The metastatic spread of cancers of the digestive system in man.
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Biomedical subjects
Publications and source records attributed to I D Bross.
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Using data from the Tri-State and a mathematical model, the hypothesis that low levels of diagnostic radiation can produce both leukemia and heart disease has been tested. The range of radiation considered is within a factor of 10 of 5 rads (0.5-50 rads). Even at the lowest levels, an estimated 5% of the persons exposed suffer damage to the DNA which is subsequently expressed as heart disease or leukemia. The risk of heart disease in an affected group is roughly tripled and there is a 10-fold increase in the risk of leukemia according to preliminary estimates.
Using the data from the Tri-State Leukemia Survey and a mathematical model, the hypothesis that low levels of diagnostic radiation produce severe genetic damage that is expressed in the child of the exposed person as leukemia and other diseases is tested. It is estimated that for about 1% of the exposed persons who are affected by radiation, there is a 50-fold increase in the risk of leukemia and a five-fold increase in certain other diseases.
In a double-blind, randomized study, 500 premature infants were treated with plasminogen or placebo intravenously within 60 minutes of birth. There was a substantial decrease in severe clinical respiratory distress, death caused by hyaline membrane disease, and total mortality in the plasminogen-treated infants as compared to the controls.
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Results after 5 years of follow-up in a cooperative trial of therapies for operable bladder cancer confirmed preliminary indications of a beneficial effect of preoperative irradiation. Improved survival was experienced by the one-third of the irradiated patients who experienced complete eradication of the tumor as indicated from the resected specimen 30-60 days after a 30-day course of 4,500 rads. These patients had a 55% chance of surviving 5 years as opposed to a 32% chance for those where irradiation did not eradicate the tumor, or similarly for those not irradiated. A postoperative course of chemotherapy with 5-fluorouracial appeared to act detrimentally when given to patients irradiated preoperatively, but may have had a slight benefit when given after surgery alone.
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We measured aryl hydrocarbon hydroxylase (AHH) in cultured human lymphocytes. A striking seasonal variation in AHH activity was observed with induced AHH activity levels from January through May measuring approximately 20% of the values during the remainder of the year. AHH inducibility was determined by comparing lymphocytes from the same person cultured with and without the inducer 3-methylcholanthrene. If measurements are limited to the summer and fall seasons when AHH activity is high, AHH inducibility is reproducible for most persons with repeat determinations on the same person averaging 11% from the mean. The values of AHH inducibility in 53 persons ranged from 0.9 to 5.0, but the distribution of values did not fall into three distinct, nonoverlapping classes as reported by others. We were not able to determine the distribution of AHH inducibility in lung cancer patients since lymphocytes from less than half of the patients tested could be successfully cultured.
The effectiveness of screening random asymptomatic women for breast cancer using mammography has been analyzed using a new mathematical-computer technology. The technology is based on a general mathematical theory of screening recently developed by Blumenson combined with a mathematical model for breast cancer developed by Blumenson and Bross over the past decade. The technology makes it relatively simple to try alternative strategies for age at onset of screening, screening interval, etc. and to calculate the relative effectiveness of the strategy. When the benefits of alternative strategies with periodic screening beginning at different ages were compared with the increasing risk of iatrogenic disease from multiple exposure to low levels of radiation, it was concluded that screening of asymptomatic women should begin no earlier than age 50.
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An autopsy study was performed on 190 cases with Hodgkin's disease and on 134 cases with reticulum cell sarcomas. It was found that a cascade spread of metastases, as opposed to a random spread, was detectable in patients with Hodgkin's disease, but not in patients with reticulum cell sarcoma. Metastatic key-sites for both lymphomas are defined as those organs whose chance of being seeded by the primary tumor is the highest; these sites are the spleen, liver, bone marrow and lungs. This study could not demonstrate in Hodgkin's cases that metastases in the liver and bone marrow were spleen dependent, but rather it showed that the spleen, liver and bone marrow acted as three independent sources of generalized metastases. Explanations proposed to account for the different metastatic spread in Hodgkin's disease and reticulum cell sarcomas, included different intrinsic cellular characteristics of the two lymphomas. the different location of the primary tumor either because of nodal, or of extra nodal origin, or because the primary tumor was located either in the upper or in the lower torso or in both areas. Malignant cells in the kidney, central nervous system and endocrine system were either released by the spleen via the lungs, or released by the liver and the lungs, or they were bone marrow dependent. The cascade spread of metastases hold true only for Hodgkin's disease. In cases with reticulum cell sarcomas, metastases appeared to spread at random from the primary tumor throughout the body, with rare exceptions such as metastases in the central nervous system, which originated either in the liver or in the spleen, lungs, kidney and bones.
Potentially, one of the most useful warning signals for the detection of environmental hazards is an unusually early age at onset of disease. Animal studies have shown age effects of this type with co-carcinogens. A clearcut example of a downward age shift in humans is provided by a study of the consumption of alcoholic beverages and cigarettes in women with oral concer. Using data on 145 white females with intraoral cancer, and 1973 non-neoplastic controls from patients seen at Roswell Park Memorial Institute between 1957 and 1966, it can be shown that exposure to both alcohol and tobacco can lead to onset of oral cancer 15 or more years earlier than would occur in women who do not use either alcohol or tobacco. Exposure to smoking only produces a smaller age shift, but exposure to alcohol only does not produce any clear shift in age of onset. Implications for co-carcinogenesis and for early detection of co-carcinogens in the environment are suggested.
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