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Wang H, Hou J, Zhang G, Zhang M, Li P, Yan X, Ma Z. Clinical characteristics and prognostic analysis of multiple primary malignant neoplasms in patients with lung cancer. Cancer Gene Ther 2019; 26:419-426. [PMID: 30700800 DOI: 10.1038/s41417-019-0084-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/02/2019] [Accepted: 01/12/2019] [Indexed: 02/06/2023]
Abstract
Retrospective analysis of data from 14,528 lung cancer patients with multiple primary malignant neoplasm (MPMN) revealed that 2.5% (364/14,528) were MPMN cases and 96.2% (350/364) were diagnosed with two primary malignancies, 3.6% (13/364) with three primary malignancies, and 0.3% (1/364) with four primary malignancies. Among 350 lung cancer patients diagnosed with two primary malignancies, 26.6% (93/350) had lung cancer diagnosed first (LCF) and 73.4% (257/350) had other cancers diagnosed initially (OCF), whereas synchronous MPMN (SMPMN) accounted for 21.1% (74/350) and metachronous MPMN (MMPMN) accounted for 78.9% (276/350) of the cases. Detection of first primary neoplasms were at an early stage for LCF patients and the age of the first lung cancer diagnosis was 59.3 years vs. 55.4 years in the OCF group (P = 0.008), whereas the onset age of second primary neoplasm diagnosis was similar in both groups (62.5 and 61.6 years, P = 0.544). Median survival times of MMPMN and SMPMN patients in the LCF group were 6.83 and 2.42 years and in the OCF group 8.67 years and 2.25 years, respectively. Multivariate analysis showed that SMPMN, LCF and the age of the primary cancer diagnosed first ( ≥ 60 years) and NSCL staging > II were significant independent factors for inferior prognosis of patients.
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Affiliation(s)
- Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Jingjing Hou
- Department of Oncology, The Second People's Hospital of Jiaozuo, 454000, Jiaozuo, China
| | - Guowei Zhang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Mina Zhang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Peng Li
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Xiangtao Yan
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China
| | - Zhiyong Ma
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, 450008, Zhengzhou, China.
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Quintela I, Vizoso F, Serra C, González LO, Fernandez R, Merino AM, Baltasar A. Immunohistochemical Study of Pepsinogen C Expression in Cutaneous Malignant Melanoma: Association with Clinicopathological Parameters. Int J Biol Markers 2018; 16:240-4. [PMID: 11820718 DOI: 10.1177/172460080101600403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The aim of this study was to evaluate the pepsinogen C expression in malignant cutaneous melanomas and analyze its possible relationship to clinical and pathological parameters. Pepsinogen C is an aspartyl proteinase primarily involved in the digestion of proteins in the stomach and represents one of the main androgen-inducible proteins in breast cancer cells. Method Tumoral pepsinogen C expression was retrospectively analyzed in 35 paraffin-embedded tissues from patients with primary malignant cutaneous melanoma and in 10 samples from 10 benign lesions (4 dermal melanocytic nevi, 4 compound melanocytic nevi and 2 dysplastic melanocytic nevi), using immunohistochemical methods. Results The benign lesions were consistently negative for pepsinogen C, whereas 20 of the 35 malignant melanomas (57%) showed positive immunostaining for pepsinogen C. The percentage of pepsinogen C-positive tumors was significantly higher in men than in women (p=0.01) and in epithelioid melanomas than in fusocellular or mixed type melanomas (p=0.003). In addition, the percentage of pepsinogen-C positive tumors was positively and significantly correlated with lesion thickness (p=0.003), Clark's level of invasion (p=0.028) and tumor stage (p<0.001). Conclusion Pepsinogen C could be a new prognosticator of unfavorable outcome in cutaneous malignant melanoma.
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Affiliation(s)
- I Quintela
- Department of General Surgery, Hospital de Jove, Gijón, Asturias
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Baldwin LA, Chen Q, Tucker TC, White CG, Ore RN, Huang B. Ovarian Cancer Incidence Corrected for Oophorectomy. Diagnostics (Basel) 2017; 7:E19. [PMID: 28368298 PMCID: PMC5489939 DOI: 10.3390/diagnostics7020019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/01/2017] [Accepted: 03/18/2017] [Indexed: 01/01/2023] Open
Abstract
Current reported incidence rates for ovarian cancer may significantly underestimate the true rate because of the inclusion of women in the calculations who are not at risk for ovarian cancer due to prior benign salpingo-oophorectomy (SO). We have considered prior SO to more realistically estimate risk for ovarian cancer. Kentucky Health Claims Data, International Classification of Disease 9 (ICD-9) codes, Current Procedure Terminology (CPT) codes, and Kentucky Behavioral Risk Factor Surveillance System (BRFSS) Data were used to identify women who have undergone SO in Kentucky, and these women were removed from the at-risk pool in order to re-assess incidence rates to more accurately represent ovarian cancer risk. The protective effect of SO on the population was determined on an annual basis for ages 5-80+ using data from the years 2009-2013. The corrected age-adjusted rates of ovarian cancer that considered SO ranged from 33% to 67% higher than age-adjusted rates from the standard population. Correction of incidence rates for ovarian cancer by accounting for women with prior SO gives a better understanding of risk for this disease faced by women. The rates of ovarian cancer were substantially higher when SO was taken into consideration than estimates from the standard population.
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Affiliation(s)
- Lauren A Baldwin
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Quan Chen
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Thomas C Tucker
- Department of Epidemiology, College of Public Health & Kentucky Cancer Registry, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
| | - Connie G White
- Kentucky Department for Public Health, Frankfort, KY 40601, USA.
| | - Robert N Ore
- The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The University of Kentucky College of Medicine, 800 Rose Street, 330 Whitney-Hendrickson Building, Lexington, KY 40536, USA.
| | - Bin Huang
- Division of Cancer Biostatistics, College of Public Health & Biostatistics Shared Resource Facility, Markey Cancer Center, University of Kentucky, Lexington, KY 40506, USA.
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Lam JUH, Lynge E, Njor SH, Rebolj M. Hysterectomy and its impact on the calculated incidence of cervical cancer and screening coverage in Denmark. Acta Oncol 2015; 54:1136-43. [PMID: 25800858 DOI: 10.3109/0284186x.2015.1016625] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The incidence rates of cervical cancer and the coverage in cervical cancer screening are usually reported by including in the denominator all women from the general population. However, after hysterectomy women are not at risk anymore of developing cervical cancer. Therefore, it makes sense to determine the indicators also for the true at-risk populations. We described the frequency of total hysterectomy in Denmark and its impact on the calculated incidence of cervical cancer and the screening coverage. MATERIAL AND METHODS With data from five Danish population-based registries, the incidence rate of cervical cancer and the screening coverage for women aged 23-64 years on 31 December 2010 were calculated with and without adjustments for hysterectomies undertaken for reasons other than cervical cancer. They were calculated as the number of cases divided by 1) the total number of woman-years from the general population; and 2) the at-risk population after exclusion of post-hysterectomy woman-years. Cases were defined as women with cervical cancer (incidence), or as women screened in the recommended interval, with or without adjustment for hysterectomies (coverage). RESULTS AND CONCLUSIONS In 2010, the all-age prevalence of hysterectomy was estimated at 6%, and ≥ 16% at age ≥ 65. This translated into an overall 6% increase in the incidence rate of cervical cancer, from 12.8 (unadjusted) to 13.5 (adjusted) per 100,000 woman-years. The screening coverage increased from 76% (unadjusted) to 79% (adjusted). In Denmark, hysterectomies do not have a large overall impact on the calculated cancer incidence and screening coverage. Nevertheless, at ≥ 65 years adjusted rates would increase by almost 20% compared to unadjusted rates. This suggests that calculating disease risks per organ-years may have a role in understanding the true burden of the disease in a population at risk of developing that disease.
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Affiliation(s)
- Janni Uyen Hoa Lam
- a Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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Schubauer-Berigan MK, Anderson JL, Hein MJ, Little MP, Sigurdson AJ, Pinkerton LE. Breast cancer incidence in a cohort of U.S. flight attendants. Am J Ind Med 2015; 58:252-66. [PMID: 25678455 PMCID: PMC4566958 DOI: 10.1002/ajim.22419] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Flight attendants may have elevated breast cancer incidence (BCI). We evaluated BCI's association with cosmic radiation dose and circadian rhythm disruption among 6,093 female former U.S. flight attendants. METHODS We collected questionnaire data on BCI and risk factors for breast cancer from 2002-2005. We conducted analyses to evaluate (i) BCI in the cohort compared to the U.S. population; and (ii) exposure-response relations. We applied an indirect adjustment to estimate whether parity and age at first birth (AFB) differences between the cohort and U.S. population could explain BCI that differed from expectation. RESULTS BCI was elevated but may be explained by lower parity and older AFB in the cohort than among U.S. women. BCI was not associated with exposure metrics in the cohort overall. Significant positive associations with both were observed only among women with parity of three or more. CONCLUSIONS Future cohort analyses may be informative on the role of these occupational exposures and non-occupational risk factors.
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Affiliation(s)
- Mary K. Schubauer-Berigan
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Jeri L. Anderson
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Misty J. Hein
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
| | - Mark P. Little
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland
| | - Alice J. Sigurdson
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Radiation Epidemiology Branch, Bethesda, Maryland
| | - Lynne E. Pinkerton
- National Institute for Occupational Safety and Health, Division of Surveillance, Hazard Evaluations and Field Studies, Industrywide Studies Branch, Cincinnati, Ohio
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Siegel RL, Devesa SS, Cokkinides V, Ma J, Jemal A. State-level uterine corpus cancer incidence rates corrected for hysterectomy prevalence, 2004 to 2008. Cancer Epidemiol Biomarkers Prev 2013; 22:25-31. [PMID: 23125334 PMCID: PMC3538963 DOI: 10.1158/1055-9965.epi-12-0991] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The interpretation of uterine cancer rates is hindered by the inclusion of women whose uterus has been surgically removed in the population at risk. Hysterectomy prevalence varies widely by state and race/ethnicity, exacerbating this issue. METHODS We estimated hysterectomy-corrected, age-adjusted uterine corpus cancer incidence rates by race/ethnicity for 49 states and the District of Columbia during 2004 to 2008 using case counts obtained from population-based cancer registries; population data from the U.S. Census Bureau; and hysterectomy prevalence data from the Behavioral Risk Factor Surveillance System. Corrected and uncorrected incidence rates were compared with regard to geographic and racial/ethnic disparity patterns and the association with obesity. RESULTS Among non-Hispanic Whites, uterine cancer incidence rates (per 100,000 woman-years) uncorrected for hysterectomy prevalence ranged from 17.1 in Louisiana to 32.1 in New Jersey, mirrored regional hysterectomy patterns, and were not correlated with obesity prevalence (Pearson correlation coefficient, r = 0.06, two-sided P = 0.68). In comparison, hysterectomy-corrected rates were higher by a minimum of 30% (District of Columbia) to more than 100% (Mississippi, Louisiana, Alabama, and Oklahoma), displayed no discernible geographic pattern, and were moderately associated with obesity (r = 0.37, two-sided P = 0.009). For most states, hysterectomy correction diminished or reversed the Black/White deficit and accentuated the Hispanic/White deficit. CONCLUSION Failure to adjust uterine cancer incidence rates for hysterectomy prevalence distorts true geographic and racial patterns and substantially underestimates the disease burden, particularly for Southern states. IMPACT Correction for hysterectomy is necessary for the accurate evaluation of uterine cancer rates.
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Affiliation(s)
- Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, 250 Williams Street, NW, 6D 123, Atlanta, GA 30303, USA.
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Jamison PM, Noone AM, Ries LA, Lee NC, Edwards BK. Trends in Endometrial Cancer Incidence by Race and Histology with a Correction for the Prevalence of Hysterectomy, SEER 1992 to 2008. Cancer Epidemiol Biomarkers Prev 2012; 22:233-41. [DOI: 10.1158/1055-9965.epi-12-0996] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Eiró N, Ovies C, Fernandez-Garcia B, Álvarez-Cuesta CC, González L, González LO, Vizoso FJ. Expression of TLR3, 4, 7 and 9 in cutaneous malignant melanoma: relationship with clinicopathological characteristics and prognosis. Arch Dermatol Res 2012. [PMID: 23179584 DOI: 10.1007/s00403-012-1300-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Toll-like receptors (TLRs) have achieved an extraordinary amount of interest in cancer research due to their role in tumor progression. The aim of this study was to investigate the expression and clinical relevance of TLR3, 4, 7 and 9 in cutaneous malignant melanoma (CMM). The expression levels of TLR3, 4, 7 and 9 were analyzed in tumors from 30 patients with CMM. The analysis was performed by immunohistochemistry, and the results were correlated with various clinicopathological findings and with relapse-free survival. Our results indicate that there was a wide variability in the immunostaining score values for each receptor. Positive staining for TLRs was generally found in tumor cells, especially for TLR4 and TLR9. Nevertheless, a significant percentage of tumors also showed TLR4 expression in mononuclear inflammatory cells (62.1 %) and in fibroblast-like cells (34.5 %). Our results showed no significant association between score values for each TLR and clinicopathological characteristics of patients. However, our results demonstrated that high TLR4 expression was significantly associated with a shortened relapse-free survival (p = 0.001). Therefore, TLR4 expression may be a new prognostic factor of unfavorable evolution in cutaneous malignant melanoma.
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Affiliation(s)
- N Eiró
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain
| | - C Ovies
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain
| | - B Fernandez-Garcia
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain
| | | | - L González
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain
| | - L O González
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain.,Servicio de Anatomía Patológica, Fundación Hospital de Jove, Gijón, Spain
| | - F J Vizoso
- Unidad de Investigación, Fundación Hospital de Jove, Avda. Eduardo Castro s/n, Gijón, 33920, Asturias, Spain. .,Servicio de Cirugía General, Fundación Hospital de Jove, Gijón, Spain.
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Merrill RM, Sloan A, Novilla LB. Understanding population-based site-specific cancer incidence rates in the USA. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:263-268. [PMID: 21874603 DOI: 10.1007/s13187-011-0266-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
As compared with conventionally reported national population-based incidence rates, incidence rates better represent the "burden" of disease if they remove prevalent cases from the denominator. In order to reflect the "risk" in a disease-free population, rates should both exclude prevalent cases from the denominator and second or later diagnosed cases at the same site from the numerator. Five common cancers were evaluated through a correction method using 2005-2007 Surveillance, Epidemiology, and End Results Program data to determine the extent of difference between conventional and corrected incidence rates. These corrections lowered the incidence rates 4.0-5.8% for female breast cancer, 4.6-7.6% for melanoma, 3.0-4.0% for colorectal cancer, and 2.1-2.5% for lung and bronchus cancer. Corrected incidence rates for prostate cancer were 9.9-13.7% higher. In cancers with either high prevalence and/or high occurrence of multiple primaries at the same site, corrected population-based incidence rates are warranted.
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Affiliation(s)
- Ray M Merrill
- Department of Health Science, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA.
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Merrill RM, Sloan A. Risk-adjusted incidence rates for prostate cancer in the United States. Prostate 2012; 72:181-5. [PMID: 21538427 DOI: 10.1002/pros.21419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Accepted: 04/12/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Risk-adjusted incidence rates (RAIRs) are population-based cancer incidence rates that reflect those who have never had the cancer but are at risk of developing it. This study compares RAIRS with conventionally reported incidence rates for prostate cancer. METHODS A retrospective cohort design was used, based on data from the Surveillance, Epidemiology, and End Results (SEER) registries, with focus on white and black malignant prostate cancer cases in the years 2000-2007. RAIRs use only the first primary cancer and adjust for cancer prevalence in order to obtain a better population-based measure of cancer risk. RESULTS Conventionally reported prostate cancer incidence rates underestimate risk for white males by from 0.1% in the age group 40-49 to 20.1% in the age group 80 years and older. In black males, conventional rates underestimate risk by 0.2% in the age group 30-39 to 26.4% in the age group 80 years and older. Trends in RAIRs from 2000 to 2007 increased in the age group 30-49 (17.0% for whites and 14.8% for blacks), decreased in the age group 50-69 (-4.5% for whites and -5.9% for blacks), and decreased in the age group 70 and older (-15.8% for whites and -26.5% for blacks). Trends in RAIRs were similar or less pronounced than trends in conventional rates. The estimated number of cases in the United States in 2007 based on RAIRS was 9.0% greater for whites and 11.3% greater for blacks than when based on conventional rates. CONCLUSION Prostate cancer incidence rates that include second and later prostate cancer primaries and adjust for prevalence better reflect cancer burden, whereas, prostate cancer incidence rates that only include the first diagnosed case and adjust for prevalence better reflect cancer risk.
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Affiliation(s)
- Ray M Merrill
- Department of Health Science at Brigham Young University, Provo, Utah, USA.
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Impact of hysterectomy and bilateral oophorectomy prevalence on rates of cervical, uterine, and ovarian cancer among American Indian and Alaska Native women, 1999–2004. Cancer Causes Control 2011; 22:1681-9. [DOI: 10.1007/s10552-011-9844-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 09/12/2011] [Indexed: 01/03/2023]
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Abstract
BACKGROUND Population-based cancer incidence rates that adjust for multiple cancer primaries and for prevalent cases of the disease provide a better approximation of risk. DESIGN This study is based on a retrospective cohort. SETTING/PATIENTS Included in the study were 9 original Surveillance, Epidemiology and End Results registries focusing on white and black males and females from 2000 through 2007. MAIN OUTCOME MEASURE The main outcome measured was malignant colorectal cancer. RESULTS Conventional colorectal cancer incidence rates overestimate population risk by 3.6% for white males, 4.0% for black males, 3.4% for white females, and 3.3% for black females. The level of overestimation bias remained similar across the age span for white and black males. However, for white females, rates were overestimated by 2.1% for ages 30 to 39 and increased to 3.8% for ages 80 years and older. Corresponding values for black females were 1.5% and 3.8%. The trends in conventional rates were generally similar to the trends in risk-adjusted incidence rates, increasing or stable before age 50, but decreasing thereafter. The number of colorectal cancer cases in the United States is estimated from conventional incidence rates. In 2007, the number of colorectal cases was 59,599 for white males, 7,670 for black males, 58,972 for white females, and 8,786 for black females. The number of colorectal cancer cases based on prevalence-corrected incidence rates increased by 2.2% for white males, 1.5% for black males, 2.1% for white females, and 1.5% for black females. CONCLUSION Colorectal cancer incidence rates that include second and later colorectal cancer primaries and adjust for prevalence better reflect cancer burden, whereas colorectal cancer incidence rates that only include the first diagnosed case and adjust for prevalence better reflect cancer risk.
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Noah-Vanhoucke J, Green LE, Dinh TA, Alperin P, Smith RA. Cost-effectiveness of chemoprevention of breast cancer using tamoxifen in a postmenopausal US population. Cancer 2011; 117:3322-31. [DOI: 10.1002/cncr.25926] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 01/13/2023]
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MYH9 genetic variants associated with glomerular disease: what is the role for genetic testing? Semin Nephrol 2011; 30:409-17. [PMID: 20807613 DOI: 10.1016/j.semnephrol.2010.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Genetic variation in MYH9, encoding nonmuscle myosin IIA heavy chain, has been associated recently with increased risk for kidney disease. Previously, MYH9 missense mutations have been shown to cause the autosomal-dominant MYH9 (ADM9) spectrum, characterized by large platelets, leukocyte Döhle bodies, and, variably, sensorineural deafness, cataracts, and glomerulopathy. Genetic testing is indicated for familial and sporadic cases that fit this spectrum. By contrast, the MYH9 kidney risk variant is characterized by multiple intronic single nucleotide polymorphisms, but the causative variant has not been identified. Disease associations include human immunodeficiency virus-associated collapsing glomerulopathy, focal segmental glomerulosclerosis, hypertension-attributed end-stage kidney disease, and diabetes-attributed end-stage kidney disease. One plausible hypothesis is that the MYH9 kidney risk variant confers a fragile podocyte phenotype. In the case of hypertension-attributed kidney disease, it remains unclear if the hypertension is a contributing cause or a consequence of glomerular injury. The MYH9 kidney risk variant is strikingly more common among individuals of African descent, but only some will develop clinical kidney disease in their lifetime. Thus, it is likely that additional genes and/or environmental factors interact with the MYH9 kidney risk variant to trigger glomerular injury. A preliminary genetic risk stratification scheme, using two single nucleotide polymorphisms, may estimate lifetime risk for kidney disease. Nevertheless, at present, no role has been established for genetic testing as part of personalized medicine, but testing should be considered in clinical studies of glomerular diseases among populations of African descent. Such studies will address critical questions pertaining to MYH9-associated kidney disease, including mechanism, course, and response to therapy.
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Katzenellenbogen JM, Sanfilippo FM, Hobbs MST, Briffa TG, Ridout SC, Knuiman MW, Dimer L, Taylor KP, Thompson PL, Thompson SC. Variable effects of prevalence correction of population denominators on differentials in myocardial infarction incidence: a record linkage study in Aboriginal and non-Aboriginal Western Australians. J Clin Epidemiol 2010; 64:658-66. [PMID: 21109397 DOI: 10.1016/j.jclinepi.2010.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/19/2010] [Accepted: 08/27/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To investigate the impact of prevalence correction of population denominators on myocardial infarction (MI) incidence rates, rate ratios, and rate differences in Aboriginal vs. non-Aboriginal Western Australians aged 25-74 years during the study period 2000-2004. STUDY DESIGN AND SETTING Person-based linked hospital and mortality data sets were used to estimate the number of prevalent and first-ever MI cases each year from 2000 to 2004 using a 15-year look-back period. Age-specific and -standardized MI incidence rates were calculated using both prevalence-corrected and -uncorrected population denominators, by sex and Aboriginality. RESULTS The impact of prevalence correction on rates increased with age, was higher for men than women, and substantially greater for Aboriginal than non-Aboriginal people. Despite the systematic underestimation of incidence, prevalence correction had little impact on the Aboriginal to non-Aboriginal age-standardized rate ratios (6% and 4% underestimate in men and women, respectively), although the impact on rate differences was more marked (12% and 6%, respectively). The percentage underestimate of differentials was greater at older ages. CONCLUSION Prevalence correction of denominators, while more accurate, is difficult to apply and may add modestly to the quantification of relative disparities in MI incidence between populations. Absolute incidence disparities using uncorrected denominators may have an error >10%.
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Affiliation(s)
- Judith M Katzenellenbogen
- Centre for International Health, Curtin Health Innovation Research Institute, Curtin University of Technology, Bently, Perth, Western Australia,
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Das A. Cancer registry databases: an overview of techniques of statistical analysis and impact on cancer epidemiology. Methods Mol Biol 2009; 471:31-49. [PMID: 19109773 DOI: 10.1007/978-1-59745-416-2_2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cancer registries provide systematically collected information on cancer incidence, prevalence, mortality, and survival of different cancers. Aggregated and de-identified patient-level information on cancer is available for analysis from individual cancer registries, nationally from the Surveillance, Epidemiology, and End Results program, the Centers for Diseases Control and Prevention, the North American Association of Central Cancer Registries; and internationally from the International Association of Cancer Registries. Over the past few decades, the type and extent of cancer-related information captured by different cancer registries have been greatly expanded by linkage with other population-based information sources, such as the census data and the Centers for Medicare and Medicaid Services claims data. In addition, sophisticated statistical analytical techniques have been developed that have greatly expanded the traditional purview of cancer registries focused on descriptive epidemiology and disease quantification to a much broader analytical horizon ranging from study of cancer etiology; rare cancers in specific demographic groups; interaction of environmental and genetic factors in causation of cancer; impact of co-morbidities, race, geographic, socioeconomic, and provider-related factors on access, diagnosis, and treatment; outcomes and end results of cancer treatment; and cancer control initiatives to diverse areas of cancer care disparity, public health policy, public health education, and importantly, cost-effectiveness of cancer care. Thus, it is not surprising that cancer registries have increasingly become indispensable parts of local, national, and international cancer control programs, and it is certain that cancer registries will continue to be extraordinary resources of information for clinicians, researchers, scientists, policy makers, and the public in our fight against cancer.
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Affiliation(s)
- Ananya Das
- Department of Medicine, Mayo College of Medicine, Mayo Clinic, Scottsdale, AZ, USA
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17
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Plevritis SK, Sigal BM, Salzman P, Rosenberg J, Glynn P. A stochastic simulation model of U.S. breast cancer mortality trends from 1975 to 2000. J Natl Cancer Inst Monogr 2007:86-95. [PMID: 17032898 DOI: 10.1093/jncimonographs/lgj012] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We present a simulation model that predicts U.S. breast cancer mortality trends from 1975 to 2000 and quantifies the impact of screening mammography and adjuvant therapy on these trends. This model was developed within the Cancer Intervention and Surveillance Network (CISNET) consortium. METHOD A Monte Carlo simulation is developed to generate the life history of individual breast cancer patients by using CISNET base case inputs that describe the secular trend in breast cancer risk, dissemination patterns for screening mammography and adjuvant treatment, and death from causes other than breast cancer. The model generates the patient's age, tumor size and stage at detection, mode of detection, age at death, and cause of death (breast cancer versus other) based in part on assumptions on the natural history of breast cancer. Outcomes from multiple birth cohorts are summarized in terms of breast cancer mortality rates by calendar year. RESULT Predicted breast cancer mortality rates follow the general shape of U.S. breast cancer mortality rates from 1975 to 1995 but level off after 1995 as opposed to following an observed decline. Sensitivity analysis revealed that the impact adjuvant treatment may be underestimated given the lack of data on temporal variation in treatment efficacy. CONCLUSION We developed a simulation model that uses CISNET base case inputs and closely, but not exactly, reproduces U.S. breast cancer mortality rates. Screening mammography and adjuvant therapy are shown to have both contributed to a decline in U.S. breast cancer mortality.
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Affiliation(s)
- Sylvia K Plevritis
- Department of Radiology, School of Medicine, Stanford University, Stanford CA 94305, USA.
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18
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Merrill RM. Impact of Hysterectomy and Bilateral Oophorectomy on Race-Specific Rates of Corpus, Cervical, and Ovarian Cancers in the United States. Ann Epidemiol 2006; 16:880-7. [PMID: 17027290 DOI: 10.1016/j.annepidem.2006.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 05/10/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE Population-based cancer incidence rates of the corpus uteri, cervix uteri, and ovaries are underestimated if they fail to remove women not at risk for developing the cancers from the denominator in the race calculation. This study compares incidence rates among selected racial groups for these cancers before and after correction for prevalence of hysterectomy and bilateral oophorectomy. METHODS The study covers 1998 through 2002 and involves Surveillance, Epidemiology, and End Results Program; Behavior Risk Factor Surveillance System; and National Health Interview Survey data. Prevalence data were obtained by using survey and life-table methods. Four racial groups are considered: whites, blacks, American Indians/Alaska Natives, and Asians/Pacific Islanders. RESULTS Risk correction significantly increased rates of corpus uterine cancer by 73.1% for whites, 93.0% for blacks, 86.3% for American Indians/Alaska Natives, and 41.0% for Asians/Pacific Islanders. Corresponding percentages among these racial groups for cervical cancer were 37.7%, 60.2%, 45.6%, and 33.0%, and for ovarian cancer, 32.5%, 31.1%, 35.0%, and 23.6%, respectively. Risk correction had large influences on the comparison of rates among racial groups. For example, for uterine corpus cancer, Asians/Pacific Islanders had 32.9% lower rates than whites before correction, but 45.3% lower rates after correction. For cervical cancer, blacks had 27.6% higher rates than whites before correction, but 48.5% higher rates after correction; and for ovarian cancer, Asians/Pacific Islanders had 31.2% lower rates than whites before correction and 35.8% lower rates after correction. CONCLUSIONS Corrected rates of corpus uteri, cervix uteri, and ovarian cancers have a large, but differential, impact on the racial groups considered.
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Affiliation(s)
- Ray M Merrill
- Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, UT 84602, USA.
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19
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Corte MD, Gonzalez LO, Corte MG, Quintela I, Pidal I, Bongera M, Vizoso F. Collagenase-3 (MMP-13) expression in cutaneous malignant melanoma. Int J Biol Markers 2006; 20:242-8. [PMID: 16398406 DOI: 10.1177/172460080502000407] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Matrix metalloproteases (MMPs), enzymes with the ability to degrade the extracellular matrix, play an important role in tissue invasion by cutaneous malignant melanoma (CMM). One specific MMP, collagenase-3 (MMP-13), is thought to have a key function in the activation of MMP. AIMS To evaluate the expression of MMP-13 in CMM and assess its possible relationship to clinical and pathological parameters. METHODS MMP-13 expression was analyzed in 51 paraffin-embedded tumor samples from patients with invasive CMM, ten samples from in situ melanomas, and in eight samples from benign lesions (three dermal melanocytic nevi, three compound melanocytic nevi and two atypical melanocytic nevi) using immunohistochemical techniques. The median follow-up period in patients with invasive CMM was 50 months. RESULTS Benign lesions were consistently negative for MMP-13, whereas three of the ten in situ melanomas (30%) and 23 of the 51 invasive CMMs (45%) showed positive immunostaining for MMP-13. The percentage of MMP-13-positive tumors correlated significantly and positively with the mitotic index (p=0.002) in invasive CMM. However, our results did not show any significant association between tumoral MMP-13 expression and relapse-free survival in patients with invasive CMM. CONCLUSIONS MMP-13 appears to be a factor associated with tumor aggressiveness in CMM. It seems to eliminate an important barrier not only against tumoral invasion but also against proliferation.
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Affiliation(s)
- M D Corte
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
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Fay MP. Estimating age conditional probability of developing disease from surveillance data. Popul Health Metr 2004; 2:6. [PMID: 15279675 PMCID: PMC517510 DOI: 10.1186/1478-7954-2-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Accepted: 07/27/2004] [Indexed: 12/02/2022] Open
Abstract
Fay, Pfeiffer, Cronin, Le, and Feuer (Statistics in Medicine 2003; 22; 1837–1848) developed a formula to calculate the age-conditional probability of developing a disease for the first time (ACPDvD) for a hypothetical cohort. The novelty of the formula of Fay et al (2003) is that one need not know the rates of first incidence of disease per person-years alive and disease-free, but may input the rates of first incidence per person-years alive only. Similarly the formula uses rates of death from disease and death from other causes per person-years alive. The rates per person-years alive are much easier to estimate than per person-years alive and disease-free. Fay et al (2003) used simple piecewise constant models for all three rate functions which have constant rates within each age group. In this paper, we detail a method for estimating rate functions which does not have jumps at the beginning of age groupings, and need not be constant within age groupings. We call this method the mid-age group joinpoint (MAJ) model for the rates. The drawback of the MAJ model is that numerical integration must be used to estimate the resulting ACPDvD. To increase computational speed, we offer a piecewise approximation to the MAJ model, which we call the piecewise mid-age group joinpoint (PMAJ) model. The PMAJ model for the rates input into the formula for ACPDvD described in Fay et al (2003) is the current method used in the freely available DevCan software made available by the National Cancer Institute.
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Affiliation(s)
- Michael P Fay
- National Cancer Institute 6116 Executive Blvd, Suite 504 Bethesda, MD 20892-8317, USA.
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Luoto R, Raitanen J, Pukkala E, Anttila A. Effect of hysterectomy on incidence trends of endometrial and cervical cancer in Finland 1953-2010. Br J Cancer 2004; 90:1756-9. [PMID: 15208619 PMCID: PMC2409756 DOI: 10.1038/sj.bjc.6601763] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The hysterectomy-corrected age-adjusted incidence rate of endometrial cancer was 29%, and for cervical cancer 11% higher than the uncorrected rate. Correction factors for such cancer sites are recommended for regular use. The levelling-off of the incidence of endometrial cancer appears to be an artefact caused by the increasing prevalence of hysterectomy.
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Affiliation(s)
- R Luoto
- Tampere School of Public Health, University of Tampere, FIN-33014 Finland.
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22
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Miranda E, Vizoso F, Martín A, Quintela I, Corte MD, Seguí ME, Ordiz I, Merino AM. Apolipoprotein D expression in cutaneous malignant melanoma. J Surg Oncol 2003; 83:99-105. [PMID: 12772203 DOI: 10.1002/jso.10245] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Apolipoprotein D (Apo D) is a protein component of the human plasma lipid transport system, and an androgen-regulated protein in both breast and prostate cancer cell lines. Our goal was to evaluate the expression of Apo D in malignant cutaneous melanomas, as well as to assess its possible relationship to clinical and pathological parameters. METHODS Apo D expression was analyzed in 32 paraffin-embedded tissues from patients with invasive cutaneous malignant melanomas, in 8 samples from in situ melanoma, and in 10 samples from 10 benign lesions (4 dermal melanocytic nevi, 4 compound melanocytic nevi, and 2 dysplastic melanocytic nevi), using immunohistochemical techniques. RESULTS The benign lesions were consistently negative for Apo D, whereas 3 of the 8 "in situ" melanomas (37.5%) and 12 of the 32 invasive melanomas (37.5%) showed positive immunostaining for Apo D. The percentage of Apo D-positive tumors was significantly higher in nodular than in superficial spreading melanomas (P = 0.011) and in melanomas with vertical growth phase than in melanomas with radial growth phase (P = 0.02). In addition, the percentage of Apo D-positive tumors was positively and significantly correlated with Clark's level of invasion (P = 0.046). CONCLUSIONS Apo D may be a new prognostic factor of unfavorable evolution in cutaneous malignant melanoma.
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Affiliation(s)
- Eva Miranda
- Department of Pathology. Hospital de Cabueñes, Gijón, Spain
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Jefford M, Toner GC, Smith JG, Ngan SYK, Rischin D, Guiney MJ. Phase II trial of continuous infusion carboplatin, 5-fluorouracil, and radiotherapy for localized cancer of the esophagus. Am J Clin Oncol 2002; 25:277-82. [PMID: 12040288 DOI: 10.1097/00000421-200206000-00015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the toxicity, response rate, failure-free survival, and overall survival in a treatment program comprising continuous infusion carboplatin, short in-fusion 5-fluorouracil (5-FU) and radiotherapy for localized carcinoma of the thoracic esophagus. To be eligible, patients were required to have Karnofsky performance status greater than or equal to 60, adequate organ function, and have received no prior therapy. Planned radiation dose was 50 Gy in 25 fractions over 5 weeks. 5-FU was to be administered commencing days 1 and 29 of radiotherapy, and given at a dose of 1 g/m2/d for 4 days as a continuous infusion. Carboplatin was to commence on day 1 of radiotherapy and be given throughout the period of radiation as a continuous infusion. The starting dose of carboplatin was 28 mg/m2/d. The protocol specified a 25% dose reduction of carboplatin if more than two of the first six patients experienced dose-limiting toxicity (DLT). DLT was defined as grade IV neutropenia lasting more than 7 days, grade IV thrombocytopenia, or any grade IV nonhematologic toxicity. All 23 patients in the study received protocol radio-therapy, except one who was given an extra 10 Gy. Seven patients received carboplatin at 28 mg/m2/d and 16 received 21 mg/m2/d. Hematologic DLTs were experienced by all of the seven patients receiving the higher dose. No patients in the low-dose group experienced hematologic DLTs, and only 2 of 16 ceased chemotherapy early because of myelosuppression. Three patients in the low-dose group experienced grade IV esophagitis but were able to complete protocol radiotherapy. Apart from esophagitis, nonhematologic toxicity was generally moderate or mild. Six patients had thrombosis complicating the central venous catheters. Endoscopy was performed in 21 patients (91%), with an overall complete response rate of 65% (CI: 43-84%) for the whole group or 71% (CI: 48-89%) for the endoscopically evaluated group. Estimated median failure-free survival time was 8.9 months (CI: 7.1-12.9), and estimated median overall survival time was 21.4 months (CI: 9.6 -35.4). Carboplatin at 21 mg/m2/d as a continuous infusion may be given safely in combination with short infusional 5-FU and radiotherapy for localized carcinoma of the esophagus. This combination has resulted in response data comparable to that of larger studies of cisplatin-containing regimens and warrants further study, ideally in a phase III randomized controlled trial.
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Affiliation(s)
- Michael Jefford
- Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Merrill RM, Lyon JL, Wiggins C. Comparison of two methods based on cross-sectional data for correcting corpus uterine cancer incidence and probabilities. BMC Cancer 2001; 1:13. [PMID: 11686855 PMCID: PMC58835 DOI: 10.1186/1471-2407-1-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2001] [Accepted: 09/06/2001] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Two methods are presented for obtaining hysterectomy prevalence corrected estimates of invasive cancer incidence rates and probabilities of the corpus uterine. METHODS The first method involves cross-sectional hysterectomy data from the Utah Hospital Discharge Data Base and mortality data applied to life-table methods. The second involves hysterectomy prevalence estimates obtained directly from the Utah Behavior Risk Factor Surveillance System (BRFSS) survey. RESULTS Hysterectomy prevalence estimates based on the first method are lower than those obtained from the second method through age 74, but higher in the remaining ages. Correction for hysterectomy prevalence is greatest among women ages 75-79. In this age group, the uncorrected rate is 125 (per 100,000) and the corrected rate based on the life-table method is 223 using 1995-97 data, 243 using 1992-94 data, and 228 from the survey method. The uncorrected lifetime probability of developing corpus uterine cancer is 2.6%; the corrected probability from the life-table method using 1995-97 data is 4.2%, using 1992-94 data is 4.5%; and based on prevalence data from the survey method is 4.6%. CONCLUSIONS Both methods provide reasonable hysterectomy prevalence estimates for correcting corpus uterine cancer rates and probabilities. Because of declining trends in hysterectomy in recent decades, corrected estimates from the life-table method are less pronounced than those based on the survey method. These methods may be useful for obtaining corrected uterine cancer rates and probabilities in areas of the world that do not have sufficient years of hysterectomy data to directly compute prevalence.
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Affiliation(s)
- Ray M Merrill
- Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, Utah, 84602, USA
- Department of Family and Preventive Medicine, University of Utah College of Medicine, 30 North 1900 East, Salt Lake City, Utah, 84108, USA
| | - Joseph L Lyon
- Department of Family and Preventive Medicine, University of Utah College of Medicine, 30 North 1900 East, Salt Lake City, Utah, 84108, USA
| | - Charles Wiggins
- Utah Cancer Registry, 546 Chipeta Way, Suite 2100, Salt Lake City, Utah, 84108, USA
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Abstract
PURPOSE A life table method is used for correcting hysterectomy rates and probabilities for prevalent cases of hysterectomies in the population. Both corrected and conventional hysterectomy rates and probabilities are reported. METHODS Hysterectomy prevalence estimates are derived from cross-sectional hysterectomy and mortality using a life table method. Analysis is based on the Utah Hospital Discharge Data Base and State death certificates. RESULTS Hysterectomy rates are strongly influenced by age, reaching 150 per 10,000 for ages 45-49 years. The corresponding corrected hysterectomy rate is 196. Differences between the corrected and uncorrected cause-specific hysterectomy rates tend to be most pronounced at their peaks, particularly later in life where the prevalence of hysterectomy is greatest. Probability of hysterectomy approaches slightly above 35% over the life span, whereas the corrected hysterectomy probability approaches 43%. Probability of hysterectomy in the next 10 years is 12.9% for women aged 35 years and 11.7% for women aged 45 years. Corresponding corrected hysterectomy probabilities are 14.3 and 15.1. Higher prevalence of hysterectomy in later ages explains the reverse in magnitude of the rates when the correction is applied to the hysterectomy rates. CONCLUSIONS Conventional hysterectomy rates are underestimated, particularly in older age groups. A prevalence correction of the rates and probabilities is necessary to fully understand the potential health related consequences and impact of this medical procedure in the population.
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Affiliation(s)
- R M Merrill
- Department of Health Science, College of Health and Human Performance, Brigham Young University, Provo, UT 84602, USA
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Crocetti E, Paci E. Prevalence of hysterectomy and its effect on uteran cancer incidence rates. Gynecol Oncol 2000; 79:337-8. [PMID: 11063671 DOI: 10.1006/gyno.2000.5989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Gail MH, Costantino JP, Bryant J, Croyle R, Freedman L, Helzlsouer K, Vogel V. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 1999; 91:1829-46. [PMID: 10547390 DOI: 10.1093/jnci/91.21.1829] [Citation(s) in RCA: 443] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In response to findings from the Breast Cancer Prevention Trial that tamoxifen treatment produced a 49% reduction in the risk of invasive breast cancer in a population of women at elevated risk, the National Cancer Institute sponsored a workshop on July 7 and 8, 1998, to develop information to assist in counseling and in weighing the risks and benefits of tamoxifen. Our study was undertaken to develop tools to identify women for whom the benefits outweigh the risks. METHODS Information was reviewed on the incidence of invasive breast cancer and of in situ lesions, as well as on several other health outcomes, in the absence of tamoxifen treatment. Data on the effects of tamoxifen on these outcomes were also reviewed, and methods were developed to compare the risks and benefits of tamoxifen. RESULTS The risks and benefits of tamoxifen depend on age and race, as well as on a woman's specific risk factors for breast cancer. In particular, the absolute risks from tamoxifen of endometrial cancer, stroke, pulmonary embolism, and deep vein thrombosis increase with age, and these absolute risks differ between white and black women, as does the protective effect of tamoxifen on fractures. Tables and aids are developed to describe the risks and benefits of tamoxifen and to identify classes of women for whom the benefits outweigh the risks. CONCLUSIONS Tamoxifen is most beneficial for younger women with an elevated risk of breast cancer. The quantitative analyses presented can assist health care providers and women in weighing the risks and benefits of tamoxifen for reducing breast cancer risk.
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Affiliation(s)
- M H Gail
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
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