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Biomedical subjects

C Mettlin

Publications and source records attributed to C Mettlin.

At least 19 recordsLinked to original sources
PubMed2001

Intakes of selected nutrients and food groups and risk of ovarian cancer.

In a hospital-based case-control study, we examined dietary intakes of selected nutrients and food groups and ovarian cancer risk among 496 women with primary, histologically confirmed epithelial ovarian cancer and 1,425 women with nonneoplastic diagnoses, ages 20-87 years, admitted to Roswell Park Cancer Institute between 1982 and 1998. Data on diet and other relevant risk factors in the few years before admission were collected with a self-administered questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression adjusting for age, education, region of residence, regularity of menstruation, family history of ovarian cancer, parity, age at menarche, oral contraceptive use, and energy intake. Women in the highest vs. the lowest quartile of total energy had a weak increase in risk (OR = 1.25, 95% CI = 0.90-1.73). Significantly reduced risks were associated with higher intakes of dietary fiber (OR = 0.57, 95% CI = 0.38-0.87), vitamin A (OR = 0.66, 95% CI = 0.45-0.98), carotenoid (OR = 0.64, 95% CI = 0.43-0.93), vitamin E (OR = 0.58, 95% CI = 0.38-0.88), beta-carotene (OR = 0.68, 95% CI = 0.46-0.98), and total fruit and vegetable intake (OR = 0.62, 95% CI = 0.42-0.92). Our findings suggest that a diet high in plant foods may be important in reducing risk of ovarian cancer.

Adult↗
PubMed2001

Regular use of analgesic drugs and ovarian cancer risk.

Analgesics have been shown to reduce risk for colorectal cancer. Results from three recent reports (D. W. Cramer et al., Lancet, 351: 104-107, 1998; C. Rodriguez et. al., Lancet, 352: 1354-1355, 1998; L. Rosenberg et al., Cancer Epidemiol. Biomark. Prev., 9: 933-937, 2000) suggest that these drugs might be associated with decreased risk for ovarian cancer. In this hospital-based case-control study, we compared 547 patients with ovarian cancer to 1094 age-matched patients with nonneoplastic conditions. All of the participants received treatment at the Roswell Park Cancer Institute between 1982 and 1998 and completed a comprehensive epidemiological questionnaire that included information on demographics, life-style factors, and reproductive characteristics as well as frequency and duration of aspirin and acetaminophen use. Women who reported that they had used one or more of these agents at least once a week for at least 6 months were classified as analgesic users. Logistic regression was used to compute crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Aspirin users were not at reduced risk of ovarian cancer compared with nonusers (adjusted OR, 1.00; CI, 0.73-1.39). There was also no evidence of a decrease in risk as a function of greater frequency of use or prolonged duration of use. Regular acetaminophen use was associated with a reduced risk (adjusted OR, 0.56; 95% CI, 0.34-0.86), and risk reductions were observed for women with the greatest frequency of use (adjusted OR, 0.32; 95% CI, 0.09-1.08) and longest duration of use (adjusted OR, 0.51; 95% CI, 0.27-0.97). These data suggest that regular use of acetaminophen, but not aspirin, may be associated with lower risk of ovarian cancer.

Acetaminophen↗
PubMed2000

Impact of screening on prostate cancer rates and trends.

Widespread implementation of prostate cancer screening has affected several epidemiologic features of the disease including incidence, tumor and patient characteristics, patterns of care and outcomes. Some of these changes have been interpreted as evidence of the success of PSA testing as a cancer control strategy. Data are available from multiple sources to assess the association of early detection on recent prostate cancer rates and trends. National mortality data in the United States may be particularly informative because of the early and widespread adoption of PSA testing there. Incidence data from tumor registries and other regional resources are also relevant to this question. Case-control analyses and modeling of relevant rates and trends have recently been reported. Multiple sources of data show that prostate cancer incidence rates rose following the introduction of PSA testing. The average age at diagnosis has fallen, the proportion of advanced stage tumors has declined, the proportion of moderately differentiated tumors has increased, and patterns of care have changed accordingly. A decline in mortality began in the United States in 1991. The decline in mortality is well established but this recent trend may only retrace an increase in mortality that immediately preceded. The descriptive epidemiology of prostate cancer reveals many effects of the introduction of prostate cancer screening. Although the evidence suggests increased prostate cancer testing has yielded public health benefit, this has not yet been shown conclusively.

Humans↗
PubMed1999

Association of free PSA percent, total PSA, age, and gland volume in the detection of prostate cancer.

BACKGROUND: Measurement of the free fraction of total prostate-specific antigen (fPSA%) has been proposed as a useful addition to total PSA for the detection of prostate cancer. METHODS: We assessed the performance of fPSA% in differentiating men with prostate cancer from men without cancer in a group of 1,709 subjects studied in five institutions. RESULTS: On the basis of PSA testing, digital rectal examination, and ultrasound examination conducted at one or more visits, 229 cancers were diagnosed. The mean fPSA% in men with cancer was 9.1% compared to 18.9% in men without cancer. The fPSA% varied by age, with men under 60 having a mean fPSA of 13.9% compared to 17.5% in men 60-69 years old and 19.8% in men over age 70. Significant associations of fPSA% with gland volume and PSA level were also observed. The sensitivity, specificity, and positive predictive value of different fPSA% cutoff levels were assessed in 513 men who underwent sextant biopsy. Sensitivity of 85.4%, 32.1% specificity, and a 39.2% positive predictive value were observed using an fPSA cutoff of 15% in men with PSA in the 4.0-9.9 ng/ml range. Sensitivity of 96.9%, 12.3% specificity, and a 36.2% positive predictive value were observed using an fPSA cutoff of 20% in the same men. If 15% fPSA had been used as a biopsy criterion in men with PSA of 4.0-9.9 ng/ml, the number of biopsies performed could have been reduced by 21.2%, with a concomitant reduction in cancer detection of 14.6%. Using a 20% fPSA criterion, biopsies would have been reduced 12.7%, with a 3.1% reduction in cancer detection. CONCLUSIONS: These results provide some evidence that the detection of prostate cancer is enhanced by measuring fPSA% in addition to the established measure of total PSA level. Further research is needed to identify other markers that have better sensitivity and specificity.

Adult↗
PubMed1998

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men.

BACKGROUND: There are minimal data on the influence of urinary symptoms and participation in prostate cancer screening in African American men. METHODS: This correlational study examined the influence of urinary symptoms on 1) participation in a free prostate cancer screening program and 2) abnormal screening results. The 1,402 African American men in the South Carolina Prostate Cancer Project (SCPCP), mean age of 50 years, completed a survey that included self-reported urinary symptoms, participated in a prostate cancer educational program, and received a free prostate cancer screening consisting of a digital rectal examination (DRE) and prostate-specific antigen (PSA) from their personal physician. RESULTS: One in 5 men reported the presence of urinary symptoms. Over 60% of the 1,402 men participated in the free CaP screening. Among the 852 men who participated in the free prostate cancer screening, 73 (8.6%) had abnormal screening results as classified by abnormal DRE and/or PSA >4.0 ng/ml. Urinary symptoms were significant predictors, both of participation in screening (OR = 1.30, CI = 1.00, 1.70) and of obtaining an abnormal screening result (OR = 1.78, CI = 1.17, 2.72). CONCLUSIONS: Prostate cancer health education needs to include the fact that prostate cancer, in its early stages, has no urinary symptoms.

Adult↗
PubMed1997

Life-long screening of patients with intermediate-thickness cutaneous melanoma for asymptomatic pulmonary recurrences: a cost-effectiveness analysis.

BACKGROUND: Costs and potential benefits of an intensive chest X-ray (CXR) screening program to detect asymptomatic pulmonary metastases in patients with intermediate-thickness, local, cutaneous melanoma were assessed. METHODS: Cost-effectiveness analysis from a societal perspective was performed using data on recurrence detection from an historic cohort at Roswell Park Cancer Institute and other published studies, estimates of new cases of melanoma in 1996 from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, and estimates of cost and treatment benefits from published articles retrieved through MEDLINE. Net costs were calculated as the added cost of CXR screening to regular follow-up and the costs incurred in the surgical treatment of lung recurrences. Net benefits were calculated as potential savings in nonquality-adjusted life years (NQALY) and quality-adjusted life years (QALY) resulting from surgical treatment. Cost-effectiveness ratios were calculated as the present value of net costs divided by net benefits, with benefits presented in discounted and undiscounted forms. RESULTS: For the base case, cost of screening per NQALY was $150,000 and was $165,000 for QALY in 1996 dollars using undiscounted health benefits. Screening accounted for approximately 80% of program costs and treatment accounted for 20%. Annual cost-effectiveness ratios were lowest in Years 3-10 of screening. The total cost of a 20-year screening program for patients diagnosed in 1996 was estimated to be between $27-$32 million. CONCLUSIONS: Even in the absence of certain benefits, the model demonstrates that significant cost savings may be possible by decreasing screening frequency in the first 2 years and limiting screening to the first 5-10 years after diagnosis.

Aged↗
PubMed1997

Changes in patterns of prostate cancer care in the United States: results of American College of Surgeons Commission on Cancer studies, 1974-1993.

BACKGROUND: Advances in medical and public health practice have led to many changes in patterns of prostate cancer care. Data from several studies of prostate cancer by the Commission on Cancer of the American College of Surgeons provide information on the directions, magnitudes, and consequences of these changes. METHODS: The Commission on Cancer conducts patient care evaluation (PCE) studies based on the voluntary participation of hospital cancer programs and their tumor registries. PCE studies have been conducted repeatedly for prostate cancer covering patients diagnosed as early as 1974 and as recently as 1990. In addition, the National Cancer Data Base of the Commission on Cancer collects data for all forms of cancer from throughout the country. The Commission on Cancer, the American Cancer Society, and the American Urologic Association also has conducted a focused survey of radical prostatectomy outcomes. In aggregate, these multiple studies have accrued 179,366 reports on treatment of prostate cancer patients. RESULTS: Predominant among practice changes are new techniques of prostate cancer detection and initial evaluation which have led to shifts in disease stage at the time of initial therapy. The proportion of prostate cancer that is localized at the time of detection has increased. Use of radiation therapy and radical prostatectomy has increased as the selection of hormone treatment and no cancer-directed treatment have decreased. Five-year prostate cancer survival has improved for every stage of disease. CONCLUSIONS: The multiple studies by the Commission on Cancer provide data that are not available from other sources. Continued monitoring of prostate cancer patterns of care may be useful in measuring progress in control of this common disease.

Aged↗
PubMed1997

Chemoprevention: will it work?

Cancer chemoprevention has been a major area of inquiry in the United States for over a decade. The field originated from the confluence of developments in laboratory carcinogenesis and nutritional epidemiology. Although still owing much to other research disciplines, chemoprevention researchers have developed models and methodologies specific to the topic. Of particular importance has been the search for intermediate endpoints which might provide valid indications of cancer prevention effectiveness. Intermediate endpoints, however, suffer the limitations of the extrapolation required to the prevention of cancer per se. More direct evidence of chemoprevention effectiveness may come from trials that use actual reduction of cancer incidence as the primary endpoint. Several trials of potential chemopreventive agents are underway or have been completed in the United States or elsewhere with U.S. investigator participation. The results to date have been mixed, and unanticipated findings have raised doubts about the probability of success of primary prevention of cancer by chemoprevention. Future prospects for success may depend upon development of a better understanding of biological mechanisms before progressing to large, long-duration human population trials.

Anticarcinogenic Agents↗
PubMed1997

Recent developments in the epidemiology of prostate cancer.

The purpose of this review is to examine the implications of recent trends in prostate cancer incidence and mortality and to consider recent progress of epidemiological research on this disease. The incidence and mortality rates for prostate cancer are changing throughout the world at an accelerating pace. Much of the increase in incidence is related to changes in detection technology, but increases in mortality rates suggest other factors are involved. Recent research has focused on race-related difference, diet and related lifestyle exposures, the aetiologic significance of vasectomy and, patterns of familial aggregation. Continued monitoring of trends in incidence and mortality will be important as prostate cancer becomes a greater public health burden worldwide. Epidemiological research has identified several possible risk factors which may be useful for prostate cancer prevention and targeting high-risk individuals for early detection intervention. Additional research may confirm and refine understanding of prostate cancer aetiology.

Diet↗
PubMed1996

The National Cancer Data Base report on bladder carcinoma. The American College of Surgeons Commission on Cancer and the American Cancer Society.

BACKGROUND: Previous Commission on Cancer Data from the National Cancer Data Base (NCDB) have examined time trends in stage of disease, treatment patterns, and survival for selected cancers. The most current (1993) data relating to patients with bladder carcinoma are described here. METHODS: Five calls for data have yielded a total of 3,700,000 cases for the years 1985 through 1993, including 447,679 cases for 1988 and 608,593 cases for 1993, from hospital cancer registries across the U.S. Data were received on 18,053 bladder carcinoma cases in 1988 and 22,606 cases in 1993. RESULTS: Interesting trends are 1) younger patients (49 years of age and younger) present with earlier stages of disease than do older patients; 2) women are slightly more likely to be diagnosed with later stages (II, III, and IV) of bladder carcinoma than men; 3) African Americans are less likely to be diagnosed with Stage 0 or Stage I disease than either Hispanic or non-Hispanic whites; and 4) National Cancer Institute designated centers treat more patients with advanced disease than do other types of hospitals. CONCLUSIONS: The NCDB data are important for analyzing what cancer treatments and outcomes are used and occurring in the country. The data suggest that African Americans are diagnosed at later stages of disease progression. The relative survival rates among African Americans are lower than among Hispanics or non-Hispanic whites. Also, the decreasing utility of adjuvant chemotherapy is being recognized.

Adult↗
PubMed1996

p53 mutations in bladder tumors from arylamine-exposed workers.

In this study we compared the frequency and pattern of p53 mutations in 34 bladder tumors from people with high-level occupational exposure to arylamines to those in 30 bladder tumors from people without such exposure. No differences were observed for p53 mutations between the two groups. The frequency of mutation was similar at 47% for arylamine-exposed individuals and 53% for unexposed individuals and showed a similar pattern of mutation, with GC to AT transitions accounting for the majority of the mutations in both groups. This finding suggests that arylamine exposure does not leave a mutational "footprint" in the p53 gene. However, compared to other tumors, bladder tumors from both exposed and unexposed individuals had a high frequency of multiple mutations and it is interesting that these mutations were highly concordant. We suggest that one explanation of this pattern of mutations could be from decreased DNA repair fidelity within tumor cells. The frequency of mutation in p53 is closely linked to tumor grade and stage and so may be a late event in the development of bladder tumors.

Aged↗
PubMed1996

The results of a five-year early prostate cancer detection intervention. Investigators of the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: The American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary evaluation of early prostate cancer detection interventions. This report summarizes the experience of the investigators to date and describes the overall and relative performance of the different detection modalities studied in this project. METHODS: Two thousand nine hundred ninety-nine men aged 55 to 70 years at entry who were not already under evaluation for prostate cancer were recruited to participate in up to 5 annual examinations by prostate specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS). In the course of 5 years of intervention, ACS-NPCDP investigators have completed 9937 examinations, recommended 1215 biopsies, and detected 203 cancers. RESULTS: Loss to cohort follow-up was greatest in the first year. Overall, TRUS led to twice the number of recommendations for biopsy compared with DRE (8.9% versus 4.4%). Elevated PSA was observed in 13.0% of 9535 measurements performed. The overall cancer detection rate declined significantly during the five years of intervention. Detection was significantly associated with age and symptom status at entry. DRE had lower sensitivity compared with TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that for DRE. PSA was elevated in 69.2% of examinations that led to cancer detection, compared with only 10.9% when cancer was not found. PSA level, PSA density, and PSA change were all related to the presence of cancer. Less than 6% of the cancers detected in this study were clinically advanced at the time of diagnosis. CONCLUSIONS: These data quantify the yield of early cancer detection that may be expected when PSA, DRE, and TRUS are used in populations comparable to the men participating in the ACS-NPCDP. Continued follow-up and further research is needed to assess whether men receiving early prostate cancer interventions benefit as a result.

Aged↗
PubMed1995

Influence of smoking on the development of lung metastases from breast cancer.

BACKGROUND: This study examined the association between cigarette smoking status and the development of lung metastases in a group of 835 women diagnosed with primary malignant unilateral breast cancer. METHOD: Female patients with breast cancer diagnosed between 1982 and 1991 at Roswell Park Cancer Institute (RPCI) in Buffalo, New York, who provided information on their cigarette smoking history at the time of their diagnosis were included. The subsequent disease status of patients was monitored by the RPCI Tumor Registry. The Cox regression model was used to estimate the relationship between smoking status and the development of lung metastases, adjusting for the patient's age, stage of disease at diagnosis, and body weight. RESULTS: Of those patients who developed lung metastases, 8.7% were nonsmokers, 14.1% were former smokers, and 14.3% were current smokers. Tests showed that nonsmokers had significantly fewer lung metastases than either of the two smoking groups (P < 0.01). The estimated relative rates of lung metastases developing adjusting for age, stage, and body weight in women who smoked less than 10,000, between 10,001 and 20,000, and more than 20,000 packs over their lifetimes compared with nonsmokers were 1.06 (95% CI, 0.51-2.20), 3.10 (95% CI, 1.5-6.3), and 3.73 (95% CI, 1.6-8.9) respectively. The Cox regression model showed that every 1000 packs of cigarettes consumed over a lifetime increased a woman's risk of developing lung metastases by about 3% to 7% (P < 0.001). CONCLUSION: This study found a significant association between cigarette smoking history and risk of lung metastases developing in women diagnosed with primary invasive unilateral breast cancer. The risk of lung metastases developing increased as the number of cigarettes smoked in a lifetime increased.

Adolescent↗
PubMed1995

Pathology review in an early prostate cancer detection program: results from the American Cancer Society-National Prostate Cancer Detection Project.

Biopsy materials obtained in the American Cancer Society National Prostate Cancer Detection Project were reviewed at the Central Pathology Laboratory at the Armed Forces Institute of Pathology. Of 265 cases submitted, 177 were diagnosed as prostatic carcinoma, 7 as prostatic intraepithelial neoplasia (PIN), 13 as atypical glands or atypical hyperplasia, and the remaining 68 were benign hyperplasias. Irrespective of the means of detectin or the grading system used (Gleason or WHO-Mostofi), a large majority of the cancers were detected as low-grade tumors. Of 27 cases of PIN reported, 20 were associated with cancer, leaving 7 cases with the sole diagnosis of PIN. These data may indicate the increased use of prostate-specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS) in the United States is shifting the spectrum of prostate cancer pathology toward early low-grade tumors.

Biopsy↗