Current Issue : April - June Volume : 2013 Issue Number : 2 Articles : 6 Articles
Background: The aim of this study was to determine the proportions and predictors of first-degree relatives (FDRs)\r\nof colorectal cancer (CRC) patients (i) ever receiving any CRC testing and (ii) receiving CRC screening in accordance\r\nwith CRC screening guidelines.\r\nMethods: Colorectal cancer patients and their FDRs were recruited through the population-based Victorian Cancer\r\nRegistry, Victoria, Australia. Seven hundred and seven FDRs completed telephone interviews. Of these, 405 FDRs\r\nwere deemed asymptomatic and eligible for analysis.\r\nResults: Sixty-nine percent of FDRs had ever received any CRC testing. First-degree relatives of older age, those\r\nwith private health insurance, siblings and FDRs who had ever been asked about family history of CRC by a doctor\r\nwere significantly more likely than their counterparts to have ever received CRC testing. Twenty-five percent of\r\nFDRs ââ?¬Å?at or slightly above average riskââ?¬Â were adherent to CRC screening guidelines. For this group, adherence to\r\nguideline-recommended screening was significantly more likely to occur for male FDRs and those with a higher\r\nlevel of education. For persons at ââ?¬Å?moderately increased riskââ?¬Â and ââ?¬Å?potentially high riskââ?¬Â, 47% and 49% respectively\r\nadhered to CRC screening guidelines. For this group, guideline-recommended screening was significantly more\r\nlikely to occur for FDRs who were living in metropolitan areas, siblings, those married or partnered and those ever\r\nasked about family history of CRC.\r\nConclusions: A significant level of non-compliance with screening guidelines was evident among FDRs. Improved\r\nCRC screening in accordance with guidelines and effective systematic interventions to increase screening rates\r\namong population groups experiencing inequality are needed....
Background: Diabetic patients have a higher risk of bladder cancer and benign prostatic hyperplasia (BPH).\r\nTheoretically, BPH patients may have an increased risk of bladder cancer because residual urine in the bladder\r\nsurely increases the contact time between urinary excreted carcinogens and the urothelium. However, whether BPH\r\nincreases bladder cancer risk in patients with type 2 diabetes has not been studied.\r\nMethods: The reimbursement databases of all Taiwanese diabetic patients under oral anti-diabetic agents or insulin\r\nfrom 1996 to 2009 were retrieved from the National Health Insurance. An entry date was set at 1 January 2006 and\r\na total of 547584 men with type 2 diabetes were followed up for bladder cancer incidence until the end of 2009.\r\nIncidences of bladder cancer for BPH by status and by duration were calculated and adjusted hazard ratios\r\n(95% confidence intervals) were estimated by Cox regression. The effects of diabetes duration and medications\r\nused for diabetic control in relation with bladder cancer risk were also evaluated by Cox regression in BPH men.\r\nResults: The incidences were 258.77 and 69.34 per 100,000 person-years for patients with and without BPH,\r\nrespectively, adjusted hazard ratio 1.794 (1.572, 2.047). For BPH patients, those who underwent surgical procedures\r\nfor BPH had a higher incidence than those who did not (355.45 vs. 250.09 per 100,000 person-years), respective\r\nadjusted hazard ratios: 2.459 (1.946, 3.109) and 1.709 (1.492, 1.958). The significantly higher risk could be\r\ndemonstrated for BPH of any duration: respective adjusted hazard ratios 1.750 (1.430, 1.605), 1.844 (1.543, 2.203),\r\n2.011 (1.680, 2.406) and 1.605 (1.341, 1.921) for BPH <1, 1ââ?¬â??3, 3ââ?¬â??5 and =5 years versus patients without BPH.\r\nSensitivity analyses for patients aged =60 years and after excluding BPH patients with surgical procedures or\r\nwithout surgical procedures, respectively, yielded similar results. In BPH men, diabetes duration was not significantly\r\nrelated with bladder cancer; but metformin was consistently associated with a significantly lower risk, with adjusted\r\nhazard ratio of 0.719 (0.590, 0.875) for all ages and 0.742 (0.604, 0.912) for age =60 years.\r\nConclusions: BPH is a significant risk factor for bladder cancer in men with type 2 diabetes. Metformin may protect\r\nagainst bladder cancer in BPH men....
Background: There is scant data regarding disease presentation and treatment response among black men living\r\nin Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with\r\nprostate cancer treated with external beam radiotherapy (EBRT).\r\nMethods: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy, Ghana\r\nfrom 2003 to 2009. Data were collected regarding patient-and tumor-related factors such as age, prostate specific\r\nantigen (PSA), Gleason score (GS), clinical stage (T), and use of androgen deprivation therapy (ADT). For patients\r\nwho received EBRT, freedom from biochemical failure (FFbF) was evaluated using the Kaplan-Meier method.\r\nResults: Of 379 patients referred for treatment 69.6% had initial PSA (iPSA) > 20 ng/ml, and median iPSA was\r\n39.0 ng/ml. A total of 128 men, representing 33.8% of the overall cohort, were diagnosed with metastatic disease at\r\ntime of referral. Among patients with at least 2 years of follow-up after EBRT treatment (n=52; median follow-up\r\ntime: 38.9 months), 3- and 5-year actuarial FFbF was 73.8% and 65.1% respectively. There was significant association\r\nbetween higher iPSA and GS (8ââ?¬â??10 vs. =7, p < 0.001), and T stage (T3/4 vs. T1/2, p < 0.001).\r\nConclusions: This is the largest series reporting on outcomes after prostate cancer treatment in West Africa. That\r\none-third of patients presented with metastatic disease suggests potential need for earlier detection to permit\r\ncurative-intent therapy. Data from this study will aid in the strategic development of prostate cancer research\r\nroadmap in Ghana...
Background: Breast cancer is a potentially fatal malignancy in females despite the improvement in therapeutic\r\ntechniques. The identification of novel molecular signatures is needed for earlier detection, monitoring effects of\r\ntreatment, and predicting prognosis. We have previously used microarray analysis to identify differentially expressed\r\ngenes in aggressive breast tumors. The purpose of the present study was to investigate the prognostic value of the\r\ncandidate biomarkers CCNB2, ASPM, CDCA7, KIAA0101, and SLC27A2 in breast cancer.\r\nMethods: The expression levels and subcellular localization of the CCNB2, ASPM, CDCA7, KIAA0101, and SLC27A2\r\nproteins were measured using immunohistochemistry (IHC) on a panel of 80 primary invasive breast tumors.\r\nFurthermore, the mRNA levels of CCNB2, KIAA0101, and SLC27A2 were subsequently examined by qRT-PCR to\r\nvalidate IHC results. Patient disease-specific survival (DSS) was evaluated in correlation to protein levels using the\r\nKaplan-Meier method. Multivariate Cox regression analysis was used to determine the impact of aberrant protein\r\nexpression of the candidate biomarkers on patient DSS and to estimate the hazard ratio at 8-year follow-up.\r\nResults: Elevated cytoplasmic CCNB2 protein levels were strongly associated with short-term disease-specific\r\nsurvival of breast cancer patients (= 8 years; P<0.001) and with histological tumor type (P= 0.04). However, no\r\nassociation with other clinicopathological parameters was observed. Multivariate Cox regression analysis specified\r\nthat CCNB2 protein expression is an independent prognostic marker of DSS in breast cancer. The predictive ability\r\nof several classical clinicopathological parameters was improved when used in conjunction with CCNB2 protein\r\nexpression (C-index = 0.795) in comparison with a model without CCNB2 expression (C-index = 0.698). The protein\r\nlevels of ASPM, CDCA7, KIAA0101, and SLC27A2 did not correlate with any clinicopathological parameter and had\r\nno influence on DSS. However, a significant correlation between the expression of the CCNB2 and ASPM proteins\r\nwas detected (P = 0.03).\r\nConclusion: These findings suggest that cytoplasmic CCNB2 may function as an oncogene and could serve as a\r\npotential biomarker of unfavorable prognosis over short-term follow-up in breast cancer....
Background: Cancer is a significant and growing problem worldwide. While this increase may, in part, be\r\nattributed to increasing longevity, improved case notifications and risk-enhancing lifestyle (such as smoking, diet\r\nand obesity), hygiene-related factors resulting in immuno-regulatory failure may also play a major role and call for a\r\nrevision of vaccination strategies to protect against a range of cancers in addition to infections.\r\nDiscussion: Human endogenous retroviruses (HERVs) are a significant component of a wider family of\r\nretroelements that constitutes part of the human genome. They were originated by the integration of exogenous\r\nretroviruses into the human genome millions of years ago. HERVs are estimated to comprise about 8% of human\r\nDNA and are ubiquitous in somatic and germinal tissues.\r\nPhysiologic and pathologic processes are influenced by some biologically active HERV families. HERV antigens are\r\nonly expressed at low levels by the host, but in circumstances of inappropriate control their genes may initiate or\r\nmaintain pathological processes. Although the precise mechanism leading to abnormal HERVs gene expression has\r\nyet to be clearly elucidated, environmental factors seem to be involved by influencing the human immune system.\r\nHERV-K expression has been detected in different types of tumors.\r\nAmong the various human endogenous retroviral families, the K series was the latest acquired by the human\r\nspecies. Probably because of its relatively recent origin, the HERV-K is the most complete and biologically active\r\nfamily.\r\nThe abnormal expression of HERV-K seemingly triggers pathological processes leading to melanoma onset, but also\r\ncontributes to the morphological and functional cellular modifications implicated in melanoma maintenance and\r\nprogression.\r\nThe HERV-K-MEL antigen is encoded by a pseudo-gene incorporated in the HERV-K env-gene. HERV-K-MEL is\r\nsignificantly expressed in the majority of dysplastic and normal naevi, as well as other tumors like sarcoma,\r\nlymphoma, bladder and breast cancer. An amino acid sequence similar to HERV-K-MEL, recognized to cause a\r\nsignificant protective effect against melanoma, is shared by the antigenic determinants expressed by some vaccines\r\nsuch as BCG, vaccinia virus and the yellow fever virus.\r\nHERV-K are also reactivated in the majority of human breast cancers. Monoclonal and single-chain antibodies\r\nagainst the HERV-K Env protein recently proved capable of blocking the proliferation of human breast cancer cells\r\nin vitro, inhibiting tumor growth in mice bearing xenograft tumors\r\nSummary: A recent epidemiological study provided provisional evidence of how melanoma risk could possibly be\r\nreduced if the yellow fever virus vaccine (YFV) were received at least 10 years before, possibly preventing tumor\r\ninitiation rather than culling melanoma cells already compromised. Further research is recommended to confirm\r\nthe temporal pattern of this protection and eliminate/attenuate the potential role of relevant confounders as\r\nsocio-economic status and other vaccinations.\r\nIt appears also appropriate to examine the potential protective effect of YFV against other malignancies expressing\r\nhigh levels of HERV-K antigens, namely breast cancer, sarcoma, lymphoma and bladder cancer.\r\nTumor immune-therapy, as described for the monoclonal antibodies against breast cancer, is indeed considered\r\nmore complex and less advantageous than immune-prevention. Cellular immunity possibly triggered by vaccines as\r\nfor YFV might also be involved in anti-cancer response, in addition to humoral immunity.....
Background: Myelosuppressive chemotherapy can lead to dose-limiting febrile neutropenia. Prophylactic use of\r\nrecombinant human G-CSF such as daily filgrastim and once-per-cycle pegfilgrastim may reduce the incidence\r\nof febrile neutropenia. This comparative study examined the effect of pegfilgrastim versus daily filgrastim on the\r\nrisk of hospitalization.\r\nMethods: This retrospective United States claims analysis utilized 2004ââ?¬â??2009 data for filgrastim- and\r\npegfilgrastim-treated patients receiving chemotherapy for non-Hodgkinââ?¬â?¢s lymphoma (NHL) or breast, lung,\r\novarian, or colorectal cancers. Cycles in which pegfilgrastim or filgrastim was administered within 5 days from\r\ninitiation of chemotherapy (considered to represent prophylaxis) were pooled for analysis. Neutropenia-related\r\nhospitalization and other healthcare encounters were defined with a ââ?¬Å?narrowââ?¬Â criterion for claims with an ICD-9\r\ncode for neutropenia and with a ââ?¬Å?broadââ?¬Â criterion for claims with an ICD-9 code for neutropenia, fever, or\r\ninfection. Odds ratios (OR) for hospitalization and 95% confidence intervals (CI) were estimated by generalized\r\nestimating equation (GEE) models and adjusted for patient, tumor, and treatment characteristics. Per-cycle\r\nhealthcare utilization and costs were examined for cycles with pegfilgrastim or filgrastim prophylaxis.\r\nResults: We identified 3,535 patients receiving G-CSF prophylaxis, representing 12,056 chemotherapy cycles\r\n(11,683 pegfilgrastim, 373 filgrastim). The mean duration of filgrastim prophylaxis in the sample was 4.8 days.\r\nThe mean duration of pegfilgrastim prophylaxis in the sample was 1.0 day, consistent with the recommended\r\ndosage of pegfilgrastim - a single injection once per chemotherapy cycle. Cycles with prophylactic pegfilgrastim\r\nwere associated with a decreased risk of neutropenia-related hospitalization (narrow definition: OR = 0.43, 95%\r\nCI: 0.16ââ?¬â??1.13; broad definition: OR = 0.38, 95% CI: 0.24ââ?¬â??0.59) and all-cause hospitalization (OR = 0.50, 95% CI:\r\n0.35ââ?¬â??0.72) versus cycles with prophylactic filgrastim. For neutropenia-related utilization by setting of care, there\r\nwere more ambulatory visits and hospitalizations per cycle associated with filgrastim prophylaxis than with\r\npegfilgrastim prophylaxis. Mean per-cycle neutropenia-related costs were also higher with prophylactic filgrastim\r\nthan with prophylactic pegfilgrastim.\r\nConclusions: In this comparative effectiveness study, pegfilgrastim prophylaxis was associated with a reduced\r\nrisk of neutropenia-related or all-cause hospitalization relative to filgrastim prophylaxis....
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