noise).

CONCLUSIONS

We evaluated performance characteristics of our source location methodology utilizing both phase and energy of EEG signals from patients who exhibited seizure events. Feasibility of the new algorithm is demonstrated and confirmed.

SIGNIFICANCE

The proposed method contributes to high-performance scalp localization for seizure events that is more straightforward and less computationally intensive than other methods (e.g., inverse source modeling). Ultimately, it may aid clinicians in providing improved patient diagnosis.

Frontal cortex selectively overrides auditory processing to bias perception for looming sonic motion

Rising intensity sounds signal approaching objects traveling toward an observer. A variety of species preferentially respond to looming over receding auditory motion, reflecting an evolutionary perceptual bias for recognizing approaching threats. We probed the neural origins of this stark perceptual anisotropy to reveal how the brain creates privilege for auditory looming events. While recording neural activity via electroencephalography (EEG), human listeners rapidly judged whether dynamic (intensity varying) tones were looming or receding in percept. Behaviorally, listeners responded faster to auditory looms confirming a perceptual bias for approaching signals. EEG source analysis revealed sensory activation localized to primary auditory cortex (PAC) and decision-related activity in prefrontal cortex (PFC) within 200 ms after sound onset followed by additional expansive PFC activation by 500 ms. Notably, early PFC (but not PAC) activity rapidly differentiated looming and receding stimuli and this effect roughly co-occurred with sound arrival in auditory cortex. Brain-behavior correlations revealed an association between PFC neural latencies and listeners' speed of sonic motion judgments. Directed functional connectivity revealed stronger information flow from PFC → PAC during looming vs. receding sounds. Our electrophysiological data reveal a critical, previously undocumented role of prefrontal cortex in judging dynamic sonic motion. Both faster neural bias and a functional override of obligatory sensory processing via selective, directional PFC signaling toward auditory system establish the perceptual privilege for approaching looming sounds.

Mesoscopic neuron population modeling of normal/epileptic brain dynamics

Simulations of EEG data provide the understanding of how the limbic system exhibits normal and abnormal states of the electrical activity of the brain. While brain activity exhibits a type of homeostasis of excitatory and inhibitory mesoscopic neuron behavior, abnormal neural firings found in the seizure state exhibits brain instability due to runaway oscillatory entrained neural behavior. We utilize a model of mesoscopic brain activity, the KIV model, where each network represents the areas of the limbic system, i.e., hippocampus, sensory cortex, and the amygdala. Our model initially demonstrates oscillatory entrained neural behavior as the epileptogenesis, and then by increasing the external weights that join the three networks that represent the areas of the limbic system, seizure activity entrains the entire system. By introducing an external signal into the model, simulating external electrical titration therapy, the modeled seizure behavior can be 'rebalanced' back to its normal state.

A pilot investigation of audiovisual processing and multisensory integration in patients with inherited retinal dystrophies

BACKGROUND

In this study, we examined audiovisual (AV) processing in normal and visually impaired individuals who exhibit partial loss of vision due to inherited retinal dystrophies (IRDs).

METHODS

Two groups were analyzed for this pilot study: Group 1 was composed of IRD participants: two with autosomal dominant retinitis pigmentosa (RP), two with autosomal recessive cone-rod dystrophy (CORD), and two with the related complex disorder, Bardet-Biedl syndrome (BBS); Group 2 was composed of 15 non-IRD participants (controls). Audiovisual looming and receding stimuli (conveying perceptual motion) were used to assess the cortical processing and integration of unimodal (A or V) and multimodal (AV) sensory cues. Electroencephalography (EEG) was used to simultaneously resolve the temporal and spatial characteristics of AV processing and assess differences in neural responses between groups. Measurement of AV integration was accomplished via quantification of the EEG's spectral power and event-related brain potentials (ERPs).

RESULTS

Results show that IRD individuals exhibit reduced AV integration for concurrent audio and visual (AV) stimuli but increased brain activity during the unimodal A (but not V) presentation. This was corroborated in behavioral responses, where IRD patients showed slower and less accurate judgments of AV and V stimuli but more accurate responses in the A-alone condition.

CONCLUSIONS

Collectively, our findings imply a neural compensation from auditory sensory brain areas due to visual deprivation.

Power Spectral Density Analysis of Electrocorticogram Recordings during Cerebral Hypothermia in Neonatal Seizures

BACKGROUND

Neonatal seizures (NS) are the most common form of neurological dysfunction observed in newborns.

PURPOSE

The purpose of this study in newborn piglets was to determine the effect of cerebral hypothermia (CH) on neural activity during pharmacologically induced NS. We hypothesized that the neuroprotective effects of CH would preserve higher frequencies observed in electrocorticogram (ECoG) recordings.

METHODS

Power spectral density was employed to determine the levels of brain activity in ECoGs to quantitatively assess the power of each frequency observed in neurological brain states of delta, theta, alpha, and beta-gamma frequencies.

RESULT

The most significant reduction of power occurs in the lower frequency band of delta-theta-alpha of CH cohorts, while t score probabilities imply that high-frequency brain activity in the beta-gamma range is preserved in the CH population.

CONCLUSION

While the overall power density decreases over time in both groups, the decrease is to a lesser degree in the CH population.

Quantitative EEG Signatures through Amplitude and Phase Modulation Patterns

Cortical spatiotemporal signal patterns based on object recognition can be discerned from visual stimulation. These are in the form of amplitude modulation (AM) and phase modulation (PM) patterns, which contain perceptual information gathered from sensory input. A high-density Electroencephalograph (EEG) device consisting of 48 electrodes with a spacing of 5 mm was utilized to measure frontal lobe activity in order to capture event-related potentials from visual stimuli. Four randomized stimuli representing different levels of salient responsiveness were measured to determine if mild stimuli can be discerned from more extreme stimuli. AM/PM response patterns were detected between mild and more salient stimuli across participants. AM patterns presented distinct signatures for each stimulus. AM patterns had the highest number of incidents detected in the middle of the frontal lobe. Through this work, we can expand our encyclopedia of neural signatures to object recognition, and provide a broader understanding of quantitative neural responses to external stimuli. The results provide a quantitative approach utilizing spatiotemporal patterns to analyze where distinct AM patterns can be linked to object perception.

Ambulatory Seizure Monitoring: From Concept to Prototype Device

BACKGROUND

The brain, made up of billions of neurons and synapses, is the marvelous core of human thought, action and memory. However, if neuronal activity manifests into abnormal electrical activity across the brain, neural behavior may exhibit synchronous neural firings known as seizures. If unprovoked seizures occur repeatedly, a patient may be diagnosed with epilepsy.

PURPOSE

The scope of this project is to develop an ambulatory seizure monitoring system that can be used away from a hospital, making it possible for the user to stay at home, and primary care personnel to monitor a patient's seizure activity in order to provide deeper analysis of the patient's condition and apply personalized intervention techniques.

METHODS

The ambulatory seizure monitoring device is a research device that has been developed with the objective of acquiring a portable, clean electroencephalography (EEG) signal and transmitting it wirelessly to a handheld device for processing and notification.

RESULT

This device is comprised of 4 phases: acquisition, transmission, processing and notification. During the acquisition stage, the EEG signal is detected using EEG electrodes; these signals are filtered and amplified before being transmitted in the second stage. The processing stage encompasses the signal processing and seizure prediction. A notification is sent to the patient and designated contacts, given an impending seizure. Each of these phases is comprised of various design components, hardware and software. The experimental findings illustrate that there may be a triggering mechanism through the phase lock value method that enables seizure prediction.

CONCLUSION

The device addresses the need for long-term monitoring of the patient's seizure condition in order to provide the clinician a better understanding of the seizure's duration and frequency and ultimately provide the best remedy for the patient.

Seizure Prediction and Detection via Phase and Amplitude Lock Values

A robust seizure prediction methodology would enable a “closed-loop” system that would only activate as impending seizure activity is detected. Such a system would eliminate ongoing stimulation to the brain, thereby eliminating such side effects as coughing, hoarseness, voice alteration, and paresthesias (Murphy et al., 1998; Ben-Menachem, 2001), while preserving overall battery life of the system. The seizure prediction and detection algorithm uses Phase/Amplitude Lock Values (PLV/ALV) which calculate the difference of phase and amplitude between electroencephalogram (EEG) electrodes local and remote to the epileptic event. PLV is used as the seizure prediction marker and signifies the emergence of abnormal neuronal activations through local neuron populations. PLV/ALVs are used as seizure detection markers to demarcate the seizure event, or when the local seizure event has propagated throughout the brain turning into a grand-mal event. We verify the performance of this methodology against the “CHB-MIT Scalp EEG Database” which features seizure attributes for testing. Through this testing, we can demonstrate a high degree of sensivity and precision of our methodology between pre-ictal and ictal events.

Amplitude suppression and chaos control in epileptic EEG signals

In this paper we have proposed a novel amplitude suppression algorithm for EEG signals collected during epileptic seizure. Then we have proposed a measure of chaoticity for a chaotic signal, which is somewhat similar to measuring sensitive dependence on initial conditions by measuring Lyapunov exponent in a chaotic dynamical system. We have shown that with respect to this measure the amplitude suppression algorithm reduces chaoticity in a chaotic signal (EEG signal is chaotic). We have compared our measure with the estimated largest Lyapunov exponent measure by the largelyap function, which is similar to Wolf's algorithm. They fit closely for all but one of the cases. How the algorithm can help to improve patient specific dosage titration during vagus nerve stimulation therapy has been outlined.

Design and evolution of the data management systems in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial

This paper describes the design and evolution of the data management systems developed in support of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. These systems span platforms from stand-alone computers to distributed systems on local area networks to mainframes. Allowing all of these systems to share appropriate information electronically introduces integration, synchronization, testing, and support challenges. For each platform, applications were developed to handle data entry, editing, trial management, reporting, telecommunications, and data sharing. Approaches to issues such as level of data access, integration with other, existing applications, and handling the expansion of the protocol are discussed.

Genetic disease in offspring of long-term survivors of childhood and adolescent cancer

Numerous case series have addressed the concern that cancer therapy may damage germ cells, leading to clinical disease in offspring of survivors. None has documented an increased risk. However, the methodological problems of small series make it difficult to draw firm conclusions regarding the potential of cancer treatments to damage the health of future offspring. We conducted a large interview study of adult survivors of childhood cancer treated before 1976. Genetic disease occurred in 3.4% of 2,198 offspring of survivors, compared with 3.1% of 4,544 offspring of controls (P=.33; not significant); there were no statistically significant differences in the proportion of offspring with cytogenetic syndromes, single-gene defects, or simple malformations. A comparison of survivors treated with potentially mutagenic therapy with survivors not so treated showed no association with sporadic genetic disease (P=.49). The present study provides reassurance that cancer treatment using older protocols does not carry a large risk for genetic disease in offspring conceived many years after treatment. With 80% power to detect an increase as small as 40% in the rate of genetic disease in offspring, this study did not do so. However, we cannot rule out the possibility that new therapeutic agents or specific combinations of agents at high doses may damage germ cells.

Educational achievement of long-term survivors of childhood and adolescent cancer

In a retrospective cohort study, the level of education attained by 2,283 long-term survivors of childhood and adolescent cancer was investigated and compared with that of 3,270 sibling controls. Survivors of central nervous system tumors were significantly less likely than controls to complete eight grades of school or, if they completed high school, to enter college. No significant differences in educational achievement were found for survivors of non-central nervous system cancers. The educational deficit of survivors of brain tumors was especially striking for tumors of the ventricles or cerebral hemispheres, and the deficit was more severe for those treated with radiation therapy than by surgery alone. Early age at diagnosis of a central nervous system tumor was associated with a larger educational deficit than late age at diagnosis. These findings are reassuring for the majority of long-term survivors of childhood and adolescent cancers given therapies used prior to 1975.

Reproductive problems and birth defects in survivors of Wilms' tumor and their relatives

In a retrospective cohort study of 47 Wilms' tumor survivors and their 77 sibling controls, female survivors had a fourfold excess risk (risk ratio, 4.1; 95% confidence interval, 1.7-10.1) for any adverse livebirth outcome, including birth defects, compared with their sibling controls. Wives of male survivors had no apparent excess risk for problem pregnancies. The families had a number of severe reproductive problems and major birth defects, such as primary amenorrhea in two survivors, bicornuate uterus in two survivors and one control, and mental retardation in one male survivor and a male control. The son of a female survivor died after bilateral Wilms' tumors. Birth defects in the offspring of female survivors are compatible either with intrauterine constraint, possibly due to radiation-induced fibrosis or with the complex of malformations associated with Wilms' tumor. Female survivors of Wilms' tumor appear to be at increased risk for a variety of reproductive problems, from sterility to fetal loss, early delivery, and birth defects in offspring. Furthermore, relatives of survivors of Wilms' tumor may be at risk of having associated birth defects, with clinically significant consequences.

Effects of treatment on fertility in long-term survivors of childhood or adolescent cancer

In a retrospective cohort study of survivors of cancer and of controls, we estimated the risk of infertility after treatment for cancer during childhood or adolescence. We interviewed 2283 long-term survivors of childhood or adolescent cancer diagnosed in the period from 1945 through 1975, who were identified at five cancer centers in the United States. Requirements for admission to the study were diagnosis before the age of 20, survival for at least five years, and attainment of the age of 21. In addition, 3270 controls selected from among the survivors' siblings were interviewed. Cox regression analysis showed that cancer survivors who married and were presumed to be at risk of pregnancy were less likely than their sibling controls to have ever begun a pregnancy (relative fertility, 0.85; 95 percent confidence interval, 0.78 to 0.92). Radiation therapy directed below the diaphragm depressed fertility in both sexes by about 25 percent. Chemotherapy with alkylating agents, with or without radiation to sites below the diaphragm, was associated with a fertility deficit of about 60 percent in the men. Among the women, there was no apparent effect of alkylating-agent therapy administered alone (relative fertility, 1.02) and only a moderate fertility deficit when alkylating-agent therapy was combined with radiation below the diaphragm (relative fertility, 0.81). Relative fertility in the survivors varied considerably according to sex, site of cancer, and type of treatment; these factors should be taken into consideration in counseling survivors about the long-term consequences of disease.

Cancer in offspring of long-term survivors of childhood and adolescent cancer

A multicentre retrospective cohort study of long-term survivors of childhood and adolescent cancer identified 7 cases of cancer among 2308 offspring (0.30%) of 2283 case-survivors and 11 cases among 4719 offspring (0.23%) of 3604 controls. Overall, the observed numbers of cases were not significantly different from those expected in the general population. Among offspring of case-survivors observed for the first 5 years of life, the group with the most person-years of follow-up, 5 cancers were reported (3 confirmed), compared with 1.7 expected, a significant excess due mostly to boys whose mothers survived cancer. Some offspring with cancer had known single-gene traits; others resembled previously recognised patterns of family cancer. The remainder may represent chance occurrences or new cancer family syndromes, such as an association with malignant melanoma. The study had an overall 79% power to detect a 3-fold excess of cancer among offspring of case-survivors, but no excess was observed. The number person-years of follow-up in the second decade of life, when most cases of cancer developed, was small.

Cancer incidence and mortality trends among whites in the United States, 1947-84

Cancer incidence trends from the late 1940s to 1983-84 were assessed among white residents of five geographic areas (Atlanta, Connecticut, Detroit, Iowa, San Francisco-Oakland) by means of data derived from several National Cancer Institute surveys, the Connecticut Tumor Registry, and the Surveillance, Epidemiology, and End Results Program. Incidence trends were compared with mortality trends for the entire United States and for the same five study areas. This study documented rising incidence and mortality rates for four cancers: lung cancer, melanoma of the skin, multiple myeloma, and non-Hodgkin's lymphomas. Increases in lung cancer continued through the early 1980s, but the rate of increase has been moderating during recent years, particularly among males and at younger ages for whom recent declines are evident. Overall, lung cancer incidence rates increased more than 220 and 400% among males and females, respectively. Although much rarer than lung cancer, melanoma of the skin and multiple myeloma increased greatly until the early 1980s among both males and females. The overall rate of increase in melanoma incidence among males was greater than that for lung cancer, and the rate of increase in multiple myeloma mortality among females was exceeded only by that for lung cancer. Increases of 70-120% were observed for non-Hodgkin's lymphomas. Increases in incidence and mortality rates for pancreatic cancer were apparent during the early years but less conspicuous in recent years. Laryngeal and kidney cancer rates generally increased substantially, although the changes were not remarkable for laryngeal cancer mortality among males and kidney cancer mortality among females. The rates for cancers of the mouth and pharynx increased among females but not males. Prostate, colon, and bladder cancer incidence rates increased more than 65% among males, whereas mortality rates changed only moderately. The incidence of thyroid cancer increased more than 75% among both sexes until the late 1970s, but mortality rates have declined during the period of study. Breast cancer incidence increased 30%, whereas mortality rates remained remarkably constant. The incidence of corpus uteri cancer increased dramatically during the mid-1970s and decreased substantially thereafter; these changes were not reflected in the mortality rates, which continually declined during the entire time period. The incidence of testicular cancer increased more than 90% and that of Hodgkin's disease did not change greatly; however, mortality rates for both cancers declined more than 50% since the late 1960s and early 1970s.(ABSTRACT TRUNCATED AT 400 WORDS)

Demographic patterns for mesothelioma in the United States

Incidence rates for pleural and peritoneal mesotheliomas in about 10% of the U.S. population were examined by various demographic characteristics based on 1973-84 data from the Surveillance, Epidemiology, and End Results Program. Although pleural mesothelioma was more common than peritoneal mesothelioma, both are rare diseases in this country. Pleural mesothelioma incidence rates among white males increased over time and were highest in seaboard areas where shipyards have been located (Seattle, San Francisco-Oakland, Hawaii). The significant secular change was attributed to both period (date of diagnosis) and cohort (date of birth) effects. Pleural mesothelioma incidence rates among white males were nearly 50% higher in the 1980-84 period compared to those in 1975-79; the cohort effect rose to a peak for the 1905-9 birth cohort and then declined. These effects probably reflect changes in asbestos exposure patterns in the past and more recent changes in clinical awareness and coding rules for mesothelioma. Geographic analysis of U.S. death certificates for pleural cancer among white males and females dying during 1968-78 indicated that mortality rates were significantly elevated in several areas that have had asbestos-manufacturing plants or shipyards. Analyses of mortality rates must be viewed with caution, since mesothelioma is considerably underreported on death certificates.

Hodgkin's disease in the United States: a comparison of patient characteristics and survival in the Centralized Cancer Patient Data System and the Surveillance, Epidemiology, and End Results Program

Demographic, pathologic, and clinical characteristics as well as subsequent survival were compared between 3,607 Hodgkin's disease (HD) patients registered by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute and 2,278 HD patients registered by comprehensive cancer centers (CCCs) belonging to the Centralized Cancer Patient Data System (CCPDS). All patients were diagnosed with HD between July 1977 and December 1982. CCPDS cases were slightly younger, more often of the nodular sclerosing histologic type, and presented with Stage II disease at diagnosis more often than did SEER cases. CCPDS and SEER cases were similar regarding the lymph node region of origin, sex, and race. The mortality rate among SEER patients was approximately 1.5 times that among CCPDS patients. This significant survival difference was observed within all stages and within all histologic subtypes and remained after controlling for the effects of age. Late-stage, older age, non-Caucasian race, and a more diffuse histologic appearance were all independent and significant predictors of poor survival. These findings suggest that the management of HD in CCCs results in improved outcome relative to that in the general population. Possible explanations for such effects are explored, and additional lines of pursuit are suggested.

Black/white differences in bladder cancer patient survival

Black bladder cancer patients have been found to have a substantially poorer survival experience than white patients; the 5-year relative survival rates are 71% for whites and 54% for blacks. To explore this difference in survival, data were analyzed on 4289 white and 380 black bladder cancer patients diagnosed during the period 1977-80 in three geographic areas covered by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The orientation of the analysis was to identify variables, using multivariable procedures, that were not only prognostic but which also were important in regard to explaining black/white differences in patient survival. Such variables are referred to as explanatory variables. Three variables were analyzed in regard to their importance as explanatory variables, i.e. histologic type, stage, and histologic grade, and all were found to be of roughly equal importance. The effects of other factors on black/white differences in survival are also discussed including the possible importance of lead-time bias and the possible lack of diagnosis of the more benign forms of bladder cancer in blacks.

The prevalence of cancer. Estimates based on the Connecticut Tumor Registry

Cancer incidence and mortality do not fully reflect the effect of cancer. To estimate the number of persons alive who have a history of cancer, we derived prevalence rates based on data from the Connecticut Tumor Registry. We did not attempt to distinguish between people who had been cured of cancer and those who still had the disease. In 1982 the age-adjusted prevalence rates of cancer among males and females were 1,789 and 2,222, respectively, per 100,000. Age-specific prevalence rates were highest among the elderly; 12 percent of men and 11 percent of women over 70 had previously been given a diagnosis of cancer. Breast cancer in females and prostate cancer in males were the two most prevalent malignant diseases. We estimate that about 5 million persons alive in the United States today have at one time received a diagnosis of cancer.

Factors associated with survival differences between black women and white women with cancer of the uterine corpus

Prognostic factors leading to the survival advantage of white women over black women with uterine corpus cancer were evaluated by using a series of patients diagnosed from 1973-1977 in three geographic areas of the United States participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Higher survival rates were observed among women under age 55 years, with stage I disease, and living in higher socioeconomic census tracts. Significant survival differences by race for patients with adenocarcinomas were found at almost all factor levels. Within each racial group, patients with adenocarcinomas had better prognosis than did those with sarcomas. A multivariate analysis found stage of disease and age at diagnosis to be the major predictors of survival among women with adenocarcinomas of the uterine corpus, followed by race, median family income, and mean highest education received. Adjustment of the black survival rates for these factors reduced the gap among patients with adenocarcinomas, but significant differences in survival between blacks and whites remained. Race was not a predictive factor for survival of patients with sarcomas, but age at diagnosis, stage of disease, and education were. After adjustment for the significant factors, prognosis was equally poor for black patients and white patients with sarcomas of the uterine corpus. These findings suggest that, even when controlling for known markers of racial differences, there remain other underlying prognostic factors associated with survival of black women and white women with adenocarcinomas of the uterine corpus that have yet to be determined.

Survival of children with brain tumors: SEER Program, 1973-1980

Eight hundred eighty-seven children with brain tumors were identified by the SEER registries (1973-1980). Twenty-five percent were low-grade supratentorial astrocytomas, medulloblastomas were 23%, cerebellar astrocytomas 12%, high-grade supratentorial astrocytomas 11%, brainstem gliomas 9%, and ependymomas 8%. The worst survivals were in children less than 2 years of age, and the best were in those aged 10 to 14 years. Five-year survivals of children with cerebellar astrocytomas were 91%, low-grade supratentorial astrocytomas 71%, high-grade supratentorial astrocytomas 35%, medulloblastomas 39%, ependymomas 28%, and brainstem gliomas 18%.

The availability of insurance to long-time survivors of childhood cancer

The authors identified 100 adults who survived cancer who were diagnosed and treated in childhood between 1945 and 1975. Using standardized interviews, each survivor and matched same-sex sibling was asked about life and health including questions about insurance. Compared with their same-sex siblings, childhood cancer survivors had significantly more difficulty in securing life insurance (P less than 0.001), in having life insurance in force (P less than 0.004), and in obtaining health insurance because of health reasons (P less than 0.001). Survivors were significantly less likely than siblings to be covered by health insurance (P less than 0.04). Cure of childhood cancer has become more common, allowing thousands of survivors to enter adult life. This study suggests that childhood cancer survivors have an unmet need in respect to life and health insurance.

Cancer incidence and survival in patients 65 years of age and older

The impact of cancer on persons 65 years of age and older has been assessed by examining incidence rates and survival rates. For all cancers combined, the incidence rate shown in Table 4 for males 65 and older (2,468.2 per 100,000) is four times the age-adjusted rate for males 45 to 64 years of age (586.7). For elderly females, the incidence rate is twice that for females aged 45 to 64 (1,401.1 versus 609.7). Ratios of incidence rates for older versus younger males are about four to five for cancers of the stomach, colon, rectum, pancreas, and urinary bladder, and for leukemia; about three for cancers of the lung and kidney, and for non-Hodgkin's lymphomas; and 10 for cancer of the prostate. For females, the corresponding ratios are similar to those for males, although a little lower for cancers of the colon, rectum, and urinary bladder, and for leukemia, and a little higher for cancers of the stomach and pancreas. The ratios for breast, uterine cervix, uterine corpus, ovary, and lung are less than two. The relative survival rates for patients 65 and older are for many cancer sites only a few percentage points lower than rates for those 45 to 64 years of age (Table 5), suggesting that patients in this age group fare only a little worse than younger patients in escaping the effects of cancer once it has been diagnosed. Exceptions are cancer of the urinary bladder and non-Hodgkin's lymphomas for both men and women and cancers of the uterine cervix, uterine corpus, ovary, and kidney for women. For these sites, the survival rates for older patients are considerably lower than for their younger counterparts. For female breast cancer patients, there was no difference in the five-year relative survival rate for those 65 and older compared with those 45 to 64.

Recurrence-free survival time for surgically treated soft tissue sarcoma patients. Multivariate analysis of five prognostic factors

A staging system, based upon the experience of 1215 patients, was published by the American Joint Committee Task Force on Soft Tissue Sarcoma in 1977. A subset of these patients, 594, was selected to study recurrence-free survival time. The authors found 331 patients with a recurrence within 5 years (100 local only, 123 metastatic only, and 108 local + metastatic); median months to recurrence was 9.7. Within 5 years, recurrence was clearly associated with mortality: among the 331 patients who experienced a recurrence, 245 died, whereas only 31 died among the 263 who had no recurrence. To further evaluate the utility of the published staging system, a multivariate analysis of five factors was carried out for 297 of the 594 patients (patients with unknown information for any one of these factors were excluded). Factors in addition to grade that exerted a significant influence on recurrence were: direct extension, symptoms, and location of tumor when survival was measured to the first of any recurrence, and tumor size, measuring survival to the first metastatic recurrence. It is therefore recommended that these factors be taken into account in staging this disease. Estimates of probable recurrence-free survival time based upon the multivariate model (Weibull) are also presented.

Psychosocial consequences of childhood and adolescent cancer survival

A Connecticut Addendum to a multi-center National Cancer Institute study was developed to investigate psychosocial effects of long-term childhood and adolescent cancer survival. Cases (450), drawn from the files of the Connecticut Tumor Registry and 587 of their siblings were located and interviewed. Overall response rate was 84%. The frequency of lifetime major depression in survivors (males, 15%; females, 22%) did not appear to differ from that of their siblings (males, 12%; females, 24%) and was similar to those reported in the literature for the general population. The usual correlates of depression (sex, marital status, perception of health) were observed, independent of a history of a childhood malignancy. There were no differences in the reported frequencies of suicide attempts, running away or psychiatric hospitalizations for either sex. Eighty percent of the male survivors were rejected from the armed forces, 13% from college and 32% from employment. These values were significantly higher than those of the male siblings. Female survivors were significantly more likely than their sisters to be denied entrance into the military (p less than 0.05), but no differences were observed between females with respect to college or employment. Both sexes had more difficulty obtaining health and life insurance than their siblings (p less than 0.0001). Although survivors of childhood and adolescent cancer do not seem to be at excess risk for major depression, they do appear to have difficulty attaining certain major socioeconomic goals.

Risk of leukemia associated with the first course of cancer treatment: an analysis of the Surveillance, Epidemiology, and End Results Program experience

The risk of leukemia associated with the first course of cancer treatment was evaluated in over 440,000 patients diagnosed during 1973-80 (average follow-up = 1.91 yr) from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Although the reporting of the first course of therapy probably was incomplete, 34 acute nonlymphocytic leukemias (ANLL) developed compared with 7.6 expected among 70,674 patients known to receive initial chemotherapy [relative risk (RR) = 4.5, 95% confidence interval (Cl) = 3.1-6.3]. Significant ANLL excesses were observed following chemotherapy for breast cancer (RR = 8.1), ovarian cancer (RR = 22.2), and multiple myeloma (RR = 9.5). Patients initially treated with radiation (with no record of chemotherapy) also had a significantly increased ANLL risk; 45 leukemias occurred versus 17.9 expected (RR = 2.5, 95% Cl = 1.8-3.4). In this group, excess ANLL were found following irradiation for uterine corpus cancer (RR = 4.0). Kidney and renal pelvis cancer patients had a twofold leukemia risk (all types) that was unrelated to treatment (RR = 2.2).

Characteristics of colon cancer patients reported in population-based tumor registries and Comprehensive Cancer Centers

The characteristics of colon cancer tumors diagnosed in patients seen at hospitals participating in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program and at Comprehensive Cancer Centers (CCC's) belonging to the Centralized Cancer Patient Data System (CCPDS) are compared. There were identified among cases diagnosed between July 1, 1977 and December 31, 1978, the first 18 months of registration for the CCPDS centers. A higher proportion of CCPDS colon tumors were diagnosed in black patients, 15.4% versus 6.8% for SEER, reflecting the urban location of many CCC's. The CCPDS has proportionally fewer patients aged 75 years or older, and a median age of 67.5 years versus 70 years for the SEER cases. Although surgery alone was the major form of therapy for both CCPDS and SEER patients with colon tumors, higher percentages of CCPDS patients than SEER patients were treated by chemotherapy alone or by modalities other than surgery, chemotherapy, and radiotherapy, particularly those with later stages of the disease. Few disagreements existed between the 2 groups in distribution by segment of the colon, stage, and histologic type. Few differences were found that would render invalid future comparative analyses of patient survival between the two data systems once adequate follow-up information is available. Such an evaluation may be a valuable instrument in measuring whether improvements in cancer patient management being developed at CCC's are, in fact, "filtering down" to the general series of colon cancer patients.

Use of hair dyes and risk of bladder cancer

The relation between use of hair dyes and risk of bladder cancer was assessed using data from a case-control study of bladder cancer. Incident cases (2982) and general population controls (5782) were interviewed. The overall estimate of relative risk of bladder cancer for users of hair dyes was 1.0 (95%) confidence interval, 0.9 to 1.2) compared to nonusers. No consistent pattern of association was detected between bladder cancer risk and various indices of timing or intensity of exposure to hair dyes. Various explanations of the lack of association are discussed.

Progress in the treatment of childhood acute leukemia: a review

The dramatic improvements in the survival experience for children diagnosed with acute leukemia are analyzed using data collected through hospitals participating in the National Cancer Institute's End Results Group Program between 1950 and 1973. Children under 15 years of age who were diagnosed with both acute lymphocytic leukemia (ALL) and acute nonlymphocytic leukemia (ANLL) showed moderate improvements in the 1950s, but beginning in the 1960s those with ALL did far better. Statistically significant differences at the 0.05 level were noted between their three-year survival rates for all cohorts analyzed between 1960 and 1973. For the 1970-1973 cohort, three-year survival rates were 49% and 20% for ALL and ANLL, respectively, and five-year survival rates were 34% and 12%. Between 1950 and 1976 the age-adjusted incidence rate for all childhood leukemias remained relatively stable in a sample of five geographic areas, changing from 4.6 per 100,000 children under 15 years of age to 4.3 per 100,000. In contrast, the corresponding age-adjusted mortality rate fell approximately 45% over the same period, from 4.4 per 100,000 to 2.4 per 100,000.

The course of five-year survivors of cancer in childhood

A follow-up study was made of two independent series of 1,807 and 425 children who were alive five years after diagnosis of a malignant neoplasm. Over the subsequent 20 years (5 to 24 years after initial diagnosis), actuarial survival rates for the cohorts were 83% and 79%, respectively, compared to 97% for matched control subjects in the general population (P less than 0.01). Cure was achieved in a large majority of the 5-year relapse-free survivors of cancer in this study.

Implications from SEER data on breast cancer management

From the SEER files of the NCI, 8,587 cases of breast cancer diagnosed in 1975 were analyzed. Of these cases, 5.3% were noninvasive. Of the invasive cancers under 0.5 cm in diameter, 17.2% had positive axillary lymph nodes. Where the physician recorded no palpable axillary lymph nodes, 34.5% were found to be positive.

Statistical methods for studying multiple primary malignant neoplasms

Case reports and case series dealing with multiple primary malignant neoplasms provided useful criteria for defining and documenting this phenomenon. The formation of tumor registries greatly aided in identifying a sufficient number of multiple primary cancer patients and facilitated case-control comparisons. Reports of two or more neoplasms occurring together in the same individual do not constitute proof of a significant association; the tumors must be shown to occur together more frequently than expected by chance. The person-years approach applied to data derived from a well-defined population makes it possible to compare the observed and expected number of subsequent primary cancers. The results of the most sophisticated procedures are no better than the quality of the data, however, and one must critically examine possible sources of bias before accepting statistical significance as representing biologic significance.

A population-based study of referral, diagnostic and treatment patterns for childhood acute lymphocytic leukemia

In order to make decisions about cancer control programs, information is needed on the current management of cancer as actually practiced in the United States. A study to address this issue for acute lymphocytic leukemia in children (age 15 years and under) has been performed. The 101 patients represent all reported incident cases during 1972 in five regions which have population-based registries. Data on patient characteristics, referral patterns, treatment regimens, remission/relapse status, and survival are presented. It is concluded that the treatment strategies developed in leukemia research are reaching the general patient population. The present study can be considered a model for future studies of other forms of malignancy.

A comparison of Hodgkin's disease in Alameda County, California, and Connecticut: histologic subtype and age distribution

A comparison of the histologic patterns of Hodgkin's disease in Alameda County, California and Connecticut was made in relation to age. All Hodgkin's disease cases from the Alameda County Cancer Registry diagnosed between 1960 and 1969 for which adequate material was available for evaluation were reviewed and histologically subtyped according to the Rye classification (159 cases). The age-specific relative frequencies and incidence rates for the histologic subtypes of Hodgkin's disease in Alameda County were estimated and compared to those estimated for Hodgkin's disease in Connecticut. The morphologic ex pression of Hodgkin's disease in both areas was similar and characteristic of economically developed regions with high living standards. The comparison supports the hypothesis that the host immune capacity, influenced by socioeconomic factors, has a strong and measurable effect on the pathogenesis of Hodgkin's disease.

Estimated median survival times of patients with colorectal cancer based on experience with 9,745 patients

From the End Results Group file at the National Cancer Institute, 9,745 colorectal cancer patients diagnosed from 1965 through 1971 and classified as adenocarcinoma NOS were selected to evaluate the joint effect of various prognostic factors on MST. A technic was developed which enables a physician to estimate the MST for a patient with a given set of patient/disease characteristics. The results are also summarized in an appendix, allowing the physician to bypass the calculation and refer directly to the MST. These results will aid the physician in determining whether a patient is at sufficiently high risk to warrant adjuvant therapy. The survival experience of this broad historical group of patients with varying prognostic factors can also serve as a basis for comparison of results of studies on highly selected patients treated in various experimental ways.

Tables and formulas for extended use of the Ederer-Myers-Mantel disease-clustering procedure

The principles of the Ederer-Myers-Mantel procedure for seeking evidence of disease clustering are reviewed. The procedure is based on cumulative empirical clusters, i.e., the largest frequency in a single time period or in two successive time periods, and comparing that cumulation with the expected cumulation of largest frequencies under random occurrence. Original tabulations covered totals of up to 15 cases distributed among three, four or five time periods. Present tabulations of expectations and variances cover up to 500 cases distributed among two or three time periods and 200 cases distributed among four or five time periods. Asymptotic formulas are provided for the expectation and variance of the largest frequency in a single period when arbitrarily many cases are distributed at random among two, three, four or five time periods.

Should curative surgery be attempted in patients with cancer of the main stem bronchus?

Among tumors of the lung, main stem bronchial cancer offers a particularly unfavorable prognosis, probably because of its rapid extension to the segmental bronchi, trachea, and extrapulmonary structures. However, analysis of data gathered by the End Results Group indicates that survival among those patients with main stem bronchial cancer whose tumor was resected was virtually the same as that of patients with resectable lung cancer of other sites. From these data it is impossible to assess what role, if any, the resection itself played, and a randomized trial would be necessary to determine whether resection improves the probability of patient survival. On the other hand, it is not now advisable to deny resection to patients with operable main stem bronchial tumors (except oat cell tumors) on the basis of the available nonexperimental evidence alone.

Cancer of the uterine corpus after hormonal treatment for breast cancer

Among 45853 women in whom breast cancer was diagnosed after age forty-nine, from the series of the End Results Program of the National Cancer Institute, cancer of the uterine corpus subsequently developed in 203. The risk was greater among those women receiving hormones than in other treatment groups, and tended to rise with increasing interval from first treatment. One method of estimating an expected value indicated that the excess risk of corpus cancer in breast-cancer patients was restricted to those treated with hormones. Given the time period under study, it may be assumed that the hormones were primarily non-steroidal oestrogens.

Who are we missing and why?

The concept of "missing" is defined as failure to diagnose cancer before it has spread beyond the organ of origin. Data are presented for the 11 sites at which cancer occurs most frequently in the United States. There is a clear association between the survival of patients with cancer of a particular site and the percentage of cancers of that site diagnosed in a localized stage. However, the reasons for variation in the proportion of cases discovered while localized, which varies from 79% for uterine corpus to 12% for pancreas, appear to be varied and complex. Available data suggest that the nature of the tumor-host relationship and metastatic potential of the neoplasm are probably more important than alertness on the part of the patient and the physician, and probably have a more profound influence on stage of disease at diagnosis than currently available screening techniques.