Showing papers by "Cancer Epidemiology Unit published in 2005"

Haemorrhagic complications and the incidence of asymptomatic bleeding associated with stereotactic brain biopsies

Abstract: Object. Stereotactic brain biopsy is a routinely used technique for the diagnosis of brain lesions. Due to its minimally invasive nature, the potential risks associated with this procedure are sometimes underestimated. We have retrospectively analyzed the incidence of symptomatic and asymptomatic haemorrhagic complications associated with stereotactic biopsies. Various variables that may contribute to such complications have been retrospectively analyzed. Methods. Medical and radiological records of 355 consecutive patients who underwent a diagnostic stereotactic brain biopsy were reviewed. The incidence of haemorrhage was derived from a routine post-operative CT scan done within 90–120 minutes of the biopsy. Demographic, radiographic, pathological, and clinical data were also extracted and evaluated for their possible association with haemorrhagic complications. Results. Twenty-five patients (7%) experienced haemorrhagic complications associated with stereotactic biopsy, about half of whom (3.4%) were asymptomatic with no impact on the clinical course. Thirteen (3.6%) complications were symptomatic and two patients (0.6%) died. Lesions located in the brainstem were found to have a significantly higher rate of complications compared to other locations. No other variables, such as location, edema, number of biopsy specimens, or pre-existing neurological deficit showed a statistically significant impact on the incidence or severity of haemorrhage. Seven of the symptomatic complications occurred immediately post biopsy, but in six patients they developed within several hours and even days. The overall diagnostic yield of the biopsies was 93.8%, but was somewhat lower in patients experiencing a haemorrhagic complication. Conclusions. Stereotactic brain biopsy was associated with a low incidence of symptomatic haemorrhagic complications, morbidity and mortality, and a high diagnostic yield. About half of the haemorrhagic complications were asymptomatic. Lesions located in the brainstem had a higher rate of complications. No other clinical, radiographic, or pathological variables were found as predictors of increased risk for haemorrhage.

Risk factors for the development of second primary tumors among men after laryngeal and hypopharyngeal carcinoma.

Abstract: BACKGROUND Second primary tumors (SPT) constitute a major threat to the survival of patients with laryngeal carcinoma. However, to the authors' knowledge little is known regarding the risk factors for developing SPTs or about the strategy to be followed to avoid them. METHODS Eight hundred seventy-six male patients with laryngeal/hypopharyngeal carcinoma enrolled in a population-based, case–control study in 5 centers from South Europe during 1979–1982 were followed up to ascertain the occurrence of SPTs. Standardized incidence ratios were calculated to estimate the risk of SPT occurring in the cohort. Cox proportional hazard models were fitted to estimate the hazard ratio for development of SPTs in relation to use of tobacco smoking, alcohol consumption, and dietary habits before the first primary tumor. RESULTS One hundred forty-five patients developed an SPT with an annual average rate of 2.1%. An excess risk of developing an SPT of the tongue, mouth, esophagus, and lung was observed. No elevated risks of SPTs were observed in other organs. Alcohol consumption strongly increased the risk of developing an SPT of the upper aerodigestive tract (UADT). Heavy cumulative cigarette smoking increased the risk of developing a lung SPT. A protective effect of high intake of citrus fruit was noticed for SPT in the lung, whereas high butter intake was associated with an increased risk for SPT of the UADT. CONCLUSIONS Continuous medical surveillance was essential in the UADT and lung to reduce the risk from an SPT after initial laryngeal/hypopahryngeal carcinoma. Alcohol consumption before the first primary tumor was a risk factor for SPT of the UADT. The study suggested a protective role of citrus fruits in the development of a lung SPT. Cancer 2005. © 2005 American Cancer Society.

Familial breast cancer: Characteristics and outcome of BRCA 1-2 positive and negative cases

Abstract: The clinical and pathological characteristics and the clinical course of patients with breast cancer and BRCA 1–2 mutation are poorly known. From 1997, patients with breast cancer and a family history of breast or ovarian cancer were offered BRCA testing. The clinical and pathological features of patients with known BRCA status were retrospectively assessed and comparisons were made between cancers arising in BRCA positive and BRCA wild type (WT) patients respectively. Type of treatment, pattern of relapse, event (local relapse, contralateral breast cancer, metastases) free and overall survival were also compared in the two groups. Out of the 210 patients tested, 125 had been treated and followed-up at our Institution and were evaluated in this study. BRCA positive patients tended to be more often premenopausal (79% vs 65%) and to have positive lymphnodes (63% vs 49%), poorly differentiated tumours (76% vs 40% – p = 0.002 at univariate analysis, not significant at multivariate analysis) and negative estrogen receptors (43% vs 29%). Treatment was not different in the two groups. In the 86 BRCA-WT patients, the first event was a local relapse in 3 (3%), metachronous contralateral breast cancer in 7 (8%) and distant metastases in 16 (19%). In the 39 BRCA positive patients, the corresponding figures were 3 (8%), 8 (21%) and 3 (8%). There was no difference in event free survival, with a median of 180 months in both groups of patients. At 20 years, projected survival was 85% for BRCA positive patients and 55% for BRCA-WT, but this difference was not statistically significant. Although BRCA positive patients have more frequently negative prognostic factors, their prognosis appears to be equal to or better than in patients with BRCA-WT.

Lifestyle habits as prognostic factors in survival of laryngeal and hypopharyngeal cancer: a multicentric European study.

Abstract: Little information is available on the role of tobacco, alcohol and diet in the survival of upper aero digestive cancers. Our study analysed the survival of 931 laryngeal and hypopharyngeal cancer patients, enrolled in a population based case-control study conducted at 5 centres in southeast Europe during 1979-1982. Age at the time of diagnosis and site of origin of tumour were observed to be predictors of the survival. Cigarette smoking, and to a limited extent alcohol drinking, before the diagnosis of tumour seem to influence the overall survival whereas high intakes of vegetables and vitamin C were observed to favourably affect the prognosis. For mortality from upper aerodigestive cancer protective effects of high intakes of vegetables, fibres and vitamin C were observed. Our results support the hypothesis that there is a role for dietary intervention to improve survival of laryngeal and hypopharyngeal cancer patients.

Incidence of multiple myeloma in Olmsted County, Minnesota

Abstract: BACKGROUND Previous studies have indicated that the incidence and mortality rates for multiple myeloma have increased in the United States. The authors reported on the incidence of multiple myeloma in Olmsted County, Minnesota, between 1991 and 2001 and on trends in multiple myeloma incidence over the last 56 years. METHODS Using the files of the Mayo Clinic and the Olmsted Medical Center (Rochester, MN), the authors identified all residents of Olmsted County who had multiple myeloma, suspected myeloma, or a related disorder. Reports of all laboratory determinations, in addition to autopsy findings and death certificates, were obtained. The criteria for the diagnosis of multiple myeloma have not changed during the last 6 decades. RESULTS All but 1 of the 47 residents with multiple myeloma first diagnosed between 1991 and 2001 were recognized antemortem. Fifty-five percent had a previous monoclonal gammopathy of undetermined significance, smoldering multiple myeloma, or solitary plasmacytoma before multiple myeloma was diagnosed. From 1991 to 2001, the overall annual incidence rate, age-adjusted to the 2000 U.S. population, was 4.3 per 100,000 (95% confidence interval, 3.0–5.5 per 100,000). Poisson regression analysis showed no statistically significant trend in Olmsted County incidence rates over 56 years. In similar fashion, the authors adjusted multiple myeloma incidence rates from nine other studies worldwide for which adequate data were available and documented similar findings in each case, except for one study that included patients with smoldering multiple myeloma. CONCLUSIONS The overall incidence of multiple myeloma in Olmsted County, Minnesota, has not changed in almost 6 decades. The apparent increase in incidence elsewhere is unexplained but probably is attributable to improvements in diagnostic techniques, particularly in older patients. Cancer 2004. © 2004 American Cancer Society.

Reduced risk of prostate cancer in men who are childless as compared to those who have fathered a child: a population based case-control study.

Abstract: Androgens are believed to play a major role in the etiology of prostate cancer, but studies of sex-hormone exposure in relation to risk for prostate cancer have been inconclusive. Male fertility may be an indicator of long-term androgen status. To study the role of testicular function in prostate cancer development, we have assessed number of biological children in relation to risk for this malignancy. We carried out a population-based case-control study with retrospective ascertainment of cases occurring in Sweden between 1958-98. In total, 48,850 cases of prostate cancer were identified through the nation-wide Cancer Registry. For each case, one control, matched by year of birth, was randomly selected from the Swedish population. Information on offspring was obtained from the Swedish Multi-Generation Registry. We estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between number of offspring and risk for subsequent prostate cancer. Being childless or having fathered one child only were associated with reduced risks for prostate cancer compared to having fathered 2 or more children (OR = 0.83; 95% CI = 0.81-0.86 and OR = 0.93; 95% CI = 0.90-0.96, respectively). There was no further change in risk associated with fathering of more than 2 children. The risk for prostate cancer is reduced among childless men. A dysfunctioning reproductive apparatus fueling to a lesser extent prostatic growth, could be a plausible mechanism of this association.

Methodology of laboratory measurements in prospective studies on gene–environment interactions: The experience of GenAir

Abstract: Several large prospective investigations are under way or are planned in different parts of the world, aiming at the investigation of gene-environment interactions for chronic diseases. Technical, practical and ethical issues are raised by such large investigations. Here we describe how such issues were approached within a case-control study nested in EPIC, a large European cohort, and the kind of validation studies that have been set up. The GenAir investigation aimed at measuring the effects of air pollution and environmental tobacco smoke on human health in EPIC with a nested design and with biological measures. Validation studies included (a) comparisons between cotinine measurements, hemoglobin adducts and questionnaire data; (b) an analysis of the determinants of DNA adduct concentration; (c) comparison among different genotyping methods; (d) an analysis of the determinants of plasma DNA amounts. We also describe how the ethical issues were dealt with in our investigation.

High constant incidence rates of second cutaneous melanomas

Abstract: The incidence of most epithelial cancers rises with a power of age. However, second breast cancers have a high constant incidence independent of age. The skin is one of the few other sites allowing examination of age incidence curves of second neoplasms of the same organ. We considered the risk of second primary cutaneous malignant melanoma (CMM) in a population-based series of 3,439 first CMM registered and followed-up between 1974 and 2003 in the Swiss Cantons of Vaud and Neuchâtel (about 786,000 inhabitants). A total of 43 cases of second CMM were observed vs. 9.3 expected, corresponding to a standardized incidence ratio (SIR) of 4.6. The SIR was 8.5 under age 50, 5.7 at age 50-59 and 3.5 at age 60 or over. At 20 years, the cumulative risk of second CMM was 5%. Age-specific incidence rates of second primary CMM did not vary across age groups 30-39 through 80+, ranging between 1 and 2.5 per 1,000 person-years. Thus, the risk of CMM is substantially increased in subjects diagnosed with a CMM, and the relative risk is greater at younger age and declines with advancing age. The high constant incidence curve of second CMM is compatible with the occurrence of a single mutational event in a population of susceptible individuals.

Invasive breast cancer following ductal and lobular carcinoma in situ of the breast

Abstract: We considered the risk of subsequent invasive breast cancer in a population-based series of 579 carcinomas in situ (CIS) of the breast (482 ductal, 88 lobular) registered between 1977 and 2002 in the Swiss Canton of Vaud. A total of 55 cases of invasive breast cancer were observed vs. 12.3 expected, corresponding to a standardized incidence ratio (SIR) of 4.5 (95% confidence interval [CI], 3.4-5.8). The SIR was 4.6 after ductal and 4.2 after lobular CIS, was similar with passing time since CIS diagnosis, but was higher (SIR = 5.5) for women aged <55 years. At 20 years following CIS, the cumulative risk of invasive breast cancer was 26%, similar for lobular and for ductal CIS. The incidence of invasive breast cancer following CIS showed no consistent pattern of trends with age, all rates in subsequent age groups ranging between 10 and 18 in 1,000. This is compatible with the occurrence of a single mutational event in a population of susceptible women.

Antibody levels against BK virus and prostate, kidney and bladder cancers in the EPIC-Oxford cohort.

Abstract: In a case–control study nested within the EPIC-Oxford cohort, there were no statistically significant differences in the prevalence or titre of antibodies against BK virus measured in plasma taken prior to diagnosis between cases with cancer of the prostate (n=31), kidney (n=5) or bladder (n=9) and controls (n=45).

Beauty product-related exposures and childhood brain tumors in seven countries: results from the SEARCH International Brain Tumor Study

Abstract: Data from 1218 cases of childhood brain tumors (CBT) diagnosed between 1976 and 1994 and 2223 matched controls from the general population were included in an analysis of maternal beauty product exposure and beauty-related employment in 9 centers in 7 countries. A 50% increased odds ratio (OR) [95% confidence interval (CI) = 1.0–2.1] for CBT was observed among children of mothers who were exposed via personal use of and/or possible ambient contact with beauty products during the 5 years preceding the index child’s birth compared with children of mothers never exposed to beauty products during this time period. Overall maternal personal use of hair-coloring agents in the month before or during the pregnancy of the index child’s birth was not associated with CBT (OR = 1.0, CI = 0.83–1.3) or with astroglial (OR = 1.1, CI = 0.85–1.4), PNET (OR = 1.0, CI = 0.71–1.5) and other glial subtypes (OR = 1.0, CI = 0.62–1.0). Similarly, no statistically increased ORs or discernable pattern of risk estimates were observed for period of use or for number of applications per year for maternal personal use of hair-coloring agents overall or by histologic type. Among children born on or after 1980, increased ORs for CBT were associated with maternal non-work-related exposure to any beauty products (OR = 2.6, CI = 1.2–5.9), hair-dyes (OR = 11, CI = 1.2–90), and hair sprays (OR = 3.4, CI = 1.0–11). No overall increased OR for CBT was observed among children of mothers employed in beauty-related jobs during the 5 years preceding the index child’s birth compared with those who reported no beauty-related employment. In general, other specific beauty product-related exposures were not associated with increased ORs for CBT. Data from our study provide little evidence of an increased risk for CBT with mothers’ exposures to beauty products.

Risk of cancer following partial gastrectomy for benign ulcer disease

Abstract: The relative risk of developing cancer after partial gastrectomy for benign ulcer disease, expressed as the standardized incidence ratio, was examined in a population-based cohort comprising 6459 patients operated on between 1950 and 1958. Follow-up to 1983 revealed 1112 patients with cancer versus 1128 expected cases (relative risk 1.0 (95 per cent confidence interval (c.i.) 0.9-1.1)). The overall risk increased over time; it was higher in younger than in older patients but was not related to sex, surgical procedure (Billroth I or II gastrectomy) or diagnosis at operation (duodenal or stomach ulcer). There was an increased risk for lung cancer (relative risk 1.5 (95 per cent c.i. 1.2-1.7)), for oesophageal cancer in patients operated on for stomach ulcer (relative risk 2.2 (95 per cent c.i. 1.0-4.2)) and for cancer of the biliary tract in men (relative risk 1.9 (95 per cent c.i. 1.2-2.9)) and in those operated on for duodenal ulcer (relative risk 1.7 (95 per cent c.i. 1.0-2.8)). The overall risk for genital cancer in women was unchanged but decreased with increasing duration of follow-up and age. Cancers of the nervous system occurred less frequently than expected (relative risk 0.5 (95 per cent c.i. 0.3-0.8)), while the risk for cancer of the buccal cavity, lymphatic and haematopoietic systems, pancreas, breast, prostate, kidney and bladder was unchanged.

Time trends in incidence rates of acute, non-traumatic extremity ischaemia: A population-based study during a 19-year period

Abstract: Time trends in the occurrence of acute limb ischaemia were studied from 1965 to 1983 in a defined geographical area in Sweden. Data were obtained from a computerized register which covers all instances of inpatient care for a population of 1.3 million. Analysis based on 5394 first admissions for acute arterial occlusion revealed that the annual number increased by 2.7 per cent yearly in women and 3.9 per cent in men whereas the age-adjusted incidence remained stable for women and increased by 2.6 per cent yearly for men. A study of 1189 patients who underwent surgical procedures showed that the annual number of embolectomy procedures increased 7.6 per cent for females and 8.6 per cent for males. The corresponding age-adjusted incidence rose annually by 3.0 per cent for women and by 7.5 per cent for men. The introduction of the Fogarty catheter and an increasing interest in vascular surgery may have contributed to the increasing rates of operations during the period of study.

Risk factors for early lower limb loss after embolectomy for acute arterial occlusion: a population-based case-control study.

Abstract: To identify risk factors for lower limb loss after arterial embolectomy a cohort of 1189 patients was studied. Detailed data were obtained for 165 patients who underwent a major amputation within 30 days of embolectomy and for 165 matched controls. The amputation risk was increased in patients with two or more myocardial infarctions (odds ratio (OR) 3.1, 95 per cent confidence interval (CI) 0.8-11.2), chronic ischaemia (OR 2.1, CI 0.9-4.9), long duration of symptoms (OR 4.3, CI 1.9-9.6, for greater than or equal to 25 h versus less than or equal to 6 h) or postoperative heart failure (OR 3.4, CI 1.8-6.5). Reduced risks were found in association with acute myocardial infarction (OR 0.3, CI 0.1-0.9) and postoperative anticoagulation treatment with warfarin (OR 0.3, CI 0.1-0.9). The independent prognostic value of chronic ischaemia and symptom duration, and the beneficial effect of postoperative anticoagulation gained additional support in multivariate analysis. We conclude that the risk of early amputation after arterial embolectomy or thrombectomy can be predicted by several clinical characteristics.

Fertility among brothers of patients with testicular cancer

Abstract: Objective: Patients with testicular cancer have decreased fertility prior to the diagnosis of cancer, although it is not clear whether the subfertility is the result of an emerging tumor, or whether subfertility and testicular cancer share causes To test if they share causes, we assessed fertility among brothers of patients with testicular cancer Methods: We compared 5,613 siblings (2,878 brothers) of patients with germ-cell testicular cancer, diagnosed in Sweden from 1960 to 2002, with 6,151 population controls (3,202 men) Using the Swedish Multi-Generation Register, we obtained information on the number of children born (until December 2003) from cases ( n = 9,480) and controls ( n = 10,739) Fertility was measured using two indicators, ( a ) offspring twinning rates, as dizygotic twinning is reduced by male subfertility, and ( b ) number of children We used unconditional logistic regression, and analyzed brothers and sisters separately Analyses on the number of children were restricted to subjects (39%) born prior to 1954, for whom information on reproductive life until age 50 was available Results: Brothers, but not sisters, of patients with testicular cancer were less likely to have unlike-sex twins than controls (for unlike-sex twins, the odds ratio for the father being a sibling of testicular cancer patient was 053; 95% confidence interval, 026-109) The likelihood of being a brother of a patient with testicular cancer decreased monotonically with increasing number of children ( P = 005), whereas no association was observed for the sisters Conclusion: The decreased fertility found among brothers of patients with testicular cancer argues in favor of shared causes between cancer-associated subfertility and testicular cancer Genetic links and shared environment could explain the association

Prospects for cancer control: colorectal cancer.

Abstract: Aims The study assessed the contribution to the control of colorectal cancer achievable from primary prevention, screening, early diagnosis, and treatment in New Zealand. Methods Available estimates of the attributable risk or protection offered by significantly increasing consumption of fruit and vegetables were used to predict the number of cases of (and deaths from) colorectal cancer prevented if these activities were effective in 1999. The potential effect of screening was also estimated from published results. Estimates of the potential effect of improvements in early diagnosis and treatment available from cancer-control plans of other countries were used to estimate the likely impact of such improvements in New Zealand. Results Primary prevention could potentially prevent 81 deaths in men and 77 deaths in women from colorectal cancer each year. The potential impact of screening differed between screening methods, with the prevention of 44 deaths in men and 35 deaths in women from colorectal cancer by screening using faecal occult blood testing or 73 deaths in men and 53 deaths in women annually from colorectal cancer by screening using flexible sigmoidoscopy. Improvements in surgical practice and reorganisation of surgical services together with improved use of radiotherapy and chemotherapy could prevent about 82 deaths in men and 78 deaths in women from colorectal cancer each year. Conclusions The most immediate control of colorectal cancer appeared to be achievable by improvements in surgical services and the introduction of screening while increased consumption of fruit and vegetables provided potential longer-term reductions in colorectal cancer incidence and mortality. Cancer control requires a systematic and coordinated approach to reduce the burden of cancer, improve the quality of care, and improve the quality of life for patients and their families. The six components by which this may be achieved are, prevention, screening, early diagnosis, treatment, rehabilitation, and palliative care. 1 The control of any particular cancer involves an evidence-based assessment of the activities making up each component and monitoring of their outcomes. Over several decades, the improved application of new knowledge has reduced incidence and mortality, and improved survival of some cancers. Moreover, many countries have identified ways to further reduce the burden of cancer in their communities through the development and implementation of specific cancer-control programmes appropriate to the organisation of their health services, and their sociodemographic and cultural characteristics. 1 New Zealand has followed this worldwide initiative and has developed the New Zealand Cancer Control Strategy. 2 Its implementation is being overseen by an independent Cancer Control Council. This is an important response to the rising incidence of cancer from an ageing population

Changing prevalence of asthma in Turin school children between 1994 and 1999.

Abstract: Beckground: Asthma is a widespread chronic disorder in children and its prevalence has been on the increase in Europe. Only few studies have described the prevalence variation in respiratory symptoms in Italian regions. The aim of this study, conducted in Turin during the 1998/1999 school year, is to investigate the distribution of respiratory symptoms in a sample of Turin school children and to compare the obtained results with the findings of the SIDRIA study performed in 1994-95. Methods: the sample in study is composed of all the children attending to three elementary schools in Turin. All of the selected schools had already participated in the 94-95 ISAAC-SIDRIA study. A total of 448 pupils aged 6- 10 years received a standardised questionnaire to be filled by parents. Results: response rate is higher than 97% in all the studies. In 1999 we found that the prevalence of wheezing in the past 12 months was 7.3%. The 13.3% of children had asthma at least once in life and the 5.3% reported an attack in the last year. The comparison of our study results with the ISAACSIDRIA (1994-95) shows that the prevalence of asthma and asthma-like symptoms is rather stable among children, while the prevalence of bronchitis reveals a reduction of about 5.5%, but not statistically significant (p=0.094; 95%CI:-11.9;0.9). A considerable reduction in exposure to parents’ passive smoke is shown: ΔP%=-4.7 (95%CI: -9.4;-0.1) for maternal smoking in pregnancy, ΔP%=-8.2 and -15.2, respectively for maternal and paternal smoking in the first two years of life. Conclusions: The results indicate a stable prevalence rate in asthma symptoms in children. A possible explanation of slight variation in asthma prevalence may be due to a reduced exposure to outdoor and indoor risk factors as reported in the questionnaires.