Context Little is known about lifetime prevalence or age of onset of DSM-IV disorders. Objective To estimate lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the recently completed National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using the fully structured World Health Organization World Mental Health Survey version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents aged 18 years and older. Main Outcome Measures Lifetime DSM-IV anxiety, mood, impulse-control, and substance use disorders. Results Lifetime prevalence estimates are as follows: anxiety disorders, 28.8%; mood disorders, 20.8%; impulse-control disorders, 24.8%; substance use disorders, 14.6%; any disorder, 46.4%. Median age of onset is much earlier for anxiety (11 years) and impulse-control (11 years) disorders than for substance use (20 years) and mood (30 years) disorders. Half of all lifetime cases start by age 14 years and three fourths by age 24 years. Later onsets are mostly of comorbid conditions, with estimated lifetime risk of any disorder at age 75 years (50.8%) only slightly higher than observed lifetime prevalence (46.4%). Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups. Conclusions About half of Americans will meet the criteria for a DSM-IV disorder sometime in their life, with first onset usually in childhood or adolescence. Interventions aimed at prevention or early treatment need to focus on youth.

https://www.ph.ucla.edu/epi/faculty/detels/PH150/Kessler_DSMIV_AGP2009.pdf

Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

Background: This study presents estimates of lifetime and 12-month prevalence of 14 DSM-III-R psychiatric disorders from the National Comorbidity Survey, the first survey to administer a structured psychiatric interview to a national probability sample in the United States. Methods: The DSM-III-R psychiatric disorders among persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States were assessed with data collected by lay interviewers using a revised version of the Composite International Diagnostic Interview. Results: Nearly 50% of respondents reported at least one lifetime disorder, and close to 30% reported at least one 12-month disorder. The most common disorders were major depressive episode, alcohol dependence, social phobia, and simple phobia. More than half of all lifetime disorders occurred in the 14% of the population who had a history of three or more comorbid disorders. These highly comorbid people also included the vast majority of people with severe disorders. Less than 40% of those with a lifetime disorder had ever received professional treatment, and less than 20% of those with a recent disorder had been in treatment during the past 12 months. Consistent with previous risk factor research, it was found that women had elevated rates of affective disorders and anxiety disorders, that men had elevated rates of substance use disorders and antisocial personality disorder, and that most disorders declined with age and with higher socioeconomic status. Conclusions: The prevalence of psychiatric disorders is greater than previously thought to be the case. Furthermore, this morbidity is more highly concentrated than previously recognized in roughly one sixth of the population who have a history of three or more comorbid disorders. This suggests that the causes and consequences of high comorbidity should be the focus of research attention. The majority of people with psychiatric disorders fail to obtain professional treatment. Even among people with a lifetime history of three or more comorbid disorders, the proportion who ever obtain specialty sector mental health treatment is less than 50%. These results argue for the importance of more outreach and more research on barriers to professional help-seeking.

/pdf/lifetime-and-12-month-prevalence-of-dsm-iii-r-psychiatric-1o9w1oagsp.pdf

Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results From the National Comorbidity Survey

ContextUncertainties exist about prevalence and correlates of major depressive
disorder (MDD).ObjectiveTo present nationally representative data on prevalence and correlates
of MDD by Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) criteria, and on study
patterns and correlates of treatment and treatment adequacy from the recently
completed National Comorbidity Survey Replication (NCS-R).DesignFace-to-face household survey conducted from February 2001 to December
2002.SettingThe 48 contiguous United States.ParticipantsHousehold residents ages 18 years or older (N = 9090) who responded
to the NCS-R survey.Main Outcome MeasuresPrevalence and correlates of MDD using the World Health Organization's
(WHO) Composite International Diagnostic Interview (CIDI), 12-month severity
with the Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR),
the Sheehan Disability Scale (SDS), and the WHO disability assessment scale
(WHO-DAS). Clinical reinterviews used the Structured Clinical Interview for DSM-IV.ResultsThe prevalence of CIDI MDD for lifetime was 16.2% (95% confidence interval
[CI], 15.1-17.3) (32.6-35.1 million US adults) and for 12-month was 6.6% (95%
CI, 5.9-7.3) (13.1-14.2 million US adults). Virtually all CIDI 12-month cases
were independently classified as clinically significant using the QIDS-SR,
with 10.4% mild, 38.6% moderate, 38.0% severe, and 12.9% very severe. Mean
episode duration was 16 weeks (95% CI, 15.1-17.3). Role impairment as measured
by SDS was substantial as indicated by 59.3% of 12-month cases with severe
or very severe role impairment. Most lifetime (72.1%) and 12-month (78.5%)
cases had comorbid CIDI/DSM-IV disorders, with MDD
only rarely primary. Although 51.6% (95% CI, 46.1-57.2) of 12-month cases
received health care treatment for MDD, treatment was adequate in only 41.9%
(95% CI, 35.9-47.9) of these cases, resulting in 21.7% (95% CI, 18.1-25.2)
of 12-month MDD being adequately treated. Sociodemographic correlates of treatment
were far less numerous than those of prevalence.ConclusionsMajor depressive disorder is a common disorder, widely distributed in
the population, and usually associated with substantial symptom severity and
role impairment. While the recent increase in treatment is encouraging, inadequate
treatment is a serious concern. Emphasis on screening and expansion of treatment
needs to be accompanied by a parallel emphasis on treatment quality improvement.

/pdf/the-epidemiology-of-major-depressive-disorder-results-from-2kfxdgis3p.pdf

The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).

Without epithelial–mesenchymal transitions, in which polarized epithelial cells are converted into motile cells, multicellular organisms would be incapable of getting past the blastula stage of embryonic development. However, this important developmental programme has a more sinister role in tumour progression. Epithelial–mesenchymal transition provides a new basis for understanding the progression of carcinoma towards dedifferentiated and more malignant states.

Epithelial–mesenchymal transitions in tumour progression

The prevalence of comorbid alcohol, other drug, and mental disorders in the US total community and institutional population was determined from 20 291 persons interviewed in the National Institute of Mental Health Epidemiologic Catchment Area Program. Estimated US population lifetime prevalence rates were 22.5% for any non—substance abuse mental disorder, 13.5% for alcohol dependence-abuse, and 6.1% for other drug dependence-abuse. Among those with a mental disorder, the odds ratio of having some addictive disorder was 2.7, with a lifetime prevalence of about 29% (including an overlapping 22% with an alcohol and 15% with another drug disorder). For those with either an alcohol or other drug disorder, the odds of having the other addictive disorder were seven times greater than in the rest of the population. Among those with an alcohol disorder, 37% had a comorbid mental disorder. The highest mental-addictive disorder comorbidity rate was found for those with drug (other than alcohol) disorders, among whom more than half (53%) were found to have a mental disorder with an odds ratio of 4.5. Individuals treated in specialty mental health and addictive disorder clinical settings have significantly higher odds of having comorbid disorders. Among the institutional settings, comorbidity of addictive and severe mental disorders was highest in the prison population, most notably with antisocial personality, schizophrenia, and bipolar disorders. (JAMA. 1990;264:2511-2518)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=383975&pdfFileName=jama_264_19_026.pdf

Comorbidity of Mental Disorders With Alcohol and Other Drug Abuse. Results From the Epidemiologic Catchment Area (ECA) Study

In February 2016, the Ovarian Cancer Research Fund Alliance convened a group of 25 scientists, clinicians, and advocates to meet at the Banbury Center, Cold Spring Harbor Laboratory, to discuss the recent results from the United Kingdom Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and implications for clinical practice and public health. Ovarian cancer is a relatively rare type of cancer that affects approximately 1.5% of U.S. women during their lifetime, but it is the fifth most common cause of cancer death among women.1 The five-year survival rate is only about 45% because most women present with advanced-stage disease.1 There has not been an accepted early detection test because of a lack of evidence that any screening approach reduces death from ovarian cancer. At the time of the conference, no organization had issued a guideline recommending screening for ovarian cancer in women not at increased risk. The current recommendations against screening for ovarian cancer are based on the large U.S. prospective randomized Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.2 The PLCO trial demonstrated that an annual cancer antigen (CA) 125 measurement (using a fixed cutoff value for a positive test result) and ultrasonography were not associated with a reduction in mortality from ovarian cancer. Furthermore, screening was associated with significant harms resulting from surgeries that were triggered by false-positive findings. In December 2015, the results of the UKCTOCS trial were reported in The Lancet.3 This landmark study included approximately 200,000 healthy postmenopausal women, of whom one-half were randomized to no screening, one-fourth were randomized to receive annual pelvic ultrasonography, and one-fourth were randomized to multimodal screening (MMS). In contrast to the PLCO approach, MMS involves a risk of ovarian cancer algorithm (ROCA) that assigns a level of risk based on an individual woman’s CA 125 levels and changes over time combined with her age and known risk factors for ovarian cancer. Based on these findings, further CA 125 testing and ultrasonography may be required. The primary analysis suggested a nonsignificant mortality reduction over years 0 to 14 of 15% (95% confidence interval, –3 to 30; P = .10) in the MMS arm vs. the usual care arm. However, the reduction in mortality was not constant over time, appearing only after seven to 10 years of screening. Compared with annual, fixed-cutoff CA 125 levels and ultrasonography, as were studied in the PLCO trial, the MMS algorithm was more sensitive and led to fewer unnecessary surgeries. The UKCTOCS trial demonstrated a stage shift in which more cases were diagnosed at an early stage with the MMS approach (40%) compared with women in the nonscreened (usual care) group (26%). There was no stage shift observed for the group receiving ultrasonography alone. Additional exploratory analysis suggested even more encouraging, though as yet inconclusive, evidence of the potential for a greater mortality reduction in the MMS group. As stated in The Lancet UKCTOCS paper, “further follow-up is needed before firm conclusions can be reached on the efficacy and cost-effectiveness of ovarian cancer screening.”3 The consensus of the Banbury group is in accord with the published conclusions of the UKCTOCS trial: It is premature to recommend MMS for the early detection of ovarian cancer at this time. Although women and health care professionals may look to these findings as finally providing a strategy for successful screening for ovarian cancer, Editorials

What women and their physicians need to know about the UKCTOCS study and ovarian cancer screening

INVITEDEDITORIAL Inherited Predisposition toBreast andOvarian Cancer

Background: Lung cancer remains the leading cause of cancer death in the United States. Non-small cell lung cancer (NSCLC) comprises 85% of cases and small cell lung cancer (SCLC) comprises most of the remainder. Molecular profiling has drastically changed the landscape in regard to treating lung cancer and has become standard practice in management. Mutations in epidermal growth factor receptor (EGFR) are well studied and can be targeted using tyrosine kinase inhibitors providing new treatment opportunities for lung cancer. We present a unique case of synchronous malignancies with a possible common origin from a molecular perspective. 

A case report of EGFR L861Q mutation in synchronous de novo small cell and non-small cell lung cancer: molecular interrogation identifies origin and potential options for targeted therapy

Purpose: The aims of this study were to determine the incidence of BRCA mutations among Ashkenazi Jewish patients with fallopian tube carcinoma (FTC) or primary peritoneal carcinoma (PPC), to study the clinicopathologic features of these cancers, and to estimate the risks of these cancers in association with a BRCA mutation. Patients and Methods: A retrospective review at two institutions identified 29 Jewish patients with FTC and 22 Jewish patients with PPC. These patients were genotyped for the three Ashkenazi Jewish BRCA founder mutations (185delAG and 5382insC in BRCA1 and 6174delT in BRCA2). Surgical and pathologic information, family history, and survival data were obtained from hospital records. All statistical tests were two sided. Results: Germline BRCA mutations were identified in five of 29 patients with FTC (17%) and nine of 22 patients with PPC (41%). Mutation carriers had a younger mean age at diagnosis than patients without a mutation (60 v 70 years; P .002). The overall median survival was 148 months for mutation carriers and 41 months for patients without a mutation (P .04). For BRCA mutation carriers, the lifetime risks of FTC and PPC were 0.6% and 1.3%, respectively. Conclusion: Substantial proportions of Ashkenazi Jewish patients with FTC or PPC are BRCA mutation carriers. Patients with BRCA-associated FTC or PPC are younger at diagnosis and have improved survival compared with patients without a BRCA mutation. Although the lifetime risks of FTC or PPC for patients with BRCA heterozygotes are greater than those for the general population, the absolute risks seem relatively low. J Clin Oncol 21:4222-4227. © 2003 by American Society of Clinical Oncology.

Fallopian T ube a nd P rimary P eritoneal C arcinomas A ssociated With BRCA Mutations

This study is the first to examine the genetic risk in a breast cancer-prone family wherein two of three triplet sisters and their mother manifested breast cancer. The unaffected triplet, the proband, was found to be monozygotic with her deceased sister through DNA testing of tumor blocks and dizygotic to her living affected sister. Genetic counseling implications are discussed.

Jeff Boyd

Papers

What women and their physicians need to know about the UKCTOCS study and ovarian cancer screening

INVITEDEDITORIAL Inherited Predisposition toBreast andOvarian Cancer

A case report of EGFR L861Q mutation in synchronous de novo small cell and non-small cell lung cancer: molecular interrogation identifies origin and potential options for targeted therapy

Fallopian T ube a nd P rimary P eritoneal C arcinomas A ssociated With BRCA Mutations

Breast cancer and importance of zygosity determination in triplet sisters