Reduce Cancer Deaths Research Articles

American Cancer Society reports progress in reducing cancer deaths

American Cancer Society reports progress in reducing cancer deaths

Aspirin and cancer: has aspirin been overlooked as an adjuvant therapy?

Aspirin inhibits the enzyme cyclooxygenase (Cox), and there is a significant body of epidemiological evidence demonstrating that regular aspirin use is associated with a decreased incidence of developing cancer. Interest focussed on selective Cox-2 inhibitors both as cancer prevention agents and as therapeutic agents in patients with proven malignancy until concerns were raised about their toxicity profile. Aspirin has several additional mechanisms of action that may contribute to its anti-cancer effect. It also influences cellular processes such as apoptosis and angiogenesis that are crucial for the development and growth of malignancies. Evidence suggests that these effects can occur through Cox-independent pathways questioning the rationale of focussing on Cox-2 inhibition alone as an anti-cancer strategy. Randomised studies with aspirin primarily designed to prevent cardiovascular disease have demonstrated a reduction in cancer deaths with long-term follow-up. Concerns about toxicity, particularly serious haemorrhage, have limited the use of aspirin as a cancer prevention agent, but recent epidemiological evidence demonstrating regular aspirin use after a diagnosis of cancer improves outcomes suggests that it may have a role in the adjuvant setting where the risk:benefit ratio will be different.

Aspirin reduces cancer death and all‐cause mortality

Aspirin reduces cancer death and all‐cause mortality

EphB2: a signature of colorectal cancer stem cells to predict relapse

Colorectal cancer is one of the most commonly diagnosed cancers and is the second leading cause of death from cancer. Currently, the conventional treatment in clinics is surgery combined with chemotherapy or radiation therapy. Although new drugs have been developed, relapse and metastasis occur in nearly half of colorectal cancer patients. As most other types of cancer, the recurrence rate of colorectal cancer is negatively correlated with the disease stage at diagnosis. Therefore, early diagnosis becomes an important approach to improve the treatment outcome. Consistent with this idea, prediction of the disease progression and recurrence has significant implications for the choices and outcome of treatment. With the rapid development of molecular biology, biochemistry and oncology in the past decade, scientists have taken great efforts identifying gene and/or biochemical markers that are associated with tumorigenesis, and several screening approaches have been developed and used in clinic. These applications have greatly benefited the early detection and remarkably reduced cancer deaths. Recently, Batlle group from Spain identified EphB2 as an intestinal stem cell (ISC) marker gene that can be used to identify colorectal cancer stem cells and predict colorectal cancer relapse (Merlos-Suarez et al., 2011). ISCs reside at the base of mucosal invaginations (crypt). Their progeny transient amplifying cells move upward as they proliferate through mitosis until get close to intestinal lumen, where cells undergo cell cycle arrest and terminal differentiation. ISCs are essential for the tissue regeneration in intestine. However, they also exhibit relatively high efficiency to develop colorectal tumors upon mutations of genes in Wnt signaling pathway, which are suggested to activate intestinal tumorigenesis. EphB2 is a receptor tyrosine kinase that is regulated by Wnt pathway. Targeted deletion of EphB2, EphB3 or their ligand ephrin-B1 in mouse caused intestinal cell compart

Reply

Reply

Tamoxifen chemoprevention reduces cancer deaths and costs

Tamoxifen chemoprevention reduces cancer deaths and costs

Forced expiratory volume predicts all-cause and cancer mortality in Mumbai, India: results from a population-based cohort study

Reduction in pulmonary function, as estimated by forced expiratory volume in 1 s (FEV(1)), has been found to predict all-cause mortality in developed-country populations. This study was designed to examine the association between FEV(1) and mortality in an urban developing-country population. Data from the large, well-characterized Mumbai Cohort Study (Maharashtra, India) were used to compute hazard ratios (HRs; deaths/100-ml FEV(1)) and 95% confidence intervals (CIs) from Cox proportional hazards regression models in which age, tobacco use, education, height and relative body weight were controlled. A total of 13,261 deaths occurred in this cohort of 148,173 individuals. After controlling for important covariates, there was a 1.7% reduction in risk of overall death in women for each 100-ml increment in FEV(1) (HR = 0.983; 95% CI = 0.980-0.986) and a 1.5% reduction in men (HR = 0.985; 95% CI = 0.984-0.986). There was a 1.6% reduction in cancer deaths in women (HR = 0.984; 95% CI = 0.973-0.996) and a 0.8% reduction in men (HR = 0.992; 95% CI = 0.987-0.997). The largest reductions in women were observed in tuberculosis deaths (3.7%/100-ml increment in FEV(1)), and in men in respiratory system deaths (3.2%). In a densely populated urban Indian population, FEV(1) predicted overall and cancer mortality. Effects were larger in women and were not attenuated by exclusion of smokers or restricting analyses to subjects dying >2 years from recruitment. Because FEV(1) may be affected by air pollution, which is worsening in urban areas of most developing countries, further research is recommended to deepen understanding of these factors in relation to mortality.

Quality of Life and Diagnostic Imaging Outcomes

The US Preventive Services Task Force recently promulgated revised guidelines for screening mammography. Criticisms were related to the undervaluation of future lives saved and the overvaluation of negative impacts of mammography. Radiologists downplayed quality-of-life factors, potentially understating the value of all imaging procedures. The task force's recommendations for core needle biopsy, based on similar conceptual frameworks, were not met with equivalent responses. Full appreciation of the costs and benefits of screening provides the basis for making the best decisions for individuals and populations. This is undermined by the mixed messages that patients and physicians receive during clinical encounters and through other means. Quantitative approaches to medical care are valid on their own terms and when evaluated in the individual context. Insights from behavioral economics and political science inform discussion of population-based medical interventions. Preventing harm from medical interventions satisfies both the "primum non nocere" dictum and the loss aversion heuristic concordantly. The most effective medical care is provided when benefits are maximized and complications are minimized, especially when the harms occur immediately and the benefits are delayed. The importance of both quality of life and longevity in health care decision making require minimizing negative impacts of mammography when screening low-risk populations. Current practice differs significantly from the successful randomized trials, front-loading costs of false-positive examinations, and overtreatment. By decreasing false-positive mammographic results through adherence to ACR BI-RADS recommendations, radiologists can answer critics of early and frequent screening while still reducing cancer deaths.

Declining death rates reflect progress against cancer.

BackgroundThe success of the “war on cancer” initiated in 1971 continues to be debated, with trends in cancer mortality variably presented as evidence of progress or failure. We examined temporal trends in death rates from all-cancer and the 19 most common cancers in the United States from 1970–2006.Methodology/Principal FindingsWe analyzed trends in age-standardized death rates (per 100,000) for all cancers combined, the four most common cancers, and 15 other sites from 1970–2006 in the United States using joinpoint regression model. The age-standardized death rate for all-cancers combined in men increased from 249.3 in 1970 to 279.8 in 1990, and then decreased to 221.1 in 2006, yielding a net decline of 21% and 11% from the 1990 and 1970 rates, respectively. Similarly, the all-cancer death rate in women increased from 163.0 in 1970 to 175.3 in 1991 and then decreased to 153.7 in 2006, a net decline of 12% and 6% from the 1991 and 1970 rates, respectively. These decreases since 1990/91 translate to preventing of 561,400 cancer deaths in men and 205,700 deaths in women. The decrease in death rates from all-cancers involved all ages and racial/ethnic groups. Death rates decreased for 15 of the 19 cancer sites, including the four major cancers, with lung, colorectum and prostate cancers in men and breast and colorectum cancers in women.Conclusions/SignificanceProgress in reducing cancer death rates is evident whether measured against baseline rates in 1970 or in 1990. The downturn in cancer death rates since 1990 result mostly from reductions in tobacco use, increased screening allowing early detection of several cancers, and modest to large improvements in treatment for specific cancers. Continued and increased investment in cancer prevention and control, access to high quality health care, and research could accelerate this progress.

Cardiotoxicity After Childhood Cancer: Beginning With the End in Mind

Worldwide, more than 28 million people live with cancer. This number could triple by 2030. With the increasing number of patients with cancer and improvements in cancer management that continue to reduce cancer death rates, the number of cancer survivors is projected to increase rapidly, in particular, those afflicted during childhood. In children and adolescents, the survival rate has jumped from fewer than 50% in the mid-1970s to 80% today. The growing population of childhood survivors is notable for its vulnerability to adverse health outcomes, many of which may not become clinically apparent until years after the completion of therapy. Despite surviving their initial cancer, childhood cancer survivors continue to face considerable premature mortality as adults. The excess risk of dying from other causes that contributes most to loss of life expectancy is the increased incidence of chronic conditions among survivors of childhood cancer. We need to monitor the health of these survivors and to minimize the use of therapies with late toxicities in newly diagnosed patients. Survivors also experience a higher prevalence of chronic conditions, with as many as two thirds of childhood cancer survivors reporting at least one chronic condition and one fourth reporting a severe, disabling, or life-threatening condition. Survivors of childhood cancer are 5 to 10 times more likely than their healthy siblings to experience heart disease. The incidence of these conditions increases with time, so the full extent of disease- and treatment-related late effects has yet to be realized. Survivors of childhood cancer are a new, large, emerging population at risk for acquired premature symptomatic cardiovascular disease. The report by Tukenova et al 1 provides important information on late excess cardiovascular mortality in childhood cancer survivors and on the factors associated with this mortality. Their report adds new information about late cardiac effects in childhood cancer survivors by specifically using carefully calculated radiation doses to the heart as a factor to assess overall mortality and cardiovascular mortality. Importantly, this study also evaluated the potential classes of medications for their association with cardiovascular mortality. This article not only validates previous studies of overall cardiac mortality, 2-7 it also provides new data on cumulative anthracycline dose, cumulative radiation dose, and the contribution of other agents. Although the dose-dependent risk of congestive heart failure and related deaths associated with anthracyclines among childhood cancer survivors is established, and although radiation exposure to the heart has also been associated with increased risk of cardiovascular disease, this article’s evaluation of the association between the dose of radiation and the dose of anthracyclines on cardiovascular mortality in the same cohort is important. Studies have generally looked only at radiation as a dichotomous variable, although others have looked at treat

Reduced Cancer Deaths Biggest Win From Bariatric Surgery

Reduced Cancer Deaths Biggest Win From Bariatric Surgery

Male tobacco smoke load and non-lung cancer mortality associations in Massachusetts

BackgroundDifferent methods exist to estimate smoking attributable cancer mortality rates (Peto and Ezzati methods, as examples). However, the smoking attributable estimates using these methods cannot be generalized to all population sub-groups. A simpler method has recently been developed that can be adapted and applied to different population sub-groups. This study assessed cumulative tobacco smoke damage (smoke load)/non-lung cancer mortality associations across time from 1979 to 2003 among all Massachusetts males and ages 30–74 years, using this novel methodology.MethodsAnnual lung cancer death rates were used as smoke load bio-indices, and age-adjusted lung/all other (non-lung) cancer death rates were analyzed with linear regression approach. Non-lung cancer death rates include all cancer deaths excluding lung. Smoking-attributable-fractions (SAFs) for the latest period (year 2003) were estimated as: 1-(estimated unexposed cancer death rate/observed rate).ResultsMale lung and non-lung cancer death rates have declined steadily since 1992. Lung and non-lung cancer death rates were tightly and steeply associated across years. The slopes of the associations analyzed were 1.69 (95% confidence interval (CI) 1.35–2.04, r = 0.90), and 1.36 (CI 1.14–1.58, r = 0.94) without detected autocorrelation (Durbin-Watson statistic = 1.8). The lung/non-lung cancer death rate associations suggest that all-sites cancer death rate SAFs in year 2003 were 73% (Sensitivity Range [SR] 61–82%) for all ages and 74% (SR 61–82%) for ages 30–74 years.ConclusionThe strong lung/non-lung cancer death rate associations suggest that tobacco smoke load may be responsible for most prematurely fatal cancers at both lung and non-lung sites. The present method estimates are greater than the earlier estimates. Therefore, tobacco control may reduce cancer death rates more than previously noted.

Early reporting for cancer screening trials

Many cancer screening trials involve a screening programme of one or more screenings with follow-up after the last screening. Usually a maximum follow-up time is selected in advance. However, during the follow-up period there is an opportunity to report the results of the trial sooner than planned. Early reporting of results from a randomized screening trial is important because obtaining a valid result sooner translates into health benefits reaching the general population sooner. The health benefits are reduction in cancer deaths if screening is found to be beneficial and more screening is recommended, or avoidance of unnecessary biopsies, work-ups and morbidity if screening is not found to be beneficial and the rate of screening drops. Our proposed method for deciding if results from a cancer screening trial should be reported earlier in the follow-up period is based on considerations involving postscreening noise. Postscreening noise (sometimes called dilution) refers to cancer deaths in the follow-up period that could not have been prevented by screening: (1) cancer deaths in the screened group that occurred after the last screening in subjects whose cancers were not detected during the screening program and (2) cancer deaths in the control group that occurred after the time of the last screening and whose cancers would not have been detected during the screening programme had they been randomized to screening (the number of which is unobserved). Because postscreening noise increases with follow-up after the last screening, we propose early reporting at the time during the follow-up period when postscreening noise first starts to overwhelm the estimated effect of screening as measured by a z-statistic. This leads to a confidence interval, adjusted for postscreening noise, that would not change substantially with additional follow-up. Details of the early reporting rule were refined by simulation, which also accounts for multiple looks. For the re-analysis of the Health Insurance Plan trial for breast cancer screening and the Mayo Lung Project for lung cancer screening, estimates and confidence intervals for the effect of screening on cancer mortality were similar on early reporting and later. The proposed early reporting rule for a cancer screening trial with post-screening follow-up is a promising method for making results from the trial available sooner, which translates into health benefits (reduction in cancer deaths or avoidance of unnecessary morbidity) reaching the population sooner.

Changes in Cancer Incidence and Mortality in England & Wales and a comparison of cancer deaths in the Major Developed Countries by Age and Sex 1979-2002 in context of GDP Expenditure on Health

Background:The successful treatment of cancer is a major health and political issue for England and Wales and the major developed countries (MDCs). All malignancy deaths by age and sex are analysed to determine how successful the MDCs were in reducing cancer mortality between the end points of 1979–81 and 2000–2, and whether there was any association between each nations ‘gross domestic product expenditure on health’ (GDPEH) and the reduction in their cancer deaths.Method:Incidence of cancer in England and Wales was examined for 1979–80 to 2003–4 to highlight the extent of the problem. The cancer mortality rates for England and Wales were compared with each MDC by age and sex, using ‘WHO all malignancies mortality rates’ for the periods of 1979–81 and 2000–2, and tests of significance were made. The GDPEH for each MDC was examined for 1980–2002, and Spearman rank-order correlations calculated to explore any association between declining cancer deaths and the GDPEH of each MDC.Results:Men’s All Age malignancy incidence in England and Wales rose 48% and women’s 51%, with notable rises for females aged 15–34 and 55–74 years.Every MDC increased its GDPEH substantially; it rose to 9.3% in the United Kingdom, but the United Kingdom still remains eighth of the ten MDCs and below the MDC average (9.85%).The average number of cancer related deaths for men in England and Wales (15–74 years) was third highest in 1979–81, but fell to eighth by 2000–2. This decline was significantly greater than in seven other MDCs. Average female death rates in England and Wales were highest both in 1979–81 and in 2000–2, but declined significantly more than most MDCs in every age band from 35 to 74 years.There was a significant correlation between reduced deaths and the level of GDPEH of each nation.Male death rates declined significantly more than that of female in each MDC, with the exception of Japan and Spain.Conclusions:The rising incidence in cancer-related deaths poses a problem for every MDC, and the poorer women’s results should be a matter of concern for most MDCs. The reduction in cancer deaths reflects well on frontline services, and the significant association between reduced cancer mortality and increased GDPEH is encouraging, but still a challenge for governments, especially if the incidence continues to rise.

Health and economic impact of HPV 16 and 18 vaccination and cervical cancer screening in India.

Cervical cancer is a leading cause of cancer death among women in low-income countries, with ∼25% of cases worldwide occurring in India. We estimated the potential health and economic impact of different cervical cancer prevention strategies. After empirically calibrating a cervical cancer model to country-specific epidemiologic data, we projected cancer incidence, life expectancy, and lifetime costs (I$2005), and calculated incremental cost-effectiveness ratios (I$/YLS) for the following strategies: pre-adolescent vaccination of girls before age 12, screening of women over age 30, and combined vaccination and screening. Screening differed by test (cytology, visual inspection, HPV DNA testing), number of clinical visits (1, 2 or 3), frequency (1 × , 2 × , 3 × per lifetime), and age range (35–45). Vaccine efficacy, coverage, and costs were varied in sensitivity analyses. Assuming 70% coverage, mean reduction in lifetime cancer risk was 44% (range, 28–57%) with HPV 16,18 vaccination alone, and 21–33% with screening three times per lifetime. Combining vaccination and screening three times per lifetime provided a mean reduction of 56% (vaccination plus 3-visit conventional cytology) to 63% (vaccination plus 2-visit HPV DNA testing). At a cost per vaccinated girl of I$10 (per dose cost of $2), pre-adolescent vaccination followed by screening three times per lifetime using either VIA or HPV DNA testing, would be considered cost-effective using the country's per capita gross domestic product (I$3452) as a threshold. In India, if high coverage of pre-adolescent girls with a low-cost HPV vaccine that provides long-term protection is achievable, vaccination followed by screening three times per lifetime is expected to reduce cancer deaths by half, and be cost-effective.

Letter to the Editor of International Journal of Low Radiation

This letter queries a figure in a paper by Sir Samurai T.D. Luckey in this journal (4(4), 2007, 336-44) and conclusions resulting from it that an annual dose of 18 mSv might 'reduce cancer death rates to zero'. A reply from Sir Samurai T.D. Luckey is included.

Lung Cancer Screening Results: Easily Misunderstood

Lung Cancer Screening Results: Easily Misunderstood

Screening Reduces Cancer Deaths in Lynch Syndrome

Screening Reduces Cancer Deaths in Lynch Syndrome

Tobacco smoke overload and ethnic, state, gender, and temporal cancer mortality disparities in Asian-Americans and Pacific Islander-Americans

Background. Asians and Pacific Islanders (APIs) are important populations nationally and globally. So we assessed cumulative tobacco smoke overexposure (smoke overload)/cancer mortality associations across states, ethnicities, years, and genders among API-Americans. Methods. Death rates were adjusted to the 2000 United States age standard, lung cancer death rates used as a smoke overload bio-index, and lung/non-lung cancer death rate linear regressions run. Cancer death rate smoking-attributable fractions (SAFs) are equal to 1 − estimated unexposed rate/observed rate. Results. The two lowest smoke overload and non-lung cancer death rates were in South Asian (Indo)-Californian females and males. The highest were in Korean-Californian males. Non-lung cancer death rates were tightly and steeply associated with smoke overload across ethnicity, state, year, or gender. Cancer death rate smoking-attributable fractions ranged from 0 in female and 6% in male Indo-Californians, to 39% in female and 57% in male API-Americans in 2002, to 71% in Korean-Californian and 69% in API Hawaiian males. Discussion. Many API American cancer death rate disparities across genders, ethnicities, states, or years can be explained by smoke overload disparities. Tobacco control may greatly reduce cancer death rates and disparities among API-Americans and, likely, others.

Race and Colorectal Cancer Screening: A Population-based Study in North Carolina

National and state data document racial differences in colorectal cancer (CRC) mortality and incidence. Screening for CRC reduces cancer incidence and deaths. Racial differences in colorectal cancer screening behavior may contribute to the racial disparity in incidence and mortality. The purpose of this study was to determine if colorectal cancer screening rates are different between blacks and whites while controlling for potential confounders. Cross-sectional survey. DATA SOURCE(S)/STUDY SETTING: We used data from the North Carolina Colon Cancer Study, a population-based case-control study conducted in 33 counties of North Carolina. We analyzed data from 598 control subjects who were eligible for colorectal cancer screening. Trained nurses conducted face-to-face interviews from October 1996 through October 2000. Overall, 50% of the respondents were compliant with CRC screening guidelines. In the multivariable logistic regression model having a regular doctor and participation in a general medical exam were significantly associated with current screening status with odds ratios (OR) (95% confidence interval (CI)) of 3.8 (1.7-8.3) and 3.7 (2.1-6.7), respectively. Older age was a significant predictor of current screening status with an OR (95% CI) of 2.9 (1.7-4.8) for those 60-69 compared to respondents 50-59 and OR 3.2 (1.9-5.5) for those 70 and older compared to respondents 50-59. After adjusting for age, having a regular doctor and participation in general medical exams, race was not significantly associated with current CRC screening status, with an OR of 1.1 (95% CI 0.7-1.6). CRC screening rates in North Carolina were low. Race was not a significant determinant of screening behavior and therefore does not explain the racial disparity in incidence or survival. Older age, having a regular doctor and participating in general medical exams were significant predictors of CRC screening. This study reinforces the fact that screening rates in North Carolina are low despite the strong evidence that colorectal cancer screening reduces cancer deaths.