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Bouchard-Fortier A, Provencher L, Blanchette C, Diorio C. Prognostic and predictive value of low estrogen receptor expression in breast cancer. ACTA ACUST UNITED AC 2017; 24:e106-e114. [PMID: 28490933 DOI: 10.3747/co.24.3238] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Anti-hormonal therapy (tamoxifen) is recommended for estrogen receptor (er)-positive breast cancer (bca); however, its effect on low-receptor cancers is unclear. We retrospectively evaluated the effect of adjuvant tamoxifen in patients with weakly er-positive bca. METHODS We identified 2221 bca patients who had been er-tested by ligand-based assay (lba) during 1976-1995 and who had been treated and followed until 2008. Cox proportional hazards models adjusted for age, body mass index, tumour size, nodal status, surgery, and chemotherapy were used to assess the effect of er level on bca survival in patients who received tamoxifen. RESULTS Overall, 17% (383) of patients were within 0-3 fmol/mg cytosol protein, and 12% (266) were within 4-9 fmol/mg cytosol protein. Patients with er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein had 20-year bca survival rates of 56%, 56%, 63%, 71%, and 60% respectively. Of the 2221 patients studied, 661 (29.8%) received anti-hormonal therapy. Within the latter group, er levels of 0-3, 4-9, 10-19, 20-49, and 50 fmol/mg or more cytosol protein were associated with a hazard ratio for lower bca mortality: respectively, 1.00 (reference), 0.59 (p = 0.09), 0.19 (p < 0.0001), 0.26 (p < 0.0001), and 0.31 (p < 0.0001)-the risk reduction being significant only for er levels of 10 fmol/mg or more cytosol protein. CONCLUSIONS Tamoxifen use in bca patients with a weakly positive er status (4-9 fmol/mg cytosol protein), compared with those having higher er levels (≥10 fmol/mg cytosol protein), is not associated with a significantly lower bca-specific mortality. Our results do not support treatment with anti-hormonal therapy for bca patients with a weakly positive er status as identified by lba.
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Affiliation(s)
| | - L Provencher
- Centre des maladies du sein Deschênes-Fabia, Hôpital du Saint-Sacrement.,Faculté de médecine, Centre de recherche sur le Cancer, Université Laval, and.,Oncology Unit, chu de Québec Research Center-Université Laval, Quebec City, QC
| | - C Blanchette
- Oncology Unit, chu de Québec Research Center-Université Laval, Quebec City, QC
| | - C Diorio
- Centre des maladies du sein Deschênes-Fabia, Hôpital du Saint-Sacrement.,Faculté de médecine, Centre de recherche sur le Cancer, Université Laval, and.,Oncology Unit, chu de Québec Research Center-Université Laval, Quebec City, QC
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2
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. Healthcare cost and utilization before and after diagnosis of pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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3
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. Treatment patterns associated with pseudomonas aeruginosa among patients with non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Blanchette C, Noone J, Stone G, Zacherle E, Runken MC, Howden R, Mapel D. The prevalence of non-cystic fibrosis bronchiectasis in the US. Pneumologie 2016. [DOI: 10.1055/s-0036-1592286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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5
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Lemieux J, Provencher L, Perron L, Brisson J, Amireault C, Blanchette C, Maunsell E. No effect of scalp cooling on survival among women with breast cancer. Breast Cancer Res Treat 2014; 149:263-8. [PMID: 25511368 DOI: 10.1007/s10549-014-3231-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/02/2014] [Indexed: 11/27/2022]
Abstract
Scalp cooling can prevent chemotherapy-induced alopecia in some cancer patients. It is not used in all countries. No data are available regarding its impact, if any, on survival. The aim of this study was to compare overall survival according to whether or not scalp cooling was used during neoadjuvant or adjuvant chemotherapy for non-metastatic breast cancer. We conducted a retrospective cohort study of 1,370 women with non-metastatic invasive breast carcinoma who received chemotherapy in the neoadjuvant or adjuvant setting. A total of 553 women who used scalp cooling came from a tertiary breast cancer clinic in Quebec City (diagnosed between 1998 and 2002) and 817 were treated in other hospitals in the province of Quebec (between 1998 and 2003) where scalp cooling was not routinely available. Overall survival of women who used scalp cooling and those who did not was compared using Cox proportional hazards models. Median follow-up for the scalp-cooled and the non-scalp-cooled groups was 6.3 years and 8.0 years, respectively. Overall mortality was no different (adjusted hazard ratio 0.89, 95 % confidence interval: 0.68-1.17, p = 0.40) among scalp-cooled women, compared to those not getting scalp cooling. Among women getting neoadjuvant or adjuvant chemotherapy for non-metastatic breast cancer, scalp cooling used to prevent chemotherapy-induced alopecia had no negative effect on survival. To our knowledge, this is the first study to compare survival of women who used scalp cooling to that of women who did not.
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Affiliation(s)
- J Lemieux
- Centre de recherche, Centre hospitalier universitaire (CHU) de Québec, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, Québec, QC, G1S 4L8, Canada,
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6
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Ndjaboué R, Brisson C, Vézina M, Blanchette C, Bourbonnais R. Effort--reward imbalance and medically certified absence for mental health problems: a prospective study of white-collar workers. Occup Environ Med 2013; 71:40-7. [PMID: 24174636 DOI: 10.1136/oemed-2013-101375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Little is known about the effects of psychosocial work factors on objectively assessed mental health problems leading to medically certified absence. Only one study has evaluated the prospective effects of effort-reward imbalance (ERI) at work with regards to this outcome. The present study aimed to evaluate the effects of ERI on the incidence of medically certified absence for mental health problems. METHODS The study included 2086 white-collar workers (63.3% women) employed in public organisations in Quebec city. Participants were followed over a 9-year period. Medical absences from work were collected from employers' files and psychosocial factors were measured using the ERI questionnaire. Cox regression models were used to estimate the incidence of certified sickness absence due to mental health problems that lasted 5 workdays or more, while controlling for confounders. RESULTS Workers exposed to ERI had a higher risk of a first spell of medically certified absence for mental health problems (HR=1.38, 95% CI 1.08 to 1.76) compared with unexposed workers. Low reward was significantly associated with a high risk among men (HR=2.80, 95% CI 1.34 to 5.89) but not in women. (HR=1.24, 95% CI 0.90 to 1.73). Effort at work had no effect on certified absence. All these effects were adjusted for potential confounders. CONCLUSIONS ERI and low reward at work were prospectively associated with medically certified absence for mental health problems. These effects seem to differ by gender. Primary prevention that is aimed at reducing these stressors should be considered to help reduce the incidence of such severe mental health problems.
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Affiliation(s)
- R Ndjaboué
- Groupe interdisciplinaire de recherche sur l'organisation et la santé au travail (GIROST), Québec, Québec, Canada
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7
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Blouin K, Leclerc P, Morissette C, Roy É, Blanchette C, Parent R, Serhir B, Alary M. P3.099 Sex Work as an Emerging Risk Factor For HIV Seroconversion Among Injection Drug Users in the SurvUDI Network. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Gilbert-Ouimet M, Brisson C, Vézina M, Milot A, Blanchette C. Repeated exposure to effort-reward imbalance, increased blood pressure, and hypertension incidence among white-collar workers: effort-reward imbalance and blood pressure. J Psychosom Res 2012; 72:26-32. [PMID: 22200519 DOI: 10.1016/j.jpsychores.2011.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 06/20/2011] [Accepted: 07/31/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether men and women with repeated ERI exposure have increased BP means or higher hypertension incidence over a 3-year follow-up. To examine the potential modifying effect of age and overcommitment. METHODS The study cohort was composed of 1,595 white-collar workers (629 men and 966 women) assessed at baseline and 3-year follow-up. Ambulatory BP measures were taken every 15 min during a working day. ERI at work was self-reported using validated scales. BP means at follow-up and cumulative incidence of hypertension were respectively modeled with analyses of covariance (ANCOVA) and log-binomial regression. RESULTS Among men, no association was observed between repeated ERI exposure and BP. Among women, age had a modifying effect. Women <45 years old exposed to ERI at both times had significantly higher BP means at follow-up (122.2/78.9 mmHg) than those unexposed (120.4/77.4 mmHg). In women ≥45 years old, the cumulative incidence of hypertension was 2.78 (95% CI: 1.26-6.10) times higher among those exposed to ERI at both times. Men and women in the higher tertile of overcommitment had higher BP means (men: 128.9/82.2 mmHg, women: 121.9/78.0 mmHg) than those in the lower tertile (men: 127.2/81.3 mmHg, women: 120.6/77.0 mmHg). CONCLUSION This prospective study showed that, among women, repeated ERI exposure led to a significant age-specific increase in BP means and a major age-specific increase in hypertension incidence. These results suggest that primary intervention aimed at reducing ERI may contribute to lower BP and prevent hypertension in women.
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Affiliation(s)
- M Gilbert-Ouimet
- Santé des Populations: URESP, Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Quebec City, Québec, Canada.
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9
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Blouin K, Parent R, Leclerc P, Blanchette C, Alary M, Morissette C, Roy E, Claessens C. P1-S2.25 HIV serostatus knowledge, absence of previous testing and sexual behaviours among injecting drug users. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Revel-Vilk S, Komvilaisak P, Blanchette V, Stain AM, Floros G, Cochrane A, Blanchette C, Hang M, Roberts EA, Ling SC. The changing face of hepatitis in boys with haemophilia associated with increased prevalence of obesity. Haemophilia 2011; 17:689-94. [PMID: 21418443 DOI: 10.1111/j.1365-2516.2010.02477.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Hepatitis in children with haemophilia was historically most often associated with transfusion-transmitted infections. However, with the use of recombinant clotting factor concentrates, acquisition of such infections has now become rare. We studied the profile of hepatitis in North-American children with haemophilia in the modern era of safe blood products and excess childhood obesity. A total of 173 boys (<18 years) registered in the Pediatric Comprehensive Care Haemophilia Program were included in this retrospective study. Hospital records were reviewed for baseline data, serial height and weight measurements and serial alanine aminotransferase (ALT) levels. A body mass index (BMI) ranking was available for 170 boys, of whom 25 (14.7%, 95% CI 9.7-20.9%) were obese. The rate of obesity was higher in severe haemophilic boys. Compared with the general childhood population, the rate of obesity trended towards being higher in young haemophilic boys (2-5 years), but was similar in other age groups. A persistently high ALT (≥80 U L(-1) ) was documented in 5 boys and was associated with obesity. Three boys had clinical and imaging studies compatible with non-alcoholic fatty liver disease (NAFLD). Overweight and obesity are common among haemophilic boys, especially those who are younger and with severe disease. In this large group of haemophilic boys, chronic viral hepatitis was rare and NAFLD was a more common cause of liver disease. Overweight and obese haemophilic boys should be evaluated for NAFLD and interventional programmes should be designed to reduce the potential complications associated with obesity.
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Affiliation(s)
- S Revel-Vilk
- Department of Nursing, The Hospital for Sick Children, Toronto, Ontario, Canada
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11
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Lancaster JM, Sayer RA, Blanchette C, Calingaert B, Konidari I, Gray J, Schildkraut J, Schomberg DW, Marks JR, Berchuck A. High expression of insulin-like growth factor binding protein-2 messenger RNA in epithelial ovarian cancers produces elevated preoperative serum levels. Int J Gynecol Cancer 2006; 16:1529-35. [PMID: 16884361 DOI: 10.1111/j.1525-1438.2006.00623.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The molecular etiology of epithelial ovarian cancer remains unclear. Using microarray expression analysis, we recently reported that expression of the insulin-like growth factor binding protein-2 (IGFBP-2) gene is elevated in advanced epithelial ovarian cancers. The aim of this study was to further delineate the role of IGFBP-2 in the pathoetiology of epithelial ovarian cancer and determine if elevated ovarian cancer IGFBP-2 gene expression is reflected in serum. Relative IGFBP-2 expression was measured using quantitative real-time polymerase chain reaction in 113 epithelial ovarian cancers and 6 normal ovarian surface epithelial samples. Preoperative serum IGFBP-2 levels were measured by radioimmunoassay in 84 women (42 ovarian cancers, 26 benign gynecological conditions, and 10 healthy female controls). Ovarian cancers demonstrated 38-fold higher mean IGFBP-2 expression than normal ovarian epithelium (P < 0.01). Serum IGFBP-2 levels were elevated in women with early- and advanced-stage ovarian cancer compared to controls and patients with benign gynecological conditions (P = 0.05 and P < 0.01, respectively). Epithelial ovarian cancers express high levels of IGFBP-2 relative to normal ovarian epithelium, and this is associated with elevated serum IGFBP-2 levels compared to both normal controls and patients with benign gynecological disease. Our findings provide further support that the insulin-like growth factor pathway plays a significant role in epithelial ovarian cancer pathogenesis. Further, IGFBP-2 may represent an additional serum biomarker with utility in detection and monitoring of epithelial ovarian cancer.
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MESH Headings
- Adenocarcinoma, Clear Cell/blood
- Adenocarcinoma, Clear Cell/genetics
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/blood
- Adenocarcinoma, Mucinous/genetics
- Adenocarcinoma, Mucinous/surgery
- Biomarkers, Tumor/blood
- CA-125 Antigen/blood
- Case-Control Studies
- Cystadenocarcinoma, Serous/blood
- Cystadenocarcinoma, Serous/genetics
- Cystadenocarcinoma, Serous/surgery
- Endometrial Neoplasms/blood
- Endometrial Neoplasms/genetics
- Endometrial Neoplasms/surgery
- Female
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Immunoenzyme Techniques
- Insulin-Like Growth Factor Binding Protein 2/blood
- Neoplasm Staging
- Neoplasms, Glandular and Epithelial/blood
- Neoplasms, Glandular and Epithelial/genetics
- Neoplasms, Glandular and Epithelial/surgery
- Ovarian Cysts/blood
- Ovarian Cysts/genetics
- Ovarian Neoplasms/blood
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/surgery
- Ovary/pathology
- Precancerous Conditions/blood
- Precancerous Conditions/genetics
- Precancerous Conditions/surgery
- Preoperative Care
- RNA, Messenger/blood
- RNA, Messenger/genetics
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- J M Lancaster
- H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa, 33612, USA.
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12
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Abstract
BACKGROUND Current literature suggests that several proteases act in a cascade to mediate remodeling of the extracellular matrix and favor cancer progression. Others and the authors of this study recently identified cathepsin D, stromelysin-3, and urokinase plasminogen activator (uPA) expression by reactive stromal cells as significant factors of poor prognosis in breast carcinoma. The authors evaluated the joint effect of protease expression on cancer aggressiveness. METHODS Protease expression was analyzed by immunohistochemistry (cathepsin D) and in situ hybridization (stromelysin-3 and uPA) on formalin fixed paraffin embedded specimens from 557 breast carcinomas without distant metastasis at diagnosis and with an average of 10 years of follow-up. RESULTS Of the 557 breast carcinomas, 80 (14.3%) expressed all 3 proteases, and 134 (24%) expressed none of them. An adjusted Cox model revealed significantly worse distant metastasis free survival (DMFS) with expression of all three proteases (P < 0.0001). The DMFS of patients whose tumor lacked at least one of the three proteases was similar to that of patients without any protease expression, irrespective of the type or number of proteases missing. CONCLUSIONS This study suggests that proteases expressed by reactive stromal cells are interdependent and that a breach in the protease pathway may impair breast carcinoma progression.
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Affiliation(s)
- B Têtu
- Department of Pathology and Centre de Recherche en Cancérologie, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Québec City, Québec, Canada.
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13
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West M, Blanchette C, Dressman H, Huang E, Ishida S, Spang R, Zuzan H, Olson JA, Marks JR, Nevins JR. Predicting the clinical status of human breast cancer by using gene expression profiles. Proc Natl Acad Sci U S A 2001; 98:11462-7. [PMID: 11562467 PMCID: PMC58752 DOI: 10.1073/pnas.201162998] [Citation(s) in RCA: 761] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2001] [Indexed: 11/18/2022] Open
Abstract
Prognostic and predictive factors are indispensable tools in the treatment of patients with neoplastic disease. For the most part, such factors rely on a few specific cell surface, histological, or gross pathologic features. Gene expression assays have the potential to supplement what were previously a few distinct features with many thousands of features. We have developed Bayesian regression models that provide predictive capability based on gene expression data derived from DNA microarray analysis of a series of primary breast cancer samples. These patterns have the capacity to discriminate breast tumors on the basis of estrogen receptor status and also on the categorized lymph node status. Importantly, we assess the utility and validity of such models in predicting the status of tumors in crossvalidation determinations. The practical value of such approaches relies on the ability not only to assess relative probabilities of clinical outcomes for future samples but also to provide an honest assessment of the uncertainties associated with such predictive classifications on the basis of the selection of gene subsets for each validation analysis. This latter point is of critical importance in the ability to apply these methodologies to clinical assessment of tumor phenotype.
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Affiliation(s)
- M West
- Institute of Statistics and Decision Sciences, Duke University, Durham, NC 27708, USA
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14
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Abstract
OBJECTIVE To assess the relationship between human papillomavirus (HPV) infection and vulvar vestibulitis syndrome. METHODS From November 1995 to December 1997, 135 women with vulvar vestibulitis were compared with 322 controls who had no evidence of vulvar vestibulitis. Human papillomavirus DNA was amplified by polymerase chain reaction and detected with liquid-capture molecular assay. RESULTS Human papillomavirus DNA was found in 29.6% of cases and in 23.9% of controls (relative risk [RR] 1.4; 95% confidence interval [CI].8, 2.2). The prevalence of HPV tended to decrease with increasing duration of pain among cases. Thus, prevalences were 37. 5%, 29.6%, and 22.0% for pain durations of 3-6 months, 7-12 months, and 13-24 months, respectively (P =.14). Prevalence of HPV also tended to increase with pain intensity among cases, but that association was not statistically significant (P =.57). Prevalence percentages for women with low, moderate, or severe pain were 27.5%, 28.8%, and 34.4%, respectively. Prevalence of HPV was slightly higher in cases with the most severe pain (34.4%) than in controls (23.9%) (RR 1.8; 95% CI.8, 4.0). In cases with the most pain in the shortest time (3-6 months), prevalence of HPV was double that of controls (50% versus 23.9%) (RR 3.5; 95% CI 1.0, 12.7; P =.054). CONCLUSION There was little support for the idea that HPV might be related to vulvar vestibulitis.
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Affiliation(s)
- C Morin
- Department of Pathology and Cytology, Quebec City, Canada.
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15
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Hébert-Croteau N, Brisson J, Latreille J, Blanchette C, Deschênes L. Variations in the treatment of early-stage breast cancer in Quebec between 1988 and 1994. CMAJ 1999; 161:951-5. [PMID: 10551190 PMCID: PMC1230703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The influence of organizational factors on the process and outcomes of the treatment of breast cancer has been extensively investigated. Although the quality of care is presumed to be better in larger centres, evidence is inconsistent. This study was conducted to determine whether therapies for patients with breast cancer varied according to hospital caseload. METHODS Women newly diagnosed between 1988 and 1994 with early-stage node-negative primary breast cancer were randomly selected from the Quebec tumour registry and the Quebec hospital discharge database. Data were collected from medical charts, and only women having undergone dissection of the axilla were included in the analyses. Logistic regression analysis was used to adjust for case mix and organizational variables. RESULTS The final sample included 1259 patients with node-negative stage I or II primary breast cancer. The proportion of women who underwent breast-conserving surgery increased significantly with hospital caseload (from 78.0% in hospitals admitting fewer than 25 new cases each year to 88.0% in those admitting 100 patients or more; p for trend < 0.001). This trend remained significant even after statistical adjustment for case mix and organizational factors (p for trend = 0.001). Of the 1039 women who underwent breast-conserving surgery 965 (92.9%) received radiotherapy. Use of systemic adjuvant therapy (tamoxifen or chemotherapy, or both) increased with the number of patients treated in a given centre (from 60.1% to 68.5%), but this trend disappeared after adjustment for case mix and other factors. The proportion of patients receiving systemic adjuvant therapy consistent with published consensus guidelines tended to increase with caseload for those treated in hospitals participating in multicentre clinical trials but decrease with caseload for patients in hospitals not involved in clinical research. INTERPRETATION The care of patients in Quebec with early-stage breast cancer is characterized by a high prevalence of both breast-conserving surgery and systemic adjuvant therapy. Large centres, especially those actively involved in clinical research, rapidly adopt innovative therapeutic modalities.
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Affiliation(s)
- N Hébert-Croteau
- Direction de santé publique, Régie régionale de la santé et des services sociaux de Montréal-centre, Que.
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16
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Têtu B, Brisson J, Lapointe H, Wang CS, Bernard P, Blanchette C. Cathepsin D expression by cancer and stromal cells in breast cancer: an immunohistochemical study of 1348 cases. Breast Cancer Res Treat 1999; 55:137-47. [PMID: 10481941 DOI: 10.1023/a:1006140213493] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study was aimed at investigating the influence of cathepsin D (CD) expression by cancer cells and stromal cells on breast cancer prognosis. This is a study of 1348 node-positive (NPBC) and node-negative (NNBC) breast cancers diagnosed between 1980 and 1986 and with a minimum follow-up of 5.2 years. CD expression was assessed by immunohistochemistry on archival material using a polyclonal antibody. The expression by cancer and stromal cells was assessed separately and correlated with distant metastasis free (DMFS) and overall survival (OS). Cancer cells expressed CD (more than 10% cells expressing CD) in 38.9% of cases and reactive stromal cells in 43.6%. CD expression by reactive stromal cells, and not cancer cells, correlated with several factors of poor prognosis by cancer cells. A strong association was also found with expression of other proteases (stromelysin-3, gelatinase A, and urokinase Plasminogen Activator) by these same reactive stromal cells. CD expression by cancer cells did not predict DMFS or OS but, by univariate analysis, CD expression by reactive stromal cells was associated with earlier recurrence and shorter survival in NNBC (p = 0.0425) and NPBC patients submitted to adjuvant chemotherapy (p = 0.0234). However, CD expression by reactive stromal cells remained a significant predictor of recurrence by multivariate analyses only in a subgroup of NPBC submitted to adjuvant chemotherapy. Overall, those data support the concept that proteases produced by reactive stromal cells are under cancer cell stimulation and that CD by stromal cells, and not cancer cells, influences the prognosis, but only in a subgroup of patients with breast cancer.
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MESH Headings
- Adenocarcinoma/chemistry
- Adenocarcinoma/enzymology
- Adenocarcinoma/genetics
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adult
- Aged
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/biosynthesis
- Biomarkers, Tumor/genetics
- Breast Neoplasms/chemistry
- Breast Neoplasms/enzymology
- Breast Neoplasms/genetics
- Breast Neoplasms/mortality
- Carcinoma, Ductal, Breast/chemistry
- Carcinoma, Ductal, Breast/enzymology
- Carcinoma, Ductal, Breast/genetics
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Cathepsin D/biosynthesis
- Cathepsin D/genetics
- Cell Count
- Disease-Free Survival
- Endopeptidases/biosynthesis
- Endopeptidases/genetics
- Enzyme Induction
- Female
- Fluorescent Antibody Technique, Indirect
- Humans
- Immunoenzyme Techniques
- Life Tables
- Lymphatic Metastasis
- Macrophages/pathology
- Middle Aged
- Neoplasm Proteins/analysis
- Neoplasm Proteins/biosynthesis
- Neoplasm Proteins/genetics
- Neoplastic Stem Cells/enzymology
- Prognosis
- Quebec/epidemiology
- Receptor, ErbB-2/analysis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Retrospective Studies
- Risk Factors
- Stromal Cells/enzymology
- Survival Analysis
- Tumor Suppressor Protein p53/analysis
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Affiliation(s)
- B Têtu
- Department of Pathology, Université Laval, Québec, Canada.
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Hébert-Croteau N, Brisson J, Latreille J, Gariépy G, Blanchette C, Deschênes L. Time trends in systemic adjuvant treatment for node-negative breast cancer. J Clin Oncol 1999; 17:1458-64. [PMID: 10334531 DOI: 10.1200/jco.1999.17.5.1458] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We conducted a population-based study in Quebec, Canada, to assess longitudinal changes in systemic adjuvant therapy for node-negative breast cancer. MATERIALS AND METHODS A stratified random sample was selected among women with newly diagnosed node-negative breast cancer in 1988, 1991, and 1993. Information on the patient, her tumor, source of care, and treatment was abstracted from medical charts. Patients were classified as being at minimal, moderate, or high risk of recurrence on the basis of criteria proposed at the 4th International Conference on Adjuvant Therapy of Primary Breast Cancer (St. Gallen, Switzerland, 1992), and systemic adjuvant treatment received was dichotomized as being consistent or not consistent with consensus recommendations. RESULTS Overall, 1,578 cases of invasive breast carcinoma were reviewed. The proportion of patients who were given hormonal or cytotoxic treatment increased from 51.7% to 73.1% from 1988 to 1993. Virtually all women at minimal risk were treated in 1991 and 1993 according to the consensus statement. The proportions of women so treated were 75.0% and 65.4% in the moderate- and high-risk categories, respectively, in 1991. In 1993, these proportions were 71.4% and 67.0%, respectively. Omission of chemotherapy, especially in high-risk women with estrogen receptor-negative tumors who were 50 to 69 years of age, was the most frequent inconsistency with guidelines. CONCLUSION Systemic adjuvant therapy for node-negative breast cancer has gained acceptance. Better understanding of the decision-making process, of the perception of the risks and benefits involved, and of the impact of alternative strategies for the dissemination of consensus recommendations are needed to promote the use of chemotherapy in specific categories of women who are at high risk of recurrence.
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Affiliation(s)
- N Hébert-Croteau
- Direction de la Santé Publique, Régie Régionale de la Santé et des Services Sociaux de Montréal-Centre, Québec, Canada.
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Morin C, Dubé J, Robinson BH, Lacroix J, Michaud J, De Braekeleer M, Geoffroy G, Lortie A, Blanchette C, Lambert MA, Mitchell GA. Stroke-like episodes in autosomal recessive cytochrome oxidase deficiency. Ann Neurol 1999. [PMID: 10072055 DOI: 10.1002/1531-8249(199903)45:3<389::aid-ana16>3.0.co;2-b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Stroke-like episodes, defined as periods of acute localized neurological dysfunction during which brain imagery suggests cerebral ischemia but vascular anatomy is normal, occurred in 3 patients with autosomal recessive Saguenay-Lac St-Jean (SLSJ) cytochrome oxidase (COX) deficiency. The patients developed focal neurological deterioration and frontal hypodensities on cerebral computerized tomography (CT). Arteriography, performed in 1 patient during an acute episode, showed normal vascular anatomy. Nevertheless, capillary shunting was evident both in regions that appeared abnormal on the initial cerebral CT study and in regions that appeared normal but subsequently developed Leigh disease. Stroke-like episodes did not exacerbate systemic acidosis, and acidotic decompensations occurred independently of stroke-like episodes. In conclusion, stroke-like episodes occur in autosomal recessively inherited congenital lactic acidoses as well as in those caused by mitochondrial DNA mutations. In some cases, acute localized neurovascular changes occur in regions that subsequently develop Leigh disease.
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Affiliation(s)
- C Morin
- Department of Pediatrics, Hôpital de Chicoutimi, Quebec, Canada
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Grondin J, Proulx JF, Hodgins S, Dewailly E, Blanchette C. Review of food-borne diseases in Nunavik. Int J Circumpolar Health 1999; 57 Suppl 1:225-7. [PMID: 10093279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- J Grondin
- Québec Centre for Public Health, Beauport, Quebec, Canada
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Hébert-Croteau N, Brisson J, Latreille J, Blanchette C, Deschênes L. Compliance with consensus recommendations for the treatment of early stage breast carcinoma in elderly women. Cancer 1999; 85:1104-13. [PMID: 10091795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The goal of this study was to assess variations with age in the management of breast carcinoma and to identify determinants of care received. METHODS A stratified random sample was selected among women age > or = 50 newly diagnosed with lymph node negative breast carcinoma in Quebec in 1988, 1991, and 1993. Information was abstracted from medical charts. Predictors of definitive locoregional treatment (total mastectomy with lymph node dissection or breast-conserving surgery with both axillary lymph node dissection and radiation therapy) were identified by multiple logistic regression analysis. RESULTS Overall, 1174 patients age > or = 50 years with breast carcinoma were included. Women age > or = 70 years were much less likely to receive definitive locoregional treatment compared with women ages 50-69 years (48.7% vs. 83.5%; P < 0.0001). Older women were less likely to undergo surgery with breast preservation (76.7% vs. 86.3%; P < 0.0001), radiation therapy (54.7% vs. 90.5%; P < 0.0001), dissection of the axillary lymph nodes (55.6% vs. 86.3%; P < 0.0001), or chemotherapy (1.2% vs. 13.9%; P < 0.0001), but not treatment with tamoxifen (66.4% vs. 64.7%; P = 0.41). Adjusting for comorbidity and other characteristics related to the disease, the hospital, and the attending physician, age remained a strong determinant of the probability of receiving definitive locoregional treatment (odds ratio [OR], 0.14; 95% confidence interval [95% CI], 0.12-0.18 for women age > or = 70 years vs. women ages 50-69 years). The same association was observed when women who did not undergo lymph node dissection but who received systemic adjuvant treatment were considered to have received definitive therapy (OR, 0.13; 95% CI, 0.10-0.17) for women age > or = 70 years vs. women ages 50-69 years). CONCLUSIONS Less aggressive patterns of care are provided to elderly breast carcinoma patients, independent of comorbidity. This could explain, at least in part, the sustained breast carcinoma mortality in this population.
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Affiliation(s)
- N Hébert-Croteau
- Direction de la Santé Publique, Régie Régionale de la Santé et des Services Sociaux de Montréal-Centre, Québec, Canada
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Larocque B, Brisson C, Blanchette C. [Internal consistency, factorial validity and discriminant validity of the French version of the psychological demands and decision latitude scales of the Karasek "Job Content Questionnaire"]. Rev Epidemiol Sante Publique 1998; 46:371-81. [PMID: 9864766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The job demands-control model developed by Karasek has greatly influenced research on psychosocial factors at work and health. Validity of the English version of the psychological demands and decision latitude scales is documented. Psychometric qualities of the French version are investigated here in a representative sample of the general population, including blue-collars and white-collars. METHODS The French translation of the psychological demand and decision latitude scales was administered by interview in a representative sample of the Quebec working population (N = 1,110). Internal consistency and factorial validity of the instrument were studied among white-collars and blue-collars separately. Discriminant validity was assessed for the whole population. RESULTS Cronbach alpha coefficients, varying between 0.68 and 0.85, support the internal consistency of the scales. Demographic distribution of the scales and intercorrelations were consistent with the English version. Results of the factor analysis were consistent with the two dimensions expected from the theory. Mean scale scores and variations in the prevalence of high psychological demands combined with low decision latitude by age, sex, education, and job category support the discriminant validity of the instrument. CONCLUSIONS Results support internal consistency, factorial validity, and discriminant validity of the French version of the psychological demands and decision latitude scales of the Karasek "Job Content Questionnaire" for white-collars and for blue-collars of the general population.
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Affiliation(s)
- B Larocque
- Groupe de Recherche en Epidémiologie de l'Université Laval (GRE), Ste-Foy, Québec
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Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, Truchon R, Parent F, Levésque J, Bergeron V, Montminy P, Blanchette C. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997; 336:1634-40. [PMID: 9171065 DOI: 10.1056/nejm199706053362303] [Citation(s) in RCA: 306] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although epidural corticosteroid injections are commonly used for sciatica, their efficacy has not been established. METHODS In a randomized, double-blind trial, we administered up to three epidural injections of methylprednisolone acetate (80 mg in 8 ml of isotonic saline) or isotonic saline (1 ml) to 158 patients with sciatica due to a herniated nucleus pulposus. All patients had Oswestry disability scores higher than 20 (on a scale of 1 to 100, with scores of 20 or less indicating minimal disability, and higher scores greater disability). RESULTS At three weeks, the Oswestry score had improved by a mean of -8.0 in the methylprednisolone group and -5.5 in the placebo group (95 percent confidence interval for the difference, -7.1 to 2.2). Differences in improvements between the groups were not significant, except for improvements in the finger-to-floor distance (P=0.006) and sensory deficits (P=0.03), which were greater in the methylprednisolone group. After six weeks, the only significant difference was the improvement in leg pain, which was greater in the methylprednisolone group (P=0.03). After three months, there were no significant differences between the groups. The Oswestry score had improved by a mean of -17.3 in the methylprednisolone group and -15.4 in the placebo group (95 percent confidence interval for the difference, -9.3 to 5.4). At 12 months, the cumulative probability of back surgery was 25.8 percent in the methylprednisolone group and 24.8 percent in the placebo group (P=0.90). CONCLUSIONS Although epidural injections of methylprednisolone may afford short-term improvement in leg pain and sensory deficits in patients with sciatica due to a herniated nucleus pulposus, this treatment offers no significant functional benefit, nor does it reduce the need for surgery.
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Affiliation(s)
- S Carette
- Department of Medicine, Laval University, Quebec City, Canada
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Sandhu BK, Blanchette C. [Health education of diabetics. Evaluation of its utility]. Can Nurse 1994; 90:44-7. [PMID: 7923037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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