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Whelan K, Mertens A, Castleberry R, Mitby P, Kawashima T, Sklar C, Packer R, Waterbor J, Blatt J, Robison L. Visual complications in childhood cancer survivors: A Childhood Cancer Survivor Study report. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9006 Background: The Childhood Cancer Survivor Study (CCSS) is an NIH funded project (U01-CA 55727) designed to study the effects of childhood cancer treatment on long- term survivors. Previous studies have found associations between certain cancer therapies and visual complications. Methods: The CCSS is a retrospective cohort study investigating health outcomes of long-term survivors (> 5 years) diagnosed and treated between 1970 and 1986 compared to a randomly selected sibling cohort. Questionnaires were completed by 14,362 survivors of childhood cancer and 3,901 sibling controls. Analysis determined the first occurrence of 8 visual conditions in 3 time periods: during therapy, end of therapy to 5 years post diagnosis, and greater than or equal to 5 years post diagnosis. Multivariate analyses, adjusting for current age and gender, determined the relative risks (RR) and 95% confidence interval (CI) of visual conditions by treatment exposure. Results: Survivors had statistically significant increases in the RR of cataracts, glaucoma, legal blindness, double vision, retinal condition, and dry eyes, across all time periods, when compared to siblings. During the time period of 5 or more years post-diagnosis, statistically significant positive associations were present for cataracts and other head radiation, craniospinal radiation, total body radiation, and prednisone; glaucoma and craniospinal radiation; double vision and craniospinal radiation; legally blind and other head radiation and craniospinal radiation; and dry eyes and other head radiation, total body radiation, and dexamethasone. There were no statistically significant associations between treatment factors and retinal conditions. Conclusions: Childhood cancer survivors are at risk of developing visual complications and treatment related factors are important determinants of this risk. Follow-up is needed to evaluate the impact of visual conditions on quality of life. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- K. Whelan
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - A. Mertens
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - R. Castleberry
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - P. Mitby
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - T. Kawashima
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - C. Sklar
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - R. Packer
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - J. Waterbor
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - J. Blatt
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - L. Robison
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
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Rubin E, Mennemeyer ST, Desmond RA, Urist MM, Waterbor J, Heslin MJ, Bernreuter WK, Dempsey PJ, Pile NS, Rodgers WH. Reducing the cost of diagnosis of breast carcinoma: impact of ultrasound and imaging-guided biopsies on a clinical breast practice. Cancer 2001; 91:324-32. [PMID: 11180078 DOI: 10.1002/1097-0142(20010115)91:2<324::aid-cncr1005>3.0.co;2-o] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 01/16/2023]
Abstract
BACKGROUND The objective of this study was to determine whether the use of ultrasound and percutaneous breast biopsies in patients with screen-detected nonpalpable abnormalities can reduce benign open surgical biopsies of the breast without increasing cost or sacrificing detection of potentially curable breast carcinomas. METHOD Using a computerized mammography database and consecutive logs of needle localization procedures and fine- and large core needle biopsies of a single university-based breast imaging practice, the authors determined the breast carcinoma yield and cost of diagnosis over a 14-year period and the changes that occurred over time with the sequential introduction of ultrasound, ultrasound-guided biopsies, and stereotactic biopsies. RESULTS The overall breast carcinoma yield for needle localization biopsies of nonpalpable lesions increased from 21% in 1984 to 68% in 1998 (P < 0.0001). The yield for nonpalpable masses increased from 21% to 87% (P < 0.0001) over the same period. The selective use of ultrasound alone and percutaneous fine- and large core needle biopsy resulted in a substantial reduction in benign open surgical biopsies. A cost analysis showed a 50% reduction in the average expense of discovering breast carcinoma. The breast carcinomas detected after introduction of these methods were prognostically favorable with 88% measuring 1.5 cm or less in size and 66% measuring less than 1 cm. CONCLUSIONS Selective use of ultrasound and imaging-guided percutaneous biopsies can significantly reduce the number of benign open surgical biopsies generated by mammographic screening. This can result in substantial cost savings without decreasing the sensitivity for detecting small potentially curable lesions.
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Affiliation(s)
- E Rubin
- Department of Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
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Heimburger DC, Waterbor J, Fish L, Brooks CM. Cancer Prevention and Control Training Program at the University of Alabama at Birmingham. J Cancer Educ 2000; 15:69-72. [PMID: 10879893 DOI: 10.1080/08858190009528659] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The pre- and postdoctoral Cancer Prevention and Control Training Program (CPCTP) at the University of Alabama at Birmingham (UAB) has attracted high-quality trainees from all over the United States. The trainees have pursued courses of study in epidemiology, nutrition sciences, health behavior, environmental health sciences, biostatistics, or public health nutrition; and research projects in cessation of tobacco use, cancer screening, cancer epidemiology, diet modification, nutrient-cancer relationships, statistical modeling of carcinogenesis, medical-nutrition education, and obesity, in precise alignment with NCI cancer control objectives. Both courses and research projects have been interdisciplinary, taking advantage of the strong interdepartmental collaborative atmosphere at UAB. Former trainees have been successfully placed in academic, administrative, and practice positions in which they can strategically apply their cancer prevention and control expertise.
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Affiliation(s)
- D C Heimburger
- Department of Nutrition Sciences, University of Alabama at Birmingham, 35294-3360, USA.
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