RESUMEN
There is an impending cancer epidemic in Africa. In Nigeria, this disease is causing untold devastation, and control measures are desperately needed. Breast, cervical, prostate, and liver cancers are the most common types in Nigerian adults. In children, the predominant malignant diseases are Burkitt's lymphoma, acute lymphoblastic leukemia, neuroblastoma, and Wilm's tumor (nephroblastoma). The focus of efforts to control cancer in Nigeria should be directed at prevention with adequate attention to planning/policy making, early detection, accurate diagnosis, treatment and palliative care. National and regional allocation of sufficient resources is required, accompanied by measurable objectives and appropriate emphasis on accountability.
Asunto(s)
Atención a la Salud/organización & administración , Educación , Tamizaje Masivo/organización & administración , Neoplasias , Población Negra , Epidemias , Planificación en Salud , Hospitales Universitarios , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/prevención & control , Neoplasias/terapia , Nigeria/epidemiología , Cuidados Paliativos , Formulación de Políticas , Factores de RiesgoRESUMEN
BACKGROUND: There is little evidence regarding the risk of leukaemia in children following exposure to radionuclides from the Chernobyl Nuclear Power Plant explosion on April 26, 1986. METHODS: This population-based case-control study investigated whether acute leukaemia is increased among children who were in utero or <6 years of age at the time of the Chernobyl accident. Confirmed cases of leukaemia diagnosed from April 26, 1986 through December 31, 2000 in contaminated regions of Belarus, Russia, and Ukraine were included. Two controls were matched to each case on sex, birth year, and residence. Accumulated absorbed radiation dose to the bone marrow was estimated for each subject. RESULTS: Median estimated radiation doses of participants were <10 mGy. A significant increase in leukaemia risk with increasing radiation dose to the bone marrow was found. This association was most evident in Ukraine, apparent (but not statistically significant) in Belarus, and not found in Russia. CONCLUSION: Taken at face value, these findings suggest that prolonged exposure to very low radiation doses may increase leukaemia risk as much as or even more than acute exposure. However the large and statistically significant dose-response might be accounted for, at least in part, by an overestimate of risk in Ukraine. Therefore, we conclude this study provides no convincing evidence of an increased risk of childhood leukaemia as a result of exposure to Chernobyl radiation, since it is unclear whether the results are due to a true radiation-related excess, a sampling-derived bias in Ukraine, or some combination thereof. However, the lack of significant dose-responses in Belarus and Russia also cannot convincingly rule out the possibility of an increase in leukaemia risk at low dose levels.
Asunto(s)
Accidente Nuclear de Chernóbil , Leucemia Inducida por Radiación/epidemiología , Liberación de Radiactividad Peligrosa , Distribución por Edad , Estudios de Casos y Controles , Preescolar , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Lactante , Recién Nacido , Cooperación Internacional , Leucemia Inducida por Radiación/etiología , Masculino , Embarazo , Efectos Tardíos de la Exposición Prenatal , Dosis de Radiación , Radiometría/métodos , República de Belarús/epidemiología , Federación de Rusia/epidemiología , Ucrania/epidemiologíaRESUMEN
There are several prognostic models for Hodgkin's disease (HD) patients, but none evaluating patient characteristics at time of blood and marrow transplantation (BMT). We developed a prognostic model for event-free survival (EFS) post-BMT based on HD patient characteristics measured at the time of autologous (auto) or allogeneic (allo) BMT. Between 1/1991 and 12/2001, 64 relapsed or refractory HD patients received an auto (n=46) or allo (n=18) BMT. A multivariate prognostic model was developed measuring time to relapse, progression or death. Median follow-up was 51.7 months; median EFS for auto and allo BMT was 36 and 3 months, respectively (P=0.001). Significant multivariate predictors of shorter EFS were chemotherapy-resistant disease, KPS <90 and > or =3 chemotherapy regimens pre-BMT. Patients with two to three adverse factors had significantly shorter EFS at 2 years (58 vs 11% in auto; 38 vs 0% in allo BMT patients). Despite a selection bias favoring auto BMT, the model was valid in both auto and allo BMT groups. We were able to differentiate patients at high vs low risk for adverse outcomes post-BMT. This prognostic model may prove useful in predicting patient outcomes and identifying high-risk patients for novel treatment strategies. Validation of this model in a larger cohort of patients is warranted.
Asunto(s)
Trasplante de Médula Ósea , Enfermedad de Hodgkin/diagnóstico , Enfermedad de Hodgkin/terapia , Trasplante de Células Madre de Sangre Periférica , Pronóstico , Adulto , Trasplante de Médula Ósea/mortalidad , Causas de Muerte , Supervivencia sin Enfermedad , Resistencia a Antineoplásicos , Femenino , Supervivencia de Injerto , Enfermedad de Hodgkin/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Modelos Teóricos , Análisis Multivariante , Trasplante de Células Madre de Sangre Periférica/mortalidad , Terapia Recuperativa , Análisis de Supervivencia , Tiempo , Trasplante Autólogo , Trasplante HomólogoRESUMEN
Neuroblastoma is a malignancy commonly diagnosed during infancy or early childhood, raising speculation about the role of perinatal factors and risk of disease. Using a case-control design, cases included 155 infants and children aged 0-5 years with histologically confirmed neuroblastoma diagnosed and reported to the New York State Cancer Registry between 1976 and 1987. Controls were randomly selected from the State's Livebirth Registry and were frequency matched to cases on year of birth (n = 310). Medical records of cases were used to verify histology and stage of disease. Data on perinatal factors were ascertained from birth certificates and standardised telephone interviews with mothers. Unconditional logistic regression was used to estimate (un)adjusted odds ratios (OR) and 95% confidence intervals (CI). Both preterm (< 37 weeks) and post-term (> 42 weeks) birth were associated with a reduction in risk (OR = 0.4 [CI = 0.1, 0.9] and OR = 0.3 [CI = 0.1, 0.7] respectively) after controlling for confounders in unconditional logistic regression analysis. Elevated risk factors included: smoking during pregnancy (OR = 1.6; CI = 0.9, 2.8), contracted pelvis (OR = 2.3; CI = 0.6, 9.8), birth injury (OR = 2.9; CI = 0.3, 24.9) and 1-min Apgar Score < or =3 (OR = 6.0; CI = 0.9, 38.6); all confidence intervals included one. These data suggest that extremes in gestation may be associated with a reduced risk, although aetiological mechanisms remain unknown.
Asunto(s)
Neuroblastoma/congénito , Neuroblastoma/epidemiología , Adulto , Puntaje de Apgar , Traumatismos del Nacimiento/complicaciones , Estudios de Casos y Controles , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Modelos Logísticos , Bienestar Materno , New York/epidemiología , Pelvis/fisiología , Embarazo , Sistema de Registros , Factores de Riesgo , Fumar/efectos adversosRESUMEN
BACKGROUND: The Chernobyl nuclear accident of 1986 released large quantities of radioactive material causing widespread contamination. In the Ukraine alone, more than 4 million people were exposed to radiation. The exact health consequences of this exposure are still being assessed. METHODS: To ascertain the effect of in utero radiation exposure and the development of leukaemia, a review was undertaken of leukaemia sub-types occurring among children born in the year of the accident (1986) and followed 10 years post-exposure. A comparison was made of leukaemia cumulative incidence rates among children from both an exposed and unexposed oblast. RESULTS: Rate ratios (RR) for the all cell types grouping of leukaemia revealed that rates in the exposed Oblast were significantly elevated for females, males and both genders combined. Rates of acute lymphoblastic leukaemia (ALL) were dramatically elevated for males and to a lesser extent for females. For both genders combined, the RR for ALL was more than three times greater in the exposed compared to the unexposed region. CONCLUSION: Study results suggest that the increased risk of leukaemia and acute leukaemia among those children born in 1986 and resident in radioactively contaminated territories may be associated with exposure to radiation resulting from the Chernobyl accident.
Asunto(s)
Leucemia Monocítica Aguda/epidemiología , Leucemia Mieloide Aguda/epidemiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiología , Liberación de Radiactividad Peligrosa , Niño , Femenino , Humanos , Incidencia , Leucemia Monocítica Aguda/etiología , Leucemia Mieloide Aguda/etiología , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/etiología , Ucrania/epidemiologíaRESUMEN
Few epidemiologic studies have investigated the potential role of HER2 in the etiology of breast cancer. We conducted a case-case study of 156 women with incident, invasive ductal carcinoma. Multivariate unconditional logistic regression was used to estimate the odds ratios for a HER2 positive tumor in relation to known and putative risk factors of breast cancer. HER2 status was detected by immunohistochemistry on archival tissue. HER2 positive breast cancers tended to be larger and were less likely to express estrogen receptors, and the incidence rate was higher in patients less than 40 years old. We observed an association between a self-reported history of benign breast disease and the occurrence of HER2 positive breast cancer (OR, 2.1;95% CI, 1.1-4.1). We did not detect associations between HER2 over-expression and family history of breast cancer, parity, late age at first birth, ever having breast fed an infant, or oral contraceptive use. Our findings merit consideration in light of recent evidence of HER2 amplification or over-expression in benign breast disease. Should the link to breast cancer be established, HER2 positive benign breast disease could potentially serve as an early marker for preventive intervention.
Asunto(s)
Neoplasias de la Mama/etiología , Neoplasias de la Mama/metabolismo , Receptor ErbB-2/metabolismo , Adulto , Anticonceptivos Orales , Femenino , Humanos , Técnicas para Inmunoenzimas , Menarquia , Menopausia , Ciclo Menstrual , Paridad , Factores de RiesgoRESUMEN
OBJECT: In this study the authors describe secular trends in the incidence of three glial tumors--glioblastoma multiforme (GBM), astrocytoma not otherwise specified (ANOS), and anaplastic astrocytoma (AA)--in New York state from 1976 through 1995. They also describe the effect of age and sex on the relative risk (RR) for these tumors, specifically GBM. METHODS: Crude, age-, and sex-specific incidence rates were calculated for each tumor type from 1976 to 1995 by using data from the New York State Cancer Registry. Age-adjusted incidence rates were calculated by the direct standardization procedure, in which the 1970 United States Census Population Standard Million is used. The RR of GBM for the female population was calculated and plotted. Statistical comparisons were made using Pearson's correlation coefficient and regression analysis with the coefficient of variation. CONCLUSIONS: The age-adjusted incidence of these three glial tumors increased during the study period. Increases in age-specific incidence of GBM were primarily limited to patients 60 years of age or older. The reasons for these increases cannot be fully explained with the data. Those in the female population had a lower risk of developing these tumors than those in the male. For GBM, the protective effect of sex was first evident at the approximate age of menarche, was greatest at the approximate age of menopause, and decreased in postmenopausal age strata. The overall protective effect of female sex and the described trend in RR for GBM in the female population suggests that sex hormones and/or genetic differences between males and females may play a role in the pathogenesis of this tumor.
Asunto(s)
Astrocitoma/epidemiología , Neoplasias Encefálicas/epidemiología , Glioblastoma/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , New York , RiesgoRESUMEN
BACKGROUND: A case-control study was conducted with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State, excluding New York City, between 1976 and 1987. Three hundred seventy-two controls were selected from the New York State live birth certificate registry and were matched to cases on year of birth. METHODS: Parental occupational exposures at the time of each child's birth were obtained from maternal telephone interviews, successfully completed for 85% of cases and 87% of controls. RESULTS: Odds ratios were significantly elevated for maternal occupation in the service (OR = 2.0, 95% CI = 1.0 4.1) and retail (OR = 2.0, 95% CI = 1.1-3.7) industries and paternal occupation in materials handling (OR = 3.8, 95% CI = 1.1-14.6). Odds ratios were also significantly elevated for maternal report of occupational exposure to acetone (OR = 3.1, 95% CI = 1.7-5.6), insecticides (OR = 2.3, 95% CI = 1.4-3.7), lead (OR = 4.7, 95% CI = 1.3-18.2) and petroleum (OR = 3.0, 95% CI = 1.5-6.1) and paternal exposure to creosote (OR = 2.1, 95% CI = 1.1-4.3), dioxin (OR = 6.9, 95% CI = 1.3-68.4), lead (OR = 2.4, 95% CI = 1.2-4.8), and petroleum (OR = 1.8, 95% CI = 1.1-2.8). CONCLUSIONS: Due to the uncertainty of the biologic plausibility of these associations and the possibility of alternative explanations, these results should be interpreted cautiously.
Asunto(s)
Neoplasias Encefálicas/etiología , Exposición Materna/efectos adversos , Neuroblastoma/etiología , Exposición Profesional/efectos adversos , Exposición Paterna/efectos adversos , Acetona/efectos adversos , Adolescente , Neoplasias Encefálicas/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Humanos , Lactante , Insecticidas/efectos adversos , Masculino , Neuroblastoma/epidemiología , Oportunidad Relativa , Petróleo/efectos adversos , Medición de Riesgo , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The clinical relationship between diabetes and hypothyroidism is becoming more widely recognized. Although American Indians are disproportionately afflicted with diabetes, the occurrence of hypothyroidism within this group has not been previously reported. METHODS: We present data from a retrospective chart review of health clinic data from a rural isolated northeastern tribe. A total of 156 cases of diabetes and 25 cases of hypothyroidism were identified among 892 eligible individuals living in the service area. RESULTS: Both conditions exhibited strong sex differences. The prevalences of diabetes (21%) and hypothyroidism (5%) among women were higher than those observed among men (13% and 0.2%, respectively). The overall prevalence of hypothyroidism among women with diabetes (8.8%) varied by age ranging from 5% among women younger than 60 years to 21% among women aged 60 years and older. CONCLUSIONS: Our findings support the need for further investigation of the association between diabetes and hypothyroidism in American Indian populations with high prevalence rates of diabetes. This association may be of particular interest to family physicians and other clinicians caring for American Indian populations.
Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus/epidemiología , Hipotiroidismo/complicaciones , Hipotiroidismo/epidemiología , Indígenas Norteamericanos/estadística & datos numéricos , Diabetes Mellitus/etnología , Femenino , Humanos , Hipotiroidismo/etnología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Distribución por SexoRESUMEN
Although a positive association between cigarette smoking and colorectal adenoma development is consistently found, the association with colorectal cancer remains controversial. We evaluated the potential roles of p27(Kip1) and bcl-2 protein expressions in conjunction with cigarette smoking exposure and colorectal cancer risk in a hospital-based case-control study. A total of 163 colorectal cancer patients from Roswell Park Cancer Institute and Buffalo General Hospital and 326 healthy controls responded to a standardized questionnaire on colorectal cancer risk factors including detailed information on their history of cigarette smoking; 110 of the patients' tumours were available for immunohistochemical analysis of p27(Kip1) and bcl-2 protein overexpression. An avidin-biotin immunoperoxidase procedure was used to determine expression after incubation with mouse monoclonal p27(Kip1) and mouse monoclonal bcl-2 antibodies, respectively. A statistically significant trend for total pack-years of smoking was found when p27(Kip1) positive cases were compared with p27(Kip1) negative cases (trend test, p = 0.007). Although a weak inverse association was observed with smoking exposure among p27(Kip1) negative tumour cases in comparison to controls, a significant dose-response association was seen with p27(Kip1) positive tumours. The relative risk of developing a p27(Kip1) positive tumour was estimated to be 1.17 (95% CI 0.54-2.54) for those with less than 20 pack-years, 1.95 (95 % CI 0.95-3.97) for those with 20-39 pack-years, and 2.25 (95% CI 1.14-4.45) for those with greater than 39 pack-years of smoking exposure (trend test, p = 0.009) when compared with controls. When cases with bcl-2 expression were compared with cases without bcl-2 expression, suggestion of a trend was also observed with pack-years smoked (trend test, p = 0.09). In our study of 110 patients with sporadic colorectal cancer and 326 controls, we observed differences in associations between cigarette smoking and expressions in p27(Kip1) and bcl-2. Our data suggest that bcl-2 overexpression (or a bcl-2 dependent pathway) is associated with cigarette smoking in the development of colorectal cancer, whereas a loss of p27(Kip1) expression is not. These associations indicate that there is aetiological heterogeneity in colorectal cancer development, and that they can indirectly allude to where these changes in protein expression occur in the adenoma-carcinoma sequence (i.e. early versus late events).
RESUMEN
Malignant disease is largely unrecognized as a leading cause of death among American Indians and Alaska Natives (AI/ANs). Published studies of cancer incidence, cancer mortality, and cancer survival are highlighted to present an overview on the epidemiology of cancer among Native peoples. Cancer incidence and mortality have demonstrated steady increases among AI/ANs during a relatively limited time frame, as well as unique patterns of site-specific cancers. Cancer-survival data reveal that Native peoples have the poorest survival of any racial group for all cancer sites combined and for eight of the ten leading sites. Opportunities to educate health care providers, through continuing medical education programs and focused conferences for postdoctoral and current medical trainees, can be used to enhance cultural sensitivity and to examine ethnic differences in cancer patterns. Enhancement of recognition of the unique cancer patterns among AI/AN populations may lead to improved identification of at-risk individuals and more effective cancer screening programs within Native communities.
Asunto(s)
Educación Médica Continua/organización & administración , Estado de Salud , Indígenas Norteamericanos/estadística & datos numéricos , Inuk/estadística & datos numéricos , Neoplasias/etnología , Neoplasias/prevención & control , Causas de Muerte , Humanos , Incidencia , Neoplasias/mortalidad , Vigilancia de la Población , Análisis de Supervivencia , Estados Unidos/epidemiologíaRESUMEN
p53 protein overexpression indicates loss of tumor suppressor activity and is the most common genetic alteration in colorectal neoplasms. Epidemiologic and experimental studies suggest that regular use of aspirin may reduce colorectal cancer risk. We set out to determine whether p53 overexpression of the colorectum was associated with a patient's history of aspirin use. Self-administered questionnaires, including information on aspirin use, were obtained from 163 patients with nonfamilial colorectal cancer and from 326 healthy controls. Nuclear p53 protein overexpression using anti-p53 CM-1 polyclonal antibody was observed in 44.8% (73/163) of patients' tumors. A nonsignificant inverse association was observed between use of aspirin and colorectal cancer. Compared with that for nonusers, the odds ratio (OR) for individuals who took aspirin at least twice weekly was 0.68 (95% confidence interval [95% CI]: 0.39-1.18). The odds ratio for those individuals who used aspirin for less than 5 years was 0.54 (95% CI: 0.24-1.23), and 0.80 (95% CI: 0.42-1.51) for those who used aspirin for 5 years or more, when compared with nonusers. An inverse association of regular aspirin use (two times per week or more) was found both for cases with p53 overexpression (OR: 0.79; 95% CI: 0.39-1.59), and for cases without p53 overexpression (OR: 0.56; 95% CI: 0.25-1.22). There was little evidence of a difference in the effect of aspirin use on cancer risk between cases with and without p53 overexpression, even after adjustment for potential confounders.
Asunto(s)
Adenocarcinoma/química , Aspirina/administración & dosificación , Neoplasias Colorrectales/química , Proteína p53 Supresora de Tumor/biosíntesis , Adenocarcinoma/epidemiología , Adenocarcinoma/genética , Administración Oral , Anciano , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/genética , Femenino , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Genes p53 , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND AND OBJECTIVES: Investigations of American Indian and Alaska Native (AI/AN) populations suggest patterns of mortality that differ from the general population. Mortality data reveal excess overall mortality among AI/ANs, as well as excesses for specific causes of death, including accidents, diabetes, liver disease, pneumonia/influenza, suicide, homicide, and tuberculosis. A relative deficit of deaths has been noted for heart disease, cancer, and HIV infections. It is important that physicians demonstrate cultural competence so they may provide quality medical care for the populations they serve. Activities such as provider education, risk assessment, and emphasis on preventive services are offered to facilitate integration into teaching curricula. Knowledge of distinctive mortality patterns among AI/ANs will help clinicians recognize the unique needs of these patients.
Asunto(s)
Estado de Salud , Indígenas Norteamericanos/estadística & datos numéricos , Inuk/estadística & datos numéricos , Mortalidad , Accidentes/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Canadá/epidemiología , Causas de Muerte , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Diabetes Mellitus/mortalidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Distribución por Sexo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The impact on survival by components of a surveillance program (physical examination, blood tests, and chest radiograph) used to detect recurrences in patients with cutaneous melanoma was assessed. METHODS: Data were collected from medical records and tumor registry information on a historical cohort of 1004 patients who presented with AJCC Stage I or II cutaneous melanoma at Roswell Park Cancer Institute from 1971 through 1995. RESULTS: Information on method of detection was available on 154 out of 174 identified first recurrences (89%). Physical examination detected 72% of recurrences, constitutional symptoms indicated 17% of recurrences, and chest radiograph revealed 11% of recurrences. Blood tests did not predict any recurrence. Only 9 of 17 patients with recurrences detected by chest radiograph alone underwent curative surgical resection. These patients had a statistically significant prolonged survival after diagnosis of recurrence compared to those surgical candidates who did not undergo resection. There was no statistically significant difference in overall survival between patients with asymptomatic pulmonary recurrences and those whose pulmonary recurrences were detected after symptoms of metastatic disease had developed. CONCLUSIONS: Most recurrences are detected on physical examination. Blood tests have no role in surveillance programs. Chest radiographs can detect pulmonary recurrences in a small number of asymptomatic patients at a stage when surgery may prolong survival.
Asunto(s)
Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundario , Melanoma/patología , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias Cutáneas/patología , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: Costs and potential benefits of an intensive chest X-ray (CXR) screening program to detect asymptomatic pulmonary metastases in patients with intermediate-thickness, local, cutaneous melanoma were assessed. METHODS: Cost-effectiveness analysis from a societal perspective was performed using data on recurrence detection from an historic cohort at Roswell Park Cancer Institute and other published studies, estimates of new cases of melanoma in 1996 from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, and estimates of cost and treatment benefits from published articles retrieved through MEDLINE. Net costs were calculated as the added cost of CXR screening to regular follow-up and the costs incurred in the surgical treatment of lung recurrences. Net benefits were calculated as potential savings in nonquality-adjusted life years (NQALY) and quality-adjusted life years (QALY) resulting from surgical treatment. Cost-effectiveness ratios were calculated as the present value of net costs divided by net benefits, with benefits presented in discounted and undiscounted forms. RESULTS: For the base case, cost of screening per NQALY was $150,000 and was $165,000 for QALY in 1996 dollars using undiscounted health benefits. Screening accounted for approximately 80% of program costs and treatment accounted for 20%. Annual cost-effectiveness ratios were lowest in Years 3-10 of screening. The total cost of a 20-year screening program for patients diagnosed in 1996 was estimated to be between $27-$32 million. CONCLUSIONS: Even in the absence of certain benefits, the model demonstrates that significant cost savings may be possible by decreasing screening frequency in the first 2 years and limiting screening to the first 5-10 years after diagnosis.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/economía , Radiografías Pulmonares Masivas/economía , Melanoma/diagnóstico por imagen , Melanoma/economía , Neoplasias Cutáneas/patología , Anciano , Análisis Costo-Beneficio , Femenino , Humanos , Neoplasias Pulmonares/secundario , Masculino , Melanoma/secundario , Persona de Mediana Edad , Vigilancia de la Población , Años de Vida Ajustados por Calidad de Vida , Sensibilidad y Especificidad , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/economíaRESUMEN
Protective effects of oral contraceptives and high parity on the development of colorectal cancer have been hypothesized. However, the epidemiological data are inconsistent. This inconsistency may be due in part to the biological heterogeneity of colorectal tumors. A recent investigation of hepatocellular carcinoma demonstrated an association between lack of p53 expression and oral contraceptive use. We investigated the relationship between oral contraceptive use and other reproductive factors with p53 over-expression in 64 post-menopausal women, 45-86 years of age, with non-familial colorectal adenocarcinoma. Fifty per cent (32/64) of colorectal tumors displayed nuclear over-expression of p53 protein. Women with a history of oral contraceptive use were significantly less likely to have p53 positive (+) tumors than women who never used oral contraceptives (P = 0.02). In contrast, tumors from women who had never been pregnant were more likely to be p53 + compared to tumors from parous women (P = 0.10). These data suggest that oral contraceptive use and pregnancy are associated with a p53 independent pathway in the development of colorectal cancer.
Asunto(s)
Neoplasias Colorrectales/prevención & control , Anticonceptivos Orales/farmacología , Regulación Neoplásica de la Expresión Génica , Genes p53 , Embarazo/fisiología , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine if N-acetyltransferase 2 (NAT2) polymorphisms result in decreased capacity to detoxify carcinogenic aromatic amines in cigarette smoke, thus making some women who smoke more susceptible to breast cancer. DESIGN: Case-control study with genetic analyses. DNA analyses were performed for 3 polymorphisms accounting for 90% to 95% of the slow acetylation phenotype among whites. SETTING AND PARTICIPANTS: White women with incident primary breast cancer (n=304) and community controls (n=327). RESULTS: Neither smoking nor NAT2 status was independently associated with breast cancer risk. There were no clear patterns of increased risk associated with smoking by NAT2 status among premenopausal women. In postmenopausal women, NAT2 strongly modified the association of smoking with risk. For slow acetylators, current smoking and smoking in the distant past increased breast cancer risk in a dose-dependent manner (odds ratios [95% confidence intervals] for the highest quartile of cigarettes smoked 2 and 20 years previously, 4.4 [1.3-14.8] and 3.9 [1.4-10.8], respectively). Among rapid acetylators, smoking was not associated with increased breast cancer risk. CONCLUSIONS: Our results suggest that smoking may be an important risk factor for breast cancer among postmenopausal women who are slow acetylators, demonstrate heterogeneity in response to carcinogenic exposures, and may explain previous inconsistent findings for cigarette smoking as a breast cancer risk factor.
Asunto(s)
Arilamina N-Acetiltransferasa/genética , Arilamina N-Acetiltransferasa/metabolismo , Neoplasias de la Mama/epidemiología , Posmenopausia/fisiología , Fumar , Adulto , Anciano , Arilamina N-Acetiltransferasa/fisiología , Neoplasias de la Mama/etiología , Neoplasias de la Mama/genética , Estudios de Casos y Controles , ADN/análisis , Femenino , Genotipo , Humanos , Persona de Mediana Edad , Plantas Tóxicas , Polimorfismo Genético , Posmenopausia/genética , Premenopausia/genética , Premenopausia/fisiología , Medición de Riesgo , Factores de Riesgo , Humo , Fumar/efectos adversos , Fumar/genética , Fumar/metabolismo , Nicotiana , Población Blanca/genéticaRESUMEN
BACKGROUND: The results of preconference and postconference surveys, as well as conference evaluation forms, distributed to attendees at the "Native American Cancer Conference III: Risk Factors, Outreach and Intervention Strategies," Seattle, Washington, June 16-19, 1995, are presented. METHODS: Conference attendees were requested to complete a multi-item survey designed to assess knowledge and perceptions relating to cancer among native peoples at the beginning and end of the conference. The evaluation instrument solicited qualitative impressions of the conference. RESULTS: Survey respondents were predominantly female (70%), and approximately half were native persons representing 48 different American Indian and Alaska Native communities. Knowledge levels were generally high at baseline for most items relating to cancer, with evidence of significant improvement for several items on the postconference survey. The majority of respondents believed that cancer was of equal importance compared with other health problems and that cancer services for American Indians and Alaska Natives are generally less extensive compared with the majority population; there was no evidence of opinion change noted in the postconference survey. Results from the qualitative evaluation expressed the unique and affirmative experiences among participants in terms of the social, cultural, and informational sharing that occurred. CONCLUSIONS: It is hoped that the positive experiences of conference attendees will serve to stimulate the organization of similar programs and the design of research projects that both assess and expand cancer control services among Native peoples.
Asunto(s)
Etnicidad , Indígenas Norteamericanos/psicología , Inuk/psicología , Neoplasias/etnología , Adulto , Alaska , Samoa Americana/etnología , Actitud del Personal de Salud , Recolección de Datos , Femenino , Hawaii/etnología , Servicios de Salud , Humanos , Conocimiento , Masculino , Nativos de Hawái y Otras Islas del Pacífico , Neoplasias/psicología , Estados UnidosRESUMEN
BACKGROUND: Cancer is becoming a significant health problem for American Indians and Alaska Natives. Despite the precipitous increase in cancer rates in these populations, limited data are available regarding the extent of cancer control services available in these communities. METHODS: A cross-sectional survey of tribal health directors of all federally recognized tribes was undertaken to discover the breadth of cancer control activities offered and directors' perceptions of and priorities ascribed to cancer. RESULTS: Little more than half (53%) of respondents perceived cancer rates to be increasing. Cancer was found to rank fifth among seven health conditions when directors were asked to rank their tribe's commitment to confronting each. Lower relative levels of awareness of cancer patterns coupled with competing health problems relegated cancer control activities to low-priority issues. CONCLUSIONS: Findings from this study underscore the need to elevate the issue of cancer in Indian Country and to educate investigators to become more sensitive and responsive to other tribal health issues.
Asunto(s)
Indígenas Norteamericanos , Inuk , Neoplasias/etnología , Alaska/epidemiología , Encuestas de Atención de la Salud , Prioridades en Salud , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Inuk/estadística & datos numéricos , Neoplasias/epidemiología , Neoplasias/prevención & control , Estados Unidos/epidemiología , United States Indian Health ServiceRESUMEN
The epidemiology of neuroblastoma suggests that prenatal exposures may be important etiologic factors in this disease. The authors describe the role of maternal health status and prenatal medication usage and risk of neuroblastoma. This retrospective study was based on completed interviews with 183 histologically confirmed neuroblastoma cases aged 0-14 years diagnosed among residents of New York State (excluding New York City) between 1976 and 1987. Controls were matched to cases on year of birth and race and were drawn from the New York State live birth certificate registry. Interviews were satisfactorily completed with 85% of the cases and 87% of controls. Significantly elevated odds ratios were noted for vaginal infections during pregnancy (odds ratio (OR) = 2.2, 95% confidence interval (CI) 1.2-4.0), medical treatments for vaginal infection during pregnancy (OR = 2.4, 95% CI 1.2-4.9), and any reported use of sex hormones during pregnancy (OR = 3.0, 95% CI 1.3-6.9). Point estimates for any hormone use suggested elevated risk among male offspring (OR = 4.4, 95% CI 1.5-13.3). Among the individual exposures comprising any hormone use, only hormone use related to infertility was observed to be significant (OR = 10.4, 95% CI 1.2-89.9). A protective effect was noted for self-reported vitamin use (OR = 0.28, 95% CI 0.03-0.69). Although it is not possible to presume a specific role for prenatal hormone exposure as initiator or promoter, these findings lend support to an association between prenatal hormone exposure and risk of neuroblastoma.