Cancer In Britain Research Articles

Trends in survival for childhood cancer in Britain diagnosed 1971-85

Survival rates were analysed for a population-based series of over 15,000 childhood cancers registered in Great Britain during 1971-85. There were highly significant improvements (P less than 0.001 for trend) in survival for many major diagnostic groups. Between 1971-73 and 1983-85 the actuarial 5-year survival rates increased from 37% to 70% for acute lymphoblastic leukaemia, from 4% to 26% for acute non-lymphoblastic leukaemia, from 76% to 88% for Hodgkin's disease, from 22% to 70% for non-Hodgkin's lymphoma, from 61% to 72% for astrocytoma, from 24% to 42% for medulloblastoma, from 15% to 43% for neuroblastoma, from 58% to 79% for Wilms' tumour, from 17% to 54% for osteosarcoma, from 26% to 61% for rhabdomyosarcoma, from 59% to 94% for malignant testicular germ-cell tumours and from 43% to 77% for malignant ovarian germ-cell tumours. These increases in population-based survival rates reflect the substantial advances in treatment of a wide range of childhood cancers since 1970. The two principal diagnostic groups for which there was no evidence of any trend were retinoblastoma, which already had an excellent prognosis with a 5-year survival rate of over 85%, and Ewing's sarcoma, for which the survival rate remained below 45%.

Childhood cancer after prenatal exposure to diagnostic X-ray examinations in Britain

Detailed data were provided by the Oxford Survey of Childhood Cancer OSCC on deaths from childhood cancer in Britain after irradiation of the fetus during diagnostic radiology of the mother. In each age group at death, 0-5, 6-9 and 10-15 years, excess cancer deaths decreased suddenly for births in and after 1958. A major factor was concerted action initiated in 1956 to reduce radiation exposure of fetal gonads for fear of genetic hazards. Dose reduction was achieved during 1957 and early 1958 by reducing the rising rate of obstetric radiography and by virtually abandoning pelvimetry as that had been understood. In the 1970s the rate of X-raying increased again and so did cancer risk but not significantly. Direct evidence that diagnostic X-rays can cause childhood cancer is the similar excess rate per X-ray in twins and singleton births when X-raying rate is 5-6 times higher in twins. In the past a dose-response for cancer in OSCC data based on number of films per X-ray examination was taken to be evidence for causation but dose per film varies with kind of X-ray examination. Fixed values for dose per film were mistakenly assumed by UNSCEAR (1972) and used by it and others when deriving risk co-efficients. In updated OSCC data cancer risk is independent of film number. The odds ratio for childhood cancer deaths after X-raying in birth years 1958-61 (1.23 with 95% confidence intervals CI 1.04-1.48) and the mean fetal whole body dose from obstetric radiography in 1958 (0.6 cGy) can each be derived from nationwide surveys in Britain. The corresponding risk coefficient for irradiation in the third trimester for childhood cancer deaths at ages 0-15 years = 4-5 x 10(-4) per cGy fetal whole body dose (95% CI 0.8-9.5 x 10(-4) per cGy). It is the same for cancer incidence and mortality. A lower risk in bomb survivors exposed in utero is not incompatible since its CI are wide. There is no dependable evidence that radiosensitivity is greater in early pregnancy. A significantly raised cancer rate after diagnostic X-raying supports the hypothesis that carcinogenesis by ionising radiation has no threshold.

Geographical variations in the incidence of colorectal cancer in Britain

The incidence of colorectal cancer was compared in nine towns in England and Wales, chosen to encompass a range of socio-economic conditions and spread of latitude in the country. Cases were ascertained through pathology records, supplemented by clinical notes. The pattern of variation in incidence was different for men and women. Among men incidences were highest in towns with better socio-economic conditions, whereas among women the trend was reversed. This supports the hypothesis that the dominant aetiological influences causing colorectal cancer differ in the two sexes. Mortality rates did not correlate closely with incidence. This, together with the markedly different patterns of incidence of colorectal cancer and appendicitis in the nine towns, casts doubt on the significance of a reported inverse correlation between regional mortality from colonic cancer and the consumption of pentosic fibre.

Trends in cervical cancer and carcinoma in situ in Great Britain.

Doubts have frequently been expressed about the effectiveness of the screening programme for cervical cancer in Britain. These doubts have been reinforced as a result of recent increases in mortality from this disease among younger women. In this paper we discuss trends in registration and mortality data, relate these to the level of screening, and conclude that screening may in fact have had a considerable impact on mortality rates. There is good evidence that in some age groups there has been a large increase in the incidence of carcinoma in situ of the cervix; it seems likely that the potential increase in cervical cancer incidence and mortality may have been partially prevented as a result of the screening programme. The extent of this effect cannot be quantified precisely because of uncertainties concerning the natural history of cervical cancer, differences in risk for different cohorts, and the possible effects of other factors. It is likely that incidence rates will continue to change, and it will be necessary to monitor these and the screening programme with some care in order to make the best use of the resources available for cervical cytology.

Incidence of hepatitis B virus infection in alcoholic liver disease, HBsAg negative chronic active liver disease and primary liver cell cancer in Britain.

A study has been undertaken to determine the incidence of serum markers of hepatitis B virus (HBV) infection in British caucasian patients with biopsy-proven alcoholic liver disease (n = 56), HBsAg negative chronic active liver disease (CALD) (n = 47) and primary liver cell cancer (PLCC) (n = 27), compared to a hospital control population without liver disease (n = 112). No increased incidence of any serum marker of HBV infection was found in alcoholic liver disease or in 'lupoid' CALD (antinuclear factor positive 1:40 and/or smooth muscle antibody positive greater than 1:40). In contrast, the incidence of antibody to HB surface and core antigens was significantly increased (p less than 0.05) in patients with cryptogenic CALD. The incidence of hepatitis B surface antigen and antibodies to HB core and 'e' antigens was significantly increased (p less than 0.005) in PLCC.

The present status of clinical studies with interferons in cancer in Britain.

Although the evaluation of cloned interferons is now under way, the only clinical results currently available from U.K. studies in cancer come from trials using the (Wellcome) lymphoblastoid preparation. Dose toxicity studies for intravenous and intramuscular administration are now complete and show that on a daily schedule the maximum tolerated dose intramuscularly is 12 x 10(6) units (12 Mu) whereas by 24 h intravenous infusion doses of up to 300 Mu may be given without undue toxicity. A programme of studies has been initiated to assess the efficacy of lymphoblastoid interferon in a variety of tumours. A number of therapeutic responses have been seen but only one study, in malignant melanoma, has completed patient entry. In this series of 16 patients who had metastatic disease and had failed on conventional cytotoxic therapy one patient experienced a remission for 8 months as a result of interferon administration. In another study the combination of interferon with conventional cytotoxics is being evaluated in advanced breast cancer. Preliminary results indicate that the combination is well tolerated but it is too early to detect any therapeutic advantage from combining the two modalities.

Childhood Cancer in Britain: Incidence, Survival, and Mortality

Childhood Cancer in Britain: Incidence, Survival, and Mortality

Primary liver cell cancer in Britain--a viral aetiology?

Primary liver cell cancer in Britain--a viral aetiology?

Urinary steroid profiles in normal women and in patients with breast cancer in Britain and Japan: Relation to thyroid function

Steroid profiles of urinary 17-oxosteroids, pregnanediol and pregnanetriol were studied by gas-liquid chromatography in normal Japanese and British women, and in women with breast cancer from both races. The results showed that both pre- and post-menopausal Japanese women excreted significantly less aetiocholanolone, 11-oxo aetiocholanolone, and 11-hydroxy aetiocholanolone than their British counterparts. Androsterone was significantly less in Japanese pre-menopausal women and pregnanetriol in post-menopausal women respectively. However, a significantly lower androsterone ( 5α): aetiocholanolone ( 5β) ratio was found in the Japanese cancer patients than in the normal Japanese women (pre-menopausal, P = < 0.02, post-menopausal, P = < 0.05). In the British pre-menopausal breast cancer patients this 5α: 5β ratio was higher than in the normal British control (P = < 0.02). A comparison of blood plasma TSH levels with the urinary androsterone: aetiocholanolone ratios gave a significantly negative correlation in both the Japanese normal and cancer cases (P = < 0.05). No agreement was found in a similar comparison in the British women. These results could signify that a diminished thyroid function may be a predisposing factor to breast cancer in Japanese women.

Clinical trials of the treatment of breast cancer in Britain and Ireland. Report by co-ordinating committee.

Thirteen trials of systemic chemotherapy in early breast cancer were identified and protocols obtained. The differences in the latter prevented a true comparison of the results. In setting up any trial it is important to define the primary objectives and to include a statistician from the start. Only truly random allocation of patients is acceptable, while treatment programmes must be fully monitored. Other important aspects include review of the results by an independent member of the trial committee and keeping full, but simple, case records. Though any trial must be designed by a committee and not a single investigator, the individual clinician remains responsible for the patients under his care. To launch a controlled randomised trial without full preparation and guaranteed resources is in the best interests of neither patients nor doctors.

Breast cancer in Britain and Japan: Plasma oestradiol-17β, oestrone and progesterone, and their urinary metabolites in normal British and Japanese women

The plasma concentrations of oestrone, oestradiol- 17β and progesterone, and the urinary excretion of oestrone, oestradiol- 17β, oestriol and pregnanediol have been determined in normal Japanese and British adolescent, pre-menopausal, menopausal and post-menopausal women. The amounts of plasma oestrogen in British and Japanese women were not significantly different except in the adolescent group. In this latter category the mean level of plasma oestrone and oestradiol- 17β in the luteal phase was significantly higher in Japanese compared with British women. The mean excretion of urinary oestrogens in the two races was similar for all age groups studied, as was plasma progesterone and urinary pregnanediol. The mean ratio of oestriol to oestrone and oestradiol- 17β for Japanese was higher than that for British women in the two pre-menopausal groups, although the difference was not statistically significant. The difference in the incidence rates of breast cancer in Britain and Japan does not appear to be related to differences in plasma levels of oestrogens or progesterone.