Differences In Prevalence Of Cancer Research Articles

Cancer Prevalence across Vertebrates.

Cancer is pervasive across multicellular species, but what explains the differences in cancer prevalence across species? Using 16,049 necropsy records for 292 species spanning three clades of tetrapods (amphibians, sauropsids, and mammals), we found that neoplasia and malignancy prevalence increases with adult mass (contrary to Peto's paradox) and somatic mutation rate but decreases with gestation time. The relationship between adult mass and malignancy prevalence was only apparent when we controlled for gestation time. Evolution of cancer susceptibility appears to have undergone sudden shifts followed by stabilizing selection. Outliers for neoplasia prevalence include the common porpoise (<1.3%), the Rodrigues fruit bat (<1.6%), the black-footed penguin (<0.4%), ferrets (63%), and opossums (35%). Discovering why some species have particularly high or low levels of cancer may lead to a better understanding of cancer syndromes and novel strategies for the management and prevention of cancer. Significance: Evolution has discovered mechanisms for suppressing cancer in a wide variety of species. By analyzing veterinary necropsy records, we can identify species with exceptionally high or low cancer prevalence. Discovering the mechanisms of cancer susceptibility and resistance may help improve cancer prevention and explain cancer syndromes.

Beyond the binary: Analysis of esophageal cancer hospitalizations in the transgender population, a national inpatient sample study.

e18888 Background: Transgenders are individuals with a gender identity that differs from their sex at the time of birth. Over &gt; 1.6 million adults identify themselves as transgender in the US, of which 39% are women and 36% are men. While gender differences in cancer prevalence have been well established between men and women, very few studies evaluate the prevalence of cancer in patients who identify as transgender people. We aimed to evaluate the trends of esophageal cancer admission hospitalizations in the transgender population compared to the general population. Methods: This was a retrospective analysis of the data obtained from the Nationwide Inpatient Sample database. Data were sampled from 2015 to 2020 utilizing the ICD-10 codes of esophageal cancer and patients( &gt; 18 years) who identified as transgender. The primary outcome was in-hospital mortality. Secondary outcomes were the length of stay (LOS) and total costs in the hospital, respectively. A multivariate logistic regression analysis was used to estimate the odds ratio. Results: A total of 212,425 patients with esophageal cancer were admitted between 2015- 2020, of which 97,950 were transgender. The mean age was 33 vs. 34 years in the general population. Both groups were predominantly Caucasian (65% vs. 68%), followed by African Americans (15.2% vs. 5.2%). Median household income (MHI) in transgender people was commonly in the lower quartile (27.8%). In cisgender patients, 37% had a MHI in the 26th-50th followed by 26% in the 76th-100th percentile. Inpatient mortality in transgender patients with esophageal cancer was OR = 5.1[1.8-8.3] (p &lt; 0.05). The average LOS was higher in the transgender population by 2.15 days [1.1-3.1](p &lt; 0.05). Increased LOS in teaching hospitals by 1.3 days [1.08- 1.59] (p &lt; 0.001) and larger hospitals by 1.4 days [0.51- 2.28] (p &lt; 0.001) was observed. The total cost of admission was significantly different in teaching hospitals ($27,774, p &lt; 0.001). Conclusions: We found a significant difference between the inpatient outcomes of transgender and the general population. Despite the markedly low representation of transgender people in the national cancer registries, they experienced an increased mean length of stay and mortality compared to cisgenders with esophageal cancer. Further investigation is required to determine the cause of disparity in healthcare utilization amongst the gender-diverse population. [Table: see text]

Differences in cancer prevalence among CHEK2 carriers identified via multi-gene panel testing

PurposeAlthough CHEK2 is a well-established cancer gene, questions remain including whether risks vary substantially between different variants and whether biallelic carriers have higher risks than heterozygotes. We report on a cohort of individuals with CHEK2 pathogenic and likely pathogenic variants (collectively, PV) in order to better characterize this gene. MethodsWe retrospectively queried samples submitted for multi-gene hereditary cancer testing to identify individuals with CHEK2 PVs and assessed differences in phenotypes among various genotypes. ResultsCHEK2 PVs were identified in 2508 individuals, including 32 individuals with biallelic CHEK2 PVs. Breast (female, 59.9% and male, 11.8%), prostate (20.1%), and colorectal (3.5%), were among the most frequently reported cancers. Select missense PVs showed similar cancer prevalence to truncating PVs while some others showed lower prevalence. No significant differences were observed between biallelic carriers and heterozygotes. ConclusionsOur data support that some, but not all, CHEK2 missense PVs demonstrate lower cancer prevalence; further studies are needed to continue characterizing possible variant specific risks. In addition, biallelic CHEK2 PVs do not appear to be associated with a more severe phenotype than single CHEK2 PVs. Furthermore, co-occurrences with PVs in other cancer risk genes are common among CHEK2 heterozygotes and often warrant additional management.

Incidental Thyroid Nodules: Race/Ethnicity Disparities and Outcomes

Black patients have a significantly lower incidence of well-differentiated thyroid cancer (WDTC) compared to all other race/ethnic groups, while white patients appear to be at greater risk. This study examines incidental thyroid nodules (ITNs) to assess whether racial disparities in WDTC arise from a differential discovery of ITNs-perhaps due to socioeconomic disparities-or reflect true differences in thyroid cancer rates. A retrospective review was performed of all patients who underwent fine-needle aspiration (FNA) of thyroid nodules by our academic medical center's endocrinology division between January 2006 and December 2010. Medical records were reviewed to identify whether the biopsied thyroid nodule was discovered incidentally through nonthyroid-related imaging or identified by palpation. FNAs were performed on 1,369 total thyroid nodules in 1,141 study patients; 547 (48%) were classified as white, and 593 (52%) were classified as nonwhite. Among this cohort, 36.6% of patients underwent biopsy for an ITN. White patients were 1.6 times more likely to have undergone a biopsy for a nodule that was incidentally identified compared to nonwhites ( P<.0001). Indicators of socioeconomic status (SES) did not have a significant association with ITNs. Within the ITN cohort, 4.9% of nonwhite patients were found to have a thyroid malignancy compared to 12.9% of white patients ( P<.01). The higher incidence of thyroid cancer in white patients appears to be not only due to diagnostic bias, but also to a true difference in cancer prevalence. FNA = fine-needle aspiration; ITN = incidental thyroid nodule; SEER = Surveillance Epidemiology and End Results; SES = socioeconomic status; WDTC = well-differentiated thyroid cancer.

Performance of multiparametric MRI appears better when measured in patients who undergo radical prostatectomy.

Utilization of pre-biopsy multiparametric MRI (mpMRI) is increasing. To optimize the usefulness of mpMRI, physicians should accurately quote patients a numerical risk of cancer based on their MRI. The Prostate Imaging Reporting and Data System (PIRADS) standardizes interpretation of mpMRI; however, reported rates of clinically significant prostate cancer (CSC) stratified by PIRADS score vary widely. While some publications use radical prostatectomy (RP) specimens as gold standard, others use biopsy. We hypothesized that much of the variation in CSC stems from differences in cancer prevalence in RP cohorts (100% prevalence) vs biopsy cohorts. To quantify the impact of this selection bias on cancer yield according to PIRADS score, we analyzed data from 614 men with 854 lesions who underwent targeted biopsy from 2014 to 2018. Of these, 125 men underwent RP. We compared the PIRADS detection rates of CSC (Gleason ≥7) on targeted biopsy between the biopsy-only and RP cohorts. For all PIRADS scores, CSC yield was much greater in patients who underwent RP. For example, CSC was found in 30% of PIRADS 3 lesions in men who underwent RP vs 7.6% in men who underwent biopsy. Our results show that mpMRI performance appears to be better in men who undergo RP compared with those who only receive biopsy. Physicians should understand the effect of this selection bias and its magnitude when discussing mpMRI results with patients considering biopsy, and take great caution in quoting CSC yields from publications using RP as gold standard.

Occupational Health Hazards of Working in the Interventional Laboratory: A Multisite Case Control Study of Physicians and Allied Staff

BackgroundThe occupational hazards of working in the interventional laboratory have been inadequately studied for physicians and remain unaddressed for nonphysician personnel. ObjectivesThis study sought to determine whether the prevalence of work-related musculoskeletal pain, cancer, and other medical conditions is higher among physicians and allied staff who work in interventional laboratories compared with employees who do not. MethodsMayo Clinic employees who work in affiliated hospitals with interventional cardiology or interventional radiology laboratories took an electronic survey. Results were stratified on the basis of self-reported occupational exposure to procedures that involve radiation. ResultsThere were 1,543 employees (mean age 43 ± 11.3 years, 33% male) who responded to the survey (response rate of 57%), and 1,042 (67.5%) reported being involved with procedures utilizing radiation. These employees reported experiencing work-related pain more often than the control group before (54.7% vs. 44.7%; p < 0.001) and after adjustment for age, sex, body mass index, pre-existing musculoskeletal conditions, years in profession, and job description (odds ratio: 1.67; 95% confidence interval: 1.32 to 2.11; p < 0.001). Musculoskeletal pain varied significantly by job description, with the highest incidence reported by technicians (62%) and nurses (60%) followed by attending physicians (44%) and trainees (19%; p < 0.001). There was no difference in cancer prevalence between groups (9% vs. 9%; p = 0.96). ConclusionsMusculoskeletal pain is more common among healthcare workers who participate in interventional procedures and is highest in nonphysician employees. The diagnosis of cancer in employees who participate in procedures that utilize radiation was not elevated when compared to controls within the same departments, although any conclusion regarding causality is limited by the cross-sectional nature of the study, as well as the low overall prevalence of malignancy in our study group.

Prevalence and Management of Pain by Different Age Groups of Korean Cancer Patients

The aims of this study were to evaluate the differences in cancer prevalence and pain management between young and elderly patients. The patients were grouped into 3 groups. The prevalence of cancer pain was 50.0% in those younger than 65 years, 55.9% in those aged between 65 and 75, and 58.3% in those older than 75 years. The prevalence of cancer pain was higher for patients in advanced stages and with poor performance status. Using logistic regression analysis, we found that performance status has a significant correlation with cancer pain. Severe cancer pain occurred in 8.0% of the patient and was most prevalent in the advanced stage. Side effects of analgesics were observed in 24.5%. Cancer pain correlates with performance status and cancer stage but not significantly with age.

Cancer survivorship and sexual orientation

Lesbian, gay, and bisexual populations are not part of cancer surveillance, resulting in scarce information about the cancer survivorship of these populations. To address this information gap, the authors examined the prevalence of cancer survivorship by sexual orientation and cancer survivors' self-reported health by sexual orientation. The authors explored these issues by analyzing pooled data from the California Health Interview survey from 2001, 2003, and 2005. By using descriptive statistics and logistic regressions, they examined the cancer prevalence in men and women by sexual orientation and subsequently compared the self-reported health of male and female cancer survivors by sexual orientation. Among women, the authors found no significant differences in cancer prevalence by sexual orientation, but lesbian and bisexual female cancer survivors had 2.0 and 2.3× the odds of reporting fair or poor health compared with heterosexual female cancer survivors. Among men, we found significant differences in cancer prevalence, with gay men having 1.9× the odds of reporting a cancer diagnosis compared with heterosexual men. There were no differences by sexual orientation in male cancer survivors' self-reported health. Our novel findings suggest sex differences in the impact of cancer on lesbian, gay, and bisexual cancer survivors. Lesbian and bisexual cancer survivors need to be targeted by programs and services to assist these cancer survivors in improving their health perceptions, whereas healthcare providers and public health agencies need to be made aware of the higher prevalence of cancer in gay men to prevent future cancers through increased screening and primary prevention.

Significance of Serum Testosterone for Prostate-Specific Antigen (PSA) Elevation and Prediction of Prostate Cancer in Patients with PSA Above 10 ng/ml

PurposeTestosterone is essential for the prostate gland's normal growth and development and is also a possible risk factor for prostate cancer. This study's aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men.Materials and MethodsThe study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated.ResultsThirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25±154.62 ng/dl and 458.10±158.84 ng/dl, respectively; average PSA was 17.58±9.02 ng/ml and 18.62±6.53 ng/ml, respectively; and average age was 69.02±7.52 years and 70.69±7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05).ConclusionsIn our study's results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness.

DECREASED CANCER PREVALENCE IN THE NURSING HOME

To the Editor: Cancer prevalence increases dramatically with advancing age (1). Yet, large registry datasets have indicated a curious decline in cancer prevalence in the oldest-old (i.e., those over the age of 85 years) (2). Although cellular and sub cellular factors associated with advanced age might favor carcinogenesis, other features of a less fertile microenvironment may be unfavorable for tumor growth. At the phenotypic level, frailty is becoming more objectively characterized (3), and dysregulated inflammatory processes are thought to figure prominently in its pathogenesis (4, 5). Furthermore, a reduced capacity to produce or respond to angiogenesis (6) or other growth factors (7) might be a definable component of frailty. Thus, in frail individuals, the above factors may be responsible for a tissue microenvironment less conducive for tumor growth, and this may result in the appearance of less cancer in frail when compared to non-frail individuals of the same age. To address this hypothesis we proposed there would be less cancer among those who reside in nursing homes because residents therein have a disproportionately higher representation of individuals meeting established criteria for frailty (8). We examined the Medicare Current Beneficiary Survey (MCBS), a continuous, multipurpose survey of a nationally representative sample of aged, disabled, and institutionalized Medicare beneficiaries (9). The sample included 40,125 persons who lived in the community and 2,190 persons who lived in a long-term care facility. Survey-reported events were linked to Medicare claims data. We examined the age-adjusted prevalence rates of cancer in the various subpopulations within the MCBS dataset. For this analysis, all beneficiaries over the age of 65 years were stratified into three age groups: 65 to 74, 75 to 84, and 85 and over. To estimate sampling error within the dataset, standard errors were determined by incorporating published variability estimates and calculating the Z value. If the absolute value of Z were greater than 1.96, we would conclude that the two rates were significantly different at a p-value of less than 0.05. The prevalence of an active (i.e., coded for reimbursement purposes) cancer diagnosis in the three selected age groups is listed in Table 1. Table 1 Prevalence (% with Cancer) Among Non-institutionalized and Institutionalized Medicare Beneficiaries We found the prevalence of cancer to be lower among institutionalized beneficiaries in all age groups, reaching a level of statistical significance for those over 85 years when compared to age-matched individuals living in the community. The prevalence of cancer among elders in the community in the 75-84 years age group was 20.22% among those who live alone, 23.15% among those who live with spouse, and 19.42% among those who live with others. This was higher when compared to 5.16% among the institutionalized. The difference was even greater for the oldest age group, those 85 years and older. Here, the prevalence of cancer in the community was 19.96% among those who live alone, 22.85 % among those who live with spouse, and 15.58 % among those who live with others. This was strikingly higher than the rate of 4.18% among those who reside in long term care facilities. The prevalence of cancer was similar among male and female Medicare beneficiaries in the 65-74 and 75-84 age groups. However, for those over 85 years, cancer was diagnosed less commonly in females. It is notable that cancer in this age group occurs less frequently in women. However, ‘frailty’ is also more common in females of this age-group (10). These observations support the premise that the development of the frail phenotype may somehow protect against cancer. Certainly, some might argue that the observations could simply reflect less aggressive screening or under reporting of cancer in the nursing home, but whether this could account for a four to five fold difference in cancer prevalence seems unlikely. Further, prospective studies are needed to evaluate the relationship between frailty and cancer among community frail elderly to confirm this finding. If this is indeed true, one logical next step would be to examine the questions of carcinogenesis and tumor growth in animal models of chronic inflammation, as this may lead to clues regarding the biology of frailty and the interrelationships of inflammation, cancer and aging.

Comparative Pathology of Mammary Gland Cancers in Domestic and Wild Animals

Mammary cancer occurs among all taxonomic groups, and comparing the disease in animals with breast cancer in women could greatly improve our understanding of the relevant risk factors and genetic profiles for this disease. Differences in cancer prevalence between carnivores and herbivores and between captive and wild carnivores are striking and support the hypotheses that diet and reproductive history are major risk factors. Domestic dogs and cats have a high prevalence of mammary tumors, and the majority of tumors in cats are aggressive cancers. Many domestic dogs and cats are prevented from breeding, resulting in their being exposed to recurrent estrogen peaks followed by high persistent levels of progesterone. Therefore progesterone appears to be a significant risk factor for cancer development. Supporting this suspicion is the observation that most mammary cancers in zoo cats are in those treated with the potent synthetic progestin contraceptive, melengestrol acetate. The more common morphologic types of mammary cancer in canids and felids include tubulopapillary, solid, cribriform, comedo and anaplastic carcinomas. Dogs also develop complex carcinomas, which likely evolve from the complex adenomas or mixed tumors that are so common in this species and are promoted by exogenous progesterone treatment. Among zoo felids, jaguars are at higher risk for mammary cancer and also have a high prevalence of ovarian papillarycystadenocarcinomas, a profile similar to women with BRCA1 mutations. As for women, estrogen (ER) and progesterone receptor (PR) expression varies in canine and feline mammary cancers. In general, ER expression is low, but PR expression persists in most cancers. Alterations in molecular controls of cell proliferation or survival in breast cancer, such as cyclin A and p53 expression, have been identified in dog and cat mammary cancers. Overall, spontaneous mammary cancers in cats and dogs make excellent models for human breast cancer, and knowledge of mammary carcinogenesis would be greatly enhanced across all species by a "One Medicine" approach.

The Association of Colour Flow Doppler Sonography and Conventional Ultrasonography Improves the Diagnosis of Thyroid Carcinoma

Objective: In the present study, we compared the results of conventional ultrasonography (US) and colour flow Doppler sonography (CFDS) with those of US guided fine needle aspiration biopsy (FNAB) and of pathologic staging of resected thyroid nodules, to assess the relative importance of US and CFDS in discriminating malignant thyroid nodules. Subjects and Study Design: We retrospectively reviewed records of 230 patients submitted to US-guided FNAB before surgery for solitary, not hot thyroid nodules. Before US guided FNAB, they were examined with conventional US and CFDS. Conventional US evaluated nodule size, echogenicity, presence of halo sign and microcalcifications. CFDS evaluated the vascular pattern classified as types I, II and III. Twenty-seven patients with inadequate cytology were excluded from this study (11.7%). Results: Two hundred and three patients underwent surgery. At histology a thyroid carcinoma was found in 36 patients (17.7%) and a benign nodule was observed in 167 patients (82.3%). We did not find any difference in cancer prevalence between nodules with a primary tumour size ≤1 cm and those >1 cm (17.6 vs. 17.7%; p = 0.99). A solid echo texture was not statistically significant to suggest malignancy (p = 0.32). Microcalcifications were seen in 83.3% (30/36) of malignant nodules and in33.5% (56/167) ofbenign nodules. These results were statistically significant (p < 0.0001). The type III flow as determined by CFDS was a statistically significant criterion to suggest malignant disease (p < 0.005). The most predictive findings of malignancy on conventional US was the combination of microcalcifications plus the absence of halo sign (sensitivity 75%, specificity 71.9%, p < 0.0001). The combination of an absence of halo sign on conventional US and a type III pattern on CFDS presented the higher sensitivity (83.3%) for malignancy with a specificity of 43.7%. Microcalcifications on US in combination with a type III CFDS pattern showed a lesser sensitivity (80.6%) with an improved specificity (75.4%). In our opinion, the better balanced combination of US and CFDS features was the absence of halo sign plus microcalcifications and a type III CDFS pattern (sensitivity 72.2%, specificity 77.2%). Conclusions: The combination of conventional US and CFDS provides benefits in increasing the screening sensitivity and accuracy in distinguishing malignant thyroid nodules.

Increased risk of cancer among relatives of patients with lung cancer in China

BackgroundGenetic factors were considered as one of the risk factors for lung cancer or other cancers. The aim of this work was to determine whether a genetic predisposition accounts for such familial aggregation of cancer among relatives of lung cancer probands.MethodsA case-control study was conducted in 800 case families identified by lung cancer patients (probands), and in 800 control families identified by the probands'spouses. The data were analysed with logistic regression analysis model.ResultsThe data revealed a significantly greater overall risk of cancer (OR = 1.82, P < 0.01) in the proband group. The relatives of lung cancer probands maintained an increased risk of non-lung cancer (P < 0.05) after adjusting for confounder factors. The crude odds ratio of a proband family having one family member with cancer was 1.67 compared with control families. Proband families were 2.56 times more likely to have two other family members with cancer. For three cancers and four or more cancers, the risk increased to 3.50 and 5.91, respectively. The most striking differences in cancer prevalence between proband and control families were noted for cancer risk among female relatives. The strongest effects were for not only lung cancer in any female relatives (OR 2.17, 95%CI 1.60–3.64) and mothers (OR 2.78, 95%CI 1.23–5.12) and sisters (OR 2.03, 95%CI 1.26–3.97), but also non-lung cancer in females and mothers (OR 2.00, 95%CI 1.26–3.01, and OR 2.34, 95%CI 1.28–4.40, respectively).ConclusionThese data support the hypothesis of a genetic susceptibility to cancer in families with lung cancer, and the female genetic susceptibility to cancer might be greater than male.

Contrasts in cancer prevalence in Connecticut, Iowa, and Utah

Cancer prevalence--the proportion of a population with cancer, including those recently diagnosed, those in treatment, and survivors--is an important indicator of future health care requirements. Only limited information on cancer prevalence is available for the United States. In particular, comparative interstate studies are not available. In this study, we estimate and analyze the prevalence of seven major cancers in Connecticut, lowa, and Utah using the tried and tested PREVAL method applied to National Cancer Institute registry data. We analyzed data on 242,851 carcinomas of the stomach, colorectum, pancreas, breast, uterus (corpus), ovary, and non-Hodgkin lymphoma (NHL), diagnosed in white Americans from 1973 through 1992. Observed prevalence was estimated by applying the PREVAL method to incidence and life status data from the cancer registries. Complete prevalence was estimated by applying correction factors obtained by modeling incidence and survival rates. The ratio of the highest to the lowest prevalence (as proportions) ranged from 1.69 for uterine carcinoma to 2.73 for stomach carcinoma, showing that marked differences in cancer prevalence exist within the United States. Utah had the lowest prevalence for each carcinoma. Connecticut and lowa had similar prevalence levels for carcinomas of the colorectum, pancreas, and ovary and for NHL. Breast carcinoma was the most prevalent, with 826 cases per 100,000 of population in Utah, 1518 per 100,000 in lowa, and 1619 per 100,000 in Connecticut. Cancer survival did not differ greatly among the three registry populations. The major determinants of prevalence differences were incidence and the population age distribution. PREVAL provides reliable estimates of the numbers of living people in a population who have had a cancer diagnosis. Prevalence depends on incidence and survival and on the age structure of population. All these factors have changed markedly in recent years and will continue to do so in the future. Cancer prevalence should be monitored over time to evaluate changes by area, sex, age, and cancer site. The prevalence figures presented are directly comparable with those from European cancer registries.

Stereotactic large core needle biopsy for all nonpalpable breast lesions?

Stereotactic large-core needle biopsy (SLCNB) is a minimally invasive method for histological diagnosis of nonpalpable breast disease. We studied differences in cancer prevalence between a group of women referred through the national screening program and a non-screening group, and assessed whether the validity of SLCNB differed between these groups. A group of non-selective, consecutive patients presenting with a nonpalpable mammographic lesion, who participated in a recently conducted multicenter study regarding the accuracy of SLCNB in The Netherlands, were the basis for this study. Prevalence of carcinoma, predictive value of a benign diagnosis, sensitivity, and specificity rate of SLCNB were compared between the two groups. Of the 1029 lesions in 972 patients included, 858 were evaluable. In 850/858 lesions (99.1%) the reason for referral was clear. The prevalence of cancer in the screening group (n = 511 lesions) was 64.0% (95%CI 59.8-68.2), versus 49.6% in the non-screening group (n = 339) (95%CI 44.2-54.9). Respective predictive values of a benign diagnosis on SLCNB were 97.0 versus 94.8% (non-significant). The sensitivity rates of SLCNB were 98.5% (screening; 95%CI 96.5-99.5) versus 95.2% (non-screening; 95%CI 90.8-97.9). Specificity rates were 97.8 (95%CI 94.5-99.4) and 99.4% (95%CI 96.8-100), respectively. Despite a significant difference in the prevalence of carcinoma, the accuracy of SLCNB did not show a statistically significant difference between both patient groups. Therefore, SLCNB appears accurate in diagnosing nonpalpable breast lesions both in screening and non-screening patient groups.

Validation of Cancer Prevalence Data from a Postal Survey by Comparison with Cancer Registry Records

Data on self-reported cancer from a health interview survey carried out in 1991 in the southeastern Netherlands by means of a postal questionnaire (n = 17,940) were validated against records from a population-based cancer registry. The sensitivity of the questionnaire was 0.552 (95% confidence interval (CI) 0.507-0.597), and the specificity was 0.995 (95% CI 0.994-0.996). The survey underestimated cancer prevalence in the population by 25%. Of the 212 false negative cases, 46% were registered with non-melanoma skin cancer. After the exclusion of nonmelanoma skin cancer from cancer registry records, cancer prevalence was overestimated by the survey by a negligible 2%. The misclassification of cancer by the postal survey was differential according to age, sex, education, and degree of urbanization. The survey overestimated cancer prevalence ratios for men versus women, old respondents versus young respondents, and urban residents versus rural residents. The prevalence ratios for respondents with a low educational level versus those with a high level were underestimated using survey data. These patterns remained essentially the same after exclusion of nonmelanoma skin cancer from the cancer registry records. This study shows that both overall cancer prevalence and differences in cancer prevalence between subgroups of the population may be biased when health interview survey data are used. If explicit attention is paid to nonmelanoma skin cancer in survey questions, this might improve the validity of overall cancer prevalence estimates, but not that of comparisons between subgroups of the population.

Increased familial risk for non-lung cancer among relatives of lung cancer patients.

Reports of two or more anatomically distinct cancer types clustering in families suggest the possible existence of a susceptibility-to-cancer gene. To determine whether a genetic predisposition accounts for such familial aggregation, a retrospective case-control study was conducted in 1976-1979 of 337 southern Louisiana families in each of which a deceased lung cancer patient was used as the proband. A comparison of first-degree relatives of proband families with spouse (control) families revealed a significantly greater overall risk of cancer (odds ratio (OR) = 2.0, p less than 0.0001) in the proband group. Using logistic regression techniques to control for the confounding effects of age, sex, cigarette smoking, and occupational/industrial exposures, relatives of lung cancer probands maintained an increased risk of non-lung cancer (p less than 0.05). The crude odds ratio of a proband family having one family member with cancer was 1.67 compared with control families. Proband families were 2.16 times more likely to have two other family members with cancer. For three cancers and four or more cancers, the risk increased to 3.66 and 5.04, respectively. Each risk estimate was significant at the 0.01 level. The most striking differences in cancer prevalence between proband and control families were noted for cancer of the nasal cavity/sinus, mid-ear, and larynx (OR = 4.6); trachea, bronchus and lung (OR = 3.0); skin (OR = 2.8); and uterus, placenta, ovary, and other female organs (OR = 2.1). These data support the hypothesis of a genetic susceptibility to cancer in families with lung cancer.