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Biomedical subjects

C Mettlin

Publications and source records attributed to C Mettlin.

At least 73 records · Page 4Linked to original sources
PubMed1988

Breast cancer survival among Orientals and whites living in the United States.

Data from the 1982 breast cancer survey of the American College of Surgeons were used to study the survival differences between Oriental and white women. Oriental women were significantly younger than white women. Oriental women were reported with a slightly higher percent of localized breast tumors (59.2% vs. 53.8%) and a slightly higher percent with negative nodes (60.3% vs. 56.2%) compared with whites. Oriental women in the United States have a higher 5-year survival rate compared to whites. Multivariate analyses taking into account differences in age, stage of disease, and histology did not alter the finding of a significant difference in survival experiences.

Breast Neoplasms↗
PubMed1988

Prostate cancer: comparison of transrectal US and digital rectal examination for screening.

The authors examined 784 self-referred men over age 60 years to compare clinical usefulness of transrectal ultrasound (US) and digital rectal examination in a screening program for prostate cancer. Biopsy was performed in 77 cases, 83% (64 of 77) for abnormalities detected with transrectal US and 38% (29 of 77) because of findings at digital examination. Twenty-two cancers were detected, 20 with transrectal US and ten at digital examination. Overall detection rate for prostate cancer with transrectal US was two times higher than that with digital examination (2.6% vs 1.3%). Sensitivity, specificity, and negative predictive value for transrectal US and digital examination were calculated for a range of prevalences (0.028-0.1543). Sensitivity was two times higher for transrectal US than for digital examination. Transrectal US demonstrated 100% (17 of 17) of tumors with the most favorable prognosis (less than or equal to 1.5 cm in diameter) compared with 41% (seven of 17) for digital examination. The authors conclude that transrectal US is more sensitive than digital examination in the detection of prostate cancer, and they advocate broader implementation and evaluation of transrectal US as a tool for early detection.

Aged↗
PubMed1988

Early prostate cancer: diagnostic costs of screening transrectal US and digital rectal examination.

A screening study with transrectal ultrasound (US) and digital rectal examination to diagnose early prostate cancer was performed to calculate diagnostic costs. The total costs of screening 784 men were $130,400 with transrectal US and $41,080 with digital rectal examination. Per diagnosed cancer, the costs were $6,520 for transrectal US and $4,108 for digital rectal examination, a difference of 37%. The costs per early diagnosed cancer (stage A or B) were $7,671 and $5,869 for transrectal US and digital rectal examination, respectively--a difference of 23%. The costs per early cancer that would have been advanced if diagnosed without screening were $22,177 for transrectal US and $28,528 for digital rectal examination--a difference of 22% in favor of transrectal US. Equations for these relative costs were generated for transrectal US and digital rectal examination. Costs are related to changes in prevalences and to changes in the stages of prostate cancer when diagnosed without screening.

Cost-Benefit Analysis↗
PubMed1987

National survey of patterns of care for testis cancer.

A national survey of testicular cancer documented recent trends in disease characteristics, treatment, and outcome, providing a basis for progress being achieved on a community basis. A long-term study of 3285 patients diagnosed between 1970 and 1975 was compared with a short-term study of 1887 patients diagnosed in 1983. An increase of the symptom of a lump in the testis from 23.1% to 31.2% and a mass as a sign of cancer from 44.5% to 53.8% suggests earlier detection of testis cancer by the patient and physician. Changes in the methods of diagnosis reflect the changing technology of tumor diagnosis. The 10-year survival rates for pathologic Stage I seminoma (82.6% of all seminomas) exceeded 96%. For pathologic Stage I nonseminomatous germ cell tumors (51.7% of all NSGCT), 10-year survival was 87.1%; whereas for Stage III (18.7% of all NSGCT) it was 22.1%. The impact of the important advances in chemotherapy is reflected in the increase of 1-year survival of Stage III NSGCT from 50.5% to 78.4%. Testis cancer can be cured in most patients.

Health Surveys↗
PubMed1987

End results, interhospital differences, and trends in patterns of care for gynecologic cancer.

Survival rates represent one measure of population-wide progress in cancer control. Data from the Surveillance, Epidemiology and End Results (SEER program of the National Cancer Institute (NCI) document that, during the 1970s, survival rates for several cancers improved. For the major gynecologic cancers and breast cancer, improvements are evident for some sites but, areas of decline also are observed. Black women in the US have a poorer survival rate than white women and the trend in recent years suggest that this gap may be widening. Comparisons of survival rates from comprehensive cancer centers and population-based rates indicate differences in outcomes associated with the treatment setting. Data from the American College of Surgeons (ACS) patterns of care surveys suggest substantial interhospital variability in cancer survival which is largely explained by characteristics of the patient populations served. Recent studies of patterns of care document major shifts in treatment practices in the US and provide insight concerning the rate at which treatment changes are adopted at the community level.

Female↗
PubMed1987

End results for urologic cancers. Trends and interhospital differences.

Long-term results for treatment of several urologic cancers have improved in recent years. Data from the studies of the American College of Surgeons and from the National Cancer Institute document these trends. For prostate cancer, the 5-year survival rate, for all stages, increased during the 1970s. Although seminomas of the testes have had high survival rates for several years, nonseminomas have had much poorer outcomes. Data from the 1985 survey of the American College of Surgeons indicate that the prognosis for nonseminoma tumors of the testes is now much improved. Analyses have been conducted to assess the influence of patient and tumor characteristics on end results. Age, race, stage and, histologic type continue to be the major determinants of survival. The role of treatment setting also has been studied. The data reveal that outcomes for similar patients differ little among hospitals which meet approval standards for operation of a cancer program. Issues regarding validity of the observations and the influence of "stage migration" on the end results have been examined. The distribution of survival improvements across stages, and, the correlation of changing survival with improved patterns of care may suggest that the improvements in urologic cancer outcomes are more than statistical artifacts.

Actuarial Analysis↗
PubMed1987

Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.

Adult↗
PubMed1986

The current status of early detection and screening for colorectal cancer.

There are several approaches to the early detection of colorectal cancer that currently are in use in various segments of the health care system. Herein, the status of cancer control research regarding symptom and risk factor assessment, sigmoidoscopy and colonoscopy, double contrast barium enema, and fecal occult blood testing is reviewed. In addition to the different technologies of early cancer detection, there are different models of disease control intervention. These include the routine clinical activities of primary care providers as well as programmatic screening of mass populations. The currently available techniques for early colorectal cancer detection appear better suited for existing patient care settings than for programs outside the direct supervision and follow-up of the health professional.

Barium Sulfate↗
PubMed1986

Dietary factors for cancer of specific sites.

Even though the issues have been greatly simplified in this article by citing of only the most salient data, when a number of different cancers are examined, a diverse range of dietary factors is implicated. For a number of cancers, very little is known, and for others, competing hypotheses are supported by conflicting data. Despite these obvious limits, some generalizations regarding common patterns of risk at different cancer sites may be possible. For example, although the nutrients and mechanisms may vary by site, lack of consumption of fruits and vegetables has been linked repeatedly to cancers of the mouth, larynx, esophagus, and lung. A similar association is suggested for cancers of the cervix and bladder. Another commonality is the association of dietary fat with cancers of the breast, ovary, prostate, and, possibly, colon. Alcohol is associated with cancers of the mouth, larynx, and, possibly, rectum. Coffee has been studied in association with cancers of the pancreas, ovaries, and lungs, but few of these studies have been replicated and the role of this common dietary exposure remains in question. In most other instances, unique cancers are linked to unique dietary exposures, for example, fiber and colorectal cancer or nitrates and stomach cancer. Given that both common and unique sources of dietary risk may be identified for different cancers, future research may benefit from a two-pronged research strategy. Basic nutrients need to be examined for multiple cancers, and specific aspects of diet require in-depth study for specific cancers. From such an approach, it may be possible to resolve some of the questions and issues reviewed herein.

Diet↗
PubMed1986

Methodological issues in epidemiologic studies of dietary fat and cancer.

Every scientific discipline has unique methodological constraints. Each scientific discipline also has differing degrees of power to resolve different questions. The methods of epidemiology are not exempt from these generalizations. In this brief review, several categories of methodological problems in epidemiological studies of dietary fat and cancer have been cited. Other problems could have been discussed and, several more examples illustrating the occurrence of the problems in research could have been presented. These problems notwithstanding, epidemiologic study of the association of dietary fat to cancer is an essential investigative tool in moving toward a better understanding of the public health impact of dietary fat. There are no known biological universals, and, as persuasive as data from animal models may be, extrapolation from the laboratory environment to human experience always is tentative. Laboratory methods require human validation before application to populations at risk of disease. Given the mutual dependency of epidemiologic studies and laboratory approaches, it is useful that the evidence from both realms be integrated and evaluated together as they are in this volume. Finally, given the limitations of any single epidemiologic method applied to the topic, future progress in understanding the role of dietary fat in cancer cause and prevention must rely on the application of multiple methodologies. By this means, it may be possible to compare and contrast the findings from different approaches to yield insights which would not otherwise be achievable.

Dietary Fats↗
PubMed1986

Risk factors and current management in carcinoma of the endometrium.

Approximately 3,000 women die each year in the United States of carcinoma of the endometrium. Statistics which have been complied by the American Cancer Society record 39,000 new instances each year. This high cure rate is dependent upon the frequent and correct use of diagnostic techniques and the excellent patient education programs now in use. The results of this study also collaborate the value and cost effectiveness of the patient receiving treatment in community-based comprehensive therapy centers or properly equipped hospitals. In this survey, patients are identified who are at high risk for having carcinoma of the endometrium and prognostic factors which are frequently discovered by careful pretherapy evaluation are discussed. The current therapy methods being used today are presented so that trends are easily detected. The data entered by 546 participating hospitals are not to be used as a guide to therapy, but as a study of the current state of the art in the treatment of this malignant disease.

Adenocarcinoma↗
PubMed1985

National survey of patterns of care for Hodgkin's disease.

Patterns of care for Hodgkin's disease were surveyed through voluntary audits of hospitals with cancer programs approved by the Cancer Commission of the American College of Surgeons. Four hundred seventy-three hospitals reported 6314 patients in the long-term survey (patients diagnosed immediately preceding December 31, 1975), and 611 hospitals identified 3168 new patients in the short-term study (patients diagnosed immediately following January 1, 1981). The latter represent 45% of the estimated annual incidence in the United States. Comparison of the two studies showed changes in the procedures employed in staging, including an increased use of lung and abdominal computed tomography and bilateral bone marrow biopsies. Use of upper mantle plus periaortic node radiotherapy increased, whereas the inverted-Y field decreased. The use of single-agent chemotherapy decreased, and MOPP (nitrogen mustard, vincristine, procarbazine, and prednisone) chemotherapy increased. The survival rates varied with age, being better at younger ages and worse in the elderly.

Adolescent↗
PubMed1985

Race-related differences in breast cancer patients. Results of the 1982 national survey of breast cancer by the American College of Surgeons.

Data from the 1982 breast cancer survey of the American College of Surgeons were used to evaluate factors related to clinical, epidemiologic, and survival differences between black and white patients. Breast cancer in blacks was not discovered as early as in whites. Distribution of pathologic types of tumors were similar for both races with the exception of medullary carcinoma, which was more frequent in blacks than in whites. Estrogen receptor-positive tumors were found significantly less frequently in blacks compared with whites. Survival was better for whites compared with blacks within each axillary nodes group 0, 1 to 3, and 4+. Black women with negative or positive estrogen receptors had lower survival rates than white women of the same receptor status. A regression analysis using Cox's proportional hazards model showed race, clinical stage or axillary nodal status, age at diagnosis, and estrogen receptor status as significant predictors of survival. Significant differences between black and white patients were also observed with respect to the report of family history of breast cancer, age at first pregnancy, number of pregnancies, and age at cessation of menses.

Analysis of Variance↗
PubMed1985

Risk factor and behavioral correlates of willingness to participate in cancer prevention trials.

Because of the growing interest in prospective trials of dietary and chemopreventive interventions for cancer, we studied the characteristics of persons likely to participate in such investigations. The study population consisted of a random sample of 576 persons who had previously attended the Prevention-Detection Center at Roswell Park Memorial Institute to receive a cancer screening examination and a risk assessment. Data were collected using a mailed questionnaire. Of the respondents, 77% indicated some degree of interest in participating in a cancer prevention study involving dietary changes, 27% indicated a definite interest and 50% indicated a possible interest. A similar pattern of response was obtained with respect to participation in a cancer prevention study that involves subjects taking medication, such as vitamin supplements. The findings suggest that those who are the most interested in participating in cancer prevention research are more likely to (on average) be younger, better educated, have higher annual family incomes, be regular vitamin users, have greater awareness of the possible link between dietary practices and cancer risk, be more concerned about getting cancer, and be more likely to believe that changes in dietary practices can decrease the cancer risk. These findings may have important implications for the planning and conduct of prospective trials of cancer prophylaxis.

Adult↗
PubMed1985

Comparison of three methods of teaching women how to perform breast self-examination.

This paper presents results from an experimental study designed to evaluate the relative effectiveness of three methods of teaching women how to do breast self-examination (BSE). Frequency of BSE, confidence in examination performance, proficiency of BSE technique, and lump detection performance were the main outcome variables assessed. The three training methods compared in this study were provision of a pamphlet describing how to do BSE, having women view a videotape depicting proper performance of BSE, and having women practice doing BSE on a life-like breast model. Results showed that passive methods of BSE instruction such as the use of pamphlets or films were of little value in helping women develop the tactile skills necessary for proficient BSE. Three months after training, it was found that lump detection performance, as measured on silicone breast models, was significantly higher among those women who had been given an opportunity to practice doing the breast examination on a breast model with corrective feedback given by a BSE instructor. The opportunity to practice doing the examination with corrective feedback on performance appears to be a critical variable in the acquisition of BSE skill.

Adolescent↗
PubMed1984

Screening for colorectal cancer using the Hemoccult II stool guaiac slide test.

Following a series of educational spots on colorectal cancer shown on a local television news program, stool guaiac slide kits (Hemoccult II; Smith Kline Diagnostics) were distributed in shopping malls in Erie County, New York during a 3-day period in February 1982. The tests kits were sold for $1.00 a piece. A total of 8711 persons purchased test kits and 3822 persons (44%) returned slides for testing. One or more slides were positive in 107 persons (2.8%). Ninety of the 107 positive screenees (84%) saw a physician for further evaluation after screening. Eighteen positive screenees had no evidence of pathology which could cause blood in their stool when evaluated by a physician, yielding an overall false-positive rate of less than 0.5%. Seven new cases of colorectal cancer were found through screening. Five of the seven cancers (71%) detected were localized disease (Dukes' Stage A, B1 or B2), and four cases had no symptoms of disease prior to diagnosis. The findings from this study suggest that screening for fecal occult blood using the stool guaiac slide test is effective in detecting some colorectal cancers at an early stage of disease, often before symptoms appear.

Adolescent↗