Showing papers by "American Cancer Society published in 1993"

Aspirin Use and Risk of Fatal Cancer

Abstract: Aspirin and other nonsteroidal antiinflammatory drugs inhibit prostaglandin synthesis and tumor growth in many experimental systems, but it is unclear which of these tumor models are relevant to humans. We have reported reduced risk of fatal colon cancer among persons who used aspirin in a large prospective study. This analysis examines other fatal cancers in relation to aspirin among 635,031 adults in that study who provided information in 1982 on the frequency and duration of their aspirin use and did not report cancer. Death rates were measured through 1988. Death rates decreased with more frequent aspirin use for cancers of the esophagus, stomach, colon, and rectum but not generally for other cancers. For each digestive tract cancer, death rates were approximately 40% lower among persons who used aspirin 16 times/month or more for at least 1 year compared to those who used no aspirin. The trend of decreasing risk with more frequent aspirin use was strongest among persons who had used aspirin for 10 years or more; it remained statistically significant, except for esophageal cancer, in multivariate analyses that adjusted for other known risk factors. Biases such as early detection or aspirin avoidance among cases do not appear to explain the results. Our data suggest that regular, prolonged use of aspirin may reduce the risk of fatal cancer of the esophagus, stomach, colon, and rectum. Future epidemiological and basic research should examine all digestive tract cancers in considering the chemopreventive or therapeutic potential of nonsteroidal antiinflammatory drugs.

Demographic predictors of mammography and Pap smear screening in US women.

Abstract: OBJECTIVES. Proven screening technologies exist for both breast and cervical cancer, but they are underused by many women. We sought to evaluate the effect of demographic characteristics on the underuse of mammography and Pap smear screening. METHODS. We analyzed responses from 12,252 women who participated in the 1987 National Health Interview Survey Cancer Control Supplement. Demographic profiles were produced to target severely underserved groups of women. RESULTS. Low income was a strong predictor of mammography underuse, as was Hispanic ethnicity and other race, low educational attainment, age greater than 65, and residence in a rural area. A strong predictor of never having had a Pap smear was never having been married; however, the importance of this characteristic is difficult to interpret in the absence of data on sexual activity. Hispanic women and women of other races of all ages and all income levels underused Pap smear screening, as did older women, particularly older Black women. CONCLUSIONS...

Utility of the National Death Index for Ascertainment of Mortality among Cancer Prevention Study II Participants

Abstract: This paper reports the results of testing and using the National Death Index to ascertain vital status in the American Cancer Society's prospective cohort study, Cancer Prevention Study II. This cohort of over one million men and women, enrolled by volunteers in 1982, is one of the largest ever to be linked with the National Death Index. In a linkage of over 15,000 persons whose vital status through 1988 had been traced through manual follow-up, 93% of all known deaths were ascertained. Sensitivity varied by demographic factors (race, sex) and availability of identifying information (Social Security number, middle initial). When the Social Security number was available, 97% of known deaths were accurately identified. A computerized matching algorithm was used to minimize manual review of records. With this method, the authors were able efficiently and accurately to reject the many false-positive matches while maintaining a reasonable level of manual record review and death certificate acquisition, thus allowing for continued automated follow-up of this valuable cohort.

Cancer in Adolescents and Young Adults

Abstract: Adolescent cancer patients present a unique challenge to health care professionals because of the impact of the disease and its treatment on the successful acquisition of age-appropriate developmental milestones, as well as the psychosocial concerns raised by the illness itself. Understanding normal adolescent development provides a framework for identifying psychosocial concerns, predicting problems, and developing appropriate interventional strategies for adolescents with cancer. A comprehensive support program with specific goals of promoting adjustment to the illness and providing a basis for community reentry by strengthening recognized coping strategies based on identified psychosocial concerns is described as a model. Cancer 1993; 71:3276-80.

Estrogen receptor, progesterone receptor, and HER-2/neu protein in breast cancers from pregnant patients

Abstract: Background. Because the occurrence of breast cancer during pregnancy is uncommon and because the high levels of estrogens and progestins associated with pregnancy could cause false-negative results from ligand binding assays (LBA), the actual incidence of steroid hormone receptor positivity in tumors from this subset of women is unclear. Methods. Estrogen receptor (ER) and progesterone receptor (PgR) were determined using LBA methods in 15 tumors from 15 pregnant patients with breast cancer. In addition, immunohistochemistry was done for ER, PgR, pS2, heat shock protein 27 (hsp27), and HER-2/neu on 12 of the 15 tumors. Results. Five of 15 (33%) tumors were positive for ER by LBA, compared with 52% of tumors from age-matched nonpregnant patients. Six of 12 (50%) were ER-positive by immunohistochemistry. For PgR, 7 of 15 (47%) tumors were positive by LBA, compared with 42% of tumors from nonpregnant patients. Ten of 12 (83%) stained positive for PgR. By LBA, 67% of tumors studied were positive for ER or PgR or both, as opposed to 57% of tumors from the nonpregnant comparison group. Two other estrogen receptor-mediated proteins, pS2 and hsp27, were present by staining in 8 of 12 (67%) and 10 of 12 (83%) of tumors, respectively. Seven of 12 tumors (58%) had positive staining for HER-2/neu, whereas only 16% of age-matched nonpregnant patients had positive-staining tumors. Conclusion. By LBA, the incidence of ER and PgR in breast tumors from pregnant women was not significantly different from that of tumors from nonpregnant age-matched patients. Some ER-negative tumors were PgR, pS2, or hsp27 positive, indicating that an intact estrogen response system was operative although ER was not detectable by standard LBA.

Characteristics of prostate cancers detected in a multimodality early detection program

Abstract: BACKGROUND: Few data are available to describe the clinical and pathologic characteristics of prostate cancers detected through early detection programs. The American Cancer Society National Prostate Cancer Detection Project (ACS-NPCDP) is a multimodality, multicenter study of the feasibility of early prostate cancer detection using digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). One hundred fifty-six prostate cancers are available from this project for analysis. METHODS: The ACS-NPCDP is a prospective, comparative study of a cohort of 2,999 men between 55 and 70 years of age not suspected of having prostate cancer. DRE, TRUS, and PSA are performed for each subject on an annual basis for as long as 5 years. Biopsies are performed on the basis of recommendations from DRE or TRUS results. Although elevated PSA alone was not typically a basis for biopsy, in some instances biopsies were recommended because of the degree of elevation in PSA. Diagnoses are confirmed by participating pathologists and by pathologic analysis. RESULTS: A small proportion of cancers detected were advanced in terms of the clinical stage at time of diagnosis. A total of only six cancers were stage C1 to D1, and five of these were preexisting cancers detected at the first examination. Cancers detected by DRE tended to be more advanced than those found on the basis of only TRUS or PSA. A large proportion of patients received curative therapy, involving radical prostatectomy for 67.9% and radiation therapy for 17.9%. Of 100 men presumed to have organ confined disease and treated by prostatectomy, 64 actually proved to have localized cancer, a rate of upstaging of 36.0%. PSA level and PSA density were associated with the detection of organ confined cancer, but several advanced cancers had PSA levels in the normal range, limiting the usefulness of these measures for staging. CONCLUSIONS: The cancers resulting from this multimodality detection effort represented a spectrum of pathologic findings. These data, however, suggest that early detection interventions in men not suspected to have prostate cancer will yield tumors with a favorable stage distribution that are likely to benefit from treatment. Further follow-up evaluation is needed to determine whether these benefits are reflected in long-term mortality and survival experience.

Family History, Age, and Risk of Fatal Breast Cancer

Abstract: A family history of breast cancer potentially identifies women at high risk for whom mammography may be especially valuable. The authors examined the association of fatal breast cancer and family history in a large, prospective study of US adults. After 6 years of follow-up, 880 cases of fatal breast cancer were observed in a cohort of 604,412 women who were cancer free at interview in 1982. Cox proportional hazards modeling found that a family history of breast cancer in a mother or sister was significantly related to fatal breast cancer risk (rate ratio = 1.59, 95% confidence interval (CI) 1.29-1.95). The association was greatly modified by age; the rate ratio was 4.91 (95% CI 1.39-17.3) in women aged or = 70 years. Among young (aged < 50 years) women, the risk associated with a positive family history was greatest if the relative was also young at the time of diagnosis (rate ratio = 5.22, 95% CI 3.00-9.11). These associations were not altered in multivariate analyses controlling for known breast cancer risk factors. In the authors' data, family history is strongly predictive of early fatal breast cancer, particularly when the disease is diagnosed before age 50 in the relative. Women with a family history of early breast cancer should receive special instructions regarding mammography and early detection.

Primary renal sarcoma in adults. A natural history and management study by the American Cancer Society, Illinois Division.

Abstract: Background. Primary renal sarcomas in adults are rare and unusual neoplasms. This study was performed to better define the natural history and current management of these sarcomas in a typical medical setting in the United States. Methods. The hospital records of 4018 adult patients with renal neoplasms treated in the state of Illinois from 1975 to 1985 were examined by American Cancer Society professional volunteers. Results. A primary renal sarcoma occurred in 34 patients (0.8% incidence). Eleven adult patients had Wilms tumor, 21 had primary renal sarcoma (47% leio-myosarcoma), and 2 were not found to have sarcoma on review. The median age of the patients with Wilms tumor was 30 years, whereas that of the patients with non-Wilms sarcoma was 65 years. Four of the patients with Wilms tumor (36%) are long-term survivors and all received adjuvant chemotherapy after radical nephrec-tomy. Six of the patients with non-Wilms sarcoma (29%) are long-term survivors after radical nephrectomy alone. Conclusions. Primary renal sarcomas, when treated with radical nephrectomy and, in the case of Wilms tumor, adjuvant chemotherapy, appear to be curable in 29–36% of cases. Histologic review of patients younger than 40 years of age with renal neoplasia is recommended.

Aggressive chemotherapy, organ-preserving surgery, and high-dose-rate remote brachytherapy in the treatment of rhabdomyosarcoma in infants and young children.

Abstract: Background. External beam radiation therapy often is avoided in the treatment of rhabdomyosarcoma (RMS) in young children because of the long-term sequelae. Conventional brachytherapy can reduce these problems, but its use is limited in young children because of radiation exposure to parents and care-givers. This is the first reported use of high-dose-rate remote brachytherapy (HDR) to treat RMS in young children. Methods. Seven young children with RMS were treated from January 1990 through September 1991 with multiagent chemotherapy, organ preserving surgery, and HDR. The primary tumor sites included the tongue, buccal mucosa, chest wall, vagina, and clitoris. A minimum peripheral dose of 36 Gy HDR was administered in 12 fractions (twice a day) at 3 Gy per fraction for a period of 8 days. The treatment was given on an outpatient basis without requiring prolonged patient sedation or immobilization. Each treatment lasted 2–5 minutes. Results. All seven children are alive and without evidence of tumor with a median follow-up of 30 months (range, 18–35 months) from diagnosis. The treatments have been reasonably well tolerated with some acute skin toxicity. There has been relatively good organ growth and function during this short follow-up period. Conclusion. The use of HDR radiation in these patients eliminated radiation exposure to care-givers and permitted constant nursing care and interaction among the parents, nursing personnel, and child. Treatments can be given on an outpatient basis, without requiring prolonged patient sedation or immobilization. Local control of tumor with preservation of organ function was achieved. HDR in young children should be restricted to controlled clinical trials until long-term morbidity and efficacy results are obtained from pilot studies.

American Cancer Society--National Prostate Cancer Detection Project. Results from multiple examinations using transrectal ultrasound, digital rectal examination, and prostate specific antigen.

Abstract: Background. The American Cancer Society-National Prostate Cancer Detection Project is a prospective study of the feasibility of early prostate cancer detection by digital rectal examination (DRE), transrectal ultrasound (TRUS), and prostate specific antigen (PSA). Two thousand nine hundred ninety-nine men not previously suspected of having prostate cancer have been entered on study in ten participating clinical centers. Methods. The study protocol requires these men to undergo testing with the three detection methods under investigation on an annual basis for up to 5 years

Adjuvant therapy for localized prostate cancer

Abstract: Background. In 1978, the National Prostatic Cancer Project launched two protocols evaluating adjuvant therapy after surgery (Protocol 900) or irradiation (Protocol 1000) for clinically localized prostate cancer. All patients underwent staging pelvic lymphadenectomy. Methods. After definitive treatment, the patients were randomized either to receive cyclophosphamide 1 g/m 2 intravenously every 3 weeks for 2 years or estramustine phosphate 600 mg/m 2 orally daily for up to 2 years or to undergo observation only

Staging Procedures, Clinical Management, and Survival Outcome for Ovarian Carcinoma

Abstract: Objective. —To evaluate the relationship between survival and patterns of clinical management for ovarian carcinoma. Design. —Retrospective analysis of cancer registry data including follow-up, operative reports, and pathology reports. Setting. —Seventy-seven Illinois hospitals with active cancer registries. Patients. —A total of 2669 women with newly diagnosed ovarian carcinoma from 1983 through 1988. Main Outcome Measures. —Frequency of use of specific staging procedures and treatment options. Survival was estimated using the Kaplan-Meier product-limit method. Results. —Thirty percent of 632 stage I patients, 31% of 233 stage II patients, and 45% of 516 stage III patients underwent hysterectomy, bilateral salpingooophorectomy, omentectomy, sampled peritoneal washings, and node biopsy. Five-year survival for those receiving this extensive surgery (who were therefore pathologically staged) was as follows: stage I, 80%; stage II, 63%; and stage III, 28%. For those not receiving this extensive surgery (who were therefore clinically staged), the 5-year survival at these stages was 76%, 62%, and 21%, respectively. The overall survival curves were not significantly different between those who were pathologically staged and those who were clinically staged forstage I patients ( P =.27) or stage II patients ( P =.47), but were for stage III patients ( P =.01). Platinum-based combination chemotherapy was given to 76% of 221 patients with pathological stage III disease. Their 5-year survival—50% for the group with no residual disease and 20% for the group with residual disease—was better than for those receiving regimens without platinum—37% and 5%, respectively, for the two groups—and the overall survival curves were significantly better for those receiving platinum ( P Conclusions. —Extensive surgery for pathological staging was not usually done for management of ovarian cancer, while platinum-based chemotherapy was commonly used. Failure to undergo extensive surgery had little impact on survival for stage I and II patients. However, use of extensive surgery and platinum-based chemotherapy improved survival for stage III patients. The improved survival for this group receiving platinum-based chemotherapy may be explained in part by selection of younger patients for this treatment. ( JAMA . 1993;269:1119-1122)

Nurses' knowledge, beliefs, and practices related to cancer prevention and detection.

Abstract: The purpose of this study was to assess the needs of nurses in the area of cancer prevention and early detection. Six parallel forms of a survey instrument were developed to assess the knowledge base, beliefs, and practices of nurses in the prevention and early detection of breast, lung, colorectal, prostate, gynecological, and skin cancers. Responses from 2,348 nurses indicated that they knew the most about prevention and early detection of breast and prostate cancer and the least about endometrial and lung cancer. When asked about specific practices, such as performing skin examinations, teaching breast self-examination, or counseling regarding smoking cessation, most nurses reported using these practices with 0-20% of their patients. Despite their apparent lack of participation in prevention and detection, the majority of nurses (66%) believe that cancer prevention is part of the role of the staff nurse. Results suggest that nurses need to be given the tools with which to perform, the knowledge and the time to participate, as well as an expectation from their employers that cancer prevention and early detection is part of their role.

Report on the American Cancer Society Workshop on Community Cancer Detection, Education, and Prevention Demonstration Projects for Underserved Populations.

Abstract: The American Cancer Society has been funding six pilot projects organized with the stated purpose of demonstrating how to implement cancer prevention and control projects for socioeconomically disadvantaged and underserved populations. This article reports on the results of a workshop held to evaluate project experiences and develop recommendations for the future.

Self-Reported Dietary Changes With Respect To American Cancer Society Nutrition Guidelines (1982-1986)

Abstract: A follow‐up study was conducted by the Illinois Division of the American Cancer Society (ACS) in conjunction with the ongoing National Cancer Prevention Study II (CPSII) to determine whether self‐report dietary changes are occurring in accordance with the ACS nutrition guidelines and to identify demographic subgroups that may be targeted for future prevention and education programs. A total of 42,300 CPSII respondents completed a 1986 questionnaire and were matched to 1982 baseline data. Dietary items were recorded as “on the average, how many days per week do you eat the following foods?” Individuals with known chronic conditions, body mass index outside a moderate range, and fewer than four completed food items were excluded. The remaining study population (n = 18,062) included men and women who were apparently healthy and primarily over the age of 50. The distribution of foods reported in 1982 and changes in foods consumed (1982–1986) among selected food groups varied modestly by sex, age, and...

Elective introduction to oncology.

Abstract: Since 1974, the St. George Medical Society, a component of the American Cancer Society's Philadelphia Division's Professional Education Program, has sponsored paid summer clinical and research fellowships for Philadelphia medical students completing their first year. Six lectures at the student level are presented throughout the year. Students run a single society, elect officers, and select site and speakers under the guidance of the St. George Medical Society Subcommittee. Faculty from six medical schools and individual faculty preceptors donate time to provide a one-on-one summer experience in medical oncology, surgical oncology, gynecologic oncology, radiation oncology, pathology, and cancer-related research in university hospitals, community hospitals, and private offices. Financial support is provided by directed donations. Currently 50 clinical fellowships are offered. Since its inception, over 750 "fellowships" have been awarded, and over 3,000 students have attended the lectures. The program successfully provides a voluntary one-on-one introduction to clinical oncology in a reproducible format.