Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer. In last year's article, the guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers were updated, as was the narrative pertaining to testing for early lung cancer detection. Although none of the ACS's guidelines were updated in 2001, work is proceeding on an update of screening recommendations for breast and cervical cancer and an update of these guidelines will be announced in the January/February 2003 issue of CA. As in previous issues, we review recommendations for the "cancer-related check-up," in which clinical encounters provide case-finding and health counseling opportunities. Finally, we provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS).

https://onlinelibrary.wiley.com/doi/pdf/10.3322/canjclin.52.1.8

American Cancer Society guidelines for the early detection of cancer.

Screening with mammography uses X-ray imaging to find breast cancer before a lump can be felt. The goal is to treat cancer earlier, when a cure is more likely. The review includes seven trials that involved 600,000 women in the age range 39 to 74 years who were randomly assigned to receive screening mammograms or not. The studies which provided the most reliable information showed that screening did not reduce breast cancer mortality. Studies that were potentially more biased (less carefully done) found that screening reduced breast cancer mortality. However, screening will result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts or lumps removed and to receive radiotherapy unnecessarily. If we assume that screening reduces breast cancer mortality by 15% after 13 years of follow-up and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.
Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed choice for women contemplating whether or not to attend a screening programme can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.

/pdf/screening-for-breast-cancer-with-mammography-36k7l5kzia.pdf

Screening for breast cancer with mammography.

PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%,...

Comparison of the Performance of Screening Mammography, Physical Examination, and Breast US and Evaluation of Factors that Influence Them: An Analysis of 27,825 Patient Evaluations

WITH neither the time nor the resources available to prevent, detect, or treat every disorder in every patient, which preventive, diagnostic, or therapeutic interventions should take priority? When

An assessment of clinically useful measures of the consequences of treatment.

Pathologic Basis of Diseaseby Stanley L. Robbins is really the fourth edition of hisPathology. Appropriate updating and addition enhance the otherwise identical format, sequence, writing, and illustrations. So many medical students have benefited from this source that it may be the best known general book in the field. I recommend it even more now. Like his former texts, this will be enjoyed for its readability. He clearly lays out a great deal of information. When he includes minutiae, the reasons are clear and one feels that all the material is pertinent. Robbins keeps the whole field in perspective—that is, he does not dwell so long or so heavily on pathologic anatomy or pathogenesis as to tempt the reader to overlook clinical presentation or prognosis. A great strength of the subject of pathology is that it bonds strongly with many other medical sciences and specialties and thus occupies the

Pathologic Basis of Disease

Four lipomatous lesions of the uterus are reported and the available literature from 1965 to 1976 is reviewed. It is suggested that these lesions result from metamorphosis of uterine smooth muscle which can proceed to form localised or diffuse mature adipose tissue in a leiomyoma or in the myometrium. Three terms are suggested for the nomenclature of the various morphological types of lipomatous lesions of the uterus: diffuse lipomatosis in a leiomyoma, circumscribed lipomatosis in a leiomyoma and uterine lipoma.

Lipomatous lesions of the uterus.

Objective- To assess the effect ofscreening for breast cancer in women aged 40-49 in the Swedish two county trial, in terms of mortality reduction, advanced cancer reduction, mode ofdetection, and the his­ tology of tumours detected. Setting - The Swedish two county trial of screening for breast cancer, in which 77 080 women aged 40-74 (19 844 aged 40-49) were randomly allocated to receive regular in­ vitation to mammographic screening for breast cancer, and 55985 women aged 40-74 (15604 aged 40-49) were allocated to an unscreened control group. Methods - The screening interval in the younger age group was two years and in the older age group about three years. Stat­ istical analysis of mortality and incidence rates wasperformedbyPoisson regression. Relative survival was estimated using pro­ portional hazards regression. Results - The relative mortality for the group invited to screening compared with the control group was 0·87 (95% confidence interval O·54 to 1'41) in the 40-49 age group, in close agreement with the relative in­ cidence of advanced cancers. For Kop­ parberg county the relative mortality was 0·73 (95% CI 0'37 to 1'41) and for Os­ tergotland 1'02 (95% CI 0·52 to 1'99). The lesser effect in the 40-49 group as a whole was largely due to a higher rate ofinterval cancers in this age group, and the oc­ currence in Ostergotland ofa higher num­ ber of cancers after randomisation, but before screening started, and in women who refused screening. The higher interval cancer rate was consistent with the higher proportion ofductal grade 3 andmedullary cancers in women aged 40-49 at diagnosis. Conclusions- A major difficulty in screen­ ing women aged 40-49 is the rapid pro­ gression of a subset of tumours arising in this age group. Shortening the screening interval from two years wouldbe necessary to achieve a higher mortality reduction.

Screening for breast cancer in women aged under 50: mode of detection, incidence, fatality, and histology.

We report an unusual mucinous tumor of low malignant potential, of ovarian-like type, arising in the retroperitoneum of an otherwise healthy 33-year-old woman. This is the fifth described case of such a tumor in the world literature, and the first reported in Scandinavia or Europe. We also discuss aspects of the histogenesis of this type of tumor and review the available literature. The histological heterogeneity and metastatic potential of the tumor warrant careful histopathologic analysis and follow-up of patients presenting with such lesions.

Primary retroperitoneal mucinous tumor of low malignant potential: histogenetic aspects and review of the literature.

BACKGROUND

Loss of heterozygosity (LOH) at 17p and 18q in colorectal carcinoma has been depicted as a potential prognostic marker for the disease. However, conclusions vary among reports, and evidence of clinically useful genetic prognostic markers is still lacking. As a rule, single biopsies are used. In this study, the authors hypothesized that an important cause of earlier contradictory results was the heterogeneity of colorectal neoplasms.



METHODS

In this study, DNA originating in each quadrant of tumors from 64 patients with colorectal carcinoma was analyzed. Microsatellite markers for chromosome 18q and 17p were amplified by polymerase chain reaction and automatically analyzed.



RESULTS

The authors found that, regardless of stage, LOH and non-LOH in both 17p and 18q varied among biopsies within the tumors in a random fashion. LOH in 18q was detected in all 4 quadrants in 22% and in 1 of 4, 2 of 4, or 3 of 4 quadrants in 56% of the tumors, whereas 22% of the tumors were homogeneously without LOH in 18q. LOH 17p was distributed similarly throughout the tumors and was present in 1 of 4, 2 of 4, or 3 of 4 of the quadrants in 44%. The authors also reexamined a subset of tumors by subdividing one biopsy from each into four. Analysis of the microsatellite markers then yielded identical results. No correlation between the degree of LOH status and patient survival was observed.



CONCLUSIONS

LOH status within a colorectal tumor is extensively heterogeneous. However, it is more homologous on a lower macroscopic level. For relevant genetic analysis, multiple biopsies and DNA sampling preceded by careful morphologic examination must be standard in the preparation of DNA. Cancer 2000;88:2661–7. © 2000 American Cancer Society.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%2820000615%2988%3A12%3C2661%3A%3AAID-CNCR3%3E3.0.CO%3B2-Q

Allelic loss is heterogeneous throughout the tumor in colorectal carcinoma

A case of necrotizing sialometaplasia of the lip in an 68-year-old pipe smoker is described. Necrotizing sialometaplasia is a self-healing non-neoplastic disease probably of ischaemic nature. Thirty-nine cases of sialometaplasia are described in the literature up to early 1979. These cases appeared in the palate, nasal cavity, gingiva, lip, hypopharynx and maxillary sinus. Six cases have also been reported from major salivary glands. Histologically there is necrosis of mucous cells with partial replacement by squamous epithelium. This entity has often been mistaken for squamous or mucoepidermoid carcinoma. One has to be familiar with the existence of necrotizing sialometaplasia in order to avoid subjecting the patient unnecessary and potentially mutilating surgery.

Adel Gad

Papers

Lipomatous lesions of the uterus.

Screening for breast cancer in women aged under 50: mode of detection, incidence, fatality, and histology.

Primary retroperitoneal mucinous tumor of low malignant potential: histogenetic aspects and review of the literature.

Allelic loss is heterogeneous throughout the tumor in colorectal carcinoma

Necrotizing sialometaplasia of the lip simulating squamous cell carcinoma.