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Biomedical subjects

G D Friedman

Publications and source records attributed to G D Friedman.

At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Colorectal cancer: have we identified an effective screening strategy?

Three currently used screening methods are aimed at detecting colorectal cancer when it is asymptomatic and curable, and at detecting polyps so that they can be removed before they can progress to cancer. Digital rectal examinations are relatively cheap and easy but can detect only a small fraction of large-bowel cancers. Sigmoidoscopy is more sensitive, but its low acceptability to patients has been only partially mitigated by the introduction of the 35-cm flexible instrument. Fecal occult blood testing has limited sensitivity because blood from cancers and polyps is neither continuously shed nor uniformly distributed in feces; specificity and positive predictive value are also low because of other sources of blood in the stool. Prudent judgment suggests that all of these screening tests may prevent death from colorectal cancer in some patients. However, none has been proven effective in general use by well-controlled studies. Case-control studies can provide timely and valuable new evidence in this regard; the authors' investigations in progress are described. The current lack of strong evidence in support of these screening tests should not be interpreted as evidence against their use.

Case-Control Studies↗
PubMedDate not supplied

Alcohol, tobacco, and hypertension.

In many studies of diverse populations it has been found that persons drinking relatively large amounts of alcohol tend to have higher blood pressures. In the Kaiser-Permanente study of about 87,000 persons, this alcohol-blood pressure association was not attributable to demographic characteristics, adiposity, reported salt use, smoking, or coffee consumption, nor could it be explained by underreporting of alcohol consumption. If the relationship is a causal one, the pathogenesis is not yet established; direct mechanisms or the effects of withdrawal from alcohol are possible explanations. The Kaiser-Permanente data suggest that about 5% of hypertension in the general population may be due to the consumption of three or more alcoholic drinks per day. Alcohol use shows a positive relation to some sequelae of hypertension but not others; the outstanding exception is coronary heart disease which is negatively related to alcohol intake, probably through different mechanisms. In most studies, cigarette smokers have shown similar or slightly lower blood pressures than non smokers. The degree to which this is due to the thinner body build of smokers, on the average, is not well established; nor is the degree to which a stronger negative relation of smoking to blood pressure might be masked by concomitant alcohol use.

Adult↗
PubMedDate not supplied

Psychiatrically-diagnosed depression and subsequent cancer.

In a follow-up of up to 19 years, 923 patients with some form of depression diagnosed in a psychiatry clinic showed a slightly elevated risk of developing cancer in comparison with the other members of a cohort of 143,574 persons who received prescriptions from a pharmacy (Standardized morbidity ratio, 1.21; 95% confidence interval 0.95-1.53). When cancers diagnosed in the first 2 years after the diagnosis of depression were ignored, the risk increased somewhat (Standard morbidity ratio, 1.38; 95% confidence interval, 1.06-1.76). A subgroup of these depressed patients who had multiphasic health checkups were more apt to be of white race, unmarried, and users of postmenopausal estrogens if females than a matched comparison group of multiphasic examinees. These differences probably explain much of the group's excess cancers, most of which were located in the breast, endometrium, and skin (both melanoma and nonmelanoma). This study lends little if any support to the hypothesis that depression predisposes to cancer occurrence.

Adolescent↗