Diagnosis Of Invasive Cancer Research Articles

Assessment of the Likelihood of Invasive Breast Cancer When Core Needle Biopsy Shows DCIS.

Abstract Background: Ductal carcinoma in-situ (DCIS) on core needle biopsy (CNB) may be associated with a final diagnosis of invasive cancer (IC). As patients with IC need axillary assessment, those at risk of upstaging may be appropriate for sentinel node biopsy (SNB) at initial surgery, preventing the need for re-operation. We assessed this risk using pre-operative factors to develop a management algorithm.Materials and Methods: All patients whose CNB showed DCIS or DCIS with microinvasion (DCISm) from a single population-based breast screening program in Australia between 1994 and 2006 were studied. Medical records were reviewed for demographic, radiologic, clinical and pathologic data.Results: 11 of 15 DCISm cases (73.3%) and 65 of 375 DCIS cases (17.3%) were upstaged to IC. Microinvasion on CNB overwhelmingly predicted presence of frank invasive cancer. For cases of DCIS, multivariate analysis showed that (1) palpability (p=0.009), (2) large mammographic size ≥20mm (p=0.001) and (3) prolonged screening interval ≥3 years (p=0.008) were associated with upstaging. On univariate analysis, (4) non-calcific mammographic features (mass, architectural distortion or non-specific density) were significantly associated with upstaging (p=0.001). There was a trend towards upstaging in patients with high grade DCIS on CNB (p=0.07). Factors not associated with upstaging were microcalcifications (p=0.12), comedonecrosis (p=0.14), age (p=0.38) and CNB method (p=0.50). The rate of upstaging increases with the number of associated risk factors present in a patient: 8.3% in patients with no risk factors, 21.2% in those with one risk factor, 38.6% in those with two risk factors, and 52.9% in those with three risk factors. 13 patients (3.3%) had lymph node metastases.Conclusions: The risk of upstaging can be estimated using pre-operative features in patients with DCIS on CNB. We propose a management algorithm that includes SNB for DCIS patients: with microinvasion on core biopsy, with two or more predictive factors, and those with planned total mastectomy. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3111.

Folate Status and Aberrant DNA Methylation Are Associated With HPV Infection and Cervical Pathogenesis

Aberrant DNA methylation is a recognized feature of human cancers, and folate is directly involved in DNA methylation via one-carbon metabolism. Previous reports also suggest that folate status is associated with the natural history of human papillomavirus (HPV) infection. A cross-sectional study was conducted to test the hypothesis that folate status and aberrant DNA methylation show a progressive change across stages of cervical pathology from normal cells to cervical cancer. Additionally, we postulated that a gene-specific hypermethylation profile might be used as a predictive biomarker of cervical cancer risk. DNA hypermethylation of seven tumor suppressor genes, global DNA hypomethylation, systemic folate status, and HPV status were measured in 308 women with a diagnosis of normal cervix (n = 58), low-grade cervical intraepithelial neoplasia (CIN1; n = 68), high-grade cervical intraepithelial neoplasia (CIN2, n = 56; and CIN3, n = 76), or invasive cervical cancer (ICC; n = 50). Lower folate status was associated with high-risk HPV infection (P = 0.031) and with a diagnosis of cervical intraepithelial neoplasia or invasive cervical cancer (P < 0.05). Global DNA hypomethylation was greater in women with invasive cervical cancer than all other groups (P < 0.05). A cluster of three tumor suppressor genes, CDH1, DAPK, and HIC1, displayed a significantly increased frequency of promoter methylation with progressively more severe cervical neoplasia (P < 0.05). These findings are compatible with a role for folate in modulating the risk of cervical cancer, possibly through an influence over high-risk HPV infection. DAPK, CDH1, and HIC1 genes are potential biomarkers of cervical cancer risk.

Neither one‐time negative screening tests nor negative colposcopy provides absolute reassurance against cervical cancer

A population sample of 10,049 women living in Guanacaste, Costa Rica, was recruited into a natural history of human papillomavirus (HPV) and cervical neoplasia study in 1993-1994. At the enrollment visit, we applied multiple state-of-the-art cervical cancer screening methods to detect prevalent cervical cancer and to prevent subsequent cervical cancers by the timely detection and treatment of precancerous lesions. Women were screened at enrollment with 3 kinds of cytology (often reviewed by more than one pathologist), visual inspection and cervicography. Any positive screening test led to colposcopic referral and biopsy and/or excisional treatment of CIN2 or worse. We retrospectively tested stored specimens with an early HPV test (hybrid capture tube test) and for >40 HPV genotypes using a research PCR assay. We followed women typically 5-7 years and some up to 11 years. Nonetheless, 16 cases of invasive cervical cancer were diagnosed during follow-up. Six cancer cases were failures at enrollment to detect abnormalities by cytology screening; 3 of the 6 were also negative at enrollment by sensitive HPV DNA testing. Seven cancers represent failures of colposcopy to diagnose cancer or a precancerous lesion in screen-positive women. Finally, 3 cases arose despite attempted excisional treatment of precancerous lesions. Based on this evidence, we suggest that no current secondary cervical cancer prevention technologies applied once in a previously under-screened population is likely to be 100% efficacious in preventing incident diagnoses of invasive cervical cancer.

The endometrial–myometrial junction: a fresh look at a busy crossing

The endometrial–myometrial junction: a fresh look at a busy crossing

BS06 INDICATIONS FOR SENTINEL LYMPH NODE BIOPSY IN PATIENTS WITH A PRE‐OPERATIVE DIAGNOSIS OF DUCTAL CARCINOMA IN SITU

Purpose: Ductal carcinoma in situ (DCIS) is non‐invasive so the use of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS is questionable. DCIS has the potential to progress to invasive cancer, so SLNB would be useful in staging disease in patients at higher risk of invasion. This study aims to identify pre‐operative characteristics of DCIS that are predictors of invasive disease and thus provide a guide as to when to use SLNB.Methodology: This study is a consecutive series of 374 patients that underwent SLNB, of whom 37 patients had a preoperative diagnosis of DCIS, treated by one surgeon between July 2001 and February 2008. The association between pre‐ operative clinical and pathological factors and a post‐operative diagnosis of invasive disease were analysed. Associations between final pathological diagnosis of DCIS or invasive disease and treatment parameters were also analysed.Results: Of the 37 patients, 13 (35%) were found to have invasive disease post‐operatively. Analysis revealed that an initial suspicion of microinvasion, larger mammographic size, younger age, diagnosis with core biopsy, nipple discharge and presence of necrosis had statistically significant association with a post‐operative diagnosis of invasive cancer. Only patients with invasive disease had positive SLNs. Analysis of treatment with mastectomy or conservative surgery showed a link between mastectomy and a palpable lump.Conclusion: SLNB is recommended for staging disease in patients with a pre‐operative diagnosis of DCIS who also have characteristics suggestive of invasive disease

Plasma cell granuloma of the urinary bladder responsive to corticosteroid therapy

Plasma cell granuloma of the urinary bladder is a rare benign entity of the submucosal stroma that is difficult to distinguish from malignant neoplasm clinically. We report a case of plasma cell granuloma of the urinary bladder treated successfully with corticosteroid. A 78-year-old man was admitted to our hospital complaining of miction pain, pollakisuria and fever for a month. He had undergone surgery for a transverse colon tumor about 4 years previously, but the pathological diagnosis was plasma cell granuloma. Urinalysis showed microscopic hematuria. Urine cytology was class I. The urine culture was negative. Computed tomography (CT) showed diffuse thickness of the bladder wall (Fig. 1a). At this point, we made a diagnosis of invasive bladder cancer. Transurethral resection of bladder tumor (TUR-BT) was carried out. Histopathological examination demonstrated a proliferation of blood vessels and infiltration of many plasma cells. Histologically it was similar to that of the previous colon tumor and no malignant cell was identified. Thus, we made a diagnosis of plasma cell granuloma of the urinary bladder. The lesion occupied a large part of the bladder and it seemed difficult to carry out partial cystectomy. So we decided to carry out corticosteroid therapy according to some reports. We started 30 mg/day of oral prednisolone. The fever and the irritated bladder symptoms were dramatically improved from the next day. Bladder-wall thickening was significantly reduced in a CT after treatment in comparison with that before the treatment (Fig. 1a,b). The dose of prednisolone was gradually tapered down in an ambulatory setting. There has been no evidence of recurrence for 28 months. Many reports have dealt with similar lesions under various names including plasma cell granuloma, inflammatory myofibroblastic tumor, inflammatory pseudotumor, pseudosarcomatous fibromyxoid tumor, etc. The cause is not well resolved , but some reports describe that urinary tract infection, operation, and Crohn’s disease have some relations with the disease. Partial cystectomy is often carried out for treatment. Some cases are overtreated as total cystectomy. Some reports describe that corticosteroid was effective for inflammatory pseudotumor of the kidney and the upper urinary tract. Some reports describe that corticosteroid is effective for plasma cell granuloma of the lung, in which serum IgG4 level is high. Serum IgG4 of this case was within normal levels. This patient had a history of plasma cell granuloma of transverse colon about 4 years ago. The relation between plasma cell granuloma of transverse colon and urinary bladder is unknown but the histological appearance is very similar (Fig. 1c,d). To the best of our knowledge, this is a rare case of plasma cell granuloma of the urinary bladder that was dramatically reactive to corticosteroid. Futoshi Kunieda MD, Koji Inoue MD and Akito Terai MD PhD Department of Urology, Kurashiki Central Hospital, Kurashiki, Oyakama, Japan f kunieda@yahoo.co.jp

Disease Progression in Bladder Cancer: Which Developments since 1994

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. Methods 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. Results For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. Conclusions Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

Infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration

The development of a convex probe endobronchial ultrasound (CP-EBUS) videobronchoscope to allow real-time transbronchial needle aspiration (TBNA) has been a significant advance in minimally invasive lung cancer staging and diagnosis. Several recent studies have demonstrated CP-EBUS-TBNA to have recovery rivalling that of the current gold standard, cervical mediastinoscopy. These same studies have indicated that the safety of this procedure has no reported complications. The present case study presents two infectious complications from full extension endobronchial ultrasound transbronchial needle aspiration and discusses possible aetiologies of these infections, as well as implications for future application of this technology.

Quantitative Fluorescence in Situ Hybridization and its Ability to Predict Bladder Cancer Recurrence and Progression to Muscle-Invasive Bladder Cancer

Fluorescence in situ hybridization (FISH) testing is used to detect bladder cancer in urine specimens. The purpose of this study was to determine whether there are associations between the percentage of chromosomally abnormal cells by FISH and time to bladder cancer recurrence and progression to metastasis. Clinical records were searched to identify patients with urine FISH results, history of non-invasive bladder cancer, and at least one follow-up pathological diagnosis. Covariates analyzed included age, gender, smoking status, treatment after FISH, cystoscopy result, and prior stage of bladder cancer. The percentage of abnormal cells (hazard ratio [HR] 1.03, 95% CI 1.02-1.03; P < 0.001), age (HR 1.02, 95% CI 1.00-1.03; P = 0.033), male gender (HR 0.60, 95% CI 0.41-0.87; P < 0.001), treatment (HR 0.37, 95% CI 0.25-0.55; P < 0.001), and history of TIS/T1-stage tumors (HR 1.66, 95% CI 1.23-2.24; P = 0.001) were significantly associated with time to cancer recurrence. Time to invasive cancer was significantly associated with the percentage of abnormal cells (HR 1.02, 95% CI 1.01, 1.03; P < 0.001), history of TIS/T1 tumor (HR 3.73, 95% CI 1.88, 7.38; P = 0.001), and treatment (HR 0.33, 95% CI 0.13, 0.83; P = 0.019), suggesting that the percentage of abnormal cells independently predicts cancer recurrence and progression to invasive disease in patients with a history of non-invasive bladder cancer.

Lobular neoplasia on core biopsy and risk factors to predict upstaging at surgical excision.

Abstract Abstract #5009 Introduction: Lobular neoplasia (including atypical lobular hyperplasia and lobular carcinoma in-situ) identified on core biopsy (CB) is often recommended for surgical excision because the risk of upstaging to invasive carcinoma is documented to be 0-50%. We sought to identify risk factors to predict upstaging at surgical excisional biopsy.&amp;#x2028; Methods: Retrospective chart review was used to identify women with CB revealing lobular neoplasia (LN) as highest risk pathological diagnosis. LN was defined as atypical lobular hyperplasia (ALH) and/or lobular carcinoma in situ (LCIS). Radiologic findings were correlated with pathology and excision results were recorded when available. Follow-up radiologic data was also recorded when available.&amp;#x2028; Results: From 1997-2008, 45 women (age ranging from 33 to 81) underwent CB revealing LN. Ten had LCIS only, 34 had ALH only and 1 had both. Twenty five (56%) underwent surgical excision and 20 (44%) were followed clinically and mammographically. Core biopsy was recommended for mammographic microcalcifications (three with associated mass or focal asymmetry) in 29 pts (64%), while 14 CB (31%) were recommended for either mammographic mass or focal asymmetry only. Two CB (4%) were recommended for MRI abnormalities. For patients who underwent surgical excision, 8 (32%) were upstaged to invasive carcinoma or DCIS. Two of these 8 (25%) had LCIS on core biopsy and 6 (75%) had ALH only. Of the 6 pts with ALH only, the original core biopsy was done for focal asymmetry or mass in 3, abnormal MRI in 1 and microcalcifications in the remaining 2 (one with synchronous contralateral carcinoma). Patients not upstaged at surgical excision had original CB done for LCIS only in 5 (31%) and ALH only in 11 (69%). Of these 11 pts with ALH who were not upstaged, 8 underwent original CB for mass, focal asymmetry or MRI finding. Patients with LN on core biopsy done exclusively for mammographic microcalcifications underwent excision only 46% (13/28) of the time. Of those excised 4 were upstaged at surgical excision ( 3 with DCIS and 1 tubular carcinoma). Follow-up mammographic data was available for 65% (13/20) of patients who did not have surgical excision. At median follow-up of 16 months no new biopsies have been recommended and no new lesions have been identified for these patients.&amp;#x2028; Conclusion :Of all patients who underwent surgical excision for LN found on core biopsy, 32% had a final diagnosis of either DCIS or invasive cancer. Of the 25 patients who underwent surgical excision, 24 were associated with one of the following risk factors: mass or focal asymmetry on mammogram, LCIS, synchronous contralateral carcinoma and non-concordant core biopsy. We did not identify any significant risk factors to predict upstaging at surgical excision, however, this may be due to selection bias. Further studies with larger number of patients are needed to identify risk factors to predict upstaging at surgical excision. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5009.

Uptake of clinical genetic testing for ovarian cancer in Ontario: A population-based study

Background Approximately 13% of ovarian cancers in Canada are attributable to a mutation in BRCA1 or BRCA2. In 2001, genetic testing for BRCA1 and BRCA2 became freely available to all women in Ontario with a diagnosis of invasive ovarian cancer. It is unknown what proportion of women with ovarian cancer receive genetic testing as a result of this recommendation. Methods Patients in Ontario who had been diagnosed with epithelial ovarian cancer from 2002 to 2004 were identified using the Ontario Cancer Registry. Information was collected on demographic and risk factors, including information on previous testing for BRCA1 and BRCA2. Women were asked to provide a blood sample for genetic testing or to provide a genetic test result if clinical testing had been done. Genetic testing for BRCA1 and BRCA2 mutations was conducted on all blood samples. Results Of the 416 women, 80 women (19%) had undergone previous clinical genetic testing for BRCA1 and BRCA2. Of these 80 women, 30% had a positive genetic test result, compared to 5% of 336 women who had not had clinical genetic testing ( p < 0.0001). Sixty percent of all mutations were identified within this group of 80 women. Conclusions Genetic testing is available in Ontario to all women with invasive ovarian cancer. However, only a small proportion of women are being referred for testing. This study suggests that increased public awareness directed at physicians and at women with cancer may expand the use of genetic testing.

Examining the association between socioeconomic status and potential human papillomavirus-associated cancers

This study examined the association between county-level measures of socioeconomic status (SES) and the incidence rate of human papillomavirus(HPV)-associated cancers, including cervical, vulvar, vaginal, anal, penile, and oral cavity and oropharyngeal cancers. The authors collected data from cancer registries for site-specific invasive cancer diagnoses between 1998 and 2003, inclusive, among adults aged >20 years at the time of diagnosis. County-level variables that included education, income, and poverty status were used as factors for socioeconomic status. Measures of rural-urban status, the percentage of the population that currently smoked, and the percentage of women who reported having ever had a Papanicolaou (Pap) test were also studied. Lower education and higher poverty were found to be associated with increased penile, cervical, and vaginal invasive cancer incidence rates. Higher education was associated with increased incidence of vulvar cancer, male and female anal cancer, and male and female oral cavity and oropharyngeal cancers. Race was an independent predictor of the development of these potentially HPV-associated cancers. These findings illustrate the association between SES variables and the development of HPV-associated cancers. The findings also highlight the importance of considering SES factors when developing policies to increase access to medical care and reduce cancer disparities in the United States.

Epithelial ovarian cancer: testing the 'androgens hypothesis'

In 1998, Risch proposed a hypothesis for the pathogenesis of ovarian cancer relating to the role of androgens in stimulating epithelial cell proliferation. Although this hypothesis has been widely discussed, direct evidence to support it is scant. To address this issue, we have conducted a detailed analysis of factors possibly associated with high circulating levels of androgens, including polycystic ovary syndrome (PCOS), hirsutism and acne (all clinically associated with hyperandrogenism) using the data collected in an Australia-wide, population-based case-control study. Cases aged 18-79 years with a new diagnosis of invasive epithelial ovarian cancer (n=1276) or borderline malignant tumour (n=315) were identified through a network of clinics and cancer registries throughout Australia. Controls (n=1508) were selected from the National Electoral Roll. Women self-reported a history of PCOS, acne, hirsutism and also use of testosterone supplements or the androgenic medication Danazol. We found no evidence that a history of PCOS, acne or hirsutism was associated with ovarian cancer overall, or with specific subtypes, with the exception of serous borderline tumours that were positively associated with a history of PCOS (OR 2.6; 95% CI 1.0-6.1). Women who had ever used testosterone supplements had an increased risk of ovarian cancer (OR 3.7; 95% CI 1.1-12.0); however, use of the androgenic medication Danazol did not increase risk (OR 1.0; 95% CI 0.4-2.9). Overall, our results do not support the hypothesis that androgen-related disorders increase the risk of ovarian cancer.

Predictors of Surgical Margin Status in Breast-Conserving Surgery Within a Breast Screening Program

Breast-conserving surgery (BCS) requires clear surgical margins to minimize local recurrence. We sought to identify groups of patients at higher risk of involved margins who might benefit from preoperative counselling and/or more generous excision at the first operation. We reviewed demographic, clinical, radiological and pathological records of all women diagnosed with ductal carcinoma in situ (DCIS) or invasive cancer (IC) through a population-based breast screening program in Melbourne, Australia between 1994 and 2005. A total of 2,160 women were diagnosed with DCIS or IC. We excluded 199 who had mastectomy (TM) as initial procedure or had missing data. Three hundred and thirteen had a diagnostic biopsy. Of 1,648 women who had BCS after a preoperative diagnosis of DCIS or IC, 13.5% had involved margins, 16.6% had close (</=1 mm), and 69.8% clear (>1 mm) margins. Of the patients, 281/1,648 (17.1%) underwent re-excision, of whom 93 (33.1%) had residual disease identified. Mammographic microcalcifications (P < 0.0001), absence of a mammographic mass (P = 0.002), presence of DCIS (P < 0.0001), high tumour grade (P < 0.0001), large size (P < 0.0001), multifocal disease (P < 0.0001) and lobular histology (P = 0.005) were associated with involved margins. Microcalcifications (odds ratio [OR] 1.97), large size (OR 4.22) and multifocal disease (OR 2.85) were independently associated with involved margins. Residual disease was associated with involved margins (P < 0.0001), presence of DCIS (P = 0.05) and large tumour size (P = 0.01). After BCS, patients with mammographic microcalcifications, larger tumour size and multifocal tumours are more likely to have involved margins. Patients with involved margins, large tumour size and/or a DCIS component are more likely to have residual disease on re-excision.

The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California

With 2.3 million breast cancer survivors in the US today, identification of modifiable factors associated with breast cancer recurrence and survival is increasingly important. Only recently new studies have been designed to examine the impact of lifestyle factors on prognosis, including Pathways, a prospective study of women with breast cancer in Kaiser Permanente Northern California (KPNC). Pathways aims to examine the effect on recurrence and survival of (1) lifestyle factors such as diet, physical activity, quality of life, and use of alternative therapies and (2) molecular factors such as genetic polymorphisms involved in metabolism of chemotherapeutic agents. Eligibility includes any woman diagnosed with invasive breast cancer within KPNC, no previous diagnosis of other invasive cancer, age 21 years or older, and ability to speak English, Spanish, Cantonese, or Mandarin. Newly diagnosed patients are identified daily from electronic pathology records and are enrolled within two months of diagnosis. An extensive baseline interview is conducted, blood and saliva samples are collected, and body measurements are taken. Women are followed for lifestyle updates, treatment, and outcomes by self-report and query of KPNC databases. Recruitment began in 9 January, 2006, and as of 16 January, 2008, 1,539 women have been enrolled along with collection of 1,323 blood samples (86%) and 1,398 saliva samples (91%). The Pathways Study will become a rich resource to examine behavioral and molecular factors and breast cancer prognosis.

Body size and risk of epithelial ovarian and related cancers: A population‐based case‐control study

Different subtypes of ovarian cancer appear to have different causes; however, the association between body mass index (BMI) and the different subtypes is unclear. We examined the associations between body-mass index (BMI) and weight gain and risk of the different histological subtypes of epithelial ovarian cancer in a case-control study in Australia. Cases aged 18-79 with a new diagnosis of invasive epithelial ovarian cancer (n = 1,269) or borderline tumor (n = 311) were identified through a network of clinics and cancer registries throughout Australia. Controls (n = 1,509) were selected from the Electoral Roll. Height and weight (1 year previously, at age 20 and maximum weight) and other risk factor information were ascertained via a self-administered questionnaire. Obesity was positively associated with clear cell tumors (Odds Ratio 2.3; 95% confidence interval 1.2-4.2) but not invasive endometrioid or mucinous tumors. Although there was no association with invasive serous tumors overall (0.9; 0.7-1.2), we did see an increased risk of serous peritoneal tumors (2.9; 1.7-4.9), but not of serous tumors of the ovary and fallopian tube. Of the borderline subtypes, obesity was positively associated with serous (1.8; 1.1-2.8) but not mucinous tumors (1.1; 0.7-1.7). Overweight was not associated with any subtype overall. There was no association with BMI at age 20, or weight gain for any of the histological subtypes. These results add to the current evidence that obesity increases a woman's risk of developing distinct histological subtypes of ovarian cancer.

Cervical cancer in patients infected with the human immunodeficiency virus

The objective of this study was to compare the human immunodeficiency virus (HIV) viral load (VL) and CD4 counts in patients infected with HIV with and without cervical cancer. The authors hypothesized that HIV-positive women with cervical cancer would have a greater risk of immune suppression. A case-control study was conducted that included all HIV-positive patients who were seen at the authors' institution from January 1, 1995 to April 20, 2006 with invasive cervical cancer (cases) and without invasive cervical cancer (controls). Patients were included only if they had a CD4 count recorded<6 months before or<3 months after their diagnosis of invasive cervical cancer (cases) or at their last gynecologic examination (controls). Controls were matched to cases on a 4:1 ratio according to current smoking history. Patients were considered immunocompetent if they had both a CD4 count>200 cells/microL and a VL<10,000 copies/mL. In total, 15 cases and 60 controls were identified. The median CD4 count for cases was 208 cells/microL (range, 18-1102 cells/microL) compared with 445 cells/microL (range, 20-1201 cells/microL) for controls (P=.03). The median VL was 16,918 copies/mL (range, 50-214,915 copies/mL) for cases compared with 1430 copies/mL (range, 50-571,000 copies/mL) for controls (P=.15). Only 1 of 14 cases (7%) was immunocompetent compared with 35 of 55 controls (64%; odds ratio, 0.04; 95% confidence interval, 0-0.37; P<.001). This significance was maintained after adjusting for other factors (P=.002). Women with HIV who were diagnosed with invasive cervical cancer appeared to have a much greater degree of immunosuppression than women with HIV without invasive cervical cancer.

Association of Clinical and Pathologic Variables with Lumpectomy Surgical Margin Status after Preoperative Diagnosis or Excisional Biopsy of Invasive Breast Cancer

Association of Clinical and Pathologic Variables with Lumpectomy Surgical Margin Status after Preoperative Diagnosis or Excisional Biopsy of Invasive Breast Cancer

Family history and colorectal cancer survival in women

Family history of colorectal cancer may be a phenotype for numerous genetic mutations which increase colorectal cancer risk and may affect survival after diagnosis. We examined the relationship between self-reported first-degree family history of colorectal cancer and survival. We identified female Wisconsin residents ages 20-74 with a new diagnosis of invasive colorectal cancer from two population-based case-control studies; 1,469 women were interviewed. Follow-up averaged 7.9 years. We performed multivariable Cox proportional hazards regressions to calculate adjusted hazard rate ratios [HR] and corresponding 95% confidence intervals [95% CI] for risk of death by family history. Of 1,391 cases with available first-degree family history, 481 were deceased, 268 due to colorectal cancer. In multivariable analyses, cases with any family history (N=262) had a statistically non-significant lower risk of death (HR 0.86, 95% CI 0.62, 1.20) compared to no family history (N=1,129). Cases with two or more affected family members (N=46) showed significantly lower risk of death when compared to women with no family history (HR 0.34, 95% CI 0.13, 0.92). Although individuals with a colorectal cancer family history are diagnosed with the disease more often than the general population, these data suggest that survival from colorectal cancer may not be worse.

Patterns of Diagnosis for Colorectal Cancer: Screening Detected vs. Symptomatic Presentation

Colorectal cancer is a leading cause of cancer death in North America; studies have shown that screening improves survival. Conducted in British Columbia, Canada, this study was performed to identify the proportion of screening-eligible patients with sporadic colorectal cancer who are detected by screening tests vs. symptomatic presentation and to compare baseline patient and tumor characteristics of these two groups. This retrospective cohort study identified 571 consecutive patients referred to the British Columbia Cancer Agency at aged 50 years and older presenting with a first diagnosis of invasive colorectal cancer between November 2002 and April 2003. Questionnaires for self-completion were mailed to all patients to capture: previous screening history, screening vs. symptomatic presentation, and demographic information. Of 212 eligible respondents (37 percent response), 14 patients (6.6 percent) with a new CRC were detected by screening vs. 198 patients (93.4 percent) presenting with symptoms. Respondents were 59 percent male, average age at diagnosis was 69 years, 91 percent white, 37 percent rectal, and 18 percent M1 at diagnosis. No significant differences in the age, gender, ethnicity, socioeconomic status, tumor stage, and site were detected between the screened vs. symptomatic cohorts. Only 33 of 212 patients (15.6 percent) reported ever having a screening test. Nineteen of 198 cancers (9.6 percent) were diagnosed by symptomatic presentation despite a compliant screening history. Less than 7 percent of patients with a new diagnosis of CRC were detected via a screening test. Furthermore, only 15 percent of screening-eligible respondents had ever been screened. Significant effort is required to increase knowledge and compliance for CRC screening.