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C Mettlin

Publications and source records attributed to C Mettlin.

143 records · Page 8Linked to original sources
PubMedDate not supplied

Prostate cancer screening: current trends and future implications.

Screening for prostate cancer represents a clinical dilemma with no clear evidence to suggest decreased mortality from any diagnostic test. We now possess new knowledge regarding optimal combinations of DRE, TRUS, and PSA. While DRE and TRUS may be too subjective and PSA too nonspecific, their combined predictive values identify not only men at high risk but also those for whom continued frequent screening may not be cost effective. A monoclonal PSA decision level of no more than 4.0 ng/ml should be used, since 40 percent of cancers detected from 4.0 to 10.0 ng/ml already have extracapsular extension. Assuming that DRE is performed by experienced examiners, the combination of PSA and DRE should produce cost-effective early detection and minimize missed cancers below 4.0 ng/ml. TRUS should be reserved for those patients with either PSA elevations and/or DRE abnormalities. The use of TRUS gland volume data to further modify PSA decision levels, such as the "predicted" PSA concept, may also improve TRUS biopsy criteria and predictive values. Prostate cancer detection can then be objectively limited to a small percentage of the population and better selected for earlier, more localized disease. The ultimate decrease in mortality from screening remains to be demonstrated in randomized trials or observed only after decades of increased public awareness about prompt early detection combined with effective, definitive therapy.

Antigens, Neoplasm↗
PubMedDate not supplied

Breast cancer detection guidelines for women aged 40 to 49 years: rationale for the American Cancer Society reaffirmation of recommendations. American Cancer Society.

Over the past year, the National Cancer Institute has altered its guidelines for early breast cancer screening by omitting any recommendation for mammography and clinical breast examination for women aged 40 to 49 years, while the American Cancer Society has reaffirmed its recommendation for these screening procedures in this age group. This article reviews the process and some of the evidence the American Cancer Society has relied upon in reaffirming its recommended guidelines for early breast cancer detection.

Adult↗
PubMedDate not supplied

Global breast cancer mortality statistics.

Breast cancer mortality is declining in the United States, as well as in certain other industrialized areas--such as Canada, Austria, Germany, and the United Kingdom--possibly due to increased utilization of mammographic screening, early detection of disease, and availability of improved therapies. At least some of the decline has been attributed, however, to the higher fertility rates of the cohort of women born between 1924 and 1938 who bore children during the post-World War II period. In contrast, certain European nations--Spain, Portugal, Greece, Hungary, Poland, and Italy--have not reported these favorable trends. The lowest breast cancer mortality rates are reported in Asian regions, leading researchers to speculate that dietary, cultural, and/or environmental factors might be implicated in the etiology of the disease.

Adult↗
PubMedDate not supplied

Pretreatment transurethral resection of prostate cancer and disease-free survival.

Data from the American College of Surgeons' national survey on prostate cancer were analyzed to determine whether recurrence-free survival differs between those patients diagnosed by transurethral resection of the prostate (TURP) and those diagnosed by needle biopsy. Only patients who received radiation therapy as treatment were included in this analysis. There were 461 patients diagnosed by TURP and 541 patients by needle biopsy. Disease free survival was calculated according to the state and tumor differentiation. Except in stage B1, none of the groups showed a statistically significant difference in recurrence-free survival between the two diagnostic procedures. The results of this analysis suggest that the disease-free survival of patients with radiation-treated prostate cancer diagnosed by TURP and needle biopsy are similar.

Aged↗
PubMedDate not supplied

Cancer control planning and establishment of priorities for intervention by a state health department.

A number of data sources routinely available to State health departments were analyzed as part of a State health department cancer control planning effort. This planning effort consisted of seven steps; the most challenging one was the establishment of priorities for cancer control interventions. Using data from available sources, however, a framework for prioritizing potential cancer control interventions as well as choosing a geographic area in which to implement selected interventions was developed. Factors considered in this framework for setting intervention priorities included the magnitude of the problem; the existence of scientific consensus regarding the efficacy of intervention techniques; the availability of data needed to plan, implement, and evaluate an intervention; the availability of resources within communities to implement an intervention; and the existence of public demand for the intervention. The development and use of this cancer control planning model and framework for setting cancer control intervention priorities in New York State are described in this paper. In using this planning model and framework for setting priorities, quantitative elements were found to be most necessary to define problems, but qualitative elements were most crucial for decision making.

Decision Making, Organizational↗