Showing papers by "Leslie G. Ford published in 1994"
TL;DR: The level of consensus among community physicians in four specialties about the performance of and appropriate intervals for screening for early detection of cancers of the breast, cervix, colon and rectum, and lung in asymptomatic patients at normal risk is examined.
Abstract: Objective: To assess factors related to consensus among community physicians regarding appropriate screening intervals for eight cancer screening procedures for which guidelines have been published...
82 citations
Journal Article•
TL;DR: A placebo-controlled randomized trial using finasteride, an inhibitor of the enzyme that converts testosterone to dihydrotestosterone, is planned and the endpoint of this trial will be reduction of prostate cancer incidence.
Abstract: Studies of prostate biology support the concept that dihydrotestosterone is the principal androgen responsible for normal and hyperplastic growth of the prostate gland. Cancer is a process of malignant transformation evolving over time, involving cellular growth and division. Therefore, an altered endocrine state, such as suppression of dihydrotestosterone activity, may have an impact on prostate cells inhibiting carcinogenic transformation. In vitro and in vivo preclinical observations support this hypothesis. A placebo-controlled randomized trial using finasteride, an inhibitor of the enzyme that converts testosterone to dihydrotestosterone, is planned. The endpoint of this trial will be reduction of prostate cancer incidence.
76 citations
TL;DR: Findings suggest that the Clinical Alert mechanism, followed by publication in the peer-reviewed scientific literature, is an effective way to communicate important research findings to practitioners in the community.
Abstract: PURPOSEThis study evaluates the effect of the 1988 National Cancer Institute Clinical Alert regarding treatment of early-stage breast cancer on the patterns of treatment provided to patients.PATIENTS AND METHODSData analyzed were collected from the hospital and outpatient records of 12,534 female patients with a primary diagnosis of breast cancer (stages I and II) initially diagnosed during the years 1983 through 1989.RESULTSAnalyses revealed that the proportions of patients with a negative lymph node status diagnosed after the May 1988 Clinical Alert who received adjuvant treatment (tamoxifen and/or multidrug chemotherapy) were significantly greater than predicted from treatment trends established before the Alert's release. Proportions of patients with positive lymph node status receiving adjuvant therapy subsequent to the Alert's release, in contrast, did not fall outside the projected confidence intervals for that group. Additional analyses showed a significant effect of the Clinical Alert among sever...
26 citations
TL;DR: Clinical trials involving hormonal manipulation and cancer prevention have the potential of providing critical information about cancer risk, etiology, screening, and genetics, as well as quantifying the risks and benefits of specific preventive interventions.
Abstract: Breast and prostate cancer are significant causes of morbidity and mortality and are very similar in etiology, epidemiology, and modalities of treatment. Investigational strategies in the prevention of these malignancies also have strong parallels. The National Cancer Institute is sponsoring several large scale clinical trials involving hormonal manipulation and cancer prevention. In the Breast Cancer Prevention Trial, 16,000 women at high risk for breast cancer are being randomized to receive the antiestrogen agent tamoxifen or placebo for 5 years in an effort to determine if breast cancer development can be inhibited. In a similar trial, the Prostate Cancer Prevention Trial, 18,000 men older than 55 years of age will be randomized to receive finasteride, a 5-alpha-reductase inhibitor, or placebo to determine if inhibition of dihydrotestosterone synthesis in the prostate over a prolonged period will lead to a decreased incidence of prostate cancer. Both clinical trials offer the possibility of demonstrating that a hormonal intervention can decrease an individual's risk of developing breast or prostate cancer. They also have the potential of providing critical information about cancer risk, etiology, screening, and genetics, as well as quantifying the risks and benefits of specific preventive interventions.
23 citations
TL;DR: An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians, and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials.
Abstract: Clinical judgment is increasingly being challenged by the need for randomized clinical trials. The 1987 National Cancer Institute mandate - that the Community Clinical Oncology Program (CCOP) accrue patients to cancer control protocols- provided an opportunity to examine the factors that affect accrual performance. An analysis of 52 CCOPs and their research bases participating in the program found that the availability of protocols, involvement with research base activities, a demonstrated link to community physicians (particularly those physicians, such as surgeons, who had access to patients), and the use of personal contacts to inform non-CCOP physicians about CCOP activities were important facilitating factors for accruing patients to cancer prevention and control trials
13 citations
Journal Article•
TL;DR: Analysis of the CCOP data reveals that there are similarities in the factors that prove to be effective for accrual to both types of protocols; however, the two are not isomorphic.
Abstract: Using data collected as part of a larger evaluation of the National Cancer Institute-funded Community Clinical Oncology Program (CCOP), this paper examines the degree to which selected community, interorganizational, and structural characteristics associated with accrual to cancer treatment protocols share equal importance in accruing patients to cancer prevention and control research protocols. Analysis reveals that there are similarities in the factors that prove to be effective for accrual to both types of protocols; however, the two are not isomorphic. CCOP structure was an important predictor of treatment accrual but was not significant for cancer control accrual. Variables measuring the community health resources available to the CCOP were not significant for either treatment or cancer prevention and control research accrual when CCOP structure and interaction with participating research bases were considered. Only CCOP interaction with participating research bases was a significant predictor of both treatment and cancer prevention and control research accrual. The policy implications of these findings are discussed.
11 citations
TL;DR: The National Cancer Institute's (NCI) chemoprevention plan employs a strategy of basic and epidemiologic studies, followed by a structured preclinical process to bringChemopreventive agents into clinical testing.
Abstract: The National Cancer Institute's (NCI) chemoprevention plan employs a strategy of basic and epidemiologic studies, followed by a structured preclinical process to bring chemopreventive agents into clinical testing. The field of chemoprevention is progressing rapidly and has reached the point where a coordinated international approach for large-scale trials would be useful. At present, NCI is sponsoring nine large trials (over $1 million per year per trial); in addition, nine agents are in phase I or II clinical testing. A number of these agents should be ready soon for phase III testing. Resources required for large-scale trials compel greater attention to efficient trial design, concept development and review, priority setting, management, budgeting, and collaboration.
2 citations