Cancer In High-risk Population Research Articles

Cervical cancer: squamocolumnar junction ablation--tying up loose ends?

Despite the commercialization of HPV vaccines, cervical cancer remains a major cause of death, especially in developing countries. Recent data implicate a discrete population of cells within the cervical squamocolumnar junction in the pathogenesis of cervical precancerous lesions, indicating that ablation of these cells might reduce the rate of cervical cancer in high-risk populations.

How to improve the diagnosis rate of early gastric cancer in China

China has great burden of gastric cancer, and the diagnosis rate of early gastric cancer is relatively low (<10%). To perform screening, early endoscopic diagnosis and treatment of gastric cancer in high-risk population is a feasible and efficient way to change the current status. Therefore, the Chinese Society of Digestive Endoscopy recently issued Consensus on screening, "Endoscopic diagnosis and treatment of early gastric cancer screening in China". The consensus suggests a feasible and efficient strategy for early detection of gastric cancer: screening with non-invasive procedures, followed by intensive endoscopic examination for screened high-risk population. In this article, we also describe the current status, the causes, high-risk population and early diagnosis of gastric cancer in China; and review the new development of serology and endoscopic techniques for early diagnosis.

Risk stratification and prevention of venous thromboembolic disease in cancerology

Patients with cancer are at high risk of venous thromboembolism (VTE), which leads to significantly increased morbidity and mortality. The rates of VTE vary between 0.5% and 20% per year and depend mainly on cancer-specific and treatment-related risk factors. Also individual risk factors related to patientś characteristics contribute to occurrence of cancer-associated VTE. Risk factors and biomarkers may help identify patients at high risk of developing VTE. In several clinical studies, risk factors for the occurrence of VTE events in patients with cancer have been investigated. The type and stage of cancer have been found to be amongst the most important risk factor for VTE occurrence. Also the histological grade of a tumor has been reported to be associated with the occurrence of VTE. In other investigations, venous diseases including a history of previous VTE, a history of superficial thrombophlebitis and the presence of varicose veins, have been associated with the risk of VTE. Some studies have recently focused on the identification of biomarkers or laboratory parameters predictive of future VTE occurrence. Parameters of blood count analysis (such as elevated leukocyte and platelet count and decreased hemoglobin) have turned out to be useful in risk stratification for VTE. In a prospective and observational cohort study, the Vienna Cancer and Thrombosis Study (CATS), associations between elevated levels and risk of future VTE have been found for D-dimer, prothrombin fragment 1 + 2, and soluble P-selectin and also for clotting factor VIII and the thrombin generation potential. The role of circulating microparticles for predicting risk of VTE in patients with cancer is unclear and has to be further investigated. Risk assessment models for prediction of VTE were developed including clinical and laboratory markers. First, Khorana and colleagues published a risk assessment score that incorporates readily available parameters: primary site of cancer, pre-chemotherapy platelet count of 350 × 109/L or more, haemoglobin level less than 10 g/dL and/or use of erythropoiesis stimulating agents, pre-chemotherapy leukocyte count of more than 11 × 109/L, and a body mass index of 35 kg/m2 or more. This score was validated in other studies. In CATS the score was expanded by adding two biomarkers (D-dimer and soluble P-selectin), and the prediction of VTE was considerably improved. In the high risk categories, patients with a VTE rate up to a 20% or higher within 6 months can be identified. In recent randomized controlled trials including cancer patients with different malignancies – without applying specific VTE risk assessment – it was shown that thromboprophylaxis is safe and effective. However, the overall VTE rates were low in these studies. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorized into high-risk groups on the basis of risk assessment scores. In conclusion, risk stratification for VTE is feasible in cancer patients. Further improvement in risk stratification would help better identify patients for VTE prevention using anticoagulant agents. However, interventional studies are needed to investigate the safety and efficacy of thromboprophylaxis in a high-risk cancer population.

Coffee Intake and Gastric Cancer Risk: The Singapore Chinese Health Study

Despite experimental evidence showing chemopreventive effects of coffee-related compounds on gastric carcinogenesis, epidemiologic studies generally do not support coffee-gastric cancer associations. Observational data are lacking among high-risk populations with sufficient regular coffee consumption. We examined the association between caffeinated coffee intake and gastric cancer risk in a population-based cohort that enrolled 63,257 Chinese men and women ages 45 to 74 years between 1993 and 1998 in Singapore. Incident gastric cancer cases (n = 647) were identified after a mean follow-up of 14.7 years. Biomarkers of Helicobacter pylori (H. pylori) infection were measured in a subset of gastric cancer cases with blood collected before cancer diagnosis and their matched controls. In the total cohort, daily versus nondaily coffee intake was associated with a statistically nonsignificant decrease in gastric cancer risk [HR = 0.85; 95% confidence interval (CI), 0.69-1.04]. In women, the inverse association strengthened and reached statistical significance (HR = 0.63; 95% CI, 0.46-0.87). In analyses restricted to never smokers and nondrinkers of alcohol, inverse associations strengthened in the total cohort (HR = 0.69; 95% CI, 0.52-0.91) and in women (HR = 0.52; 95% CI, 0.37-0.74). There was no coffee-gastric cancer risk association among men, regardless of smoking status or alcohol consumption. Similar results were observed in the nested case-control study after adjustment for H. pylori infection. Daily coffee consumption may reduce the risk of gastric cancer in high-risk populations, especially among women. Research aimed at identifying the compounds in coffee that may protect against gastric carcinogenesis is warranted.

Screening and early detection of pancreatic cancer in high risk population

Pancreatic cancer is a serious growing health issue in developed countries. For patients diagnosed with pancreatic cancer, the five year survival rate is below 5%. One major important reason leads to the poor survival rate is lack of early detection of pancreatic cancer. Over 80% of the patients are diagnosed in advanced disease stages. Screening for pancreatic cancer is a desirable option for high risk individuals to allow early detection and treatment of curable pancreatic neoplasms at a pre-invasive stage. This article highlights the need, endpoint, population, method, diagnostic yield, and the problems of current screening programs.

Naturally Occurring Substances and Their Role in Chemo-protective Effects

Cancer chemoprevention is defined as the use of natural, synthetic or biological chemical agents to reverse, suppress or prevent carcinogenic progression of invasive cancer. Carcinogenesis is a complex multi-step process; therefore, it is necessary to attack cell proliferation, stimulate apoptosis and inhibit angiogenesis. There have been more than 60 randomised trials using chemopreventive potential agents. The success of several recent clinical trials in preventing cancer in high-risk populations suggests that chemoprevention is a rational and appealing strategy. In this review, we describe the conceptual basis for the chemoprevention of cancer, proven concepts of efficiency and current trends in the use of chemopreventive agents according to place and mechanism of action. We classify chemopreventive substances into seven groups based on their chemical structure and their effects, namely, deltanoids (paracalcitriol), retinoids (13-cis retinoic acid), non-steroidal anti-rheumatics (Deguelin), antiestrogens (genistein), polyphenols (curcumin), sulphur containing compounds (sulforaphane) and terpenes (lycopene). Chemoprevention is one of several promising strategies for reducing the incidence of malignant tumours or helping to prolong the time before recurrence.

CT Scans Recommended for Lung Cancer Screening

Abstract The U.S. Preventive Services Task Force has released draft recommendations calling for annual low-dose computed tomography scans to screen for lung cancer in high-risk populations.

Breast Tumor Detection Using Piezoelectric Fingers: First Clinical Report

Mammography is key to detection of breast cancer in high-risk populations. Currently, aside from palpation and risk-assessment questionnaires, there is no prescreening test that can improve the accuracy, safety, and cost effectiveness of screening low-risk populations. The piezoelectric finger (PEF) is a radiation-free, portable, and low-cost breast tumor detector we developed to be used as a prescreening tool. Patients presenting with breast abnormalities detected by palpation or imaging were enrolled in this IRB-approved study. The PEF testing was performed with the patient in supine position before undergoing biopsy or surgical excision. The locations of the lesions detected by PEF were compared with those confirmed on imaging or pathology. A total of 40 patients were enrolled and 46 lesions were confirmed by imaging or pathology. The PEF reported 55 lesions, with 9 false positives and 2 true positives not originally found on imaging or palpation. The overall sensitivity of the PEF test was 87% (40 of 46). In women 40 years old or younger, overall sensitivity was or 100% (19 of 19). In women who had a lesion visible on mammography, PEF had a sensitivity of 83% (24 of 29). Of these, in women aged 40 years or younger, PEF identified all 7 mammographically visible lesions, including 2 malignant lesions. When compared with ultrasound, PEF correctly identified 87% (34 of 39) in this group. Of these, in women aged 40 years or younger, PEF identified 100% (19 of 19) of all ultrasound-visible lesions. The PEF identified abnormalities in all 39 patients who presented with breast abnormalities and did not demonstrate any false negatives that would prevent the patients from additional evaluation, which makes it a good prescreening tool. In addition, PEF demonstrated 100% sensitivity in women aged 40 years or younger, a traditionally low-risk population.

Impact of Venous Thromboembolism (VTE) Prophylaxis and Risk Stratification with the Caprini Model in Hospitalized Patients with Cancer

AbstractAbstract ▪364▪This icon denotes a clinically relevant abstract Introduction:VTE is a common complication in hospitalized medical patients and the role of pharmacologic anticoagulation prophylaxis is well-established. Patients with active malignancy are at higher risk for VTE during hospitalization. However, VTE prophylaxis is underutilized in these patients due to many real and perceived contraindications to prophylaxis. To aid clinicians in determining VTE risk and guide choice of prophylaxis, our institution adopted the Caprini risk assessment model (Ann Surg, 2010; 251[2]:344–50), based on clinical factors such as age, comorbidities, and recent surgery.Our primary objective was to assess adherence to recommended VTE prophylaxis in hospitalized medical patients with solid tumors, hematological malignancies, and bone marrow transplant (BMT) patients in comparison to general medical (GM) patients, and the impact of recommended prophylaxis use on VTE outcomes. Secondary objectives were to evaluate the distribution of Caprini risk scores and the utility of the Caprini risk assessment model for guiding prophylaxis in this population. Methods:Patients admitted to the hematology/oncology (HO; oncology, malignant hematology, and BMT) and GM inpatient services at the University of Michigan between July 1, 2009 to December 31, 2011 were included in the study. After IRB approval, patient information was extracted from the electronic medical record (EMR). A point-scoring method based on the Caprini risk assessment model was used to calculate VTE risk at admission. A score of 3–4 was high risk and ≥ 5 highest risk for VTE. Type of VTE prophylaxis and VTE rate were determined. Recommended prophylaxis was 5000 units TID SQ heparin, 30–40 mg SQ enoxaparin, or 2.5 mg SQ fondaparinux, ± sequential compression devices (SCDs). Pharmacological prophylaxis administration was verified in the EMR. VTE is defined as deep venous thrombosis (DVT) or pulmonary embolism (PE) occurring during hospitalization or within 90 days, confirmed by Doppler, CT or V/Q scan. Adherence was defined as the percentage of patients at high or highest risk for VTE with a length of stay ≥ 2 days who received guideline recommended prophylaxis within 2 days of admission. Patients with a contraindication to prophylaxis were excluded. A retrospective cohort study was performed. Chi-squared test was used to test differences in proportions and Cochran-Armitage test for trends. Results:4300 patients were admitted to HO and 18,347 to GM services. Compared to GM patients (86.8%), the rate of adherence to recommended VTE prophylaxis was similar for oncology (87.6%), hematology (85.4%), and lower (45.6%) for BMT patients (p<0.0001). The overall VTE rate on HO services was 2.77%. Compared with 1.45% in GM, VTE rate was 3.02% in oncology (p=0.070), 2.01% in hematology (p=0.220), and 3.61% for BMT (p=0.001). Over half (51.3%) of VTE in HO patients occurred in patients who did not receive pharmacologic prophylaxis. In HO patients with a VTE, ordered prophylaxis included 16.0% combined pharmacological and SCD, 32.8% pharmacological alone, 32.8% SCD alone, and 18.5% none. Use of combined or pharmacologic prophylaxis alone was non-significantly increased in the non-VTE HO patients.By the Caprini risk assessment model, 33.3% of all patients on HO services were high and 62.2% highest risk, with less oncology (p=0.0001) and more BMT (p=0.0003) patients classified as high or highest risk. VTE rate in HO patients rose as Caprini risk score increased: score (n, % with VTE) 0–1 (23, 4.35%,); 2 (169, 0.59%); 3–4 (1434, 1.67%); 5–6 (1691, 2.90%); 7–8 (745, 3.76%); and 9 (238, 6.72%), p<0.0001 for trend. Conclusions:Adherence to recommended VTE prophylaxis was high in medical patients with cancer, resulting in low overall rates of VTE during and following discharge. The majority of patients with VTE did not receive recommended pharmacologic prophylaxis. Most VTE occurred in patients at highest risk (Caprini risk assessment score ≥ 5), with a trend to higher VTE rate as individual score increased. These data suggest that the individual Caprini score may provide more detailed VTE risk assessment and may help inform the need for prophylaxis despite perceived relative contraindications in this high risk cancer population. Further study is needed to understand the barriers to ordering VTE prophylaxis in this population and encourage increased prophylaxis use. Disclosures:No relevant conflicts of interest to declare.

Clinical indications: what is the evidence?

Extensive international research spanning more than two decades has demonstrated the contribution of MRI in improved screening, diagnosis and assessment of response to treatment for patients with breast cancer. While the contribution of breast MRI to clinical practice is supported in published research, there are concerns raised regarding the impact of breast MRI on potential overdiagnosis and over-treatment of patients at risk for and with breast cancer. Because of its high sensitivity, MRI has transitioned into standard clinical practice as a screening tool for women at high risk. Many organizations that publish cancer screening guidelines, including the American Cancer Society, the American College of Radiology, and the European Society of Breast Imaging, now support MRI as a screening tool for patients at high risk for breast cancer [1– 4]. These guidelines are supported by multiple studies which demonstrate screening breast MRI is significantly more sensitive in identifying cancer in high-risk populations [5–10]. Taken together, fourteen studies conducted between 2000–2011 found that MRI had a sensitivity of 84.6% for detecting malignancies compared to 38.6% for mammography and 39.6% for US in high-risk populations (Table 1). In addition to detecting invasive cancers in high-risk populations, MRI has the advantage of identifying cancers at a significantly earlier stage than cancers detected by mammography alone. A study undertaken by the International Breast MRI Consortium (Schnall, PI) found all MR cancers detected during the study period were node negative [11]. A large screening study of 1909 women done in the Netherlands in 2004 found women who underwent MR screening had half the incidence of positive nodes compared to age-matched controls (p < 0.001) [12]. This is consistent with findings by TilanusLinthorst and colleagues in which the MR screen group had less

The value of positron emission tomography in early detection of lung cancer in high‐risk population: a systematic review

Early detection trials with chest radiography and sputum cytology were ineffective in decreasing lung cancer mortality. The advent of low-dose spiral chest computed tomography (LDCT) provided clinicians with a new tool that could be with early diagnosis; however, this also raised significant concerns regarding the systematic use of LDCT with its high false-positive rate for benign nodules. At this time, there is limited information about the true role of PET (positron emission tomography) for early detection of lung cancer. We used systematic methods, including Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, to identify relevant studies, assess study eligibility, evaluate study methodological quality, and summarize findings regarding diagnostic accuracy and outcome. In total, only seven eligible studies were selected from 82 potentially relevant studies. The sensitivity of 18F-FDG-PET for the detection of T1 lung cancers ranged between 68% and 95%. The rate of detection tended to be lower for carcinoid tumors, adenocarcinoma and bronchoalveolar cell carcinomas. FDG-PET using SUV (standardized uptake value) level can predict the outcome of the screening detected lung cancer. A combination of FDG-PET and LDCT may improve screening for lung cancer in high-risk patients. PET or PET/CT may be used as a useful tool for early detection of lung cancer in high-risk population based on the existing information. However, there is still limited information with regards to evidence of survival benefits from PET screening in high-risk patients.

EarlyCDT®-Lung test: improved clinical utility through additional autoantibody assays

Tumor-associated autoantibodies (AAbs) have been described in patients with lung cancer, and the EarlyCDT®-Lung test that measures such AAbs is available as an aid for the early detection of lung cancer in high-risk populations. Improvements in specificity would improve its cost-effectiveness, as well as reduce anxiety associated with false positive tests. Samples from 235 patients with newly diagnosed lung cancer and matched controls were measured for the presence of AAbs to a panel of six (p53, NY-ESO-1, CAGE, GBU4-5, Annexin I, and SOX2) or seven (p53, NY-ESO-1, CAGE, GBU4-5, SOX2, HuD, and MAGE A4) antigens. Data were assessed in relation to cancer type and stage. The sensitivity and specificity of these two panels were also compared in two prospective consecutive series of 776 and 836 individuals at an increased risk of developing lung cancer. The six-AAb panel gave a sensitivity of 39 % with a specificity of 89 %, while the seven-AAb panel gave a sensitivity of 41 % with a specificity of 91 % which, once adjusted for occult cancers in the population, resulted in a specificity of 93 %. Analysis of these AAb assays in the at-risk population confirmed that the seven-AAb panel resulted in a significant increase in the specificity of the test from 82 to 90 %, with no significant change in sensitivity. The change from a six- to a seven-AAb assay can improve the specificity of the test and would result in a PPV of 1 in 8 and an overall accuracy of 92 %.

A noninvasive multi-analyte diagnostic assay: combining protein and DNA markers to stratify bladder cancer patients

PurposeThe authors recently reported the development of a noninvasive diagnostic assay using urinary matrix metalloproteinases (MMPs) as monitors of disease-free status and bladder cancer in high-risk populations. Using an approach called clinical intervention determining diagnostic (CIDD), they identified with high confidence those patients who could be excluded from additional intervention. To maximize performance, MMPs were combined with DNA-based markers and CIDD was applied to a population of patients undergoing monitoring for recurrence.Patients and methodsUrine samples were obtained from 323 patients, 48 of whom had a recurrence and 275 of whom did not have cancer upon cytoscopic evaluation. Twist1 and Nid2 methylation status was determined using methylation-specific polymerase chain reaction, FGFR3 mutational status by quantitative PCR, and MMP levels by enzyme-linked immunosorbent assay.ResultsUsing a combination of these DNA and protein markers, the authors identified with high confidence (97% negative predicted value) those patients who do not have cancer. Cutoffs were adjusted such that at 92% sensitivity, 51% of disease-free patients might be triaged from receiving further tests.ConclusionThe multi-analyte diagnostic readout assay described here is the first to combine protein and DNA biomarkers into one assay for optimal clinical performance. Using this approach, the detection of FGFR3 mutations and Twist1 and Nid2 methylation in the urine of patients undergoing bladder cancer recurrence screening increase the sensitivity and negative predictive value at an established MMP protein cutoff. This noninvasive urinary diagnostic assay could lead to the more efficient triage of patients undergoing recurrence monitoring.

Venous thromboembolism in cancer patients – Risk scores and recent randomised controlled trials

Cancer patients are at increased risk of developing venous thromboembolism (VTE). Guidelines recommend routine thromboprophylaxis in hospitalised acutely ill cancer patients and in myeloma patients receiving combination treatments including thalidomide or lenalidomide. Currently, thromboprophylaxis is not recommended in cancer outpatients. It is the aim of this review to give an overview of studies that applied scores for the risk assessment of cancer-related VTE. We will also discuss randomised controlled trials (RCTs) that investigated primary thromboprophylaxis in cancer patients. Recently, Khorana et al. published a practical and reproducible risk assessment score that includes clinical and laboratory parameters for the stratification of cancer patients according to their propensity to develop VTE. Patients assigned to the high-risk group are likely to benefit most from primary thromboprophylaxis. This score was validated in prospective and retrospective observational studies. In the Vienna Cancer and Thrombosis Study (CATS) the score was expanded by adding two biomarkers, and the prediction of VTE was considerably improved. In recent RCTs including cancer patients with different malignancies it was shown that thromboprophylaxis is safe and effective. However, VTE incidence rates were low. To date, no data is available from interventional studies applying thromboprophylaxis in cancer patients categorised into high-risk groups on the basis of risk assessment with scores. From the available literature we conclude that risk assessment for VTE is feasible in cancer patients; however, interventional studies to investigate the safety and efficacy of thromboprophylaxis in a high risk cancer population have yet to be performed.

Attitudes toward Vaccination for Pandemic H1N1 and Seasonal Influenza in Patients with Hematologic Malignancies

Patients with hematologic malignancies are at increased risk of influenza and its complications. Despite current health recommendations and evidence favoring influenza vaccination, vaccination rates remain low in cancer patients. The purpose of this study was to determine which factors influenced vaccination rates. During the 2009-2010 pandemic H1N1 and seasonal influenza season, we surveyed patients with hematologic malignancies in a Canadian cancer center. Of the patients participating in our study (n = 129), 66% and 57% received the H1N1 pandemic influenza and seasonal influenza vaccines, respectively. A number of reasons for vaccination refusal were reported, most relating to general skepticism about the safety and efficacy of vaccination. Physician advice was also a factor influencing vaccination rates in patients. The vaccination rate for seasonal influenza was 39% in patients < 65 years old, significantly lower than the rate of 73% reported for patients aged > or = 65 years (P < 0.0001). Future education programs should target younger patient populations and health-care workers, focusing on vaccine safety and efficacy in the high-risk cancer population.

ABC Transporters, Bile Acids, and Inflammatory Stress in Liver Cancer

The biliary secretion of bile acids is critical for multiple liver functions including digesting fatty nutrients and driving bile flow. When this process is impaired, the accumulating bile acids cause inflammatory liver injury. Multiple ABC transporters in the liver are key players to safeguard the hepatocyte and avoid toxicity due to bile acid over-accumulation. BSEP provides for efficient secretion of bile acids across the canalicular membrane against a steep concentration gradient. MDR3/Mdr2 and ABCG5/G8 secrete phosphatidylcholine and cholesterol, respectively, in coordination with BSEP-mediated bile acid secretion to mask the detergent/toxic effects of bile acids in the bile ductular space. Several lines of evidence indicate that when these critical steps are compromised, bile acid toxicity in vivo leads to inflammatory liver injury and liver cancer. In bsep-/- mice, liver cancer is rare. These mice display greatly increased expression of alternative bile acid transporters, such as Mdr1a/1b, Mrp3 and Mrp4. We believe these alternative transport systems provide an additional safeguard to avoid bile acid overload in liver. Such backup systems appear to be under-utilized in humans, as defects in BSEP and MDR3 lead to severe, often fatal childhood diseases. It is possible, therefore, that targeting ABC transporters and modulating the toxicity of the bile acid pool could be vital interventions to alleviate chronic inflammation and reduce the incidence of liver cancer in high-risk populations. The combination of an alternative ABC transporter with a novel substrate may prove an effective chemo-preventive or therapeutic strategy.

Early detection of lung cancers – Comparison of computed tomography, cytology and fuzzy-based tumor markers panels

Lung cancer is still a primary cause of cancer death in the western world. Thus, a comprehensive primary diagnostic program which comprises the measurement of biomarkers released by lung cancers is of great importance in the clinical management of lung cancer patients. This review present data for the early lung cancer detection comparing computed tomography (CT), sputum cytology and a tumor marker panel of CYFRA 21-1, CEA, NSE, ProGRP, and SCC which was included into fuzzy classification.Sensitivities in the CT studies were mainly reported with 100% and in sputum analyses with a maximum of 87.5%. The corresponding specificity in sputum cytology analysis was 92.7%. By use of CT, all peripheral squamous or adenocarcinomas of the lung were detected, but there was a lack in detection of SCLC or central localised tumors. In addition, CT detected many non-calcified nodules, of which only a fraction is actual lung cancer leading to a considerable amount of false positive results. At 95{\%}-specificity the sensitivity of a tumor marker panel included into fuzzy modelling for the detection of NSCLC was 50% at stage I. Also SCLC patients could be detected in more than 70% in limited disease stage. Detection rates of advanced tumor stages were even higher. The positive predictive value of biological markers was 80% while the negative predictive value reached around 90%. Modern biological marker approaches in combination with CT and sputum cytology analyses may improve the differential diagnosis especially for the early detection of lung cancer in high-risk populations.

Long-term outcomes of a pilot CT screening for lung cancer.

Background:Low-dose computed tomography (CT) screening can detect early stage lung cancer in high-risk populations. However, no data on repeated annual screening over more than 5 years are available, and the impact of screening on lung cancer mortality is controversial.Methods:We analysed outcomes in high-risk asymptomatic volunteers (smokers and former smokers, >50 years) enrolled in a pilot study over 1 year from June 2000, who received annual low-dose CT for 7 years. Cumulative lung cancer incidence and survival were represented by Kaplan–Meier curves. Standardized incidence and mortality ratios were used to estimate risks relative to the general Italian and US population.Results:Compliance was 86% at the end of the seventh year in 1035 recruited volunteers (71% men, mean age 58 years). Lung cancer was diagnosed in 54 (5.3%); radical surgery was possible in 48/54 (87%); 39/54 (72%) had stage I disease. Five-year survival was 63% overall, 89% for stage I cases. During 6308 person-years of observation, 47 participants had died versus 75 expected in the Italian general population standardised for age and sex. Fourteen lung cancer deaths were registered versus 27 expected in a standardised US smoker population.Conclusions:Seventy percent of screening-diagnosed patients had stage I disease, and the survival of screen-detected cancer patients was high. Lung cancer mortality was favourable compared to age- and sex-matched population of US smokers, suggesting that mortality can be lowered by screening, although larger trials with longer follow-up are necessary to confirm these findings.

Tailored Community Cancer Education Programs: Pawsox and Prostates

To assess the prostate cancer screening practices in Rhode Island, we designed a questionnaire which was sent to 150 primary care physicians. A population-based survey was distributed to 194 men over 40 asking about screening history and risk factors. Eighty-five percent of primary care physicians reported performing annual prostate-specific antigen tests (PSAs) and digital rectal exams, 63% recognized family history as a risk factor, and 14% identified African Americans as a high-risk population. The survey found that 48% of men recognized family history as a risk factor and 6% understood that African Americans were at high risk. Each year, 200 men, primarily SED, are invited to a PawSox baseball game where physicians provide information on prostate cancer risk, treatment options, and outcomes. Free PSAs are provided. The questionnaire and survey demonstrate a need for more public education regarding prostate cancer in high-risk populations. Tailored community-based interventions, such as the Pawsox & Prostate program, can be effective professional and public education strategies to increase screening in high-risk populations.

Genetic polymorphisms in DNA base excision repair gene XRCC1 and the risk of squamous cell carcinoma of the head and neck

BackgroundThe genes of base excision repair (BER) pathway have been extensively studied in the association with various human cancers. We performed a case-control study to test the association between two common single nucleotide polymorphisms (SNPs) of XRCC1 gene with human head and neck squamous cell carcinoma (HNSCC).MethodsThe genotype analysis of Arg194Trp and Arg399Gln gene polymorphisms for 92 HNSCC patients and 124 controls of cancer free subjects, in Polish population were performed using the PCR-based restriction fragment length polymorphism (PCR-RFLP) with endonuclease MspI.ResultsNo altered risk has been found individually for these SNPs, however haplotypes analysis showed high association with head and neck cancer. The highest frequency, according to wild-type of Arg194Arg and Arg399Arg genotypes, was identified for Arg194Trp-Arg399Arg haplotype (OR, 2.96; 95% CI, 1.01–8.80).ConclusionFinally, we identified the combined Arg194Trp-Arg399Arg genotype of base excision repair gene XRCC1 that was associated with HNSCC and may have an impact on identification of a high-risk cancer population.