Latest & greatest articles for cancer

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Top results for cancer

8461. Quality of informed consent in cancer clinical trials: a cross-sectional survey.

Quality of informed consent in cancer clinical trials: a cross-sectional survey. BACKGROUND: Investigators have to obtain informed consent before enrolling participants in clinical trials. We wanted to measure the quality of understanding among participants in clinical trials of cancer therapies, to identify correlates of increased understanding, and to assess providers' beliefs about clinical research. We also sought evidence of therapeutic misconceptions in participants and providers. METHODS (...) : We sent a standard questionnaire to 287 adult patients with cancer who had recently enrolled in a clinical trial at one of three affiliated institutions, and surveyed the provider who obtained each patient's consent. FINDINGS: 207 of 287 (72%) patients responded. 90% (186) of these respondents were satisfied with the informed consent process and most considered themselves to be well informed. Nevertheless, many did not recognise non-standard treatment (74%), the potential for incremental risk

Lancet2001

8462. Potential cancer therapy with the fragile histidine triad gene: review of the preclinical studies.

Potential cancer therapy with the fragile histidine triad gene: review of the preclinical studies. CONTEXT: The fragile histidine triad gene (FHIT) encompasses a human common fragile site, FRA3B, that is susceptible to environmental carcinogens. Deletion and inactivation of FHIT have been seen in a number of human premalignant and malignant lesions. OBJECTIVE: To review and evaluate preclinical studies of cancer therapy using the FHIT tumor suppressor gene and related studies involving Fhit (...) protein expression. DATA SOURCES: A MEDLINE search of articles published from 1996 to June 2001 was performed; article reference lists were used to retrieve additional relevant articles. STUDY SELECTION: Immunohistochemical studies of primary tumors or relevant lesions were selected to evaluate Fhit expression in premalignant or malignant stages. Preclinical studies on antitumorigenic or therapeutic introduction of FHIT were reviewed for the effects of exogenous Fhit expression

JAMA2001

8463. Priority-setting decisions for new cancer drugs: a qualitative case study.

Priority-setting decisions for new cancer drugs: a qualitative case study. BACKGROUND: Frameworks for legitimate and fair priority setting emphasise the importance of the rationales for priority setting decisions. However, priority setting rationales, in particular for new cancer drugs, are not well described. We describe the rationales used by a committee making funding decisions for new cancer drugs. METHODS: We did a qualitative case study of a priority setting committee (Cancer Care Ontario

Lancet2001

8464. Analysis of hereditary component of cancer by use of a familial index by site.

Analysis of hereditary component of cancer by use of a familial index by site. To quantify hereditary factors in the risk of cancer, we matched 1283047 cancer patients listed in the Swedish Cancer Registry with healthy controls from a national database, and identified the number of individuals who were first-degree relatives of other individuals in the same cohort. Division of the number of relatives in the patient cohort by the number in the control cohort yielded a "familial index (...) ". The following cancers had high familial indices: eye 16.5 (95% CI 2.5-666), testis 9.0 (3.2-35), Hodgkin's disease 6.5 (2.3-26.0), and thyroid 6.2 (3.7-12). Overall, however, familial factors made only a minor contribution to susceptibility to cancer.

Lancet2001

8465. Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms.

Alcohol and breast cancer: review of epidemiologic and experimental evidence and potential mechanisms. The association of alcohol consumption with increased risk for breast cancer has been a consistent finding in a majority of epidemiologic studies during the past 2 decades. Herein, we summarize information on this association from human and animal investigations, with particular reference to epidemiologic data published since 1995. increased estrogen and androgen levels in women consuming (...) alcohol appear to be important mechanisms underlying the association. Other plausible mechanisms include enhanced mammary gland susceptibility to carcinogenesis, increased mammary carcinogen dna damage, and greater metastatic potential of breast cancer cells, processes for which the magnitude likely depends on the amount of alcohol consumed. Susceptibility to the breast cancer-enhancing effect of alcohol may also be affected by other dietary factors (such as low folate intake), lifestyle habits

JAMA2001

8466. Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis.

Aspirin as an adjunct to screening for prevention of sporadic colorectal cancer. A cost-effectiveness analysis. BACKGROUND: Aspirin may decrease colorectal cancer incidence, but its role as an adjunct to or substitute for screening has not been evaluated. OBJECTIVE: To examine the potential cost-effectiveness of aspirin chemoprophylaxis in relation to screening. DESIGN: Markov model. DATA SOURCES: Literature on colorectal cancer epidemiology, screening, costs, and aspirin chemoprevention (1980 (...) -1999). TARGET POPULATION: General U.S. population. TIME HORIZON: 50 to 80 years of age. PERSPECTIVE: Third-party payer. INTERVENTION: Aspirin therapy in patients screened with sigmoidoscopy every 5 years and fecal occult blood testing every year (FS/FOBT) or colonoscopy every 10 years (COLO). OUTCOME MEASURES: Discounted cost per life-year gained. RESULTS OF BASE-CASE ANALYSIS: When a 30% reduction in colorectal cancer risk was assumed, aspirin increased costs and decreased life-years because

Annals of Internal Medicine2001

8467. Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease.

Familial breast cancer: collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. BACKGROUND: Women with a family history of breast cancer are at increased risk of the disease, but no study has been large enough to characterise reliably how, over women's lives, this risk is influenced by particular familial patterns of breast cancer. This report, on the relevance of breast cancer in first-degree (...) relatives, is based on combined data from 52 epidemiological studies. METHODS: Individual data on breast cancer in first-degree relatives (mothers, sisters, and daughters) of 58209 women with breast cancer and of 101986 controls were collected, checked, and analysed centrally. Risk ratios for breast cancer were calculated by conditional logistic regression, stratified by study, age, menopausal status, number of sisters, parity, and age when the first child was born. Breast-cancer incidence and mortality

Lancet2001

8468. Customer fee and participation in breast-cancer screening.

Customer fee and participation in breast-cancer screening. Until 1997, breast screening by mammography was free for all women living in Turku, Finland. After this date, women born in certain years had to pay to be screened. We did a retrospective study, using data obtained from Statistics Finland, to ascertain whether or not the introduction of a fee affected attendance. We also assessed the effect of socioeconomic status on attendance. Our findings show that people who had to pay

Lancet2001

8469. Cochrane review on screening for breast cancer with mammography.

Cochrane review on screening for breast cancer with mammography. In 2000, we reported that there is no reliable evidence that screening for breast cancer reduces mortality. As we discuss here, a Cochrane review has now confirmed and strengthened our previous findings. The review also shows that breast-cancer mortality is a misleading outcome measure. Finally, we use data supplemental to those in the Cochrane review to show that screening leads to more aggressive treatment.

Lancet2001

8470. Bethesda guidelines: relation to microsatellite instability and MLH1 promoter methylation in patients with colorectal cancer.

Bethesda guidelines: relation to microsatellite instability and MLH1 promoter methylation in patients with colorectal cancer. BACKGROUND: Microsatellite instability is a hallmark of mismatch repair deficiency in hereditary nonpolyposis colorectal cancer and results from mutations in the mismatch repair genes MLH1 or MSH2 or from gene inactivation associated with DNA methylation. The Bethesda guidelines were established to identify patients with colorectal cancer who should be tested (...) for microsatellite instability. OBJECTIVE: To assess the Bethesda guidelines for detection of microsatellite instability and to determine the role of MLH1 promoter methylation in colorectal cancer. DESIGN: Prospective cohort study. SETTING: Tertiary care referral center in Frankfurt, Germany. PATIENTS: 125 consecutive patients with colorectal cancer. MEASUREMENTS: Patients were assessed according to the Bethesda guidelines, and tumor specimens were analyzed for microsatellite instability. Patients

Annals of Internal Medicine2001

8471. Cost-effectiveness of microsatellite instability screening as a method for detecting hereditary nonpolyposis colorectal cancer.

Cost-effectiveness of microsatellite instability screening as a method for detecting hereditary nonpolyposis colorectal cancer. BACKGROUND: The National Cancer Institute has published consensus guidelines for universal screening for hereditary nonpolyposis colorectal cancer (HNPCC) in patients with newly diagnosed colorectal cancer. OBJECTIVE: To determine the cost-effectiveness of screening compared with standard care in eligible patients with colorectal cancer and their siblings and children (...) . DESIGN: Cost-effectiveness analysis. DATA SOURCES: National colorectal cancer registry data, the Creighton International Hereditary Colorectal Cancer Registry, Medicare claims records, and published literature. TARGET POPULATION: Patients with newly diagnosed colorectal cancer and their siblings and children. TIME HORIZON: Lifetime (varies depending on age at screening). PERSPECTIVE: Societal. INTERVENTIONS: Initial office-based screening to determine eligibility (based on personal and family cancer

Annals of Internal Medicine2001

8472. Venous limb gangrene during warfarin treatment of cancer-associated deep venous thrombosis.

Venous limb gangrene during warfarin treatment of cancer-associated deep venous thrombosis. BACKGROUND: The cause of cancer-associated venous limb gangrene is unknown but could paradoxically be due to warfarin. OBJECTIVE: To determine the pathogenesis of venous gangrene in a patient with cancer. DESIGN: Case report. SETTING: University hospital in Ontario, Canada. PATIENT: 66-year-old woman with metastatic lung cancer and deep venous thrombosis. MEASUREMENTS: Levels of vitamin K-dependent (...) of factor VII, which correlated closely with protein C levels; therefore, the high INR was a surrogate marker for severely reduced protein C activity. CONCLUSION: Warfarin may contribute to the pathogenesis of cancer-associated venous limb gangrene by leading to severe depletion of protein C while at the same time failing to reduce thrombin generation.

Annals of Internal Medicine2001

8473. Importance of perspective in economic analyses of cancer screening decisions.

Importance of perspective in economic analyses of cancer screening decisions. As the fifth, and final, report in this Lancet series on health economics, we discuss how economic analyses in public health, with cancer screening as the example, differ depending on the perspective taken. We identify nine different, but related, decision makers at various levels, from the individual patient to society as a whole, and discuss how their different viewpoints affect their ultimate decisions. Central (...) to the effect of perspective on cancer screening decisions and show how the costs (negative consequences) and benefits (positive consequences) vary depending on the decision maker.

Lancet2001

8474. Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: nested cohort crossover study.

Squamous-cell cancer of the skin in patients given PUVA and ciclosporin: nested cohort crossover study. BACKGROUND: Immunosuppressive treatments have been associated with an increased risk of skin cancer, especially in patients who have had organ transplants. We aimed to assess the risk of skin cancer in patients taking the ciclosporin who had been exposed to psoralen and ultraviolet-A light (PUVA) and other treatments for severe psoriasis. METHODS: We did a nested cohort crossover study of 28 (...) participants in the PUVA follow-up study who were on ciclosporin to compare the frequency of squamous-cell carcinoma before and after first use of ciclosporin. We also analysed the entire PUVA study cohort (1380) to assess the relation between use of this drug and frequency of squamous-cell carcinoma. FINDINGS: In the 5 years before first use, six of 28 (21%) ciclosporin users developed a total of 20 squamous cell cancers. After ciclosporin use (average follow-up 6 years), 13 (46%) developed a total of 169

Lancet2001

8475. Uptake of screening and prevention in women at very high risk of breast cancer.

Uptake of screening and prevention in women at very high risk of breast cancer. Management of women at high lifetime risk of familial breast cancer is hampered because of limited data concerning the appropriateness of treatment options. Over the past 8 years women at very high (>40%) lifetime risk of breast cancer have had the option of entering two chemoprevention treatment trials, a magnetic resonance imaging (MRI) breast screening study, or a risk-reducing mastectomy (RRM) study. Only 10

Lancet2001

8476. Helicobacter pylori infection and the development of gastric cancer.

Helicobacter pylori infection and the development of gastric cancer. BACKGROUND: Although many studies have found an association between Helicobacter pylori infection and the development of gastric cancer, many aspects of this relation remain uncertain. METHODS: We prospectively studied 1526 Japanese patients who had duodenal ulcers, gastric ulcers, gastric hyperplasia, or nonulcer dyspepsia at the time of enrollment; 1246 had H. pylori infection and 280 did not. The mean follow-up was 7.8 (...) years (range, 1.0 to 10.6). Patients underwent endoscopy with biopsy at enrollment and then between one and three years after enrollment. H. pylori infection was assessed by histologic examination, serologic testing, and rapid urease tests and was defined by a positive result on any of these tests. RESULTS: Gastric cancers developed in 36 (2.9 percent) of the infected and none of the uninfected patients. There were 23 intestinal-type and 13 diffuse-type cancers. Among the patients with H. pylori

NEJM2001

8477. Cancer in siblings of children with cancer in the Nordic countries: a population-based cohort study.

Cancer in siblings of children with cancer in the Nordic countries: a population-based cohort study. BACKGROUND: In some rare inherited disorders such as Li-Fraumeni syndrome, relatives of children with cancer are at increased risk of cancer. We aimed to assess relations between childhood cancer and sibling risk, and evaluate the influence of recessive conditions in cancer causation. METHODS: We did a population-based cohort study in the Nordic countries of 42277 siblings of 25605 children (...) with cancer. Children with cancer were identified from records in the five Nordic cancer registries, and their siblings from nationwide population registries. Cancers in siblings were documented through record linkage with cancer registries and compared with national incidence rates. We also assessed cancer incidence in parents to identify familial cancer syndromes. FINDINGS: 284.2 cancers were expected in siblings, whereas 353 were diagnosed (standardised incidence ratio 1.24 95% CI 1.12-1.38). Risk

Lancet2001

8478. Exposure to ultraviolet radiation: association with susceptibility and age at presentation with prostate cancer.

Exposure to ultraviolet radiation: association with susceptibility and age at presentation with prostate cancer. A positive association between latitude and prostate cancer mortality has been interpreted to indicate that ultraviolet radiation (UVR) protects against development of this cancer. We aimed to examine this hypothesis. We compared exposure between 210 cases and 155 controls. Childhood sunburn (odds ratio 0.18, 95% CI 0.08-0.38), regular foreign holidays(0.41, 0.25-0.68), sunbathing (...) score (0.83, 0.76-0.89), and low exposure to UVR (3.03, 1.59-5.78) were associated with development of prostate cancer. Furthermore, cases with low UVR exposure developed cancer at a younger median age (67.7 years, IQR 61.5-74.6) than cases with higher exposure (72.1 years, 67.5-76.4); p=0.006. These findings are compatible with UVR having a protective role against prostate cancer.

Lancet2001

8479. One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon.

One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon. BACKGROUND: Fecal occult-blood testing and sigmoidoscopy have been recommended for screening for colorectal cancer, but the sensitivity of such combined testing for detecting neoplasia is uncertain. At 13 Veterans Affairs medical centers, we performed colonoscopy to determine the prevalence of neoplasia and the sensitivity of one-time screening with a fecal occult-blood test (...) plus sigmoidoscopy. METHODS: Asymptomatic subjects (age range, 50 to 75 years) provided stool specimens on cards from three consecutive days for fecal occult-blood testing, which were rehydrated for interpretation. They then underwent colonoscopy. Sigmoidoscopy was defined in this study as examination of the rectum and sigmoid colon during colonoscopy, and sensitivity was estimated by determining how many patients with advanced neoplasia had an adenoma in the rectum or sigmoid colon. Advanced

NEJM2001

8480. Occupational exposure to carbon black and risk of bladder cancer.

Occupational exposure to carbon black and risk of bladder cancer. Exposure to carbon black has been linked to risk of lung and bladder cancer. We therefore investigated the frequency of these cancers in a group of 2286 longshoremen who were exposed occupationally to carbon-black dust. We identified 208 cancers (standardised incidence ratio 96, 95% CI 83-109), 53 lung cancers (108, 81-141), and 32 bladder cancers (130, 89-184). Longshoremen exposed to high concentrations of carbon black (n=14 (...) ) had a significantly increased frequency of bladder cancer (204, 112-343). We conclude that the increase in bladder cancer in longshoremen is probably related to high exposure to carbon black.

Lancet2001