Showing papers by "American Cancer Society published in 1995"

Cancer statistics, 1995

Abstract: The American Cancer Society's Department of Epidemiology and Statistics reports its 29th annual compilation of cancer incidence, survival and mortality data for the United States and around the world.

Efficacy of breast cancer screening by age. New results swedish two-county trial

Abstract: Background. Several studies have found a smaller effect of breast cancer screening on breast cancer mortality in women aged younger than 50 years compared with older women. Various possible reasons have been suggested for this, but none firmly is established. Methods. The Swedish Two-County Study is a randomized trial of breast cancer screening of women aged 40-74 years, comprising with 133,065 women with a 13-year follow-up of 2467 cancers. The Breast Cancer Detection Demonstration Project (BCDDP) is a nonrandomized screening program in the United States, with a 14-year follow-up of 3778 cancers in women aged 40-74 years. The Swedish results by age were updated. The lesser effect of screening at ages 40-49 years was investigated in terms of sojourn time (the duration of the preclinical but detectable phase) size, lymph node status, and histologic type of the tumors diagnosed in the Swedish Study and their subsequent effect on survival using survival data from both studies. Results. In the Swedish Trial, a 30% reduction in mortality associated with the invitation to screening of women aged 40-74 years was maintained after 13-years of follow-up. The reduction was 34% for women aged 50-74 years and 13% for women aged 40-49 years. Results indicated that the reduced effect on mortality for women aged 40-49 years was due to a differential effect of screening on the prognostic factors of tumor size, lymph node status, and histologic type. The mean sojourn times in the age groups 40-49 years, 50-59 years, 60-69 years, and 70-74 years were 1.7, 3.3, 3.8, and 2.6 years, respectively. Conclusions. These results suggest that much, although not all, of the smaller effect of screening on mortality in women aged 40-49 years is due to faster progression of a substantial proportion of tumors in this age group and the rapid increase in incidence during this decade of life. It is concluded that the interval between screenings should be shortened to achieve a greater benefit in this age group. It is estimated that a 19% reduction in mortality would result from an annual screening regime. Cancer 1995 ;75 :2507-17.

Prospective Study of Intentional Weight Loss and Mortality in Never-Smoking Overweight US White Women Aged 40–64 Years

Abstract: Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.

Estrogen Replacement Therapy and Risk of Fatal Colon Cancer in a Prospective Cohort of Postmenopausal Women

Abstract: BACKGROUND The results of several recent epidemiologic studies suggest that estrogen replacement therapy (ERT) in postmenopausal women may decrease their risk of subsequently developing colon or colorectal cancer. However, the association is not clear, as other similar studies have failed to show this inverse relationship. PURPOSE The present study attempts a more definitive analysis of the relationship between fatal colon cancer and use of ERT among women in a large prospective study of adults in the United States. METHODS Women were selected for study from the 676,526 female participants in Cancer Prevention Study II (CPS-II), a prospective mortality study of about 1.2 million American men and women (from all 50 states, the District of Columbia, and Puerto Rico), begun by the American Cancer Society in 1982. The median age of the female CPS-II participants was 56 years in 1982. Vital status was determined through December 31, 1989; 630,585 participants (93.2%) were still alive and 43,862 (6.5%) had died after 7 years of follow-up. Death certificates were obtained for 96.2% of participants known to have died. At the end of follow-up, 897 colon cancer deaths were observed in a cohort of 422,373 postmenopausal women who were cancer free at study entry. Cox proportional hazards modeling was used to compute rate ratios (RRs) and to adjust for other potential risk factors. The likelihood ratio test (two-sided) was used to determine the statistical significance of the interaction terms. RESULTS Ever use of ERT was associated with significantly decreased risk of fatal colon cancer (RR = 0.71; 95% confidence interval [CI] = 0.61-0.83). The reduction in risk was strongest among current users (RR = 0.55; 95% CI = 0.40-0.76), and there was a significant (P = .0001) trend of decreasing risk with increasing years of use among all users: Users of 1 year or less had an RR of 0.81 (95% CI = 0.63-1.03), while users of 11 years or more had an RR of 0.54 (95% CI = 0.39-0.76). These associations were not altered in multivariate analyses controlling for other risk factors. CONCLUSIONS In our data, estrogen therapy, particularly recent and long-term use, was associated with a substantial decrease in risk of fatal colon cancer. These results were consistent with several published studies suggesting a protective role of exogenous estrogens in the development of colorectal cancer and merit further investigation.

Benefit of mammography screening in women ages 40 to 49 years. Current evidence from randomized controlled trials

Abstract: Background. Eight randomized controlled trials (RCTs) of screening mammography were conducted involving women ages 40 to 49 years at entry. Current data gathered for periods ranging from 7 to 18 years of follow-up are available from these trials. Methods. Meta-analyses were performed using a Mantel-Haenszel estimator method to combine current follow-up data from the eight RCTs of mammography that included women ages 40 to 49 years. Results. Combining all current data on women ages 40 to 49 years at entry into the trials yielded a 14% benefit from screening mammography, without statistical significance at the 95% confidence level. Combining all data on women ages 40 to 49 years at entry, excluding results from the Canadian National Breast Screening Study, yielded a 23% benefit to women invited for screening, with statistical significance at the 95% confidence level. Conclusions. These results suggest that screening mammography in women ages 40 to 49 years at entry can reduce mortality from breast cancer when combined with adequate follow-up. Cancer 1995;75:1619-26.

Excess mortality among cigarette smokers: changes in a 20-year interval.

Abstract: OBJECTIVES: This study was undertaken to examine changes in smoking-specific death rates from the 1960s to the 1980s. METHODS: In two prospective studies, one from 1959 to 1965 and the other from 1982 to 1988, death rates from lung cancer, coronary heart disease, and other major smoking-related diseases were measured among more than 200,000 current smokers and 480,000 lifelong non-smokers in each study. RESULTS: From the first to the second study, lung cancer death rates (per 100,000) among current cigarette smokers increased from 26 to 155 in women and from 187 to 341 in men; the increase persisted after current daily cigarette consumption and years of smoking were controlled for. Rates among nonsmokers were stable. In contrast, coronary heart disease and stroke death rates decreased by more than 50% in both smokers and nonsmokers. The all-cause rate difference between smokers and nonsmokers doubled for women but was stable for men. CONCLUSIONS: Premature mortality (the difference in all-cause death rate...

Is there really a difference in survival of women with squamous cell carcinoma, adenocarcinoma, and adenosquamous cell carcinoma of the cervix?

Abstract: Background. The authors' aim was to assess whether there is a difference in biologic behavior and survival in comparing adenocarcinoma (AdCA), squamous cell carcinoma (SCC), and adenosquamous carcinoma (Ad/SC) of the cervix. Methods. Cancer registrars at 703 hospitals submitted anonymous data on 11,157 patients with cervical cancer diagnosed and/or treated in 1984 and 1990 for a Patient Care Evaluation Study of the American College of Surgeons. Among these patients, 9351 (83.8%) had SCC ; 1405 (12.6%), AdCA ; and 401 (3.6%), Ad/SC cancers. There were no significant changes in percentages of the different histologic types between the study years 1984 and 1990, nor was the patient distribution different regarding age, race/ethnicity, and socioeconomic background for each histologic group. Furthermore, the distribution of patients who had had a hysterectomy did not change between 1984 and 1990. Results. A larger percent of patients with SCC (63.8%) than those with Ad/SC (59.8%) or AdCA (50.2%) had tumors larger than 3 cm at greatest dimension. Early stage patients (IA, IB, IIA) often were treated by hysterectomy alone (45.5%) or combined with radiation (21.1%). The remaining patients (21.9%) received radiation alone. Of the patients with clinical stage I disease, 7.6% of Ad/CA patients, 15.5% of Ad/SC patients and 12.6% of SCC patients had positive nodes. Although patients with SCC had higher survival rates for all four clinical stages (I-IV), the differences were only significant for Stage II patients. Patients with clinical stage IB SCC and AdCA treated by surgery alone were found to have significantly better survival rates (93.1% and 94.6% at 5 years, respectively) than women treated by either radiation alone or a combination of surgery and radiation (P < 0.001, both histologic comparisons). For women with Ad/SC tumors, however, the 5-year survival rate was 87.3% for those receiving combined treatment compared with those receiving surgery alone (69.2%) or radiation alone (79.2%). However, these survival curves were not significantly different (P = 0.496). One hundred six patients with positive nodes were available for analysis. The 5-year survival rate of patients with SCC and positive nodes was 76.1%. Surprisingly, patients with Ad/SC and positive nodes had the highest 5-year survival rate (85.7%), whereas, women with AdCA and positive nodes had a sharply reduced 5-year survival rate (33.3%). The curves were significantly different (P < 0.01). For patients with clinical stage I, the risk factors for age, tumor size, nodal status, histologic features, and treatment were analyzed with Cox's multivariate regression. In this analysis, subset IB, greater tumor size, age 80 or older, and positive nodal status were each independently significant for poorer survival. Patients who were treated by surgery alone had a significantly better survival than patients who had other types of treatment or no treatment. Histologic characteristics had no significant effect on survival. In the analysis of patients with pathologic stage I disease, those with SCC had significantly poorer survival and those with Ad/SC had significantly better survival than patients with Ad/CA. Positive nodes had no significant independent effect on survival. In another analysis, tissue type was not found to be an important factor in recurrence time.

Estrogen replacement therapy and fatal ovarian cancer.

Abstract: The authors examined the relation between use of estrogen replacement therapy and ovarian cancer mortality in a large prospective mortality study of 240,073 peri- and postmenopausal women, none of whom had a prior history of cancer, hysterectomy, or ovarian surgery at enrollment in 1982. During 7 years of follow-up, 436 deaths from ovarian cancer occurred. Cox proportional hazard regression was used to adjust for other risk factors. Ever use of estrogen replacement therapy was associated with a rate ratio for fatal ovarian cancer of 1.15 (95% confidence interval (CI) 0.94-1.42). The mortality rate ratio increased with duration of use prior to entry to this study to 1.40 (95 CI% 0.92-2.11) with 6-10 years of use and 1.71 (95% CI 1.06-2.77) with > or = 11 years of use. The increase in mortality associated with > or = 6 years of use was observed in both current users (rate ratio (RR) = 1.72, 95% CI 1.01-2.90) and former users at study entry (RR = 1.48, 95% CI 0.99-2.22), relative to never users. Risk associated with use was not modified by any of the other risk factors. These data suggest that long-term use of estrogen replacement therapy may increase the risk of fatal ovarian cancer.

The current status of the Papanicolaou smear

Abstract: Since its introduction as a screen for cervical cancer in the late 1940s, the Pap smear has become one of the most widely accepted screening procedures for cancer. Numerous scientific studies have now attested to its effectiveness. However, important issues related to the Pap smear, including cytologic nomenclature, accuracy, regulatory procedures, and screening guidelines, are still being evaluated and debated. This article provides an overview of important issues related to the Pap smear.

Occupation and the risk of malignant melanoma

Abstract: Background. The incidence of malignant melanoma is increasing rapidly. The risk for development of malignant melanoma has been reported to be higher in persons of higher socioeconomic status. Methods. This case-control study explores the relation between occupation and malignant melanoma relative risk through analysis of data collected by the American Cancer Society. A total of 1.2 million people were enrolled in a study of lifestyles and environmental factors in relation to mortality from cancer and other diseases. A total of 2780 persons had a history of malignant melanoma when the study began or developed malignant melanoma during the 6-year study follow-up period. The controls were matched for age, sex, race, and geographic location on an approximately 1:3 basis to persons selected from the remaining people enrolled. Results. In men, malignant melanoma risk was significantly higher in high-paying versus low-paying occupations (odds ratio [OR], =1.58; P<0.001) and in white-collar versus blue-collar occupa ions (OR=1.33; P<0.001). No significant conclusions could be drawn for women. No significant difference in risk was noted between those with indoor versus outdoor occupations. Among specific occupational exposures, only exposure to X-rays significantly raised malignant melanoma risk (OR=1.37; P=0.002). Conclusion. Upper pay scale and white-collar occupations significantly increase the risk for development of malignant melanoma

Prospective study of combination chemotherapy with cyclophosphamide, doxorubicin, and cisplatin for unresectable or metastatic malignant pleural mesothelioma

Abstract: Background. This study was designed to determine the efficacy and side effects of a combination of cyclophosphamide (C), doxorubicin (D), and cisplatin (P) in patients with inoperable, unresectable, or metastatic malignant pleural mesothelioma. Methods. Twenty-three patients with unresectable or metastatic malignant pleural mesothelioma were entered onto the study. The median age was 62 years (range, 42-74 years); there were 20 males and 3 females; the median performance status was 1 (Zubrod's scale). The histologic types included epithelial (14 patients), sarcomatoid (4 patients), unclassified (4 patients), and mixed type (1 patient). Twenty patients were known to have been exposed to asbestos and 3 were not. All patients were treated with the following starting dose of chemotherapy: a cycle comprised of C, 500 mg/m2 intravenously, day 1; D, 50 mg/m2 intravenously, day 1; and P, 80 mg/m2 intravenously, day 1 every 3 weeks. The cisplatin dose was reduced to 50 mg/m2 for the subsequent courses. For the assessment of tumor response, all patients had computed tomography scans of the chest after each three cycles of chemotherapy. Results. Overall, 7 of 23 patients (30%) had partial responses (durations of responses [weeks]: 158+, 91+, 70+, 41+, 40, 39, 25), three had minor responses, and 14 had stable or progressive disease. One partial responder later underwent surgical resection and no viable tumors cells were found in the pathologic specimen. All patients have stopped treatment, and eight are still alive. The most common side effect was granulocytopenia (grade 4, 52%; grade 3,17%). Other hematologic side effects were modest. Nonhematologic side effects included mild to moderate nausea and vomiting, neutropenic fever (three patients), peripheral neuropathy (one patient), and congestive heart failure (one patient). The overall median duration of survival was 60 weeks. Conclusion. Combination chemotherapy with CDP was well tolerated and had significant activity against unresectable or metastatic malignant pleural mesothelioma. The median duration of responses was 60 weeks; however, the survival rate was far from satisfactory. Continued development of new approaches including the biologic understanding of tumor development and testing new agents is warranted. Cancer 1995; 76:2230-6.

Lifestyle activities of the elderly: composition and determinants.

Abstract: Recent work suggests that lifestyle can be considered using a 2 x 2 model of indoor/outdoor and work/leisure activities. This paper replicates the factor analysis of the Frenchay Activities Index (FAI) reported by Bond et al., using a group of subjects living independently in the community. Results confirmed empirically the existence of the four hypothesized dimensions of lifestyle. Further analyses demonstrated the construct validity of these dimensions by establishing their sensitivity to age, sex, domestic circumstances, and physical and cognitive status. We discuss ways in which various deficiencies in the FAI might be rectified in a revised index of activities designed to retain and clarify the four established dimensions of lifestyle. Future directions include the development of such an instrument, and its application as a rehabilitation outcome measure.

Patterns of care for invasive cervical cancer. Results of a national survey of 1984 and 1990

Abstract: Background The American College of Surgeons conducted a national patient care and evaluation study of invasive cervical cancer to measure any changes in patterns of care for the years 1984 and 1990 Methods Hospitals with cancer programs were invited to submit data on up to 25 consecutive patients with newly diagnosed invasive cervical cancer for each of the two study years Data were obtained from 684 hospitals on 5904 patients diagnosed in 1984 and from 700 hospitals on 5817 patients diagnosed in 1990 A long term study of patients diagnosed in 1984 was compared with a short term study of patients diagnosed in 1990 Survival data were described only for patients diagnosed in 1984 Results Of a total of 11,721 patients, 594% were diagnosed and treated at the reporting institution in 1984 and 548% in 1990 The remaining patients were referred for treatment after diagnosis elsewhere The diagnosis was established by cervical biopsy for 698% of patients, by conization alone for 93%, and by both procedures for 118% The histopathologic diagnoses were squamous cell carcinoma (798%), adenocarcinoma (158%), and other (44%) The stage distributions were as follows : IA, 159% ; IB, 368% ; IIA, 82% ; IIB, 155% ; IIIA, 25% ; IIIB, 133% ; IVA, 26% ; and IVB, 52% The stage was listed as unknown for 203% of patients Patients were treated with surgery alone (292%), radiation alone (407%), chemotherapy alone (07%), or combination therapy (215%), and 79% received no treatment at the reporting institution The overall survival for patients diagnosed in 1984 was 683% Survival by stage in this group was as follows : IA, 937% ; IB, 800% ; IIA, 672% ; IIB, 647% ; III, 379% ; and IV, 113% Conclusions These data indicate that invasive cervical cancer is highly curable when diagnosed early During the 5-year period, stage distributions were similar, the use of extended hysterectomy increased, and gynecologic oncologists were more often the primary surgeons The use of radiation alone decreased

Perspectives on cancer prevention

Abstract: The best way to control cancer is to find means to reduce the risk of cancer. Mr. Garfinkel, the former Vice President for Epidemiology and Statistics and Director of Cancer Prevention for the American Cancer Society, discusses the ongoing research on cancer prevention and suggests that based on the accumulated evidence, authoritative groups must now seriously consider making recommendations about chemopreventive substances to reduce cancer risk.

Spontaneous abortion and risk of fatal breast cancer in a prospective cohort of United States women.

Abstract: Controversy exists over the possible relationship between induced and spontaneous abortion and risk of breast cancer. Thus, the association of fatal breast cancer and spontaneous abortion was examined in a large prospective study of United States adult women. After seven years of follow-up, 1,247 cases of fatal breast cancer were observed among 579,274 women who were cancer-free at interview in 1982 and who provided complete reproductive histories. Results from Cox proportional hazards models, adjusted for other risk factors, showed no association between a history of spontaneous abortion and risk of fatal breast cancer (rate ratio [RR]=0.89, 95 percent confidence interval [CI]=0.78–1.02). The RR did not increase with increasing numbers of abortions. Parous women who had a spontaneous abortion before their first term birth were not at increased risk compared with parous women with no history of spontaneous abortion (RR=0.76, CI=0.54–1.05). Women whose only pregnancy ended in a spontaneous abortion were not at increased risk compared with women who were never pregnant (RR=0.61, CI=0.27–1.38) or whose only pregnancy ended in a livebirth (RR=0.72, CI=0.32–1.65). These findings do not support an association between spontaneous abortion and fatal breast cancer.

Health Effects of Tobacco Use: Global Estimates and Projections

Abstract: Over the last few years, the University of Oxford, the World Health Organization, and the American Cancer Society have been collaborating on the quantification of tobacco-attributable mortality in counties with reliable data. It is widely known that smoking is hazardous, but few people understand just how great the risks of smoking are. In order to better inform the public health authorities and tobacco control advocates about the magnitude of these risks in their countries, a method has been developed to estimate deaths from smoking indirectly, based on national vital registration data on causes of death. The details of, and preliminary results from the application of this method to the developed countries, were published in The Lancet in 19921. Revised projections for 1995, together with much more detail for individual countries were published in a book which was made available to all delegates to the Paris Conference2. This chapter reproduces selected material from that book.

Estrogen Replacement Therapy and Fatal Ovarian Cancer

Abstract: The authors examined the relation between use of estrogen replacement therapy and ovarian cancer mortality in a large prospective mortality study of 240,073 peri- and postmenopausal women, none of whom had a prior history of cancer, hysterectomy, or ovarian surgery at enrollment in 1982. During 7 years of follow-up, 436 deaths from ovarian cancer occurred. Cox proportional hazard regression was used to adjust for other risk factors. Ever use of estrogen replacement therapy was associated with a rate ratio for fatal ovarian cancer of 1.15 (95% confidence interval (CI) 0.94-1.42). The mortality rate ratio increased with duration of use prior to entry to this study to 1.40 (95 CI% 0.92-2.11) with 6-10 years of use and 1.71 (95% CI 1.06-2.77) with > or = 11 years of use. The increase in mortality associated with > or = 6 years of use was observed in both current users (rate ratio (RR) = 1.72, 95% CI 1.01-2.90) and former users at study entry (RR = 1.48, 95% CI 0.99-2.22), relative to never users. Risk associated with use was not modified by any of the other risk factors. These data suggest that long-term use of estrogen replacement therapy may increase the risk of fatal ovarian cancer.