Shanghai Cancer Research Articles

Association of Aflatoxin and Gallbladder Cancer

Aflatoxin, which causes hepatocellular carcinoma, may also cause gallbladder cancer. We investigated whether patients with gallbladder cancer have higher exposure to aflatoxin than patients with gallstones. We measured aflatoxin B1 (AFB1)-lysine adducts in plasma samples from the Shanghai Biliary Tract Cancer case-control study, conducted from 1997 through 2001. We calculated age- and sex-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) and the population-attributable fraction for 209patients with gallbladder cancer and gallstones vs 250 patients with gallstones without cancer (controls). In 54 patients with gallbladder cancer, tumor tissue was examined for the R249S mutation in TP53, associated with aflatoxin exposure, through targeted sequencing. The AFB1-lysine adduct was detected in 67 (32%) of 209 patients with gallbladder cancer and 37 (15%) of the 250 controls (χ2P< .0001), almost threefold more patients with gallbladder cancer than controls (OR, 2.71; 95% CI, 1.70-4.33). Among participants with detectable levels of AFB1-lysine, the median level of AFB1-lysine was 5.4 pg/mg in those with gallbladder cancer, compared with 1.2 pg/mg in controls. For patients in the fourth quartile of AFB1-lysine level vs the first quartile, the OR for gallbladder cancer was 7.61 (95% CI, 2.01-28.84). None of the 54 gallbladder tumors sequenced were found to have the R249S mutation in TP53. The population-attributable fraction for cancer related to aflatoxin was 20% (95% CI, 15%-25%). In a case-control study of patients with gallbladder cancer and gallstones vs patients with gallstones without cancer, we associated exposure to aflatoxin (based on plasma level of AFB1-lysine) with gallbladder cancer. Gallbladder cancer does not appear associate with the R249S mutation in TP53. If aflatoxin is a cause of gallbladder cancer, it may have accounted for up to 20% of the gallbladder cancers in Shanghai, China, during the study period, and could account for an even higher proportion in high-risk areas. If our findings are verified, reducing aflatoxin exposure might reduce the incidence of gallbladder cancer.

Determinants of Quality of Life for Breast Cancer Patients in Shanghai, China.

PurposeTo evaluate the association of social support status, health insurance and clinical factors with the quality of life of Chinese women with breast cancer.MethodsInformation on demographics, clinical characteristics, and social support status was collected from 1,160 women with newly diagnosed breast cancer in Shanghai, China. The Perceived Social Support Scale was used to assess different sources of social support for breast cancer patients. The quality of life was evaluated using the Functional Assessment of Cancer Therapy-Breast Cancer that consisted of five domains: breast cancer-specific, emotional, functional, physical, and social & family well-being. Multivariate linear regression models were used to evaluate the associations of demographic variables, clinical characteristics, and social support status with the quality of life measures.ResultsAdequate social support from family members, friends and neighbors, and higher scores of Perceived Social Support Scale were associated with significantly improved quality of life of breast cancer patients. Higher household income, medical insurance plans with low copayment, and treatment with traditional Chinese medicine for breast cancer all were associated with higher (better) scores of quality of life measures whereas patients receiving chemotherapy had significantly lower scores of quality of life.ConclusionSocial support and financial aids may significantly improve the quality of life of breast cancer survivors.

Incidence trend of malignant tumors in children in Shanghai

To understand the incidence trend of malignant tumors in children aged <15 years in Shanghai. The <15 years old children diagnosed with cancer in Shanghai between 2009 and 2011 were included in this study. The types of malignant tumors were classified according to International Classification of Childhood Cancer, Version 3 (ICCC-3). The gender and age specific incidences of malignant tumors were analyzed. Software Joinpoint was used to calculate the annual percentage of childhood cancer cases. A total of 460 cases of childhood cancer were diagnosed in Shanghai during 2009-2011, accounting for 0.3% of total cancer cases. The crude incidence was 129.0 per million and the age standardized rate (ASR) was 129.6 per million. The ASR was higher in boys (142.1 per million) than in girls (116.4 per million). The boy to girl ratio was 1.2(95%CI: 1.0-1.5). The incidence was highest in age group <5 years (165.1 per million). The incidences in age groups 5-9 years and 10-14 years were 101.2 per million and 113.9 per million, respectively. Leukemia was the most common cancer in children (n=165, 35.9%, ASR: 47.0 per million), followed by central nervous system tumors (n=91, 19.8%, ASR: 25.6 per million) and lymphomas (n=45, 9.8%, ASR: 12.6 per million). The age and gender specific incidence of malignant tumors and the type specific incidence of malignant tumors in children in Shanghai had no significant changes during the study period. The incidence of malignant tumors was higher in boys than in girls in Shanghai. Leukemia, central nervous system tumors and lymphomas were the three most common cancers in children. The overall incidence of malignant tumors in children in Shanghai had no significant changes during 2002-2011.

Incidence and survival of non-small cell lung cancer in Shanghai: a population-based cohort study

ObjectivesLarge population-based studies on the incidence and outcome of non-small cell lung cancer (NSCLC) are lacking in mainland China. This study aimed to investigate the NSCLC incidence, demographic features and...

Changing attitudes toward needle biopsies of breast cancer in Shanghai: experience and current status over the past 8 years.

Diagnostic patterns in breast cancer have greatly changed over the past few decades, and core needle biopsy (CNB) has become a reliable procedure for detecting breast cancer without invasive surgery. To estimate the changing diagnostic patterns of breast cancer in urban Shanghai, 11,947 women with breast lesions detected by preoperative needle biopsy between January 1995 and December 2012 were selected from the Shanghai Cancer Data base, which integrates information from approximately 50% of breast cancer patients in Shanghai. The CNB procedure uses an automated prone unit, biopsy gun, and 14-gauge needles under freehand or ultrasound guidance and was performed by experienced radiologists and surgeons specializing in needle biopsies. Diagnosis and classification for each patient were independently evaluated by pathologists. Over the indicated 8-year period, biopsy type consisted of 11,947 ultrasound-guided core needle biopsies (UCNBs), 2,015 ultrasound-guided vacuum-assisted biopsies (UVABs), and 654 stereotactic X-ray-guided vacuum-assisted biopsies (XVABs). For all the 11,947 women included in this study, image-guided needle biopsy was the initial diagnostic procedure. Approximately 81.0% of biopsied samples were histopathologically determined to be malignant lesions, 5.5% were determined to be high-risk lesions, and 13.5% were determined to be benign lesions. The number of patients choosing UCNB increased at the greatest rate, and UCNB has become a standard procedure for histodiagnosis because it is inexpensive, convenient, and accurate. The overall false-negative rate of CNB was 1.7%, and the specific false-negative rates for UCNB, UVAB, and XVAB, were 1.7%, 0%, and 0%, respectively. This study suggests that the use of preoperative needle biopsy as the initial breast cancer diagnostic procedure is acceptable in urban Shanghai. Preoperative needle biopsy is now a standard procedure in the Shanghai Cancer Center because it may reduce the number of surgeries needed to treat breast cancer.

Time trends and age-period-cohort analyses on incidence rates of thyroid cancer in Shanghai and Hong Kong.

BackgroundIncreasing incidence rates of thyroid cancer have been noted worldwide, while the underlying reasons remain unclear.MethodsUsing data from population-based cancer registries, we examined the time trends of thyroid cancer incidence in two largest cities in China, Shanghai and Hong Kong, during the periods 1973–2009 and 1983–2011, respectively. We further performed age-period-cohort analyses to address the possible underlying reasons for the observed temporal trends.ResultsWe observed continuous increases in the incidence rates of thyroid cancer in Shanghai and Hong Kong, since the 1980s, in addition to higher incidence rates in the 1970s in both sexes in Shanghai. The age-standardized incidence rate of thyroid cancer increased by 3.1% [95% confidence interval (CI): 1.0%, 5.1%] and 3.8% (95% CI: 1.9%, 5.7%) per year on average, respectively, in Shanghai men and women during the period 1973–2009, while it increased by 2.2% (95% CI: 1.5%, 2.8%) and 2.7% (1.6%, 3.8%) per year on average, respectively, in Hong Kong men and women during the period 1983–2011. We observed global changes in trends across all age groups in similar ways, in addition to varied trends across different generations (birth cohorts).ConclusionsThe increased incidence rates of thyroid cancer in these two Chinese populations during recent decades may be contributable to a combination of the introduction of more sensitive diagnostic techniques and the increasing prevalence of environmental exposures in the populations.

Prognostic Value of Myeloid Differentiation Primary Response 88 and Toll-Like Receptor 4 in Breast Cancer Patients

PurposeBreast cancer remains a major cause of death in women worldwide, and tumor metastasis is the leading cause of death in breast cancer patients after conventional treatment. Chronic inflammation is often related to the occurrence and growth of various malignancies. This study evaluated the prognosis of breast cancer patients based on contributors to the innate immune response: myeloid differentiation primary response 88 (MyD88) and Toll-like receptor 4 (TLR4).MethodsWe analyzed data from 205 breast invasive ductal carcinoma (IDC) patients who were treated at the Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Fudan University Shanghai Cancer Center, from 2002 to 2006. Overall survival (OS) and disease-free survival (DFS) were compared.ResultsIn total, 152 patients (74.15%) were disease-free without relapse or metastasis, whereas 53 (25.85%) patients developed recurrence or metastasis. A significant positive correlation was observed between MyD88 and TLR4 expression (p<0.001). Patients with high expression were more likely to experience death and recurrence/metastasis events (p<0.05). Patients with low MyD88 or TLR4 expression levels had better DFS and OS than patients with high expression levels (log-rank test: p<0.001). Patients with low MyD88 and TLR4 expression levels had better DFS and OS than patients with high expression levels of either (log-rank test: p<0.001). In a multivariate analysis, high MyD88 expression was an independent predictive factor for decreased DFS (adjusted HR, 3.324; 95% CI, 1.663–6.641; p = 0.001) and OS (adjusted HR, 4.500; 95% CI, 1.546–13.098; p = 0.006).ConclusionsTLR4-MyD88 signaling pathway activation or MyD88 activation alone may be a risk factor for poor prognosis in breast cancer. Therefore, TLR4-MyD88 signaling pathway activation in tumor biology provides a novel potential target for breast cancer therapy.

Abstract 4140: Secular trends in incidence and mortality of female cancers in Shanghai, China (1973-2009)

Abstract Socioeconomic development and urbanization have resulted in dramatic changes in cancer incidence and mortality in China. As one of the largest and most developed cities in China, Shanghai's cancer rates reflect the changing burden of cancer in China. This study was undertaken to evaluate trends and quantify changes in the incidence and mortality of breast, ovarian, endometrial, and cervical cancers among female residents of urban Shanghai from 1973 to 2009. Data on cancer incidence and mortality were collected by the Shanghai Cancer Registry. International Classification of Disease version 10 codes for breast (C50), cervical (C53), endometrial (corpus uteri and uterus unspecified; C54 and C55), and ovarian cancer (C56) were included in the current analysis. Annual population data was provided by the Department of Vital Statistics, Shanghai Municipal Center for Disease Control and Prevention. A total of 73,755 female cancers and 28,274 related deaths were documented between 1973 and 2009. Age-standardized incidence and mortality rates were calculated using the Segi/Doll 1960 world standard. Joinpoint regression models were used to fit joined straight lines on a log-scale for annual age-standardized rates and to calculate annual percent changes (APC). Between 1973 and 2009, the incidence of breast, ovarian, and endometrial cancers increased, with overall APCs of 2.93, 2.20, and 1.66, respectively. Significant trends were found for breast cancer between 1979 and 1998 (APC 3.07) and for ovarian cancer between 1983 and 2009 (APC 2.83). For endometrial cancer a significant decrease occurred from 1973 to 1983 (APC -4.27), followed by a significant increase from 1983 to 1996 (APC 2.58). The incidence of cervical cancer decreased, with an overall APC of -3.91; this included three significant decreasing trends between 1973 and 1996, followed by a significant increase through 2009 (APC 8.49). The mortality of breast and ovarian cancers increased, with overall APCs of 0.70 and 0.58, respectively. Significant trends were found for breast cancer between 1982 and 2004 (APC 1.55) and for ovarian cancer during the entire time period. The mortality of cervical and endometrial cancers decreased, with overall APCs of -5.36 and -2.33, respectively. For cervical cancer, this included a significant decrease between 1973 and 1999 (APC -7.34), followed by a significant increase through 2009 (APC 3.24). For endometrial cancer, this included a significant decrease between 1973 and 1988 (APC -5.59). In summary, increasing trends were found for breast, ovarian and endometrial cancer incidence, and for breast and ovarian cancer mortality, while decreasing trends were found for cervical cancer incidence and cervical and endometrial cancer mortality among women in urban Shanghai. Additional analyses to identify age-period-cohort effects in this data are underway. This study lays the ground work for the establishment of cancer prevention and control priorities in China. Citation Format: Zhezhou Huang, Alicia C. Beeghly-Fadiel, Ying Zheng, Wanqing Wen, Yutang Gao, Chunxiao Wu, Pingping Bao, Weijian Zhong, Fan Jin, Yongbing Xiang, Wei Zheng, Xiao Ou Shu, Wei Lu. Secular trends in incidence and mortality of female cancers in Shanghai, China (1973-2009). [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 4140. doi:10.1158/1538-7445.AM2014-4140

The survival and the long-term trends of patients with gastric cancer in Shanghai, China.

BackgroundGastric cancer remains a major health issue and a leading cause of death worldwide. This study presented a long-term survival data of gastric cancer registered in Shanghai of China from 1972–2003, with aims to describe the trends as well as the age, sex, stage and tumor sites specific characteristics.MethodsThe main source of information on cancer cases was the notification card sending to the registry. The residential status of cancer cases was confirmed by home-visits. The methods of follow-up have been a mixture of both active and passive ones.ResultsWe observed an increased trend of survival probability during the last decades. Patients diagnosed during 1972–1976 had a 5-years relative survival rate at 12% for males and 11% for females, respectively, which had dramatically increased to 30% for male and 32% for female patients respectively during the period of 2002–2003. Among the patients diagnosed in 2002–2003, the overall survival probability declined with patient’s age at the time of diagnosis. The lowest survival rate was observed among the oldest group, with the median survival time of 0.8 years. Patients diagnosed with stage I had a higher relative survival rate. Patients with cardia cancer had the worst prognosis, with the 5-year relative survival rate of 29%.ConclusionsThe survival probability of patients with gastric cancer in Shanghai has improved significantly during the last decades. Age, stage and site of tumor have an impact on prognosis.

Cancer statistics: Current diagnosis and treatment of pancreatic cancer in Shanghai, China

A multi-center population-based study in Shanghai, China was performed to explore the implications for the management of pancreatic cancer by comparing diagnosis and survival rates. Novel imaging modalities including MRI (13.9%), PET/CT (1.8%), and EUS (5.6%) were not widely used in our population. Only 39.7% of cases were histologically verified (surgery with histologic diagnosis 31.0%, cytological diagnosis 8.7%, surgery without histologic diagnosis 12.1%, and clinical diagnosis 48.2%). Overall, 30.0% of patients underwent curative-intent operation, and only 9.8% of patients received comprehensive treatment. The prognosis of pancreatic cancer patients was significantly better for patients who were treated in high-volume centers than in low-volume centers. We propose that more effort should be put on novel diagnostic modalities, histological confirmation, and comprehensive treatment in China. Multidisciplinary teams specialized in pancreatic cancer therapy in high-volume centers are urgently needed.

Risk-adapted chemotherapy without procarbazine in treatment of children with Hodgkin lymphoma

Because procarbazine is not available in the mainland of China, a risk-adapted chemotherapy without the drug was adopted for children with Hodgkin lymphoma (HL) in two tertiary referral centers for childhood cancer in Shanghai. The objective of the present study was to obtain the results comparable with those of previous studies. From January 1998 to December 2009, patients below 18 years with newly diagnosed, untreated HL were enrolled in the study. The patients were stratified into risk groups R1 (early stage), R2 (intermediate stage) and R3 (advanced stage). All the patients who had attained a complete remission were not given involved field radiotherapy. Fifty-six patients were eligible for the study. The 4-year event-free survival (EFS) rate was 100%, 80.3%±7.2%, and 62.5%±12.1% for the risk groups R1, R2, and R3, respectively. There was statistically significant difference in EFS between patients with and those without B symptoms (P<0.001). In group R2, the EFS rate was higher for patients treated with chemotherapy combined with radiation (100% vs. 75%±8.8%). But no statistical difference was observed (P=0.177). At the time of evaluation (December 31, 2010), secondary malignancy was not observed. A significant fraction of children with early stage or intermediate stage HL can be cured with a chemotherapy regimen without procarbazine. Complete response to chemotherapy seems not to be a determinant to omit radiotherapy.

Abstract CN05-03: Lifestyle, infection, and genetic factors in relation to biliary tract cancer

Abstract Biliary tract cancers include tumors of the gallbladder, extrahepatic bile duct, and ampulla of Vater. These cancers are relatively uncommon in most parts of the world, with a reported age-adjusted incidence of less than 10 per 100,000 in most populations. However, South Americans, native Americans, East Europeans, and residents of India experience higher incidence rates. Of the three anatomical subsites, gallbladder cancer is the most common, while cancer of the ampulla of Vater is least common, with rates generally lower than 1.0 per 100,000. Gallbladder cancer is one of the few cancers with female dominance, while extrahepatic bile duct cancer is generally more common in men. Of great interest is the fact that Chile and India have very high rates of gallbladder cancer (&amp;gt;30 per 100,000) but relatively low rates of bile duct and ampulla of Vater cancer. Differences in geographic and gender patterns as well as molecular profiles for these three cancers support the hypothesis that these three anatomic subsites have distinct etiologies. Apart from gallstones, the etiology of biliary tract cancer is unclear, but data from epidemiologic studies suggest that family history of gallstones, higher parity (for gallbladder cancer), obesity, diabetes, metabolic syndrome, history of chronic liver conditions, and history of cholecystitis are associated with increased risk, while tea drinking and aspirin use are associated with reduced risk. It has been reported that chronic hepatitis B infection is associated with a 2-fold risk of extrahepatic bile duct cancer in Shanghai, an endemic area for hepatitis B infection. Similarly, in Chile and India, endemic areas for typhoid fever, it has been suggested that chronic typhoid carriage may increase the risk of gallbladder cancer and help explain partially the unusually high risk of gallbladder cancer in those two countries. To date, most of the epidemiologic findings appear to have a common biological basis, inflammation, which was confirmed by recent genetic data, showing that variants in inflammation-related genes are associated with gallstones and with biliary tract cancer. Genes involved in lipid metabolism, in particular ABCG5, have also been shown to be associated with a higher risk of gallstones and gallbladder cancer risk. Although having gallstones is the predominant risk factor for gallbladder cancer, additional risk factors (cofactors) must be required for the development of gallbladder cancer, since only 1% of gallstone patients develop gallbladder cancer. Currently, identification of other risk factors is the most critical challenge for biliary tract cancer research. A better understanding of the role of cofactors will help identify a subset of the population with an extremely great need for primary prevention or early detection of biliary tract cancer. Citation Format: Ann W. Hsing. Lifestyle, infection, and genetic factors in relation to biliary tract cancer. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr CN05-03.

Abstract LB-322: Cruciferous vegetable intake after diagnosis of breast cancer and survival: a report from the shanghai breast cancer survival study

Abstract BACKGROUND: Cruciferous vegetables are a major source of glucosinolate-derived bioactive compounds, such as isothiocyanates and indoles, which have been shown in animal studies and in vitro to inhibit cancer growth and progression. However, little is known regarding the role of cruciferous vegetables in breast cancer prognosis. Using resources from the Shanghai Breast Cancer Survival, a large population-based prospective cohort study of Chinese breast cancer survivors, we evaluated the association of cruciferous vegetable consumption after cancer diagnosis and breast cancer outcomes with repeated dietary assessments after diagnosis. METHODS: Women with incident breast cancer aged 20-75 years were recruited within 6-months of diagnosis during 2002-2006. In-person baseline interviews collected detailed data on clinic characteristics, socio-demographics, and lifestyle factors. Medical records were used to verify clinical data. The cohort has been followed-up by a combination of in-person follow-up surveys and record linkage to the Shanghai Vital Statistics Registry. Cruciferous vegetable intake (g/day) was reassessed at 18- and 36-months. Cox regression models were used to derive hazard ratios (HR) and 95% confidence intervals (CIs) for the associations of cruciferous vegetables and breast cancer outcomes. Analyses include 4,886 women with stage I-IV breast cancer. RESULTS: After a median follow-up of 5.2 years, 587 deaths (496 breast cancer deaths) and 615 recurrences occurred. Cruciferous vegetable intake increased after diagnosis (mean (SD)=62.5 (44.5) at 6-months and 133.8 (93.3) at 36-months). After adjustment for socio-demographics, clinical characteristics including treatment and tumor characteristics, and lifestyle factors, cruciferous vegetable intake was associated with improved breast cancer survival in a dose-response pattern (P for trend &amp;lt; 0.01). The multivariable hazard ratios (95% confidence intervals) across increasing quartiles (vs. Q1) were 0.73 (0.60-0.90), 0.51 (0.41-0.64), and 0.38 (0.29-0.49) for total mortality; 0.78 (0.62-0.97), 0.53 (0.41-0.68), and 0.38 (0.29-0.51) for breast cancer-specific mortality; 0.79 (0.63-0.98), 0.71 (0.57-0.88), and 0.65 (0.52-0.81) for recurrence. These associations persisted after excluding the first year of observation, although the association for recurrence was no longer statistically significant. CONCLUSION: Cruciferous vegetable intake after breast cancer diagnosis was associated with improved prognosis among Chinese women. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-322. doi:1538-7445.AM2012-LB-322

Increasing Incidence of Thyroid Cancer in Shanghai, China, 1983-2007

Increasing incidence of thyroid cancer has been observed in some countries such as the United States, United Kingdom, France, and so on. Joinpoint regression was used to analyze the incidence of thyroid cancer in Shanghai, China, from 1983 to 2007. The results showed that there were 2 distinct slopes: in men, representing a significant annual percentage change (APC) of 2.6% from 1983 to 2000 (P < .001) followed by a sharp APC of 14.4% (P < .001), and in women, representing a significant APC of 4.9% from 1983 to 2003 (P < .001) followed by a sharp APC of 19.9% (P = .001). The sharp increase in thyroid cancer occurred 5 and 8 years after the iodine supplementation by salt, for men and women, respectively, suggesting that either the developed screening techniques or iodine supplementation might have contributed to the rapid increase in the incidence of thyroid cancer. The burden of thyroid cancer cases is expected to be substantial, based on predictions through 2020.

Population‐based survival for childhood cancer patients diagnosed during 2002–2005 in Shanghai, China

There have been no population-based studies on cancer survival among children aged 0-14 years in China. In this study, we aimed to characterize the cancer survival among children in Shanghai. Childhood cancer cases registered by the Shanghai Cancer Registry between 2002 and 2005 and enrolled in the Shanghai Childhood Survival Study were included in this study. We used Kaplan-Meier product-limit method for survival analysis and Cox proportional hazards models for investigating the effects of various prognostic factors. The median follow-up time was 5.4 years (range 0-8.9 years). The 5-year observed survival for all childhood cancers combined was 55.7% (95% CI: 51.7-59.6%). For leukemia, lymphoma, and central nervous system tumors, the three most common types of childhood cancer, 5-year survival rates were 52.2%, 58.8%, and 41.2%, respectively. Higher 5-year survival rates were observed for epithelial cancer (88.9%), malignant renal tumors (86.7%), germ cell and other gonadal tumors (78.4%), and retinoblastoma (75.0%). Cancers with poor prognosis included sympathetic nervous system tumors (57.9%), soft tissue sarcoma (54.1%), bone tumors (52.6%), and liver cancer (33.3%). There were no significant differences between survival rates by gender and age groups. Compared with those reported in the USA and Europe, the survival rates for all cancers combined and the three most common types in Shanghai were lower. The survival rate for children aged 0-14 diagnosed with cancer in Shanghai during 2002-2005 was at the medium level. There was a substantial survival difference from childhood cancers between Shanghai and specific developed countries.

Medical history and the risk of biliary tract cancers in Shanghai, China: implications for a role of inflammation

Several lines of evidence suggest that inflammation may play a role in the etiology of biliary tract cancers. To examine further the role of inflammation, we evaluated the associations between self-reported inflammatory-related medical conditions and the risk of biliary tract cancers in a population-based case-control study in Shanghai, China. Our analysis included 368 gallbladder cancer cases, 191 bile duct cancer cases, 68 ampulla of Vater cancer cases, and 959 healthy subjects. We used logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for biliary tract cancers in relation to six inflammation-related conditions. Gallbladder cancer was significantly associated with cholecystitis occurring at least 5 years prior to interview (OR = 1.7, 95% CI 1.1-2.9). Even though biliary stones did not significantly modify the associations between cholecystitis and gallbladder cancer, 90% of the gallbladder cancer cases with cholecystitis also had biliary stones, indicating that stones likely play an important role in the link between cholecystitis and gallbladder cancer. Among subjects who smoked and drank alcohol, a history of gastric (OR = 4.3, 95% CI 1.2-15.0) or duodenal ulcers (OR = 3.7, 1.2-12.0) was associated with an excess risk of gallbladder cancer. Although the mechanisms are unclear, our results further support the role for inflammation in the etiology of biliary tract cancers.

Increasing incidence of thyroid cancer in shanghai, China, 1983-2007

AbstractIncreasing incidences of thyroid cancer were observed in some countries, like USA, UK, France, etc. Jointpoint regression was used to analyze the incidence of thyroid cancer in Shanghai, China, from 1983 to 2007. The results showed there were both two distinct slopes, in males representing a significant APC of 2.6% from 1983 to 2000 (P&lt;0.001), followed by a sharply increased APC of 14.4% (P &lt;0 .001), and in females representing a significant APC of 4.9% from 1983 to 2003 (P&lt;0.001), followed by a sharply increased APC of 19.9% (P =0 .001). Incidence of thyroid cancer increased 5 to 8 years after the supplement of iodine, for males and females respectively, suggesting that either the developed screening techniques or supplement of iodine might contribute to this accelerated increase in incidence of thyroid cancer. The predicated future burdens indicated that thyroid cancer is never an unusual cancer, either in the present or in the future.

Increasing incidence of thyroid cancer in shanghai, China, 1983-2007

Increasing incidence of thyroid cancer in shanghai, China, 1983-2007

Concordance of self-reported and medical chart information on cancer diagnosis and treatment

BackgroundSelf-reported information is an important tool for collecting clinical information for epidemiologic studies and in clinical settings where electronic medical records are not employed and shared.MethodsUsing data collected from the Shanghai Breast Cancer Survival Study (SBCSS), a population-based, prospective cohort study of 5,042 women diagnosed with breast cancer in Shanghai, China, we compared the concordance of patient questionnaire responses to a survey administered approximately 6 months after cancer diagnosis with medical chart information obtained from the diagnostic hospitals for several disease and treatment-related variables.ResultsOf 5,042 SBCSS participants, medical chart information was available for 4,948 women (98.1%). Concordance between patient self-reported and medical chart information was high for the majority of disease-related variables, including: diagnosing hospital (agreement: 98.7%, kappa: 0.99), type of surgery conducted (94.0%, 0.53), ER/PR status (94.5%, 0.91), and tumor position (98.2%, 0.97), as well as for important calendar dates, such as date of diagnosis, surgery, and first chemotherapy treatment. The 10 most commonly used chemotherapeutic drugs were all reported with agreement rates of at least 82%, with associated kappa values that ranged from 0.41 for calcium folinate to 0.76 for vinorelbine.ConclusionsOur study found high validity for patient self-reported information for a variety of disease and treatment-related variables, suggesting the utility of self-reports as an important source of clinical information for both epidemiological research and patient care.

Chronic typhoid infection and the risk of biliary tract cancer and stones in Shanghai, China

Previous studies have shown a positive association between chronic typhoid carriage and biliary cancers. We compared serum Salmonella enterica serovar Typhi antibody titers between biliary tract cancer cases, biliary stone cases without evidence of cancer, and healthy subjects in a large population-based case-control study in Shanghai, China.Participants included 627 newly diagnosed primary biliary tract cancer patients; 1,037 biliary stone cases (774 gallbladder and 263 bile-duct) and 959 healthy subjects without a history of cancer, randomly selected from the Shanghai Resident Registry.Overall only 6/2,293 (0.26%) were Typhi positive. The prevalence of Typhi was 1/457 (0.22%), 4/977 (0.41%), and 1/859 (0.12%) among cancer cases, biliary-stone cases, and population controls, respectively.We did not find an association between Typhi and biliary cancer in Shanghai, due to the very low prevalence of chronic carriers in this population.The low seroprevalence of S. Typhi in Shanghai is unlikely to explain the high incidence of biliary cancers in this population.